One effort toward the use of XML in healthcare is that of ASTM (American Society for Testing and Materials), Committee E31 ("Healthcare Informatics"), Subcommittee 25.
Subcommittee E31.25, 'XML Document Type Definitions (DTDs) for Health Care' is "developing DTDs for health care documents. In October of 1999 we held a joint meeting with the Massachusetts Medical Society and developed draft DTDs for prescriptions, discharge summaries, encounter notes, operative reports, diagnostic imaging reports and the HCFA 1500 form for Medicare reimbursements. We are actively seeking submissions to further the DTD development." [Rachael Sokolowski, Thu, 17 Feb 2000 09:10:55 -0500]
"The advent of managed care and shifting alliances between HMOs, hospitals, and providers has fragmented the [health care] industry into separate entities that are highly dependent upon each other for the exchange of patient information. But that information, in the form of a medical record, is on paper -- not a form easily processed by computers. Documents, whether on paper or computer, must be in a form in which humans can read and analyze and one in which machines are able to process. . . Currently there is no standard set of document types for healthcare, nor is there a commonly defined service for accessing the XML documents. However, to address this issue, the American Society for Testing and Materials (ASTM) E31.25 subcommittee is developing a standard set of DTDs for healthcare documents. . .The scope of ASTM E31.25 is the development of standards and promotion of knowledge related to DTDs for healthcare. The subcommittee is developing implementation guides, sample document instances (versions of the document with XML markup), and a validation facility for verifying conformance to the voluntary ASTM standard DTDs. The DTDs are being developed under the current XML standards and will adapt as the XML standard evolves. The first priority for E31.25 is to develop standard document type definitions for transcribed documents. To reach this goal, the subcommittee coordinates with other ASTM subcommittees and outside organizations with related interests and standards, for instance, HL7. HL7 is using XML as the syntax for HL7 messages to request and send healthcare information. In addition, the HL7 patient record architecture is being developed as an exchange mechanism for electronic documents. The focus of ASTM E31.25 is document-centric. This focus differentiates activities from other ongoing efforts that focus on: (1) object-oriented technologies (ASTM, CEN, CORBAmed, HL7); (2) healthcare messages and transactions (HL7, X12); (3) document exchange (HL7 patient record architecture); (4) financial transactions (XML-EDI, X12). E31.25 views the medical records as a collection of electronic documents and incorporates other efforts when possible. . . XML has great potential for representing the paper documents in the medical record as well as forms and other paper-based documentation. A standard set of document types within the medical record must be developed to move the information to a digital form. Once the set of XML document types are developed, there will be a common electronic representation. In order for XML to become the solution, however, there must be coordination between standardization efforts so that the document descriptions, tag names, and attribute representations do not diverge." [from "XML Makes Its Mark"; see below]
"ASTM Committee E31 on Healthcare Informatics develops standards related to the architecture, content, storage, security, confidentiality, functionality, and communication of information used within healthcare and healthcare decision making, including patient-specific information and knowledge. Established in 1970, E31 meets semi-annually as a committee in May and November. Members and visitors attend three days of meetings that include technical subcommittee sessions and a plenary meeting. Some subcommittees occasionally meet on an accelerated basis. The committee, with current membership of approximately 270 members, currently holds jurisdiction of over 30 approved standards and additional draft standards."
100 Barr Harbor Drive
Pennsylvania, USA 19428-2959
[March 14, 2001] XML Schema for Patient Medical Record. From Jonathan Borden, Co-Chair, ASTM E31.25 XML Healthcare DTDs.
[March 14, 2001] ASTM E31.25 XML Healthcare DTDs. 2001-03-14. From http://www.openhealth.org/ASTM/. XML DTDs for Healthcare, including: clinical.header.dtd; operative.report.dtd; pathology.report.dtd; radiology.report.dtd; radiation.therapy.summary.dtd; admission.note.dtd; history.physical.dtd; discharge.summary.dtd; Also the DICOM 3.0 XML DTDs: astm.dicom.dtd; astm.dicom.base.dtd; astm.dicom.elements.dtd. [DICOM DTDs example]
"XML Makes Its Mark." By Rachael Sokolowski. In Journal of AHIMA (American Health Information Management Association) (November/December 1999). See the excerpt above. [Rachael Sokolowski is president of Magnolia Technologies in Arlington, MA, vice president of research at iTrust, co-chair, HL7 XML/SGML special interest group, and co-chair, ASTM E31.25, XML DTDs for Health Care. Her e-mail address is firstname.lastname@example.org.]
"Report of the October 1999 E31.25/MMS Workshop on XML for DTDs in Health Care." Viz., "Minutes and Results. ASTM Committee E31 and the Massachusetts Medical Society Workshop on XML Document Type Definitions In Health Care. October 4-5, 1999." - "The workshop consisted of a relatively small but diverse group which provided the needed viewpoints and experiences with clinical documentation. There was representation from vendors, providers, the US government, and European and American standards. The meeting goals were to develop a common set of sections for clinical reports of a specific type and across types. A set of section types for different document types were achieved and with some additional work post-workshop, a common set of sections and DTDs can be developed. . . Rachael Sokolowski, co-chair of E31.25 and the HL7 XML SIG, provided an overview of E31.25 on XML for DTDs for Healthcare and its relationship to other standards development organizations. Liora Alschuler, co-chair of the HL7 XML SIG and chair of the KEG (editorial group responsible for the Patient Record Architecture) provided and overview of the Health Level 7 HL7 XML Efforts with the Patient Record Architecture. Rachael Sokolowski established the workshop goals. The participants would break into groups that would hold working sessions to identify: (1) the sections or categories that exist in clinical documents; (2) The order of the sections, if the sequence is important; (3) The number of times the different sections appear in clinical document types. The supporting materials and knowledge of clinical documentation would be used to determine the sections, the order of the sections and the number of times the sections appeared in document. This included a review of transcribed reports for common areas, sections and sub-sections, government forms for categories for data entry, and demographic information contained within the header of the Patietn Record Architecture. Using the results of the workshop, draft DTDs would be developed. Discussion of DTDs and sections would continue after the workshop on e-mail for a limited period of time. . . .There was agreement among the participants that although no standardized document types with regular sections exist in health care, there is a need and a useful purpose for defining DTDs." See the draft sample DTDs from the report. [cache]
See also: HL7 SGML/XML Special Interest Group