Pediatric Informatics: Computer Applications in Child Health (Health ...

418 S.T. Rosenbloom and J. Kuhl
Armed with this information, developers, and users can judge whether a given EHR
system conforms to these standards, and therefore meets the minimum need for
pediatrics providers. Likewise, the Health Level 7 (HL7) Electronic Health Record
System Functional Model standard includes many of the important pediatricspecific
functions identified by the AAP and the HL7 Pediatric Data Special
Interest Group (HL7 PeDSSIG). 11
32.2.2 Syntactic Standards
Standards exist to define the technical formatting of clinical data produced by EHR
systems. Formatting standards, herein called syntactic standards, describe the specific
method for notating the clinical data such that computer systems can properly
identify and use it. Syntactic standards specify how data is packaged, including
the sequence that information is encoded, the specific character codes that delimit
data fields and how data are contained among the computer character codes
(e.g., whether a field is between the characters ‘’ or ‘{’ and ‘}’). Syntactic
standards can be thought of as a specification for the size, shape, and color of an
envelope a person may use for mailing a letter, the color and type of ink used to
write the letter, and the placement of the address and the greeting line on the page,
while the prose itself may be written in any language.
A commonly used syntactic standard is the eXtensible Markup Language
(XML), a method designed to describe data and text. 12–14 In particular, XML specifies
a method for marking up text with specific character delimiters and for describing
text in a way that allows for both human- and machine-readability. In addition,
XML allows for the relationships among different pieces of data to be indicated,
including which data elements are more or less specific forms of other data elements
(e.g., that the medication “metoclopromide” is available in the form, “oral
tablets 10 mg”) and attributes that modify a given data element (e.g., a medication
may have attributes defining the dose, the frequency, the duration and how much
should be dispensed). A sample of data describing a prescription for metoclopromide
marked up using XML is presented in Fig. 32.1.
32.2.3 Semantic Standards
For clinical information to be shared among and used by different EHR systems,
there must be a standardized method for describing it. 15 Semantic standards define
and name the concepts that underlie clinical information and entities. 16 They ensure
that the words used to describe something are consistent, regardless of where or in
which EHR system it is described. For example, a patient’s weight may be documented
in an EHR system and called “weight.” However, the same weight may be
documented as “Weight,” “patient weight,” “dosing weight,” “dry weight,” “birth