Discharge and referral data exchange using global standards—the SCIPHOX project in Germany

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Abstract

The goal of the German project “Standardization of Communication between Information Systems in Physician Offices and Hospitals using XML” (aka SCIPHOX) in its first phase is to provide information exchange based on the Extended Markup Language XML between Hospital Information Systems (HIS) and Physician Office Systems (POS). The Clinical Document Architecture (CDA), a standard developed by the Health Level Seven organization (HL7), was chosen to serve as the “backbone” specification. The CDA is an ANSI approved document architecture for exchange of clinical information using XML. In phase I of the SCIPHOX project the proposal specifies the use of the CDA as a generalized international standard in the national context of discharge and referral letters in Germany. The specification defines how to use the CDA header and associated vocabularies by providing a translation and interpretation of the CDA header tags and provides a solution for taking local needs (insurance information etc.) into account.

Introduction

Electronic data interchange in healthcare meanwhile covers not only the hospital area, but also the non-hospital environment, for example the communication between physician offices/general practitioners (GPs). While the first is often done using the message standards of HL7 (Health Level Seven [1]), support of information exchange between applications in the non-hospital arena is achieved utilizing a variety of other protocols like EDIFACT or even proprietary exchange formats.

In Germany the use of HL7 is widespread for communication of applications within and between hospitals. EDIFACT never played a substantial role in Germany concerning medical messaging. In the outpatient sector a local proprietary protocol suite has been established, called “*DT”.

Both protocols, HL7 and “*DT”, were used (and developed) in Germany in parallel in both domains and without any point of contacts. Over time the old pragmatic “*DT” approach became more and more insufficient and efforts has been undertaken to replace it by newer specifications concerning both, the semantics and the exchange format aspects and to start electronic communications between the two domains.

Section snippets

The general practitioner arena in Germany: *DT

First interface specifications of the “*DT” set of protocols were endorsed by the German physicians statutory association in 1988 already. They are intended for storing and also exchange of data in the outpatient area only. The *DT set primarily supports communication of lab results, the reimbursement process and also the storage medical symptoms and findings, among others.

Although it is a pragmatic approach without an underlying data model, a valuable repository of tags for data fields along

Extensible Markup Language as a “mediator” between worlds

The Extensible Markup Language (XML) plays a key role in various economical and scientific domains for both as an interchange format for messages and as a document standard. XML is a set of recommendations of the World Wide Web industry consortium (W3C) covering the meta language itself [2], the definition of schemas [3] to constrain structure and semantics of instance documents, and the processing of XML documents concerning presentation, transformation [4], navigation [5] etc.

Healthcare

The SCIPHOX project

The goal of the German project “Standardization of Communication of Information Systems in Physician Offices and Hospitals using XML” (also called SCIPHOX) in its phase I is to close the gap of electronic communication between hospital systems and applications for the outpatient sector, such as for referral or discharge letters, by providing an XML based method of communication between the two parts. The project started at the beginning of the year 2000 with a pilot study aiming on content

Results of Phase I

Beginning in 2001, the SCIPHOX project group has chosen to adopt the generally defined global CDA standard. Two key results can be reported and the preceding independent efforts on alternative XML based encoding for both, the “*DT” and the HL7 protocols were found helpful to create the SCIPHOX specification.

In order to make the original standard feasible for the needed requirements in the focussed communication use cases, parts of the original standard have been translated, and definitions,

Future aspects of SCIPHOX

Phase II of the SCIPHOX project began in 2002 and aims on the extension of the communication scope, for example the electronic prescription, on runtime implementation issues including transport mechanisms and security, and on highly domain specific documentation such as diabetes and cancer documentation, outpatient treatment/operational notes quality assurance, electronic version of the emergency health card etc. A web site was created to publish all project related information [11].

Another

Discussion and conclusion

Making a global standard like the ANSI-CDA specification feasible for the use in a local environment by “enriching” the already existing definitions and identifying the issues that make the difference between what exists and what is still locally required can be seen as a opportunity to a “smooth” migration process rather than enforce superfluousness of existing (and successfully running) approaches in healthcare application communication and data storage. Relying on the standard approach also

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This paper is an updated and extended version of a paper for the Medical Informatics Europe 2002 conference.

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