A fundamental requirement for achieving continuity of care is commonly accepted to be the integration and interoperability of different clinical oriented systems towards the realization of a “longitudinal” Electronic Healthcare Record. To enable seamless integration of various kinds of IT applications into a healthcare network, a commonly accepted framework based on international relevant standards has become an urgent need. However, there is much marketplace confusion today in the healthcare domain, due to the variety of overlapping or complementary interoperability standards and initiatives, which have evolved over the years addressing integration of applications at different levels. This chapter provides a brief overview of the most relevant Electronic Healthcare Record standards, by examining the level of interoperability and functionality they provide, in terms of context, structure, access services, multimedia support, and security, to provide healthcare decision-makers and system integrators with a clear perspective regarding the capabilities and limitations of each standard.
Key Terms in this Chapter
Electronic Health Record (EHR) Standards: Standards are documented agreements containing technical specifications or other precise criteria to be used consistently as rules, guidelines, or definitions of characteristics, to ensure that materials, products, processes and services are fit for their purpose. There are three main organizations that create standards related to EHR- HL7, CEN TC 215 and ASTM E31. HL7, operating in the United States, develops the most widely used healthcare-related electronic data exchange standards in North America, while CEN TC 215, operating in 19 European member states, is the preeminent healthcare information technology standards developing organization in Europe.
E-Health: It is a relatively recent term for healthcare practice which is supported by electronic processes and communication. The term is inconsistently used: some would argue it is interchangeable with health care informatics and a sub set of Health informatics, while others use it in the narrower sense of healthcare practice using the Internet. The term can encompass a range of services that are at the edge of medicine/healthcare and information technology like electronic health records, telemedicine, evidence-based medicine, virtual healthcare teams etc.
Health Level Seven (HL7): It is an all-volunteer, not-for-profit organization involved in development of international healthcare standards. HL7 is also used to refer to some of the specific standards created by the organization (i.e. HL7 v2.x, v3.0, HL7 RIM etc.).
Electronic Health Record: An electronic health record (EHR) refers to an individual patient’s medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. A variety of types of healthcare-related information may be stored and accessed in this way.
Interoperability: Interoperability is the ability of information and communication systems and business processes to support data flow and to enable the exchange of information and knowledge. Interoperability must be secured at the technical (norms and standards for linking computer systems and services), semantic (meaning of data) and process levels (defining business aims, modelling business processes and actualizing cooperation between various management units). Interoperability can be achieved by adopting national and international technical norms.