Preprint version of paper forthcoming in Journal of Biomedical Informatics The goal of referent tracking is to create an ever-growing pool of data relating to the entities existing in concrete spatiotemporal reality. In the context of Electronic Healthcare Records (EHRs) the relevant concrete entities are not only particular patients but also their parts, diseases, therapies, lesions, and so forth, insofar as these are salient to diagnosis and treatment. Within a referent tracking system, all such entities are referred to directly and explicitly, something which cannot be achieved when familiar concept-based systems are used in what is called “clinical coding”. In this paper we describe the components of a referent tracking system in an informal way and we outline the procedures that would have to be followed by healthcare personnel in using such a system. We argue that the referent tracking paradigm can be introduced with only minor – though nevertheless ontologically important – technical changes to existing EHR infrastructures, but that it will require a radically different mindset on the part of those involved in clinical coding and terminology development from that which has prevailed hitherto.

Medical information systems today store clinical information about patients in all kinds of proprietary formats. To address the resulting interoperability problems, several Electronic Healthcare Record standards that allow to structure the clinical content for the purpose of exchange are currently under development. In this article, we present a survey of the most relevant Electronic Healthcare Record standards, examine the level of interoperability they provide and assess their functionality in terms of content structure, access services, multimedia support and security. We further investigate the complementarity of the standards and assess their market relevance.

Medical information systems today store clinical information about patients in all kinds of proprietary formats. To address the resulting interoperability problems, several Electronic Healthcare Record standards that structure the clinical content for the purpose of exchange are currently under development. In this article, we present a survey of the most relevant Electronic Healthcare Record standards, examine the level of interoperability they provide, and assess their functionality in terms of content structure, access services, multimedia support, and security. We further investigate the complementarity of the standards and assess their market relevance.

In enterprise integration, a data-exchange specification is an architectural artifact that evolves along with the business. Maintaining a coherent, data-exchange, semantic model is an important, yet non-trivial task. A coherent, semantic model of data- exchange specifications supports reuse, promotes interoperability, and, consequently, reduces integration costs. Components of data-exchange specifications must be consistent and valid in terms of agreed upon standards and guidelines. In this paper, we propose an activity model for the creation, test, and maintenance of a shared semantic model that is coherent and supports scalable standards-based enterprise integration. While it frames our research and the development of tools to support those activities for semantic models implemented using XML (Extensible Markup Language) Schema, the activity model presented in this paper is independent of the data-exchange technology.

In enterprise integration, a data-exchange specification is an architectural artifact that evolves along with the business. Maintaining a coherent, data-exchange, semantic model is an important, yet non-trivial task. A coherent, semantic model of data- exchange specifications supports reuse, promotes interoperability, and, consequently, reduces integration costs. Components of data-exchange specifications must be consistent and valid in terms of agreed upon standards and guidelines. In this paper, we propose an activity model for the creation, test, and maintenance of a shared semantic model that is coherent and supports scalable standards-based enterprise integration. While it frames our research and the development of tools to support those activities for semantic models implemented using XML (Extensible Markup Language) Schema, the activity model presented in this paper is independent of the data-exchange technology.