Open EMR File Format?

OpenEMR Development
1

mbaw wrote on Thursday, April 07, 2011:

Hi, I am new to this forum, but am very interested in the development of an open source EMR platform for the UK medical market. I am a General Practitioner (Family Doctor) in the UK and the commercial EMR options here are not great.

I see the future of EMR interoperability being in developing a universal file format for EMRs that means it no longer matters which EMR software you’re using - the patient data can be used the same in them all - kind of like the web - it doesn’t matter which browser you use, the web page data is a standard format that can be understood & displayed similarly by all the browsers.

This seems to me why certain technologies become ubiquitous (PDF, MP3, HTML, WiFi) - there is an open or industry standard agreed and all developers can make their own software (paid/free/open/closed source - whatever) the consumer makes their choice but is not tied to any one EMR software because all their files can be easily read in a different EMR package.

So my question is: is there anyone out there working on this already?

Thanks

Marcus

2

aethelwulffe wrote on Thursday, April 07, 2011:

We call that “CCR”.  Continuity of care record.  In the states, we have a push for a real sort of standard (minimalist though it be) for the ability to import and export records.  There is also the “HL7 Format” (another term you can search if you are not familiar with it already).  As far as being “easy to read”, well, HL7 has never been accused of that.  It is mostly used for lab results and the like.  It is pure poo, much as the x-12 are.  They could and should be human readable, with a format more like a .ini file, but sadly, no.  CCR is exportable as an XML or pdf for starters.  In XML format, it can, with effort) be parsed (read and organized) by an EMR, and reorganized and uploaded into a database.  GoogleHealth and Microsoft Medical Vault are using this standard.  OpenEMR, as part of an attempt to comply with “Meaningful Use” standards that make an EMR user qualified for some government financial incentives via Medicaid/Medicare is headed in the direction of implementing CCR import/export.  You will find many references to it’s development here in the Developer Forum.  I have not played with it, but it is well under way.
YOU guys have had a National Health System since 2005.  You already have centralized records, Ja?  What is your opinion/integration with the NHS Site status?  I thought it was a pretty massive national IT program (sorry, “programme”).

3

johnbwilliams wrote on Thursday, April 07, 2011:

After CCR, there some next generation exchangeable clinical document standards being defined in the U.S.

For an overview, please see:    http://www.healthstory.com/pdf/HIMSS11Final.ppt

This an clinical standards harmonization process among HL7, IHE and Health Story.

There is a public balloting process to confirm/approve these standards - and an upcoming webninar on how to participate in the ballot process:

From the US HHS ONC:

Dear Members and Friends of the HL7 IHE Health Story Consolidation Project: (An ONC S&I Framework Project)

You are invited to participate in an education session to encourage participation in the current HL7 ballot cycle for the HL7/IHE Health Story Consolidation Project implementation guide.  Please register using the link below, and forward as you wish to colleagues who may have an interest.

Webinar: HL7/IHE Health Story Consolidation Project: How to Participate in the HL7 Ballot
When: Wednesday, April 13, 4-5 PM eastern
Register for Webinar: https://www2.gotomeeting.com/register/810108362

The HL7 International data standards organization will soon open a ballot for an important package of standards for health information exchange.  The Health Story Project is hosting a webinar is to show those unfamiliar with the process how to participate in the ballot.

The HL7/IHE Health Story Consolidation Project has harmonized exchange standards for eight common types of clinical documents along with the HL7 Continuity of Care Document (CCD) standard and the HITSP C32 requirements for Meaningful Use into one single implementation package.  ONC’s Office of Standards and Interoperability (S&I) is hosting the effort within its S&I Framework and is facilitating the project.  Within HL7, the project is sponsored by the Structured Documents Work Group. 

Development of the original eight implementation guides for History & Physical, Discharge Summary, Operative Note, Consult Note, Progress Note, Procedure Note, Unstructured Documents and Diagnostic Imaging Reports was supported by the Health Story Project through an associate charter agreement with HL7. The project has harmonized these with complementary IHE Profiles and will result in a series of corresponding change proposals to IHE and updates to templates required for Meaningful Use.

The HL7 Ballot is open to all. This webinar will review all administrative, documentary and technical steps needed to cast your ballot and to participate in the ballot reconciliation process.

On behalf of the Health Story Project
Integrating Narrative Notes and the EHR
www.healthstory.com

4

aethelwulffe wrote on Thursday, April 07, 2011:

As you see, there is not an integrated file format.  Data is stored in databases, and not individual files.  Different ideas about how things should be, different operating systems, different interface methods, and different…well everything…comes into play.  It is a pain to simply add a feature or integrate new technology input/output for one application.  To enable an integrated standard that allows for ongoing R&D in an EMR, you must have the ability to go beyond some simple standards.  Ultimately, if we have the perfect pentultimate model for empirical medicine science that accommodates analysis of every possible state of the human condition, we would have an integrated modular set of data that any system would be foolish not to accommodate.  This is not, and will not be the case for a significant time period, if ever.  What we must do in the meantime is have an intermediate standard that tries to capture some basic data, and a whole bunch of different individualized systems that are equipped for translators.  Different databases use different operating systems, different servers, different database programs, and different variables.  What happens when you have a widely accepted standard, and one guy really feels the need to add a variable to the database?  Incompatibility, or stagnation.
  Frankly, even among users of the same system, you find widely varying implementations/uses.  Doctors don’t write their notes the same way (even for the same patient), they don’t utilize the same features of the patient’s record, or even in the same way.
  Hopefully, we will eventually get a centralized database that is state run.  We can’t have “competition” or “free market” in this arena.  Hopefully, the standard will be comprehensive without being restrictive, and comprehensible/intuitive.  Hopefully, the standard will have frequent reviews, well funded updates, and really smart people running it that are in it for the greater good.  Hopefully, I will finally get my personal android and my kid can finally get that slight saber he always wanted.  Reality sucks.