Based On HL7/XML Development of A Prenatal Genetic Diagnosis Declaring System reporting system HL7/XML-based Construction of prenatal genetic diagnosis to

Construction of prenatal genetic diagnosis to HL7/XML-based reporting system

Development of A Prenatal Genetic Diagnosis Declaring System Based On HL7/XML

Lin Shengkai

Su Yanlang

Qiu Yuna

Chia-Hsien Wen

by Cai Cong

Peng Zhenxing

a

Taichung Veterans General Hospital

Tokai University Institute of Information Science and Engineering

c

Taichung Healthcare and Management University Institute of Health Management

Ju Yan Technology

Summary

The entire health care supply chain management covers the relationship between patients, Intranets, Extranets and the Internet interface data access

switching. With the upgrading of computer hardware and software technology, many traditional concepts and methods of medical care, is bound to change with it, so reporting to improve the overall efficiency and data accuracy, electronic operation is an inevitable trend. We established a national electronic database of prenatal genetic diagnosis and the online reporting system that can improve the examination and reporting, case tracking and payment of administrative efficiency audit to improve internal force in the prenatal diagnosis of the cases the lack of communication operations. Our approach is to allow organization of medical laboratory testing in-house staff to log cases, web-based information to the reporting system of the body, and type of case information to enhance

operational efficiency and the quality of reporting, and simplify the health care

grant reporting process, the original submission unit can also be web-based log

mining case review information and check the diagnostic report. In addition, the

reporting system to meet the Health Department to promote the international

exchange of medical information standard HL7 way, in real time or periodically

sent this summary of electronic medical records to the system host, to do further

statistical analysis of medical assistance or work with. The system will be the

case records of the cell genetic diagnosis changed to ISCN (International System for

Human Cytogenetic Nomenclature 1995) Karyotype analysis of the encoding (Karyotype

designation). ISCN karyotype encoding for cell genetics is now generally

accepted by clinical diagnosis, and because its encoding is also suitable for a concise and clear analysis and processing done by computer, allowing prenatal diagnosis database for the future with greater public health decision making and clinical analysis of the value of applications

Keywords: prenatal genetic diagnosis, HL7, ISCN I. Introduction

To improve the population quality, protection and promotion of family well-being of mother and child health, public health policy to set the implementation of genetic health, includes a pre-marital health examinations, prenatal diagnosis and counseling, newborn screening for congenital metabolic disorders and so on, and prenatal genetic diagnosis was one of the important work of prenatal care, their objective is to understand whether the fetus has a genetic disease. The so-called genetic diseases (genetic disease) is passed to offspring by the parent's disease [2], the major genetic diseases, including: (a) single-gene disorders (2) chromosomal abnormalities (3) multi-gene genetic disease (4) mitochondrial genetic disease.

Prenatal genetic diagnosis mainly through the adoption of amniotic fluid, chorionic villi, fetal blood and other samples, do the analysis of fetal cells and to diagnose fetal chromosomal or gene associated with hereditary diseases. ^Health

Department has a grant approach [1], for subjects with different conditions, testing in accredited units of amniocentesis and chorionic villus sampling or amniotic fluid of fetal blood analysis (thalassemia) and other tests, there are different benefits limit. Prenatal genetic diagnosis of the existing domestic processes, primarily a manual handwriting will compile case information on a regular basis to the Bureau of Health on file, so will inevitably lead to the following several major

disadvantages:

1. Artificial fill in the information written in clear or easily fill the situation is not complete, will result in data accuracy problems.

2. Longer operating time transmission of information and inefficient.

3. The case of existing pooled data items emphasis on grants work function, indication and diagnosis in case records are not reflected on the actual situation of clinical diagnosis.

4. The current format is too simplified form, is not conducive to further

analysis of statistics and tracking of cases, the database can not play in

public health decision making and clinical analysis of the value of

applications.

To the case record form on the genetic test results 』『 cytology column, for example, the results of its choice of only a few, if able to convert to the international nomenclature of human chromosomes ISCN (International System for Human Cytogenetic Nomenclature 1995) the nuclear type of encoding (Karyotype

designation), will enable the test results become a concise and clear (for example:

46, XX, 1qh +, 16qh +). ISCN karyotypes for clinical coding is now generally

accepted cytogenetic diagnosis, and because of its encoding clear, well-suited to use computers to do analysis, may allow the future of prenatal genetic diagnosis of the database will have a greater public health the application of statistical and clinical analysis of the value.

In order to improve the domestic force in the prenatal diagnosis of the cases the lack of communication work, commissioned by the Department of Health Bureau of Health, Taichung Veterans General Hospital plan to establish a national

database of prenatal genetic diagnosis, prenatal genetic diagnosis and the development of case reporting system to provide health Department

commissioned the inspection agencies. Reporting system to meet the Health Department to promote the international exchange of medical information standard HL7 way, in real time or periodically send a summary of this electronic medical records to the National Health Council, the host, to do further statistical analysis of medical assistance or work with. This program will make planning and construction analysis of the practice.

Two, the method

Our goal is to establish a national electronic database of prenatal genetic diagnosis, can improve the examination, reporting, case tracking and review of payment of administrative efficiency, provide a wider range effective applications to improve the internal force in the notification of cases of prenatal genetic diagnosis lack of work.

Prenatal genetic diagnosis of the current national reporting processes, primarily a manual approach to handwritten summary of case information on a regular basis to file with the National Health Council, the current process is as follows:

censorship unit (attach samples and case record form)  Inspected units (laboratory tests and output the report)  Written notice of submission unit  ^{Bureau of}

Health sent a list of track management and apply for subsidy.

The plan of operation as follows planning new: the national information database system of prenatal genetic diagnosis of a healthy build Yu Guo Min Ju; Er various testing agencies Zeyong You own Shenbao system Zhu Ji, Ke, in the institution directly to web-based approach in reporting system log information of the case, or the use of the original hospital information system (HIS) after the transfer of case information log on to declare the system host; login information of the case in the reporting system will automatically check the data on the completeness and accuracy, and then only to HL7 / XML approach uploaded to the national Jiankang Board database. In addition, units of the original submission can be web-based approach to inspection unit landed directly on the declaration of the host can query data collected cases of diagnostic inspection report, to replace the existing duplication of written materials and reports of artificial transcription reply mode of operation.

In the initial plan, first with the National Health Council, meetings of experts, invited representatives of all the testing institutions to discuss the new workflow concept. And continuously to questionnaires and interviews, surveys and testing institutes with the intention of mining inspection institutions, and the National Institutes of large medical testing database systems and the workflow status of the suggestions to the new system handles more meet the required medical testing unit.

The plan developed by the online reporting system architecture that allows the inspection agency can be typed directly into the case information to improve operational efficiency and the quality of reporting, and simplify the reporting process Medicaid. Electronic prenatal genetic diagnosis after the new reporting system processes network architecture, such as (Figure 1) as follows:

To consider the future of transplantation system and Application Server

compatibility, while the system has been tested and will be through the Internet /

Intranet at the Bureau of Health commissioned review of the medical unit on-line

use, so we JSE as a system development environment [3], while database access

will be centrally managed by the change to multi-layered structure (inspection units

/ Municipal Health Bureau / Bureau of Health). The user interface, we chose to use

web-based interface as a login in order to reduce personnel to operate the training

on the adaptation schedule, while the former mining inspection units can also be

web-based way of inquiry cases the diagnostic report.

The current definition of the HL7 standard electronic data exchange, data management and integration to support patient care and health services, particularly for the establishment of a flexible, cost-effective, standardized, and there are guidelines for implementation of the method of cross-platform and related services health care information system [9], so this system was the format of data exchange using HL7 messages for hospitals in the medical testing

samples reporting process, due to two-way interaction did not involve the

exchange of information, so consider using the HL7's temporarily query messages (Query Message) [6]. Also based on the exchange of information models and trends of medical documents, so the system uses HL7/XML-based format to send the case reports and grant official case record inventory of electronic files.

The electronic reporting database system consists of four main modules:

1. Case Database

The storage unit includes implementation of the test cases of prenatal diagnosis of the basic data, samples data, samples the results, and diagnostic reports. ^The

system will use the SQL database to develop, but also planning for the system the way other modules to access to ODBC database, so the system architecture will not be limited to SQL databases, the future will need to replace the database platforms visible. (Currently MySQL DB)

2. National database of cases of prenatal genetic diagnosis

The store includes a nationwide test unit 33 notified cases of prenatal diagnosis of genetic information and diagnostic report. The system of statistical analysis to the National Health Council, mutatis mutandis, the existing analysis of prenatal diagnosis of 『』 both management reporting analysis capabilities, while tracking each case to local health bureau and the Bureau of Health to track contractor personnel can check the results.

3. HL7 Gateway (HL7 interface programming)

The main function of this module is to meet international standards of HL7 medical information transmission means, to send cases of prenatal diagnosis of genetic information, including the two most applications, one reported to 主机 to test prenatal genetic diagnosis with the national information database

transmission, the other is reported to test both the host and the hospital

information system data integration. ^{As the} HL7 standard does not receive messages sent to both the network system, most of the industry's system to provide TCP / IP Socket programming or file transfer (FTP) way linked, so we will be working on TCP / IP Socket programming transmission .

4. Web Server and Application Server

The main function of this module is to provide users of Web-Based User Interface, and to Client-Server approach to the implementation of the user commands the results sent by the Web Server receives, and then processing them through the Application Server; generated by the Application Server output screen, and finally by the Web Server feedback to a user's Web browser to render.

Parameters, the system features and discussion

1. System function

1. As some of the inspected unit, in its hospital information system (HIS) in the test has been associated with the generation of inspection process features may not consider the additional system operation, so as not to allow users to repeatedly enter information, create additional difficulties.

For this demand, we will open systems integration interface (Application Program Interface, API), and setting data transmission to the hospital information system to exchange information with the system. ^{And using}

HL7/XML standard data format, to unify the integration of medical

institutions in data format, to avoid future maintenance on the complexity.

2. ^{Used in the} HL7 message standard, we are targeting "Censored data transfer," "submission information reply", "the report data transmission"

and "Report Data Reply," the initiative to update the class definition of the message format to facilitate information exchange platform heterogeneous data transfer, used to send the message mainly includes Inspection data transfer OML_O21 (laboratory order message) message, test report data

transmission ORU_R01 (unsolicited observation message) message, and reply to messages ACK (general acknowledgment), but because there was not any other medical resource sharing EPR provisions of law, so We do not to the Query class of HL7 messages into.

3. Chromosome structure to digital, while the future for health care

administration unit for further statistical analysis, and therefore the system

in the case record form on the "Cellular genetic test results" column, so

that the importer fill ISCN Karyotype analysis of coding format, will enable the test results become a concise and clear, for example; 46, XY, inv (3) (p13q21). However, because user input errors that may arise, or even whether there will be wrong for the description of chromosome structure approach, will be part of the next one to observe.

4. We will also "unusual case tracking results", "transpose operations on application data" and "Bureau of Health for information on audit work"

included in the system function to enable local health bureau or censorship unit can track the development of abnormal cases and XML message

inspection flats will be uploaded to the Bureau of Health has issued report cases subsidy claims data.

1. Data Management

With focus on information management or decentralized, it may have to consider several factors: management control, application technology, data attributes, IT support staff, user capabilities, organizational structure, etc. [3], the choice of the database structure will also affect the system implementation and follow-up of maintenance and management. We do not use a centralized master planning framework, and choose to deal with multi-layered structure of prenatal diagnosis of Operation:

o Prenatal genetic diagnosis database: Database system host build on the National Health Council. National prenatal genetic diagnosis have complete information, non-Taipei and Kaohsiung inspection information directly sent to this host, Taipei and Kaohsiung in the test data is through the Women and Children Hospital, Taipei City and Kaohsiung City Health Department declared the host to upload data.

o Women and Children Hospital, Taipei and Kaohsiung City Health Department to the reporting system host: summary of cases

dealing with jurisdiction grants audit inspection unit operations, and related information summary From the work of the National Health Council hosts. Jurisdictions have the complete information to the benefit of the region, statistics and analysis.

o The test units reporting system host: unit test cases to handle the data log, upload, query and statistical analysis operations.

Inspection units can open the original log mining and query.

The system uses multi-layered structure factors are as follows:

1. Offline needs. Even if the test unit for the time being the host can not connect Bureau of Health, will remain at a medical testing institutions function within the normal operation of the system.

2. Distinction between information ownership. Ownership according to the different levels of information can keep the integrity of information in varying degrees, to test the unit to declare the host, for example, for non-reporting information, such as insurance program (Bureau of Health not to subsidize the project) the information at its disposal.

3. Safety factors. In addition to the information kept separately, the Bureau of Health because of restrictions on access to the server user identity, and the need for disclosure of information before encryption and decryption through a one-way transmission or query, will benefit all levels of server security maintenance. ^In

addition, while respecting the privacy of the doctor-patient context information, the system set user permissions according to the scope of control of the Ke read and use function, Er, MD, Suo signed the inspection report of the nuclear Yexutouguo Renzhengchengxu, prevent data tampering and achieve undeniable of security.

4. Customization factors. The medical testing services institutions can increase their own systems in their host institutions to play the medical laboratory characteristics of medical services for prenatal genetic diagnosis can make full use of the database, to play a greater value. For example:

 Provide public health education function of patient-related.

 Strengthen the (hospital clinics and former mining review) physician-related knowledge management.

 Can be taken as a test unit and bridge inspection units of information.

 Statistical analysis of public health and clinical research.

 Institutions with existing information systems integration testing, greatly simplify workflow, and enhance the accuracy, completeness, and

timeliness.

3. System maintenance and update

Since the implementation of this system just on the line, the future is bound to face problems adjusting system functions (such as new grants program), so in the face of updates, we may experience the following problems:

1. Program update online all the nodes can not synchronize. More direct way is from the Bureau of Health server checks if the user is old he will be refused entry, but this approach may result in test reporting operations of the troubled unit.

2. Perhaps consider using Web-based download

automatic updates, but to use the units to meet the demand (for example, combined with the local HIS), so this system allows the use of units currently have the system modify the content of rights, and therefore left for future system update the variables.

3. To Bureau of Health point of view, the accuracy of claims data is the first priority, the agencies are currently allowed to modify the content, whether it may affect the data integrity and consistency?

Another exception reports when required by the State Health Department's Bureau of Health sent surveys to track, and they also have the right to amend the information content, that is what we need to include assessment of factors.

Calibrations Conclusions

Electronic medical information operations in the trend, we developed a prenatal diagnosis database reporting system, in addition to changing the traditional manual or semi-manual mode of operation, improve operating efficiency, and reduce the overall reporting process may error variables. The new report described in this article not only has the electronic data processing ease of storage, transfer, modification, management benefits, creation of a database to track cases are still capable of further application, analysis, statistical results, not only value-added medical examination HIS unit features will also help public health policy development reference.

Wu, references

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