xml used for healthcare messaging and electronic health record communication
DESCRIPTION
XML used for Healthcare Messaging and Electronic Health Record Communication. David Markwell - Clinical Information Consultancy Andrew Hinchley - Communication Planning Ltd. Three intertwined projects. CEN TC251 Healthcare Informatics Standards ENV13606 - Prestandard for EHCR Communication - PowerPoint PPT PresentationTRANSCRIPT
XML used for Healthcare Messaging and Electronic
Health Record Communication
David Markwell - Clinical Information Consultancy
Andrew Hinchley - Communication Planning Ltd
Three intertwined projects
CEN TC251 Healthcare Informatics Standards ENV13606 - Prestandard for EHCR Communication Part 4 - Messages for exchange of information
XML-EDI Project - using XML for EDI EU Information Society Initiative for Standardisation
(ISIS)
XMLEPR Project - validation of the message UK National Health Service and
Royal College of General Practitioners
Three parallel objectives
A standard message for health record transfer
Investigate XML as a syntax for EDI Propose good practice guidelines for XML/EDI Identify benefits & issues raised by XML/EDI
Validation of a draft of ENV13606 Confirm it meets UK NHS needs for GP to GP
transfer of patient records Propose revisions where needed to meet needs Identify needs for implementation guidelines
Background to healthcare record messages in the XML/EDI project
Background EHCR Communication Prestandards
Part 1 - Extended Architecture A Standardised view of EHCR information
Part 2 -Term List High-level categories & annotations
Part 3 - Distribution Rules A Standard way to express access rules
Part 4 - Messages Standard messages for EHCR
communication
ImplementableMessage
Specification
Syntax
ScopeSpecification
Userrequirements
Scenarios
GeneralMessage Description
HierarchicalGMD
Domain InformationModel
CEN TC251 Message Development Method
Communicationroles & services
Content Dependent
Proposed EHCRmessage data items
plain textplain text
quantifiable observationquantifiable observation
medicationmedication
structured codedstructured coded
record component
record component
eventevent
physical entity referencephysical entity reference
external data referenceexternal data reference
patient related partypatient related party
community definedcommunity defined
data itemdata item
person identifierperson identifier
person nameperson name
languagelanguage
addressaddress
telecomtelecom
related locationrelated location
a type of
EHCR message structure
specialised as1contains
1..*
specialised as
1..*
EHCR extractEHCR extract
original component
complex
original component
complex
record component
record component
link itemlink item
data itemdata item
folderfolder
compositioncomposition
headed section
headed section
1
EHCR messageEHCR
message
clustercluster
Coding, terminology & semanticsPresent healthcare data structures
Allow use of a variety of coding schemes ENV13606 Part 2 Term List provides a
minimum set of heading context terms
Improved communication requires Standard terms, qualifiers and classifications Mapping between terms and classifications
An interesting development Merger between the UK NHS Clinical Terms
(Read Codes) and SNOMED-RT
Is cheese extended chalk?
But HTML is a layout
mark-up format XML represents data
HTML uses fixed tags XML enables tags to be
purpose-defined
But Chalk is good for
display Cheese is nourishing
Chalk is hard Cheese soft or resilient
Both based on SGML Both contain tags
Both are edible solids Both contain calcium
BackgroundHTML & XML -- Chalk & Cheese Is XML extended HTML?
Mapping from UML models of messages to XML
Mapping message models for implementationMapping to EDIFACT
Difficult manual process Conformance to models unverifiable
Mapping to XML Automatable process Preserves structure of model Verifiable conformance Easier profiling Opportunity for ISO led convergence with HL7
Mapping - General Points
Message Development Methods lead to syntax independent models
Limits of automation Extra information needed in models to
support maps UML may not be rich enough!
Retain links back to the model
Mapping messages or models
XML to represent UML models generalised DTD possible content represents classes & relationships
XML to represent information storage Freer use of XML cross-references (e.g. ID &
IDREF)
Messaging environment some relationships by nested containment others refer to instance Ids not in message
Mapping classes
Concrete classes Mapped to XML-Elements
Abstract (generalised) classes Represented as XML-Entities Add to the content model
• In XML-Elements for classes specialised from them
Create a choice structure for specialisations• In XML-Elements that include the generalisation
Mapping attributes
Most attributes mapped to an appropriate XML-Element
Attributes mapped to XML-Attributes include
Metadata such as:• Coding scheme identifier for a code value • The language of the content (xml:lang)
Status or typing data that affects processing Possibly for unique IDs ("ID" & "IDREF”) Enumerated data types (pragmatic reasons)
Mapping common classes
Common Class XML-Element Example:
• “PersonName" in "PatientMatchingInfo”
ORXML-Element specific to each attribute
with derived content Example:
• "AlternativeName" in "PatientMatchingInfo”
Mapping to DTDs or XML Schema
Mapping to DTDs now because they are: Stable Well supported by software
Schema proposals offer major advantages More flexible constraints Data Typing Archetypes Extensibility
Mapping to Schemas next logical step
XML/EDI in use to validate the healthcare record message for UK GP to GP communication
Background to XMLEPRUK NHS GP computing
The situation 95% of UK GPs have computers 50% use these computers for clinical patient
records
GP computer systems in the UK Three major suppliers of GP systems Twelve widely used systems or versions Different record structures
None transfer records when patients move
Clinical validation
What is clinical validation of a message? Suppliers of diverse systems map real record
from their systems into the message structure Clinical professionals review original records and
the messages generated Look for inconsistencies, missing or added info. Determine whether the representations are
“safe”
XML used for validation because it offered Direct mapping from message models Freely available viewers and software libraries
The validation process
Viewer
Instance of XML message/document
PT29 Provide EHCR Message
Provide EHCR DTD
GP system
Export Layout
ObserveCompare &Comment
Mapping
Experts
Clinicians
Comment and resolution
EHCR information
Specifications and rules
XMLEPR projectValidation of GP to GP communicationSupplier results
Four leading GP system suppliers populated the messages with information from their systems
Found XML learning-curve/implementation easier than EDIFACT
Viewers used for clinical validation IE5 XML-Notepad Specialised viewer developed in the project
Results of validation
The Provide EHCR message is substantially able to convey the information present in a majority of existing GP Electronic Patient Records (in the UK)
Some weaknesses in the draft message proposal
Reported as formal comments to the Project Team responsible for the draft prestandard
All these comments were accepted and resulted either in changes to the message or clarifications in the documentation
Further validation, piloting and implementation recommended to the UK NHS
Other results and progress
EHCR Communication Prestandards Accepted by ballot on 29 June 1999 Comments from use will be monitored for the next
revision in 2-3 years time
ISIS XML/EDI project continues to end of year Further recommendations and demonstrations
expected
ISO TC215 Health Informatics May draft guidelines for use of XML in messaging
References
Material about the message and links to other sites
http://www.clinical-info.co.uk CEN TC251 Standards including ENV13606
http://www.centc251.org XMLEPR project
http://www.CommunicationsPlanning.co.uk/infopages Other XML/EDI information
http://www.tieke.fi/isis-xmledi
Healthcare uses of XML
Application
User Interface
ViewEnter
ReadWrite
Data storeED
I Inte
rface
Application
User Interface
View Enter
Read Write
Data storeED
I In
terf
ace
Messages in XML
Messages in XML
Application
User Interface
ViewEnter
ReadWrite
Data storeX
ML p
ublish
er
Application
User Interface
View Enter
Read Write
Data store
XM
L doc
um
ent
Browser
API
Data store
XML publisher
Application
User Interface
View Enter
Read Write
Data store
XML
docu
men
t
Browser
API
Data store
ExtractExtract
Extr
act
Browsable referencematerial on web sites
Application
User Interface
View Enter
Read Write
Data store
XML
docu
men
t
Browser
API
Application
User Interface
ViewEnter
ReadWrite
Data storeX
ML a
rch
i ver
Application
User Interface
View Enter
Read Write
Data store
XM
L
Browser
API
ArchiveXML
XM
L a
rch
ive re
ad
erXML
Application
User Interface
ViewEnter
ReadWrite
Application
User Interface
View Enter
Read Write
Data store
Browser
API
Data store as XML documents
XM
L doc
um
ent
Application
User Interface
ViewEnter
ReadWrite
Application
User Interface
View Enter
Read Write
Data store as XML documents
References
Material about the message and links to other sites
http://www.clinical-info.co.uk CEN TC251 Standards including ENV13606
http://www.centc251.org XMLEPR project
http://www.CommunicationsPlanning.co.uk/infopages Other XML/EDI information
http://www.tieke.fi/isis-xmledi