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SynExML as a vehicle for Electronic Patient Records A status report from the SynEx project

The advent of shared care coupled with the proliferation of heterogeneous distributed systems containing patient data have resulted in an urgent need to provide seamless integration of distributed electronic patient records. This paper presents the approach to this problem, which is being developed as part of a majorEU (European Union)Health Telematics project, SynEx. The approach is based on a coreXML (eXtensible Markup Language) DTD corresponding to a flexible common model of the shared or federated Electronic Healthcare Record. Using this DTD, SynEx has successfully demonstrated the exchange of records between two heterogeneous and geographically separated sites. Introduction and motivation The management of electronic patient data was relatively easy as long as the data was collected, stored and viewed in a closed environment like a single hospital/department or doctor’s practice. A single vendor provided compatible systems and a centralised system administrator was responsible for the smooth running of all installed components. No ’digital’ connection to the ’outside world’ was provided which avoided many of the problems associated with "open" systems, in particular safeguarding the security and confidentiality of patient data. With the use of hospital-specific information system, that are well known by the staff, maintenance and use became very easy and people felt familiar with it. On the other side, complexity increased with each new version and/or change to a different product. Data exchange with external organisations was only possible by paper, mail, fax or telephone, which is clearly both time-consuming and error-prone. Any feedback and results had to be manually entered and often even cross-checked. This approach is no longer sufficient. Increased computerisation throughout the health sector has given rise to a proliferation of independent systems storing and maintaining patient data. However, the growing trend towards shared care requires that these systems are able to share their data. This has led to the development of projects such as Synapses and its successor, SynEx that aim to provide healthcare professionals with integrated access to patient records and related data. One of the goals of SynEx is to bring together the work on Federated Healthcare Records from the Good European Health Record project , emerging standards from CEN/TC251(Comité Européen de Normalisation Technical Committee 251) and the Synapses project with the Information Systems perspective of middleware based pre-standard HISA (Health Information Systems Architecture) . The Synapses project exploited ideas from federated database technology that provide client applications with an integrated view of data stored in heterogeneous, distributed database systems. At the heart of Synapses is the FHCR(Federated Health Care Record) server that accepts requests for data (in the