Slashdot Mirror
Domain: ihe.net
Stories and comments across the archive that link to ihe.net.
Comments · 7
-
Re:Feds
There are already industry standards for EMR
Common Document Architecture (CDA) - provides formats for the interchange of data built on the OASIS schema.
Integrating Healthcare in the Enterprise - defines profiles for implementing technologies in an interoperable manner.
Open eHealth - open source baseline implementation of the above.That's just for clinical data. There are a whole other set of standard for financial/claims records (X12) and pharmacy records/scripts (NCPDP).
The problem is that medical data is pretty complicated and often the context of the document is as important as the content. You almost always have to massage documents coming in even if they are ostensibly formatted to a standard you consume. You have to normalize units, make sure all the fields are part of the subset of the standard your system supports, etc.
And that doesn't even begin to get into tracking patient consent, tracking identity across multiple orgs, depts, and visits (MPI,PIX/PDQ), plus access restrictions and emergency access exceptions.
-
IHE? Anyone?
It's strange that this does topic did not trigger anyone to mention the IHE (Integrating the Healthcare Enterprise) This initiative by healthcare professionals AND industry tries to improve the way computer systems in healthcare share information.
As one working for one of the members of IHE I can say it works: the communication in healthcare does improve.
This is achieved by IHE through selecting standards to use (NO new standards are created) and testing that the members comply to these standards.
-
Re:The full solution
How is sheets of paper being faxed/mailed between docs the best possible standard? The whole system is jive, adding storing it with Google might make it slightly less jive, actually fixing it would, well, fix it.
The Clinical Document Architecture defined by HL7 provides a standard electronic format for medical records.
Another group called IHE has defined standards for sharing electronic documents called Cross-Enterprise Document Sharing (XDS). The preferred format for XDS documents is CDA.
The healthcare industry is understandably pretty conservative and implementation is still in its infancy.Give people their medical records. Digitally signed by the docs that made them so they're authentic if the medical system must.
The specs exist for digitally signed medical documents (see the digital signature supplement to XDS documents), but there isn't a widespread PKI to support it. Even if there was, not many EMR platforms know how to sign their output. Also, many organizations use their own internal coding systems for things like diagnoses, lab results, medications, etc. These would have to get converted over to standard coding systems such as ICD9 and LOINC before being handed over to the patient. And once they are converted, is the signature still valid? Should it be? What if there is a translation error?
I guess what I'm trying to say is baby steps. It took the better part of a decade after HIPAA was passed to get on a standard electronic billing system and financial data is a cake walk compared to clinical. We're just starting to implement shared EHRs at a time when some practices still don't have any electronic medical records at all. It will probably be 5 years or more before patient-accessible public EHRs are the norm. -
Re:The full solution
How is sheets of paper being faxed/mailed between docs the best possible standard? The whole system is jive, adding storing it with Google might make it slightly less jive, actually fixing it would, well, fix it.
The Clinical Document Architecture defined by HL7 provides a standard electronic format for medical records.
Another group called IHE has defined standards for sharing electronic documents called Cross-Enterprise Document Sharing (XDS). The preferred format for XDS documents is CDA.
The healthcare industry is understandably pretty conservative and implementation is still in its infancy.Give people their medical records. Digitally signed by the docs that made them so they're authentic if the medical system must.
The specs exist for digitally signed medical documents (see the digital signature supplement to XDS documents), but there isn't a widespread PKI to support it. Even if there was, not many EMR platforms know how to sign their output. Also, many organizations use their own internal coding systems for things like diagnoses, lab results, medications, etc. These would have to get converted over to standard coding systems such as ICD9 and LOINC before being handed over to the patient. And once they are converted, is the signature still valid? Should it be? What if there is a translation error?
I guess what I'm trying to say is baby steps. It took the better part of a decade after HIPAA was passed to get on a standard electronic billing system and financial data is a cake walk compared to clinical. We're just starting to implement shared EHRs at a time when some practices still don't have any electronic medical records at all. It will probably be 5 years or more before patient-accessible public EHRs are the norm. -
IHE is worth a look for those interested
I am in the IT healthcare field at present and have had a look at EHR (Electronic Health Records) and other iniatives. For an overall healthcare experience the data is one component of the quacks keeping me alive. Process is the other. I recommend looking at IHE (Integrating the Health Enterprise) and what they are trying to achieve using existing and open standards. Here is the intro from their website.
IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively. -
Re:Standard schema
The medical industry has already worked very, very hard on standardized schemas to represent medical information, and the work has been ongoing for at least 20 years. Support for these is, literally, world-wide.
HL7 (Health Level 7) is the industry standard for the management of medical information in a hospital or other medical institution. The currently popular version is 2.x (typically 2.3.1 or 2.5), and is a transaction-based ASCII protocol. The newer version 3.0 is XML based, and introduces a new, sophisticated and object-based (specifically, inheritance) set of entities and relationships.
DICOM (Digital Imaging and Communications in Medicine) is the industry standard for medical images. It also has E-R relationships for patients, studies, etc., albeit in an intentionally smaller domain. DICOM's and HL7's models are somewhat different, but the industry has worked very hard to reconcile the differences to support interoperability.
IHE (Integrating the Healthcare Environment) is an initiative of healthcare professionals organization that seeks to coordinate the uses of DICOM and HL7, and define which to use in those places where they overlap.
XDS (Cross-Enterprise Document Sharing) is an emerging standard for integrating the medical information from multiple providers into an accessible, usable, unified electronic patient medical record. It is part of IHE, and has governmental backing.
These efforts operate largely together, and the same key people tend to be involved in all of these. (I don't know how they find the time.) Industry organizations (HL7, NEMA, RSNA, HIMSS,
The worldwide open-source community has been heavily, heavily involved, and there is plenty of opportunity for more.
Those interested can read much more information on the IHE web site, which is a good way to start: http://www.ihe.net/ -
Re:If nothing else, it can help.
There's also a big push to create RHIOs (Regional Health Information Organizations) so that facilities can exchange patient records directly. Ideally, your PCP would refer you somewhere, and you medical history would be waiting for the specialist to review at the hospital or clinic. See also IHE.