Electronic Health Record
Standards, Coding Systems, Frameworks, and Infrastructures
1. Edition January 2013
376 Pages, Hardcover
Wiley & Sons Ltd
Short Description
With the EHR (Electronic Health Record) being central to most health informatics applications, several countries have initiated programs for implementing national EHR infrastructures. Building and implementing such a national EHR infrastructure requires an understanding of healthcare standards, coding systems, and standard frameworks, each of which may vary across borders and/or come from a myriad of sources. With this in mind, the authors compiled their study and analysis results in a groundbreaking single-source guide to fill the void in this area for the benefit of others working in similar areas.
ISBN:
978-1-118-28134-5
John Wiley & Sons
With the EHR (Electronic Health Record) being central to most health informatics applications, several countries have initiated programs for implementing national EHR infrastructures. Building and implementing such a national EHR infrastructure requires an understanding of healthcare standards, coding systems, and standard frameworks, each of which may vary across borders and/or come from a myriad of sources. With this in mind, the authors compiled their study and analysis results in a groundbreaking single-source guide to fill the void in this area for the benefit of others working in similar areas.
Preface XVII
Acronyms XXVII
PART ONE Introduction
1 Introduction to EHR 3
1.1 Introduction, 3
1.2 Definition of EHR, 4
1.3 Functions of EHR, 5
1.4 Significance of EHR, 6
1.5 Factors Affecting Implementation of EHR, 7
1.6 Role of Standards, 8
1.7 Role of Clinical Coding Systems, 9
1.8 Role of Standard Frameworks, 9
1.9 Case Studies of National EHR Implementations, 10
PART TWO EHR Standards
2 Standard for EHR Architecture Requirements 15
2.1 Introduction, 15
2.2 ISO/TS 18308 Requirement Specification, 16
2.3 Discussion, 18
2.4 Conclusion, 20
3 Standard for Healthcare Concepts 23
3.1 Introduction, 23
3.2 CEN/TC EN 13940-1, 24
3.3 CEN/TC prEN 13940-2, 28
3.4 Discussion, 30
3.5 Conclusion, 32
4 Standard for EHR Functional Specifications 33
4.1 Introduction, 33
4.2 HL7 EHR-S Functional Model, 34
4.3 Comparison of HL7 EHR-S FM and ISO/TS 18308, 38
4.4 Discussion, 39
4.5 Conclusion, 40
5 Standard for EHR Communication 43
5.1 Introduction, 43
5.2 CEN/ISO EN 13606 Requirement Specification, 45
5.3 Discussion, 51
5.4 Conclusion, 53
6 Messaging Standard for Healthcare Data 57
6.1 Introduction, 57
6.2 HL7 v2.x, 58
6.3 Discussion, 64
6.4 Conclusion, 67
7 Model-Based Messaging Standard for Healthcare Data 69
7.1 Introduction, 69
7.2 HL7 v3, 69
7.3 HL7 v2.x and v3 Comparison, 75
7.4 Discussion, 75
7.5 Conclusion, 77
8 Clinical Document Standards 81
8.1 Introduction, 81
8.2 Clinical Document Architecture (CDA), 82
8.3 Continuity of Care Document (CCD), 85
8.4 Clinical Document Exchange, 87
8.5 Discussion, 87
8.6 Conclusion, 89
9 Standard for Medical Imaging and Communication 93
9.1 Introduction, 93
9.2 DICOM, 94
9.3 Improvements in DICOM Standard, 96
9.4 Discussion, 96
9.5 Conclusion, 100
10 Standard for Patient Health Summary 103
10.1 Introduction, 103
10.2 Continuity of Care Record (CCR), 103
10.3 Discussion, 107
10.4 Conclusion, 108
PART THREE Coding Systems
11 Coding System for Classification of Diseases and Related Health Problems 113
11.1 Introduction, 113
11.2 ICD, 114
11.3 Improvements in ICD-10, 114
11.4 Discussion, 116
11.5 Conclusion, 116
12 Coding System for Laboratory Tests and Observations 119
12.1 Introduction, 119
12.2 LOINC, 120
12.3 Discussion, 122
12.4 Conclusion, 123
13 Coding System for Patient Care Procedures 125
13.1 Introduction, 125
13.2 CPT, 126
13.3 Discussion, 129
13.4 Conclusion, 130
14 Extended Coding System for Patient Care Procedures 131
14.1 Introduction, 131
14.2 HCPCS, 132
14.3 Discussion, 134
14.4 Conclusion, 134
15 Comprehensive Coding System for Clinical Terms 137
15.1 Introduction, 137
15.2 SNOMED CT, 138
15.3 SNOMED CT Database Browsers, 141
15.4 Discussion, 141
15.5 Conclusion, 142
16 Unified Medical Language System 145
16.1 Introduction, 145
16.2 UMLS-Supported Coding Systems, 146
16.3 UMLS Architecture, 146
16.4 UMLS Licensing, 150
16.5 Discussion, 150
16.6 Conclusion, 151
17 Other Coding Systems 153
17.1 Introduction, 153
17.2 AHFS Drug Information (AHFS DI), 154
17.3 Current Dental Terminology (CDT), 154
17.4 International Classification of Diseases for Oncology (ICD-O), 155
17.5 International Classification of Functioning, Disability and Health (ICF), 155
17.6 Coding Systems for Nursing Practices, 156
17.7 Radiology Lexicon (RADLEX), 157
17.8 RxNorm, 157
17.9 Discussion, 157
17.10 Conclusion, 158
PART FOUR Standard Frameworks
18 openEHR 163
18.1 Introduction, 163
18.2 openEHR Process Model, 164
18.3 openEHR Architecture, 166
18.4 Discussion, 170
18.5 Conclusion, 172
19 Integrating the Healthcare Enterprise (IHE) 175
19.1 Introduction, 175
19.2 IHE Domains, 176
19.3 IHE Initiatives on Electronic Health Record, 180
19.4 Exchange, 180
19.5 Security, 181
19.6 Discussion, 182
19.7 Conclusion, 183
PART FIVE Case Studies: National EHR Efforts
20 Australia's HealthConnect 189
20.1 Introduction, 189
20.2 Overview, 190
20.3 Architecture, 190
20.4 Discussion, 195
20.5 Conclusion, 196
21 Austria's ELGA 199
21.1 Introduction, 199
21.2 Overview, 200
21.3 Architecture, 200
21.4 Functional Implementation, 203
21.5 Exchange, 205
21.6 Discussion, 205
21.7 Conclusion, 207
22 Canada's EHRS Blueprint 211
22.1 Introduction, 211
22.2 Overview, 211
22.3 Architecture, 212
22.4 Discussion, 217
22.5 Conclusion, 219
Bibliography, 219
23 Denmark's MedCom 221
23.1 Introduction, 221
23.2 Overview, 221
23.3 Architecture, 222
23.4 Discussion, 225
23.5 Conclusion, 226
24 Hong Kong's eHR Sharing System 229
24.1 Introduction, 229
24.2 Overview, 229
24.3 Architecture, 230
24.4 Discussion, 234
24.5 Conclusion, 235
25 India's Health IT Initiatives 239
25.1 Introduction, 239
25.2 Overview, 240
25.3 ITIH Framework, 240
25.4 Recommendations on Guidelines, Standards, and Practices for Telemedicine in India, 242
25.5 iHIND, 244
25.6 Other Initiatives, 247
25.7 Discussion, 249
25.8 Conclusion, 251
26 Netherlands' AORTA 253
26.1 Introduction, 253
26.2 Overview, 253
26.3 Architecture, 254
26.4 Discussion, 256
26.5 Conclusion, 257
27 Singapore's NEHR 259
27.1 Introduction, 259
27.2 Overview, 259
27.3 Architecture, 260
27.4 Discussion, 263
27.5 Conclusion, 264
28 Sweden's NPO 267
28.1 Introduction, 267
28.2 Overview, 268
28.3 Architecture, 269
28.4 Discussion, 273
28.5 Conclusion, 274
29 Taiwan's Health Information Network 277
29.1 Introduction, 277
29.2 Overview, 278
29.3 Architecture, 278
29.4 Exchange, 280
29.5 Discussion, 282
29.6 Conclusion, 284
30 United Kingdom's Spine 287
30.1 Introduction, 287
30.2 Overview, 287
30.3 Architecture, 288
30.4 Discussion, 292
30.5 Conclusion, 294
31 USA's EHR Meaningful Use 295
31.1 Introduction, 295
31.2 Overview, 296
31.3 EHR Meaningful Use, 296
31.4 National Health Information Network (NHIN), 301
31.5 Discussion, 304
31.6 Conclusion, 307
PART SIX Findings and Conclusion
32 Findings and Conclusion 313
32.1 EHR Standards, 313
32.2 Coding Systems, 317
32.3 Standard Frameworks, 318
32.4 Case Studies: National EHR Efforts, 319
32.5 Recommended Phases for Implementing A National EHR System, 325
Glossary 327
Index 339
Acronyms XXVII
PART ONE Introduction
1 Introduction to EHR 3
1.1 Introduction, 3
1.2 Definition of EHR, 4
1.3 Functions of EHR, 5
1.4 Significance of EHR, 6
1.5 Factors Affecting Implementation of EHR, 7
1.6 Role of Standards, 8
1.7 Role of Clinical Coding Systems, 9
1.8 Role of Standard Frameworks, 9
1.9 Case Studies of National EHR Implementations, 10
PART TWO EHR Standards
2 Standard for EHR Architecture Requirements 15
2.1 Introduction, 15
2.2 ISO/TS 18308 Requirement Specification, 16
2.3 Discussion, 18
2.4 Conclusion, 20
3 Standard for Healthcare Concepts 23
3.1 Introduction, 23
3.2 CEN/TC EN 13940-1, 24
3.3 CEN/TC prEN 13940-2, 28
3.4 Discussion, 30
3.5 Conclusion, 32
4 Standard for EHR Functional Specifications 33
4.1 Introduction, 33
4.2 HL7 EHR-S Functional Model, 34
4.3 Comparison of HL7 EHR-S FM and ISO/TS 18308, 38
4.4 Discussion, 39
4.5 Conclusion, 40
5 Standard for EHR Communication 43
5.1 Introduction, 43
5.2 CEN/ISO EN 13606 Requirement Specification, 45
5.3 Discussion, 51
5.4 Conclusion, 53
6 Messaging Standard for Healthcare Data 57
6.1 Introduction, 57
6.2 HL7 v2.x, 58
6.3 Discussion, 64
6.4 Conclusion, 67
7 Model-Based Messaging Standard for Healthcare Data 69
7.1 Introduction, 69
7.2 HL7 v3, 69
7.3 HL7 v2.x and v3 Comparison, 75
7.4 Discussion, 75
7.5 Conclusion, 77
8 Clinical Document Standards 81
8.1 Introduction, 81
8.2 Clinical Document Architecture (CDA), 82
8.3 Continuity of Care Document (CCD), 85
8.4 Clinical Document Exchange, 87
8.5 Discussion, 87
8.6 Conclusion, 89
9 Standard for Medical Imaging and Communication 93
9.1 Introduction, 93
9.2 DICOM, 94
9.3 Improvements in DICOM Standard, 96
9.4 Discussion, 96
9.5 Conclusion, 100
10 Standard for Patient Health Summary 103
10.1 Introduction, 103
10.2 Continuity of Care Record (CCR), 103
10.3 Discussion, 107
10.4 Conclusion, 108
PART THREE Coding Systems
11 Coding System for Classification of Diseases and Related Health Problems 113
11.1 Introduction, 113
11.2 ICD, 114
11.3 Improvements in ICD-10, 114
11.4 Discussion, 116
11.5 Conclusion, 116
12 Coding System for Laboratory Tests and Observations 119
12.1 Introduction, 119
12.2 LOINC, 120
12.3 Discussion, 122
12.4 Conclusion, 123
13 Coding System for Patient Care Procedures 125
13.1 Introduction, 125
13.2 CPT, 126
13.3 Discussion, 129
13.4 Conclusion, 130
14 Extended Coding System for Patient Care Procedures 131
14.1 Introduction, 131
14.2 HCPCS, 132
14.3 Discussion, 134
14.4 Conclusion, 134
15 Comprehensive Coding System for Clinical Terms 137
15.1 Introduction, 137
15.2 SNOMED CT, 138
15.3 SNOMED CT Database Browsers, 141
15.4 Discussion, 141
15.5 Conclusion, 142
16 Unified Medical Language System 145
16.1 Introduction, 145
16.2 UMLS-Supported Coding Systems, 146
16.3 UMLS Architecture, 146
16.4 UMLS Licensing, 150
16.5 Discussion, 150
16.6 Conclusion, 151
17 Other Coding Systems 153
17.1 Introduction, 153
17.2 AHFS Drug Information (AHFS DI), 154
17.3 Current Dental Terminology (CDT), 154
17.4 International Classification of Diseases for Oncology (ICD-O), 155
17.5 International Classification of Functioning, Disability and Health (ICF), 155
17.6 Coding Systems for Nursing Practices, 156
17.7 Radiology Lexicon (RADLEX), 157
17.8 RxNorm, 157
17.9 Discussion, 157
17.10 Conclusion, 158
PART FOUR Standard Frameworks
18 openEHR 163
18.1 Introduction, 163
18.2 openEHR Process Model, 164
18.3 openEHR Architecture, 166
18.4 Discussion, 170
18.5 Conclusion, 172
19 Integrating the Healthcare Enterprise (IHE) 175
19.1 Introduction, 175
19.2 IHE Domains, 176
19.3 IHE Initiatives on Electronic Health Record, 180
19.4 Exchange, 180
19.5 Security, 181
19.6 Discussion, 182
19.7 Conclusion, 183
PART FIVE Case Studies: National EHR Efforts
20 Australia's HealthConnect 189
20.1 Introduction, 189
20.2 Overview, 190
20.3 Architecture, 190
20.4 Discussion, 195
20.5 Conclusion, 196
21 Austria's ELGA 199
21.1 Introduction, 199
21.2 Overview, 200
21.3 Architecture, 200
21.4 Functional Implementation, 203
21.5 Exchange, 205
21.6 Discussion, 205
21.7 Conclusion, 207
22 Canada's EHRS Blueprint 211
22.1 Introduction, 211
22.2 Overview, 211
22.3 Architecture, 212
22.4 Discussion, 217
22.5 Conclusion, 219
Bibliography, 219
23 Denmark's MedCom 221
23.1 Introduction, 221
23.2 Overview, 221
23.3 Architecture, 222
23.4 Discussion, 225
23.5 Conclusion, 226
24 Hong Kong's eHR Sharing System 229
24.1 Introduction, 229
24.2 Overview, 229
24.3 Architecture, 230
24.4 Discussion, 234
24.5 Conclusion, 235
25 India's Health IT Initiatives 239
25.1 Introduction, 239
25.2 Overview, 240
25.3 ITIH Framework, 240
25.4 Recommendations on Guidelines, Standards, and Practices for Telemedicine in India, 242
25.5 iHIND, 244
25.6 Other Initiatives, 247
25.7 Discussion, 249
25.8 Conclusion, 251
26 Netherlands' AORTA 253
26.1 Introduction, 253
26.2 Overview, 253
26.3 Architecture, 254
26.4 Discussion, 256
26.5 Conclusion, 257
27 Singapore's NEHR 259
27.1 Introduction, 259
27.2 Overview, 259
27.3 Architecture, 260
27.4 Discussion, 263
27.5 Conclusion, 264
28 Sweden's NPO 267
28.1 Introduction, 267
28.2 Overview, 268
28.3 Architecture, 269
28.4 Discussion, 273
28.5 Conclusion, 274
29 Taiwan's Health Information Network 277
29.1 Introduction, 277
29.2 Overview, 278
29.3 Architecture, 278
29.4 Exchange, 280
29.5 Discussion, 282
29.6 Conclusion, 284
30 United Kingdom's Spine 287
30.1 Introduction, 287
30.2 Overview, 287
30.3 Architecture, 288
30.4 Discussion, 292
30.5 Conclusion, 294
31 USA's EHR Meaningful Use 295
31.1 Introduction, 295
31.2 Overview, 296
31.3 EHR Meaningful Use, 296
31.4 National Health Information Network (NHIN), 301
31.5 Discussion, 304
31.6 Conclusion, 307
PART SIX Findings and Conclusion
32 Findings and Conclusion 313
32.1 EHR Standards, 313
32.2 Coding Systems, 317
32.3 Standard Frameworks, 318
32.4 Case Studies: National EHR Efforts, 319
32.5 Recommended Phases for Implementing A National EHR System, 325
Glossary 327
Index 339
PRADEEP K. SINHA, PhD, is the Senior Director (High Performance Computing) at the Centre for Develop- ment of Advanced Computing (C-DAC), India, and coordinator and mentor to several high-technology R&D groups there.
GAUR SUNDER heads research and development at Medical Informatics Group (MIG) at C-DAC, India, and is a member of the eHealth Committee of the Bureau of Indian Standards and the National EHR Standards Committee of the Union Health Ministry of India.
PRASHANT BENDALE is involved in the research and development of the distribution and integration model for building EHR stores at C-DAC.
MANISHA D. MANTRI is involved in the research and development of an evolving EHR model, compliance to eHealth standards, and security policies for EHR systems at C-DAC.
ATREYA C. DANDE is involved in the research and development of EHR standards, national EHR frameworks, distributed technologies, and optimal search algorithms in healthcare at C-DAC.
GAUR SUNDER heads research and development at Medical Informatics Group (MIG) at C-DAC, India, and is a member of the eHealth Committee of the Bureau of Indian Standards and the National EHR Standards Committee of the Union Health Ministry of India.
PRASHANT BENDALE is involved in the research and development of the distribution and integration model for building EHR stores at C-DAC.
MANISHA D. MANTRI is involved in the research and development of an evolving EHR model, compliance to eHealth standards, and security policies for EHR systems at C-DAC.
ATREYA C. DANDE is involved in the research and development of EHR standards, national EHR frameworks, distributed technologies, and optimal search algorithms in healthcare at C-DAC.