October 11, 2018
Most of us don't think a lot about data formats. As long as we can open the files we need, we're satisfied. But when documents contain structured information, they have extra value.
Software can reliably extract information from them and tell what it is. For instance, a medical record with clearly identified "name" and "date of birth" fields lets software pull those pieces of information out without making mistakes. Getting the same information out of a free-form document requires data mining, and it's prone to mistakes.
Often, though, such formats are proprietary. They work fine with the software they're designed for, but applications to read them for any other purpose don't exist, or they aren't entirely reliable. This locks the users into one application. If a medical office sends records to a specialist, the recipient might not be able to use them. Delays happen while the office figures out how to send the information in a usable format. Very often, printed records or their electronic equivalent (e.g., PDF files) are the only method of communication that works.
Health data on a patient usually comprises multiple records from different sources. When these are all in different formats, the problem gets even worse. Important information may get lost or inadvertently altered in the effort to merge them all.
The transmission of health information needs to follow strict privacy and security requirements, so data transfer methods also are often proprietary. Interoperability needs to cover not only how the information is encoded but how it is sent.
Resolving a babel of health records
Electronic Health Records (EHR) have gained wide adoption for transmitting patient information. However, there is no one format for EHRs. Vendors each devise their own software and format, locking providers into their product. We can't expect them all to adopt a common format in the near future. The path to interoperability has to be a format which can be translated to and from as many of these formats as possible — an interchange format.
It has to be one that has broad support, otherwise it's just one more to add to the confusion. It has to be built on well-established standards. We support these standards in our software.
The DICOM standard supports interoperability in medical imaging. It's used in nearly all hospitals all over the world. It includes definitions for specific medical applications, such as CT scans. The standard is updated every two months but remains backward compatible.
HL7 is an organization which aims at providing standards for the exchange and sharing of electronic health information. The HL7 V3 standard, released in 2005, builds on the well-established XML syntax. Several countries use its standards on a national level. HL7 and DICOM have a joint working group for integration of the two standards.
Faster acquisition, better outcomes
The faster a health provider receives full information on a patient, the faster it can begin appropriate treatment. The more accurately it's conveyed, the less chance there is of a harmful mistake. Paper records are slower to get to where they're needed, and they're subject to copying errors. Merging a set of disparate records from different sources takes time and is likewise error-prone.
For the sake of patients, interoperability of records is a vitally important goal. Its lack has been implicated in cases of serious harm to patients, resulting in lawsuits. Erroneous data transcription, delays in delivering supplies, and misrouted information have been a few of the factors involved.
Having medical information in a consistent format, delivered using secure protocols, allows delivery in a form that software will handle correctly, without going through intermediate conversions. Patients experience better outcomes, and healthcare providers work more efficiently.