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Ringholm Whitepapers

This page provides an overview of the various whitepapers, site reviews and other documents available on this website. Please note that some of the documents may only be available in one language or in one format (e.g. PDF/HTML).

Latest whitepapers

HL7 Message examples: version 2 and FHIR
This whitepaper contains 2 HL7 version 2 to FHIR mapping scenarios. The scenarios are supported by an example HL7v2 message as well as its functional FHIR equivalent.
Intended audience: standard users.
 
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The early history of health Level 7
The HL7 protocol dates back to the late 1970s when its precursor was developed at University of California at San Francisco (UCSF) Medical Center and first implemented in production in 1981. HL7 v1 and v2 are essentially refinements of the UCSF protocol. X12 and ASTM E1238 have had a large impact on the development of HL7. The HL7 organization matured from a small ad hoc working group in 1987 into a fullblown standards development organization within its first 5 years.
Intended audience: general.
 
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Clinical Models and SNOMED
There are two fundamentally different kinds of modeling logic (extensional and intensional). If Authors of clinical models mix them then you have to follow rules for mixing the two types of models or else they will not be implementable.
Intended audience: data modelers.
 
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Integration strategies and technologies

AORTA, the Dutch national infrastructure
AORTA is the Dutch national infrastructure for the exchange of data between healthcare providers. The focus of this program is to facilitate the realization of a national "continuity of care" oriented EPR. AORTA uses HL7 version 3 messages and documents as its core mechanism for information exchange. This whitepaper describes the key components of the infrastructure.
Intended audience: Analysts.
 
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Implementing Web Services in Dutch Healthcare
Healthcare in the Netherlands is moving rapidly towards an infrastructure where XML data will be exchanged over the Internet. This whitepaper discusses the implementation issues and pitfalls discovered during the implementation of web services, and more specifically SOAP and WSDL, in this large and complex environment.
Intended audience: integration analysts.
 
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The NPfIT Spine, an English national programme
This document describes the architecture of the English NPfIT Spine (the national IT infrastructure for healthcare). Its aim is to provide a commonly accessible patient based resource, making information from multiple sources available to all those with a legitimate care relationship to the patient. The architecture of the Spine is based on a centralized partial care record, supported by directory services and HL7 version 3 messaging.
Intended audience: Analysts.
 
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Creating a messaging interface
This paper discusses the integration issues a vendor has to deal with during the process of developing a messaging interface for an application.
Intended audience: Software development managers, Integration engineers.
 
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Act Reference Registries
This document provides an overview of the Act Reference Registry (Dutch: verwijsindex), part of the planned Dutch national infrastructure. The Act Reference Registry contains a set of metadata which supports the retrieval process of care related data from various systems when required by a healthcare provider.
Intended audience: General.
 
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Message Brokers
This document provides an overview of the role of a Message Broker in a systems integration project.
Intended audience: IT management.
 
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IHE (Integrating the Healthcare Enterprise)

An implementation framework based on messaging standards
This paper provides a high-level overview of the IHE framework and some of the results of the European connectathon held in Bern in May 2012.
Intended audience: IT management, standard developers, integration analysts.
 
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DICOM Imaging

The DICOM standard, overview and characteristics
This paper provides a high-level overview of the characteristic elements of the Digital Imaging and Communications in Medicine (DICOM) imaging standard.
Intended audience: IT management, integration analysts.
 
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The seven levels of PACS integration
This document describes seven different levels of PACS integration, ranging from No Integration up to API Level Integration. The current trend seems to gravitate towards the use of messaging standards (e.g. DICOM) and integration profiles (e.g. IHE). All integration levels have their advantages and disadvantages.
Intended audience: General.
 
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Structured Reporting, a Powerful DICOM mechanism
This paper contains a description of the structure and the usage areas of DICOM Structured Reporting (SR).
Intended audience: Integration analysts.
 
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Terminologies

Clinical Models and SNOMED
There are two fundamentally different kinds of modeling logic (extensional and intensional). If Authors of clinical models mix them then you have to follow rules for mixing the two types of models or else they will not be implementable.
Intended audience: data modelers.
 
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Semantic Node labeling (SNL)
To solve the problems introduced when conflicting logic types exist in clinical information models, explicit labeling of model components for intensional logic (by means of Semantic Node Labeling, SNL) can improve machine level interoperability and enable semantic web tools to be used safely.
Intended audience: data modelers.
 
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HL7 Modeling

The early history of health Level 7
The HL7 protocol dates back to the late 1970s when its precursor was developed at University of California at San Francisco (UCSF) Medical Center and first implemented in production in 1981. HL7 v1 and v2 are essentially refinements of the UCSF protocol. X12 and ASTM E1238 have had a large impact on the development of HL7. The HL7 organization matured from a small ad hoc working group in 1987 into a fullblown standards development organization within its first 5 years.
Intended audience: general.
 
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History of the HL7 RIM
The history of the RIM goes back to the MEDIX organization (1986) who introduced the concept of a common healthcare data model. this paper covers the major steps in the development of the HL7 RIM as we know it today.
Intended audience: general.
 
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An explanation of HL7 version 3 in terms of HL7 version 2
HL7 version 3 is an entirely new standard - this paper aims to explain some of the features of HL7 version 3 using HL7 version 2 terminology. The reader is assumed to be familiar with HL7 version 2.
Intended audience: standard users.
 
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The HL7 MIF - Model Interchange Format
The Model Interchange Format (MIF) is a set of XML formats used to support the storage and exchange of HL7 version 3 artefacts as part of the HL7 Development Framework. It is the pre-publication format of HL7 v3 artefacts used by tooling. It is also the formal definition of the HL7 metamodel. The MIF can be transformed -to a certain degree- into UML/XMI.
Intended audience: standard implementers, standard developers.
 
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HL7 v3 RIM Act Essentials: moodCode
The semantic interpretation of the Act class in the HL7 version 3 RIM heavily relies on one of its properties: its mood. This whitepaper attempts to explain the concept of mood - a lot of examples are provided in the process. Related concepts such as the ActClass, ActStatus and the impact of the NegationIndicator are also covered.
Intended audience: standard users.
 
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Common issues found in implementations of the HL7 Clinical Document Architecture (CDA)
A large number of XML instances of HL7's CDA R2 standard were examined in detail. Two different tools, based on the CDA R2 XML schema and the CDA R2 MIF, were used to identify issues and errors. The issues identified are mainly related to the intent of the CDA standard and to misinterpretations of the underlying data type standard. The paper contains recommendations as to how these issues could have been detected and avoided. The reader is assumed to be familiar with the CDA R2 standard.
Intended audience: standards implementers.
 
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The RIMBAA Technology Matrix
An increasing number of software implementations in healthcare use a HL7 version 3 RIM based application architecture (RIMBAA). The subject of this whitepaper, the RIMBAA Technology Matrix, was created in order to be able to identify the architectural choices used by the designers of these applications in a technology independent fashion. This in order to determine a set of generic approaches and best practices related to the use of HL7 version 3 RIM-based models for purposes other than messaging.
Intended audience: Software Architects
 
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An Overview of OIDs used in European HL7 Artefacts
This document provides an overview of the of OIDs (Object Identifiers) assigned by the European HL7 affiliates.
Intended audience: HL7 version 3 implementers.
 
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HL7 version 3: Messages or CDA Documents?
HL7 creates open standards for the exchange, management and integration of electronic healthcare related data. Its standards are both based on the messaging (HL7 v2.x, HL7 v3 messaging) as well as on the document (HL7 v3 documents CDA) paradigm. Given the choice: what should one use given a particular use-case?
Intended audience: Analysts.
 
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HL7 Messaging

HL7 Message examples: version 2 and FHIR
This whitepaper contains 2 HL7 version 2 to FHIR mapping scenarios. The scenarios are supported by an example HL7v2 message as well as its functional FHIR equivalent.
Intended audience: standard users.
 
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New features of HL7 2.7
This document provides an overview of the of the additional functionality as offered by the HL7 2.7 standard when compared to HL7 2.6.
Intended audience: implementers.
 
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SAP IS-H Interfacing capabilities
What interfacing capabilities does the SAP IS-H application have, and how do I support HL7 interfaces? That question is at the heart of this whitepaper. It describes the three interfacing options and how those can be used to import and export data.
Intended audience: implementers.
 
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HL7 Message examples: version 2 and version 3
This whitepaper contains 2 use case descriptions. Each use case could be supported by either the HL7 v2.x or the HL7 v3 messaging standard. Each example use case has two example messages associated with it: a HL7 v2.x message, and its functional equivalent in v3. The whitepaper aims to show some the differences as well as similarities between example v2.x and v3 message instances.
Intended audience: standards implementers.
 
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New features of HL7 2.6
This document provides an overview of the of the additional functionality as offered by the HL7 2.6 standard when compared to HL7 2.5.
Intended audience: implementers.
 
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Navigating the pitfalls: Implementing HL7 version 3
The amount of implementations of the HL7 Version 3 standard, whether in the form of HL7 messages or the HL7 Clinical Document Architectures (CDA), is steadily increasing. This whitepaper contains a number of recommendations for implementers of HL7 version 3 artefacts. It is based on the experiences of other implementers.
Intended audience: standards implementers, product architects.
 
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HL7 ADT Messages
HL7 ADT messages (Admission, Discharge and Transfer) are a group of messages as defined in the HL7 version 2.x messaging standard. The focus of ADT messages is to convey data related to patient demographics and/or to healthcare encounters (visits). ADT messages are implemented by almost all software applications in a hospital setting.
Intended audience: general.
 
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Query messages: the next step in German systems integration ?
This paper describes the query-response messaging mechanism in general and lists the main categories of query messages; its aim is to promote the use of query messages in Germany.
Intended audience: Integration analists, Integration engineers.
 
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Act Reference Registries
This document provides an overview of the Act Reference Registry (Dutch: verwijsindex), part of the planned Dutch national infrastructure. The Act Reference Registry contains a set of metadata which supports the retrieval process of care related data from various systems when required by a healthcare provider.
Intended audience: General.
 
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Registries and Master Files
The data as contained in healthcare IT applications is synchronized by the exchange of HL7 messages. These messages will refer to the identifiers of commonly used objects such as locations, physicians and laboratory tests. A Registry maintains the identifiers of certain objects. This whitepaper describes HL7 Master Files and Registries.
Intended audience: integration analysts.
 
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New features of HL7 2.5
This document provides an overview of the of the additional functionality as offered by the HL7 2.5 standard when compared to HL7 2.4.
Intended audience: implementers.
 
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The HL7 CX Datatype and the German insurance card
The specification of datatypes has been updated in version 2.5 of the HL7 standard. Table 0203 "Identifier Type Code" has been updated and expanded. With the aid of some of the new values in this table the data present on the German insurance card (German: KV-Karte) can now be encoded using the CX datatype.
Intended audience: integration analysts.
 
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Role Agents
This paper discusses some of the integration issues that have been highlighted by the introduction of the new HL7 version 3 standard. These are identified, and can be covered by a new type of middleware product: a Role Agent.
Intended audience: Integration analists.
 
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Historic Movements in HL7
This document provides an overview of how movements are used in HL7.
Intended audience: standard developers.
 
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New features of HL7 2.4
This document provides an overview of the of the additional functionality as offered by the HL7 2.4 standard when compared to HL7 2.3.1.
Intended audience: implementers.
 
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HL7 Query/Response Conformance Statements
This document provides an overview of Query/Response Conformance Statements to be used for HL7 2.x based query and response messages.
Intended audience: implementers.
 
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