Advances in information technology have provided many tools necessary to streamline healthcare administration costs, but the inability of disparate systems to communicate with each other has prevented the effective use of advanced IT solutions. Extensible Markup Language (XML) and .NET technologies can be used to link various payer and provider systems, and offer a number of other benefits to the healthcare industry.
Information systems continue to evolve in the healthcare industry, with many organizations relying on data from a wide range of technology sources. Historically, healthcare information systems were built for legacy mainframe, Unix, NT or Linux systems. This meant that data in patient records, financial statements and insurance forms were defined in different ways, making it almost impossible for applications to communicate with each other.
New technology tools, including XML, Java and Microsoft .NET, provide the communication link between healthcare payers and providers, and allow for the introduction of new products, such as consumer-driven health plans, disease management programs, and new reimbursement pay-for-performance reimbursement models.
XML for communication
The value of Extensible Markup Language (XML) for the healthcare industry is its ability to define data structures and deliver data between different information systems. Using XML, data may be represented as a simple text stream that can travel between systems using existing Internet protocols.
In today's healthcare IT environment, many managed care organizations consolidate hospital, provider network and specialist information systems.
In this scenario, a hospital may use an IBM mainframe; the physicians' network, a LAN-based (local area network) medical records application; and the specialists, a medical group software application. The challenge for the IT manager is to have all of these systems communicate with each other. This can be accomplished by directing staff to log onto three separate systems to input and retrieve data; convert all systems to a common platform; or combine the information from all systems into a data warehouse.
Because the maintenance and continued use of three different systems would require staff members to input the same data into each of those systems, the first solution would lead to operational inefficiencies, reduced productivity and increased administrative costs. Likewise, converting all systems to a single platform would require a large investment in capital and human resources. Because XML provides a common representation for data and uses an HTTP protocol to transfer the data between different systems, creating a data warehouse is a cost-effective and time-saving solution.
The primary benefit of XML for healthcare organizations is its ability to import and export data from different IS platforms using a simple text format. Moreover, XML allows data to be displayed in a Web-based format on an organization's private intranet, over NHSNet, or on the Internet. In this way, back-end systems can work together in an efficient, cost-effective manner.
HL7 and XML
Health Level Seven (HL7) is one of several American National Standards Institute (ANSI)-accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. The HL7 membership ratified Version 1 of Clinical Documentation Architecture (CDA) in September 2000, and it is currently working with Version 3.
The HL7 CDA is an XML-based document markup standard that specifies the structure and semantics of clinical documents for the purpose of exchange. CDA provides an exchange model for clinical documents such as discharge summaries and progress notes, and brings the healthcare industry closer to the realization of an electronic medical record.
The use of XML for clinical documentation architecture allows hospitals, pharmaceutical companies and managed care organizations to capture patient data, validate the data, and save it as a CDA-compliant file. These CDA-compliant files can be read and stored by other back-end systems, document management software, portals and partners. As a result, the secure exchange of clinical documents inside and outside of an organization is efficient and affordable.
Microsoft's .NET framework is designed to make information readily available over the Internet by providing developers with a single approach to building desktop and Web-based applications. Microsoft's .NET framework is similar, in many respects, to Java E2, which runs on a variety of platforms, including Unix systems.
In addition to running on different platforms, a key distinction between the two approaches is .NET's extensive use of XML as its data delivery and presentation standard, while Java components are configured by property files, rather than XML files. With .NET technology, XML provides the bridge that connects disparate applications and data from a variety of sources — payers, providers and consumers.
In addition to facilitating the link between the disparate information systems, .NET technology offers healthcare organizations several time- and cost-saving benefits. Because .NET is designed to seamlessly integrate Web-based applications, it adapts easily to support new products, like consumer-directed healthcare Web portals, and disease management. New pay-for-performance reimbursement models require data exchange between several organizations, and the combination of XML and .NET technology provides the tools and framework to support these programs.
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