HL7 v3.0 Clinical Interoperability to Improve Quality and the point-of-care EHR system
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Transcript of HL7 v3.0 Clinical Interoperability to Improve Quality and the point-of-care EHR system
Presented By: Gunjan PatelPG Student: MS-Medical Software
PGD-QM, BME
National Conference Information Science -2010
MCIS, Manipal University
Clinical Clinical Interoperability to Improve Interoperability to Improve Quality Quality & the Point& the Point--ofof--Care of EHRCare of EHR
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Motivation
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Why are the patient clinical records need for to be exchanged for Interoperability?
How can we improve the quality of patient health record?
What are the basic standards to meet specifications? What are the basic needs for the design CCD template? What is the Module structure and semantics of a patient
summary clinical document for exchange?
Outline Literature view Introduction Health Level 7 What is the ASTM CCR? How did the CCD develop? Development and results Conclusion Future Work References
List of Abbreviations HL7 = Health Level 7ASTM=American Society for Testing and MaterialsANSI=American National Standards Institute RIM = Reference Information ModelCDA = Clinical Document ArchitectureCCR=Continuity of Care Record CCD= Continuity of Care Document HITSP= Healthcare Information Technology Standards PanelCI= Clinical Interoperability XML = eXtensible Markup LanguageXSD = XML Schema DefinitionVB.Net = Visual Basic.Net
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Literature view
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Year History & Article Released
2004 -2005
The board of Health Level Seven, a standards development organization has specification for a CDA approved the Electronic Health Record System Functional Model for clinical interoperability.
Dec 2006
Health Level 7 - CCD will be a component of hl7's Clinical Document Architecture -> balloted by HL7 members and Healthcare Information Technology had included CCR functionality in its testing criteria for interoperability of EHR systems
JUNE -2007
CCD structure was developed as a collaborative effort between ASTM and HL7, combining the benefits of ASTM - Continuity of Care Record (CCR) and the HL7 CDA specifications
Nov 2008
Hl 7 CCD Clinical documents by supporting interoperability through a common structure and semantics.
Mar 2009
The Healthcare Information Technology Standards Panel (HITSP) approved the Continuity of Care Document (CCD), which set standards for interoperability that enabled clinical data to be transportable, thus enhancing patient safety and efficiency.
Basic Term Clinical Interoperability The Clinical Interoperability relationship is represented to
support the electronic exchange of patient summary information and the high reliability exchange of information between an EHR system and other healthcare IT systems
Interoperability aims to support clinical documents Integration with clinical and non-clinical information Medical terminology transfer, mapping at the point of care
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Introduction Clinical interoperability is to support the electronic
exchange of patient summary information among caregivers and other authorized parties via potentially disparate EHR systems to improve the quality, safety, and worth of care delivery
The HL7 Clinical Document Architecture (CDA) is a CCD document markup standard that specifies the structure and semantics of ‘clinical documents’ for the purpose of exchange that would improve quality and the point-of-care of EHR.
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Scenario of without Interoperability in Healthcare systems
Without interoperability, EHR further strengthen the information that exist in today’s paper-based medical files & other systems.
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Clinical Documents of Patient’s Record File
Patient File
How can clinical Interoperability support in current Healthcare systems ?
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To exchange of Patient Summary of Information
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Clinical Interoperability Solutions offerings help healthcare organizations
Improve patient health and safety: CI is to support the electronic exchange patient summary
information among caregivers and other authorized parties via potentially different EHR systems to improve safety and efficacy of care delivery
Delivering medication history, prescriptions & formulary formation to clinicians on demand for the purpose of exchange that would improve quality and the point-of-care of EHR
Achieve operational efficiencies and reduce costs: Providing existing information systems the ability to exchange
data electronically, including lab, clinical notes and demographics
Generate Automating patient record location services across networks and systems
Health Level 7 Organization
HL7 is an organization - clinical interoperability problem by providing a standard that allows the exchange of patient health information across diverse medical systems in healthcare facilities
HL7 standards in Healthcare The data to be exchanged and the timing of the interchange The communication of certain errors to the application Supports such functions as security checks Participant identification and exchange mechanism, data
exchange structuring
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What is the ASTM Continuity of Care Record (CCR)?
XML-based standard for clinical data exchange Developed by ASTM International
Provides a “snapshot” of treatment and basic patient information – it is not comprehensive like an EHR.
Information in this record Focused on Diagnostics and reason for referral Rather than symptoms and treatment chronology
Important distinction between CCR and CDA CCR uses only specified XML code. It does not support/allow
narrative text (free-text) which can sometimes be hindering to physicians, and it is not electronically acceptable by all systems
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ASTM CCR + HL7 CDA = CCD
The resulting specification, known as the Continuity of Care Document (CCD), is being developed as a collaborative effort between ASTM and HL7.
CCD is also a true document, not just a record, and is designed for the same type of exchanges as those performed in an EHR – including import, management, and export data in XML
How did the Continuity of Care Document (CCD) develop for Interoperability?
Why CCD is universally Accepted for electronic exchange? A universal standard Broad compatibility Easy incorporation into new and existing technology or standards
Easy integration The HL7 CDA RIM-based specifications Compatible existing applications, browsers, EHR and legacy
systems Universally rendered as HTML or PDF
XML Encouraging the implementation of XML for clinical document exchange
CCHIT given approval of CCD as part of their certification process is an important step in facilitating the widespread adoption of both CCD and XML
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CCD Template Design Process
Reference Information
Model
Reference Information
Model
Clinical Document
Architecture
Clinical Document
ArchitectureHierarchical DescriptionHierarchical Description
XML Schema
Definition
XML Schema
Definition
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The RIM, CDA, Hierarchical Description and XML Schema defination
< CCD template />
Reference Information Model (RMI) Primarily based on a data model called RIM. Shared information model that offers a consistent
vocabulary for clinical data content. Applies an object-oriented development
methodology, expressed with the Unified Modeling Language (UML), which includes classes, attributes, relationships and state-machine diagrams
UML is an industry-standard language for specifying, visualizing, constructing, and documenting object-oriented and component-based system architectures and designs
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Clinical Document Architecture The CDA Release 2.0 provides an exchange model
for clinical documents By leveraging the use of XML, the HL7 Reference
Information Model (RIM) & Coded vocabularies The CDA makes documents both Machine – Readable >> Easily parsed and processed electronically
Human - Readable >> Easily retrieved and used by the people
Displayed using XML- Web browsers It provides state-of-the-art interoperability for machine-
readable coded semantics.
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A CDA Document could be a:- Discharge Summary Referral Clinical Summary Report History & Physical examination Diagnostic Reports (DI, lab…) Medication Prescription Rx Public health report
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IHE IHE MedicalMedical
Summaries Summaries HIMSS 2006: HIMSS 2006:
a CDA Gallerya CDA Gallery
Allscripts TouchworksAllscripts Touchworks
Eclipsys Sunrise Eclipsys Sunrise
GE Centricity GE Centricity
MediNotes eMediNotes eSiemens Soarian (XML) Siemens Soarian (XML)
Siemens Soarian (PDF) Siemens Soarian (PDF)
Hierarchical Description
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Development and results The design of the CCD module for the
Interoperability of clinical documents , not just a record, and is congruently designed for the same type of exchanges as those performed in an EMR Including import Management Export of information in the XML format
Because of its small fixed XML tag set CCD can be universally rendered as HTML or PDF or print
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CCD template structure components
Template Modules Section
A. HeaderB. Body
Purpose Medications
Problems Immunizations
Procedures Medical equipment
Family history Vital signs
Social history Functional status
Payers Results
Advance directives Encounters
Alerts Plan of care23
Example of birthTime Mapping for CCD XML file
Illustration the CDA’s XSD to VB.net
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<xs:complexType name="POCD_MT000040.Patient"><xs:sequence>
<xs:element name="birthTime" type="TS" minOccurs="0"/></xs:sequence>
</xs:complexType>
XSD
VB.net
19320924birthTime
XML
value
<patient><birthTime value="19320924"/>
</patient>
objClinicalDocument.RecordTarget.patientRole.patient.birthTime = New TSobjClinicalDocument.RecordTarget.patientRole.patient.birthTime.value = "19320924"
Clinical Interoperability of CCD module
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Select the CCD Option for XML file
Display the Clinical
Document in XML Format
Select option for Rendering
Display the CCD Template in Web
Browser
Display the CCD Template as PDF
Display the CCD Template in any type
of display device
Print out of CCD template
CCD document generation work flow
Future Option
A. Implementation Specification the CCD Module
Operating System:Windows Service Pack 2 Platform: Microsoft visual studio 2008 Language: VB.Net, XML XML stylesheet: CCD.xsl Web Browser: Microsoft visual studio 2008 – toolbox web browser
component Supporting Files Clinical Interoperability.dll POCD_HD000040.xls datatypes.xsd,datatypes-base.xsd,NarrativeBlock.xsd,voc.xsd,CDA.xsd SampleCCDDocument-QSG-level-3.xml ccd_qsg.Ver1.Nov12007.doc
Validation Tool for CCDDoc.xml file: Online Tool: http://xreg2.nist.gov/cda-validation/validation.html
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B. Implemented Design of Module
Implementation, the parameters and classes for Header and Body
The Clinical document’s of CCD templates parameters and class Clinical Interoperability.dll POCD_HD000040.xls of CDA R2 POCD_HD000040
Hierarchical Description
StreamWriter method is instantiated and the file “CCDdoc.xml“ -- writing
StreamReader method is being read of XML-based specification for exchange of clinical summary information
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Standard CCD Document-QSG
Validation NIST in collaboration with Alschuler Associates, LLC,
Integrating the Healthcare Enterprise (IHE) and the CCHIT Health IT Collaboration Effort "LAIKA", is working on a series of testing tools for promoting the adoption of standards-based interoperability by vendors and users of healthcare information systems.
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CCD document XML file Validation to meet the standard specifications
Validation Tool for CCDDoc.xml file: Online Tool: http://xreg2.nist.gov/cda-validation/validation.html
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Upload the CCD .xml file for
CCD validation
Advantage of CCD Easy to Rendering as PDF, or on any type of display
device, including local EMRs. Discharge Summary, is specifically out of scope for CCR
and therefore CCD eDocument Integration Into the Electronic Health
Record International and National Acceptance healthcare
organization USA, Canada, Asia/Pacific to England, Europe, and
Mexico
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Conclusion It summarizes the most commonly needed relevant
information about current and past patient health status in a form that can be shared by all computer applications and electronic medical records.
The HL7 CDA RIM-based specifications in small XML tag form that the base of CCD are widely compatible with web browsers, PDF and print
Overall, the viability and prospects for this clinical venture appear to be an excellent approach to reinforce the importance of high quality health care and services.
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Future Work Interoperability is to support the electronic exchange of
patient summary information among caregivers and other authorized parties via potentially disparate EHR systems and other aspects of interoperability: “plug and play” and extensibility
Furthermore, data mining techniques can be applied on these module instances to extract substantial knowledge about the patients health report
Integrate and testing of Interoperability Module with EHR system and validation of CCD template
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Any Question
Any <ideas/> or <suggestion/> …
References HL7 Electronic Health Record (EHR) Interoperability,
http://wiki.hl7.org/index.php?title=EHR_Interoperability_WG, wiki HL7 Implementation Guide: “CDA Release 2 – Continuity of Care
Document”, Version 1.0 November 1, 2007, pp-7-8,16-18,20-24 Health Level Seven (HL7),http://en.wikipedia. org/wiki/
Health_Level_7#HL7_Version_3 Clinical Document Architecture (CDA) Workshops
,http://www.hl7.org.au/CDA.htm Continuity of Care Document (CCD) specification, http
//en.wikipedia.org/wiki/Continuity_of_Care_Document HL7 Clinical Document Architecture, Release 2, JAMIA 2006 13: 30-
39, Published by group.bmj.com HL7 Resources, CCR contents http://
www.corepointhealth.com/resource-center/hl7-resourcess
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XML Tutorial, http://www.w3schools.com/xml/ default .asp Using W3C XML Schema, http://www.xml.com/pub/
a/2000/11/29/schemas/part1.html?page=2#slicing Structured Documents of CCD - http://www.hl7.org/
Special/committees/structure/docs.cfm?wg_docs_subfolder_name=AllDocuments&sortBy=DTCreated&sortDirection=desc&offset=121
http://wiki.hl7.org/index.php?title=Product_CCD http://xreg2.nist.gov/cda-validation/validation.html http://www.himssehra.org/ASP/CCD_QSG_20071112.asp
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< Thank You />< Thank You />For your Kind attention …For your Kind attention …
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