Dear all, Could you help me with some clinical use cases to demonstrate the differences between an 'EHR' based on standardized messages and an EHR based on a standardized information architecture/ reference model.
As you might be aware here in the Netherlands our government has chosen, for now, to use standardized messages in combination with a central 'switch point'. Basically this provides a communication infrastructure which deals with identification and authorization en provides a look-up function so data can be found in other systems. Data remains de-central in legacy systems and vendors translate their legacy data to these standardized messages in XML so those bits of information can be shared between the health care providers connected to the switch point. Recently within NEN (the Dutch partner of CEN) we've completed an inventarisation with regard to the existing standards in this area. Goal is to provide an overview and some guidance for the NEN members wrt to these standards. In short the conclusion is that the HL7 and EN13606 standards should be seen as complementary. HL7 has proven it's use for the exchange of messages and will be around for some time since legacy systems will use this to communicate with each-other. EN13606 defines an information architecture which assures semantic interoperability between information systems based on that standard. Both systems can (and in the Netherlands will) use the 'switch point infrastructure and with regard of the exchange of information between information systems HL7 v3 can be used as the envelope for the information. Since openEHR isn't an CEN/ISO standard yet, we've left this out for now. Next year we'll do an re-inventarisation and hopefully we can add openEHR to the list (We'll take small steps at the time. This was already quite a big step within the Netherlands). Now there is a request to provide a document which can be used by a broader public (especially decision makers, healthcare providers and vendors of health care applications/systems) which explains in more detail where we're heading for, what choices can be made and what the consequences of those choices could be. Our idea is to explain this with a couple of clear use cases and from there zoom in on the technical requirements/ choices to be made/ consequences. We're looking for use cases for which standardized messages is a sufficient solution and use cases for which one really needs information systems which provide semantic interoperability. Of course other suggestions are more than welcome. Cheers, Stef
