Integration, Standards, and Interoperability

• Complex Information Technology Environment

  no single information system can provide all of the functionality necessary for safe, high-quality, accurate, and efficient operations. Information systems must, therefore, share data and status with each other. This information can be shared either through proprietary interfaces or through IT standards.
• Proprietary Interfaces


  typically expensive to develop and difficult to maintain; evolve slowly because market demand for any given configuration may be very small. Given their nature, these interfaces are often confidential. This makes understanding their rationale and workings difficult. Use of this is usually tightly controlled by the vendor(s) and this impedes innovation and research
• IT standards


  consensus documents that define information system behavior in an open fashion
• In the United States, the American National Standards Institute (ANSI) coordinates standards development
• two of the most important ANSI-designated SDOs in healthcare are Health Level Seven (HL7) and the National Electrical Manufacturer's Association (NEMA)
• HL7 is responsible for the development of its eponymous standard, HL7, while NEMA is the secretariat for the Digital Imaging and communications in Medicine (DICOM) standard.
• Network Time Protocol (NTP)


  used to synchronize clocks in computer systems. When systems communicate with each other, it is critical that their clocks be synchronized so that messages are interpreted in the appropriate time frame.
• Uniform Resource Locators (URL)

  the syntax and semantics of formalized information for location and access of resources via the Internet.
• Hypertext Markup Language (HTML)


  This Remote Function Call (RFC) formalized the initial description of it that has been in use since 1990.
• Multipurpose Internet Message Extensions (MIME)


  Prior to this, email messages could only include ASCII text. With the advent of this, email messages could be extended to include many different non-textual content elements including DICOM images
• Transport Layer Security (TLS)and its predecessor Secure Sockets Layer (SSL) define cryptographic mechanisms for securing the content of Internet transactions.
• Hyper Text Transfer Protocol (HTTP)


  This RFC defines the basic protocol for transferring HTML content between the client and the server. This is the backbone of the World Wide Web
• Simple Mail Transfer Protocol (SMTP) and now Internet Message Access Protocol (IMAP); RFC 3501) as well as Post Office Protocol (POP; RFC2449) are the basis for e-mail transactions on the Internet.
• The BSD Syslog Protocol and its reliable extension (Reliable Delivery for Syslog; RFC 3195) specify a very simple, yet powerful mechanism for delivering a log file payload to a server for audit trail and logging purposes
• Recommendation Extensible Markup Language (XML)


  a free, open standard for encoding structured data and serializing it for communication between systems. It is being used as the method of choice for almost all new standards development related to distributed systems. It is rapidly penetrating healthcare information technology standards, for example in HL7 version 3.
• Digital Imaging and Communications in Medicine (DICOM)

  has become an almost universally accepted standard for exchanging medical images among networked medical devices.
• DICOM is managed by Medical and Imaging Technical Alliance (MITA), a division of NEMA
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  DICOM is an ANSI, ISO, and European standard for medical imaging
• DICOM Standards Committee


  organized as a set of working groups and revisions and additions are always in progress
• DICOM uses unique identifiers (UID) to globally identify each image set, so that if the images are sent to multiple systems, the identifying number will remain unique and not be confused with those images on other systems
• DICOM also provides a framework for the use of compression technologies on image data.
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  In DICOM, after an image has been captured, all of the demographic information and information about the actual capture of the image is recorded in the image header
• Health Level Seven (HL7); accredited healthcare Standards Developing Organization (SDO) headquartered in Ann Arbor, Michigan


  an independent, not-for-profit, organization is an American National Standards Institute (ANSI); it is also an accredited? headquartered in? .
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  The standards set by HL7 are used in most health care applications such as medical devices, imaging, insurance, and pharmacy.
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  HL7 oversee most clinical and administrative data such as demographics, reports, claims, and orders.
• HIS

  holds the patient's full medical information, from hospital billing to the inpatient ordering
• RIS:

  holds all radiology-specific patient data, from the patient scheduling information to the radiologist's dictated and transcribed report
• The EMR is either part of the HIS or runs along with it and contains all the patient's record, including lab results, radiology reports, pathology results and nurses' and doctors' notes
• INTEROPERABILITY


  a term used to describe the transmission of information, and it must be consistent. The source of the information and the receiver of the information must be compatible so that all information transmitted is correctly received.