Joachim Dudeck

Discharge and referral data exchange using global standards--the SCIPHOX project in Germany.

The goal of the German project Standardization of Communication between Information Systems in Physician Offices and Hospitals using XML (aka SCIPHOX) in its first phase is to provide information exchange based on the Extended Markup Language XML between Hospital Information Systems (HIS) and Physician Office Systems (POS). The Clinical Document Architecture (CDA), a standard developed by the Health Level Seven organization (HL7), was chosen to serve as the backbone specification. The CDA is an ANSI approved document architecture for exchange of clinical information using XML. In phase I of the SCIPHOX project the proposal specifies the use of the CDA as a generalized international standard in the national context of discharge and referral letters in Germany. The specification defines how to use the CDA header and associated vocabularies by providing a translation and interpretation of the CDA header tags and provides a solution for taking local needs (insurance information etc.) into account.

Value of XML in the implementation of clinical practice guidelines - the issue of content retrieval and presentation

The purpose of guidelines in clinical practice is to improve the effectiveness and efficiency of clinical care. It is known that nationally or internationally produced guidelines which, in particular, do not involve medical processes at the time of consultation, do not take local factors into account, and have no consistent implementation strategy, have limited impact in changing either the behaviour of physicians, or patterns of care. The literature provides evidence for the effectiveness of computerization of CPGs for increasing compliance and improving patient outcomes. Probably the most effective concepts are knowledge-based functions for decision support or monitoring that are integrated in clinical information systems. This approach is mostly restricted by the effort required for development and maintenance of the information systems and the limited number of implemented medical rules. Most of the guidelines are text-based, and are primarily published in medical journals and posted on the internet. However, internet-published guidelines have little impact on the behaviour of physicians. It can be difficult and time-consuming to browse the internet to find (a) the correct guidelines to an existing diagnosis and (b) and adequate recommendation for a specific clinical problem. Our objective is to provide a web-based guideline service that takes as input clinical data on a particular patient and returns as output a customizable set of recommendations regarding diagnosis and treatment. Information in healthcare is to a very large extent transmitted and stored as unstructured or slightly structured text such as discharge letters, reports, forms, etc. The same applies for facilities containing medical information resources for clinical purposes and research such as text books, articles, guidelines, etc. Physicians are used to obtaining information from text-based sources. Since most guidelines are text-based, it would be practical to use a document-based solution that preserves the original cohesiveness. The lack of structure limits the automatic identification and extraction of the information contained in these resources. For this reason, we have chosen a document-based approach using eXtensible Markup Language (XML) with its schema definition and related technologies. XML empowers the applications for in-context searching. In addition it allows the same content to be represented in different ways. Our XML reference clinical data model for guidelines has been realized with the XML schema definition. The schema is used for structuring new text-based guidelines and updating existing documents. It is also used to establish search strategies on the document base. We hypothesize that enabling the physicians to query the available CPGs easily, and to get access to selected and specific information at the point of care will foster increased use. Based on current evidence we are confident that it will have substantial impact on the care provided, and will improve health outcomes.The purpose of guidelines in clinical practice is to improve the effectiveness and efficiency of clinical care. It is known that nationally or internationally produced guidelines which, in particular, do not involve medical processes at the time of consultation, do not take local factors into account, and have no consistent implementation strategy, have limited impact in changing either the behaviour of physicians, or patterns of care. The literature provides evidence for the effectiveness of computerization of CPGs for increasing compliance and improving patient outcomes. Probably the most effective concepts are knowledge-based functions for decision support or monitoring that are integrated in clinical information systems. This approach is mostly restricted by the effort required for development and maintenance of the information systems and the limited number of implemented medical rules. Most of the guidelines are text-based, and are primarily published in medical journals and posted on the internet. However, internet-published guidelines have little impact on the behaviour of physicians. It can be difficult and time-consuming to browse the internet to find (a) the correct guidelines to an existing diagnosis and (b) and adequate recommendation for a specific clinical problem. Our objective is to provide a web-based guideline service that takes as input clinical data on a particular patient and returns as output a customizable set of recommendations regarding diagnosis and treatment. Information in healthcare is to a very large extent transmitted and stored as unstructured or slightly structured text such as discharge letters, reports, forms, etc. The same applies for facilities containing medical information resources for clinical purposes and research such as text books, articles, guidelines, etc. Physicians are used to obtaining information from text-based sources. Since most guidelines are text-based, it would be practical to use a document-based solution that preserves the original cohesiveness. The lack of structure limits the automatic identification and extraction of the information contained in these resources. For this reason, we have chosen a document-based approach using eXtensible Markup Language (XML) with its schema definition and related technologies. XML empowers the applications for in-context searching. In addition it allows the same content to be represented in different ways. Our XML reference clinical data model for guidelines has been realized with the XML schema definition. The schema is used for structuring new text-based guidelines and updating existing documents. It is also used to establish search strategies on the document base. We hypothesize that enabling the physicians to query the available CPGs easily, and to get access to selected and specific information at the point of care will foster increased use. Based on current evidence we are confident that it will have substantial impact on the care provided, and will improve health outcomes.

DTDs go XML Schema—a tools perspective

Document Type Definitions (DTDs) are widely used to describe the structure of XML documents. The Clinical Document Architecture (CDA) and the Guideline Element Model (GEM) are examples from the healthcare domain. XML schemas provide another way to describe types of XML documents. In this paper we aim to advocate XML schemas from the perspective of an ANSI standard, the XML based CDA from HL7 (ANSI/HL7 CDA R1.0-2000). It turned out that existing tools do not fully exploit the knowledge contained in DTDs and XML schemas. The result of this study is a set of tools (DTD to XML Schema translator, DTD and XML schema browser, XML editor), which can be downloaded from the official W3C site and which work with any DTD and XML schema.Document Type Definitions (DTDs) are widely used to describe the structure of XML documents. The Clinical Document Architecture (CDA) and the Guideline Element Model (GEM) are examples from the healthcare domain. XML schemas provide another way to describe types of XML documents. In this paper we aim to advocate XML schemas from the perspective of an ANSI standard, the XML based CDA from HL7 (ANSI/HL7 CDA R1.0-2000). It turned out that existing tools do not fully exploit the knowledge contained in DTDs and XML schemas. The result of this study is a set of tools (DTD to XML Schema translator, DTD and XML schema browser, XML editor), which can be downloaded from the official W3C site and which work with any DTD and XML schema.

XML-based application interface services—a method to enhance integrability of disease specific systems

Disease specific systems usually offer excellent functionality for the management of the covered diseases. But the restriction to a certain disease often hampers their wide spread use since they are not optimised for clinical workflow. The Giessener Tumordokumentationssystem (GTDS) is a disease specific system that is not only designed for the use in tumour registries but also to support clinical care. In order to integrate it into hospital information systems, we implemented standard communication interfaces. However, interfaces are not satisfactory since they do not consider aspects of the normal workflow of a clinical user. Therefore, we developed a strategy that should ease the access to the system in the environment of existing systems. From the technical point of view, XML with its capabilities to represent even complex data in a rather simple way helped to implement this strategy. We use XML to communicate with API-like services and created a WWW environment to demonstrate the access to these services. Since HTML based access itself is a means to integrate systems, we intend to expand this environment to an appropriate region based means to improve the communication with registries. Another application using the services is the transfer of data between two registries with common patients.

Transparent ICD and DRG Coding Using Information Technology: Linking and Associating Information Sources with the eXtensible Markup Language

With the introduction of ICD-10 as the standard for diagnostics, it becomes necessary to develop an electronic representation of its complete content, inherent semantics, and coding rules. The authors design relates to the current efforts by the CEN/TC 251 to establish a European standard for hierarchical classification systems in health care. The authors have developed an electronic representation of ICD-10 with the eXtensible Markup Language (XML) that facilitates integration into current information systems and coding software, taking different languages and versions into account. In this context, XML provides a complete processing framework of related technologies and standard tools that helps develop interoperable applications. XML provides semantic markup. It allows domain-specific definition of tags and hierarchical document structure. The idea of linking and thus combining information from different sources is a valuable feature of XML. In addition, XML topic maps are used to describe relationships between different sources, or semantically associated parts of these sources. The issue of achieving a standardized medical vocabulary becomes more and more important with the stepwise implementation of diagnostically related groups, for example. The aim of the authors work is to provide a transparent and open infrastructure that can be used to support clinical coding and to develop further software applications. The authors are assuming that a comprehensive representation of the content, structure, inherent semantics, and layout of medical classification systems can be achieved through a document-oriented approach.

Datenschutz in regional verteilten, in Krankenhausinformationssysteme integrierten klinischen Tumorregistern

Im Tumorzentrum Magdeburg/Sachsen-Anhalt e.V. wird gegenwartig erfolgreich ein lokal und regional integriertes Tumorregister realisiert. Im Beitrag werden Notwendigkeit und Moglichkeiten der Integration klinischer Tumorregister in Krankenhausinformationssysteme und andere Strukturen diskutiert. Die Schaffung integrierter Strukturen, insbesondere die Einbindung externer Partner in der Region, stellt hohe Anforderungen an die Gewahrleistung der Datensicherheit. Im Zusammenhang mit den hochsensiblen administrativen und klinischen Daten krebskranker Patienten mus der Datenschutz besonderen Anspruchen genugen. Das Datensicherheits- und Datenschutzkonzept des Magdeburger Tumorregisters und seine Realisierung werden vorgestellt. Der Einsatz hardwaregestutzter Zugriffssteuerungsverfahren sowie integrierter Datenverschlusselung in der externen Kommunikation sowie die weiteren Schritte zur Entwicklung sicherer Informationssysteme im Anwendungsbereich werden beschrieben.