There are a number of different standard available for exchanging clinical information between disparate systems. For the OpenHIE Shared Health Record (SHR) we need to choose to support the standard standards that make the most sense for our environment. OpenHIE implementation The chosen standard will be used to help define the format of the message that get exchanged with the SHR via its interface. OpenHIE implementations will focus on middle to low income countries so that we can make the most impact where it counts. Therefore, we have some key criteria that will influence the decision of what standards would be the 'best' standards to support. These are as follows:
- Easily Implementable - The standard should be easy to implement in point of care systems and within the HIE as countries will have to support and maintain these with a lower low number of skilled informatics specialists.
- Size efficient - The messages should be size efficient due to possible bandwidth restricts restrictions in low resource settings.
- Understandable - The standard should be easily understandable and not require informatics professionals to work with the standard or understand the standard.
- Mature tooling - The standard should have some mature tooling to assist application to implement the needed functionality for the standard.
Currently, the community believes that there are a few standards that exist that we should be looking at for use within the SHR, these are:
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Each of these has are described in more details below:
HL7 v2
Overview
HL7v2 HL7 v2 messages are very popular and are commonly used as a message exchange format. This standard has been around for a long time so it has a large number of freely available tools that developers can make use of. It consists of a large number of message types for many different use cases each with their own structure and defined syntax. For technical interoperability HL7v2 employs the MLLP protocol that build upon TCP sockets. HL7 v2 messages can be encoded in either the ER7 (pipes and bars) format or as XML. The XML format allows thes HL7 v2 to be used in more current day web services.
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We could make use of a specific message types that we profile ourselves to so that the use of them well known. For example we could make use of the ORIORU_R01 message type to transmit patient encounters by using the OBX segments within the message.
Pros/Cons
Pros:
- Mature tooling
- Well know known and understood
- Efficient message size
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Unknown. Would we have to restrict and profile HL7v3 message messages for our own use?
Pros/Cons
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Cons
- Very large message size
- Standard need HL& v3 needs extensive work by informatics specialists to be usable for a domain
- Not a large amount of tooling support
- Difficult to understand and use
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Integrating the Healthcare Enterprise (IHE) is an initiative that attempts to improve the way in which health information systems share information. IHE produce technical specifications for health information systems interoperability. Specifications that relate to a particular problem are grouped in an IHE profile. Standardised IHE profiles such as XDS or PIX describe and restrict the use of other standards in order to achieve full system, syntactic and semantic interoperability. IHE profiles are pragmatic as they attempt to make use of existing standard that already have wide adoption so that integration of the IHE profile into existing systems can be simplified. IHE profiles are also very use case specific. This has the benefit of allowing them to clearly specify exactly how semantic interoperability can be achieved, however, it also mean that different IHE profiles are needed for each different use cases. IHE covers many of the priority use cases, however, it is difficult to cover all use cases due to the many different uses of health system information exchange world-wide.
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We could identify certain standards profiles that could achieve the goal that we need goals needed for a SHR (transmitting structured and unstructured clinical information). For example, we could make use of the XDS profile to convey documents and make use of defined CDA document types to ensure semantic interoperability.
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- Standards are tested in the field
- Highly specified transaction and message formats help developers
Cons
- IHE profiles concentrate on specific use cases and are not by definition general use, you have to implement a profile for each use cases you would like to support
- Each profile could make use of a variety of different standards.
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