August 25, 1997
News Analysis
Health care uses XML for records
Other vertical industry groups also expected to cooperate to customize XML
By Lynda Radosevich
Imagine yourself as a patient in an emergency room, and you'll probably applaud the idea that the attending physician can easily access your medical records -- and find out about that penicillin allergy.
To enable such access, forward-thinkers in the health-care industry are devising ways to use Extensible Markup Language (XML) as an open framework for creating portable electronic medical records. XML is just starting to make its way into products, but it is considered more powerful than HTML, particularly for defining and accessing structured data. (See "Component Dreams," July 21.)
Although XML is just emerging as a Web document format, a group within the Health Level 7 (HL7) standards body is floating a plan called the Kona Proposal, which aims to enable the exchange of medical information in a vendor-neutral structure built on the Standard Generalized Markup Language (SGML) and XML.
"XML provides data neutrality that patients should demand. Would you as a patient want your medical information stored in a proprietary structure that is controlled by an application?" asked John C. Spinosa, a pathologist, founding member of HL7, and medical director at Pathology Medical Laboratory, in La Jolla, Calif.
Although the Kona Proposal is specific to the health-care business, it is a harbinger of how vertical industry groups will cooperate to customize XML into an exchange medium for their industries.
Like HTML, XML is a subset of SGML that has been simplified for the Web. Unlike HTML, it lets developers design their own tags and thereby create documents with sophisticated underlying structures that can be exposed to a search engine or any end-user application.
"It's like taking a document and putting it in a lemon press: If a system squeezes this XML document, a bunch of structured information will come out, namely information that has been tagged," explained Mark Tucker, co-chair of the HL7 control committee and a researcher with the Regenstrief Institute, a health-care research organization, in Indianapolis.
XML is gaining mind share because it provides industries with the flexibility to create their own tags, and XML parsers are portable enough to include in Web browsers.
Indeed, Microsoft has built an XML parser into Internet Explorer 4.0, due by the end of the summer, and Netscape officials have said they will support XML via the Meta Content Framework in an upcoming version of Communicator.
XML is more useful than display technologies, such as the Portable Document Format (PDF), because of its capability to provide structured information that applications can understand, one expert said.
"PDF is for page-based presentation and does not support contextual search of the information. XML provides the underlying structure that allows for contextual search and retrieval," explained Marion Elledge, vice president of information technology at Graphic Communications Association, in Alexandria, Va., which participates in the development of XML.
If the Kona Proposal takes off, the portability of XML documents combined with the Web's broad reach could be a boon to the health-care industry.
Health-care professionals are increasingly working in multiple locations. If a hospital needs to consult a doctor about a patient who's just been admitted, and the doctor is at a different clinic, the doctor could use the Web to pull up clinical records in XML format from multiple locations, said Liora Alschuler, a consultant specializing in healthcare documentation at The-Word-Electric, in Thetford, Vt.
And XML is the obvious way to create the records themselves, because it is an open format that won't tie patients' medical records to proprietary systems in the control of specific health-care institutions and insurance companies, Spinosa said.
The lack of openness could have major implications, including making it difficult for patients to change health-care institutions and making it easier for businesses to misuse information they own.
"I think if a patient's medical record is not in an open data structure, the information will eventually be used to exclude the ill or infirm [because] health-care trends don't seem to want to pay for care of the ill, but do want to pay for care of the healthy. ... It's less expensive," Spinosa said.
Using XML to make clinical documents available on the Web raises a classic concern: confidentiality.
Federal legislation to protect health-care information in the electronic age is set to be proposed this month. And the confidentiality concern has a flip side: Making certain that the right people can access records -- physicians in an emergency room, for example -- can be of even greater concern, Alschuler said.
XML toolkit
A sampling of tools for creating XML documents
ArborText's Adept Series supports Standard Generalized Markup Language (SGML) and Extensible Markup Language (XML). ArborText Inc., Ann Arbor, Mich.: http://www.arbortext.com/.
Grif's WYSIWYG is an SGML editor with a Japanese version built on Unicode, an XML specification used to represent double-byte characters, such as Kanji. Grif S.A., St Quentin en Yvelines Cedex, France: http://www.grif.com/.
Microsoft's XML Parser in Java checks for well-formed documents and optionally permits checking of the documents' validity. Once parsed, the XML document is exposed as a tree through Java methods that support reading and/or writing of XML structures. Microsoft Corp., Redmond Wash.: http://www.microsoft.com/standards/xml/.
webMethods Web Automation is a Java-class creator that "reads" a document's HTML or XML structure, transforms it into its constituent objects, and stores these objects in a repository for use in Java applications. webMethods Inc., Fairfax, Va.: http://www.webMethods.com/.
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