Evaluation Of CityEHR Toolkit Through Development Of An Open ...

Naveed Dogar
2.0 Literature review
2.5 Open standards for clinical data
‘A standard is a document, established by consensus and approved by a recognised
body, that provides for common and repeated use, rules, guidelines or
characteristics for activities or their results, aimed at achievement of the optimum
degree of order in a given context’[22]. This definition is provided by ISO
(International Standardisation Organisation), a body in charge of collaborating
international standards.
Another standards development organisation defines open standards as
standards that are ‘made available to the general public and are developed (or
approved) and maintained via a collaborative and consensus driven process. Open
Standards facilitate interoperability and data exchange among different products
or services and are intended for widespread adoption’[26]. Open standards have to
be made available for implementation on royalty free bases[27].
2.5.1 ISO standards
ISO established the Health Informatics committee (ISO TC215) in 1999 with the
aim to ratify and approve standards such as HL7 (Health Level 7) and RIM
(Reference Integration Model). The ISO website defines the TC215 scope to
‘promote interoperability between independent systems, to enable compatibility
and consistency for health information and data, as well as to reduce duplication of
effort and redundancies’ in health informatics[28]. Creating customised and
interoperable EHR systems requires one to use such standards. Abiding to these
standards also provides the ability to share success. If a successful EHR system has
been implemented in an acute department, it can be deployed by others with
minimal effort. Toolkits such as the CityEHR provide functionality to easily
personalise an existing standards based system. The ISO also provides specific
standards for electronic health record communications - the ISO 13606s. There are
five subsets of 13606 and they refer to the:
Reference model (ISO 13606-1)
Archetype interchange specification (ISO 13606-2)
Reference archetypes and term lists (ISO 13606-3)
Security (ISO 13606-4)
Interface specification (ISO 13606-5)
The most relevant to this project is the ISO 13606-1:2008 standard, the one
specifying the reference model. The objective of this project is to develop an EHR
system using open standards, and then evaluates its success based on the
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