Beyond regional health information exchange in China: a practical and industrial-strength approach.

In this paper, we present the design and implementation of a regional health information system that reconciles patient clinical data from heterogeneous Point of Services(POS) applications and supports complicated clinical queries. We propose to design a simple XML format for the representation of clinical documents and a messaging-based protocol for exchanging of clinical documents to facilitate the adoption of international standards such as CDA and IHE XDS profile for local application vendors. We also propose to use a hybrid relational-XML database for the storage of CDA documents that leverages both relational and XML optimization techniques to improve the performance of flexible clinical queries. This system has been deployed in a pilot phase to a regional health information organization operated by a top hospital in Beijing, China.