JSON-LD as an Interchange Technology to Facilitate Health Information Exchange

JSON-LD as an Interchange Technology to Facilitate Health Information Exchange

Daniel L. Kaukinen
DOI: 10.4018/IJEACH.2019010107
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Sharing information between medical records to form a comprehensive electronic health record leads to effective health management. However, full implementation of an electronic health record has met various barriers including companies wanting to protect their proprietary data storage formats and resisting conversion to a common data exchange format. Through the development of prototype systems, this article investigates the use of JSON-LD as an interpreter to aid in data interchange and data encapsulation. The prototypes demonstrate that JSON-LD can be applied, with nominal code changes, to an existing electronic medical record system employing JSON as a serialization protocol. This article concludes that JSON-LD works as an efficient wrapper that, when well designed, allows for simplified and robust consumption from and serving of data to other JSON-LD enabled medical systems, thereby elevating the usability and effective interconnectivity of new and existing electronic medical record systems.
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The Emergence of the Electronic Medical Record

Historically the medical history of a patient was stored as a paper-based document at the site of the medical appointment. A paper-based system was used as that was the availability of the technology, it was easy to use, and it was the approach most widely implemented (Bates, Ebell, Gotlieb, Zapp, & Mullins, 2003). These paper records, though easy to use, had their own disadvantages: the documents were not easily accessible from other sites, the information was often illegible, and they could only be used by a single person at a time (Bates, Ebell, Gotlieb, Zapp, & Mullins, 2003). Therefore, when the patient received any medical attention at any other site, their record was disconnected and incomplete, unless the required document was transferred to the patient’s primary medical practitioner’s location either through courier, mail or fax.

Today most medical institutions now employ an electronic format for storing a patient’s information. This document, specific to the medical institution providing the care, is referred to as an electronic medical record (EMR). The EMR records the patient’s demographics, medical and drug history, and results from various test sources. When regarding health information technology (HIT) the EMR is recognized as a valuable tool for improving the quality, safety and the efficiency in health care systems (Jha, Doolan, Grandt, Scott, & Bates, 2008).

However, as was the case with the paper-based solution, the electronic medical story of the patient is spread among many different institutions where they may receive care: emergency rooms, specialized medical facilities such as cancer clinics, specialist practitioners such as rheumatologists, etc. When consolidating all the medical information for a single patient an electronic health record (EHR) emerges that contains a more complete story of the patient as they interact with the medical system.

Patents for EMR systems were starting to be registered in the early 1990’s (Evans, 1999) (Myers & Culp, 1998) showing that they were being investigated seriously as a replacement for the paper-based solutions. Since their inception, the uptake of the EMR has been ever increasing. EMR adoption from early 2000 to 2010 saw an increase from 16% to 52% (Kokkonen et al., 2013). With the American government providing incentives and enacting legislation, the saturation of the EMR has increased further. After the introduction of the Health Information Technology for Economic and Clinical Health (HITECH) Act, EMR adoption in non-federal hospitals, in emergency departments and by hospital-based physicians has improved to between 78% and 94% (Mennemeyer, Menachemi, Rahurkar & Ford, 2016).

With this increasing use of the EMR there are many vendors that are developing their own variation of an EMR system. Each vendor has chosen to implement their system so that it provides the information in the way that they believe their client would want it displayed, managed, and interacted with. Underneath the operations of the system, all the information that is entered into the system is stored in some proprietary format.

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