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TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients

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Published on: April 13, 2021

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

Hauke Heidemeyer¹, Emily Wedek¹, Raphael W Majeed^1,2

¹Institute of Medical Informatics, Medical Faculty of RWTH Aachen University, Germany.

Studies in Health Technology and Informatics

|May 23, 2026

Summary

This study introduces a "wildcard" mechanism for extending Health Level Seven Clinical Document Architecture (HL7 CDA) datasets, improving flexibility in electronic health record systems. This innovation allows for the structured addition of new clinical data without compromising interoperability.

Keywords:

CDA Data Warehousing Emergency Service FHIR Health Level Seven International Hospital Medical Informatics Semantic Interoperability

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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

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Published on: April 12, 2021

Area of Science:

Health Informatics
Clinical Data Standards
Interoperability

Background:

Modifying interoperable healthcare datasets and infrastructures is challenging, hindering the integration of new clinical concepts.
Existing systems require flexible, standards-compliant methods to incorporate evolving documentation needs without disrupting established infrastructures.

Purpose of the Study:

To enable controlled extensibility of Health Level Seven Clinical Document Architecture (HL7 CDA) and Fast Healthcare Interoperability Resources (FHIR)-based emergency department datasets within the AKTIN infrastructure.
To introduce a "wildcard" mechanism for the structured addition of new variables, ensuring flexibility and standards compliance.

Main Methods:

Implementation of two open CDA entry templates integrated into the AKTIN data-processing pipeline.
Development of corresponding FHIR profiles for semantic alignment across HL7 CDA and FHIR standards.
Evaluation using synthetic CDA documents to test processing through validation, transformation, and storage.

Main Results:

Demonstrated standards-conformant processing of synthetic CDA documents within the AKTIN data warehouse.
Successfully integrated new CDA entry templates and FHIR profiles into the existing data pipeline.
Validated the feasibility of the wildcard mechanism for controlled extensibility.

Conclusions:

The proposed wildcard mechanism offers a novel approach for controlled extensibility in HL7 CDA infrastructures, complementing FHIR's extension options.
This method preserves interoperability and data provenance within defined boundaries, facilitating future governance and evaluation.
Establishes a foundation for adapting clinical documentation to emerging requirements while maintaining system integrity.