Semantic Interoperability in Czech Healthcare Environment Supported by HL7 Version 3

Summary

Objectives: The data interchange in the Czech healthcare environment is mostly based on national standards. This paper describes a utilization of international standards and nomenclatures for building a pilot semantic interoperability platform (SIP) that would serve to exchange information among electronic health record systems (EHR-Ss) in Czech healthcare. The work was performed by the national research project of the “Information Society” program.

Methods: At the beginning of the project a set of requirements the SIP should meet was formulated. Several communication standards (open EHR, HL7 v3, DICOM) were analyzed and HL7 v3 was selected to exchange health records in our solution. Two systems were included in our pilot environment: WinMedicalc 2000 and ADAMEKj EHR.

Results: HL7-based local information models were created to describe the information content of both systems. The concepts from our original information models were mapped to coding systems supported by HL7 (LOINC, SNOMED CT and ICD-10) and the data exchange via HL7 v3 messages was implemented and tested by querying patient administration data. As a gateway between local EHR systems and the HL7 message-based infrastructure, a configurable HL7 Broker was developed.

Conclusions: A nationwide implementation of a full-scale SIP based on HL7 v3 would include adopting and translating appropriate international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our pilot study showed that our approach is feasible but it would demand a huge effort to fully integrate the Czech healthcare system into the European e-health context.

Keywords

Electronic health record - HL7 - semantic inter-operability - information storage and retrieval - communication standards

• References

• 1 Pirnejad H, Niazkhani Z, Berg M, Bal R. Intra-organizational communication in healthcare – Considerations for standardization and ICT application. Methods Inf Med 2008; 47 (04) 336-345.
• 2 Ministry of Health of the Czech Republic (home-page on the Internet).. Data Standard of MH CR – DASTA and NCLP. Available from: http://ciselniky. dasta.mzcr.cz (cited Oct 26, 2009).
• 3 Health Level Seven, Inc.. (homepage on the Internet). Available from: http://www.hl7.org (cited Oct 26, 2009).
• 4 European Committee for Standardization (CEN). Technical Committee CEN/TC 251: European Standard EN 13606. “Health informatics – Electronic health record communication”.;
• 5 NEMA – Medical Imaging & Technology Alliance. (homepage on the Internet). DICOM. Available from: http://dicom.nema.org (cited Oct 26, 2009).
• 6 IZIP Ltd.. (homepage on the Internet). Internet Access to Patient Health Care Information. Available from: http://www.izip.cz (cited Oct 26, 2009).
• 7 Mead CN. Data Interchange Standards Healthcare IT – Computable Semantic Interoperability: Now Possible but Still Difficult, Do We Really Need a Better Mousetrap?. J of Healthcare Information Management 2006; 20 (01) 71-78.
• 8 Tomeckova M. et al. Minimal data model of cardiological patient (in Czech). Cor et Vasa 2002; 4: 123.
• 9 Medicalc Software Ltd.. (homepage on the Internet). WinMedicalc 2000. Available from: http://medicalc.cz/winmedicalc (cited Oct 26, 2009).
• 10 Mares R, Tomeckova M, Peleska J, Hanzlicek P, Zvárová J. User interface for patients’ database systems – an example of application for data collection using minimal data model of cardiology (in Czech). Cor et Vasa 2002; 4: 76.
• 11 Nagy M, Hanzlicek P, Preckova P, Kolesa P, Misur J, Dioszegi M, Zvárová J. Building Semantically Inter-operable EHR Systems Using International Nomenclatures and Enterprise Programming Techniques. CeHR 2007: Conference Proceedings; Dec 2-5, 2007; Regensburg, Germany. Amsterdam: IOS press; 2008. pp 105-110.
• 12 Hinchley A. HL7 V3 Guide – July 27, 2009. Available from: http://www.hl7.org/v3ballot/html/help v3guide/v3guide.htm (cited Oct 26, 2009).
• 13 Hinchley A. Understanding Version 3 – A primer on the HL7 Version 3 Communication Standard. Understanding HL7 Series. 3rd ed. Munich: Alexander Moench Publishing; 2005
• 14 Lopez DM, Blobel GME. A development framework for semantic interoperable health information systems. Int J Med Inform 2009; 78 (02) 83-103.
• 15 openEHR (homepage on the Internet).. openEHR – future-proof and flexible EHR specifications. Available from: http://www.openehr.org (cited Oct 26, 2009).
• 16 European Committee for Standardization (CEN). Technical Committee CEN/TC 251: European Standard ENV 13606-1. “Health informatics – Electronic healthcare record communication”.;
• 17 Spahni S, Lovis C, Mercille R, Verdel H, Cotten M, Geissbuhler A. Implementing a new ADT based on the HL7 version 3 RIM. Int J Med Inform 2007; 76 2–3 190-194.
• 18 Carlsson G, Hagberg T, Bogavac L, Wintell M. How HL7 version 3 is used at the Sahlgrenska University Hospital to exchange information with a central archive. Pro Biomed Opt Imag – Proceedings of SPIE 2008; vol. 6919, art. no. 691902.
• 19 Orgun B, Vu J. HL7 ontology and mobile agents for interoperability in heterogeneous medical information systems. Comput Biol Med 2006; 36 7–8 817-836.
• 20 Logical Observation Identifiers Names and Codes – LOINC (homepage on the Internet). Available from: http://loinc.org (cited Oct 26, 2009).
• 21 SNOMED International (homepage on the Internet).. Available from: http://www.snomed.org (cited Oct 26, 2009).
• 22 WHO (homepage on the Internet).. International Classification of Diseases. Available from: http://www.who.int/classifications/icd/en (cited Oct 26, 2009).
• 23 US NIH National Library of Medicine (homepage on the Internet).. UMLS Knowledge Source Server. Available from: http://umlsks.nlm.nih.gov (cited 2009 Oct 26).
• 24 Hanzlicek P, Preckova P, Zvarova J. Semantic Inter-operability in the Structured Electronic Health Record. Ercim News 2007; 69: 52-53.
• 25 Garde S, Knaup P, Hovenga EJS, Heard S. Towards Semantic Interoperability for Electronic Health Records: Domain Knowledge Governance for openEHR Archetypes. Methods Inf Med 2007; 46 (03) 332-343.
• 26 The openEHR Foundation. (homepage on the Internet). Relationship between openEHR Specifications and HL7v3 Standards. Available from: http://www.openehr.org/206-OE.html (cited Oct 26, 2009).
• 27 Blobel BG, Engel K, Pharow P. Semantic interoper-ability – HL7 Version 3 compared to advanced architecture standards. Methods Inf Med 2006; 45 (04) 343-353.
• 28 Lopez DM, Blobel B. Enhanced Semantic Inter-operability by Profiling Health Informatics Standards. Methods Inf Med 2009; 48 (02) 170-177.
• 29 Eichelberg M, Aden T, Riesmeier J, Dogac A, Laleci GB. A Survey and Analysis of Electronic Healthcare Record Standards. ACM Comput Surv 2005; 37 (04) 277-315.