Testing Conformance and Interoperability of eHealth Applications

Summary

Objective: To explain the common conformance and interoperability testing requirements of eHealth applications through two case studies; one using a prominent eHealth messaging standard, namely HL7 v3 [1], and the other using Integrating the Healthcare Enterprise (IHE) [2] Profiles and to describe how these testing requirements can be addressed through an automated, modular and scenario-based testing framework, namely Test BATN.

Methods: Summarizing the conformance testing requirements of HL7 v3 messages. Illustrating the interoperability testing requirements of IHE Profiles through a scenario based on the IHE XDS, IHE XDS-MS and IHE PIX profiles. Explaining how these requirements can be handled through a dynamic and configurable test framework addressing all the layers in the interoperability stack within a single test scenario.

Results: Conformance and interoperability testing are necessary to maintain correct information exchange as the correctness of the exchanged data is essential in the healthcare domain. There are many standards used in eHealth that the applications need to conform. Additionally, there are profiling initiatives such as IHE and Continua Health Alliance which publish integration profiles addressing a specific clinical need or a use case and describe how to combine or use the existing standards to provide interoperability. However, as the results of our case studies demonstrate, there are many commonalities in the conformance and interoperability testing requirements of these standards and profiles and therefore an integrated testing environment is needed.

Conclusion: Our main conclusion is that rather than having individual testing tools for each standard or initiative, a generic and modular test framework exploiting the commonalities in the testing processes and fostering reusability of modular, pluggable testing components will improve the efficiency of testing. Through the TestBATN framework, we describe how this modularity can be achieved by providing common interfaces facilitating the development of adaptors which allows different testing components to be plugged into the system.

Keywords

Medical informatics applications - standards - software validation - systems integration

• References

• 1 hl7.org (Internet).. Health Level 7 (cited 2010 Feb 25). Available from: http://www.hl7.org.
• 2 ihe.net (Internet).. Integrating the Healthcare Enterprise (IHE) (cited 2010 Feb 25). Available from: http://www.ihe.net.
• 3 Eichelberg M, Aden T, Riesmeier J, Dogac A, Laleci G. A Survey and Analysis of Electronic Healthcare Record Standards. ACM Computing Surveys 2005; 37 (04) 277-315.
• 4 HL7 Version 3 Standard: Transport Specification – eb XML, Release 2.. HL7 (Internet). December 2009 (cited 2010 Feb 25). Available from: http://www.hl7.org/v3ballot/html/infrastructure/transport/transport-ebxml.htm.
• 5 HL7 Version 3 Standard: Transport Specification – Web Services Profile, Release 2.. HL7 (Internet). December 2009 (cited 2010 Feb 25). Available from: http://www.hl7.org/v3ballot/html/infrastructure/transport/transport-wsprofiles.htm.
• 6 Transport Specification: MLLP, Release 2.. HL7 (Internet). December 2009 (cited 2010 Feb 25). Available from: http://www.hl7.org/v3ballot/html/infrastructure/transport/transport-mllp.htm.
• 7 HL7 Clinical Document Architecture, Release 2.. HL7 (Internet). August 2004 (cited 2010 Feb 25). Available from: http://hl7.org/library/Committees/structure/CDA.ReleaseTwo.CommitteeBallot03.Aug.2004.zip.
• 8 The Systematized Nomenclature of Medicine (SNOMED).. International Health Terminology Standards Development Organization (Internet). February 2010 (cited 2010 Feb 25). Available from: http://www.ihtsdo.org/snomed-ct.
• 9 International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), Second Edition.. World Health Organization (Internet). 2007 (cited 2010 Feb 25). Available from: http://www.who.int/whosis/icd10.
• 10 Logical Observation Identifiers Names and Codes (LOINC) (Internet). July 2009 (cited 2010 Feb 25). Available from: http://www.regenstrief.org/loinc.
• 11 ebXML Business Process Specification Schema.. OASIS (Internet). May 2001 (cited 2010 Feb 25). Available from: http://www.ebxml.org/specs/eb BPSS.pdf.
• 12 HL7 v3 Ballot Site.. HL7 (Internet). May 2009 (cited 2009 October 28). Available from: http://www.hl7.org/v3ballot2009may/html/welcome/introduction/index.htm.
• 13 López D, Blobel B. Enhanced semantic interoper-ability by profiling health informatics standards. Methods Inf Med (serial on the Internet) (2009), (cited 2010 February 2)]; 48 (02) 170-177.
• 14 Ohmann C, Kuchinke W. Future developments of medical informatics from the viewpoint of networked clinical research. Interoperability and integration. Methods Inf Med (serial on the Internet). (2009) (cited February 25, 2010); 48 (01) 45-54.
• 15 hitsp.org (Internet).. Healthcare Information Technology Standards – HITSP; c2008-2009 (cited 2010 Feb 25). Available from: http://www.hitsp.org.
• 16 sagliknet.gov.tr (Internet).. Saglik Net; c2008-2009 (cited 2010 Feb 25). Available from: http://www.sagliknet.saglik.gov.tr.
• 17 HL7 Message Maker web site (Internet).. HL7 Conformance Testing with Message Maker (cited 2010 Feb 25). Available from: http://www.itl.nist.gov/div897/ctg/messagemaker/.
• 18 IHE Mesa Tools web site (Internet).. MESA IHE Test Tools (cited 2010 Feb 25). Available from: http://ihedoc.wustl.edu/mesasoftware/index.htm?highlight=2_2.
• 19 Global eBusiness interoperability test bed methodologies (GITB) Final Report, draft CEN Workshop Agreement on GITB:Feasibility Study.. CEN GITB Project (Internet). October 2009 (cited 2010 Feb 25). Available from: http://www.stadlar.is/files/FeasibilityOutline20090807V32clbgfinal_796618017.pdf.
• 20 Namli T, Aluc G, Dogac A. An Interoperability Test Framework for HL7 based Systems. IEEE Transactions on Information Technology in Biomedicine 2009; 13 (03) 389-399.
• 21 hl7.org.au (Internet).. HL7 v2 Resources, HL7 Australia; c2001-2009 (updated 2009 December; cited 2010 Feb 25). Available from: http://www.hl7.org./au/HL7-V2-Resources.htm.
• 22 HL7 Reference Information Model v0227.. HL7 (Internet). May 2009 (cited 2010 Feb 25). Available from: http://www.hl7.org/v3ballot/html/infrastructure/rim/rim.htm.
• 23 IHE Cross Enterprise Document Sharing (XDS) Profile, ITI Technical Framework 5.0, Volume 1.. IHE (Internet). December 2008 (cited 2010 Feb 25). Available from: http://www.ihe.net/Technical_Framework/upload/IHE_ITI_TF_5-0_Vol1_FT_2008-12-12.pdf.
• 24 IHE Cross-Enterprise Sharing of Medical Summaries (XDS-MS) Integration Profile, Patient Care Coordination Technical Framework 4.0.. IHE (Internet). October 2008 (cited 2010 Feb 25). Available from: http://www.ihe.net/Technical_Framework/upload/IHE_PCC_TF_4-0_Vol_1_2008-10-10.pdf.
• 25 IHE Patient Identifier Cross Referencing (PIX) Integration Profile, ITI Technical Framework 5.0, Volume 1.. IHE (Internet). December 2008 (cited 2010 Feb 25). Available from: http://www.ihe.net/Technical_Framework/uploadIHE_ITI_TF_5-0_Vol1_FT_2008-12-12.pdf.
• 26 hhs.gov (Internet).. National Health Information Network (NHIN), US Department of Health & Human Services (cited 2010 Feb 25). Available from: http://www.hhs.gov/healthit/healthnetwork/background/.
• 27 infoway-inforoute.ca (Internet).. Canada Health Infoway; ©2010 (cited 2010 Feb 25). Available from: http://www.infoway-inforoute.ca.
• 28 nhs.uk (Internet).. National Health System (NHS) UK (cited 2010 Feb 25). Available from: http://www.nhs.uk.
• 29 d-m-p.org (Internet).. Dossier Médical Personnel (DMP) (cited 2010 Feb 25). Available from: http://www.d-m-p.org.
• 30 Kabak Y, Dogac A, Kose I, Akpinar N, Gurel M, Arslan Y. et al. The Use of HL7 CDA in the National Health Information System (NHIS) of Turkey. Proceedings of 9th International HL7 Interoperability Conference (IHIC), October 2008 Crete, Greece: 2008 pp 49-55. Available from: http://www.srdc./metu.edu.tr/webpage/publications/2008/10.pdf.
• 31 medical.nema.org (Internet).. Digital Imaging and Communications in Medicine (DICOM) (cited 2010 Feb 25). Available from: http://medical.nema.org/.
• 32 CEN EN 13606-1, “Health informatics – Electronic health record communication – Part 1: Reference model,” European Committee for Standardization. Brussels, Belgium: Tech. Rep. EN 13606-1, 2007
• 33 XML Schema Specification.. W3C (Internet). October 2004 (cited 2010 Feb 25). Available from: http://www.w3.org/XML/Schema.
• 34 International Standard for Schematron.. ISO/IEC (Internet). May 2009 (cited 2010 Feb 25). Available from: http://www.iso.org/PubliclyAvailableStandards.
• 35 XML Path Language (XPath), Version 1.0.. W3C (Internet). November 1999 (cited 2010 Feb 25). Available from: http://www.w3.org/TR/xpath.
• 36 TestBATN web site (Internet).. TestBATN – Testing Business, Application, Transport and Network Layers, SRDC Ltd. (cited 2010 Feb 25). Available from: http://www.srdc.com.tr/index.php?option=com_content&task=view&id=182&Itemid=192.
• 37 Namli T, Aluc G, Sinaci A, Kose I, Akpinar N, Gurel M. et al. Testing the Conformance and Interoperability of NHIS to Turkey’s HL7 Profile. Proceedings of 9th International HL7 Interoperability Conference (IHIC), October 2008 Crete, Greece: 2008 pp 63-68.