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Gunther Schadow - One of the best experts on this subject based on the ideXlab platform.
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structured product labeling improves detection of drug intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Objectives: This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design: The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements: The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Results: Although <70% of terms were mapped to SPL, the new approach detected four times as many drug-intolerance issues on twice as many patients. Conclusion: The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved.
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structured product labeling improves detection of drug intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Abstract Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Results Although Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved.
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structured product labeling improves detection of drug intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Abstract Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Results Although Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved.
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secure hl7 transactions using internet mail internet draft
Studies in health technology and informatics, 2002Co-Authors: Gunther Schadow, Mark Tucker, Wes RishelAbstract:The document describes the applicability of the Internet standardisation efforts on secure electronic data interchange (EDI) transactions for Health Level-7 (HL7), an EDI standard for Healthcare used world-wide. The document heavily relies on the work in progress by the IETF EDIINT working group. It is in most parts a restatement of the EDIINTs requirements document and application statement 1 (AS#1) tailored to the needs of the HL7 audience. The authors tried to make the document as self consistent as possible. The goal is to give to the reader who is not a security or Internet standards expert enough foundational and detail information to enable him to build communication software that complies to the Internet standards. Even though the authors rely on and promote the respective Internet standards and drafts, they did not withstand from commenting on and criticising the work where they see upcoming problems in use with HL7 or other EDI protocols that have not been in the initial focus of the EDIINT working group. The authors make suggestions to add parameters to the specification of the MIME type for EDI messages in RFC 1767 in order to enhance functionality. The authors give use cases for a larger subset of disposition types and modifiers of message disposition notifications. One key issue where the document goes beyond the current EDIINT drafts is the concept of non-repudiation of commitment to an EDI transaction. Secure EDI transactions should be regarded as "distributed contracts," i.e. not only the sending and receiving of single messages should be non-refutable but also the connection between messages interchanges. In anticipation of this requirement HL7 usually requires a response message to be sent to acknowledge every transaction. The authors therefore have the requirement to securely couple an EDI response message to its request message. Given the current shape of RFC 1767 this is generally possible only if a response message is coupled with an MDN receipt and the combination of both signed by the responder. The document describes a protocol to bundle MDN and response that uses the MIME multi-part/related content type in RFC 2112.
Sooyoung Yoo - One of the best experts on this subject based on the ideXlab platform.
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converting clinical document architecture documents to the common data model for incorporating Health information exchange data in observational Health studies cda to cdm
Journal of Biomedical Informatics, 2020Co-Authors: Seok Kim, Jeong Whun Kim, Hee Hwang, Sooyoung YooAbstract:Abstract Background Utilization of standard Health information exchange (HIE) data is growing due to the high adoption rate and interoperability of electronic Health record (EHR) systems. However, integration of HIE data into an EHR system is not yet fully adopted in clinical research. In addition, data quality should be verified for the secondary use of these data. Thus, the aims of this study were to convert referral documents in a Health Level 7 (HL7) clinical document architecture (CDA) to the common data model (CDM) to facilitate HIE data availability for longitudinal data analysis, and to identify data quality Levels for application in future clinical studies. Methods A total of 21,492 referral CDA documents accumulated for over 10 years in a tertiary general hospital in South Korea were analyzed. To convert CDA documents to the Observational Medical Outcomes Partnership (OMOP) CDM, processes such as CDA parsing, data cleaning, standard vocabulary mapping, CDA-to-CDM mapping, and CDM conversion were performed. The quality of CDM data was then evaluated using the Achilles Heel and visualized with the Achilles tool. Results Mapping five CDA elements (document header, problem, medication, laboratory, and procedure) into an OMOP CDM table resulted in population of 9 CDM tables (person, visit_occurrence, condition_occurrence, drug_exposure, measurement, observation, procedure_occurrence, care_site, and provider). Three CDM tables (drug_era, condition_era, and observation_period) were derived from the converted table. From vocabulary mapping codes in CDA documents according to domain, 98.6% of conditions, 68.8% of drugs, 35.7% of measurements, 100% of observation, and 56.4% of procedures were mapped as standard concepts. The conversion rates of the CDA to the OMOP CDM were 96.3% for conditions, 97.2% for drug exposure, 98.1% for procedure occurrence, 55.1% for measurements, and 100% for observation. Conclusions We examined the possibility of CDM conversion by defining mapping rules for CDA-to-CDM conversion using the referral CDA documents collected from clinics in actual medical practice. Although mapping standard vocabulary for CDM conversion requires further improvement, the conversion could facilitate further research on the usage patterns of medical resources and referral patterns.
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design of a hospice referral system for terminally ill cancer patients using a standards based Health information exchange system
Healthcare Informatics Research, 2018Co-Authors: Kahyun Lim, Jeong Whun Kim, Sooyoung Yoo, Eunyoung Heo, Beodeul KangAbstract:Objectives The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified Health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. Methods Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. Results Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic Health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. Conclusions Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.
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developing a common Health information exchange platform to implement a nationwide Health information network in south korea
Healthcare Informatics Research, 2015Co-Authors: Minho Lee, Eunyoung Heo, Heesook Lim, Jun Young Lee, Sangho Weon, Hoseok Chae, Hee Hwang, Sooyoung YooAbstract:OBJECTIVES We aimed to develop a common Health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea. METHODS By exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements. RESULTS As the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies. CONCLUSIONS We expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.
Kensaku Kawamoto - One of the best experts on this subject based on the ideXlab platform.
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clinical information system services and capabilities desired for scalable standards based service oriented decision support consensus assessment of the Health Level 7 clinical decision support work group
American Medical Informatics Association Annual Symposium, 2012Co-Authors: Kensaku Kawamoto, Peter J Haug, Jason Jacobs, Brandon M Welch, Vojtech Huser, Marilyn D Paterno, Guilherme Del Fiol, David Shields, Howard R Strasberg, Zhijing LiuAbstract:A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service.
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proposal for fulfilling strategic objectives of the u s roadmap for national action on decision support through a service oriented architecture leveraging hl7 services
Journal of the American Medical Informatics Association, 2007Co-Authors: Kensaku Kawamoto, David F LobachAbstract:Despite their demonstrated effectiveness, clinical decision support (CDS) systems are not widely used within the U.S. The Roadmap for National Action on Clinical Decision Support , published in June 2006 by the American Medical Informatics Association, identifies six strategic objectives for achieving widespread adoption of effective CDS capabilities. In this manuscript, we propose a Service-Oriented Architecture (SOA) for CDS that facilitates achievement of these six objectives. Within the proposed framework, CDS capabilities are implemented through the orchestration of independent software services whose interfaces are being standardized by Health Level 7 and the Object Management Group through their joint Healthcare Services Specification Project (HSSP). Core services within this framework include the HSSP Decision Support Service, the HSSP Common Terminology Service, and the HSSP Retrieve, Locate, and Update Service. Our experiences, and those of others, indicate that the proposed SOA approach to CDS could enable the widespread adoption of effective CDS within the U.S. Health care system.
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the clinical document architecture and the continuity of care record a critical analysis
Journal of the American Medical Informatics Association, 2006Co-Authors: Jeffrey M Ferranti, Kensaku Kawamoto, Clayton R Musser, Ed W HammondAbstract:Health care provides many opportunities in which the sharing of data between independent sites is highly desirable. Several standards are required to produce the functional and semantic interoperability necessary to support the exchange of such data: a common reference information model, a common set of data elements, a common terminology, common data structures, and a common transport standard. This paper addresses one component of that set of standards: the ability to create a document that supports the exchange of structured data components. Unfortunately, two different standards development organizations have produced similar standards for that purpose based on different information models: Health Level 7 (HL7)'s Clinical Document Architecture (CDA) and The American Society for Testing and Materials (ASTM International) Continuity of Care Record (CCR). The coexistence of both standards might require mapping from one standard to the other, which could be accompanied by a loss of information and functionality. This paper examines and compares the two standards, emphasizes the strengths and weaknesses of each, and proposes a strategy of harmonization to enhance future progress. While some of the authors are members of HL7 and/or ASTM International, the authors stress that the viewpoints represented in this paper are those of the authors and do not represent the official viewpoints of either HL7 or of ASTM International.
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the clinical document architecture and the continuity of care record a critical analysis
Journal of the American Medical Informatics Association, 2006Co-Authors: Jeffrey M Ferranti, Kensaku Kawamoto, Clayton R Musser, Ed W HammondAbstract:Health care provides many opportunities in which the sharing of data between independent sites is highly desirable. Several standards are required to produce the functional and semantic interoperability necessary to support the exchange of such data: a common reference information model, a common set of data elements, a common terminology, common data structures, and a common transport standard. This paper addresses one component of that set of standards: the ability to create a document that supports the exchange of structured data components. Unfor- tunately, two different standards development organizations have produced similar standards for that purpose based on different information models: Health Level 7 (HL7)'s Clinical Document Architecture (CDA) and The American Society for Testing and Materials (ASTM International) Continuity of Care Record (CCR). The coexistence of both standards might require mapping from one standard to the other, which could be accompanied by a loss of information and functionality. This paper examines and compares the two standards, emphasizes the strengths and weaknesses of each, and proposes a strategy of harmonization to enhance future progress. While some of the authors are members of HL7 and/or ASTM International, the authors stress that the viewpoints represented in this paper are those of the authors and do not represent the official viewpoints of either HL7 or of ASTM International. j J Am Med Inform Assoc. 2006;13:245-252. DOI 10.1197/jamia.M1963.
Hune Cho - One of the best experts on this subject based on the ideXlab platform.
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development of compatible Health Level 7 parser
Journal of the Korea Academia Industrial Cooperation Society, 2014Co-Authors: Hyun Sang Park, Hwa Sun Kim, Hune ChoAbstract:The previous HL7 interface should be developed as a separate package or conversion module for each version to process HL7 messages from different versions. This study designed and developed an HL7 parser compatible among different versions based on the requirements of compatibility defined in HL7 V2.5. According to the structure of the parser, the inheritance concept in object-oriented programming was adopted so that the class object of the HL7 message from the lower version could be inherited to the class object of the upper version. Therefore, every version’s HL7 messages could be processed using only the upper class’ object regardless of the version. To evaluate the compatibility of the developed parser, 700 data sets about inpatients with rheumatoid arthritis were used. The 700 cases underwent the compatibility test successfully. In the near future, further research on the Inter-compatibility HL7 parser is planned.
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Health Level 7 development framework for medication administration.
Computers informatics nursing : CIN, 2009Co-Authors: Hwa Sun Kim, Hune ChoAbstract:We propose the creation of a standard data model for medication administration activities through the development of a clinical document architecture using the Health Level 7 Development Framework process based on an object-oriented analysis and the development method of Health Level 7 Version 3. Medication administration is the most common activity performed by clinical professionals in Healthcare settings. A standardized information model and structured hospital information system are necessary to achieve evidence-based clinical activities. A virtual scenario is used to demonstrate the proposed method of administering medication. We used the Health Level 7 Development Framework and other tools to create the clinical document architecture, which allowed us to illustrate each step of the Health Level 7 Development Framework in the administration of medication. We generated an information model of the medication administration process as one clinical activity. It should become a fundamental conceptual model for understanding international-standard methodology by Healthcare professionals and nursing practitioners with the objective of modeling Healthcare information systems.
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Health Level 7 version 3 based generating clinical document architecture for medication administration system
Journal of Korea Multimedia Society, 2008Co-Authors: Genunhee Kim, Hwa Sun Kim, Sumi Cho, Eunjoo Lee, Hune ChoAbstract:This study proposes the actualization of a standard data model for activities through the development of clinical document architecture for medication administration using the Health Level 7 development frameworks(HDF) process based on object oriented analysis and development method of Health Level 7 V 3. Medication administration is the most common activity performed by clinical professionals at Healthcare settings. A standardized information model and structured hospital information system are necessary to achieve evidence-based clinical activities. We had used HDF and various tools(Rose tree, RMIM designer, V3 generator) to create the clinical document architecture(CDA). This allowed us to illustrate each step of the HDF in the administration of medication. This study generated a information model of the medication administration process, which is one clinical activity. It should become a fundamental conceptual model for understanding international standard methodology by information technology(IT) developers with the objective of modeling Healthcare information systems.
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design and implementation of a nursing records for the nursing process for use within the Health Level 7 clinical document architecture
Journal of Korea Multimedia Society, 2006Co-Authors: Hwa Sun Kim, Eunjoo Lee, Tung Tran, Hyunghoi Kim, Hune ChoAbstract:This study proposes a new paradigm hospital information system through the nursing classification system and design of the HL7 clinical document architecture (Health Level Seven CDA) for information-sharing among various Healthcare institutions. Nursing information CDA are included coding systems of nursing diagnosis, nursing intervention, nursing activity and outcomes. And, we have developed CDA generator for active generation of XML document. This study aims to facilitate the optimum care by providing Health information required for individuals to nursing specialists in real-time, to help improvements in Health, to improve the quality of productive life. This study has the following significance. First, an expansion and redefining process conducted, founded on the HL7 clinical document architecture and reference information model, to apply international standards to Korean contexts. Second, we propose a next-generation web based hospital information system that is based on the clinical document architecture. In conclusion, the study of the clinical document architecture will include an electronic Health record (EHR) and a clinical data repository (CDR), and also make possible Healthcare information-sharing among various Healthcare institutions.
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Clinical Document Repository System for Electronic Health Record
Journal of Korean Society of Medical Informatics, 2005Co-Authors: Il Kwang Kim, Hune Cho, Jae-young Lee, Il Kon Kim, Yun Sik KwakAbstract:OBJECTIVE: The needs of sharing clinical documents in order for Health professionals to provide better diagnosis and treatment have been tremendously increasing. However, when a patient visits the hospital, current hospital information system doesn't allow for physicians to obtain patient's medical history even though she has some records in different hospital, because the lack of the standardization to overcome the incompatibility among heterogeneous systems. CDA(Clinical Document Architecture) of HL7(Health Level 7) is standardized technology in purpose of creating and exchanging various clinical documents. In this article, we discuss the method of exchanging, storing, and utilizing CDA and present the work of development and implementation based on CDR(Clinical Document Repository) framework reported earlier9). METHODS: We convert paper-based discharge summary from each Health institutions into CDA format. And in order to exchange, manage, and utilize those CDA, Registry structure of ebXML is introduced and applied. RESULTS: The relationship among patients, physicians, clinical organizations, and clinical documents is well-organized and modeled. Because transfered CDA document can be easily registered and managed by complying with RIM structure of ebXML, this system can effectively exchange and share patient's CDA document when patient move to other area or among heterogenous systems. CONCLUSION: This system can be utilized to categorize and store various clinical documents such as, ECG and Radiology reading report. In addition, this system suggests the potential of Electronic Health Record system that is able to communicate among heterogenous systems and manage the CDA documents via this CDR system.
Brian E Dixon - One of the best experts on this subject based on the ideXlab platform.
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a service oriented architecture approach to achieve interoperability between immunization information systems in iran
American Medical Informatics Association Annual Symposium, 2014Co-Authors: Masoud Hosseini, Maryam Ahmadi, Brian E DixonAbstract:Clinical decision support (CDS) systems can support vaccine forecasting and immunization reminders; however, immunization decision-making requires data from fragmented, independent systems. Interoperability and accurate data exchange between immunization information systems (IIS) is an essential factor to utilize Immunization CDS systems. Service oriented architecture (SOA) and Health Level 7 (HL7) are dominant standards for web-based exchange of clinical information. We implemented a system based on SOA and HL7 v3 to support immunization CDS in Iran. We evaluated system performance by exchanging 1500 immunization records for roughly 400 infants between two IISs. System turnaround time is less than a minute for synchronous operation calls and the retrieved immunization history of infants were always identical in different systems. CDS generated reports were accordant to immunization guidelines and the calculations for next visit times were accurate. Interoperability is rare or nonexistent between IIS. Since inter-state data exchange is rare in United States, this approach could be a good prototype to achieve interoperability of immunization information.
