title: Design and development of an international clinical data exchange system: the international layer function of the Dolphin Project.
abstract: OBJECTIVE
  At present, most clinical data are exchanged between organizations within a regional system. However, people traveling abroad may need to visit a hospital, which would make international exchange of clinical data very useful.
  
  
  BACKGROUND
  Since 2007, a collaborative effort to achieve clinical data sharing has been carried out at Zhejiang University in China and Kyoto University and Miyazaki University in Japan; each is running a regional clinical information center. Methods An international layer system named Global Dolphin was constructed with several key services, sharing patients' health information between countries using a medical markup language (MML). The system was piloted with 39 test patients.
  
  
  RESULTS
  The three regions above have records for 966,000 unique patients, which are available through Global Dolphin. Data exchanged successfully from Japan to China for the 39 study patients include 1001 MML files and 152 images. The MML files contained 197 free text-type paragraphs that needed human translation. Discussion The pilot test in Global Dolphin demonstrates that patient information can be shared across countries through international health data exchange. To achieve cross-border sharing of clinical data, some key issues had to be addressed: establishment of a super directory service across countries; data transformation; and unique one-language translation. Privacy protection was also taken into account. The system is now ready for live use.
  
  
  CONCLUSIONS
  The project demonstrates a means of achieving worldwide accessibility of medical data, by which the integrity and continuity of patients' health information can be maintained.
authors.affiliation: Healthcare Informatics Engineering Research Center, Zhejiang University, Hangzhou, China. ljs@zju.edu.cn
authors.forename: Jing-song
authors.initials: JS
authors.lastname: Li
authors.forename: Tian-shu
authors.initials: TS
authors.lastname: Zhou
authors.forename: Jian
authors.initials: J
authors.lastname: Chu
authors.forename: Kenji
authors.initials: K
authors.lastname: Araki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshihara
mesh_terms: D002681:China; D016494:Computer Security; D057286:Electronic Health Records / Q000458:organization & administration*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007391:International Cooperation; D007564:Japan; D008498:Medical Record Linkage / Q000379:methods*; D009323:Natural Language Processing; D011381:Programming Languages; D012015:Reference Standards; D018511:Systems Integration; D014175:Translating; D014584:User-Computer Interface