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Transformation Between HL7 and Continuity of Care Record to Facilitate Web-Based Personal Health Record Systems

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Transformation Between HL7 and Continuity of Care Record to Facilitate Web-Based Personal Health Record Systems Transformation between HL7 and Continuity of Care Record to Facilitate Web-Based Personal Health Record Systems by Jofry Hadi Sutanto A Dissertation Presented in fulfillment of the requirements for the degree of Master of Science at Swinburne University Of Technology December 2011 ABSTRACT To establish interoperability between Health/Hospital Information System (HIS), there exist standards or protocols designed by capable organizations to help different HISs communicatebetter with each other. Reliable and accurate communication is nowadays a prerequisite to delivering fully integrated health care to patients. In practice, there are two main leading standards adopted by various HISs, Health Level 7 (HL7) and Continuity of Care Record (CCR). The HL7 v2.x set of healthcare messaging standards are the predominant ones used by healthcare institutions in much of the world. They have been designed for managing healthcare and so provide a complete set of information and messages necessary for the provision of healthcare. Also, the scope of HL7 has expanded to include standards for the interchange of clinical data in all settings, a reference information model, data types, decision support and clinical guidelines, clinical documents and clinical templates, clinical context objects, terminology, security, XML, and the electronic health record. More recently the Continuity of Care Record (CCR) standard was proposed as a digital form of referrals; it describes the condition of a person – a snapshot – at the time of the referral. It offers a light-weight, easy implemented approach, and its focus is on the exchange of health summaries. Personal Health Record (PHR) systems such as Google Health and Microsoft Health Vault use the CCR format for input (and output), which is correct, as such systems collect snapshots of health (rather than or in addition to healthcare) information. While both were initially made for different purposes, the need to collaborate with each other was soon deemed necessary, resulting in the release by HL7 of the Continuity of Care Document (CCD). This is a patient summary clinical document that is derived from the HL7 CDA (Clinical Document Architecture) Reference Information Model (RIM), but provides health summary information parallel to that of the CCR. This result is a standard that is much more complex than the CCR, so it still does not solve the integration issue between HISs which favour the HL7 (version 2.x or CCD) and those (especially PHRs)which prefer the CCR due to its simplicity. For healthcare institutions, which use HL7, to effectively communicate with PHR systems which use the CCR, there must be a translation between these two standard formats. We present such a translation; it is in the public domain, so is open for improvements from knowledgeable institutions and individuals. ACKNOWLEDGEMENTS I would like to extend my deepest gratitude and appreciation to the following individuals who made it possible for me to complete this thesis during my study. Dr. Henry Lee Seldon – my coordinating supervisor, for recruiting me into this research project and patiently guiding me from the beginning until the completion of this thesis. His extensive knowledge and support is the biggest help for me in my study. He is also the one that lead me forward when I was about to take the first step into research. Dr. Biju Issac and Dr. Lau Bee Theng who also gave advice and insightful comments during my progress, they helped me to gain a wider view on polishing the content of my research as well as my thesis. My fellow colleagues, Wendy Japutra Jap, Ong Chin Ann, Valentine Lau Tiu Chung, Shane Wee Jonah, Nia Valeria, Vivi Mandasari, Serena Sim, and other colleagues with whom I spent time to discuss about my research and progressing to excellence as Master by Research student overall. My parents, Bonny Hadi Sutanto and Phang Tjhun Fa, my brothers and sisters for their unending support that always encourage me and push me forward in my study. Last but not least, to the closest friend of mine, Verawati Then, for being so inspirational and kind, and for being there for me when I find myself lack of the motivation to do my research, for teaching me to trust myself when I was in doubt. DECLARATION I hereby declare that this thesis is my own work and effort and that it has not been submitted anywhere for any award. Where other sources of information have been used, they have been acknowledged. Signature: ………………………………………. Date: 30 Novermber 2011 TABLE OF CONTENTS 1 Introduction ........................................................................................................................................ 1 1.1 Problem Statement ........................................................................................................................ 1 1.2 General Overview of Health Care and HIS related to Indonesia .................................................... 2 1.2.1 History of health care in Indonesia ...................................................................................... 2 1.2.2 Different levels of players in the chain of health care.......................................................... 4 1.2.3 Health Information System (HIS) in Health Care .................................................................. 6 1.3 Communication of Health Information in General ...................................................................... 11 1.3.1 Current General Solutions for Communication .................................................................. 11 1.3.2 Problems with Current General Communication Solution ................................................. 12 1.4 IT Systemsin Health Care ............................................................................................................. 13 1.4.1 Types and Examples of Health Information Systems ......................................................... 13 1.4.2 Basis of communication ..................................................................................................... 18 1.4.3 Problems with Current IT Communication ......................................................................... 29 1.5 Analysis of Other Available Solutions .......................................................................................... 31 1.6 Proposed Solution ........................................................................................................................ 31 1.6.1 A PHR as a way to EHRs in Developing Countries ............................................................... 31 1.6.2 Integrate a PHR with Existing HISs ..................................................................................... 32 1.6.3 Introduce Middleware/Gateway for Integration ............................................................... 32 1.6.4 Choose Communication Standards for Integration ............................................................ 33 2 Methodology .................................................................................................................................... 34 2.1 Survey to establish current status of HISs in Indonesia ............................................................... 34 2.2 Requirements ............................................................................................................................... 37 2.2.1 Communication gateway .................................................................................................... 37 2.2.2 Hospital Health Information System (HIS) .......................................................................... 39 2.2.3 PHR ..................................................................................................................................... 40 2.3 Design of the Mapping ................................................................................................................. 40 2.3.1 CCR to HL7 v2.x Translation ................................................................................................ 40 2.3.2 The HL7 v2.x to CCR translation ......................................................................................... 47 2.3.3 Challenges in Mapping ....................................................................................................... 49 2.4 Implementation ........................................................................................................................... 55 2.4.1 Choosing base packages ..................................................................................................... 56 2.4.2 Choosing the tools .............................................................................................................. 62 2.4.3 Message system architecture ............................................................................................. 64 2.5 Testing and Evaluation Method ................................................................................................... 65 2.5.1 The CCR -> HL7 v2.x map .................................................................................................... 65 2.5.2 The HL7 v2.x -> CCR map .................................................................................................... 67 2.5.3 Compare Results with CCRViewPort by Solventus ............................................................. 70 3 Results .............................................................................................................................................. 71 3.1 Survey on healthcare
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