Friday, July 17, 2009

Electronic Health Record Interoperability: Specifications, Standards, and Working Groups

{Prelude to upcoming post - semantic interoperability}

The American Recovery and Reinvestment Act of 2009 (ARRA) states that the
HIT Policy Committee shall make recommendations on standards and implementation specifications, among other tasks.

Healthcare Information Technology Standards Panel (HITSP) EHR-Centric Interoperability Specification consolidates all information exchanges that involve an Electronic Health Record (EHR) System within any of the thirteen HITSP Interoperability Specifications existing as of February 13, 2009, the enactment date of the American Recovery and Reinvestment Act (ARRA).

Reading these two statements and others like them requires an understanding of terms such as

* specification
standard, and
working group

Each of these bullets is linked to its Wikipedia entry.

Given that many of the readers of this blog (from 42 countries so far) are interested in the information technology aspects of The American Recovery and Reinvestment Act , electronic health record interoperability and the like, it may be easier for them if I elaborate on the four terms listed above by using the example of cascading style sheets (CSS), a simple language that allows you to declare how documents are displayed by Web browsers. By so doing, I’ll be introducing additional expressions with which these members of the IT community are already familiar.

The Cascading Style Sheets language was created through a collaborative effort between Web developers and browser programmers under the auspices of the
World Wide Web Consortium (W3C for short).

The W3C is an international industry group that comprises over 500 companies, research institutions, and Web development organizations that issues technical specifications for Web languages and protocols.

W3C specifications are called "recommendations" because the W3C is technically not a standards-issuing organization, but in practice this is usually an issue of semantics.

Recommendations are taken as defining a standard form of a Web language, and they are used by Web developers, software tools creators, browser programmers, and others as a blueprint for computer communication over the Web. Examples of W3C Recommendations include Hypertext Markup Language (HTML) and Extensible Markup Language (XML).

The CSS Specifications

The W3C Recommendations issued by the Cascading Style Sheet working group compose the official specification for the CSS language. The CSS working group consists of a number of experts in Web development, graphic design, and software programming, representing a number of companies, who all work together to establish a common styling language for the Web.

CSS Level 1

The Cascading Style Sheets Level 1 (sometimes called CSS1 for short) was officially issued as a W3C Recommendation in December 1996. The URL for this specification is

If you try to read the W3C Recommendation for CSS1, you may end up confused. That's because W3C documents aren't written as a general introduction to a subject but rather as precise language definitions for software developers. Most W3C Recommendations are quite opaque to most normal people, although the CSS1 specification isn't too bad compared with some. Being able to refer to the official specification is quite useful, though.

Optional note for programmers - Classes and IDs

In addition to setting styles based on HTML elements, CSS allows for rules based on two optional attributes in HTML: class and id. Each of these can serve as the selector part of a CSS rule and can be set on any visible HTML tag.

The div and span elements really come into their own with class and id selectors. Through the use of class and id attributes, div or span tags can be made to have nearly any effect and presentation, which is often good but sometimes bad. Care must be taken to avoid using class or id selectors that you're not ignoring more appropriate markup, which has understood semantics. In other words, a div with a class of bldtxt has no specific meaning in the context of HTML, but a strong tag definitely does. Before using div or span, consider if another tag would make more sense.

The mention above of the word "semantics" is meant to be a segue to the subject of a later post, semantic interoperability.