Electronic Health Record

Name: Electronic Health Record | Standards, Coding Systems, Frameworks, and Infrastructures
Brand: Wiley-IEEE Press
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Standards, Coding Systems, Frameworks, and Infrastructures

Pradeep K. Sinha Gaur Sunder Prashant Bendale Manisha Mantri Atreya Dande(Autor*in)

Wiley-IEEE Press

Erschienen am 4. Dezember 2012

376 Seiten

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Inhalt

Cover
Electronic Health Record: Standards, Coding Systems, Frameworks, and Infrastructures
Contents
Preface
Acronyms
Part One: Introduction
1 Introduction to EHR
1.1 Introduction
1.2 Definition of EHR
1.3 Functions of EHR
1.4 Significance of EHR
1.5 Factors Affecting Implementation of EHR
1.6 Role of Standards
1.7 Role of Clinical Coding Systems
1.8 Role of Standard Frameworks
1.9 Case Studies of National EHR Implementations
Bibliography
Part Two: EHR Standards
2 Standard for EHR Architecture Requirements
2.1 Introduction
2.2 ISO/TS 18308 Requirement Specification
2.2.1 Content Structure Model
2.2.2 Inclusion of Clinical and Record Processes
2.2.3 Content Exchange
2.2.4 Privacy and Security
2.2.5 Legal Considerations
2.2.6 Ethical, Consumer/Cultural Aspects
2.2.7 Future-proof Framework
2.3 Discussion
2.4 Conclusion
Bibliography
3 Standard for Healthcare Concepts
3.1 Introduction
3.2 CEN/TC EN 13940-1
3.2.1 Actors in Continuity of Care
3.2.2 Health Issues and Their Management
3.2.3 Concepts Related to Responsibility
3.2.4 Time-Related Concepts
3.2.5 Concepts Related to Knowledge, Activities, and Decision Support
3.2.6 Health Data Management
3.3 CEN/TC prEN 13940-2
3.3.1 Healthcare Process
3.4 Discussion
3.5 Conclusion
Bibliography
4 Standard for EHR Functional Specifications
4.1 Introduction
4.2 HL7 EHR-S Functional Model
4.2.1 Functional Profiles
4.2.2 Exchange
4.2.3 Security/Privacy
4.3 Comparison of HL7 EHR-S FM and ISO/TS 18308
4.4 Discussion
4.5 Conclusion
Bibliography
5 Standard for EHR Communication
5.1 Introduction
5.2 CEN/ISO EN 13606 Requirement Specification
5.2.1 Part 1: Reference Model
5.2.2 Part 2: Archetypes Interchange Specification
5.2.3 Part 3: Reference Archetypes and Term Lists
5.2.4 Part 4: Security
5.2.5 Part 5: Exchange Models
5.3 Discussion
5.4 Conclusion
Bibliography
6 Messaging Standard for Healthcare Data
6.1 Introduction
6.2 HL7 v2.x
6.2.1 Message Structure
6.2.2 Auxiliary Messaging Protocols
6.2.3 Usage Scenario
6.2.4 Example of HL7 v2.x Message
6.3 Discussion
6.4 Conclusion
Bibliography
7 Model-Based Messaging Standard for Healthcare Data
7.1 Introduction
7.2 HL7 v3
7.2.1 Message Structure
7.2.2 Interaction Model
7.2.3 Role-Based Access Control
7.2.4 HL7 v3 and SNOMED CT
7.2.5 HL7 v3 and Service-Oriented Architecture (SOA)
7.3 HL7 v2.x and v3 Comparison
7.4 Discussion
7.5 Conclusion
Bibliography
8 Clinical Document Standards
8.1 Introduction
8.2 Clinical Document Architecture (CDA)
8.2.1 Document Structures
8.2.2 Example of CDA Component
8.3 Continuity of Care Document (CCD)
8.3.1 Example of CCD Component
8.4 Clinical Document Exchange
8.5 Discussion
8.6 Conclusion
Bibliography
9 Standard for Medical Imaging and Communication
9.1 Introduction
9.2 DICOM
9.2.1 Information Model
9.2.2 Message Exchange Model
9.3 Improvements in DICOM Standard
9.4 Discussion
9.5 Conclusion
Bibliography
10 Standard for Patient Health Summary
10.1 Introduction
10.2 Continuity of Care Record (CCR)
10.2.1 Structural Model
10.2.2 Exchange
10.3 Discussion
10.4 Conclusion
Bibliography
Part Three: Coding Systems
11 Coding System for Classification of Diseases and Related Health Problems
11.1 Introduction
11.2 ICD
11.2.1 Chapters
11.2.2 Blocks
11.3 Improvements in ICD-10
11.4 Discussion
11.5 Conclusion
Bibliography
12 Coding System for Laboratory Tests and Observations
12.1 Introduction
12.2 LOINC
12.2.1 Code Classification
12.2.2 Code Structure
12.2.3 Regenstrief LOINC Mapping Assistant (RELMA)
12.3 Discussion
12.4 Conclusion
Bibliography
13 Coding System for Patient Care Procedures
13.1 Introduction
13.2 CPT
13.2.1 Data Model
13.2.2 CPT Sections
13.2.3 CPT Index
13.2.4 CPT Symbols
13.2.5 CPT Modifiers
13.2.6 Descriptive Qualifiers
13.3 Discussion
13.4 Conclusion
Bibliography
14 Extended Coding System for Patient Care Procedures
14.1 Introduction
14.2 HCPCS
14.2.1 Level I Codes
14.2.2 Level II Codes
14.3 Discussion
14.4 Conclusion
Bibliography
15 Comprehensive Coding System for Clinical Terms
15.1 Introduction
15.2 SNOMED CT
15.2.1 Concepts
15.2.2 Structure of SNOMED CT Code
15.3 SNOMED CT Database Browsers
15.4 Discussion
15.5 Conclusion
Bibliography
16 Unified Medical Language System
16.1 Introduction
16.2 UMLS-Supported Coding Systems
16.3 UMLS Architecture
16.3.1 Metathesaurus
16.3.2 Semantic Network
16.3.3 Specialist Lexicon and Lexical Tools
16.4 UMLS Licensing
16.5 Discussion
16.6 Conclusion
Bibliography
17 Other Coding Systems
17.1 Introduction
17.2 AHFS Drug Information (AHFS DI)
17.3 Current Dental Terminology (CDT)
17.4 International Classification of Diseases for Oncology (ICD-O)
17.5 International Classification of Functioning, Disability and Health (ICF)
17.6 Coding Systems for Nursing Practices
17.6.1 North American Nursing Diagnosis Association (NANDA)
17.6.2 Nursing Interventions Classification (NIC)
17.6.3 Nursing Outcomes Classification (NOC)
17.7 Radiology Lexicon (RADLEX)
17.8 RxNorm
17.9 Discussion
17.10 Conclusion
Bibliography
Part Four: Standard Frameworks
18 openEHR
18.1 Introduction
18.2 openEHR Process Model
18.3 openEHR Architecture
18.3.1 EHR Information Model
18.3.2 Exchange
18.4 Discussion
18.5 Conclusion
Bibliography
19 Integrating the Healthcare Enterprise (IHE)
19.1 Introduction
19.2 IHE Domains
19.2.1 Integration Profiles
19.2.2 Integration Statements
19.2.3 Technical Frameworks
19.3 IHE Initiatives on Electronic Health Record
19.4 Exchange
19.4.1 Cross-Enterprise Document Sharing (XDS)
19.5 Security
19.5.1 Audit Trail & Node Authentication (ATNA)
19.6 Discussion
19.7 Conclusion
Bibliography
Part Five: Case Studies: National EHR Efforts
20 Australia's HealthConnect
20.1 Introduction
20.2 Overview
20.3 Architecture
20.3.1 EHR Concept
20.3.2 EHR Design
20.3.3 e-Health Services
20.3.4 National Privacy Principles (NPP)
20.3.5 Exchange
20.4 Discussion
20.5 Conclusion
Bibliography
21 Austria's ELGA
21.1 Introduction
21.2 Overview
21.3 Architecture
21.3.1 Master Patient Index
21.3.2 HSP Index
21.3.3 Authorization System
21.3.4 HSP System
21.3.5 Storage (Document Registry)
21.3.6 Network
21.3.7 ELGA Portal
21.4 Functional Implementation
21.4.1 Healthcare Services
21.5 Exchange
21.6 Discussion
21.7 Conclusion
Bibliography
22 Canada's EHRS Blueprint
22.1 Introduction
22.2 Overview
22.3 Architecture
22.3.1 Electronic Health Record Solution (EHRS)
22.3.2 Electronic Health Record Infostructure (EHRi)
22.3.3 Exchange
22.3.4 Legal Framework
22.4 Discussion
22.5 Conclusion
Bibliography
23 Denmark's MedCom
23.1 Introduction
23.2 Overview
23.3 Architecture
23.3.1 EHR Concept
23.3.2 EHR Design
23.3.3 Danish Health Data Network
23.3.4 Security Infrastructure
23.3.5 National Health Portal (Sundheds.dk)
23.3.6 Exchange
23.4 Discussion
23.5 Conclusion
Bibliography
24 Hong Kong's eHR Sharing System
24.1 Introduction
24.2 Overview
24.3 Architecture
24.3.1 E-Health Engagement Initiative (EEI)
24.3.2 eHR Sharing System
24.3.3 Exchange
24.3.4 Security/Privacy Guidelines
24.4 Discussion
24.5 Conclusion
Bibliography
25 India's Health IT Initiatives
25.1 Introduction
25.2 Overview
25.3 ITIH Framework
25.4 Recommendations on Guidelines, Standards, and Practices for Telemedicine in India
25.5 iHIND
25.5.1 Architecture
25.5.2 Confidentiality, Access, and Security
25.5.3 Standards
25.6 Other Initiatives
25.6.1 Integrated Disease Surveillance Project
25.6.2 National Rural Telemedicine Network (NRTN)
25.6.3 National Medical College Network
25.6.4 Standardization of EHR
25.7 Discussion
25.8 Conclusion
Bibliography
26 Netherlands' AORTA
26.1 Introduction
26.2 Overview
26.3 Architecture
26.3.1 Dutch Electronic Patient Dossier (EPD) System
26.3.2 NICTIZ Healthcare IT Infrastructure Workflow
26.3.3 Exchange
26.3.4 Security/Privacy Guidelines
26.4 Discussion
26.5 Conclusion
Bibliography
27 Singapore's NEHR
27.1 Introduction
27.2 Overview
27.3 Architecture
27.3.1 Health Clusters
27.3.2 EMR Exchange (EMRX)
27.3.3 National Electronic Health Record (NEHR)
27.4 Discussion
27.5 Conclusion
Bibliography
28 Sweden's NPO
28.1 Introduction
28.2 Overview
28.3 Architecture
28.3.1 Clinical Process Model
28.3.2 Information Model
28.3.3 Sjunet
28.3.4 Electronic Catalog For Health and Social Care
28.3.5 Secure it in Health Services
28.3.6 Basic Services for Information
28.3.7 Regulatory Framework for Information Interoperability in Healthcare
28.3.8 National Patient Summary
28.4 Discussion
28.5 Conclusion
Bibliography
29 Taiwan's Health Information Network
29.1 Introduction
29.2 Overview
29.3 Architecture
29.3.1 National Health Information Network (HIN) 2.0
29.4 Exchange
29.4.1 TMT Standard
29.5 Discussion
29.6 Conclusion
Bibliography
30 United Kingdom's Spine
30.1 Introduction
30.2 Overview
30.3 Architecture
30.3.1 Spine Infrastructure
30.3.2 Structure of Summary Care Record
30.3.3 Content of Summary Care Record
30.3.4 Security Infrastructure
30.3.5 Exchange
30.4 Discussion
30.5 Conclusion
Bibliography
31 USA's EHR Meaningful Use
31.1 Introduction
31.2 Overview
31.3 EHR Meaningful Use
31.3.1 Requirement Specifications
31.4 National Health Information Network (NHIN)
31.4.1 NHIN Architecture
31.4.2 Exchange Services
31.4.3 Transaction Profiles
31.4.4 Authorization Framework
31.4.5 NHIN Trial Project
31.4.6 NHIN Direct Project
31.5 Discussion
31.6 Conclusion
Bibliography
Part Six: Findings and Conclusion
32 Findings and Conclusion
32.1 EHR Standards
32.2 Coding Systems
32.3 Standard Frameworks
32.4 Case Studies: National EHR Efforts
32.4.1 Quantitative Assessment
32.4.2 Qualitative Assessment
32.5 Recommended Phases for Implementing A National EHR System
Glossary
Index

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