Electronic Health Records

A. Hoerbst; E. Ammenwerth

doi:10.3414/ME10-01-0038

Methods of Information in Medicine, Table of Contents

Methods Inf Med 2010; 49(04): 320-336
DOI: 10.3414/ME10-01-0038

Review Article

Schattauer GmbH

Electronic Health Records

A Systematic Review on Quality Requirements

A. Hoerbst

¹Research Division eHealth and Telemedicine, UMIT – University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria

,

E. Ammenwerth

²Institute for Health Information Systems, UMIT – University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria

› Author Affiliations

Abstract

Summary

Objectives: Since the first concepts for electronic health records (EHRs) in the 1990s, the content, structure, and technology of such records were frequently changed and adapted. The basic idea to support and enhance health care stayed the same over time. To reach these goals, it is crucial that EHRs themselves adhere to rigid quality requirements. The present review aims at describing the currently available, mainly non-functional, quality requirements with regard to electronic health records.

Methods: A combined approach – systematic literature analysis and expert interviews – was used. The literature analysis as well as the expert interviews included sources /experts from different domains such as standards and norms, scientific literature and guidelines, and best practice. The expert interviews were performed by using problem-centric qualitative computer-assisted telephone interviews

Methods Inf Med 2010; 49: 320–336 doi: 10.3414/ME10-01-0038 received: May 17, 2010 accepted: June 9, 2010 prepublished: July 6, 2010 (CATIs) or face-to-face interviews. All of the data that was obtained was analyzed using qualitative content analysis techniques.

Results: In total, more than 1200 requirements were identified of which 203 requirements were also mentioned during the expert interviews. The requirements are organized according to the ISO 9126 and the eEurope 2002 criteria. Categories with the highest number of requirements found include global requirements, (general) functional requirements and data security. The number of nonfunctional requirements found is by contrast lower.

Conclusion: The manuscript gives comprehensive insight into the currently available, primarily non-functional, EHR requirements. To our knowledge, there are no other publications that have holistically reported on this topic. The requirements identified can be used in different ways, e.g. the conceptual design, the development of EHR systems, as a starting point for further refinement or as a basis for the development of specific sets of requirements.

Keywords

Electronic health record - personal health record - medical records - quality - requirements - review

Full Text

References

References
1 Waegemann CP. Status Report 2002: Electronic Health Records. Medical Records Institute; 2002
2 Waegemann CP. EHR vs. CPR vs. EMR. Healthcare Informatics Online 2003 (May): 1-4.
3 Ball M, Smith C, Bakalar RS. Personal Health Records: Empowering Consumers. Journal of Health-care Information Management 2006; 21 (01) 76-86.
4 Iakovidis I. Towards personal health record: current situation, obstacles and trends in implementation of electronic healthcare record in Europe. Int J Med Inform 1998; 52 1–3 105-115.
5 International Standardization Organization.. ISO 12207 – Systems and software engineering – Software life cycle processes. International Standardization Organization; 2008
6 International Standardization Organization.. ISO 9000 – Quality management systems. Fundamentals and vocabulary. International Organization for Standardization; 2005
7 Institute of Electrical and Electronics Engineers.. IEEE St. 610.121990 – Standard Glossary of Software Engineering Terminology. The Institute of Electrical and Electronics Engineers; 1990
8 Denzin N. editor. Strategies of multiple triangulation. New York: McGraw-Hill; 1978
9 Mayring P. Introduction to Social Sciences. 5th ed. Weinheim und Basel:: Beltz Verlag; 2002. (In German).
10 ANSI.. eStandards Store. American National Standards Institute; 2010 (cited 2010 01.04.). Available from: http://webstore.ansi.org.
11 ASTM International.. ASTM Standards and Engineering Digital Library. American Society for Testing and Materials; 2010 (cited 2010 01.04.). Available from: http://www.astm.org/Standard/index.shtml?complete.
12 CEN.. Extended search for standards and/or projects. European Committee for Standardization; 2010 (cited 2010 01.04.) Available from: http://esearch.cen.eu.
13 ISO.. ISO Standards. International Standardization Origanization; 2010 (cited 2010 01.04.). Available from: http://www.iso.org/iso/search.htm.
14 Mayring P. Qualitative Content Analysis – Basics and Techniques. 8th ed. Weinheim und Basel:: Beltz Verlag; 2000. (In German).
15 Bortz J, Döring N. Methods and Evaluation for Human and Social Scientists. 3rd ed. Berlin, Heidelberg, New York:: Springer Verlag; 2003. (In German).
16 International Standardization Organization.. ISO/ IEC 9126 – Software Engineering. Product Quality. International Organization for Standardization; 2001
17 Commission of the European Communities.. eEurope 2002: Quality Criteria for Health related Websites. Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions. Brussels: Commission of the European Communities; 2002
18 Hoerbst A, Schabetsberger T, Hackl W, Ammenwerth E. Requirements Regarding Quality Certification of Electronic Health Records. In: Adlassnig K-P, Blobel B, Mantas J, Masic I. editors. Medical Informatics in a United and Healthy Europe – Proceedings of MIE 2009 – The XXIInd International Congress of the European Federation for Medical Informatics. Sarajevo: IOS Press; 2009. pp 384-388.
19 Merkens H. Selection Procedures, Sampling, Case Construction. In: Flick U, von Kardorff E, Steinke I. editors. A Companion to Qualitative Research. London: Sage Publications Ltd.; 2000. pp 165-171.
20 Pidgeon N, Henwood K. Grounded theory: practical implementation. In: Richardson JTE. editor. Handbook of Qualitative Research Methods for Psychology and the Social Sciences. Oxford: British Psychological Society; 1996. pp 75-85.
21 Carey MA. The Group Effect in Focus Groups – Planning, Implementing, and Interpreting Focus Group Research. In: Morse JM. editor. Critical Issues in Qualitative Research Methods: Sage Publications Inc.; 1994
22 Ishikawa K, Ohmichi H, Umesato Y, Terasaki H, Tsukuma H, Iwata N. et al. The guideline of the personal health data structure to secure safety health-care: The balance between use and protection to satisfy the patients’ needs. Int J Med Inform 2007; 76 5–6 412-418.
23 Burns F. Information for Health: An information strategy for the modern NHS 1998-2005. A national strategy for local implementation. NHS – Department of Health Publications; 2006 (cited 2007 16.05.). Available from: http://www.dh.
24 Commission of the European Communities.. e-Health – making healthcare better for European citizens: An action plan for a European e-Health Area. Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions. Brussels; 2004
25 Cunningham S. An Investigation of Electronic Health Records. 2003
26 Hammond WE. Making the boundaries clearer: revisiting information systems with fading boundaries. Int J Med Inform 2003; 69 2–3 99-104.
27 Hasselbring W, Reussner R. Toward trustworthy software systems. Computer 2006; 39 (04) 91-92.
28 Hanmer L. Criteria for the evaluation of district health information systems. Int J Med Inform 1999; 56 1–3 161.
29 Humphreys BL. Electronic Health Record Meets Digital Library: A New Environment for Achieving an Old Goal. J Am Med Inform Assoc 2000; 7 (05) 444-552.
30 Huston JL. Information governance standards for managing e-health information. Journal of Tele-medicine and Telecare 2005; 11 (02) 56-58.
31 Office of Health and the Information Highway Health Canada.. Toward Electronic Health Records. 2001 (cited 2007 22.05.). Available from: http://www.hc-sc.gc.ca/hcs-sss/alt_formats/pacrbdgapcr/pdf/pubs/ehealth-esante/2001-towards-vers-ehr-dse/2001-towards-vers-ehr-dse-eng.pdf.
32 Saastamoinen H. Exception-Based Approach for Information Systems Evaluation: The Method and its Benefits to Information Systems Management. The Electronic Journal of Information Systems Evaluation 2004; 8 (01) 51-60.
33 Ueckert F, Goerz M, Ataian M, Tessmann S, Prokosch H-U. Empowerment of patients and communication with health care professionals through an electronic health record. Int J Med Inform 2003; 70 2–3 99.
34 Waegemann CP. Testimony regarding Personal Health Records. Chicago: National Committee on Vital and Health Statistics; 2002
35 Agrawal R, Johnson C. Securing electronic health records without impeding the flow of information. Int J Med Inform 2007; 76 5–6 471-479.
36 Beun JG. Electronic healthcare record; a way to empower the patient. Int J Med Inform 2003; 69 2–3 191.
37 Birkmann C, Dumitru RC, Prokosch H-U. Evaluation of Health-related Internet Use in Germany. Methods Inf Med 2006; 45 (04) 367-376.
38 Boeske M, Franz H, Goetz C, Haibach S. Frank-Johannes, Hümmelink R et al. Managementpapier “Elektronische Patientenakte”. Aktionsforum Telematik im Gesundheitswesen. 2004
39 Winkelman WJ, Leonard KJ. Overcoming Structural Constraints to Patient Utilization of Electronic Medical Records: A Critical Review and Proposal for an Evaluation Framework. J Am Med Inform Assoc 2004; 11 (02) 151-61.
40 de Meyer F, Lundgren P-A, de Moor G, Fiers T. Determination of user requirements for the secure communication of electronic medical record information. Int J Med Inform 1998; 49 (01) 125.
41 Agrawal R, Grandison T, Johnson C, Kiernan J. Enabling the 21st Century Health Care Information Technology Revolution. Communications of the ACM 2007; 50 (02) 35-42.
42 Blobel B. Comparing approaches for advanced e-health security infrastructures. Int J Med Inform 2007; 76 5–6 454-459.
43 Spidlen J, Hanzlicek P, Riha A, Zvarova J. Flexible information storage in MUDRII EHR. Int J Med Inform 2006; 75 3–4 201.
44 Wozak F, Schabetsberger T, Ammmenwerth E. End-to-end Security in Telemedical Networks – A Practical Guideline. Int J Med Inform 2007; 76 5–6 484-490.
45 Cimino JJ, Patel VL, Kushniruk AW. The patient clinical information system (PatCIS): technical solutions for and experience with giving patients access to their electronic medical records. Int J Med Inform 2002; 68 1–3 113.
46 Halamka JD, Osterland C, Safran C. CareWeb(TM), a web-based medical record for an integrated health care delivery system. Int J Med Inform 1999; 54 (01) 1.
47 Hassol A, Walker JM, Kidder D, Rokita K, Young D, Pierdon S. et al. Patient Experiences and Attitudes about Access to a Patient Electronic Health Care Record and Linked Web Messaging. J Am Med Inform Assoc 2004; 11 (06) 505-513.
48 Jepsen T. IT in healthcare: progress report. IT Professional 2003; 5 (01) 8-14.
49 Kim MI, Johnson KB. Personal Health Records: Evaluation of Functionality and Utility. J Am Med Inform Assoc 2002; 9 (02) 171-180.
50 Yee WG, Trockman B. editors. Bridging a Gap in the Proposed Personal Health Record. The international workshop on Healthcare information and knowledge management; 2006. Virginia: ACM Press; 2006
51 Blobel B. Advanced EHR Architectures – Promises or Reality. Methods Inf Med 2006; 45: 95-101.
52 Egyhazy C, Mukherji R. Interoperability Architecture using RM-ODP. Communications of the ACM 2004; 47 (02) 93-97.
53 Hristidis V, Clarke PJ, Prabakar N, Deng Y, White JA, Burke RP. A Flexible Approach for Electronic Medical Records Exchange. International workshop on Healthcare information and knowledge management. Virginia; 2006. pp 33-40.
54 Loane M, Wootton R. A review of guidelines and standards for telemedicine. Journal of Telemedicine and Telecare 2002; 8: 63-71.
55 Lekkas D, Gritzalis D. Long-term verifiability of the electronic healthcare records’ authenticity. Int J Med Inform 2007; 76 5–6 442-448.
56 Sucurovic S. Implementing security in a distributed web-based EHCR. Int J Med Inform 2007; 76 5–6 491-496.
57 Han S, Skinner G, Potdar V, Chang E. A Framework of Authentication and Authorization for e-Health Services. 3rd ACM workshop on secure web services. Virginia: 2006. pp 105-6.
58 Bakker AR. The need to know the history of the use of digital patient data, in particular the EHR. Int J Med Inform 2007; 76 5–6 438-441.
59 Kalra D. Electronic Health Record Standards. IMIA Yearbook of Medical Informatics 2006. Stuttgart:: Schattauer;; 2006. pp 136-144.
60 Safran C, Bloomrosen M, Hammond WE, Labkoff S, Markel-Fox S, Tang PC. et al. Toward a National Framework for the Secondary Use of Health Data: An American Medical Informatics Association White Paper. J Am Med Inform Assoc 2007; 14 (01) 1-9.
61 Blobel B, Roger-France F. A systematic approach for analysis and design of secure health information systems. Int J Med Inform 2001; 62 (01) 51-78.
62 Huston T. Security issues for implementation of e-medical records. Communications of the ACM 2001; 44 (09) 89-94.
63 van der Linden H, Boers G, Tange H, Talmon J, Hasman A. PropeR: a multi disciplinary EPR system. Int J Med Inform 2003; 70 2–3 149-160.
64 Berner ES, Moss J. Informatics Challenges for the Impending Patient Information Explosion. J Am Med Inform Assoc 2005; 12 (06) 614-617.
65 Bergmann J, Bott OJ, Pretschner DP, Haux R. An e-consent-based shared EHR system architecture for integrated healthcare networks. Int J Med Inform 2007; 76 2–3 130-136.
66 Espinosa AL. Availability of health data: requirements and solutions. Int J Med Inform 1998; 49 (01) 97.
67 Handler T, Holtmeier R, Metzger J, Overhage M, Taylor S, Underwood C. HIMSS Electronic Health Record Definitional Model Version 1.0. 2003 (cited 2007 01.06.). Available from: http://www.himss.org/content/files/ehrattributes070703.pdf.
68 Tang PC, Newcomb C. Informing Patients: A Guide for Providing Patient Health Information. J Am Med Inform Assoc 1998; 5 (06) 563-570.
69 Fullerton C, Aponte P, Hopkins R, Bragg D, Ballard DJ. Lessons learned from pilot site implementation of an ambulatory electronic health record. Baylor University Medical Center Proceedings 2006; 19 (04) 303-310.
70 Gemmill J. Network basics for telemedicine. Journal of Telemedicine and Telecare 2005; 11: 71-76.
71 Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption. J Am Med Inform Assoc 2006; 13 (02) 121-126.
72 Müller ML, Ückert F, Bürkle T, Prokosch H-U. Cross-institutional data exchange using the clinical document architecture (CDA). Int J Med Inform 2005; 74 2–4 245-256.
73 Blobel B. Advanced tool kits for EPR security. Int J Med Inform 2000; 60 (02) 169.
74 Kontio J. Common Gaps in Information Systems. The Electronic Journal of Information Systems Evaluation 2005; 8 (02) 123-132.
75 Rigby M, Budgen D, Turner M, Kotsiopoulos I, Brereton P, Keane J. et al. A data-gathering broker as a future-orientated approach to supporting EPR users. Int J Med Inform 2007; 76 2–3 137.
76 ISO 18308 – Health Informatics – Requirements for an Electronic Health Record. 2003
77 van der Linden H, Talmon J, Tange H, Grimson J, Hasman A. PropeR revisited. Int J Med Inform 2005; 74 2–4 235.
78 Nowinski CJ, Becker SM, Reynolds KS, Beaumont JL, Caprini CA, Hahn EA. et al. The impact of converting to an electronic health record on organizational culture and quality improvement. Int J Med Inform 2007; 76 (01) 174-183.
79 Hasman A, Tange H, Vissers M. Combining a scientific approach and prototyping in the design of EHCR systems. IEEE Transactions on Information Technology in Biomedicine 1998; 2 (03) 117-123.
80 Arts DGT, de Keizer NF, Scheffer G-J. Defining and Improving Data Quality in Medical Registries: A Literature Review, Case Study, and Generic Framework. J Am Med Inform Assoc 2002; 9 (06) 600-611.
81 Kostagiolas P. Information Services for Supporting Quality Management in Healthcare. The Journal on Information Technology in Healthcare 2006; 4 (03) 137-146.
82 Ash JS, Bates DW. Factors and Forces Affecting EHR System Adoption: Report of a 2004 ACMI Discussion. J Am Med Inform Assoc 2005; 12 (01) 8-12.
83 Adelhard K, Obst O. Evaluation of Medical Internet Sites. Methods Inf Med 1999; 38 (02) 75-79.
84 Bernstam EV, Sagaram S, Walji M, Johnson CW, Meric-Bernstam F. Usability of quality measures for online health information: Can commonly used technical quality criteria be reliably assessed?. Int J Med Inform 2005; 74 (07) 675-683.
85 Hier DB, Rothschild A, LeMaistre A, Keeler J. Differing faculty and housestaff acceptance of an electronic health record. Int J Med Inform 2005; 74 7–8 657.
86 Ammenwerth E, Ehlers F, Hirsch B, Gratl G. HIS-Monitor: An approach to assess the quality of information processing in hospitals. Int J Med Inform 2007; 76 2–3 216.
87 Motta GHMB, Furuie SS. A contextual role-based access control authorization model for electronic patient record. IEEE Transactions on Information Technology in Biomedicine 2003; 7 (03) 202-207.
88 Heinzelmann PJ, Lugn NE, Kvedar JC. Telemedicine in the future. Journal of Telemedicine and Telecare 2005; 11: 384-390.
89 Sohr K, Drouineaud M, Ahn G-J. editors. Formal Specification of Role-based Security Policies for Clinical Information Systems. ACM Symposium on Applied Computing; Santa Fe; 2005
90 Pratt W, Unruh K, Civan A, Skeels MM. Personal in-formation management: Personal health information management. Communications of the ACM 2006; 49 (01) 51-55.
91 Lang JR, Collen A. Evaluating Personal Health Care and Health Promotion Web Sites. Methods Inf Med 2005; 44: 328-333.
92 Zurita L, Nohr C. editors. Patient opinion – EHR assessment from the users perspective. Medinfo 2004; San Francisco. 2004
93 Anderson JG. Social, ethical and legal barriers to E-health. Int J Med Inform 2007; 76 5–6 480-483.
94 Scott RE. e-Records in health – Preserving our future. Int J Med Inform 2007; 76 5–6 427-431.
95 Bruun-Rasmussen M, Bernstein K, Vingtoft S, Nohr C, Andersen S. Quality Labelling and Certification of Electronic Health Record Systems. In: Engel-brecht R, Geissbuhler A, Lovis C, Mihalas G. editors. Connecting Medical Informatics and Bio-Informatics – Proceedings of MIE2005 – The XIXth International Congress of the European Federation for Medical Informatics. IOS Press; 2005. pp 47-52.
96 Chu S. From Component-based to Service Oriented Software Architecture for Healthcare. The Journal on Information Technology in Healthcare 2006; 4 (01) 5-14.
97 Classen DC, Avery AJ, Bates DW. Evaluation and Certification of Computerized Provider Order Entry Systems. J Am Med Inform Assoc 2007; 14 (01) 48-55.
98 Karsten H, Laine A. User interpretations of future information system use: A snapshot with technological frames. Int J Med Inform 2007; 76 (01) 136-140.
99 Adler KG. How to Successfully Navigate Your EHR Implementation. Family Practice Management 2007; February: 33-69.
100 Goldschmidt PG. HIT and MIS: Implications of Health Information Technology and Medical Information Systems. Communications of the ACM 2005; 48 (10) 69-74.
101 Chang E, Dillon TS. A usability-evaluation metric based on a soft-computing approach. IEEE Transactions on Systems, Man and Cybernetics, Part A. 2006; 36 (02) 356-372.
102 Niland JC, Rouse L, Stahl DC. An Informatics Blueprint for Healthcare Quality Information Systems. J Am Med Inform Assoc 2006; 13 (04) 402-417.
103 Haux R. Health information systems – past, present, future. Int J Med Inform 2006; 75 3–4 268-281.
104 Johnson CM, Johnson TR, Zhang J. A user-centered framework for redesigning health care interfaces. J Biomed Inform 2005; 38 (01) 75.
105 Rose AF, Schnipper JL, Park ER, Poon EG, Li Q, Middleton B. Using qualitative studies to improve the usability of an EMR. J Biomed Inform 2005; 38 (01) 51.
106 Bossen C. editor. Participation, Power, Critique: Constructing a Standard for Electronic Patient Records. Conference on Participatory design: Expanding boundaries in design; 2006
107 Ertmer A, Ückert F. editors. User Acceptance of and Satisfaction with a Personal Electronic Health Record. Medical Informatics 2005
108 Beuscart-Zephir MC, Anceaux F, Crinquette V, Renard JM. Integrating users’ activity modeling in the design and assessment of hospital electronic patient records: the example of anesthesia. Int J Med Inform 2001; 64 2–3 157.
109 Merrill C, Feldman D. Rethinking the path to usability: how to design what users really want. IT Professional 2004; 6 (03) 51-57.
110 Bernstein K, Bruun-Rasmussen M, Vingtoft S, Andersen SK, Nøhr C. Modelling and implementing electronic health records in Denmark. Methods Inf Med 2005; 74 (02) 213-220.
111 Rosenbloom ST, Miller RA, Johnson KB, Elkin PL, Brown SH. Interface Terminologies: Facilitating Direct Entry of Clinical Data into Electronic Health Record Systems. J Am Med Inform Assoc 2006; 13 (03) 277-288.
112 Hjelm NM. Benefits and drawbacks of telemedicine. Journal of Telemedicine and Telecare 2005; 11: 60-70.
113 Stausberg J, Koch D, Ingenerf J, Betzler M. Comparing Paper-based with Electronic Patient Records: Lessons Learned during a Study on Diagnosis and Procedure Codes. J Am Med Inform Assoc 2003; 10 (05) 470-477.
114 Chu S. Towards Global Inter-operability: Health Level Seven as the Enabling Technology. The Journal on Information Technology in Healthcare 2003; 1 (05) 313-319.
115 Lenz R, Beyer M, Kuhn KA. Semantic integration in healthcare networks. Int J Med Inform 2007; 76 2–3 201.
116 Benigeri M, Pluye P. Shortcomings of health information on the Internet. Health Promotion International 2003; 18 (04) 381-386.
117 Porter SC, Mandl KD. editors. Data Quality and the Electronic Medical Record: A Role for Direct Parental Data Entry. Proceedings AMIA Symposium; 1999
118 Middleton B, Hammond WE, Brennan PF, Cooper GF. Accelerating U, S. EHR Adoption: How to Get There From Here. Recommendations Based on the 2004 ACMI Retreat. J Am Med Inform Assoc 2005; 12 (01) 13-19.
119 Forsstrom JJ, Rigby M. Considerations on the quality of medical software and information services. Int J Med Inform 1999; 56 1–3 169-176.
120 Johannsen N, Kensing F. editors. Empowerment Reconsidered. 4th decennial conference on Critical computing: between sense and sensibility. Aarhus: ACM Press; 2005
121 Kim J, Feng DD, Cai TW, Eberl S. editors. A Solution to the Distribution and Standardization of Multimedia Medical Data in E-Health. Pan-Sydney area workshop on Visual information processing. Sydney: 2002
122 Bates DW, Ebell M, Gotlieb E, Zapp J, Mullins HC. A Proposal for Electronic Medical Records in U. S. Primary Care. J Am Med Inform Assoc 2003; 10 (01) 1-10.
123 Ean-Wen H, Der-Ming L. Performance Analysis of a Medical Record Exchanges Model. IEEE Transactions on Information Technology in Biomedicine 2007; 11 (02) 153-160.
124 Hori M, Ohashi M, Suzuki S. Citizen-Centric Approach and Healthcare Management Based on the XML Web Services. The Electronic Journal of Information Systems Evaluation 2006; 8 (03) 179-86.
125 Hooda JS, Dogdu E, Sunderraman R. editors. Health Level-7 Compliant Clinical Patient Records System. ACM symposium on Applied computing. 2004 Cyprus.:
126 Märkle S, Lemke HU. The Electronic Patient Record – Is there a standardization in the near future?. Tagungsband der Jahrestagung des VDE2002. pp 69-74. (In German).
127 Prokosch H. KAS, KIS, EKA, EPA, EGA, E-Health: – A pleading against the babylonic confusion of terms in medical informatics. Informatik, Biometrie und Epidemiologie in Medizin und Biologie 2001; 32 (04) 371-382.
128 National Institutes of Health, National Center for Research Resources.. Electronic Health Records Overview. In: U. S. Department of Health and Human Services, editor. 2007
129 Coyle JF, Mori AR, Huff SM. Standards for detailed clinical models as the basis for medical data exchange and decision support. Int J Med Inform 2003; 69 2–3 157.
130 Rassinoux A-M, Lovis C, Baud R, Geissbuhler A. XML as standard for communicating in a document-based electronic patient record: a 3 years experiment. Int J Med Inform 2003; 70 2–3 109.
131 Tamblyn R, Huang A, Kawasumi Y, Bartlett G, Grad R, Jacques A. et al. The Development and Evaluation of an Integrated Electronic Prescribing and Drug Management System for Primary Care. J Amer Med Inform Assoc 2006; 13 (02) 148-159.
132 Giere W. Electronic Patient Information – Pioneers and Much More – A Vision, Lessons Learned, and Challenges. Methods Inf Med 2004; 43: 543-552.
133 Staes CJ, Bennett ST, Evans RS, Narus SP, Huff SM, Sorensen JB. A Case for Manual Entry of Structured, Coded Laboratory Data from Multiple Sources into an Ambulatory Electronic Health Record. J Am Med Inform Assoc 2006; 13 (01) 12-15.
134 Eichelberg M, Aden T, Riesmeier J, Dogac A, Laleci GB. Electronic Health Record Standards – A brief Overview. Information Processing in the Service of Mankind and Health: ITI 4th International Conference on Information and Communications Technology: Information Technology Institute, Giza, Egypt; 2006 pp 7-19.
135 Johansen I, Henriksen G, Demkjaer K, Jensen H, Jorgensen L. editors. Quality assurance and certification of health IT-systems communicating data in primary and secondary health sector. Medical Informatics 2003
136 IHE International.. About IHE. IHE International; 2008 (cited 2008 01.05). Available from: http://www.ihe.net/About/index.cfm.
137 CCHIT. Get involved with the Certification Commission. CCHIT; 2010 (cited 2010 10.05.9. Available from: http://www.cchit.org/participate.
138 EuroRec. European Projects – Q-REC. The European Institute for Health Records; 2007 (updated 20.02.; cited 2008 01.11.). Available from: http://www.eurorec.org/projects/qrec.cfm?actief=Q-Rec.
139 European Commission – Information Society. EHR-Q-TN: Thematic Network on Quality and Certification of EHR systems. 2010 (updated 09.04.2010; cited 2010 14.05.;) Available from: http://ec.europa.eu/information_society/apps/projects/factsheet/index.cfm?project_ref=238912.
140 EuroRec. Healthcare Interoperability Testing and Conformance Harmonisation. The European Institute for Health Records; 2010 (updated 07.04.2010; cited 2010 14.04.). Available from: http://www.eurorec.org/RD/HITCH.cfm.
141 Hörbst A, Basics for the quality certification of services for Electronic Health Records. Hall in Tyrol: UMIT – University for Health Sciences, Medical Informatics and Technology; 2008. (In German).