Collage of Applied Medical Sciences

Department of Health Information Management and Technology

ELECTRONIC HEALTH RECORDS (EHR)

WEEK 3: ELECTRONIC HEALTH RECORD STANDARDS
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

STUDENTS RESOURCES:
- John Wiley & Sons, PART 2: EHR standards,
Defined parts of these Chapters ( 2, 4, 6, 8, 9)
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

Introduction

▪ EHR Standards are the building blocks for the

exchange of health information. They provide a
common reference framework to promote uniformity in
the definition and identification of health system
components.
▪ This includes messaging and data interchange standards which
allow for consistent data flow among systems and
organizations, specifying format, data elements and structure. It
also includes terminology standards which provide specific
codes for clinical concepts such as diseases, problem lists,
allergies, medications, and diagnoses. These standards
enhance data quality, reduce medical errors and reduce the
need for customization of IT solutions across the health care
system.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS
- Informatics Standards released by Standards Development
Organizations and Facilitators.
- Standards can be applied on the terminology level like ICD,
DRG (Diagnosis Related Group), and/or on the data
interchange level like HL7, DICOM.
- DRG codes are used to classify inpatient hospital
services and are commonly used by many insurance
companies and Medicare.
- The DRG code, the length of the inpatient stay and the
CPT code are combined to determine claim payment and
reimbursement.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

▪ Digital Imaging and Communications in Medicine

(DICOM)— is the international standard for medical
images and related information. It defines the formats
for medical images that can be exchanged with the
data and quality necessary for clinical use.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - ISO/TS 18308

• These efforts have resulted in several publications dealing with
architecture, model, and implementation mechanisms of EHR.
• International Organization for Standardization (ISO) initiated efforts to
address this requirement and published ISO/TS 18308.
• ISO/TC 215 is a Technical Committee (TC) of ISO working in the area of
Health Informatics.
• The purpose of ISO/TS 18308:2004 is to assemble and collate a set of
clinical and technical requirements for an electronic health record
architecture (EHRA) that supports using, sharing, and exchanging
electronic health records across different health sectors, different
countries, and different models of healthcare delivery.
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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - ISO/TS 18308

CONTENT STRUCTURE MODEL
ISO/TS 18308 specifies that:
• EHR should have structural elements that encapsulate contained
data.
• The encapsulation enables interoperability and automatic
processing of EHR.
• An EHR should also support exchange of its structural elements
across healthcare systems and should be independent of
hardware, software, and so on.
• Information stored in an EHR may be clinical or administrative.
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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - ISO/TS 18308

CONTENT STRUCTURE MODEL
ISO/TS 18308 specifies that:
• An EHR should be able to contain both structured and non structured
data with suitable data types to represent all possible types of clinical
information.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - ISO/TS 18308

CONTENT EXCHANGE
HIS, EHR systems, and clinical systems developed by different
vendors or organizations often need to interoperate. According
to ISO/TS 18308, it should be possible to exchange partial or
complete record while maintaining integrity and context of EHR
data. Additionally, it should provide support for authentication
and audit trail of exchange process.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - HL7 EHR-S FUNCTIONAL

MODEL
- In 2003, the HL7 EHR Special Interest Group (HL7 EHR SIG)
initiated the development of a functional guidelines document
to cover expectations from an EHR system. This set of
requirements is called the HL7 EHR-System Functional Model
(HL7 EHR-S FM).
- This standard defines the guidelines that are neither
messaging specifications nor EHR specifications, but are
descriptive understanding of functions expected in a system
claiming to be an EHR system.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - HL7 EHR-S FUNCTIONAL

MODEL
- HL7 EHR-SIG defined a template for specifying functional
profiles in medical specialties.
- It keeps on adding new functional profiles to the template.
- Users can submit new functional profiles for addition to the
template by following the HL7 EHR-S FM template.
- The HL7 EHR-S FM approved by ANSI (American National
Standards Institute) covers more than 160 functional profiles
related to EHR systems.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - HL7 EHR-S FUNCTIONAL

MODEL

As shown, the set of functions are divided into three categories including
Direct Care, Supportive, and Information Infrastructure. Each category has
various functional areas with specific codes assigned to them. 12
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - HL7 EHR-S FUNCTIONAL

MODEL

Examples of the Functional profiles:

A- EHR Child Health Functional Profile. “Pediatrics Data Standards”

B- EHR Clinical Research Profile. “Assist in Clinical Research”

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - HL7 EHR-S FUNCTIONAL MODEL

- HL7 EHR-SIG has also developed EHR Interoperability
Model (EHR/IM), which specifies how EHRs could be
interoperable during transmission and reception.
- EHR Interoperability Model (IM) specifies guidelines and
requirements for standards developed to exchange health
information from one source to another. Examples of such
standards are: HL7 v2/3, Clinical Document Architecture
(CDA), Continuity of Care Record (CCR), Continuity of Care
Document (CCD).
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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - MESSAGING STANDARD FOR HEALTHCARE

DATA
- Health Level Seven (HL7) family of standards is one of the most
widely discussed and used application data exchange standards in
the health information technology industry.
- The family consists of several standards, namely, HL7v2.x, HL7 v3,
Clinical Document Architecture (CDA), and Continuity of Care
Document (CCD), and so on.
- International [HL7] is a not-for-profit, ANSI-accredited standards
developing organization. It is dedicated to providing a
comprehensive framework and related standards for exchange,
integration, sharing, and retrieval of electronic health information.
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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - MESSAGING STANDARD FOR HEALTHCARE DATA

MESSAGE STRUCTURE
Messages in HL7 v2.x standards are of two basic types:
1. Event. These messages represent real-world events
happening in healthcare environment that involve transfer
of health-related data.
2. Query. These messages are used to query health care
information of one or more patients. They are responded to
by using respective response messages containing the
required information. 16
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - MESSAGING STANDARD FOR HEALTHCARE DATA

MESSAGE STRUCTURE
Every HL7 v2.x communication has the following components:
1. Message. It is the main component of data transfer in HL7 v2.x
standard. It describes a real-world healthcare event or query. It
comprises a collection of segments described in a fixed sequence that
defines the structure of the message. Each message contains an MSH
(Message Header) as a mandatory segment that describes the message
transaction identifier, message type, event code, HL7 standard version,
healthcare application identifier, and related information.
Collage of Applied Medical Sciences
Department of Health Information Management and Technology
EHR STANDARDS - MESSAGING STANDARD FOR
HEALTHCARE DATA
MESSAGE STRUCTURE
Every HL7 v2.x communication has the following components:
2. Segment and Groups. A segment represents a set of packaged data
units for a specific kind of information such as Patient Identification (PID),
Patient Visit (PV1), Observation Result (OBX), Specimen (SPM), and so on.
Each segment contains a number of fields.
3. Fields and Data Value Tables. A field is the smallest unit of health-
related information used in HL7 v2.x messages. HL7 v2.x provides a
comprehensive list of fields along with their identifier, data type, data
value table, and so on.
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Collage of Applied Medical Sciences
Department of Health Information Management and Technology
EHR STANDARDS - MESSAGING STANDARD FOR
HEALTHCARE DATA
MESSAGE STRUCTURE
Every HL7 v2.x communication has the following components:
4. Data Types. Each field has a data type. Data types are categorized as
Primitive and Composite. Primitive data types are the basic data types
that can represent a single unit of information. These are ST, IS, ID, FT,
and NM. Composite data types contain multiple primitive data types or
other composite data types. For example, AD (Address) contains Street
Address (ST), Other Designation (ST), City (ST), State or Province (ST),
etc.
(ST: String data; FT: Formated Text; ID: Coded values for HL7 tables;
IS; Coded values for user-defined tables) 19
Collage of Applied Medical Sciences
Department of Health Information Management and Technology
EHR STANDARDS - MESSAGING STANDARD FOR
HEALTHCARE DATA

Message Header Segment (MSH), Patient Identification Segment (PID), Patient Visit
Segment (PV1), Observation Request Segment (OBR), Observation/Result Segment
(OBX).
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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - CLINICAL DOCUMENT STANDARDS

- Health Level Seven International (HL7) and American Society for
Testing Materials (ASTM) have developed such document standards.
The HL7 organization has developed the HL7 Clinical Document
Architecture (CDA) standard with the aim to bring a real-world view to
medical records that medical practitioners can understand and
machines can process.
- For this purpose, CDA represents a medical record as a document
having a structure that XML technology can represent and that the
information model called Reference Information Model (RIM) can
represent.
- (XML stands for extensible markup language)
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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - CLINICAL DOCUMENT STANDARDS

- CDA Release 2.0 provides a model for exchange of clinical
documents like discharge summaries, prescriptions, and aims to
cater to the needs of an actual electronic medical record.
- CDA uses XML document format and is based on HL7 v3 RIM and its
vocabularies to represent content data. Thus, CDA makes the
documents both machine-readable and human-readable.
- CDA documents can be displayed using XML-aware Web browsers
or wireless applications such as cell phones.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - DICOM

- With increasing use of computers in radiology, American College of
Radiology (ACR) and National Electrical Manufacturers Association
(NEMA) started work in 1983 for defining a standard for structure and
transmission of images between medical devices and computer
systems.
- Their effort resulted in a standard called DICOM (Digital Imaging and
Communications in Medicine).
- The standard deals with the structure and transmission of medical
images in digital form.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

EHR STANDARDS - DICOM

The DICOM standard supports a wide range of features to
facilitate interoperability between communicating entities.
These include:
1. Specification for network communication.
2. Syntactic and semantic level description of network level
commands.
3. Interchange media support through standard description of file
format and media directory structure.
4. Concrete conformance statement framework.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

THANK YOU
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