Clinical Document Engineering offers solutions and services for all the phases of the clinical document life cycle
By Jaime Delgado Universitat Politècnica de Catalunya (UPC) & Clinical Document Engineering (CDE)
Many systems have been developed and are in place to manage health information. Some of these Healthcare Information Systems (HIS) follow standards in their document structure and communications protocols, but many do not. In fact, they are mostly proprietary and do not interoperate.
Standards are key for interoperability. HL7 International (www.hl7.org), a Standards Developing Organization (SDO) in the healthcare area, to which nearly all worldwide actors in the healthcare industry belong, has made significant efforts for the standardization of healthcare information systems, including the Clinical Document Architecture (CDA).
"Standards are key for interoperability of the Healthcare Information Systems (HIS)"
However, even though these standards are well accepted, there is still a lot to do to be able to take the maximum benefit of clinical documents.
The use of proprietary software systems limits the possibilities to share documents between and inside organizations. Using software that support standards, such as the mentioned HL7 CDA (also ISO 27932), may help in improving the situation. But this is not the only problem.
When patients move from one hospital to another, or when healthcare professionals work in different points of care, there is a need to access to patients’ information from as many different devices as possible. In addition, this needs to be done taking into account privacy of patients, which could imply the possibility of defining flexible privacy rules to guarantee it.
Secure and controlled access, however, is not enough to fulfil current healthcare information protection requirements, since healthcare information should be also stored in a secure way.
Clinical Document Engineering
OpenCDE is provided by Clinical Document Engineering (clinicaldocumentengineering.com), a company that offers solutions and services for all the phases of the clinical document life cycle. OpenCDE goes one step forward to solve the issues just presented, and a few more. It provides digital archiving services, custody, and access to structured clinical documents in a secure and confidential manner, using the only globally accepted standard in this regard, HL7 CDA (ISO 27932).
The main element of OpenCDE is the DACS, a secure clinical documents repository in the cloud for a specific healthcare organization
Using international standards such as HL7 CDA, it is possible to offer solutions that are independent of any information system (“Vendor Neutral Archive”, VNA), solving in this way the current problem of many different and incompatible HIS and related software. OpenCDE helps structuring clinical documents to be compliant with the HL7 CDA standard, starting from plain documents provided by healthcare organizations' systems. In any case, healthcare organizations do not need to withdraw their HIS to use OpenCDE. The main element of OpenCDE is the DACS (Document Archiving and Communication System), a secure clinical documents repository in the cloud for a specific healthcare organization.
As previously indicated, security (and also continuous availability) is essential to what refers to patients’ information. OpenCDE focus on providing this, while keeping a quick access to the relevant clinical information. Digital protection is implemented over all documents in all storage, access and processing phases.
Protection of patient’s privacy
It is worth mentioning the innovative approach to the protection of patient’s privacy. With OpenCDE, patients, healthcare professionals and/or organizations may define their own privacy rules at the granularity level they prefer. In addition, rules may be defined according to “roles” (family doctor, specialty, emergencies doctor, etc.). Nevertheless, there is always the possibility of medical organizations defining simple template policies to which patients adhere. With this approach of defining privacy rules, patients can verify that the specified policies are enforced. In addition, confidentially, integrity and availability requirements are met by enforcing the specified privacy rules. Information encryption enhances the security of the whole system. Again, the implementation of all these privacy and security functions is done using relevant international standards.
Access to the information in the DACS could be done with the CDE Finder, which may run in a web application or in a mobile device. This highly improves the access possibilities. Examples of use cases where this is an advantage could be patient’s medical care in the location of an accident, or patients accessing their records when visiting different healthcare professionals. It is then possible to gather the possibly scattered documents of a patient (under the custody of more than one organization). The CDE Finder may provide also a consolidated view of the time series of clinical documents.
Finally yet importantly, having shared authorized access to all patients’ documents (orders, reports, consultations, authorizations, etc.) helps getting better clinical decisions, and, therefore, improving the continuity of care and patient’s quality of life.