Extending Interoperable Emergency Department Data: Standards-Based Design and Evaluation in AKTIN

Studies in health technology and informatics, vol. 336, pp. 1103–1107

Abstract

Interoperable datasets and infrastructures are technically and organizationally difficult to modify, making timely incorporation of newly emerging clinical concepts very difficult. Flexible yet standards-conformant mechanisms are needed to accommodate unforeseen documentation requirements without disrupting established infrastructures based on slowly evolving datasets. This work aims to enable controlled extensibility of the HL7 CDA and FHIR-based emergency department dataset within the AKTIN infrastructure through a "wildcard" mechanism for structured addition of new variables. We implemented two open CDA entry templates and integrated them into the existing AKTIN data-processing pipeline, combined with corresponding FHIR profiles to enable semantic alignment across standards. Evaluation with synthetic CDA documents demonstrated standards-conformant processing throughout validation, transformation, and storage in the AKTIN data warehouse. While FHIR has already defined extension options, the proposed wildcard mechanism provides a concept for controlled extensibility in CDA infrastructures. It preserves interoperability and provenance within defined datatype boundaries and establishes a foundation for future governance and real-world evaluation.

Authors 11

1. Hauke Heidemeyer Aachen Institute of Medical Informatics Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Germany

2. Emily Wedek Aachen Institute of Medical Informatics Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Germany

3. Raphael W. Majeed Aachen Institute of Medical Informatics Medical Faculty

   German Center for Lung Research · Universities of Giessen and Marburg Lung Center · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Germany

   Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Germany

4. Kai U. Heitmann
   Affiliation as printed

   Heitmann Consulting and Services, Beelitz, Germany

5. Alexander Kombeiz Aachen Institute of Medical Informatics Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Germany

6. Saskia Ehrentreich

   University Hospital Magdeburg · Otto-von-Guericke-Universität Magdeburg

   Affiliation as printed

   Institute for Public Health in Acute Medicine, University Medicine Magdeburg, Germany

7. Susanne Drynda

   University Hospital Magdeburg · Otto-von-Guericke-Universität Magdeburg

   Affiliation as printed

   Institute for Public Health in Acute Medicine, University Medicine Magdeburg, Germany

8. Ronny Otto

   University Hospital Magdeburg · Otto-von-Guericke-Universität Magdeburg

   Affiliation as printed

   Institute for Public Health in Acute Medicine, University Medicine Magdeburg, Germany

9. Wiebke Schirrmeister

   University Hospital Magdeburg · Otto-von-Guericke-Universität Magdeburg

   Affiliation as printed

   Institute for Public Health in Acute Medicine, University Medicine Magdeburg, Germany

10. Rainer Röhrig Aachen Institute of Medical Informatics Medical Faculty

    RWTH Aachen University

    Affiliation as printed

    Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Germany

11. Jonas Bienzeisler Aachen Institute of Medical Informatics Medical Faculty

    RWTH Aachen University

    Affiliation as printed

    Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Germany