Standards-based Clinical Data Repository

Information

Abstract

During the treatment process of a patient the physician usually requests a Laboratory Report (e.g. a blood count) from the laboratory. The delivery of the Laboratory Report is ususally performed via fax or letter to the treating physician. The structured laboratory data, which were initially generated by the laboratory, are not available for the physician. Furthermore, the physician has to import the Laboratory Report manually to the Electronic Medical Record (EMR) system. Thus, enabling the electronic data exchange between a laboratory and relevant healthcare providers improves the current treatment processes. The aim was the connection between a laboratory and an existing distributed Health Information Exchange (HIE), where several healthcare providers are connected to exchange medical docu-ments via the Cross-Enterprise Document Sharing (XDS) profile. A challenge was to perform the integration transparently with existing established exchange mechanisms and interfaces. While the Laboratory Information System (LIS) sends laboratory data via Health Level 7 (HL7) V2 messages over Transmission Control Protocol/Internet Protocol (TCP/IP), the HIE follows the document-based approach, and exchanges documents via XDS transactions over SOAP 1.2. A Clinical Data Repository (CDR) has been established for the storage and management of the laboratory data as Fast Healthcare Interoperability Resources (FHIR) resources. Furthermore, a Health Service Bus (HSB) has been developed to support the communication between the LIS, the CDR, and the HIE participating systems and components. The Clinical Document Architecture (CDA) standard was used to create a structured laboratory document, which has been exchanged with the participating healthcare providers of the HIE. The HSB integrates translation engines, which are responsible for the mapping from HL7 V2 messages into FHIR resources and further from FHIR resources into CDA documents. The integration of the laboratory with the HIE was successful. An adequate mapping between the HL7 V2, FHIR, and CDA standards has been specified. Gaps between the particular standards have been identified and if necessary, an extension of the data structure has been defined. FHIR has proven its suitability as a flexible and robust storage format and its ability to provide the appropriate data structure to map laboratory data from HL7 V2 and convert FHIR resources to a CDA document.

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BibTeX

@mastersthesis{schmidlehner2021,
  title =      "Standards-based Clinical Data Repository",
  author =     "Sandra Schmidlehner",
  year =       "2021",
  abstract =   "During the treatment process of a patient the physician
               usually requests a Laboratory Report (e.g. a blood count)
               from the laboratory. The delivery of the Laboratory Report
               is ususally performed via fax or letter to the treating
               physician. The structured laboratory data, which were
               initially generated by the laboratory, are not available for
               the physician. Furthermore, the physician has to import the
               Laboratory Report manually to the Electronic Medical Record
               (EMR) system. Thus, enabling the electronic data exchange
               between a laboratory and relevant healthcare providers
               improves the current treatment processes. The aim was the
               connection between a laboratory and an existing distributed
               Health Information Exchange (HIE), where several healthcare
               providers are connected to exchange medical docu-ments via
               the Cross-Enterprise Document Sharing (XDS) profile. A
               challenge was to perform the integration transparently with
               existing established exchange mechanisms and interfaces.
               While the Laboratory Information System (LIS) sends
               laboratory data via Health Level 7 (HL7) V2 messages over
               Transmission Control Protocol/Internet Protocol (TCP/IP),
               the HIE follows the document-based approach, and exchanges
               documents via XDS transactions over SOAP 1.2. A Clinical
               Data Repository (CDR) has been established for the storage
               and management of the laboratory data as Fast Healthcare
               Interoperability Resources (FHIR) resources. Furthermore, a
               Health Service Bus (HSB) has been developed to support the
               communication between the LIS, the CDR, and the HIE
               participating systems and components. The Clinical Document
               Architecture (CDA) standard was used to create a structured
               laboratory document, which has been exchanged with the
               participating healthcare providers of the HIE. The HSB
               integrates translation engines, which are responsible for
               the mapping from HL7 V2 messages into FHIR resources and
               further from FHIR resources into CDA documents. The
               integration of the laboratory with the HIE was successful.
               An adequate mapping between the HL7 V2, FHIR, and CDA
               standards has been specified. Gaps between the particular
               standards have been identified and if necessary, an
               extension of the data structure has been defined. FHIR has
               proven its suitability as a flexible and robust storage
               format and its ability to provide the appropriate data
               structure to map laboratory data from HL7 V2 and convert
               FHIR resources to a CDA document.",
  month =      mar,
  address =    "Favoritenstrasse 9-11/E193-02, A-1040 Vienna, Austria",
  school =     "Research Unit of Computer Graphics, Institute of Visual
               Computing and Human-Centered Technology, Faculty of
               Informatics, TU Wien ",
  URL =        "https://www.cg.tuwien.ac.at/research/publications/2021/schmidlehner2021/",
}