Current initiatives worldwide are aiming to deliver a healthcare system where care integrity is improved and at the same time the risks of adverse events are reduced, both through seamless information interchange between systems and care providers. Achieving this goal of a joined-up care information system has certain crucial pre-requisites: key building blocks (standards) must be agreed and mandated. Once the standards infrastructure has been set out, the private sector will rapidly build compliant systems that incorporate those standards. Over 20 years ago this is exactly how the New Zealand National Health Infrastructure was set in place (1).
The real challenge, then, is to determine precisely which standards are essential to create the coherent infrastructure and framework. The crucial elements for exchange of recorded information are four:
- Data Definitions - systems must be configured to collect data which is consistent, and where the definitions of the data elements are agreed upon then all the data collected is semantically consistent;
- Data Classifications - it is essential that there is consistency relating to the ways in which the clinical details are recorded, and the ways in which clinical, administrative and procedural entities are sub-divided, classified and described;
- Data Sets - it is important that the same groupings of data elements are gathered in respect of each and every patient with similar clinical conditions so that data can be aggregated for research, and can be linked with knowledgebases and intelligent engines to support clinical decisions. Of course the specific sets of data recorded in different clinical and administrative situations will differ depending upon what is required to fulfil the purpose of the data collection. These data sets will populate the messages passed between systems and providers;
- Data import/export Standards - all systems must incorporate one of a range of standard data import/export interfaces so that data required for messages and reports/aggregations can be easily configured at minimum cost.
As far as the actual technology of data interchange is concerned, how the rest of the system is structured and functions makes little difference: use of a structured messaging environment such as HL7, together with an appropriate interface engine where required, can ensure that meaningful messages can readily be passed between systems as long as the requisite data has been recorded.
However from the point of view of technical system operations, flexibility and future-proofing, it is self-evident that the use of proprietary data structures and technologies may create serious obstacles in terms of system maintenance and development. It is important to specify how the modules of the overall system are interfaced together, so that modules can be revised, removed and replaced with alternates conforming to the same interface specification. And it is always important to identify where specific proprietary technologies have been adopted, in order to ensure that their potentially restrictive impact (in terms of being legally strictly under the control of the copyright holder) is negated by contractual agreement.
1: Neame, R.L.B. and J. Johnston (1994) Developing a National Health Information Network: insights from experiences in New Zealand. Proceedings of HC94 (March 1994), Harrogate, 503-509; and International Journal of Bio-Medical Computing, Volume 40, Issue 2 , Pages 95-100 , October 1995 http://www.journals.elsevierhealth.com/periodicals/ijbold/article/0020-7101(95)01131-W/abstract
Students at www.health-informatics.co will cover ‘standards’ topics throughout the Certificate and Diploma in Health Informatics programs – in particular HI203-10 “Standards in Health Information Management Systems” provides a review of the role and importance of standardisation, and of the crucial importance of selection and implementation of appropriate standards in a technology initiative.