A Generic, Web-based Clinical Information System Architecture Using HL7 CDA: Successful Implementation in Dermatological Routine Care

The requirements of highly specialized clinical domains are often underrepresented in hospital information systems (HIS). Common consequences are that documentation remains to be paper-based or external systems with insufficient HIS integration are used. This paper presents a solution to overcome this deficiency in the form of a generic framework based on the HL7 Clinical Document Architecture. The central architectural idea is the definition of customized forms using a schema-controlled XML language. These flexible form definitions drive the user interface, the data storage, and standardized data exchange. A successful proof-of-concept application in a dermatologic outpatient wound care department has been implemented, and is well accepted by the clinicians. Our work with HL7 CDA revealed the need for further practical research in the health information standards realm.

[1]  Thomas Norgall,et al.  Interoperability--a key infrastructure requirement for personalised health services. , 2005, Studies in health technology and informatics.

[2]  E. B. Steen,et al.  The Computer-Based Patient Record: An Essential Technology for Health Care , 1992, Annals of Internal Medicine.

[3]  Hans-Ulrich Prokosch,et al.  Cross-institutional data exchange using the clinical document architecture (CDA) , 2005, Int. J. Medical Informatics.

[4]  Peter Kokol,et al.  Medical informatics Europe '99 , 1999 .

[5]  Klaus A. Kuhn,et al.  Towards a continuous evolution and adaptation of information systems in healthcare , 2004, Int. J. Medical Informatics.

[6]  Keith Cheverst,et al.  Rapid prototyping and user-centered design of interactive display-based systems , 2005, IEEE Pervasive Computing.

[7]  Hans-Ulrich Prokosch,et al.  Electronic Discharge Letters Using the Clinical Document Architecture (CDA) , 2003, MIE.

[8]  Ulrich Schrader,et al.  Realization of a CPR Using HL7 Queries From Communication Server to Information Server , 1999, MIE.

[9]  Astrid M. van Ginneken,et al.  The computerized patient record: balancing effort and benefit , 2002, Int. J. Medical Informatics.

[10]  R Klar,et al.  The minimum basic data set as the core of the Freiburg University Hospital information system. , 1995, Medinfo. MEDINFO.

[11]  Amnon Shabo,et al.  Model Formulation: HL7 Clinical Document Architecture, Release 2 , 2006, J. Am. Medical Informatics Assoc..

[12]  T Beale,et al.  Archetypes: Constraint-based Domain Models for Future-proof Information Systems , 2000, OOPSLA 2000.

[13]  Robert C Wu,et al.  Implementation of a computerized physician order entry system of medications at the University Health Network--physicians' perspectives on the critical issues. , 2006, Healthcare quarterly.