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136 © 2006 IMIA and Schattauer GmbH

Electronic Health Record Standards
D. Kalra CHIME, University College London, London, United Kingdom

Objectives:This paper seeks to provide an overview of the initiatives that are proceeding internationally to develop standards for the exchange of electronic health record (EHR) information between EHR systems. Methods:The paper reviews the clinical and ethico-legal requirements and research background on the representation and communication of EHR data, which primarily originates from Europe through a series of EU funded Health Telematics projects over the past thirteen years. The major concepts that underpin the information models and knowledge models are summarised. These provide the requirements and the best evidential basis from which HER communications standards should be developed. Results: The main focus of EHR communications standardisation is presently occurring at a European level, through the Committee for European Normalisation (CEN). The major constructs of the CEN 13606 model are outlined. Complementary activity is taking place in ISO and in HL7, and some of these efforts are also summarised. Conclusion: There is a strong prospect that a generic EHR interoperability standard can be agreed at a European (and hopefully international) level. Parts of the challenge of EHR interoperability cannot yet be standardised, because good solutions to the preservation of clinical meaning across heterogeneous systems remain to be explored. Further research and empirical projects are therefore also needed. Haux R, Kulikowski C, editors. IMIA Yearbook of Medical Informatics 2006. Methods Inf Med 2006; 45 Suppl 1: S13644. Electronic health records, interoperability, standardisation, information model

Summary

Introduction
Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multimedia entries. A longitudinal person-centred electronic health record (EHR) is a muchanticipated solution to this problem, but the challenge of providing clinicians of any profession or speciality with an integrated and relevant view of the complete health and health care history of each patient under their care has so far proved difficult to meet. This need is now widely recognised to be a major obstacle to the safe and effective delivery of health services, by clinical professions, by health service organisations and by governments internationally. From an academic vision in the late 1980’s the Electronic Health Record (EHR) has evolved to become centre-stage in the national health informatics strategies of most European countries, and internationally [1-4]. International research over the past fifteen years has highlighted the clinical, ethical and technical requirements that need to be met in order to effect this transition. There is a need for interoperability standards meeting these requirements that can permit clinical computer systems to share health record data whilst preserving faithfully the clinical meaning of the individual authored contributions within it. Concerns about protecting the confidentiality of sensitive personal information must also be addressed if consumer confidence is to be maintained when EHRs are widely accessible.

This paper summarises the key EHR standards that are presently being developed to meet these requirements.

The Need for Generic and Interoperable EHRs
Patient care increasingly requires clinical practitioners to access detailed and complete health records in order to manage the safe and effective delivery of complex and knowledge-intensive health care, and to share this information within and between care teams [5]. Patients nowadays also require access to their own EHR to an extent that permits them to play an active role in their health management....
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