Session Chairs: Dr. med. Kai Heitmann, HL7 Germany, Prof. D. Koutsouris, HL7-Hellas

Welcome address, HL7-Hellas:
Catherine Chronaki, FORTH-ICS, IHIC2008 Program Committee Chair

Welcome Address HL7-Hellas:
George Patoulis, Chair of HL7-Hellas, Mayor of Amaroussion, President of the Intermunicipality Health Network

Welcome Address HL7 International:
Dr. Charles Jaffe, PhD, HL7 CEO

Health Information Technology Architecture vs. Semantic Interoperability
John Quinn, HL7 CTO

Traditional HIT vendor approaches to applications architecture create a barrier to semantic interoperability, efficient information management and managed “best-of-breed” user application architectures. SOA and modern “context rich” integration standards offer an opportunity to overcome this situation. There is now a unique opportunity for solution buyers and vendors to both greatly improve both the computer assisted clinical and administrative solutions that they offer their users by applying both SOA principals to their product designs while at the same time adopting new approaches to integration that HL7 V3 and especially its related CDA Standards offer.

Keynote Speech
Friday October 10, 2008
Conference Room: HERMES

Session Chair: Niels Rossing, MedCom International, Denmark.

The Electronic Health Record - the Gold at the End of the Rainbow,
W. Edward Hammond, PhD Professor Emeritus, Duke University, Chairman HL7 Board of Directors

The Electronic Health Record (EHR) has become the focus of Health Information Technology (HIT). Its content and architecture is shaped by its sites of care, specialty groups, the variety of stakeholders, multiple uses of data, and purpose. The EHR, and its derivatives, must serve the providers of care and their institutional requirements; it must serve the population at large in public health functions, including health and biosurveillance; and it must serve the consumer – an application that might become the “killer app” of HIT. The required functionality is driven by demands for high quality care that is delivered in the most economic way possible. That care must be safe and efficient. The use of knowledge must be built into EHRs to make sure these benefits are realized. Future directions of HIT must include the use of genetic information with clinical data to provide personal health plans that enable preemptive and preventive care. Finally, the EHR must satisfy requirements of security and privacy demanded by the population. Such an EHR system requires the application of a full set of standards that begins with the data elements, data types and data structures; data models and information flow models; structured documents; data interchange; EHR architecture; EHR functionality; knowledge representation and decision support; geographical expression standards; data query; and standards for rule-based data sharing.

Plenary Session I: EHRs, PHRs, and their integration based on HL7 Standards

Friday October 10, 2008, 09:30 - 11:00
Conference Room: HERMES

Session Chairs: Thomas Norgall, Chair HL7 Germany – Pantelis Angelidis, Secretary HL7-Hellas BoD

Healthcare 2015 and Personal Health Records: A Standards Framework
Jill Kaufman, Jim Adams, Richard Bakalar and Edgar Mounib,IBM Healthcare and Life Sciences,US

A High Interoperable Healthcare System Using HL7 Adaptor Technology
Chih-Hung Chen, C.Y. Wang, T.J. Huang and T.Y. Lai
Information & Communications Research Laboratories, Industrial Technology Research Institute, Chutung, Hsinchu, Taiwan

The consumer oriented healthcare system has been developed and remotely managed by homecare clinicians in the community. In order to support the tele-monitoring of individuals’ vital signs, information standards including HL7, CDA R2, FDA Annotated ECG, and IEEE 11073, are adopted to promote system interoperability. A CDA template has been defined and discussed in this paper to reflect the practical needs. An HL7 adapter is designed to manage the differences among systems and between standards. The functional components and infrastructure of the HL7 adapter are introduced. Problems encountered during system development and possible solutions are discussed. In conclusion, we found that adaptation of information standards improves healthcare system development.

Interoperable Clinical Information Sharing System based on CDA and Document Registry Framework
H. Kim¹, Byoung-Kee Yi¹, I. Kim¹, K. Ha², Y-S Kwak¹.
¹Kyungpook National University, Daegu, Korea
²Seoul National University Bundang Hospital, Gyeonggi, Korea

Clinical information sharing among healthcare providers is in early stage in Korea. With the governmental support, we developed an interoperable clinical information sharing system, of which overall design and implementation are reported in this paper. For maximum interoperability, it complies with most of the key standards such as HL7 messages, CDA, and DRF (hence, IHE XDS.b). To evaluate the effectiveness of the system, a pilot program is currently under way within a group of healthcare providers. We expect that the system will see nation-wide deployments in both public and private healthcare sectors after being stabilized and enhanced during the program.

The need for integration of genomic information in a future EHR: An ACGT case study,
Anca Bucur¹, A. Persidis², D. Kafetzopoulos³, M. Tsiknakis⁴, V. Danilatou³, L. Koumakis<sup>4

1</sup>Philips Research Europe Eindhoven, the Netherlands,
²BioVista SA Athens, Greece,
³FORTH, Institute of Molecular Biology Heraklion, Greece,
⁴FORTH, Institute of Computer Science Heraklion, Greece

Plenary Session II:
Electronic Health Records: From Strategy to implementation,
Sharing experiences on regional, trans-regional, or national implementations
Friday October 10, 2008, 11:30 - 13:00
Conference Room: HERMES

Session Chairs: Stephen Chu, Vice Chair HL7 New Zealand – M. Skiadas, HL7-Hellas BoD

Development of a database with a standardized XML structure for data exchange of Object Identifier (OID) in the healthcare system, Sylvia Thun¹, A.² and K. U. Heitmann<sup>3

1</sup>German Institute of Medical Documentation and Information, Cologne, Germany,
²gematik Gesellschaft für Telematikanwendungen der Gesundheitskarte mbH, Berlin, Germany,
³Heitmann Consulting and Services, Germany/The Netherlands

OID (Object Identifier) are identifiers for objects standardised worldwide by ISO/IEC 9834/1. This identification system for objects and concepts ensures electronic information exchange. Administration and Registration is regulated by a set of rules. HL7 Germany designed a database and an exchange format for these and further requirements and is handling the registration.

The Use of HL7 CDA in the National Health Information System (NHIS) of Turkey
Y. Kabac¹, Asuman Dogac^1,2, İ. Köse³, N. Akpinar³, M. Güre^l3, Y. Arslan³, H. Özer³, N. Yurt³, A. ÖzÇam³, S. Kirici³, M. Yükse^l2 and E. Sabur³

1Software Research, Development and Consultancy Ltd., METU-KOSGEB Tekmer, Ankara, 06531, Turkey,
2Dept. of Computer Engineering, Middle East Technical University, İnönü Bulvari, Ankara, 06531, Turkey,
3Dept. of Information Processing, Ministry of Health, Ankara, 06434, Turkey

Turkey’s National Health Information System (NHIS) aims to provide a nation-wide infrastructure for sharing the Electronic Health Records (EHRs). The current implementation supports the transfer of EHRs, called the “Transmission Schema” instances from the Family Medicine Information Systems (FMIS) and the Hospital Information Systems (HIS) to the NHIS servers at the Ministry of Health (MoH). During the localization of the “Transmission Schemas”, the rules which are set in the “HL7 Refinement, Constraint and Localization” are applied. In other words, the CDA RMIM is edited and then converted to HMD and XSD, respectively. Hence, the “Transmission Schemas” are HL7 CDA compliant and are based on the national Minimum Health Data Sets (MHDS). The MHDSs use the data elements from the National Health Data Dictionary (NHDD). The data elements are coded with coding systems which are available from the Health Coding Reference Server (HCRS). “Doctor Data Bank (DDB)” provides healthcare professional identity and specialization. HL7 Web service Profile is used for the transportation of “Transmission Schema” instances. In this paper, we explain the differences between the “Transmission Schemas” and the HL7 CDA R2 conformant EHRs and describe the “Adaptor” that is being developed to convert the “Transmission Schema” instances to the HL7 CDA R2 conformant EHRs. It turns out that this process is straight forward in one direction, which is, converting the “Transmission Schema” instances to the HL7 CDA R2 conformant EHRs. The transformation in the reverse direction requires keeping various mapping tables giving the correspondences between elements.

CDA Implementation Approach for the pan-Canadian EHR
P. Loyd and Louise Brown, Gordon Point Informatics, Victoria, Canada

The Clinical Document Architecture (CDA) approach being used for the pan-Canadian Electronic Health Record (EHR) specifications represent a departure from standards activities currently being contemplated in the United States and other countries. Many countries implementing the CDA, are doing so in a predominantly document centric and distributed storage approach with limited access to central indexing capabilities. In Canada, discrete data will be captured using individual message interactions. Encapsulating messages (i.e. using CDA) such as Clinical Observation Documents, Referrals and Care Summaries will provide rendered views of data and will provide links to discrete data captured elsewhere but will not embed discrete data themselves except for indexing and search capabilities.

Germany’s Sustainable Service-Interoperable EHR Solution Based on International Standards
Bernd G.M.E. Blobel, Head, eHealth Competence Center, University of Regensburg Medical Center, Germany

Based on an EHR reference model, existing and emerging standards as well as most advanced national EHR approaches have been comparatively analyzed for deriving a German national EHR solution.

Keynote Speech
Friday October 10, 2008
Conference Room: HERMES

Session Chair: Zoi Kolitsi, Ministry of Health and Social Solidarity, Hellas

Towards Large Scale Deployment: Wishes and Reality
Ilias Iakovidis, PhD, EU, ICT for Health

There are thousands of eHealth solutions deployed in Europe and beyond on a small scale but only few large scale - regional and national- deployments of scalable and interoperable eHealth solutions such as EHR, e-prescription, telemedicine services (e.g. remote monitoring). The challenges towards large scale deployment have been studied extensively and are subject to many publications including the EU eHealth Action Plan - EC Communication (2004) 356 final. This presentation will include snapshot of the eHealth deployment in Europe identifying the strengths, weaknesses and potential for growth. It will highlight some critical issues for large scale deployment, and Commission actions on these issues, such as

• Development and Implementation of interoperability standards and approaches including the possible roles and challenges in this area for different healthcare jurisdictional levels (local, municipality or regional and national)
• Creating body of evidence of benefits of eHealth, all the way to impact on health outcomes and cost-efficiency, that will leave no room for hesitation to health authorities, policy makers and professionals
• Financing and procuring of large scale interoperable solutions and need for effective and transparent public private partnerships.

Parallel Session IIIa: Achieving interoperability with standards, terminologies, and coding systems
Friday October 10, 2008, 14:30 - 16:00
Conference Room: HERMES

Session Chairs: Morten Bruun-Rasmussen, MEDIQ Denmark, Massimo Mangia, Chair HL7 Italy

Testing the Conformance and Interoperability of NHIS to Turkey’s HL7 Profile, T. Namli¹, G. Aluc², A. A. Sinaci², İ. Köse³, N. Akpinar³, M. Gürel³, Y. Arslan³, H. Özer³, N. Yurt³, S. Kirici³, E. Sabur³, A. Özçam³ and Asuman Dogac²

1Software Research, Development and Consultancy Ltd., METU-KOSGEB Tekmer, Ankara, 06531, Turkey
2Dept. of Computer Engineering, Middle East Technical University, İnönü Bulvari, Ankara, 06531, Turkey
3Dept. of Information Processing, Ministry of Health, Ankara, 06434, Turkey

Turkey’s National Health Information System (NHIS) aims to provide a nation-wide infrastructure for sharing Electronic Health Records (EHRs). In order to guarantee the interoperability, the Ministry of Health (MoH), Turkey developed an Implementation/ Integration/ Interoperability Profile based on HL7 standards. The current implementation supports the transfer of Minimum Health Data Sets, called the “Transmission Schemas”, from the Family Medicine Information Systems (FMIS) and the Hospital Information Systems (HIS) to the NHIS servers at the MoH premises. The “Transmission Schemas” are HL7 CDA R2 compliant EHRs. In this paper, we describe how the conformance and interoperability tests of NHIS are performed. For this purpose we use a generic testing tool, namely, TestBATN, and configure it to test the conformance of applications to Turkey’s HL7 CDA R2 Profile and their interoperability.

A Generic Concept Model for Scoring Systems and Diagnostic Assessment facilitating HL7 Version 2.x and 3
Frank Oemig1 and S. Thun2

1Project Manager, Communication Standards, Agfa HealthCare, Germany
2German Institute of Medical Documentation and Information, Cologne, Germany

Scoring Systems and Diagnostic Assessments are essential for therapeutic procedures and documentation of health problems in medicine. Therefore, data is captured from different systems and this data exchange has to be standardized. HL7 Germany with the collaboration of scientific experts created a generic model which can be mapped to HL7 Version 2.x and 3 with the option to use coding systems like LOINC, Snomed CT, ICF or ICD-10-GM.

Semantics of Integrated BioMedical Database Project - A Japanese National Project
Jun Nakaya1, S. Sakota2, R. Mizoguchi2, K. Kozaki2, K. Hiro1, K. Ido1, M. Kimura3 and H. Tanaka1

1Project Leader of ISO TC215 GSVML, Tokyo Medical and Dental University, Japan
2Osaka University, School of Medicine, Japan
3Hamamatsu University, School of Medicine, Japan

To utilize dispersed information effectively in Omics medicine that stands on a massive amount of Clinical Omics information, the first hurdle to overcome is to establish a social IT infrastructure that has Electronic Health Record (EHR) and integrated biomedical database with standardized technologies derived from HL7/CEN/ISO. In preparation for Omics Medicine, Japan started the Integrated biomedical database project as a National project of Japan on 2007. This project tries to establish semantic integration, semantic navigation, and semantic interoperability with the Clinical Omics ontology which integrates clinical ontology and omics ontology. This paper introduces the project, its semantic bases, and the status of it.

Privacy in the German Health Telematic Infrastructure, Herbert Bunz and Manuel Koch, gematik, Germany

The responsibility to introduce, maintain and develop the electronic health card along with a health Telematic- Infrastructure for patient centric health care applications in Germany is assigned to the gematik, founded by the National organizations of the health system in Germany. European and national privacy und security regulations must be strictly fulfilled to make the electronic health card acceptable for patients as well as health care professionals. We present the privacy and security principles in the Telematic-Infrastructure and describe the privacy enhancing technologies indispensable for the exchange of patient data using the Telematic-Infrastructure.

Discussion

Parallel Session IIIb: Electronic Health Records and Decision Support
Friday October 10, 2008, 14:30 - 16:00
Conference Room: KALIA

Session Chairs: Jill Kaufmann, HL7 International BoD – Alexander Berler, HL7-Hellas BoD

LuMIR: A Region-wide Virtual Longitudinal EHR
M. Contenti, G. Mercurio, F. L. Ricci and Luca D. Serbanati
Institute of Biomedical Technologies, National Research Council, Rome, 00162 Italy

In 2006, the Italian government launched the General Practitioners’ Network Pilot Program (RMMG), in the 9 autonomous regions in south-central Italy. An interregional harmonization workgroup ensures the coordination of efforts and the inter-regional interoperability of platforms issuing jointly agreed implementation guidelines. The LuMiR – Lucania Medici in Rete – project is an enactment of the RMMG Program in the Basilicata Region. It is carried out by the Institute of Biomedical Technologies of the Italian National Council of Research, and involves all the public healthcare organizations operating in the Region. Core activities of the project are the analysis, design and implementation of a software platform which integrates local medical applications and other legacy systems in a SOA architecture. The platform is centred on a Virtual Healthcare Record (VHR) that gathers, integrates, records and retrieves clinical data of all significant medical events occurred throughout the citizens’ life.

Supporting Continuity of Care with a Virtual Electronic Health Record, B. M Marculescu, Andrei Vasilateanu, C. Belet, D. Balasoiu and D. Zamfira,
“Politehnica” University, Bucharest, Romania

The paper presents MedInRe (Medici in Retea, i.e. Networked Physicians), an ongoing project of a distributed system aimed to support the continuity of care concept in the Romanian National Health System.

An Integrated and Interoperable Platform of Services for the Management of Heart Failure

Sergio Di Bona¹, D. Guerri1, M. Lettere¹, R. Fontanelli¹, Franco Chiarugi², A. Marsh3 and O. Salvetti⁴

1Synapsis S.r.l., P.zza Dante 19/20, 57121 Livorno, Italy
2FORTH-Institute of Computer Science, Heraklion, Crete, Greece
3VMWS Ltd, 9 Northlands Road Hampshire SO51 5RU, UK
4ISTI-CNR, Via G. Moruzzi 1, 56124 Pisa, Italy

This paper describes the implementation of a web-based platform of services, designed and developed in the context of the HEARTFAID project with the goal to improve and to make more effective the processes of diagnosis, prognosis, treatment and personalization of heart failure care in elderly patients. The platform is based on a multi-functional middleware that adopts the most common standards for data encoding and communication, as well as the standard solutions actually available to support the interoperability among heterogeneous systems, such as IHE profiles, HL7 messaging, Service Oriented Architectures and Enterprise Service Bus. The main focus of this paper is on the description of the challenges and the solutions adopted for the implementation of a suitable Middleware; however, for a better comprehension the implemented solutions are selected and shown in the context of the overall platform of services for the management of heart failure.

Design and Implementation of Encapsulated HL7 v3 Standard EHR with Video Conferencing Trigger for Physiological Monitoring Systems
T.-L. Tsai, Johnny Hsu, H.-C. Lin and S-C Lin,

Industrial Network Access Technology Department, Home Network Technology Center, Home Infotainment, Technology Research Institute, Taiwan

Encapsulated HL7 v3 standard EHR with video conferencing trigger for physiological monitoring systems, was designed and implemented. According to the six backbones of the RIM in HL7, the procedure of handling emergent accident at home is also designed in our system. If a patient accident occurs, telemedicine data center would be informed according to the monitored physiological data and further enable mobile video conferencing function to promote and aid telemedicine emergent care where the mobile videoconferencing system is built based on VideoLan Video Conference (VLVC) network architecture. According to presence information by VLVC, patients can download the generated presence information of physicians from the presence server and determine a suitable “on-line physician to process telemedicine videoconferencing where the physician information also can be sorted by hospital name. Besides benefiting to healthcare organizations, the system may as well provide assistance to students who major in medical informatics for tele-education in the future.

Building a Reference Implementation of the Canadian EHRS Blueprint: Lessons Learned,
Derek Ritz1, R. Parker2 and M. Fuller3

1ecGroup Inc, Canada
2Canada Health Infoway, Canada
3Canadian Institute for Health Information, Canada

In May, 2008 a prototype of the pan-Canadian EHRS was demonstrated in the Interoperability Showcase at Canada’s eHealth 2008 Conference. This paper describes lessons learned by the partners from their experiences building and demonstrating a working version of an SOAbased EHR system constructed according to Canada Health Infoway’s EHRS Blueprint and based on the HL7v3 messaging standards.

Discussion

Plenary Session IV: Electronic Health Records, Best Practices, Lessons learned & Challenges for the Future

Friday October 10, 2008, 16:30 - 18:00
Conference Room: HERMES

Session Chairs: Liora Alschuler, HL7 International BoD - Catherine Chronaki, HL7-Hellas BoD

A Method for Applying Graphical Templates to HL7 CDA
Rik Smithies Chair HL7 UK, NProgram Ltd, UK

The English National Programme for IT (NPfIT) is being delivered by NHS Connecting for Health (NHS CFH). Initial NPfIT work built upon earlier local HL7 V3 specifications and concentrated on constraining and refining the RIM in a bottom up approach. Models were built from RIM components assembled into messages and CMETs (Common Message Element Types). These artifacts were created with the HL7 modeling tools based on Microsoft Visio. CMETs were reused across message domains and message definitions were constructed by piecing CMETs together. This approach was successful, with several live systems in operation and many millions of messages having been sent.

Creating CDA R2 Laboratory Reports to Meet Public Health Surveillance Requirements
Sondra R. Renly1, S. E. Knoop1 , J. H. Kaufman1, and R. Ram2

1IBM Almaden Research Center, USA
2IBM Haifa Research Lab, University of Haifa, Mount Carmel, Haifa, Israel

In the absence of world-wide public health standards-based networks, the ability to internationally monitor and quickly respond to cross-border outbreaks is often relegated to media correspondents and website technologies. HL7 Clinical Document Architecture Release 2 (CDA R2) provides unique benefits to resource poor agencies compared with laboratory messaging. With guidance from the public health community, today’s technology can transform international public health surveillance methods into reliable electronic networks. IBM Research successfully incorporated public health laboratory reporting requirements into the Integrating the Healthcare Enterprise (IHE) Cross Enterprise Document Sharing Laboratory Report (XD-Lab) profile for a research surveillance prototype being developed with input from participants in the Middle East Consortium for Infectious Disease Surveillance (MECIDS).

Squeezing Quality Data out of EHRs: developments in the USA
Sheila Teasdale, American Medical Association, Clinical Performance Evaluation, USA

The work of the Physician Consortium for Performance Improvement in developing and specifying performance measures will be outlined followed by a description of the creation of the Collaborative for Performance Measure Integration with EHRs, and the progress that has been made over the last two years. The work of a number of expert users of EHRs in obtaining and utilizing quality data will be discussed, together with the challenges they have faced and resolved. The Collaborative’s plans for future work with national standards organizations will be outlined, including the alignment with the Quality Reporting Document Architecture (QRDA), the HL7 Clinical Interoperability Council, and the Agency for Healthcare Research and Quality initiative ‘The Quality Supply Chain’. All these bodies are increasingly working together so that we can realize the purpose of implementing performance measures into EHRs: the improvement of the quality of health care.

HL7 and Spatial Interoperability Standards for Public Health and Healthcare Delivery
W. Davenhall, A. Bossard and D. Sheres, ESRI Health and Human Services, USA

HL7 in decision support, especially in healthcare delivery and emergency public health response, has gained incredible importance. Recent events such as the unintentional spread of SARS, the devastation of Hurricane Katrina and the Indian Ocean Tsunami, the global threat of avian influenza have increased the awareness that data interoperability is a major problem. Many public health authorities are now developing sophisticated information systems that will monitor and surveil the health of an entire nation’s people, animals, and food supplies. All too often many of these systems are relying on episodic data gleaned from the various transactional clinical systems of healthcare and veterinary providers without accurate geographic representation; thus most health data collected from many of these sources have inaccurate geographic references which inevitably compromise the entire decision chain. More recently, the high level of interest in creating electronic health records has many nations investing in eHealth on a broad scale and in many cases across geopolitical boundaries. One of the most critical challenges of a “borderless” health record is the ability to share accurate geographic references easily. The outcomes of this interoperability are to create a standard frame of reference that facilitates decision-making and cooperation by promoting the interoperability of geographic information. This paper will describe the current HL7 CMET “A_SpatialCoordinate” now available to the health community worldwide, and how the use of this improved geographic standard inside HL7 will help improve the spatial interoperability of health data across all public health authorities as well as between healthcare providers such as hospitals, clinics, physicians, and emergency responders.

CDA: a standard to handle notifiable infectious diseases
M. Schnürer and F. Oemig, Agfa HealthCare GmbH, Germany

Measurements to fight notifiable disease require high quality and real-time send forms. To allow further analysis not only on a national but international level the handling of notification forms should follow a certain standard. A possible solution is presented by Agfa HealthCare.

Keynote Speech
Saturday October 11, 2008
Conference Room: HERMES

Session Chairs: Richard Dixon Hughes, ΗL7 Advisory Committee, Standards Australia

Global Standards in Transition : Global HIT SDO Collaboration, Coordination and Cooperation for Interoperable EHR
Yun Sik Kwak, MD, PhD, Chairman ISO TC215, Dept Medical Informatics, Kyungpook National University Medical School, Daegu, Korea

Plenary Session V: Collaborative use of Standards
Saturday October 11, 2008, 09:30 - 11:00
Conference Room: HERMES

Session Chairs: Asuman Dogac, METU, Turkey – Michael Van Campen, Chair HL7 Canada

A Regional Health Information Exchange System for Stroke Care (Nagoya-RHIE), Masaharu Obayashi1, M. Kagawa2, M. Mizuno and J. Yoshida

1Lead Researcher, Software R&D Group Kanrikogaku, Ltd, Tokyo 153-0063, Japan
2 FUJITSU LIMITED, Minato-ku, Japan
3Director NPO, Nagoya University, Japan
4Head Director of NPO, National Hospital Organization, Higashi-Nagoya Hospital, Japan

In this paper, the overview of Nagoya-RHIE system and technical key points on the implementation are described. For stroke care, collaborative use of clinical information is important and secure IT infrastructure for sharing documents is required. Also, standards are needed for interoperability such as common collaborative pathway for stroke care, common clinical documents for the pathway, common framework for sharing documents and transformation between legacy HIS data and common clinical documents. The Nagoya-RHIE project has tackled those technical challenges of building an EHR system. The system has been developed based on HL7 standards and IHE profiles. However, some of IHE profiles have been enhanced for applying them in the real field. Also, a new approach and tool for creating CDA document from specification and instance value set has been developed. A specification template has about 300 elements and 6 type CDA documents have been automatically generated using the specification template. Their framework and many profiles will be useful for the other EHR projects. This mandate (M/403) aims to provide a consistent set of standards to address the needs of the rapidly-evolving field of eHealth for the benefit of future healthcare provision.

Focused Profiles for Chronic Patients in Integrated Care and Clinical Governance
Angelo Rossi Mori1,2,3, Gregorio Mercurio1,3, W. Palumbo2,4, I. Paolini2,5 and L. Ruotolo2,3,6

1eHealth Unit, Istituto Tecnologie Biomediche, ITB-CNR - Circonvallazione Nomentana 496, 00162 Roma, Italy
2PROREC Italia, Centro per la promozione della cartella clinica elettronica,Italy
3HL7 Italia,
4Clinical Governance Area of the Italian Federation of General Practitioners – FIMMG,Italy
5Informatics and Telematics Area of the Italian Society for General Practitioners – SIMG, Italy
6Openetica, Italy

“Focused Profiles” were deployed for major chronic conditions in a region-wide EHR system. The clinical data sets used for the profiles are derived from evidence-based clinical pathways approved by the related Medical Societies. The data are represented as CDA documents, according to the CCD implementation guide (CDA level 2) and further local constraints (CDA level 3). Based on previous experiences in other regions, the profiles are intended for multiple usages, e.g.: sharing basic data between GP and specialist for direct patient care, local and regional governance, continuous education on clinical pathways, self audit of the GPs. After a large-scale testing, the specifications should be balloted by HL7 Italy and adopted by the Department of Technological Innovation as a standard for the Italian realm.

Transformation of DICOM SR to CDA Release 2,
Helmut König, Siemens Healthcare, Germany.

The communication of imaging evidence document and report data is an important step in coordinating clinical tasks that involve multiple specialties in intra- and cross-institutional settings. Relevant images, image-based quantitative measurements and interpretations are needed by the clinician for planning diagnostic and therapeutic activities. The joint working group HL7 Imaging Integration and DICOM WG20 has specified the transformation of DICOM SR (Structured Reporting) Basic Diagnostic Imaging Reports to HL7 CDA (Clinical Document Architecture) Release 2 and the use of CDA artifacts for diagnostic imaging reports. The harmonization of structured document standards (i.e. DICOM SR and HL7 CDA) is a prerequisite for the exchange of document data between imaging and clinical information systems.

eHealth Interoperability: Report in response to EU Mandate/403-2007
Pantelis Angelidis1, G. Heidenreich2, C. Parisot3 and M. Reynolds4

1University of Western Macedonia & Vidavo Health Telematics, Greece
2Siemens AG Healthcare Sector
3GE Healthcare Integrated IT Solutions
4AMS Consulting, UK

The results of the work in Phase I under the EC Mandate M403 on eHealth interoperability are reported. This mandate (M/403) aims to provide a consistent set of standards to address the needs of the rapidly-evolving field of eHealth for the benefit of future healthcare provision.

Parallel Session VIa: Electronic Health Records, HL7 messages and CDA
Saturday October 11, 2008, 11:30 - 13:00
Conference Room: HERMES

Session Chairs: Vesa Pekarinen, HL7 Finland – Ana Esterlich, HL7 France

Common issues found in implementations of the HL7 Clinical Document Architecture (CDA),
Rene J. Spronk1 and G. Grieve2

1Ringholm GmbH, Benrather Schlossallee 32, Düsseldorf, 40597 Germany
2Kestral Computing, 17 Burgundy Street, Heidelberg, Victoria 3083, Australia

A large number of XML instances of HL7’s CDA R2 standard were examined in detail. Two different tools, based on the CDA R2 XML schema and the CDA R2 MIF, were used to identify issues and errors. The issues identified are mainly related to the intent of the CDA standard and to misinterpretations of the underlying data type standard. The paper contains recommendations as to how these issues could have been detected and avoided. The reader is assumed to be familiar with the CDA R2 standard..

Interconnection of Philips Motiva and Catharina Hospital Eindhoven using the Clinical Document Architecture
Charalampos Xanthopoulakis, Philips Applied Technologies, Eindhoven, Digital Systems & Technologies, The Netherlands

In this paper, we present the findings of the venture held between Philips Applied Technologies and the Catharina Hospital Eindhoven aiming at interconnecting the Philips Motiva remote patient telemonitoring platform with the information system of the latter. The objective was the exchange of medical information between the two systems – in the form of patient referral and discharge notes – and in the context of the Dutch and German national healthcare infrastructures. For the purposes of the project, we developed a proof-of-concept to demonstrate the transfer of the patient referral and discharge notes as clinical documents over SOAP and secure HTTP. Our venture showed that the Health Level 7 Clinical Document Architecture (HL7 CDA) is a highly promising way of structuring such documents, allowing sufficient flexibility in formatting the medical information (structured/narrative form). Our experience with HL7 CDA for in this context is highlighted by the low implementation threshold required and by a series of challenges in development which were surfaced owing to this endeavor and are described in this paper.

Simplifying HL7 v3 Message Implementation and Adaptation Using CDA
Fatih Boy and A. G. Avcı, Birim Information Tech. Co. Izmir, Turkey

This paper describes HL7 v3 message implementation and adaptation simplification approaches used in the National Health Information System of Turkey (NHIS) founded by the Ministry of Health. Primary objective of the NHIS project is to provide a nation-wide infrastructure to share the Electronic Health Records (EHRs). The system is implemented based on HL7 v3 messages with HL7 Web Service Profile as transport protocol. Messages are designed, referenced on HL7v3 CDA release 2 and CCD specifications and fully compliant with HL7 v3, then mapped to backend web services A common logical design is implemented covering all datasets by using such a design; it is easier to construct a layered architecture to perform tasks in parallel.

Implementation of electronic Anatomic Pathology Report using as a representation format the HL7 CDA standard,
Nikos Kyriakoulakos,
Apollo SA, Greece

The case study describes the implementation of electronic Anatomic Pathology Report based on HL7 CDA document standard, in the Anatomic Pathology Laboratory of the University of Athens. The implementation focused on the design of the CDA document and the exchange using appropriate interface regarding recipient. Key role in the implementation is the decisions about the version, the level support of the CDA, the appropriate coding of the data and the use of integration engine in to order to support the exchange and messaging.

Clinical Applications written in CDA/R2 in Japan
Masaaki Hirai, Nihon Kohden corp., Japan

Over the years several kinds of CDA applications have been introduced in Japan. Patient referral documents: We have two national standards for such kind of purpose. One is to grasp own condition by her/him self. Another one is for interchange health care information between health care organizations. Medical check documents: an adult person over forty years old have to take a medical check in Japan, compulsory. The medical check document is written in CDA/R2. ECG report: this standard is for 12 lead ECG report including ECG waveform which is described in MFER, ISO/TS 11073-92001 as an external document. Anesthesia record: A patient demographic, anesthesia agent information, drug information, IV/water balance, laboratory data and vital signs information are written in CDA/R2 and the data sent from vital sign monitors are described in MFER. Infrastructure: We have other three standard to support CDA document which are developed by HL7 Japan. these are digital signature, encryption, and portable document standards.

Discussion

Parallel Session VIb: HL7 messages, IHE profiles, and other standards
Saturday October 11, 2008, 11:30 - 13:00
Conference Room: KALIA

Session Chairs: Bernd Blobel, HL7 Germany – Angelo Rossi-Morri, HL7 Italy

Connectivity Prototype of Medical Act Coverage in Uruguay, Juan Andrés Ghigliazza,

SUEIIDISS, Uruguay

At present in Uruguay, there are not standarized ways of computer communication among its health actors. Although there might be some works pointing to that direction, most of the formats of data exchange are defined by efforts done by single institutions, when needed. The main purpose of this work, is to demonstrate the benefits of using standards for this task. The prototype, consists in a group of programs that send and receive information about a medical act coverage, using CDA documents. The outcome of the work has been very satisfactory, and concluded that CDA data exchange can be implemented in production systems, running in different platforms, and that new developments, are reusable for new needs of communications.

An ebRIM profile for efficient network of federated registries and CDA repositories, Gregorio Mercurio1, F. L. Ricci1, A. Rossi Mori1, S. Lotti2

1Institute of Biomedical Technologies, National Research Council, Italy
2 National Agency for the attraction of investment and development business, Italy

We describe the architectural strategy for eHealth adopted in Italy by the government and several Regional authorities, and an efficient ebRIM interoperability profile to manage CDA-compliant “Documental Units”, semantically customized according to the Header of the CDA R-MIM.

Using Cross-Enterprise Document Sharing protocol to build the prototype of Personal Health Record, Hsiao-Li Chien and Der-Ming Liou

Institute of BioMedical Informatics, National Yang Ming University, Taiwan

Medical records are indispensable for healthcare providers. In order to offer a better quality of medical treatment for patients, healthcare organizations worldwide are all on their way to have electronic medical records developed. Even though electronic medical records have indeed improved some parts of healthcare process, they still focus on recording formation about individual while they are ill. To have an easier and more transparent circulation of medical records in the system for patients and medical personnel, Personal Health Record should be built based on accepted standards. With the transmission of standard information, personal health records can be fully utilized and reduce the cost of medical treatment. The purpose of this study is to use Cross-Enterprise Document Sharing (XDS) Profile offered by Integration the Healthcare Enterprise (IHE). Based on the method of medical record sharing and transmission from IHE-XDS, this study will build up the prototype of Personal Health Record System with its content easily shared.

Regional cooperation: HL7 v2 meets CDA in IHE Cross Document Exchange Alexander Henket,
E. Novation B.V., Netherlands

When two hospitals decide they want to share information for patient referrals, the underlying data flows are diverse. There’s DICOM for images, and HL7 version 2 for results and reports. This presentation is about a specific part of a successful proof of concept around IHE Cross-Enterprise Document Exchange (XDS), whereby the HL7 version 2 messaging is converted into CDA documents before storing them in the XDS index/repository for access to both parties involved in the XDS affinity domain.

Medical Device Communication: A Standards-based Conformance Testing Approach, John Garguilo, S. Martinez and M. Cherkaoui
National Institute of Standards and Technology (NIST), USA

NIST researchers are collaborating with medical device experts to facilitate the development and adoption of standards for medical device communications throughout the healthcare enterprise as well as integrating it into the electronic health record. We have developed test tools and corresponding electronic representation of an international standard’s information model that provides several important capabilities leading toward device interoperability. We describe a conformance testing approach which allows users to abstractly define devices via device profiles and implementation conformance statements. This information is subsequently used to provide syntactic and semantic validation of medical device messages according to medical device communication standard ISO/IEEE 11073.

Discussion

Closing Session: Late Breaking stories, Awards, Comments, and Recommendations, IHIC2009
Saturday October 11, 2008, 13:00 - 13:30
Conference Room: HERMES

Session Chairs: Dr. Med. Kai Heitmann, Prof. D. Koutsouris

Poster Session