Technology and Policy Challenges in the Adoption and Operation of Health Information Exchange Systems / 대한의료정보학회지

OBJECTIVES: This study aimed to identify problems and issues that arise with the implementation of online health information exchange (HIE) systems in a medical environment and to identify solutions to facilitate the successful operation of future HIE systems in primary care clinics and hospitals. METHODS: In this study, the issues that arose during the establishment and operation of an HIE system in a hospital were identified so that they could be addressed to enable the successful establishment and operation of a standard-based HIE system. After the issues were identified, they were reviewed and categorized by a group of experts that included medical information system experts, doctors, medical information standard experts, and HIE researchers. Then, solutions for the identified problems were derived based on the system development, operation, and improvement carried out during this work. RESULTS: Twenty-one issues were identified during the implementation and operation of an online HIE system. These issues were then divided into four categories: system architecture and standards, documents and data items, consent of HIE, and usability. We offer technical and policy recommendations for various stakeholders based on the experiences of operating and improving the online HIE system in the medical field. CONCLUSIONS: The issues and solutions identified in this study regarding the implementation and operate of an online HIE system can provide valuable insight for planners to enable them to successfully design and operate such systems at a national level in the future. In addition, policy support from governments is needed.

Bidirectional transmission and standardization of LIS and instrument in hospital / 中国医学装备

Objective:The one-way communication between traditional LIS system and equipment has been unable to meet the needs of business development of medical laboratory in our hospital, we need to upgrade our equipment and to develop the bidirectional communication interface between LIS and equipment.Methods: Our hospital has invested a lot of money to upgrade previous One-way communication interface based on ASTM, the new instrument specifications conform to HL7 standard, and develop bidirectional transmission program based on HL7.Results: After the implementation of the bidirectional communication, testing equipment can automatically identify bar code to get the test request information, after the completion of the test instrument, the inspection unit can automatically send sample results to LIS.Conclusion: Bidirectional transmission improves the work efficiency, transmission based on HL7 is not only fast, but also conducive to the sharing of data between heterogeneous medical information systems, and it is a general tendency.

Convergence of Health Level Seven Version 2 Messages to Semantic Web Technologies for Software-Intensive Systems in Telemedicine Trauma Care / 대한의료정보학회지

OBJECTIVES: To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care. METHODS: This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics into an HL7v2 message as an eXtensible Markup Language (XML) file, which was validated against an XML schema that defines constraints on a common reference model. This message was exchanged with a second prototype application, developed on the Mirth middleware, which was also used to parse and validate both the original and the hybrid messages. RESULTS: Both versions of the data instance (one pure XML, one embedded in the HL7v2 message) were equally validated and the RDF-based semantics recovered by the receiving side of the prototype from the shared XML schema. CONCLUSIONS: This study demonstrated the semantic enrichment of HL7v2 messages for intensive-software telemedicine systems for trauma care, by validating components of extracts generated in various computing environments. The adoption of the method proposed in this study ensures the compliance of the HL7v2 standard in Semantic Web technologies.

Developing a Common Health Information Exchange Platform to Implement a Nationwide Health Information Network in South Korea / 대한의료정보학회지

OBJECTIVES: We aimed to develop a common health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea. METHODS: By exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements. RESULTS: As the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies. CONCLUSIONS: We expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.

HL7 in personal health system component's integration for mental health treatment / HL7 como componente de integração em Sistema de PEP para tratamento em Saúde Mental

Help4Mood is a project inside 7th European Framework Programme (FP7) for developing a computational distributed system to support remotely the treatment of patients with major depression at home. Core components are integrated with Health Level Seven (HL7) standard. One of the main goals of this system is to use the paradigm of a Virtual Agent to support the first symptoms of clinician alert of a patient, to interact with him an to prevent some causes of relapse. The system processes inputs from different devices (to monitor sleeping, eating and motor activity) in a decision support system, and the Virtual Agent interacts with the patient before clinical support from hospital is needed. The technical framework is using the open source HL7-standard-based healthcare integration engine, Mirth Connect, to interact with the different subsystems, analyze data and give different priorities for messages in queues. Particularly, the use of standard HL7 will contribute to interest in the project results and the potential impact through the development, dissemination and use, as stated in the analysis of the European commission.

Help4Mood é um projeto do 7 º Programa de Framework Europeu (FP7) para desenvolvimento de um sistema computacional distribuído para apoio remoto de tratamento domiciliar de pacientes com depressão. Os principais componentes são integrados com o padrão Health Level Seven (HL7). Um dos objetivos principais deste sistema é a utilização do paradigma de um agente virtual para apoiar os primeiros sintomas de alerta clínico de um paciente, interagirindo com ele de forma a impedir que algumas ocorrências de recaída. O sistema processa as entradas de dispositivos diferentes (para monitorar a dormir, comer e atividade motora) em um sistema de apoio à decisão, e o Agente Virtual interage com o paciente antes que o atendimento clínico hospitalar seja necessário. O framework usa o código-fonte ?open source? como motor de integração baseado no padrão HL7, chamado ?Mirth Connect? a fim de interagir com os diferentes subsistemas, analisar os dados, e dar prioridades diferentes para as mensagens enviadas. A utilização do padrão HL7, por certo, contribuirá para os resultados do projeto e o impacto potencial através do desenvolvimento, difusão e utilização, como referenciado na análise da Comissão Europeia do programa.

Almacenamiento externo de los datos patronímicos de un CDA / External storage of the patronymic data on a CDA

En el Uruguay el Decreto Nº 396/003 sobre Historia clínica electrónica establece que los datos patronímicos tienen que separarse de los datos clínicos salvo contexto de atención medica, el CDA es un documento que normalmente contiene ambos. Utilizamos esta especificación para registrar el documento clínico referente a la ?descripción operatoria?, restringiendo lo patronímico a un solo identificador, el cual permite encontrar los datos almacenados en otro sistema desacoplado. La conciliación del identificador con la información patronímica, se realiza mediante transacciones IHE pertenecientes al perfil PDQ de forma transparente al usuario autorizado, que edita o revisa el documento.

In Uruguay, the Decree No. 396/003 on electronic medical records states that patronymic data must be separated from clinical data except in the medical care context, the CDA is a document that typically contains both. We use this specification to record the clinical document regarding ?operative description?, restricting the patronymic information to a single identifier, which allows to find data stored on another disengaged system. Reconciliation of the identifier with the patronymic information is effected through IHE transactions belonging to the PDQ Profile which it is done transparently to the user authorized to edit or revise the document.

The Development of Clinical Document Standards for Semantic Interoperability in China / 대한의료정보학회지

OBJECTIVES: This study is aimed at developing a set of data groups (DGs) to be employed as reusable building blocks for the construction of the eight most common clinical documents used in China's general hospitals in order to achieve their structural and semantic standardization. METHODS: The Diagnostics knowledge framework, the related approaches taken from the Health Level Seven (HL7), the Integrating the Healthcare Enterprise (IHE), and the Healthcare Information Technology Standards Panel (HITSP) and 1,487 original clinical records were considered together to form the DG architecture and data sets. The internal structure, content, and semantics of each DG were then defined by mapping each DG data set to a corresponding Clinical Document Architecture data element and matching each DG data set to the metadata in the Chinese National Health Data Dictionary. By using the DGs as reusable building blocks, standardized structures and semantics regarding the clinical documents for semantic interoperability were able to be constructed. RESULTS: Altogether, 5 header DGs, 48 section DGs, and 17 entry DGs were developed. Several issues regarding the DGs, including their internal structure, identifiers, data set names, definitions, length and format, data types, and value sets, were further defined. Standardized structures and semantics regarding the eight clinical documents were structured by the DGs. CONCLUSIONS: This approach of constructing clinical document standards using DGs is a feasible standard-driven solution useful in preparing documents possessing semantic interoperability among the disparate information systems in China. These standards need to be validated and refined through further study.

The Development of a Graphical User Interface Engine for the Convenient Use of the HL7 Version 2.x Interface Engine / 대한의료정보학회지

OBJECTIVES: The Health Level Seven Interface Engine (HL7 IE), developed by Kyungpook National University, has been employed in health information systems, however users without a background in programming have reported difficulties in using it. Therefore, we developed a graphical user interface (GUI) engine to make the use of the HL7 IE more convenient. METHODS: The GUI engine was directly connected with the HL7 IE to handle the HL7 version 2.x messages. Furthermore, the information exchange rules (called the mapping data), represented by a conceptual graph in the GUI engine, were transformed into program objects that were made available to the HL7 IE; the mapping data were stored as binary files for reuse. The usefulness of the GUI engine was examined through information exchange tests between an HL7 version 2.x message and a health information database system. RESULTS: Users could easily create HL7 version 2.x messages by creating a conceptual graph through the GUI engine without requiring assistance from programmers. In addition, time could be saved when creating new information exchange rules by reusing the stored mapping data. CONCLUSIONS: The GUI engine was not able to incorporate information types (e.g., extensible markup language, XML) other than the HL7 version 2.x messages and the database, because it was designed exclusively for the HL7 IE protocol. However, in future work, by including additional parsers to manage XML-based information such as Continuity of Care Documents (CCD) and Continuity of Care Records (CCR), we plan to ensure that the GUI engine will be more widely accessible for the health field.

Development of an Electronic Claim System Based on an Integrated Electronic Health Record Platform to Guarantee Interoperability / 대한의료정보학회지

OBJECTIVES: We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. METHODS: The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. RESULTS: The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. CONCLUSIONS: The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.

Developement of an Application Program Interface for the Exchange of Medical Information on Plastic Surgery between Hospitals using Heath Level 7 Protocol

The amount of medical information is rapidly increasing in accordance to the development of medical technology. Therefore, it is an important issue to develop the efficient ways of management, exchange and sharing of medical informations. Though the variable models and tools have been introduced to hospitals, departments and clinics, those became obstacles in the production and utilization of informations. A proficient mean of exchanging this medical informations, known as an Application Program Interface(API) has been designed and introduced in the study. A discharge summary has been chosen as the source for this exchange of medical information, because it contains major description of medical or surgical care. API translated the information as Health Level Seven(HL7) messages, which is the standard protocol for exchanging informations. Users could send or receive a discharge summary using a web browser in this API. In summary, HL7 based on an API for the exchange of information of the plastic surgical care can be used in different computing environments such as an internet based system and is convenient to use for most doctors.

A Research Of Web-Based Real Time Automatic Fetal Monitoring System / 대한의료정보학회지

In this paper, using ultrasonic doppler signal, we composed fetal heart sound / fetal movement diagnosis and web-based database server/client environment. Detecting fetal heart rate and movement at the same time, for the data loss-caused from telemetering-protection and the high speed diagnosis, we made two signals mix and transmit. For the better communication between obstetrician and remote woman/fetus, we proposed database table that could reflect the whole information about remote fetus and its mom. And we supported HL-7 format so that we might be compatible with other vendor product and easy to access web-based hospital computerization system. Applying doctor to web-based high level biosignal analysis algorithm and expert system, we offered remote fetal biosignal and diagnostic assistant data inducing fast diagnosis. We made web-based fetal diagnostic system and improved web system compatibility, fast diagnosis and minimum of the rate of misdiagnosis.

Implementation of HL7 Interface Engine for Unifying Medical Records / 대한의료정보학회지

Health Level Seven(HL7) is a standard protocol for electronic data exchange in healthcare environments. We implemented HL7 interface engine, for unifying medical records between heterogeneous hospital databases. As a HL7 message toolkit, we modified ProtoGen/HL7 C++ class library from World Wide Web. The whole system is composed of two modules, the client module and the server module. The client module accepts user's requests, and builds them into HL7 message stream. The server module parses this data stream, searches the requested data and then sends them to the client module for displaying. Healthcare professionals can find the patient's medical data from two hospital databases by typing patient's name and patient ID. This test confirms that HL7 interface engine can be used meaningfully in our clinical system.

Implementation of HL7 Interface Engine for Unifying Medical Records / 대한의료정보학회지

Health Level Seven(HL7) is a standard protocol for electronic data exchange in healthcare environments. We implemented HL7 interface engine, for unifying medical records between heterogeneous hospital databases. As a HL7 message toolkit, we modified ProtoGen/HL7 C++ class library from World Wide Web. The whole system is composed of two modules, the client module and the server module. The client module accepts user's requests, and builds them into HL7 message stream. The server module parses this data stream, searches the requested data and then sends them to the client module for displaying. Healthcare professionals can find the patient's medical data from two hospital databases by typing patient's name and patient ID. This test confirms that HL7 interface engine can be used meaningfully in our clinical system.