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Principles of Effective Profiling

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Abstract

A major challenge for the healthcare industry is achieving interoperability among proprietary applications provided by different vendors. For example, each hospital department may use one or more applications that need to share clinical and administrative information with other applications. Each application may require multiple communication interfaces that must be modified and maintained. This approach is a difficult way to achieve interoperability. Alternatively, interoperability can be achieved through the use of standardized interfaces, which can reduce the cost of building and managing unique interfaces for each associated application. Developers can build applications that conform to the standardized interface definition, increasing the likelihood of interoperability and reducing cost. Maintenance cost is also reduced, since there are fewer unique interfaces to maintain. One obstacle to achieving usable standardized interfaces is that the base standards are often not defined at a granular enough level to support a specific use case or local requirements; therefore, the base standard must be further defined or “constrained”. The mechanism for constraining standards is called profiling.

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Notes

  1. 1.

    For example, a constrained value set definition specific to a particular data element (is generally not provided at the base standard level).

  2. 2.

    The Functional Requirements specifications are not yet published, so the diagram indicates a desired state. The 2015 Edition ONC Health IT Certification Program Final Rule does include display requirements for EHRs.

  3. 3.

    The term conformance statement is also used to indicate, from a high level, the capabilities of an implementation or system (i.e., a set of things that the implementation or system is claiming it can do). In the context of this section, conformance statement simply refers to a statement of a requirement. See Chap. 6 for a discussion on the use of overloaded terms for specifying requirements at various levels.

  4. 4.

    Some standards, such as HL7 FHIR®, do not include constraints at the base level; this refinement is performed at subsequent levels.

  5. 5.

    The intent of the IHE Technical Frameworks is to specify only compatible message profiles in the different integration profiles. However, a thorough examination (as of 2013) reveals that different IHE integration profiles have specified message profiles that are incompatible with each other. Therefore, a single implementation cannot be compliant with both specifications, and configuration is necessary

  6. 6.

    Via work performed in the HL7 Conformance and Guidance for Implementation and Testing (CGIT) Working Group.

  7. 7.

    Message profiles are not to be confused with the Integrating the Healthcare Enterprises (IHE) integration profiles. Often IHE integration profiles will use HL7 v2.x message profiles.

  8. 8.

    Since the example is HL7 v2 the term table is used, but this can be thought of as a value set.

  9. 9.

    Although the code would be expected to be forthcoming. The necessity of having a code for the concept immediately prevents an orderly deliberation and document process (which will happen later).

  10. 10.

    Although this is not explicitly stated but can be inferred.

  11. 11.

    For the complete HL70203 table many more codes would be listed, most of which would be “Excluded” with a handful set to “Permitted” for these four data elements.

  12. 12.

    In this case, the sender’s expectation is in a “collective” sense. For a particular instance, data may be processed and discarded because the receiver recognizes that the data are duplicate and the existing data are of better quality. A typical case is where the receiver has data from the provider who administered the vaccine and the duplicate data newly received are a historical recollection provided by the patient.

  13. 13.

    This is an underlying basic principle of many data exchange standards such as HL7 v2.

  14. 14.

    To simplify the diagram, the acknowledgement interactions are omitted, which is not to diminish their importance. When errors occur, correct recognition and response by the receiving system is a critical aspect of this workflow.

  15. 15.

    This workflow coincides with the ONC 2014 Edition Certification criteria. The more likely scenario is that the LIS sends the reportable results directly to Public Health. Both scenarios are valid and in both cases the ELR specification is applicable.

  16. 16.

    Diagnosis Related Group.

  17. 17.

    A constrainable profile is not typically an artifact that is considered to be implementable (points 1 and 3). It is included in this diagram to show that, in some cases, implementations are developed only to the requirements specified in a constrainable profile and not to optional (or undefined) aspects. In essence, the constrainable profile is an implementable profile, although not explicitly documented as such; and therefore, in this regard, the implementation can be said to be conformant to the constrainable profile.

References

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Oemig, F., Snelick, R. (2016). Principles of Effective Profiling. In: Healthcare Interoperability Standards Compliance Handbook. Springer, Cham. https://doi.org/10.1007/978-3-319-44839-8_7

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