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      Developing a Common Health Information Exchange Platform to Implement a Nationwide Health Information Network in South Korea

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          Abstract

          Objectives

          We aimed to develop a common health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea.

          Methods

          By exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements.

          Results

          As the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies.

          Conclusions

          We expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.

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          Most cited references14

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          HL7 Clinical Document Architecture, Release 2.

          Clinical Document Architecture, Release One (CDA R1), became an American National Standards Institute (ANSI)-approved HL7 Standard in November 2000, representing the first specification derived from the Health Level 7 (HL7) Reference Information Model (RIM). CDA, Release Two (CDA R2), became an ANSI-approved HL7 Standard in May 2005 and is the subject of this article, where the focus is primarily on how the standard has evolved since CDA R1, particularly in the area of semantic representation of clinical events. CDA is a document markup standard that specifies the structure and semantics of a clinical document (such as a discharge summary or progress note) for the purpose of exchange. A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content. It can be transferred within a message and can exist independently, outside the transferring message. CDA documents are encoded in Extensible Markup Language (XML), and they derive their machine processable meaning from the RIM, coupled with terminology. The CDA R2 model is richly expressive, enabling the formal representation of clinical statements (such as observations, medication administrations, and adverse events) such that they can be interpreted and acted upon by a computer. On the other hand, CDA R2 offers a low bar for adoption, providing a mechanism for simply wrapping a non-XML document with the CDA header or for creating a document with a structured header and sections containing only narrative content. The intent is to facilitate widespread adoption, while providing a mechanism for incremental semantic interoperability.
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            Health information exchange: persistent challenges and new strategies.

            Recent federal policies and actions support the adoption of health information exchange (HIE) in order to improve healthcare by addressing fragmented personal health information. However, concerted efforts at facilitating HIE have existed for over two decades in this country. The lessons of these experiences include a recurrence of barriers and challenges beyond those associated with technology. Without new strategies, the current support and methods of facilitating HIE may not address these barriers.
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              Health information exchange and patient safety.

              One of the most promising advantages for health information exchange (HIE) is improved patient safety. Up to 18% of the patient safety errors generally and as many as 70% of adverse drug events could be eliminated if the right information about the right patient is available at the right time. Health information exchange makes this possible. Here we present an overview of six different ways in which HIE can improve patient safety-improved medication information processing, improved laboratory information processing, improved radiology information processing, improved communication among providers, improved communication between patients and providers, and improved public health information processing. Within the area of improved medication information processing we discuss drug-allergy information processing, drug-dose information processing, drug-drug information processing, drug-diagnosis information processing, and drug-gene information processing. We also briefly discuss HIE and decreased patient safety as well as standards and completeness of information for HIE and patient safety.
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                Author and article information

                Journal
                Healthc Inform Res
                Healthc Inform Res
                HIR
                Healthcare Informatics Research
                Korean Society of Medical Informatics
                2093-3681
                2093-369X
                January 2015
                31 January 2015
                : 21
                : 1
                : 21-29
                Affiliations
                [1 ]R&D Center, ezCaretech Co. Ltd., Seoul, Korea.
                [2 ]Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea.
                [3 ]IT Convergence Policy Team, National IT Industry Promotion Agency, Seoul, Korea.
                Author notes
                Corresponding Author: Sooyoung Yoo, PhD. Center for Medical Informatics, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. Tel: +82-31-787-1151, Fax: +82-31-787-4004, yoosoo0@ 123456snu.ac.kr
                Article
                10.4258/hir.2015.21.1.21
                4330195
                25705554
                b48760a2-ff95-4138-ad00-ecdeed4f2bc4
                © 2015 The Korean Society of Medical Informatics

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 December 2014
                : 26 January 2015
                : 26 January 2015
                Funding
                Funded by: MSIP
                Award ID: I0114-14-1016
                Categories
                Original Article

                Bioinformatics & Computational biology
                health information exchange,electronic health records,health level seven,computer system,data security

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