Cross-institutional data exchange using the clinical document architecture (CDA).
OBJECTIVE
Although electronic communication of clinical data between various actors in the healthcare domain seems crucial for a cost-effective patient treatment, it is mostly restricted to paper based documents. In order to meet the growing need for improved data communication, it is necessary to overcome the barriers of software heterogeneity and lack of standards, especially in cross-institutional shared care communication. HL7's clinical document architecture (CDA) is a new and promising tool to exchange any clinical document. In this paper we show how CDA can be used to (1) share electronic discharge letters and other clinical data generated and stored in the hospitals electronic patient record (EPR) with general practitioners and (2) to transfer these clinical data to a personal electronic health record (EHR). The latter scenario is in routine use. Ease-of-use and data security and integrity were the main design principles in both scenarios.


METHODS
Within the electronic patient record a data extraction and exporting mechanism has been built. For both scenarios appropriate data processing and transmission methods have been developed, and the receiving information systems have been prepared for the CDA based data input.


RESULTS
Although there still remain technical and organizational issues to be solved, this is a promising method in order to enhance data exchange between hospital and primary care and to move towards an electronic patient record (EPR) and an electronic health record (EHR) crossing institutional borders. This paper describes the design and current implementation and discusses our experiences.
Müller
Marcel Lucas
ML
Department of Dermatology, University Hospital of Freiburg, Hauptstreet 7, 79104 Freiburg, Germany. Marcel.Mueller@uniklinik-freiburg.de
Uckert
Frank
F
Bürkle
Thomas
T
Prokosch
Hans-Ulrich
HU
D005858:Germany; D058016:Health Facility Administration; D008498:Medical Record Linkage; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D018511:Systems Integration