journal of biomedical informatics
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Interoperability in the 21st Century: Cost Effective Solutions and Guidelines for Interoperable Electronic Health Records

Author(s): Ken Salyards, Ioana Singureanu, Kenneth Lord

This paper describes the use of standards to enhance the capability of creating semantically interoperable doc- uments and messages. Over the past few years, many information exchange formats have been created. While the health industry continues to develop new formats that attempt to simplify or modernize interoperability across healthcare, it is continually challenged by the diculty of current applications to exchange documents that can be interpreted by the receiver of the document. Given the va- riety of standard formats, a framework should be developed that can bridge across multiple exchanged formats/syntax and semantics. It should reference the business content in a consistent way that represents clinical best practices and connects to the clinical work ow that triggers information exchange. This paper describes the use of model-driven development to bring balance to the art of data exchange by supporting semantic interoperability for design and run- time. The proposed model-based approach to mapping addresses the semantic challenges and allows sending sys- tems to rst specify the meaning of their data by relating it to a de ned common data dictionary of business data elements thus making it independent of other datasets. The resulting architecture proposes two sets of open- source components intended to provide a clear separation of concerns throughout the development process between design and run-time. SAMHSA is using this approach in its Information Exchange Hub (IExHub), the transforma- tion/interface engine supporting both behavioral health and physical health interoperability for health information exchange network (HIEs).