XML for Health

Information
Systems
By
Tacey Lenyard
MSCS-6380 Advanced Database Systems
4/28/2015

History of Patient Records

Most medical institutions used a completely manual
process to record medical notes.
In addition to medical notes, information was also kept in
regards to patient billing, including sensitive financial
information.
To decrease cost in the healthcare setting, the
incorporation of information technology was taken into
consideration as a solution.

Digitizing the Admitting, Discharging,

and Transferring (ADT) of Patients
Fueled by the success of
the electronic business
model.
Provided medical
institutions to not only
locate patients, but keep
accurate count of how
many they had.

Electronic Medical Record

(EMR)
Displays lab results, allergies,
ADT information, and medical
notes etc. all in the same place.
Shares patient information
between multiple medical
institutions within seconds.
Creates a need for a standard
of details to be formatted and
implemented.

Health Level 7 (HL7)

Arden Syntax- medical terminology as it
applies to representation of medical
conditions and recommendations.
Structured Product Labeling- all of the
published information in regards to a
medicine or drug.
Clinical Context Object WorkgroupSpecifications as they apply to
interoperability and visual integration of
user applications.
Claims Attachments- a standard
attachment that accompanies healthcare
documents and assist in another
healthcare transaction.

Clinical Document Architecture

(CDA)
Persistence- It remains in an unaltered state

predefined by the user.

Stewardship- Certain personnel must be
designated and entrusted to maintain the
document and be help responsible for this.
Potential for Authentication- The intention of
the document is for it to be legally
authenticated.
Wholeness- Legal authentication applies to the
document as a whole and not just bits or
pieces of the documents.
Human Readability- A clinical document
should be readable by all humans and not just
the personnel entrusted to manage the
document.

Reference Information Model

(RIM)
Ensure coverage of previous HL7 version 2

standards.
Remove content from the model that the technical
team can find no reason to retain.
Unified Service Action Model (USAM). This is an
accurate, well-defined set of structures and
vocabularies that can be applied to clinical
scenarios across the board.
Ensures quality. RIM addresses any discrepancies
between the model and the modeling style guide.
Addresses "left-hand side" of the model. It
introduces some structure to the non-clinical
portions of the model including but not limited to:
patient administration, finance, and scheduling.

Hierarchical Structure of CDA

Level One-simple standard
that allows for drilling
down to other levels to
provide for more specific
information as it applies to
patient records and
departments.
Level One-Comparable to
DTD in XML language.

XML Security & Encryption

SignedInfo: Contains
information about what part of
the EMR is actually signed.
SignatureValue: Contains the
actual output of the encryption
data (the actual digital
signature).
KeyInfo: Provides information on
finding the key to validate the
signature within the EMR.

XML Security & Encryption

contd
Do not replace standard
SSL/TLS security
protocols, but are in
addition to them.
Attribute Based Encryption
(ABE) works well with
XML, allows users with
certain attribute sets to
access certain information.

Conclusions
This particular paper addresses the history and business requirements associated
with using XML for Health Information Systems.
It is a great example of how to take a manual process and automate it to increase
productivity of human resources and lower business operating costs.
It results in increasing knowledge of how XML language can be applied to bigger
development projects in a corporate arena.
Going forward Understanding XML Schemas/Oracle integration if necessary for data mining and data storage
and retrieval.

Understanding proper syntax of actual clinical documents

Design elements of the EMR.
Implementation of the EMR among multiple medical institutions.

References
Paper
Brewton, Justin., Yuan, Xiaohong., Akowuah, Francis. (2013). XML in
Health Information Systems.
http://worldcomp-proceedings.com/proc/p2012/BIC4653.pdf
Images
http://www.slideshare.net/frankfangwang/digitized-health
http://www.microwize.com/peakpractice /
http://www.altova.com/HL7_technology_primer.html
https://htg.his.uvic.ca/datasets/EHRArchitecture/CommonEOLDatabase.php
http://wiki.hl7.org/index.php?title=ORM_best_practices