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Usage of Standards to Integration of Hospital Information Systems

Leila Shahmoradi, Maryam Ebrahimi, Somayeh Shahmoradi, Ahmadreza Farzanehnejad, Hajar Moammaie, Mahdi Habibi Koolaee



Introduction: Data exchange across healthcare facilities is a major issue in healthcare information systems. Standards play an important role in the context of communication. In this paper, we surveyed the usage of standards in the hospital information systems (HISs) in the affiliated hospitals of Tehran University of Medical Sciences.

Material and Methods: This survey was performed in 2014-2015. A total of 17 hospitals with HISs were surveyed. The data were collected using a structured questionnaire. The design of the questionnaire was based on a literature review and consisted of three parts. Descriptive statistics were used to analyze the data.

Results: XML, HL7 and DICOM are commonly used international interchange standards. In the case of security standards, 76.5% of HISs do not support the HIPPA and CEN TC 251 security standards.  ICD was the most commonly used terminology standard in the HISs. Several studies have indicated that HISs should cover data exchange, security and terminology standards to provide integration of heterogeneous systems.

Conclusion: In the current study, the role of standards in the architecture of the HISs was inconspicuous. To make the HIS effective, it is necessary to consider the standards when developing the system. In this matter, legislation could help.


Degoulet P. Hospital information systems. In: Venot A, Burgun A, Quantin C [ed]. Medical Informatics, e-Health. Paris: Springer. 2014; 289-313.

Amiri M, Sadeghi E, Khosravi A, Chaman R. Self-assessment of managers and network operators about the effect of hospital information system on the performance and processes of Imam Hossein hospital in Shahroud. Health Information Management. 2011; 8(4): 490-9.

Karimi Hosseini N, Nordin JG, Mahdiani M, Sadrzadeh Rafiei S. A low cost hospital information system: A case study of the Mehr hospital in Mashhad city. Research Journal of Applied Sciences, Engineering and Technology 2014;7(7): 1132-8.

Lu X, Duan H, Li H, Zhao C, An J. The architecture of enterprise hospital information system. Conf Proc IEEE Eng Med Biol Soc. 2005;2005:6957-60. PMID: 17281875 DOI: 10.1109/IEMBS.2005.1616106

Cruz-Correia R, Vieira-Marques P, Ferreira A, Oliveira-Palhares E, Costa P, Costa-Pereira A. Monitoring the integration of hospital information systems: How it may ensure and improve the quality of data. Stud Health Technol Inform. 2006;121:176-82. PMID: 17095815

Trinkunas J, Tuinyliene E, Puronaite R. Research on hospital information systems integration to national electronic health record system. International Conference BIOMDLORE: IEEE; 2018.

Karampela I, Tzortzis E, Kefala I, Zygoura E, Mantzana V, Armaganidis A. Proposal for the implementation of quality standards in a medical unit through integration to the hospital information system. Stud Health Technol Inform. 2017; 238: 185-8. PMID: 28679919

Ko L-F, Lin J-C, Chen C-H, Chang J-S, Lai F, Hsu KP, et al. HL7 middleware framework for healthcare information system. International Conference on e-Health Networking, Applications and Services. New Delhi: IEEE; 2006.

Frascina AC. The integration of hospital information systems through user centerd design. [PhD Thesis] Sheffield: Sheffield Hallam University; 1994.

Li X, Vojisavljevic V, Fang Q. An XML based middleware for ECG format conversion. Conf Proc IEEE Eng Med Biol Soc. 2009; 2009: 1691-4. PMID: 19964551 DOI: 10.1109/IEMBS.2009.5333907

Vlach K, Jirka J, Cernohorsky J. Integration of DASH and ICS 3000 devices with hospital information system and REPACE central registry. Conf Proc IEEE Eng Med Biol Soc. 2012; 2012: 5798-801. PMID: 23367247 DOI: 10.1109/EMBC.2012.6347312

Strahle M, Ehlbeck M, Prapavat V, Kück K, Franz F, Meyer JU. Towards a service-oriented architecture for interconnecting medical devices and applications. Joint Workshop on High Confidence Medical Devices, Software, and Systems and Medical Device Plug-and-Play Interoperability. Boston: IEEE; 2007.

Sujansky WV, Overhage JM, Chang S, Frohlich J, Faus SA. The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems. J Am Med Inform Assoc. 2009 May-Jun; 16(3): 285–90. PMID: 19261950 DOI: 10.1197/jamia.M2610

Modaresnezhad M, Vahdati A, Nemati H, Ardestani A, Sadri F. A rule-based semantic approach for data integration, standardization and dimensionality reduction utilizing the UMLS: Application to predicting bariatric surgery outcomes. Comput Biol Med. 2019; 106: 84-90. PMID: 30708220 DOI: 10.1016/j.compbiomed.2019.01.019

Center of Statistics and Information Technology Management. SEPAS middleware concepts: Electronic health records development plan. Tehran: Ministry of Health and Medical Education; 2011.

Muñoz P, Trigo JD, Martínez I, Muñoz A, Escayola J, García J. The ISO/EN 13606 standard for the interoperable exchange of electronic health records. Journal of Healthcare Engineering. 2011; 2(1): 1-24.

Schmitt L, Falck T, Wartena F, Simons D. Novel ISO/IEEE 11073 standards for personal telehealth systems interoperability. Joint Workshop on High Confidence Medical Devices, Software, and Systems and Medical Device Plug-and-Play Interoperability. Boston: IEEE; 2007.

Soceanu A, Egner A, Moldoveanu F. Towards interoperability of eHealth system networked components. International Conference on Control Systems and Computer Science, Bucharest: IEEE; 2013.

Yao J, Warren S. Applying the ISO/IEEE 11073 standards to wearable home health monitoring systems. J Clin Monit Comput. 2005; 19(6): 427-36. PMID: 16437294 DOI: 10.1007/s10877-005-2033-7

Muller ML, Uckert F, Burkle T, Prokosch HU. Cross-institutional data exchange using the clinical document architecture (CDA). Int J Med Inform. 2005; 74(2-4): 245-56. PMID: 15694631 DOI: 10.1016/j.ijmedinf.2004.09.005

Heitmann KU, Schweiger R, Dudeck J. Discharge and referral data exchange using global standards--the SCIPHOX project in Germany. Int J Med Inform. 2003; 70(2-3): 195-203. PMID: 12909170 DOI: 10.1016/s1386-5056(03)00036-4

Channin DS. Integrating the healthcare enterprise: A primer. Part 2. Seven brides for seven brothers: The IHE integration profiles. Radiographics. 2001;21(5):1343-50.

Siegel EL, Channin DS. Integrating the Healthcare Enterprise: a primer. Part 1. Introduction. Radiographics. 2001; 21(5): 1339-41. PMID: 11553842 DOI: 10.1148/radiographics.21.5.g01se391343

Dvorak CD, Seow K, Bormann D, Larsen S, Michalski C, Ma A, et al. System and method for integration of health care records. Patent No. 20020120472. 2002.

Samy GN, Ahmad R, Ismail Z. Security threats categories in healthcare information systems. Health Informatics J. 2010; 16(3): 201-9. PMID: 20889850 DOI: 10.1177/1460458210377468

Barber B, Garwood D, Skerman P. Security in hospital information systems. International Journal of Biomedical Computing. 1995; 39(1): 133-8.

Sharifian R, Nematollahi M, Monem H, Ebrahimi F. Evaluating the security safeguards in hospital information system according to the health insurance portability and accountability act of university hospitals in Shiraz university of medical sciences, Iran. Health Information Management. 2013; 10(1): 35-46.

Viangteeravat T, Anyanwu MN, Nagisetty VR, Kuscu E, Sakauye ME, Wu D. Clinical data integration of distributed data sources using health level seven (HL7) v3-RIM mapping. J Clin Bioinforma. 2011; 1: 1-10. PMID: 22104558 DOI: 10.1186/2043-9113-1-32

Bowman S. Coordinating SNOMED-CT and ICD-10. J AHIMA. 2005; 76(7): 60-1. PMID: 16097126

DOI: http://dx.doi.org/10.30699/fhi.v9i1.215


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