Preface XVII -- Acronyms XXVII -- PART ONE Introduction -- 1 Introduction to EHR 3 -- 1.1 Introduction, 3 -- 1.2 Definition of EHR, 4 -- 1.3 Functions of EHR, 5 -- 1.4 Significance of EHR, 6 -- 1.5 Factors Affecting Implementation of EHR, 7 -- 1.6 Role of Standards, 8 -- 1.7 Role of Clinical Coding Systems, 9 -- 1.8 Role of Standard Frameworks, 9 -- 1.9 Case Studies of National EHR Implementations, 10 -- PART TWO EHR Standards -- 2 Standard for EHR Architecture Requirements 15 -- 2.1 Introduction, 15 -- 2.2 ISO/TS 18308 Requirement Specification, 16 -- 2.2.1 Content Structure Model, 16 -- 2.2.2 Inclusion of Clinical and Record Processes, 17 -- 2.2.3 Content Exchange, 17 -- 2.2.4 Privacy and Security, 17 -- 2.2.5 Legal Considerations, 17 -- 2.2.6 Ethical, Consumer/Cultural Aspects, 18 -- 2.2.7 Future-proof Framework, 18 -- 2.3 Discussion, 18 -- 2.4 Conclusion, 20 -- 3 Standard for Healthcare Concepts 23 -- 3.1 Introduction, 23 -- 3.2 CEN/TC EN 13940-1, 24 -- 3.2.1 Actors in Continuity of Care, 24 -- 3.2.2 Health Issues and Their Management, 25 -- 3.2.3 Concepts Related to Responsibility, 25 -- 3.2.4 Time-Related Concepts, 26 -- 3.2.5 Concepts Related to Knowledge, Activities, and Decision Support, 27 -- 3.2.6 Health Data Management, 28 -- 3.3 CEN/TC prEN 13940-2, 28 -- 3.3.1 Healthcare Process, 29 -- 3.4 Discussion, 30 -- 3.5 Conclusion, 32 -- 4 Standard for EHR Functional Specifications 33 -- 4.1 Introduction, 33 -- 4.2 HL7 EHR-S Functional Model, 34 -- 4.2.1 Functional Profiles, 34 -- 4.2.2 Exchange, 36 -- 4.2.3 Security/Privacy, 37 -- 4.3 Comparison of HL7 EHR-S FM and ISO/TS 18308, 38 -- 4.4 Discussion, 39 -- 4.5 Conclusion, 40 -- 5 Standard for EHR Communication 43 -- 5.1 Introduction, 43 -- 5.2 CEN/ISO EN 13606 Requirement Specification, 45 -- 5.2.1 Part 1: Reference Model, 45 -- 5.2.2 Part 2: Archetypes Interchange Specification, 46 -- 5.2.3 Part 3: Reference Archetypes and Term Lists, 49 -- 5.2.4 Part 4: Security, 49 -- 5.2.5 Part 5: Exchange Models, 50 -- 5.3 Discussion, 51.

5.4 Conclusion, 53 -- 6 Messaging Standard for Healthcare Data 57 -- 6.1 Introduction, 57 -- 6.2 HL7 v2.x, 58 -- 6.2.1 Message Structure, 60 -- 6.2.2 Auxiliary Messaging Protocols, 61 -- 6.2.3 Usage Scenario, 62 -- 6.2.4 Example of HL7 v2.x Message, 62 -- 6.3 Discussion, 64 -- 6.4 Conclusion, 67 -- 7 Model-Based Messaging Standard for Healthcare Data 69 -- 7.1 Introduction, 69 -- 7.2 HL7 v3, 69 -- 7.2.1 Message Structure, 70 -- 7.2.2 Interaction Model, 74 -- 7.2.3 Role-Based Access Control, 74 -- 7.2.4 HL7 v3 and SNOMED CT, 75 -- 7.2.5 HL7 v3 and Service-Oriented Architecture (SOA), 75 -- 7.3 HL7 v2.x and v3 Comparison, 75 -- 7.4 Discussion, 75 -- 7.5 Conclusion, 77 -- 8 Clinical Document Standards 81 -- 8.1 Introduction, 81 -- 8.2 Clinical Document Architecture (CDA), 82 -- 8.2.1 Document Structures, 82 -- 8.2.2 Example of CDA Component, 83 -- 8.3 Continuity of Care Document (CCD), 85 -- 8.3.1 Example of CCD Component, 86 -- 8.4 Clinical Document Exchange, 87 -- 8.5 Discussion, 87 -- 8.6 Conclusion, 89 -- 9 Standard for Medical Imaging and Communication 93 -- 9.1 Introduction, 93 -- 9.2 DICOM, 94 -- 9.2.1 Information Model, 94 -- 9.2.2 Message Exchange Model, 96 -- 9.3 Improvements in DICOM Standard, 96 -- 9.4 Discussion, 96 -- 9.5 Conclusion, 100 -- 10 Standard for Patient Health Summary 103 -- 10.1 Introduction, 103 -- 10.2 Continuity of Care Record (CCR), 103 -- 10.2.1 Structural Model, 104 -- 10.2.2 Exchange, 106 -- 10.3 Discussion, 107 -- 10.4 Conclusion, 108 -- PART THREE Coding Systems -- 11 Coding System for Classification of Diseases and Related Health Problems 113 -- 11.1 Introduction, 113 -- 11.2 ICD, 114 -- 11.2.1 Chapters, 114 -- 11.2.2 Blocks, 114 -- 11.3 Improvements in ICD-10, 114 -- 11.4 Discussion, 116 -- 11.5 Conclusion, 116 -- 12 Coding System for Laboratory Tests and Observations 119 -- 12.1 Introduction, 119 -- 12.2 LOINC, 120 -- 12.2.1 Code Classification, 120 -- 12.2.2 Code Structure, 120 -- 12.2.3 Regenstrief LOINC Mapping Assistant (RELMA), 122.

12.3 Discussion, 122 -- 12.4 Conclusion, 123 -- 13 Coding System for Patient Care Procedures 125 -- 13.1 Introduction, 125 -- 13.2 CPT, 126 -- 13.2.1 Data Model, 127 -- 13.2.2 CPT Sections, 128 -- 13.2.3 CPT Index, 128 -- 13.2.4 CPT Symbols, 128 -- 13.2.5 CPT Modifiers, 128 -- 13.2.6 Descriptive Qualifiers, 129 -- 13.3 Discussion, 129 -- 13.4 Conclusion, 130 -- 14 Extended Coding System for Patient Care Procedures 131 -- 14.1 Introduction, 131 -- 14.2 HCPCS, 132 -- 14.2.1 Level I Codes, 132 -- 14.2.2 Level II Codes, 132 -- 14.3 Discussion, 134 -- 14.4 Conclusion, 134 -- 15 Comprehensive Coding System for Clinical Terms 137 -- 15.1 Introduction, 137 -- 15.2 SNOMED CT, 138 -- 15.2.1 Concepts, 138 -- 15.2.2 Structure of SNOMED CT Code, 140 -- 15.3 SNOMED CT Database Browsers, 141 -- 15.4 Discussion, 141 -- 15.5 Conclusion, 142 -- 16 Unified Medical Language System 145 -- 16.1 Introduction, 145 -- 16.2 UMLS-Supported Coding Systems, 146 -- 16.3 UMLS Architecture, 146 -- 16.3.1 Metathesaurus, 146 -- 16.3.2 Semantic Network, 148 -- 16.3.3 Specialist Lexicon and Lexical Tools, 149 -- 16.4 UMLS Licensing, 150 -- 16.5 Discussion, 150 -- 16.6 Conclusion, 151 -- 17 Other Coding Systems 153 -- 17.1 Introduction, 153 -- 17.2 AHFS Drug Information (AHFS DI), 154 -- 17.3 Current Dental Terminology (CDT), 154 -- 17.4 International Classification of Diseases for Oncology (ICD-O), 155 -- 17.5 International Classification of Functioning, Disability and Health (ICF), 155 -- 17.6 Coding Systems for Nursing Practices, 156 -- 17.6.1 North American Nursing Diagnosis Association (NANDA), 156 -- 17.6.2 Nursing Interventions Classification (NIC), 156 -- 17.6.3 Nursing Outcomes Classification (NOC), 156 -- 17.7 Radiology Lexicon (RADLEX), 157 -- 17.8 RxNorm, 157 -- 17.9 Discussion, 157 -- 17.10 Conclusion, 158 -- PART FOUR Standard Frameworks -- 18 openEHR 163 -- 18.1 Introduction, 163 -- 18.2 openEHR Process Model, 164 -- 18.3 openEHR Architecture, 166 -- 18.3.1 EHR Information Model, 168 -- 18.3.2 Exchange, 170.

18.4 Discussion, 170 -- 18.5 Conclusion, 172 -- 19 Integrating the Healthcare Enterprise (IHE) 175 -- 19.1 Introduction, 175 -- 19.2 IHE Domains, 176 -- 19.2.1 Integration Profiles, 176 -- 19.2.2 Integration Statements, 179 -- 19.2.3 Technical Frameworks, 179 -- 19.3 IHE Initiatives on Electronic Health Record, 180 -- 19.4 Exchange, 180 -- 19.4.1 Cross-Enterprise Document Sharing (XDS), 180 -- 19.5 Security, 181 -- 19.5.1 Audit Trail & Node Authentication (ATNA), 181 -- 19.6 Discussion, 182 -- 19.7 Conclusion, 183 -- PART FIVE Case Studies: National EHR Efforts -- 20 Australia's HealthConnect 189 -- 20.1 Introduction, 189 -- 20.2 Overview, 190 -- 20.3 Architecture, 190 -- 20.3.1 EHR Concept, 190 -- 20.3.2 EHR Design, 191 -- 20.3.3 e-Health Services, 193 -- 20.3.4 National Privacy Principles (NPP), 194 -- 20.3.5 Exchange, 194 -- 20.4 Discussion, 195 -- 20.5 Conclusion, 196 -- 21 Austria's ELGA 199 -- 21.1 Introduction, 199 -- 21.2 Overview, 200 -- 21.3 Architecture, 200 -- 21.3.1 Master Patient Index, 201 -- 21.3.2 HSP Index, 201 -- 21.3.3 Authorization System, 202 -- 21.3.4 HSP System, 202 -- 21.3.5 Storage (Document Registry), 202 -- 21.3.6 Network, 202 -- 21.3.7 ELGA Portal, 203 -- 21.4 Functional Implementation, 203 -- 21.4.1 Healthcare Services, 205 -- 21.5 Exchange, 205 -- 21.6 Discussion, 205 -- 21.7 Conclusion, 207 -- 22 Canada's EHRS Blueprint 211 -- 22.1 Introduction, 211 -- 22.2 Overview, 211 -- 22.3 Architecture, 212 -- 22.3.1 Electronic Health Record Solution (EHRS), 212 -- 22.3.2 Electronic Health Record Infostructure (EHRi), 213 -- 22.3.3 Exchange, 216 -- 22.3.4 Legal Framework, 217 -- 22.4 Discussion, 217 -- 22.5 Conclusion, 219 -- Bibliography, 219 -- 23 Denmark's MedCom 221 -- 23.1 Introduction, 221 -- 23.2 Overview, 221 -- 23.3 Architecture, 222 -- 23.3.1 EHR Concept, 222 -- 23.3.2 EHR Design, 223 -- 23.3.3 Danish Health Data Network, 223 -- 23.3.4 Security Infrastructure, 224 -- 23.3.5 National Health Portal (Sundheds.dk), 224 -- 23.3.6 Exchange, 225.

23.4 Discussion, 225 -- 23.5 Conclusion, 226 -- 24 Hong Kong's eHR Sharing System 229 -- 24.1 Introduction, 229 -- 24.2 Overview, 229 -- 24.3 Architecture, 230 -- 24.3.1 E-Health Engagement Initiative (EEI), 230 -- 24.3.2 eHR Sharing System, 231 -- 24.3.3 Exchange, 233 -- 24.3.4 Security/Privacy Guidelines, 233 -- 24.4 Discussion, 234 -- 24.5 Conclusion, 235 -- 25 India's Health IT Initiatives 239 -- 25.1 Introduction, 239 -- 25.2 Overview, 240 -- 25.3 ITIH Framework, 240 -- 25.4 Recommendations on Guidelines, Standards, and Practices for Telemedicine in India, 242 -- 25.5 iHIND, 244 -- 25.5.1 Architecture, 245 -- 25.5.2 Confidentiality, Access, and Security, 246 -- 25.5.3 Standards, 246 -- 25.6 Other Initiatives, 247 -- 25.6.1 Integrated Disease Surveillance Project, 247 -- 25.6.2 National Rural Telemedicine Network (NRTN), 247 -- 25.6.3 National Medical College Network, 248 -- 25.6.4 Standardization of EHR, 248 -- 25.7 Discussion, 249 -- 25.8 Conclusion, 251 -- 26 Netherlands' AORTA 253 -- 26.1 Introduction, 253 -- 26.2 Overview, 253 -- 26.3 Architecture, 254 -- 26.3.1 Dutch Electronic Patient Dossier (EPD) System, 254 -- 26.3.2 NICTIZ Healthcare IT Infrastructure Workflow, 255 -- 26.3.3 Exchange, 256 -- 26.3.4 Security/Privacy Guidelines, 256 -- 26.4 Discussion, 256 -- 26.5 Conclusion, 257 -- 27 Singapore's NEHR 259 -- 27.1 Introduction, 259 -- 27.2 Overview, 259 -- 27.3 Architecture, 260 -- 27.3.1 Health Clusters, 260 -- 27.3.2 EMR Exchange (EMRX), 260 -- 27.3.3 National Electronic Health Record (NEHR), 261 -- 27.4 Discussion, 263 -- 27.5 Conclusion, 264 -- 28 Sweden's NPO 267 -- 28.1 Introduction, 267 -- 28.2 Overview, 268 -- 28.3 Architecture, 269 -- 28.3.1 Clinical Process Model, 269 -- 28.3.2 Information Model, 270 -- 28.3.3 Sjunet, 271 -- 28.3.4 Electronic Catalog For Health and Social Care, 271 -- 28.3.5 Secure it in Health Services, 271 -- 28.3.6 Basic Services for Information, 271 -- 28.3.7 Regulatory Framework for Information Interoperability in Healthcare, 272.

28.3.8 National Patient Summary, 273 -- 28.4 Discussion, 273 -- 28.5 Conclusion, 274 -- 29 Taiwan's Health Information Network 277 -- 29.1 Introduction, 277 -- 29.2 Overview, 278 -- 29.3 Architecture, 278 -- 29.3.1 National Health Information Network (HIN) 2.0, 279 -- 29.4 Exchange, 280 -- 29.4.1 TMT Standard, 280 -- 29.5 Discussion, 282 -- 29.6 Conclusion, 284 -- 30 United Kingdom's Spine 287 -- 30.1 Introduction, 287 -- 30.2 Overview, 287 -- 30.3 Architecture, 288 -- 30.3.1 Spine Infrastructure, 288 -- 30.3.2 Structure of Summary Care Record, 290 -- 30.3.3 Content of Summary Care Record, 290 -- 30.3.4 Security Infrastructure, 291 -- 30.3.5 Exchange, 292 -- 30.4 Discussion, 292 -- 30.5 Conclusion, 294 -- 31 USA's EHR Meaningful Use 295 -- 31.1 Introduction, 295 -- 31.2 Overview, 296 -- 31.3 EHR Meaningful Use, 296 -- 31.3.1 Requirement Specifications, 297 -- 31.4 National Health Information Network (NHIN), 301 -- 31.4.1 NHIN Architecture, 301 -- 31.4.2 Exchange Services, 303 -- 31.4.3 Transaction Profiles, 303 -- 31.4.4 Authorization Framework, 304 -- 31.4.5 NHIN Trial Project, 304 -- 31.4.6 NHIN Direct Project, 304 -- 31.5 Discussion, 304 -- 31.6 Conclusion, 307 -- PART SIX Findings and Conclusion -- 32 Findings and Conclusion 313 -- 32.1 EHR Standards, 313 -- 32.2 Coding Systems, 317 -- 32.3 Standard Frameworks, 318 -- 32.4 Case Studies: National EHR Efforts, 319 -- 32.4.1 Quantitative Assessment, 320 -- 32.4.2 Qualitative Assessment, 324 -- 32.5 Recommended Phases for Implementing A National EHR System, 325 -- Glossary 327 -- Index 339.