CDA R2 XAY Dl/NG HE THONG TRAO DOI HOA DON

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Nguyen Hai Minh vd dtg Tap chi KHOA HOC & CONG NGHE 83(07): 81 -87

iTNG DUNG

C H U A N

HL7 - CDA R2 XAY Dl/NG HE THONG TRAO

D O I

HOA DON GIAO NHAN THUOC TRONG CAC CO SO Y TE

Nguyen Hai Minh'', Vu Manh Xuan\ Nguyen Quang Dung\ Truong Dong Tam^

Khoa Cong nghi Thong tin - Dgi hoc Thdi Nguyin, ' Trudng DH Su phgm - DH Thai Nguyin, Phdng CNTT - Bdo hiim xd hgl tinh Thai Nguyin, Binh viin tntcrng Dgi hoc Y Duac - Dgi hoc Thdi nguyen

TOM TAT

Xay dung cac chuang trinh ung dung ho trg viec trao doi thong tin giCra cac he thong khac nhau co sir dung chuan trao doi thong tin quoc te trong cac ca sa y te la rat can thiet, vi no khong nhii-ng giiip ta giam dugc thai gian khi phai nhap lai dir lieu tir he thong nay vao cac he thong khac ma con giup cho ta tranh dugc cac loi phat sinh khi nhap dQ- lieu.

Nham phat trien he thong trao doi thong tin dua tren cac ca sa dCr lieu (CSDL) hien dang sii dung tai cac ca sa y te va irng dung chuan quoc te Health Level 7 standards (HL7) diing trong y hoc, chung toi trinh bay mot giai phap diing de trao doi va chia se thong tin hoa don giao nhan thuoc gitra cac khoa dieu tri vai khoa dugc. Chiing toi da img dung chuan trao doi tai lieu lam sang Clinical Document Architecture Release 2 (CDA R2) ciia HL7 ket hgp vai hai CSDL khac nhau:

CSDL he thong lin benh vien va CSDL ciia he thong quan ly dugc. Giai phap nay se giiip cho cong tac nhap va xir ly dQ- lieu don thuoc cua cac y bac sy don gian va chinh xac hon, gop phan giam chi phi van phong pham. tang tinh tuang tac giua cac he thong quan ly trong benh vien dong thai cung la giai phap de thich ung giua chuan quoc te vai mot chuan cue bg trong viec phat trien cac chuang trinh Q-ng dung. Ngoai ra, vai giai phap nay he thong con dap ung dugc viec trao doi thong tin ngay ca khi viec ket noi mang (connection) gSp sir co.

Tir khoa: Clinical Documenl Architecture (CDA R2). drug bills

MODAU

Chuan tai lieu Clinical Document Architecture Release 2 (CDA R2) da duoc to chuc chuan quoc te ve ITnh vuc lin hoc trong y te Health Level 7 (HL7) thong qua va dua vao ung dung vao nam 2005 [12]. Ke lii- do rat nhieu cac he thong ho trg trao doi tai lieu lam sang tren the gioi da su dung mo hinh thiet ke tai lieu nay de phat trien cac irng dung va da thu dugc nhieu thanh cong lo Ion.

d Han Quoc, he thong phan mem "CDA Studio" dugc phat trien nham ho trg cac co sa y le thiet ke va lap cac bao bieu Iam sang, dugc dimg de trao doi giua cac chuong trinh irng dung khac nhau mot each lir dgng. Dac trung CO- ban ciia he thong nay la dugc thiet ke dua tren mgl he thong Quan ly thong tin benh vien co san va cac tai lieu chiet xuat ra dugc thi^t ke dua tren CDA R2 [13, 14]. Tai

Email: nhmlnh tnuv'dyahoo.com

Nhat Ban, he thong "Referral Letter System"

dugc thiet ke nham ket hgp cac chuan Quoc gia hien co va chuan quoc te de ho trg trao doi lai lieu lam sang giua cac ca sa y le trong nuoc va cac to chii-c Y le nuac ngoai [4].

Tai Dai Loan, be thong "Portable CDA" dugc xay dung nham ho trg trao doi cac tai lieu Iam sang qua moi truong offline thong qua cac thiet bi luu trir ngoai [9,16]. Ngay lii' rat sam, dua tren CDA RI va chuan trao doi thong tin trong y hgc quoc gia (SCIPHOX), lai Due da trien khai va xay diing thanh cong he thong

"HER akteonIine.de" giup cho viec trao doi thong lin benh nhan giua cac ca so kham chua benh, ke don thuoc, cap nhat va ra y lenh cua bac sy cho benh nhan true luyen thong qua moi truong Internet [10].

O nuoc la mgl trong nhung nguyen nhan dan tai viec chia se va trao doi thong tin giua cac he thong thong lin quan ly dung trong y hgc chua nhieu la vi trong thai diem hien tai

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Nguyen Hai Minh va dig Tap chi KHOA HOC & CONG NGHE 83(07): 81 -87 chung ta con thieu cac chuyen gia ve ITnh vuc

tin hgc Irong y te [15], thieu nhung thong tin can thiet ve cac chuan quoc te dung trong y hgc. Hon nua viec diing van ban de luu trCr va diing cac mau ke don thuoc, ghi y lenh ciia bac sy trong cac co- so y te cho benh nhan a ta con kha pho bien [15]. Chinh dieu nay da gop phan lam tang chi phi cho benh nhan trong viec kham chira benh, gia tang thai gian cho- dgi ciia bfnh nhan, giam hieu sual lam viec ciia cac y Bac sy va dieu duang.

Trong bai viet nay, chung loi trinh bay mgl thiet ke CDA dimg cho boa don giao nhan thuoc hang ngay giua cac khoa dieu tri vai khoa dugc ma lai cac co- sa nay chua co dieu kien dau tu be thong quan ly dong bg. He thong quan ly dugc va he thong quan ly kham chiia benh dugc cung cap boi cac nha cung cap khac nhau va hon nua viec ITnh thuoc lai khoa dugc cung la mot cong viec hang ngay ciia cac dieu duong vien. Do do cong lac phuc vu, cbi phi cho in an va ban giao ky nhan giu'a cac can bg co trach nhiem trong viec nay con kha nhieu bat cap. Phan mem da duoc thiet ke va cai dat tai benh vien truong Dai hgc Y khoa Thai nguyen voi ten san pham la Medipro 2.0

Bai bao co cau Iriic nhu sau: Sau phan ma dau la mo ta bai toan; phan ke tiep trinh bay ky thuat de xuat, va ket qua ung dung. Cuoi cimg la thao luan.

M6 TA BAI TOAN

Cong viec giao nhan thuoc noi tren ciia moi CO so y te co the mo ta qua bon buac nhu sau:

- Buo'c 1: Dieu duong vien phai nhap thong lin ve don thuoc ciia benh nhan vao he thong quan ly, chung toi ggi tat la He thong lin benh vien, (ten tieng Anh: Hospital Information System), hay con vi^l tk la he HIS.

- Biroc 2: Diing chirc nang ciia he HIS d^ linh loan va long hgp so lugng thudc se ITnh theo tii-ng nhom thuoc va lap hoa don pbiSu ITnh thuoc cho khoa minh quan ly. Bien phap thong thuang bien nay diing cho viec tinh long theo liing nhom dugc phan loai dua bang phan loai danh muc thuoc quoc tk. - Anatomical Therapeutic Chemical lassification System (ACT) [3] (Bang 1).

- Buoc 3: Dieu duong vien in, ky, cam hoa dan giao nhan thuoc xuong khoa dugc. Dua vao hoa don. dieu duong se ciing can bg khoa dugc tien hanh giao - nhan va ciing ky vao ban giao nhan thuoc.

- Buoc 4: Hoa don giao nhan thuoc se dugc in lam 2 ban. mot ban luu tai khoa dugc, mot ban giao lai cho khoa dieu trj de Iam chirng lir quyet loan. Khi cong viec giao nhan da duoc thuc hien xong, can bg tai khoa dugc se tiep tuc nhap cac thong tin ve thuoc vao trong he thong quan ly dugc.

Bang L Bang ma phan loai nhom thuoc theo ATC

ATC Ten nhom

A B6 may tieu hoa va Chuyen hoa B Mau va cac co quan tao mau C He tim mach

D Da lieu

G He Nieu-Sinh due va hormon sinh due

H Cac che pham noi tiet tac dung toan than (trir hormon sinh due)

J Cac chat khang khuan cho sir dung toan than L Cac chat chong tan tao va dieu bien he mien dich M He CO xuong

N He than kinh

P Cac san pham diet ky sinh triing R He ho hap

S Ca quan thu cam V Cac nhom khac

Viec irng dung CDA trong thiet ke hoa don giao nhan thuoc tren dam bao viec giao nhan CO the thuc hien dugc thong qua cac van ban dien tir, ma van dam bao dugc tinh phap ly va linh quy trach nhiem theo quy dinh chung ve cong tac quan ly duoc hien nay. Khong nhung the no con lam giam thai gian xu- ly cong viec cho cac nhan vien y te, giam chi phi cho dau tu van phong pham. Voi giai phap nay chiing toi da thiet ke CDA template cho mau hoa dan ITnh thuoc dugc diing trong Benh vien truong Dai hgc Y Dugc - Dai hgc Thai nguyen, ciing vai ca sa dfl- lieu benh an va ca sa dfl- lieu quan ly dugc hien co tai benh vien.

KY THUAT D E X U A T

Trong phan nay, chung toi xin giai thieu chi tiel thiet ke CDA template cho hoa don tren va dugc dugc dimg de phat trien he thdng trao doi thong tin giua hai he thdng quan ly; He thong tin benh vien va He thong quan ly

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Nguyen Hai Minh vd dig T a p chi K H O A H O C & C O N G N G H E 83(07): 81 - 8 7

Str lirtrc ve CDA R2

Kien Iriic CDA R2 dugc to chiic HL7 cong nhan la kien true tai lieu chuan, diing trong trao doi lai lieu Iam sang tir nam 2005. Kien triic lai lieu nay dugc phat trien dua tren HL7 V3 Reference Information Model (RIM), la mgl mo hinh thiet ke huong doi lugng. Kien triic RIM nay gom co 6 lhanh phan co ban:

Act, Participation, Entity, Role, AclRelationship, and RoleLink [1,12].

- Act: Su kien kich boat de sinh cac lai lieu, dugc nhan tii' cac trinh iing dung Irong cac co- sa y le. Vi du: Benh nhan nhap vien, xuat vien, in phieu ITnh thuoc ...

- Participation: Thong lin ve cac su kien. Vi du: ai la ngudi thuc hien su kien, thai gian bat dau, thdi gian ket thiic ...

- Entity: Md ta ngudi ihiic hien hoac co- quan Id chuc, gay phat sinh su kien.

- Role: Md ta cac hanh vi va boat dgng cua cac su kien.

- ActRelationship: Quan he giua cac sir kien vai nhau

- RoleLink: Md la tinh phu thudc giua hai hanh vi (Roles).

Mot tai lieu CDA dugc thiet ke dua tren luge dd Extensible Markup Language (XML), ndi dung tai lieu se dugc ddng gdi trong the (tag) nguyen thiiy <CIinicaIDocument>

</CIinicaIDocuinent>. Nam trong lag nay cau triic tai lieu se dugc chia lam bai phan: Cau triic dau file (Header) va ndi dung ciia file (body). Ddi vdi phan body ciia tai lieu th cd the diing 2 loai khudn dang lai lieu dd la: Van ban cd dinh dang <slructuredBody> hoac van ban khdng dinh dang <NonXMLBody> de luu IriT ndi dung chinh ciia tai lieu can trao ddi.

Mot tai lieu CDA cd the md ta sa bd bang cau triic luge dd XML nhu hinh 1.

Qua phan tich cac hda don giao nhan thudc tai cac benh vien chiing tdi thay mdt hda don giao nhan thudc bao gdm 4 phan chinh (Hinh 2).

o PhSn 1: Trinh bay cac thdng lin co ban cua CO sd kham chua benh nlur: ten ca quan. ten khoa phdng .. (Pl).

oPhan 2: Trinh bay phan lieu de chinh - ndi dung chinh trong hda don giao nhan thudc (P2).

oPh4n 3: Trinh bay chi tiet cac thudc se dugc thuc hien tren thiic te khi giao (P3).

oPhAn 4: Phan xac nhan thdng tin ciia nhung ngudi cd trach nhiem trong viec giao nhan thudc - Phan chir ky (P4).

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H i n h I: C a u triic m o t tai lieu C D A

m^iiliH m6c iwit iHnr.va«im

Hinh 2. Vi du hoa dan giao nhan thuoc Thiet ke CDA Template cho Hda dan giao nhiin thuoc.

De thuan tien cho cdng viec giira ben giao va ben nhan, chiing tdi thiet ke mdi hda don giao nhan la mdt cap ddi lai lieu: Mdt luu IrQ- cac thdng tin ve nhdm thudc se dugc thuc hien, mgl luu trir thdng lin chi tiel cho tirng loai thudc. Lien kel giua 2 lai lieu nay dugc Ihuc hien thdng qua ca che hyperlink, dudng link nay dugc "gan" va dau trong lai lieu ve nhdm thudc, so dd lien ket dugc md ta qua (Hinh 3).

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Nguyen Hai Minh vd dtg Tap chi KHOA HOC & CONG NGHE 83(07): 81 -87

Ban thiet ke CDA diing cho nhdm thuoc Trong cau true CDA nay chiing tdi da diing cac thudc tinh ciia phan Header de luu trQ- cac thdng tin ve ca sd kham chua benh, nhung thdng tin ve dieu dudng vien, bac sy tham gia trong qua trinh ke don thudc cho benh nhan.

CD.\ nliom thuoc

<. .>

<H>perlink n

CDA chi tiet ve thuoc

CDA chi tiet ve thuoc 2

Hinh 3. Sa d6 quan he giQa CDA nhom thuoc va CDA chi tiet ve thuoc

Trong phan Body cua tai lieu chiing tdi sii- dung cac tag <recordTarget> de luu tru- cac thdng lin co- ban cua benh nhan, ngudi ma se sii' dung cac thudc dugc the hien tren phieu ITnh thudc; diing tag <author> de luu IrQ- thdng lin ve ihdng tin ngudi lap phieu ITnh, lap tai lieu CDA; diing tag <custodian> de luu Iru' thdng tin ve khoa, noi luu tru' cac thdng lin co' ban cua viec sii' dung trudc khi lap phieu ITnh Ihudc; diing tag

<relatedDocument> luu tru- cac thdng tin bd sung khi cd su dieu chinh ve hoa do-n giao nhan thudc (Hinh 4). Tag <lext> diing de luu trQ- thdng lin chi tiet ve cac nhdm thudc se dugc ITnh tai khoa dugc, va ngoai ra sir dung tag <enlry> de luu tru- chir ky sd ciia nhung thanh vien tham gia trong qua trinh giao djch.

<''xml version="1.0" encoding="UTF-8"''>

<'!'xnil-stylesheet type="text/xsl"

hrel^"St\le.Sheet4DrugGroup.xsr"'>

<ClinicalDocument xmlns="urn:hl7-org:v3"

xmlns:voc="um:hl7-org:v3/voc"

xmhis:xsi="http://\v\v\v.\v3.org/2001/XML.Schema- instance" xsi:schemaLocation="um:hl7-org:v3 CDA.xsd">

<!-CDA Header^

<typeld root="2.16.840.1.113883.1.3"

extension="POCD_HD000040" />

<codecode="34820-l"

codeSystem="2.16.840.1.113883.6.1"

codeSvsteniName="L01NC"

displayNanie="C0NSULTAT10N NOTE" />

<titie>PHIEU LINH THUOC TAI KHO/KHOA DU'OC</title>

<confidentialityCode code="N"

codeSystem="2.16.840.1.113883.5.25"/>

<id e.\tension="09002456"

root="2.2.110.1.113883.19.5.2"/>

<city> Thai

Nguyen</city><country>Vietnam</country>

<streetAddressLine> Quyet thang - TP Thai nguyen </streetAddressLine>

</addr>

<telecom use="MC" value="tel:+84-9l5-444-149"

/>

<given>Minh</given> <suffix>Nguyen Van </suffix>

</nanie>

<administrativeGenderCode code="M"

codeSystem="2.16.840.1.1 13883.5.1"/>

</patient>

</patientRole>

</recordTarget>

<patientRo!e>

<id extension="Or'

root="2.2.1 lO.1.113883.19.5.2"></id>

<id extension="Or'

root="2.2.110.1.113883.19.5.2"></id>

<name>K.HOA NGOAl</name>

</providerOrganization>

</patientRole>

</recordTarget>

<id extension="D00065"

root="2.16.410.1.113883.19.5"/>

<name>

<pretTx>Dr.</prefix> <given>Nguyen Van</given>

</name>

</assignedPerson>

</representedOrganization>

</assignedAuthor>

</author>

<id extension="1011"

root="2.2.110.1.113883.19.5.2" />

<name> BV truong Dai hoc Y - DHTN</nanic>

<addr>

<city >Thai Nguyen</city>

<country>Vietnani</country>

</addr>

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Nguyen Hai Minh vd dig Tap chi KHOA HOC & CONG NGHE 83(07): 81 -87

</rcpresentedCustodianOrganization>

</assignedCustodian>

</custodian>

<setld extension="BV02-01-BS002"

root="2.2.110.1,113883.19.5.2"/>

</parentDocument>

</relaledDocument>

</ClinicalDocument>

Hinh 4. Cau triic Header cho tai lieu CDA template.

Bdn thiet ki CDA cho phieu linh thuoc chi tiet

Ve CO- ban cau true Header cua CDA chi liet phieu phieu ITnh thudc dugc td chuc gan gidng nhu Header ciia CDA nhdm thudc, nhung trong dd cd mdt diem khac la trong lag

<recordTarget> la chi luu tru thdng tin cac benh nhan tluic su cd sir dung thudc tren phieu ITnh. Cd nghTa la danh sach benh nhan dugc luu tru' d day la mdt lap con ciia danh sach benh nhan luu tru' trong CDA nhdm thudc, ben canh dd lag nay ciing dugc dimg de luu cac thdng lin ve khoa va co sd kham chiia benh. Diing Tag <text> de luu trfr Ihdng lin chi liel ve tiing loai thudc se dugc ITnh lai khoa dugc va sau dd se dugc phan phat tai cac khoa dieu tri. Ngoai ra tag <enlry> cung dugc diing de luu lai chu' ky sd ciia cac can bd lien quan trong qua trinh giao nhan.

Sinh (generating) tdi lieu CDA: Hda dim giao nhan thuoc

CDA hda don giao nhan thudc dugc sinh ra dua tren Database ciia he ihdng quan ly thdng tin benh vien. va dugc luu tru- mdt each cd he thong nhd mgl he thdng hd trg quan ly cac lai lieu CDA. Thdng qua he thdng nay cac dieu duong vien cd the gui, chuyen cac tai lieu mdt each true tiep sang cho cac dugc sy va tir dd tien hanh cac thao tac thirc hien giao va nhan.

Quy trinh thuc hien dugc md la qua so dd giai Ihual 1 (Hinh 5).

KETQUA

Dua tren Database be thdng tin benh vien va he thdng quan ly dugc tai Trudng dai hgc Y Dugc thudc Dai hgc Thai nguyen, chiing tdi da thiet ke va lien hanh cai dat phan mem ung dung (Exchange drug bills system).

•Start the application

Selection of a drug group Invalid

Loading CDA xml file into the buffer

Adoption of interoperability information

No

Hinh 5. Sa do giai thuat xu ly h6a don ITnh thudc He thdng sinh tdi lieu CDA

Sau dang nhap he thdng quan ly chung ciia benh vien, mdt chuong Irinh ho trg sinh hda don giao nhan thudc dudi dang chuan lai lieu CDA - (CDA Generator) se dugc kich boat.

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Nguyen Hai Minh vd dig Tap chi KHOA HOC & CONG NGHE 83(07): 81 -87 Sii- dung phan mem nay va CDA template, tai

lieu CDA se tao ra va khi ta sir dung trinh duyet web de bien thi thi se cho ket qua: CDA nhdm thudc se cd dang nhu hinh 6 va CDA phieu ITnh thudc chi liel cd dang nhu binh 7.

I'lttd i.lMi nil (n I \i kliu Kite J \ 111 x)<

Hinh 6. CDA nhom thuoc nhin duoi Internet Browser

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Hinh 7. CDA Hoa don phieu ITnh thu6c chi tiet Tren thuc te. do cac di^u kien khach quan.

mdi trudng truyen ibdiig d ta chua duoc ihirc SU tdl, viec viec kgt ndi Internet khdng ihl dam bao lien tuc 24/24 gid. nen chiing tdi lich hgp cdng nghe CDA portable vao dl trao ddi lai lieu hda don giao nhan thuoc. Trong trudng hgp nay chiing tdi da thiet kl mgl ca che bang dgi (queue) de luu triT cac thdng tin Irong qua trinh lam viec trong mdi trudng offline, thdng lin giao nhan se dugc luu lai may chu ciia vien va trong tai khoan account ciia user khoa dugc. Khi trang thai ket ndi Internet la san sang thi viec Ihuc hien trao ddi thdng lin cap nhat van dien ra binh thudng ma khdng anh hudng tdi viec cham sdc va dieu tri benh nhan tai vien.

THAO LUAN * Thuat ngii- Tin hgc trong y te (Medical

Informatics) tren the giai klidng cdn la mai me. nhung ddi vdi nude ta thi nhung thdng tin mdi nhat trong cdng nghe nay dugc diing de phat trien cac ung dung thi cdn nhieu ban che.

Qua bai viet nay chimg tdi hy vgng da dua den cho cac ban mdt each tiep can mdi trong viec thiet ke, cai dat cac tai lieu sd diing trong y hgc. Net dac biet cua tai lieu nay la cd the diing trong trao ddi thdng tin tren mdi trudng Internet ddc lap khdng phu thudc vao cac He quan tri co- sa dQ- lieu va database ciia cac he thdng quan ly hien cd.

Vdi giai phap nay, viec giao nhan thud^ ta' cac benh vien se don gian hon, giam dugc chi phi cho cac co- sd y te, va giam thdi gian xu ly cac cdng viec giay Id cho cac can bd lai vien.

Ngoai ra de nang cap he thdng, trong thai gian tdi chiing tdi se lap trung vao nghien ciru he thdng ma hda chuan qudc te RxNorm, SNOMED CT [14], dd tich hgp vao he thong de hd trg xir ly dugc tren dien rdng.

TAI LIEU THAM KHAO

[I].Frieda Kaiser, James Angus, Helen Stevens, e- MS Clinical Document Architecture Implementation Guide, e-MSIG, 2006.

[2].George Beeler. Jr., et al. Health Level Seven.

HL7- Reference Information Model, Release I, 2006.

[3].Analomical Therapeutic Chemical Classification System, htlp://en.wikipedia.org.

Accessed on March 2010.

[4].Huang Yong, Guo Jinqiu, Yoshio Ohta. A Prototype Model Using Clinical Document Architecture (CDA) with a Japanese Local Standard: Designing and Implementing a Referral Letter System. Acta Medica. Okavama. pp. 1-6.

2008.

[5].Puustjarvi Juha, Puustjarvi Leena. Towards Semantic Exchange of Clinical Documents.

Intemational Journal on Advances in Life Sciences, pp. 69-76, 2009.

[6].Kim, H., Yi. B.-K.. Kim, I., Ha, K.. Kwak, Y.- S.. Interoperable clinical information sharing system based on CDA and document registry framework, 9th International HL7 Interoperability Conference 2008, pp. 34-39, 2008.

[7].Kim, I. K., Lee, J. Y., Kim, I. K.. and Kwak, Y. S., A new method of registering the XML- based clinical document architecture supporting

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S U M M A R Y

S T A N D A R D A P P L I C A T I O N HL7 - CDA R2 E X C H A N G E B U I L D I N G S Y S T E M S BILL D E L I V E R Y O F D R U G S IN M E D I C A L F A C I L I T Y

Nguyen Hai Minh'*, Vu Manh Xuan', Nguyen Quang Dung^, Truong Dong Tarn"*

'Faculty Information Technology - TNU

^ College of Education - DH Thdi Nguyen, Social Insurance In Thai Nguyen province

^ Hospital oflhe University of Medicine - Thai Nguyen University Applying international exchange standard to develop a support exchange clinical documents application among differcnl systems in a heallhcare providers is really necessary and needed work, because it is not only reducing the time of work-office process but also help the staffs avoid the human mistake when they have to do it in manual.

In order to develop the exchange clinical documents application by applying the Health Level 7 standards (HL7). that is based on the existing databases of healthcare providers. In ihis paper we represent a method to develop an application for exchanging and sharing of drug bill documents between departments and Department of pharmacy in healthcare providers. Our method is developed by adapting the Clinical Document Architecture Release 2 (CDA R2). an existing database of the Hospital Information System (HIS) and a database of the pharmacy management systems. This method allows the staffs improving the work- office in hospital, contribution to reducing healthcare costs, and increasing to interaction between modules of the management information systems in hospital, and it also is a solution to adapt the CDA R2 to a local standard. Additionally, this method is also possible to exchange the drug bill documents when local area conneclion has a problem.

Key words: Clinical Document Architecture (CDA R2), drug bills Email: nhmlnh jniivd^yahoo. com

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