title: CCR+: Metadata Based Extended Personal Health Record Data Model Interoperable with the ASTM CCR Standard.
abstract: OBJECTIVE
  Extension of the standard model while retaining compliance with it is a challenging issue because there is currently no method for semantically or syntactically verifying an extended data model. A metadata-based extended model, named CCR+, was designed and implemented to achieve interoperability between standard and extended models.
  
  
  METHODS
  Furthermore, a multilayered validation method was devised to validate the standard and extended models. The American Society for Testing and Materials (ASTM) Community Care Record (CCR) standard was selected to evaluate the CCR+ model; two CCR and one CCR+ XML files were evaluated.
  
  
  RESULTS
  In total, 188 metadata were extracted from the ASTM CCR standard; these metadata are semantically interconnected and registered in the metadata registry. An extended-data-model-specific validation file was generated from these metadata. This file can be used in a smartphone application (Health Avatar CCR+) as a part of a multilayered validation. The new CCR+ model was successfully evaluated via a patient-centric exchange scenario involving multiple hospitals, with the results supporting both syntactic and semantic interoperability between the standard CCR and extended, CCR+, model.
  
  
  CONCLUSIONS
  A feasible method for delivering an extended model that complies with the standard model is presented herein. There is a great need to extend static standard models such as the ASTM CCR in various domains: the methods presented here represent an important reference for achieving interoperability between standard and extended models.
authors.affiliation: Department of Biomedical Informatics, Asan Medical Center, Seoul, Korea.
authors.forename: Yu Rang
authors.initials: YR
authors.lastname: Park
authors.affiliation: Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Yoon
authors.affiliation: Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Tae Hun
authors.initials: TH
authors.lastname: Jang
authors.affiliation: Medical Informatics, Graduate School of Public Health, Gachon University of Medicine and Science, Incheon, Korea.
authors.forename: Hwa Jeong
authors.initials: HJ
authors.lastname: Seo
authors.affiliation: Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul, Korea. ; Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
keywords: Interoperability; Metadata; Personal Health Record; Standards