Definition and Scope Electronic medical record

Departmental EMR Inter-departmental EMR Hospital EMR Inter-hospital EMR

Electronic patient record Computerised patient record Electronic health care record Electronic client record Virtual EHR Personal health record Digital medical record Clinical data repository Computerised medical record Population health record

Definition and Scope

The basic–generic EHR The basic–generic definition for the EHR is a

repository of information regarding the health status of a subject of care, in computer processable form.

no assumptions about the health system of any country or region

no assumptions about the type of information in the record

The shareable EHRThe sharing of EHR information can take place

at three different levels :

Level 1Level 2Level 3 = The Integrated Care EHR

Purpose of the EHR(primary)The primary purpose of the EHR is to provide

a documented record of care that supports present and future care by the same or other clinicians.

The primary beneficiaries are the patient and the clinician(s).

Purpose of the EHR(Secondary) medico-legal – evidence of care provided, indication of compliance with

legislation, reflection of the competence of clinicians, quality management – continuous quality improvement studies,

utilisation review, performance monitoring (peer review, clinical audit, outcomes analysis), benchmarking, accreditation,

education – training of clinicians and other health professionals, research – development and evaluation of new diagnostic modalities,

disease prevention measures and treatments, epidemiological studies, population health analysis,

public and population health - access to quality information to enable the effective determination and management of real and potential public health risks.

policy development – health statistics analysis, trends analysis, casemix analysis,

health service management – resource allocation and management, cost management, reports and publications, marketing strategies, enterprise risk management, and

billing/finance/reimbursement – insurers, government agencies, funding bodies.

The key role of interoperabilityThere are two main levels of shareability or

interoperability of information:1.functional interoperability – the ability of

two or more systems to exchange information (so that it is human readable by the receiver)

2.semantic interoperability – the ability for information shared by systems to be understood at the level of formally defined domain concepts (so that information is computer processable by the receiving system).

four pre-requisites of interoperability1. a standardised EHR reference model2. standardised service interface models3. a standardised set of domain-specific

concept models4. standardised terminologies

Standard OrganizationASTM(The American Society for Testing and Materials )CEN/TC251 (Comité Européen de Normalisation

Technical Committee 251 "Health Informatics“)DICOM(Digital Imaging and Communications in Medicine)EBI (European BioInformatics Institute)ETSI (European Telecommunications Standards Institute)HL7(Health Level 7)HIMSS(Healthcare Information and Management

Systems Society)IEEE (Institute of Electrical and Electronics Engineers)ISO/TC215 (International Organisation for Standardization

Technical Committee 215 "Health Informatics" )OASIS (Organisation for the Advancement of

Structured Information Standards)Regenstrief Institute

(Logical Observation Identifiers Names and Codes )

ISO (International Organization for Standardization) is the world's largest developer and publisher of International Standards.

ISO is a non-governmental organization that forms a bridge between the public and private sectors

Founded on 23 February 1947It is headquartered in Geneva, SwitzerlandISO has 157 national members

TC 215 - Health informatics

Standardization in the field of information for health, and Health Information and Communications Technology (ICT) to achieve compatibility and interoperability between independent systems. Also, to ensure compatibility of data for comparative statistical purposes (e.g. classifications), and to reduce duplication of effort and redundancies.

The Evolution of ICT in Health Care

Organizations in liaison CDISC - Clinical Data Interchange Standards

Consortium, Inc.DICOM - Digital Imaging and Communications in

Medicine Standards CommitteeICN - International Council of NursesIHTSDO - International Health Terminology

Standards Development OrganizationIMIA - International Medical Informatics AssociationUNECE - United Nations Economic Commission for

EuropeW3C - World Wide Web ConsortiumWHO - World Health Organization

Subcommittee/Working GroupTC 215/WG 1 Data structure TC 215/WG 2 Data interchange TC 215/WG 3 Semantic content TC 215/WG 4 Security TC 215/WG 5 Health cards TC 215/WG 6 Pharmacy and medicines business TC 215/WG 7 Devices TC 215/WG 8 Business requirements for

Electronic Health Records TC 215/WG 9

ISO TC215 Scope Health

informatics – generally interpreted as ISO/OSI Level 7

Some groups work in Levels 1-6 by reference to other standards.

ISO/OSI Level 7: Application

ISO/OSI Level 6: Presentation

ISO/OSI Level 5: Session

ISO/OSI Level 4: Transport

ISO/OSI Level 3: Network

ISO/OSI Level 2: Datalink

ISO/OSI Level 1: Physical

Thank youhttp:\\tc215.behdasht.gov.irisiri.tc215@behdasht.gov.ir