Healthc Inform Res.  2015 Jan;21(1):21-29. 10.4258/hir.2015.21.1.21.

Developing a Common Health Information Exchange Platform to Implement a Nationwide Health Information Network in South Korea

• Lee M
• Heo E
• Lim H
• Lee JY
• Weon S
• Chae H
• Hwang H
• Yoo S

• KMID: 2284594
• DOI: http://doi.org/10.4258/hir.2015.21.1.21

Abstract

OBJECTIVES
We aimed to develop a common health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea.
METHODS
By exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements.
RESULTS
As the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies.
CONCLUSIONS
We expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.

Keyword

Health Information Exchange; Electronic Health Records; Health Level Seven; Computer System; Data Security

MeSH Terms

Computer Security
Computer Systems
Continuity of Patient Care
Delivery of Health Care
Electronic Health Records
Health Level Seven
Humans
Information Services*
Korea
Privacy
Referral and Consultation
Workers' Compensation

Figure

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  Figure 1 Health information exchange architecture models. (A) Integrated Registry - Repository, (B) One Registry - Multiple Repositories, (C) Federated Registry - Multiple Repositories, and (D) Peer-to-Peer. EHR: Electronic Health Record.

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  Figure 2 Architecture for the common health information exchange platform. CDA: Clinical Document Architecture, CRS: Care Record Summary, PIX: Patient Identifier Cross-Referencing, PDQ: Patient Demographics Query, HIE: health information exchange, HIS: hospital information system, API: application programming interface, IHE: Integrating the Healthcare Enterprise, ATNA: Audit Trail and Node Authentication, WCF: Windows Communication Foundation.

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  Figure 3 Health information exchange (HIE) system architecture for exchanges between the workers' compensation (WC) hospitals and clinics. MPI: master patient index, EHR: Electronic Health Record, VPN: virtual private network, DLP: data loss prevention, DMZ: demilitarized zone, SSL: secure sockets layer, IPS: intrusion prevention system.

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  Figure 4 Workflow for exchanging referral and care record summaries among the workers' compensation (WC) hospitals and clinics (A) referral process from a clinic to a WC hospital, (B) generate and access the Care Record Summary (CRS) for the continuity of care. HIE: health information exchange, CDA: Clinical Document Architecture.

Reference

1. Shade SB, Chakravarty D, Koester KA, Steward WT, Myers JJ. Health information exchange interventions can enhance quality and continuity of HIV care. Int J Med Inform. 2012; 81(10):e1–e9.

2. Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform. 2007; 40:6 Suppl. S40–S45.

3. Dobbs D, Trebatoski M, Revere D. The Northwest public health information exchange's accomplishments in connecting a health information exchange with public health. Online J Public Health Inform. 2010; 2(2):e5.

4. Shapiro JS, Mostashari F, Hripcsak G, Soulakis N, Kuperman G. Using health information exchange to improve public health. Am J Public Health. 2011; 101(4):616–623.

5. Vest JR, Miller TR. The association between health information exchange and measures of patient satisfaction. Appl Clin Inform. 2011; 2(4):447–459.

6. Feldman SS, Schooley BL, Bhavsar GP. Health information exchange implementation: lessons learned and critical success factors from a case study. JMIR Med Inform. 2014; 2(2):e19.

7. Dolin RH, Alschuler L, Boyer S, Beebe C, Behlen FM, Biron PV, et al. HL7 Clinical Document Architecture, Release 2. J Am Med Inform Assoc. 2006; 13(1):30–39.

8. Health Level Seven International. HL7 Implementation Guide for CDA Release 2 - Level 1 and 2 - Care Record Summary (US realm) [Internet]. Ann Arbor (MI): Health Level Seven International;2006. cited at 2015 Jan 5. Available from: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=29.

9. Health Level Seven International. HL7 Implementation Guide: CDA Release 2 - Continuity of Care Document (CCD) [Internet]. Ann Arbor (MI): Health Level Seven International;2007. cited at 2015 Jan 5. Available from: ftp://ftp.ihe.net/TF_Implementation_Material/PCC/schemas/ccd/CCD-final.pdf.

10. HL7. HL7 Impementation Guide for CDA Release 2: IHE Health Story Consolidation, Release 1.1 (US realm) [Internet]. Ann Arbor (MI): Health Level Seven International;2011. cited at 2015 Jan 5. Available from: http://wiki.siframework.org/file/view/CDAR2_IG_IHE_CONSOL_R1_DSTU_2011DEC.pdf/322738944/CDAR2_IG_IHE_CONSOL_R1_DSTU_2011DEC.pdf.

11. Korea Health and Welfare Information Service [Internet]. Seoul: Korea Health and Welfare Information Service;c2014. cited at 2015 Jan 5. Available from: http://www.khwis.or.kr/eng/main.do.

12. Thorn SA, Carter MA, Bailey JE. Emergency physicians' perspectives on their use of health information exchange. Ann Emerg Med. 2014; 63(3):329–337.

13. Vest JR, Gamm LD. Health information exchange: persistent challenges and new strategies. J Am Med Inform Assoc. 2010; 17(3):288–294.

14. Zwaanswijk M, Verheij RA, Wiesman FJ, Friele RD. Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study. BMC Health Serv Res. 2011; 11:256.