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HICSS-35 Hawaii International Conference on System Sciences Using the XML-Based Clinical Document Architecture for Exchange of Structured Discharge Summaries.

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Presentation on theme: "HICSS-35 Hawaii International Conference on System Sciences Using the XML-Based Clinical Document Architecture for Exchange of Structured Discharge Summaries."— Presentation transcript:

1 HICSS-35 Hawaii International Conference on System Sciences Using the XML-Based Clinical Document Architecture for Exchange of Structured Discharge Summaries Grace I. Paterson, Michael Shepherd, Xiaoli Wang, Carolyn Watters, and David Zitner DALHOUSIE University

2 HICSS-35 Hawaii International Conference on System Sciences Overview äHealth Level Seven (HL7) and XML äClinical Document Architecture (CDA) äLevels within the CDA äVocabulary Domains äImplementation äClinical/Admin Information Exchange äCurrent Status

3 HICSS-35 Hawaii International Conference on System Sciences Health Level Seven (HL7) äHL7 is an ANSI-accredited Standards Development Organization äDomain is clinical and administrative data äFocus is the interchange of health care data äLevel 7 refers to the highest level, applications, of the communications model for Open Systems Interconnection

4 HICSS-35 Hawaii International Conference on System Sciences HL7 Mission Functional Interoperability Semantic Interoperability

5 HICSS-35 Hawaii International Conference on System Sciences HL7 and SGML/XML äInitial release of HL7 Version 3 slated for December 2001 will use only XML encoding äTwo groups in HL7 SGML/XML äXML as an alternative syntax for messages äStructured Documents Technical Committee äAn architecture for structured documents defines relationships between documents and document specifications in terms of specialization and inheritance – a Clinical Document Architecture

6 HICSS-35 Hawaii International Conference on System Sciences Clinical Document Architecture (CDA) äKona Proposal drafted in 1996 (Kona Mansion) äClinical Document Architecture (CDA) is a specification for exchanging clinical documents using eXtensible Markup Language (XML) äLeverages the use of XML, the HL7 Reference Information Model and coded vocabularies to specify the structure and semantics äMachine and Human-readable documents äApproved as an ANSI standard November 2000

7 HICSS-35 Hawaii International Conference on System Sciences A CDA Document âA CDA document is a defined and complete information object âCan exist outside of a messaging context and/or can be a payload within an HL7 message

8 HICSS-35 Hawaii International Conference on System Sciences Clinical Documents in QEII âCurrently each page of paper chart reviewed to produce Discharge Summary and Abstract âDemographic information âLength of Stay âDiagnoses and Procedures âMost of this information is produced by clinicians âHuge potential cost savings if the summary could be captured concurrent with care and used for discharge communication

9 HICSS-35 Hawaii International Conference on System Sciences Discharge Summary –Hospital Communication to Family Doctor âQEII Department of Medicine Structured Discharge Summary äHeader Information (Participants and Roles – Patient, Sender, Recipient) äMost Responsible Diagnosis äComorbidities/Cardiac Risk Factors äCourse in Hospital and Conclusions äPertinent Investigations/Lab Results äFurther steps and scheduling

10 HICSS-35 Hawaii International Conference on System Sciences Referral Communications âFrom Family Physician to Hospital âPatient Information âReason for referral âSymptoms and Duration âInvestigations and Results âDiagnosis and Treatment âPrescribed Medications

11 HICSS-35 Hawaii International Conference on System Sciences Features of DoctorPortal âAdding a discharge or referral âFinding a discharge or referral âEditing a discharge or referral âQuerying a discharge or referral âListing all discharges and referrals assigned to a given doctor

12 HICSS-35 Hawaii International Conference on System Sciences

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15 Query the Database

16 HICSS-35 Hawaii International Conference on System Sciences Levels within the CDA âLevel One is the root âMost general specification (low-hanging fruit) âDefined and complete information object – web implementation of paper documents to start âRIM classes are used in the CDA Header âTerms from controlled vocabularies in body âLevel Two will be a specialization of Level One âLevel Three: Clinical content can be marked up to the extent that it is modeled in the HL7 RIM

17 HICSS-35 Hawaii International Conference on System Sciences Level One CDA Document âComposed of CDA Header and CDA Body âPurpose of the CDA Header is to enable clinical document exchange across and within institutions âCoded entries uses HL7 Version 3 Data Types

18 HICSS-35 Hawaii International Conference on System Sciences HL7 Version 3 Data Types âXML Element Names map to Data Types â_cd vocabulary domain has coding strength ãCNE coded, no extensions ãCWE coded, with extensions (allows local codes) ãMake use of published authoritative sources of code values â_tmr document time stamp â _id identifier â_nbr number âVocabulary domains may be HL7-defined concepts or recognized coding schemes such as SNOMED, READ, ICD10, Medcin

19 HICSS-35 Hawaii International Conference on System Sciences Captions, Coded Captions, and Registered Vocabularies Most Responsible Diagnosis Unstable Angina Y

20 HICSS-35 Hawaii International Conference on System Sciences Level One Document Instance … …

21 HICSS-35 Hawaii International Conference on System Sciences Level One: CDA Header 1. Document information includes,,,,, 2. Encounter data describe the setting in which the documented encounter occurred and includes,,,,. 3. Provider includes the persons who participated in the services being documented 4. Patient includes the patient and other significant participants (such as family members)

22 HICSS-35 Hawaii International Conference on System Sciences Level One: CDA Body äNested containers in Level One body: sections, paragraphs, list and tables. äMinimal amount of markup and minimal constraint for this markup

23 HICSS-35 Hawaii International Conference on System Sciences Doctor Portal Implementation äThe portal has three features: 1. Ability to add, edit, find, and query discharge summaries 2. Ability to add, edit, find, and query referral forms 3. Ability to list all discharges and referrals assigned to a specific doctor äJavascript and HTML implement the interface and interact with the user as information is entered into the form

24 HICSS-35 Hawaii International Conference on System Sciences HTML JAVA Servlet SAX Parser XML DB API dbXML Database Validates XML Handles requests & responses Performs dbXML Operations Web interface

25 HICSS-35 Hawaii International Conference on System Sciences Database Platform âdbXML is an open source Native XML Database âstores and indexes compressed XML documents in order to provide that data to a client application with very little server-side processing overhead âprovides functionality that is unique to XML data, which can't easily be reproduced by relational databases âhttp://www.dbxml.org/ for Users Manualhttp://www.dbxml.org/

26 HICSS-35 Hawaii International Conference on System Sciences Clinical/Administration Information Exchange âCDA is sufficient backbone for communication between Information Systems in Physician Offices and Hospital âCanadian hospitals abstract each patient record for Canadian Institute for Health Information âInformation should support clinical, administration, education and research

27 HICSS-35 Hawaii International Conference on System Sciences Current Status âWorking demonstration system âPlanned implementations for 2002 âHealthInfoRx™: Lifelong Learning for Chronic Disease Patients ãCDA will be used for physician to physician referral/discharge communications for patients in Inflammatory Bowel Disease Clinic (Level Two) âConcurrent Review Document ãData collection January 2002 using XML system ãTest of implementation in a District (Level Three)

28 HICSS-35 Hawaii International Conference on System Sciences Thank You Questions? Further Information:

29 HICSS-35 Hawaii International Conference on System Sciences Acknowledgements âDr. Michael Shepherd, Computer Science, Dalhousie âDr. Carolyn Watters, Computer Science, Dalhousie âDr. David Zitner, Director, Medical Informatics, Dalhousie âDr. John Ginn, Medical Informatics, Dalhousie âKathy MacNeil, Director, Patient Information Services, QEII Health Sciences Centre âPatient Care Record Committee, Capital Health District Authority âMary Eileen Wall, Clinical Informatics Coordinator, QEII Health Sciences Centre âSandra Cascadden, Director of IT Services, QEII Health Sciences Centre âDr. Elizabeth Cowden, Head, Department of Medicine, QEII âRon Soper, Computer Science CO-OP Student


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