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Electronic health records

eHealth Ontario develops interoperability spec

By Catherine Krever

TORONTO – Every time you see your doctor or nurse practitioner, visit a hospital or lab, your visit is recorded on a form. And although many providers use electronic forms, sharing between facilities is fraught with challenges because more often than not, each form is unique and the information is captured inconsistently.

eHealth Ontario’s standards team – through its Clinical Document Specification (CDS) initiative – is committed to changing this.

“We are currently developing the standards-based CDS to allow clinical documents to be shared electronically between hospitals, physicians, Community Care Access Centres (CCACs) and other health care providers,” says Grant Gillis, Director, eHealth Standards.

“The project involves two frequently exchanged forms – assessment and consults reports,” said Gillis. “We already have a specification to support discharge summaries and we have built upon this previous work for the CDS.”

Available as an initial draft since November 2010, the CDS offers a number of unique attributes in comparison to other specifications. First, it is based on an overarching clinical document architecture that can incorporate additional document types, as well as allowing for the accommodation of subcomponents (i.e., the ability to run queries on patient demographics, allergies etc.).

The CDS is based on an international document standard adapted for pan-Canadian use and is suited to meet Ontario health-sector business requirements. It also provides a framework for vendors responsible for implementing clinical document repositories by providing guidance on exchanging clinical documents.

“Patients benefit if their comprehensive, accurate and secure health information is in the hands of their healthcare providers at the point of care,” adds Greg A. Reed (pictured), President and CEO of eHealth Ontario. “Patient forms play a critical role in this, so it’s important that they follow a consistent standard across the system. The CDS initiative brings greater consistency to the collection and exchange of patient information.”

Beyond the ultimate benefits to patients, the CDS is a valuable tool that will help healthcare providers do their important work, while also improving efficiencies. It will enable the digitization of paper-based processes – such as assessments and consults – which will advance access and quality of care provided. It will also contribute to a digital history of a patient’s care that can be traced and queried from multiple points of care.

To date, the CDS has undergone six reviews including two public reviews – open to providers and provider organizations across Ontario and across the country – two vendor reviews tailored to implementers, and also technical and business reviews, each with representatives from across the health sector.

CDS has generated significant interest in the ehealth community.

“I have had the opportunity to lead, facilitate and/or participate in a number of public review and ballot processes in the establishment of health informatics standards over the past 10-plus years,” says Michael van Campen, CDS project facilitator. “The level of participation and interest in the CDS rivals and indeed exceeds levels in many pan-Canadian and international standards efforts. Kudos to eHealth Ontario’s ability to develop relevant and timely specifications for Ontario’s ehealth stakeholders.”

The Public Review Period, which allowed for wide review of the draft CDS, closed on January 28, 2011.

During that period, the eHealth Ontario standards team received interest, feedback and requests for the specification from across the province as well as from other jurisdictions in North America and abroad.

Some 100 comments and observations on the draft CDS were received from a variety of major vendors, hospitals and other healthcare organizations during this period. Their input ranged from suggestions for technical adjustments to the clinical information model to meet specific requirements, to the addition of more detailed guidance on the document-sharing architecture.

February 28, 2011 marks the Interim Release of the CDS. It will include feedback received throughout the Public Review Period. The Interim Release will be made available at Please visit this website for further news and developments.

Public Reviews Fast Facts:

• 35 healthcare organizations participated in the business review.

• The technical review involved 26 individuals from healthcare organizations, informatics associations as well as government, agencies and LHIN representatives.

• The public and vendor reviews brought well over an additional 200 healthcare and IT professionals to the table.

• The CDS received over 120 downloads within the first two weeks of being posted.

Posted February 10, 2011