Building a high quality medical data architecture for multiple uses in an integrated health care environment

Objective: The aim was to create a reliable information provisioning system in healthcare for both care and research processes, based on existing data standards and standardized electronic messages. The research question is: How can a Clinical Data Ware House (CDWH) be developed for standardized basic patient data, generic nursing data and data about oncology nursing, allowing management of Electronic Health Record data, electronic data exchange and data analytics? Materials and methods: The main instrument used was the Detailed Clinical Model (DCM) data standardization approach. Further, data communication utilized HealthLevel7v3 (HL7v3) messages, transported by Mirth Connect. In an incremental, design-oriented research project, CDWH-prototypes were constructed using Enterprise Architect, a HL7v3 generator plug-in, SQL Server technology and PostgreSQL-based CDWH-technology. Results: The project resulted in 16 existing DCMs selected and 6 new DCMs defined. From those DCMs, a HL7v3 message structure was generated and a CDWH created. Implementing specialized Data Marts (DM) a connection between the CDWH and one Electronic Health Record system was built. Discussion: Detailed Clinical Models improve data quality, yet building them consumes time and resources. Some required data codes could not be identified in time and dummy codes were used instead. The existence of unstructured medical data in legacy systems may proof to be an obstacle in the future. Conclusion: The project shows that using Detailed Clinical Models as the sole source for system development leads to a sound design for a CDWH and HL7v3 messages, supporting a standards based health information system, suitable for multiple uses.