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Pulsing together

The healthcare industry has yet to fix data standards. It is more a question of standards for various uses than that of an overlap.

CORBAmed (an OMG working group) has issued a Patient Identification Standard (PIDS) that can be used to serve demographic information. Demographic information relates to the patient's name, social security number, medical record number, insurance policy number, birth date, sex and chart details.

CORBAmed is also trying to provide access to clinical data through a request for proposal (RFP) on Clinical Observations Access Service, as well as an RFP outstanding that seeks proposals to manage access control. Another RFP is in the development stage to manage the transcription process.

CORBAmed is based on the Common Object Request Broker Architecture (CORBA) distributed object model. It provides scalable infrastructure for a distributed object model of computing. The CORBAmed domain task force has to develop standards for the ``busine ss objects'' for healthcare.

By viewing a set of hosts as a network of distributed, communicating ``objects'', clients are able to obtain processed information over an enterprise-scale network. In the long run, hosts may use each other's distributed object services to provide inform ation on demand, thus providing an alternative to the exchange of HL7 messages. However, CORBAmed will best be used in client-server communications. By providing an object-oriented view of clinical information, CORBAmed allows hosts to ``protect'' their data by exposing only specific ``methods'' to clients.

Clients can rely on CORBA hosts to provide information on demand and need not keep duplicates of information in local storage, eliminating problems of freshness and authenticity which are inherent in message exchanges. CORBA standards are platform and la nguage neutral, which is a key requirement for any large-scale client-server integration effort.

HL7 is a messaging standard which is used to exchange healthcare related information via a coded textual message. The messages may be sent ad hoc, eg, based on certain trigger events in the sending system, or may be sent in response to a query (however, the latter mode is not well supported at present). HL7 has been criticised for the lack of an information model to standardise the semantics of the information being exchanged. This has been rectified in version 3.0.

In addition, real-world HL7 experience will be used to define clinical observation information to be exchanged via the forthcoming CORBAmed Clinical Observation Access Service (COAS). The COAS, request for proposal (RFP) mandates that existing standards (including HL7, DICOM, MIB and others) be looked at for definitions of the information to be exchanged. Further, CORBAmed has an active working group looking at inter-operability with HL7.

HTML/XML: XML stands for extensible markup language. It is a universal language in a network's middleware layer, the conduit that ties together distributed applications with software components based on CORBA (Component Object Request Broker Architecture ), COM (Common Object Model) and Enterprise Java.

The healthcare industry has yet to resolve the problem of data confusion. Applications built for legacy mainframe, Unix, NT or Linux systems all define data in patient records, financial statements and insurance forms differently. As expansions and merge rs reshuffle IT infrastructures of large healthcare organisations, there must be a common ground for defining data so that old and new applications can communicate with each other.

Universal pipeline

Healthcare-savvy application developers and integrators find XML particularly appealing. Healthcare providers could eventually use similar Web-based systems for insurance eligibility checks, claims processing and clinical referrals. The tools that were u sed before XML came in to vogue were data-interchange standards such as network file system (NFS) or ANSI X.12.

XML's data definitions are simpler and more universal than existing specifications such as standard generalised mark-up language (SGML) or the proprietary specifications used in electronic data interchange (EDI) networks. Thus, developers and systems int egrators have a simple guidebook for, say, labeling ``penicillin'' as an adverse-reaction drug in the field ``allergies,'' so patient records in a hospital database and the Web browser in a pharmacy both know where to store the data.

XML also works with existing Web standards. Hypertext markup language (HTML) determines how data is displayed on screen. The data passes from the Web to a variety of hardware that connect to the network via TCP/IP. XML labels incoming data so any applica tion knows how to handle it. Because XML can exchange data among different computing platforms it helps solve the inter-operability problems of middleware: Getting various back-end systems that use CORBA or COM components to work together.

The component technologies described in this article are being standardised through various organisations in the US.

Conclusion

Thus, many ``flavours'' or interpretations of the standard exist today. The problems with standards are that there are so many! This has led many healthcare IT professionals to view standards with some skepticism. However, there is not a great deal of ov erlap among these standards, and development try to make use of the best features of existing standards, rather than compete with them.

While it is true that the many standards activities within the healthcare arena are not perfectly aligned, they are generally not competitive. Healthcare IT professionals are not faced with a choice of standards, but a set of standards to use in differen t circumstances. HL7 will continue to dominate in the host world, although CORBA could play a role, particularly where the retention of data ownership rights is an issue. CORBAmed should provide the standards for client-host computing, as CORBA middlewar e is robust and proven in enterprise-scale applications.

DICOM should provide the model for observational reporting as well as the representation for medical image data, particularly for primary diagnosis. ASTM on healthcare applications standards, ASC X12 on billing standards, and various organisations on cod ing and vocabulary standards.

Users should insist that they continue to co-operate toward greater re-use and inter-operability.

Healthcare IT can be run by those who have gained experience and success in non-healthcare IT, where IT experts learned to use IT to support organisational goals. The future path to management advancement in healthcare may be through enterprise IT.

Concluded

Contributed by Orleans Healthcare, orleans_healthcare@usa.net.

This is the second and concluding part of the article When you plug in, are you on? which appeared in eWorld dated October 18.

(Please e-mail us at bleditor@thehindu.co.in if you have queries on computer usage or if you find an interesting way of using a computer.)