1.  LOINC, a Universal Standard for Identifying Laboratory Observations: a 5-year Update

Author(s): McDonald CJ, Huff SM, Suico JG, Hill G, Leavelle D, Aller R, Forrey A, Mercer K, DeMoor G, Hook J, Williams W, Case J, Maloney P

Source: Clinical Chemistry. 2003 Apr;49(4):624-633.

Summary: The Logical Observation Identifier Names and Codes (LOINC) database provides a universal code system for reporting laboratory and other clinical observations. Its purpose is to identify observations in electronic messages such as Health Level Seven (HL7) observation messages, so that when hospitals, health maintenance organizations, pharmaceutical manufacturers, researchers, and public health departments receive such messages from multiple sources, they can automatically file the results in the right slots of their medical records, research, and/or public health systems. For each observation, the database includes a code (of which 25 000 are laboratory test observations), a long formal name, a "short" 30-character name, and synonyms. LOINC codes are being used by large reference laboratories and federal agencies, and are part of the Health Insurance Portability and Accountability Act (HIPAA) attachment proposal. Laboratories should include LOINC codes in their outbound HL7 messages so that clinical and research clients can easily integrate these results into their clinical and research repositories.

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2.  The HL7 Clinical Document Architecture

Author(s): Dolin RH, Alschuler L, Beebe C, Biron PV, Boyer SL, Essin D, Kimber E, Lincoln T, Mattison JE

Source: Journal of the American Medical Informatics Assocation (JAMIA). 2001 Nov-Dec;8(6):552-569.

Summary: Health Level 7 (HL7) is developing standards for the representation of clinical documents (such as discharge summaries and progress notes). These document standards make up the HL7 Clinical Document Architecture (CDA). This article presents the approach and objectives of the CDA, along with a technical overview of the standard. The CDA is a document markup standard that specifies the structure and semantics of clinical documents and can include text, images, sounds, and other multimedia content. The first release of the standard has attempted to fill an important gap by addressing common and largely narrative clinical notes. Being a part of the emerging HL7 version 3 family of standards, the CDA derives its semantic content from the shared HL7 Reference Information Model and is implemented in Extensible Markup Language (XML). The HL7 mission is to develop standards that enable semantic interoperability across all platforms; the CDA is helping to move us closer to the realization of this vision.

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3.  The Continunity of Care Record

Author(s): Kibbe DC, Phillips RL Jr, Green LA

Source: American Family Physician. 2004 Oct 1;70(7):1220, 1222-1223. 2004 Oct 1;70(7):1220, 1222-1223.

Summary: For more than a decade there has been agreement in the United States that information technology is a critical part of any effort to achieve high performance health care for everyone. The potential benefits of moving from sequences of disconnected and episodic visits between patients and doctors to continuous connectivity are widely recognized to be of great value to patients, families, communities, investigators, payers and purchasers, employees, health organizations, and physicians.  The Continuity of Care Record (CCR) is a document being developed to foster and improve continuity of patient care, reduce medical errors, increase patients' role in managing their health, enable epidemic monitoring and public health research, and ensure at least a minimum standard of secure health information transportability.  This article discusses the various ways that physicians and patients are able to use this personal health information standard tool.

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4.  The Unified Medical Language System: An Informatics Research Collaboration

Author(s): Humphreys BL, Lindberg DAB, Schoolman HM, Barnett GO

Source: Journal of the American Medical Informatics Assocation (JAMIA). 1998 Jan-Feb;5(1):1-11.

Summary: In 1986, the National Library of Medicine (NLM) assembled a large multidisciplinary, multisite team to work on the Unified Medical Language System (UMLS), a collaborative research project aimed at reducing fundamental barriers to the application of computers to medicine. The UMLS illustrates the strengths and challenges of substantive collaboration among widely distributed research groups. Over the past decade, advances in computing and communications have minimized the technical difficulties associated with UMLS collaboration and also facilitated the development, dissemination, and use of the UMLS Knowledge Sources. Wider use of the World Wide Web has increased the visibility of the information access problems caused by the multiple vocabularies and many information sources that are the focus of UMLS work. The time is propitious for building on UMLS accomplishments and making more progress on the informatics research issues first highlighted by the UMLS project more than 10 years ago.