The electronic health record (DMP) is changing the development of software for healthcare professionals

DMP | 21 Jun 2010
With the objective of improving the quality of healthcare, the implementation of the electronic health record (DMP) project will improve the structure of the entire health information system, particularly in regards to the computerization of healthcare provision activities. One example of how this will impact the structure is that in order for healthcare professionals to successfully employ the DMP, it will need to be integrated into their everyday working life. 
Pharmacist with his computerThe interoperability framework for health information systems produced by ASIP Santé supports this integration.

Developing structured medical documents 

The interoperability framework for health information systems promotes their development by structuring their content. Hence, the documents added by healthcare professionals into a patient's DMP, as well as the documents added by patients into their personal patient area, comply with the CDA release 2 (CDA R2) standard. Each document has two elements – a structured heading describing the context of the document, and the body of the document, which corresponds to one of the following levels: 
  • Level 1: the body of the document (unstructured) contains text or an image 
  • Level 2, structured for the reader: the document is split into sections. The content of each section is revealed by its logical observation identifiers names and codes (LOINC ) code and a title, if there is one; this content is then displayed in its edited form (with text and any illustrative images).
  • Level 3, structured for the reader and the health information system: the body of the document is split into sections as in level 2, but each section is completed by entries containing the structured and coded medical data corresponding to the content of the section. This data can be imported into the database of the healthcare professional who is consulting the document. 
The production of level 3 CDA R2 documents by healthcare professionals is a significant development in medical practice and makes it necessary to incorporate coding systems (including the LOINC nomenclature) into software for healthcare professionals. In the initial phase, the DMP will accept the various CDA R2 levels, but ultimately ASIP Santé will bring level 3 documents into widespread use. With this future goal in mind, ASIP Santé is working with specialist societies and representatives of healthcare professionals to design documents that are structured in accordance with professional practice, in order to facilitate their use. These documents are published within the interoperability framework.

Metadata enable intelligent consultation of the DMP 

Medical documents, whatever their format, are accompanied by XDS.b metadata, most of which are directly derived from the CDA heading. The DMP hosting service only accepts documents with XDS metadata whose compulsory fields are specified in the interoperability framework of the health information systems. The metadata of a document describes its type, author, content and the date it was created. It allows search enquiries to be carried out and the viewing of documents contained in the DMP. Based on this metadata, the designers of software for healthcare professionals will be able to develop new services that will add value for healthcare professionals. These services must enable healthcare professionals using the DMP to consult it intelligently and effectively with the aim of optimizing patient care.

The DMP and software for healthcare professionals: supporting the coordination of care

Improving the quality and coordination of care involves sharing relevant medical data which can be effectively manipulated and interpreted, both by practitioners and by the systems assisting them in their everyday work. 
The interoperability framework provides the foundations for this data sharing: content models, coded vocabularies and nomenclatures, and secure services and channels. Based on these foundations, the DMP represents a high-performance national data sharing tool that is capable of increasing the information capacity and usage power of software for healthcare professionals. The implementation of the DMP is a real opportunity for software for healthcare professionals to evolve, which in turn will lead to the development of new features that will improve the coordination of care and enhance the usage of the DMP.