Review on CDSS implementation with CDA generation and integration for health information exchange in cloud

Successful Deployment of EHR helps to improve patient safety and quality of care, but it has the prerequisite of interoperability between health information exchange at different hospital. The clinical document architecture developed HL7 is core document standard to ensure such interoperability and propagation of this document. Unfortunately, hospitals are reluctant to adopt interoperable HIS due to its deployment cost except for in a handful countries. A problem arises even when more hospital s start using the CDA document format because the data scattered in different documents are hard to manage. CDA document generation and integration Open API service based on cloud computing through which hospitals are enabled to conveniently generate CDA document per patient into a single CDA document and physician and patients can browse the clinical data in chronological order. CDA system of CDA document generation and integrati cloud computing and the service is offered in Open API. A clinical decision support system (CDSS) is a health information technology system that is designed to provide physicians and other health professionals with clinical decision support (CDS), that is assistance with clinical decision –making tasks. A working definition has been proposed by Robert Hayward of the Centre for Health Evidence: “Clinical decision support systems link health observations with health | Volume – 2 | Issue – 3 | Mar-Apr 2018 6470 | www.ijtsrd.com | Volume Journal of Trend in Scientific and Development (IJTSRD) International Open Access Journal Dr. H R. Deshmukh HOD, Department of Computer Science & Engineering, Dr. of Research and Technology, Amravati, Maharashtra, India Prof O A. Assistant Professo Gode Institute Technology Maharashtra, India on is based on knowledge to influence health choices by clinicians for improved health. Our system will implement CDSS clinical decision support system it the system looking towards the clinical decision support from existing CDA system provided information. CDSS will help the doctor’s do the diagnosis of the patient from the existing CDA system. So that the time will be saved of the patient or if the patient is unable to bring or collect the health record the doctor’s will be able to detect the particular disease.


Prof O A. Assistant Professo
Gode Institute Technology Maharashtra, India Successful Deployment of EHR helps to improve patient safety and quality of care, but it has the prerequisite of interoperability between health at different hospital. The clinical document architecture developed HL7 is core document standard to ensure such interoperability and propagation of this document. Unfortunately, hospitals are reluctant to adopt interoperable HIS due t except for in a handful countries. A problem arises even when more hospital s start using the CDA document format because the data scattered in different documents are hard to manage. CDA document generation and integration d computing through which hospitals are enabled to conveniently generate CDA document per patient into a single CDA document and physician and patients can browse the clinical data in chronological order. CDA system of CDA document generation and integration is based on cloud computing and the service is offered in Open A clinical decision support system (CDSS) is a health information technology system that is designed to provide physicians and other health professionals with t (CDS), that is assistance with making tasks. A working definition has been proposed by Robert Hayward of the Centre for Health Evidence: "Clinical decision support systems link health observations with health knowledge to influence health choices by clinicians for improved health. Our system will implement CDSS clinical decision support system it the system looking towards the clinical decision support from existing CDA system provided information. CDSS will help the doctor's do the diagnosis of the patient from the existing CDA system. So that the time will be saved of the patient or if the patient is unable to bring or collect the health record the doctor's will be able to detect the particular disease. health choices by clinicians for improved health. Our system will implement CDSS clinical decision support system it the system looking towards the clinical decision support from existing CDA system provided information. CDSS e diagnosis of the patient from the existing CDA system. So that the time will be saved of the patient or if the patient is unable to bring or collect the health record the doctor's will be able to detect the particular disease.

Literature Review
Health Level Seven has established CDA as a major standard for clinical documents [2]. CDA is a document markup standard that specifies the structure and semantics of 'clinical documents' for the purpose of exchange. The first version of CDA was developed in 2001 and Release 2 came out in 2005 [1]. Many projects adopting CDA have been successfully completed in many countries [3], [4], [5]. Active works are being done on improving semantic interoperability based on open EHR and CEN13606 [6], [7]. To establish confidence in HIE interoperability, more HIS's need to support CDA. However, the structure of CDA is very complex and the production of correct CDA document is hard to achieve without deep understanding of the CDA standard and sufficient experience with it. In addition, development the HIS platforms for hospitals vary so greatly that generation of CDA documents in each hospital invariably requires a separate CDA generation system. Also, hospitals are very reluctant to adopt a new system unless it is absolutely necessary for provision of care. As a result, the adoption rate of EHR is very low except for in a few handful countries such as New Zealand or Australia [8]. In the USA, the government implemented an incentive program called the Meaningful Use Program to promote EHR adoption among hospitals [9]. When a patient is diagnosed at a clinic, a CDA document recording the diagnosis is generated.

CLOUD COMPUTING :
This refers to both the applications delivered as service over internet and the hardware and systems software in the data centers that provide those services [10]  Diagram of architecture of our CDA generation system based on cloud

CDA Generation System Based on Cloud
Computing : The above diagram shows the overall architecture of how CDA documents can be generated on the health information systems of other hospitals by using our cloud computing based CDA generation systems .

Advantages:
 Construction of a cloud computing environment and deployment of CDA generation and integration system based on it.  Generation of CDA documents on different developer platforms through Cloud.

Limitations:
 As a number of HIE based on CDA documents increases , interoperability is achieved ,but it also brings a problem while managing various CDA documents per patient becomes inconvienent as the clinical information for each patient is scattered in different documents .  The followsing problems were encountered while developing our CDA document generation and integration system. First, the default language of the Amazon Cloud OS is US English and it did not adequately handle Korean language. In this paper interoperability between hospitals not only helps improves patient safety and quality of service . It reduces time and resources spent on data format conversion [3]