XML in Health Care
ABSTRACT
Healthcare is entering a completely new area of XML application, the representation and utilisation of medical knowledge by using XML structures. XML provides a reasonable way of providing the healthcare practitioner with specific, problem-related knowledge at the point of care, in addition to the patient's medical records. This day contains impressive examples on the structuring of medical guidelines, on the management of healthcare records in XML, and on the management of drug information and the mapping of medical classification systems into topic maps.
XML is moving into the health care world, slowly but distinctly. In particular hospitals in the UK have already recognised the advantages of managing health care records by using the structuring, storage and retrieval tools of XML. Experiences of these pilot projects are an important part of our health care track today. Several other examples show an increasing usage of XML in Medicine. The world-wide most frequently used communication standard in health care, Health Level 7 (HL7) has published an already ANSI accredited document standard Clinical Document Architecture (CDA) using XML as the representation format of medical and administrative data. HL7 is also working on a proposal to apply XML as interchange format in their version 2.x messages and nevertheless HL7 has definitely agreed to use XML as the standard interchange format of the new model based version 3 messages.
In the United Kingdom, France and Germany XML is used for exchanging messages between hospitals and General Practitioners, a problem of increasing importance. A project team in Germany has elaborated a proposal to connect the HL7 world in hospitals with the BDT world, the standard in physicians office systems in Germany by using XML messages which are based on the described Clinical Document Architecture. Results of this project, the Standardized Communication of Information Systems in Physician Offices and Hospitals using XML (SCIPHOX) project will be presented in this workshop. Another impressive example of XML application in health care has been currently presented by the CEN TC 251 project team PT44 which has published a proposal to map model based hierarchical messages directly into XML.
Nevertheless the number of really operational applications is still limited. Even today we cannot assume that XML is generally accepted and applied in health care. There are at least three reasons which could explain this situation. Two of them will be overcome by the ongoing development of XML definitions and tools. The third reason has to be carefully considered within the XML community since the solution will require an active intervention.
First of all the XML standards are currently still not completely ready. Important parts like XML schema are becoming more stable but have not achieved the status of a finalised W3C recommendation. Several new features of XML schema like datatypes, the definition of constraints and the support of namespaces are quite essential in health care documents. When writing these lines the tools required for utilising these features are improving but are also mostly under development and still not really ready for routine use.
Secondly it becomes more and more aware that real applications of XML require an XML environment which has to be built up within health care facilities and networks. A complete range of tools ranging from powerful and user friendly XML editors, XML databases, XML interfaces, stylesheets up to linking and retrieval tools has to be provided and must be easily available and accessible. Here there are still important gaps which have to be filled.
The third reason seem to be that we still miss more comprehensive attempts to standardise the semantic meaning of XML objects like names of elements and attributes or structures of generally used simple and complex types in schemata's. It is not useful if everybody is going to define commonly used types like addresses, person names or diagnosis and procedures in Medicine etc. in his own way, if everybody is going to use different names for elements and attributes with the same semantic meaning. XML schemata's will be designed in a much more bottom up approach than DTD's. Useful and rational definitions of XML schemata will therefore require such standard definitions. If they will not be provided in the near future it could easily occur that we end up with the Babylonian language diversity also in XML. The W3C has already successfully provided the syntactical part of the XML standard. The semantic relationship is still an open problem which has to be carefully considered in the future application of XML.
Nevertheless comparing the programs of the XML health care tracks of the last four meetings we can definitely see an impressive progress. The invading process of the XML technology lasts indeed longer than we all have expected. Working with XML is still a little bit of pioneering work, but the results are definitely proceeding.
This can in particular be seen in some of our presentations today which are entering a complete new area of XML application, the representation and utilising of medical knowledge by using XML structures. It is an important and growing concern of Medical Informatics to provide the healthcare practitioner with specific, problem related knowledge at the point of care. In healthcare most of this knowledge is still represented as textual information. It is always difficult to identify those parts of the medical knowledge which are really needed in a specific case or situation. XML seems to provide a reasonable way to structure this textually described knowledge for improving the access to problem relevant pieces of knowledge information. We will have impressive examples of this new and important approach in XML in presentations on structuring of medical guidelines, on the management of drug information and the mapping of medical classification system into topic maps which is another way of representing knowledge. These presentations show the important progress which have been made in XML applications in health care.