Perhaps openEHR can help you?

http://www.openehr.org/

Dear pouke thanks alot for help me.NEHTA belives openehr can not provides interoperablity for healthconnect but ISO 13606 is better. I confuse.

Take a look at HL7 standards.

http://www.hl7.org/about/index.cfm?ref=nav

EHR's are going to undergo a revolution in the next several years, as they must not only document a pts health record as input in "conclusion" format by clinicians and other staff, but also include the plethora of "raw format" data that is now automatically injected by patient monitoring systems.  For example, I am visiting the Mayo Clinic now; here many devices (e.g. blood pressure monitor, as a simple example) are tied into the EHR, so EVERY TIME a pt's BP is taken, it is AUTOMATICALLY injected into the EHR.  As the number of devices connected to the EHR increase, and as the devices become wearable (and indeed patients will wear them outside the clinic) and streamable (continuous feed) the EHR will need to become much "smarter" as it will be literally inundated with data feeds that will be useless unless they are processed into actionable information for the clinicians to assess.

I suggest you have a look at HL7 Continuity of Care Document (CCD) (http://www.hl7.org/implement/standards/product_brief.cfm?product_id=6)

One solution which is a real interoperable EHR summary was developed by epSOS. See : http://www.epsos.eu/. Ongoing work is spanning this summary across the North Atlantic, e.g. Trillium Bridge, which links epSOS to Consolidated CDA of Meaningful Use in the US: http://www.trilliumbridge.eu/.

Despite these efforts, it is still a puzzle because these solutions are extremely static.  For instance, in an earlier Delphi study, I identified 22 structures in the EHR that are required to support nursing care, including assessment structure, care process structure, tabular and graphical presentations, pathway, problem oriented , http://www.ncbi.nlm.nih.gov/pubmed/9401196 . CDA, epSOS and C-CDA only have 15 topics in a fixed order.

However, patients are diverse and patient care is dynamic, which is required too be supported (See, e.g. the ISO 18308 for EHR, and the HL7 EHR-System Functional Model). Therefore I prefer the HL7 v3 Care Record message and query, which is a flexible standard that does not only support the "throw something over the walls" approach of CDA, epSOS and Trillium Bridge, but allows full continuity of care with multiple actors in continuous communications.

The structures within an EHR can be based on the CCD for typical sections in a record, or defined from the ISO 13606 part 1. These are find for starters, but too much top down. ISO 18308 does not define structures, only sais it is part of an EHR to have structures.

A solution which works in all mentioned frameworks is the Detailed Clinical Modeling approach: See how this maps between archetypes, HL7 v3 XML and UML: http://www.e-hir.org/journal/viewJournal.html?year=2014&vol=020&num=03&page=163. The best of DCM for EHR structure is that it is flexible: it standardizes bottom up: (data elements, small molecular structures) and allows millions of compositions to accommodate the diversity of patient populations and the required variations in clinical practice. Typical structures that can be build up from DCM include the assessment, the problem list, the plan of care, a clinical pathway, a discharge summary, a checklist for preoperative care and all these paper things we have developed in the past.  

OpenEHR framework is an extended framework compared to ISO 13606 standard. In CKM (Clinical Knowledge Management) part of OpenEHR web site, you can find the structure of discharge summary elements.

Iran ministry of health was published some documents about connecting hospital information systems to national EHR based on OpenEHR concepts. Using web service middlewares made it easier to communicate to this framework. You could find related document from below link:

http://it.behdasht.gov.ir/page/document

There are currently (2017) three international projects dealing with the patient summary:

Interpass by HL7

International Patient Summary by CEN

International Patient Summary by the Joint Initiative Council. The latter uses the HL7 and CEN specifications that are more regional to accomplish a world wide usable patient summary.

Our eHealth is based on the IHE technical infrastructure that enables the exchange of documents between all healthcare providers. In addition, we have upgraded the overall architecture with an OpenEHR based solution that is also IHE certified and is appended to the existing IHE environment. We are using HL7 CDA-R2 documents that can contain either unstructured pdf documents or on the other side can have an OpenEHR based XML schema compliant XML data. This type of data is handled in a way that it is sent additionally also to the OpenEHR solution.

In this way, we are supporting different use cases. Lately, we are also looking into Continua to include also the small devices etc. It is true, though, that some kind of smart processing will be needed here so that not all raw data is stored in the EHR but only the important information. In our cases, this includes generating documents automatically from the measurements and storing those in the EHR whilst keeping the raw device's data in other systems.