Like many electronic medical records systems, the PrimeChart software of Greenway Medical Technologies automates patient data into “facesheets” for physician review. A facesheet is a document that gives a physician a quick look at a patient’s vital signs, problem list, reason for visit, past medical history, current medications and other information.
But Carrollton, Ga.-based Greenway is using Extensible Markup Language technology, or XML, to give new functionality to facesheets and other software features. PrimeChart, for instance, enables a physician to customize facesheets to show different types of information or display the information in a certain order. “We can do this because of how XML ‘tags’ data,” says Jonathan Samples, senior software engineer.
XML, like Hypertext Markup Language, or HTML, defines electronic text so a computer can decipher and display it. However, XML underlying codes, or tags, are far more sophisticated than those used by HTML.
XML tags, unlike HTML tags, can identify and organize data bits, making the collection, search, analysis and exchange of online data more efficient.
For example, XML technology enables the analysis of data in its proper context, says Robert Taylor, D.O., clinical data architect at Greenway. “Chest pain is more significant if you know the patient has a history of heart failure,” he says. “XML enables data to be organized so physicians can see, for example, how many patients with certain conditions were treated with certain protocols.”
Greenway is among a growing number of information technology vendors using XML when building new software products. The technology has come of age, says Wes Rishel, a vice president at Gartner Group, a Stamford, Conn.-based consulting firm. “New programming for information exchange is being done in XML,” he says. “It’s a trend that started in 2000. If you’re starting a project, you’d be foolish to use anything else.”
Emerging standard
Beyond the trend, XML is becoming the standard for information exchange, making interoperability among disparate information systems easier, Rishel says. “It will have replaced enough old programming to become dominant within a couple of years.”
Entrust Inc., a Dallas-based vendor of data security software, used Secure Assertion Markup Language—called SAML and based on XML’s data formatting—when developing version 7.0 of its GetAccess identity management software. Entrust uses SAML as a standard way of exchanging “federated” identities in cases where persons from different organizations have access to parts of each other’s disparate computer systems.
“You can log into your company’s and your partner company’s Web sites with a single login,” says Steven Neville, senior manager of product marketing for Entrust.
“Before, you could do this only if Entrust was on both Web sites. Now, SAML and XML help make security protocols interoperable.”
Another example: A pharmaceutical company with many research partners could give each partner single-sign-on access to its information systems, but only to system areas the partners are authorized to use, Neville says.
Another XML-based language, called Extensible Access Control Markup Language, or XACML, can help a hospital enforce computer usage policies. “XACML gives more ‘granular’ access control,” Neville says. “A doctor accessing certain information can only do so if physically on the hospital premises, as opposed to doing so from home. This means a doctor can do certain things, such as discharging a patient, only if he is at the hospital.”
Other uses
XML technology also is playing a role in the move to develop new standard procedures for the exchange of clinical data.
For instance, the Massachusetts Medical Society is leading an effort to develop a standard electronic “Continuity of Care Record” for use when physicians refer a patient for additional treatment. The document—a digitized version of a mandated paper form in Massachusetts—includes the patient’s relevant past history, allergies, medications and a brief care plan.
The medical society converted the paper form into an XML format that physicians can download for free from its Web site, a service it hoped to offer this fall. The society is considering ways to make the Continuity of Care Record available via a centralized Web repository for national use, enabling clinicians to easily access it before treating a patient and update it following treatment.
ASTM International, a New York-based standards development organization, is developing a national standard for the electronic Continuity of Care Record. The Healthcare Information and Management Systems Society, Chicago, will assist in consensus-building and promotional efforts for the standard. •
