An IHE Profile Proposal for Document Templates

As promised last week, attached is the copy of a profile proposal that I just submitted to the IHE Patient Care Coordination Domain of Integrating the Healthcare Enterprise.

Proposed Profile:	Document Templates
Editor:	Keith W. Boone
Date:	September 15th, 2009
Domain:	Patient Care Coordination
The Problem
Presently, HL7, IHE, ANSI/HITSP, ePSOS and other organizations worldwide are defining templates for the HL7 Clinical Document Architecture that allow for validation of the document content. However, these templates do not allow for easy creation of documents within an Electronic Medical Record system. Providers want to be able to use templates to support reuse of data already contained within the EMR. The problem is that there is no defined interchange format for document templates that allows an EMR to import a document, section or entry template and use it.
Key Use Case
A professional society develops a document template to gather the appropriate information to provide care for a specific condition. Providers want to use that document template in their own EMR systems. They connect to the professional societies registry of document templates and locate the appropriate template by the condition. Next they download the template to their Electronic Medical Record System. The EMR imports the template, and makes it available to the provider to use inside the electronic medical record system. The provider can now create documents using that template, and reuse section or entry templates found in that template in other documents.
Standards and Systems
Electronic Medical Record systems Template Registries IS0 15000 Electronic Business Extensible Markup provides a schema (ebRIM) to describe information stored in document registries. This schema could be used to describe information about the template. ISO/IEC 11179 describes the framework for metadata registries which could house template metadata. HL7 CDA Release 2.0 describes the structure of clinical documents. ISO 19757-3 Rule-based validation — Schematron describes a rule based language for verifying that implementations are producing correct XML. HL7 Version 3 Standard: Specification and Use of Reusable Constraint Templates, Release 1 (DSTU) describes a mechanism by which templates can be defined for use with HL7 Version 3 (e.g., CDA) standards. HL7 Version 3 Standard: Context-aware Information Retrieval (Infobutton), Release 1 defines a mechanism by which information can be retrieved based on a specific context. Context-aware information retrieval (Infobutton) URL-based implementation guide describes a URL-based implementation which could provide a REST service to locate templates.
Discussion
IHE has already developed a large template library and has the necessary experience developing and using document templates. IHE should develop the necessary profiles to house clinical templates within a template registry, and to provide access to those templates to an EMR system.