Healthcare information technology infrastructures in Turkey.

OBJECTIVES: The objective of this paper is to describe some of the major healthcare information technology (IT) infrastructures in Turkey, namely, Saglik-Net (Turkish for "Health-Net"), the Centralized Hospital Appointment System, the Basic Health Statistics Module, the Core Resources Management System, and the e-prescription system of the Social Security Institution. International collaboration projects that are integrated with Saglik-Net are also briefly summarized. METHODS: The authors provide a survey of the some of the major healthcare IT infrastructures in Turkey. RESULTS: Saglik-Net has two main components: the National Health Information System (NHIS) and the Family Medicine Information System (FMIS). The NHIS is a nation-wide infrastructure for sharing patients' Electronic Health Records (EHRs). So far, EHRs of 78.9 million people have been created in the NHIS. Similarly, family medicine is operational in the whole country via FMIS. Centralized Hospital Appointment System enables the citizens to easily make appointments in healthcare providers. Basic Health Statistics Module is used for collecting information about the health status, risks and indicators across the country. Core Resources Management System speeds up the flow of information between the headquarters and Provincial Health Directorates. The e-prescription system is linked with Saglik-Net and seamlessly integrated with the healthcare provider information systems. Finally, Turkey is involved in several international projects for experience sharing and disseminating national developments. CONCLUSION: With the introduction of the "Health Transformation Program" in 2003, a number of successful healthcare IT infrastructures have been developed in Turkey. Currently, work is going on to enhance and further improve their functionality.

Electronic health record interoperability as realized in the Turkish health information system.

OBJECTIVES: The objective of this paper is to describe the techniques used in developing the National Health Information System of Turkey (NHIS-T), a nation-wide infrastructure for sharing electronic health records (EHRs). METHODS: The UN/CEFACT Core Components Technical Specification (CCTS) methodology was applied to design the logical EHR structure and to increase the reuse of common information blocks in EHRs. RESULTS: The NHIS-T became operational on January 15, 2009. By June 2010, 99% of the public hospitals and 71% of the private and university hospitals were connected to NHIS-T with daily feeds of their patients' EHRs. Out of the 72 million citizens of Turkey, electronic healthcare records of 43 million citizens have already been created in NHIS-T. Currently, only the general practitioners can access the EHRs of their patients. In the second phase of the implementation and once the legal framework is completed, the proper patient consent mechanisms will be available through the personal health record system that is under development. At this time authorized healthcare professionals in secondary and tertiary healthcare systems can access the patients' EHRs. CONCLUSIONS: A number of factors affected the successful implementation of NHIS-T. First, all stakeholders have to adopt the specified standards. Second, the UN/CEFACT CCTS approach was applied which facilitated the development and understanding of rather complex EHR schemas. Finally, the comprehensive testing of vendor-based hospital information systems for their conformance to and interoperability with NHIS-T through an automated testing platform enhanced substantially the fast integration of vendor-based solutions with the NHIS-T.

Testing conformance and interoperability of eHealth applications.

OBJECTIVE: To explain the common conformance and interoperability testing requirements of eHealth applications through two case studies; one using a prominent eHealth messaging standard, namely HL7 v3 [1], and the other using Integrating the Healthcare Enterprise (IHE) [2] Profiles and to describe how these testing requirements can be addressed through an automated, modular and scenario-based testing framework, namely TestBATN. METHODS: Summarizing the conformance testing requirements of HL7 v3 messages. Illustrating the interoperability testing requirements of IHE Profiles through a scenario based on the IHE XDS, IHE XDS-MS and IHE PIX profiles. Explaining how these requirements can be handled through a dynamic and configurable test framework addressing all the layers in the interoperability stack within a single test scenario. RESULTS: Conformance and interoperability testing are necessary to maintain correct information exchange as the correctness of the exchanged data is essential in the healthcare domain. There are many standards used in eHealth that the applications need to conform. Additionally, there are profiling initiatives such as IHE and Continua Health Alliance which publish integration profiles addressing a specific clinical need or a use case and describe how to combine or use the existing standards to provide interoperability. However, as the results of our case studies demonstrate, there are many commonalities in the conformance and interoperability testing requirements of these standards and profiles and therefore an integrated testing environment is needed. CONCLUSION: Our main conclusion is that rather than having individual testing tools for each standard or initiative, a generic and modular test framework exploiting the commonalities in the testing processes and fostering reusability of modular, pluggable testing components will improve the efficiency of testing. Through the TestBATN framework, we describe how this modularity can be achieved by providing common interfaces facilitating the development of adaptors which allows different testing components to be plugged into the system.