In the field of electronic health records (EHR), Cross Enterprise Document Sharing (XDS) is a system of standards for cataloging and sharing patient records across health institutions. [1]
XDS provides a registry for querying which patient records are in an EHR repository and methods for retrieving the documents. The XDS system of registry and repository is termed an integration profile and was created by Integrating the Healthcare Enterprise. [2] XDS uses structured EHR standards such as Continuity of Care Record (CCR) and Clinical Data Architecture (CDA) to facilitate data exchange. [2]
The registry stores metadata about each document stored in a repository, including its source or location. [3] There may be multiple repositories of documents indexed, [4] but only one registry per clinical domain. XDS provides a Patient Identity Service for cross-referencing patients across multiple domains.
Conceptually, patient health record data is classified as Longitudinal Records (EHR-LR) and Care Records (EHR-CR). [2] Longitudinal records describe the basic patient health data across clinics and over the lifetime of the patient. Care records describe specific clinical data contained within a clinical domain. There have also been XDS standards XDS-I and XDS-b developed for electronic imaging records. [5]
Health informatics is information engineering applied to the field of health care, essentially the management and use of patient health care information. It is a multidisciplinary field that uses health information technology (HIT) to improve health care via any combination of higher quality, higher efficiency, and new opportunities. The disciplines involved include information science, computer science, social science, behavioral science, management science, and others. The United States National Library of Medicine (NLM) defines health informatics as "the interdisciplinary study of the design, development, adoption and application of IT-based innovations in health care services delivery, management and planning".
Health Level Seven or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. These standards focus on the application layer, which is "layer 7" in the OSI model. The HL7 standards are produced by Health Level Seven International, an international standards organization, and are adopted by other standards issuing bodies such as American National Standards Institute and International Organization for Standardization.
An electronic health record (EHR) is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.
Logical Observation Identifiers Names and Codes (LOINC) is a database and universal standard for identifying medical laboratory observations. First developed in 1994, it was created and is maintained by the Regenstrief Institute, a US nonprofit medical research organization. LOINC was created in response to the demand for an electronic database for clinical care and management and is publicly available at no cost.
Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region, community or hospital system. Participants in data exchange are called in the aggregate Health Information Networks (HIN). In practice the term HIE may also refer to the health information organization (HIO) that facilitates the exchange.
The Clinical Data Interchange Standards Consortium (CDISC) is a standards developing organization (SDO) dealing with medical research data linked with healthcare, to "enable information system interoperability to improve medical research and related areas of healthcare". The standards supports medical research from protocol through analysis and reporting of results and have been shown to decrease resources needed by 60% overall and 70–90% in the start-up stages when they are implemented at the beginning of the research process.
The HL7 Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange. In November 2000, HL7 published Release 1.0. The organization published Release 2.0 with its "2005 Normative Edition."
Laika is an open source Electronic Health Record (EHR) testing framework which analyzes and reports on the interchangeability of EHR systems. This includes the testing for certification of EHR software products and networks. Laika is designed to verify the input and output of EHR data against the standards and criteria identified by the Certification Commission for Healthcare Information Technology (CCHIT).
Consent management is a system, process or set of policies for allowing consumers and patients to determine what health information they are willing to permit their various care providers to access. It enables patients and consumers to affirm their participation in e-health initiatives and to establish consent directives to determine who will have access to their protected health information (PHI), for what purpose and under what circumstances. Consent management supports the dynamic creation, management and enforcement of consumer, organizational and jurisdictional privacy policies.
The Veterans Health Information Systems and Technology Architecture (VISTA) is a health information system deployed across all veteran care sites in the United States. VISTA provides clinical, administrative, and financial functions for all of the 1700+ hospitals and clinics of the Veterans Health Administration
popHealth is an open-source reference implementation software tool that automates population health reporting.
AHLTA is a global Electronic Health Record (EHR) system used by U.S. Department of Defense (DoD). It was implemented at Army, Navy and Air Force Military Treatment Facilities (MTF) around the world between January 2003 and January 2006. It is a services-wide medical and dental information management system. What made AHLTA unique was its implementation date, its Central Data Repository, its use in operational medicine and its global implementation. There is nothing like it in the private sector.
Radiation Exposure Monitoring (REM) is a framework developed by Integrating the Healthcare Enterprise (IHE), for utilizing existing technical standards, such as DICOM, to provide information about the dose delivered to patients in radiology procedures, in an interoperable format.
Medical device connectivity is the establishment and maintenance of a connection through which data is transferred between a medical device, such as a patient monitor, and an information system. The term is used interchangeably with biomedical device connectivity or biomedical device integration. By eliminating the need for manual data entry, potential benefits include faster and more frequent data updates, diminished human error, and improved workflow efficiency.
A Vendor Neutral Archive (VNA) is a medical imaging technology in which images and documents are stored (archived) in a standard format with a standard interface, such that they can be accessed in a vendor-neutral manner by other systems.
Medical image sharing is the electronic exchange of medical images between hospitals, physicians and patients. Rather than using traditional media, such as a CD or DVD, and either shipping it out or having patients carry it with them, technology now allows for the sharing of these images using the cloud. The primary format for images is DICOM. Typically, non-image data such as reports may be attached in standard formats like PDF during the sending process. Additionally, there are standards in the industry, such as IHE Cross Enterprise Document Sharing for Imaging (XDS-I), for managing the sharing of documents between healthcare enterprises. A typical architecture involved in setup is a locally installed server, which sits behind the firewall, allowing secure transmissions with outside facilities. In 2009, the Radiological Society of North America launched the "Image Share" project, with the goal of giving patients control of their imaging histories by allowing them to manage these records as they would online banking or shopping.
Life Image is the world's largest medical evidence and image exchange network providing access to points of care and curated imaging data. Founded in 2008, Life Image's Interoperability Suite is a digital platform that uses vendor-agnostic integration standards to connect more than 10,000 facilities, 160,000 providers, 58,000 global clinics, and millions of patients with life sciences, medical devices, and telehealth companies.
Integrating the Healthcare Enterprise (IHE) is a non-profit organization based in the US state of Illinois. It sponsors an initiative by the healthcare industry to improve the way computer systems share information. IHE was established in 1998 by a consortium of radiologists and information technology (IT) experts.
Health Level Seven International (HL7) is a non-profit organization ANSI-accredited standards development organization dedicated to providing standards and solutions that empower global health data interoperability.
Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic health records. The US Congress included a formula of both incentives and penalties for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the, American Recovery and Reinvestment Act of 2009.
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