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Workshop on Standardization in E-Health
Geneva, 23-25 May 2003


Towards standards for management and transmission of medical data in web technology
Dr. Francesco Sicurello
President @ITIM – Italian Association of Telemedicine and Medical Informatics (Italy)
Medical Informatics Unit, CNR-Institute of Biomedical Technology, Milan
Health Directorate, Lombardia Region – Research and Innovation Office

Medical record consists in a set of patient health information, related to therapeutical and diagnostic processes of care. It is a clinical history of patient, useful to improve quality of life, to exchange knowledge among physicians and for epidemiological and health surveillance of population risk groups.

The medical record is made up of medical information concerning the process of diagnosis and care of a patient; these data are collected during hospitalization or ambulatory visits. It sets up the medical history of each patient and is useful for the physician as a support and as a communication-documentation instrument, for statistical and epidemiological research.

For a better management of patient care, the Electronic Patient Record (EPR) or Electronic Medical Record (EMR) must be complete as possible, containing also biomedical signals and images, video, etc. This constitutes the Multimedia Medical Record (MMR).

The standardization of medical records can also allow generation of basic healthcare statistics (frequency among patients of one or more conditions, duration of stay in hospital, use of particular drug, inserting in a experimental protocol) as well as more sophisticated tests. It should also be interactive to allow hypothesis testing and generation.

The process of medical record standardization can be composed of the following phases:

  • structure analysis of medical records;
  • random retrieval and review of records of cases;
  • comparison of the results among the different records;
  • recording of data from new cases using a common record format.

The development of Multimedia Medical Record and heterogeneous data bases makes difficult the sharing of clinical information due to the difference of software platforms, data bases structures and connection between the location of the medical data. Moreover, there is the necessity of a common global communication standard. For example, DICOM (Digital Imaging and Communication in Medicine) is a standard model for images transfer (associated with clinical/diagnostic information), so that the images could be managed by a "multivendor" platforms system.

Another standard for communication in the frame of Health Information Systems is HL7 (Health Level 7), This standard was created with the aim to exchange electronic data between health structures and different information systems. So that, the HL7 document is a basis of an EMR/EPR document-oriented.

Diffusion of Internet and web technology, also in healthcare systems and intra/extranet architecture make necessary to rewrite medical records using new tools for database in web environment. HTML is not sufficient in solving the problems related to medical information transmission. HTML is based on data presentation (data form) and not on the data contents, in this way the doctor can consult a list of data but it is not possible to send them to another doctor or to make a "cut and paste" on his data base.

With the use of SGML (Standardized General Markup Language, standard ISO 8879:1986) and XML (eXtensible Markup Language) it is possible now to solve this problem, making a standardization of the information exchanged and not of the data format.

Developing MMR using XML can favourite diffusion of telemedicine, using Internet services, with strong reduction of costs.

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