[April 19, 2000] Experimental research is being done with an XML-based electronic patient record (EPR) template to assist in the creation and sharing of medical knowledge by clinical processionals. The research is being carried out at Department of Medical Informatics, University Hospital, University of the Ryukyus, Okinawa, and Division of Medical Informatics Chiba University Hospital, Chiba, Japan, together with a TDL Working Group (one of the special research interest groups in the Japanese Association of Medical Informatics). The principals report that the Template Definition Language (TDL) has been developed "to share knowledge of how to construct an electronic patient record (EPR) template, based on XML (Extensible Markup Language). TDL has been designed to be independent of EPR platforms or databases. Our research of TDL was conducted through the evaluation of the description of various templates in currently available EPRs and through comparisons with some electronic clinical guidelines. We conclude that TDL is sufficient for the objective but still needs improvement of the algorithm for describing dynamic changes."
"The Electronic Patient Record (EPR) system is expected to provide a number of beneficial results. For example, data from the EPR system can be applied for decision making and clinical research. The EPR can be used for remote patient care together with a health card or in the framework of telemedicine, as well as in daily hospital use. It can also be applied to hospital billing and administration and can be used for the analysis of quality of care and cost. These beneficial effects are rapidly becoming visible. To realize these effects, patient data, which are currently documented as narrative text, must be captured in coded form... Structured data entry (SDE) is a more promising approach. The advantage of SDE over NLP is that the process of data capturing can be influenced by implemented knowledge. Physicians can be stimulated to produce more complete records through online reminders and alerts.
"To achieve the objective of sharing knowledge, we developed a simple platform-independent language for describing the contents and structures of templates and named it Template Definition Language (TDL). Using the TDL editor and translator, physicians can generate templates by themselves. In this paper we examine the first and second step of this process. A TDL Working Group (one of the special research interest groups in the Japanese Association of Medical Informatics) began developing these steps in 1997, and decided in 1998 to use the extensible markup language (XML) to attain these objectives.
"The user's data entry or other user actions should trigger the action, not only showing messages on the screen, but also changing the screen design. The description of the rule should represent judgment criteria on changes of the template after being triggered. Data from the patient database may be required as parameters of the rule. The Arden Syntax for Medical Logic Modules (ASTM E 31.15) is one of the most appropriate and suitable standards that meets these requirements. In MLM the input is usually a set of patient data from the database, and the output is messages to the users. Therefore MLM should be extended to carry out a TDL-defined action. Chaining of multiple MLMs together, which is not well supported by the current MLM, is required. A script can be described in the extensible style language (XSL) document for XML. The ECMA Script standard provides the basis for the XSL scripting language, and the script is the standardized specification of JavaScript. Control of the screen and processing of the data entered by users is expressed with the ECMA Script. However, because handling data from a patient database is difficult, the adoption of the ECMA Script to describe the rule would require an XSL document to be added to the TDL document. We are expecting a new version of Arden Syntax and will decide whether it can be used in TDL."
"Until now, there was nothing available for the exchange of the contents and structure of a template other than free-format paper documents. There was no standard expression and there existed even confusion of the terms concerning templates. Our version of TDL has solved this problem. It can describe the contents and structure of a template, which may be exchanged between institutions, vendors and platforms. Standardization of ATOM items (title, value, and other attributes) of templates is part of the value of TDL. Ideally, these ATOM items should be standardized, but this takes time and requires further discussion. We do not aim for standardization of the templates. TDL itself does not regulate the contents of templates. Rather, TDL differentiates between various kinds of templates, even those having the same title (including problem), and makes apparent the differences between medical practices. TDL will also provoke discussions on such issues."
References:
[April 21, 2000] "Standard Method for Describing an Electronic Patient Record Template: Application of XML to Share Domain Knowledge." By Shunji Yamazaki (Department of Medical Informatics, University Hospital, University of the Ryukyus, Okinawa) and Yoichi Satomura (Division of Medical Informatics Chiba University Hospital, Chiba, Japan). In Methods of Information in Medicine Volume 39, Number 1 (March 2000), pages 50-55 (with 24 references). [ISSN: 0026-1270; the official journal of the European Federation for Medical Informatics EFMI.] "TDL (Template Definition Language) was developed to share knowledge of how to construct an electronic patient record (EPR) template, based on XML (Extensible Markup Language). TDL has been designed to be independent of EPR platforms or databases. Our research of TDL was conducted through the evaluation of the description of various templates in currently available EPRs and through comparisons with some electronic clinical guidelines. We conclude that TDL is sufficient for the objective but still needs improvement of the algorithm for describing dynamic changes." [cache]
"Template Definition Language for Electronic Patient Record. Toward Medical Knowledge Sharing." By Shunji Yamazaki, Takahiro Suzuki, Masayuki Honda, Katsuhiko Takabayashi, and Yoichi Satomura. Division of Medical Informatics, Chiba University Hospital. Abstract: "An electronic patient record (EPR) system with a template function has been reported by several institutions. This template function is used to provide a framework for the patient record and interactive assistance to the user for entering data. A structured data-entry system can be applied for direct use of EPRs by clinicians. Specialist's medical knowledge is necessary to generate an EPR template, and consistent methodology and terminology (Template Definition Language TDL) are required to overcome platform differences in an EPR system. The developed prototype of the TDL has been made by Chiba University. The electronic health record research group in JAMI has decided to join the TDL development.The prototype can be refined to provide a common base for template generation." [17th JCMI, November, 1997]
See also: "Health Level Seven XML Patient Record Architecture"
