Electronic Health Record – Standards, Coding Systems, Frameworks and Infrastructures

Preface XVII
<p>Acronyms XXVII</p>
<p>PART ONE Introduction</p>
<p>1 Introduction to EHR 3</p>
<p>1.1 Introduction, 3</p>
<p>1.2 Definition of EHR, 4</p>
<p>1.3 Functions of EHR, 5</p>
<p>1.4 Significance of EHR, 6</p>
<p>1.5 Factors Affecting Implementation of EHR, 7</p>
<p>1.6 Role of Standards, 8</p>
<p>1.7 Role of Clinical Coding Systems, 9</p>
<p>1.8 Role of Standard Frameworks, 9</p>
<p>1.9 Case Studies of National EHR Implementations, 10</p>
<p>PART TWO EHR Standards</p>
<p>2 Standard for EHR Architecture Requirements 15</p>
<p>2.1 Introduction, 15</p>
<p>2.2 ISO/TS 18308 Requirement Specification, 16</p>
<p>2.2.1 Content Structure Model, 16</p>
<p>2.2.2 Inclusion of Clinical and Record Processes, 17</p>
<p>2.2.3 Content Exchange, 17</p>
<p>2.2.4 Privacy and Security, 17</p>
<p>2.2.5 Legal Considerations, 17</p>
<p>2.2.6 Ethical, Consumer/Cultural Aspects, 18</p>
<p>2.2.7 Future–proof Framework, 18</p>
<p>2.3 Discussion, 18</p>
<p>2.4 Conclusion, 20</p>
<p>3 Standard for Healthcare Concepts 23</p>
<p>3.1 Introduction, 23</p>
<p>3.2 CEN/TC EN 13940–1, 24</p>
<p>3.2.1 Actors in Continuity of Care, 24</p>
<p>3.2.2 Health Issues and Their Management, 25</p>
<p>3.2.3 Concepts Related to Responsibility, 25</p>
<p>3.2.4 Time–Related Concepts, 26</p>
<p>3.2.5 Concepts Related to Knowledge, Activities, and Decision Support, 27</p>
<p>3.2.6 Health Data Management, 28</p>
<p>3.3 CEN/TC prEN 13940–2, 28</p>
<p>3.3.1 Healthcare Process, 29</p>
<p>3.4 Discussion, 30</p>
<p>3.5 Conclusion, 32</p>
<p>4 Standard for EHR Functional Specifications 33</p>
<p>4.1 Introduction, 33</p>
<p>4.2 HL7 EHR–S Functional Model, 34</p>
<p>4.2.1 Functional Profiles, 34</p>
<p>4.2.2 Exchange, 36</p>
<p>4.2.3 Security/Privacy, 37</p>
<p>4.3 Comparison of HL7 EHR–S FM and ISO/TS 18308, 38</p>
<p>4.4 Discussion, 39</p>
<p>4.5 Conclusion, 40</p>
<p>5 Standard for EHR Communication 43</p>
<p>5.1 Introduction, 43</p>
<p>5.2 CEN/ISO EN 13606 Requirement Specification, 45</p>
<p>5.2.1 Part 1: Reference Model, 45</p>
<p>5.2.2 Part 2: Archetypes Interchange Specification, 46</p>
<p>5.2.3 Part 3: Reference Archetypes and Term Lists, 49</p>
<p>5.2.4 Part 4: Security, 49</p>
<p>5.2.5 Part 5: Exchange Models, 50</p>
<p>5.3 Discussion, 51</p>
<p>5.4 Conclusion, 53</p>
<p>6 Messaging Standard for Healthcare Data 57</p>
<p>6.1 Introduction, 57</p>
<p>6.2 HL7 v2.x, 58</p>
<p>6.2.1 Message Structure, 60</p>
<p>6.2.2 Auxiliary Messaging Protocols, 61</p>
<p>6.2.3 Usage Scenario, 62</p>
<p>6.2.4 Example of HL7 v2.x Message, 62</p>
<p>6.3 Discussion, 64</p>
<p>6.4 Conclusion, 67</p>
<p>7 Model–Based Messaging Standard for Healthcare Data 69</p>
<p>7.1 Introduction, 69</p>
<p>7.2 HL7 v3, 69</p>
<p>7.2.1 Message Structure, 70</p>
<p>7.2.2 Interaction Model, 74</p>
<p>7.2.3 Role–Based Access Control, 74</p>
<p>7.2.4 HL7 v3 and SNOMED CT, 75</p>
<p>7.2.5 HL7 v3 and Service–Oriented Architecture (SOA), 75</p>
<p>7.3 HL7 v2.x and v3 Comparison, 75</p>
<p>7.4 Discussion, 75</p>
<p>7.5 Conclusion, 77</p>
<p>8 Clinical Document Standards 81</p>
<p>8.1 Introduction, 81</p>
<p>8.2 Clinical Document Architecture (CDA), 82</p>
<p>8.2.1 Document Structures, 82</p>
<p>8.2.2 Example of CDA Component, 83</p>
<p>8.3 Continuity of Care Document (CCD), 85</p>
<p>8.3.1 Example of CCD Component, 86</p>
<p>8.4 Clinical Document Exchange, 87</p>
<p>8.5 Discussion, 87</p>
<p>8.6 Conclusion, 89</p>
<p>9 Standard for Medical Imaging and Communication 93</p>
<p>9.1 Introduction, 93</p>
<p>9.2 DICOM, 94</p>
<p>9.2.1 Information Model, 94</p>
<p>9.2.2 Message Exchange Model, 96</p>
<p>9.3 Improvements in DICOM Standard, 96</p>
<p>9.4 Discussion, 96</p>
<p>9.5 Conclusion, 100</p>
<p>10 Standard for Patient Health Summary 103</p>
<p>10.1 Introduction, 103</p>
<p>10.2 Continuity of Care Record (CCR), 103</p>
<p>10.2.1 Structural Model, 104</p>
<p>10.2.2 Exchange, 106</p>
<p>10.3 Discussion, 107</p>
<p>10.4 Conclusion, 108</p>
<p>PART THREE Coding Systems</p>
<p>11 Coding System for Classification of Diseases and Related Health Problems 113</p>
<p>11.1 Introduction, 113</p>
<p>11.2 ICD, 114</p>
<p>11.2.1 Chapters, 114</p>
<p>11.2.2 Blocks, 114</p>
<p>11.3 Improvements in ICD–10, 114</p>
<p>11.4 Discussion, 116</p>
<p>11.5 Conclusion, 116</p>
<p>12 Coding System for Laboratory Tests and Observations 119</p>
<p>12.1 Introduction, 119</p>
<p>12.2 LOINC, 120</p>
<p>12.2.1 Code Classification, 120</p>
<p>12.2.2 Code Structure, 120</p>
<p>12.2.3 Regenstrief LOINC Mapping Assistant (RELMA), 122</p>
<p>12.3 Discussion, 122</p>
<p>12.4 Conclusion, 123</p>
<p>13 Coding System for Patient Care Procedures 125</p>
<p>13.1 Introduction, 125</p>
<p>13.2 CPT, 126</p>
<p>13.2.1 Data Model, 127</p>
<p>13.2.2 CPT Sections, 128</p>
<p>13.2.3 CPT Index, 128</p>
<p>13.2.4 CPT Symbols, 128</p>
<p>13.2.5 CPT Modifiers, 128</p>
<p>13.2.6 Descriptive Qualifiers, 129</p>
<p>13.3 Discussion, 129</p>
<p>13.4 Conclusion, 130</p>
<p>14 Extended Coding System for Patient Care Procedures 131</p>
<p>14.1 Introduction, 131</p>
<p>14.2 HCPCS, 132</p>
<p>14.2.1 Level I Codes, 132</p>
<p>14.2.2 Level II Codes, 132</p>
<p>14.3 Discussion, 134</p>
<p>14.4 Conclusion, 134</p>
<p>15 Comprehensive Coding System for Clinical Terms 137</p>
<p>15.1 Introduction, 137</p>
<p>15.2 SNOMED CT, 138</p>
<p>15.2.1 Concepts, 138</p>
<p>15.2.2 Structure of SNOMED CT Code, 140</p>
<p>15.3 SNOMED CT Database Browsers, 141</p>
<p>15.4 Discussion, 141</p>
<p>15.5 Conclusion, 142</p>
<p>16 Unified Medical Language System 145</p>
<p>16.1 Introduction, 145</p>
<p>16.2 UMLS–Supported Coding Systems, 146</p>
<p>16.3 UMLS Architecture, 146</p>
<p>16.3.1 Metathesaurus, 146</p>
<p>16.3.2 Semantic Network, 148</p>
<p>16.3.3 Specialist Lexicon and Lexical Tools, 149</p>
<p>16.4 UMLS Licensing, 150</p>
<p>16.5 Discussion, 150</p>
<p>16.6 Conclusion, 151</p>
<p>17 Other Coding Systems 153</p>
<p>17.1 Introduction, 153</p>
<p>17.2 AHFS Drug Information (AHFS DI), 154</p>
<p>17.3 Current Dental Terminology (CDT), 154</p>
<p>17.4 International Classification of Diseases for Oncology (ICD–O), 155</p>
<p>17.5 International Classification of Functioning, Disability and Health (ICF), 155</p>
<p>17.6 Coding Systems for Nursing Practices, 156</p>
<p>17.6.1 North American Nursing Diagnosis Association (NANDA), 156</p>
<p>17.6.2 Nursing Interventions Classification (NIC), 156</p>
<p>17.6.3 Nursing Outcomes Classification (NOC), 156</p>
<p>17.7 Radiology Lexicon (RADLEX), 157</p>
<p>17.8 RxNorm, 157</p>
<p>17.9 Discussion, 157</p>
<p>17.10 Conclusion, 158</p>
<p>PART FOUR Standard Frameworks</p>
<p>18 openEHR 163</p>
<p>18.1 Introduction, 163</p>
<p>18.2 openEHR Process Model, 164</p>
<p>18.3 openEHR Architecture, 166</p>
<p>18.3.1 EHR Information Model, 168</p>
<p>18.3.2 Exchange, 170</p>
<p>18.4 Discussion, 170</p>
<p>18.5 Conclusion, 172</p>
<p>19 Integrating the Healthcare Enterprise (IHE) 175</p>
<p>19.1 Introduction, 175</p>
<p>19.2 IHE Domains, 176</p>
<p>19.2.1 Integration Profiles, 176</p>
<p>19.2.2 Integration Statements, 179</p>
<p>19.2.3 Technical Frameworks, 179</p>
<p>19.3 IHE Initiatives on Electronic Health Record, 180</p>
<p>19.4 Exchange, 180</p>
<p>19.4.1 Cross–Enterprise Document Sharing (XDS), 180</p>
<p>19.5 Security, 181</p>
<p>19.5.1 Audit Trail &amp; Node Authentication (ATNA), 181</p>
<p>19.6 Discussion, 182</p>
<p>19.7 Conclusion, 183</p>
<p>PART FIVE Case Studies: National EHR Efforts</p>
<p>20 Australia′s HealthConnect 189</p>
<p>20.1 Introduction, 189</p>
<p>20.2 Overview, 190</p>
<p>20.3 Architecture, 190</p>
<p>20.3.1 EHR Concept, 190</p>
<p>20.3.2 EHR Design, 191</p>
<p>20.3.3 e–Health Services, 193</p>
<p>20.3.4 National Privacy Principles (NPP), 194</p>
<p>20.3.5 Exchange, 194</p>
<p>20.4 Discussion, 195</p>
<p>20.5 Conclusion, 196</p>
<p>21 Austria′s ELGA 199</p>
<p>21.1 Introduction, 199</p>
<p>21.2 Overview, 200</p>
<p>21.3 Architecture, 200</p>
<p>21.3.1 Master Patient Index, 201</p>
<p>21.3.2 HSP Index, 201</p>
<p>21.3.3 Authorization System, 202</p>
<p>21.3.4 HSP System, 202</p>
<p>21.3.5 Storage (Document Registry), 202</p>
<p>21.3.6 Network, 202</p>
<p>21.3.7 ELGA Portal, 203</p>
<p>21.4 Functional Implementation, 203</p>
<p>21.4.1 Healthcare Services, 205</p>
<p>21.5 Exchange, 205</p>
<p>21.6 Discussion, 205</p>
<p>21.7 Conclusion, 207</p>
<p>22 Canada′s EHRS Blueprint 211</p>
<p>22.1 Introduction, 211</p>
<p>22.2 Overview, 211</p>
<p>22.3 Architecture, 212</p>
<p>22.3.1 Electronic Health Record Solution (EHRS), 212</p>
<p>22.3.2 Electronic Health Record Infostructure (EHRi), 213</p>
<p>22.3.3 Exchange, 216</p>
<p>22.3.4 Legal Framework, 217</p>
<p>22.4 Discussion, 217</p>
<p>22.5 Conclusion, 219</p>
<p>Bibliography, 219</p>
<p>23 Denmark s MedCom 221</p>
<p>23.1 Introduction, 221</p>
<p>23.2 Overview, 221</p>
<p>23.3 Architecture, 222</p>
<p>23.3.1 EHR Concept, 222</p>
<p>23.3.2 EHR Design, 223</p>
<p>23.3.3 Danish Health Data Network, 223</p>
<p>23.3.4 Security Infrastructure, 224</p>
<p>23.3.5 National Health Portal (Sundheds.dk), 224</p>
<p>23.3.6 Exchange, 225</p>
<p>23.4 Discussion, 225</p>
<p>23.5 Conclusion, 226</p>
<p>24 Hong Kong′s eHR Sharing System 229</p>
<p>24.1 Introduction, 229</p>
<p>24.2 Overview, 229</p>
<p>24.3 Architecture, 230</p>
<p>24.3.1 E–Health Engagement Initiative (EEI), 230</p>
<p>24.3.2 eHR Sharing System, 231</p>
<p>24.3.3 Exchange, 233</p>
<p>24.3.4 Security/Privacy Guidelines, 233</p>
<p>24.4 Discussion, 234</p>
<p>24.5 Conclusion, 235</p>
<p>25 India′s Health IT Initiatives 239</p>
<p>25.1 Introduction, 239</p>
<p>25.2 Overview, 240</p>
<p>25.3 ITIH Framework, 240</p>
<p>25.4 Recommendations on Guidelines, Standards, and Practices for Telemedicine in India, 242</p>
<p>25.5 iHIND, 244</p>
<p>25.5.1 Architecture, 245</p>
<p>25.5.2 Confidentiality, Access, and Security, 246</p>
<p>25.5.3 Standards, 246</p>
<p>25.6 Other Initiatives, 247</p>
<p>25.6.1 Integrated Disease Surveillance Project, 247</p>
<p>25.6.2 National Rural Telemedicine Network (NRTN), 247</p>
<p>25.6.3 National Medical College Network, 248</p>
<p>25.6.4 Standardization of EHR, 248</p>
<p>25.7 Discussion, 249</p>
<p>25.8 Conclusion, 251</p>
<p>26 Netherlands′ AORTA 253</p>
<p>26.1 Introduction, 253</p>
<p>26.2 Overview, 253</p>
<p>26.3 Architecture, 254</p>
<p>26.3.1 Dutch Electronic Patient Dossier (EPD) System, 254</p>
<p>26.3.2 NICTIZ Healthcare IT Infrastructure Workflow, 255</p>
<p>26.3.3 Exchange, 256</p>
<p>26.3.4 Security/Privacy Guidelines, 256</p>
<p>26.4 Discussion, 256</p>
<p>26.5 Conclusion, 257</p>
<p>27 Singapore′s NEHR 259</p>
<p>27.1 Introduction, 259</p>
<p>27.2 Overview, 259</p>
<p>27.3 Architecture, 260</p>
<p>27.3.1 Health Clusters, 260</p>
<p>27.3.2 EMR Exchange (EMRX), 260</p>
<p>27.3.3 National Electronic Health Record (NEHR), 261</p>
<p>27.4 Discussion, 263</p>
<p>27.5 Conclusion, 264</p>
<p>28 Sweden′s NPO 267</p>
<p>28.1 Introduction, 267</p>
<p>28.2 Overview, 268</p>
<p>28.3 Architecture, 269</p>
<p>28.3.1 Clinical Process Model, 269</p>
<p>28.3.2 Information Model, 270</p>
<p>28.3.3 Sjunet, 271</p>
<p>28.3.4 Electronic Catalog For Health and Social Care, 271</p>
<p>28.3.5 Secure it in Health Services, 271</p>
<p>28.3.6 Basic Services for Information, 271</p>
<p>28.3.7 Regulatory Framework for Information Interoperability in Healthcare, 272</p>
<p>28.3.8 National Patient Summary, 273</p>
<p>28.4 Discussion, 273</p>
<p>28.5 Conclusion, 274</p>
<p>29 Taiwan′s Health Information Network 277</p>
<p>29.1 Introduction, 277</p>
<p>29.2 Overview, 278</p>
<p>29.3 Architecture, 278</p>
<p>29.3.1 National Health Information Network (HIN) 2.0, 279</p>
<p>29.4 Exchange, 280</p>
<p>29.4.1 TMT Standard, 280</p>
<p>29.5 Discussion, 282</p>
<p>29.6 Conclusion, 284</p>
<p>30 United Kingdom′s Spine 287</p>
<p>30.1 Introduction, 287</p>
<p>30.2 Overview, 287</p>
<p>30.3 Architecture, 288</p>
<p>30.3.1 Spine Infrastructure, 288</p>
<p>30.3.2 Structure of Summary Care Record, 290</p>
<p>30.3.3 Content of Summary Care Record, 290</p>
<p>30.3.4 Security Infrastructure, 291</p>
<p>30.3.5 Exchange, 292</p>
<p>30.4 Discussion, 292</p>
<p>30.5 Conclusion, 294</p>
<p>31 USA′s EHR Meaningful Use 295</p>
<p>31.1 Introduction, 295</p>
<p>31.2 Overview, 296</p>
<p>31.3 EHR Meaningful Use, 296</p>
<p>31.3.1 Requirement Specifications, 297</p>
<p>31.4 National Health Information Network (NHIN), 301</p>
<p>31.4.1 NHIN Architecture, 301</p>
<p>31.4.2 Exchange Services, 303</p>
<p>31.4.3 Transaction Profiles, 303</p>
<p>31.4.4 Authorization Framework, 304</p>
<p>31.4.5 NHIN Trial Project, 304</p>
<p>31.4.6 NHIN Direct Project, 304</p>
<p>31.5 Discussion, 304</p>
<p>31.6 Conclusion, 307</p>
<p>PART SIX Findings and Conclusion</p>
<p>32 Findings and Conclusion 313</p>
<p>32.1 EHR Standards, 313</p>
<p>32.2 Coding Systems, 317</p>
<p>32.3 Standard Frameworks, 318</p>
<p>32.4 Case Studies: National EHR Efforts, 319</p>
<p>32.4.1 Quantitative Assessment, 320</p>
<p>32.4.2 Qualitative Assessment, 324</p>
<p>32.5 Recommended Phases for Implementing A National EHR System, 325</p>
<p>Glossary 327</p>
<p>Index 339</p>