Interoperability Review: Global Traveler’s EHR template (TrEHRT) Standard developed by International Informatics Community Members under the Aegis of IMIA

Don E. Detmer, MD, MA, Professor Emeritus and Professor of Medical Education, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA; Yu-Chuan Li, MD, PhD, Professor of Biomedical Informatics, Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan

Informaticians associated through IMIA collaborated to publish a template and create an associated open code source cell phone application to support timely access globally to minimum dataset fields of highly relevant medical information (1). This template standard is of potential use for travelers where there is minimal Internet access, or as a default for sharing personal health information with clinical personnel worldwide on a need-to-know basis. Data security technologies are incorporated in the design and International Classification of Diseases (ICD) and Anatomical Therapeutic Chemical (ATC) codes are used to enhance understanding of the information regardless of location of global access.

The development team identified in the acknowledgement in the JAMIA article sought to identify a minimalist list of data elements. These elements include demographic data likely to be important for communications relating to the individual of record, e.g., full name, country by code(s), blood group and type, allergies, marital status, mother language, insurance status, emergency contact information, passport number/ID, language, body weight and height, occupation, spouse name, religion and employer. Medication information is limited to medication by name, prescription period (from-to), medication (ATC code), and frequency. Medical historical information includes diagnosis(es) in ICD-10 preferred or ICD-9 or SNOMED when and if available, allergy (free text at present moving to RxNorm), smoking and alcohol use, and vaccination status. Any major family diseases may be listed. Finally, recent or past relevant medical data include listing of any major surgical procedures, laboratory report data of immediate relevance and reports from such examinations. Travel history is limited to country code(s), dates, and recent status. Finally, the source of regular medical care, e.g., physician, clinical and contact information is listed. The HL-7 Continuity of Care Document (CCD) was also reviewed.

The dataset was developed by narrowing down potential candidate data through an informal group discussion of candidate elements generated by the team for their own systems and/or experience. Priority was given to data deemed most relevant for individual authentication, timely contact information for communications purposes, and medical information for emergency care purposes including international recognition of data elements supporting good care and improved patient outcomes.

Interested parties can access the prototype application at http://TrEHRT.com (pronounced TREAT) for the useful travel data plus the template. This template is the first IMIA-related standard developed through a formal collaboration of internationally-located informaticians. The authors believe that others might follow since this initial effort was both valuable in light of harmonizing international perspectives as well as producing a potentially lifesaving application.

(1) See Li, Y, D. Detmer, S. Shabbir, P A Nguyen, W Jian, G. I. Mihalas, E H Shortliffe, P Tang, R Haux, M Kimura, K Toyoda. 2011. A global travelers’ electronic health record template (TrEHRT) standard for personal health records. J Am Med Inform Assoc amiajnl-2011-000323Published Online First: 17 August 2011 doi:10.1136/amiajnl-2011-000323.