AMedP-5.2 data interchange between health information systems

What it is

What AMedP-5.2 covers

AMedP-5.2 is a NATO Allied Medical Publication (an "AMedP") that names the technical standards a deployable Military Health Information System (MHIS) has to use when it exchanges personal medical data and medical information with another nation's system or with a NATO system. It leaves each nation free to run whatever it likes inside its own national health IT, and only reaches in at the interchange boundary: whatever a nation runs, it has to be able to hand data across in the standards this publication lists. Those standards are civil and international ones the document adopts rather than writes itself, set out domain by domain in a single annex.

Why it exists

The document traces its own reason for being to an operational problem rather than a policy preference. Recent NATO and coalition operations had shown a need to exchange personal medical data electronically to support patient care, and variation in national and military health data, semantics and system architecture was getting in the way of doing that reliably. AMedP-5.2 is NATO's answer: not a new data format of its own, but a shared list of which existing standard applies to which kind of medical data, so that two nations' systems, built independently, can still exchange it.

What each domain has to use

The annex works through eleven technical domains and names a standard against each. DICOM covers most imaging (dental X-ray, ECG, endoscopic pictures, nuclear medicine, radiology and ultrasound), with JPEG for microscopic images and any clinical picture not covered elsewhere. HL7 covers clinical messaging (order entry, scheduling, patient administration and patient care), laboratory results (with LOINC for result names and ELINCS for result content), immunizations (alongside the CVX and MVX code sets), patient demographics and clinical encounters, and, in its Clinical Document Architecture form, text-based reports such as history and physical. The Anatomical Therapeutic Chemical (ATC) classification system covers medications, and ICD-10 covers interventions, procedures, and diagnosis and problem lists. Personal health monitoring uses HL7 together with IEEE standards. One domain, multimedia, is recorded as not yet defined. This page names those standards and what each one covers; the annex itself, not this page, is where the message formats and code lists live.

What implementation actually looks like

The publication's own front matter shows that implementing every domain is not automatic. At promulgation, three nations recorded reservations: Bulgaria's military medical service could not provide the imaging standard for ECG, nuclear medicine or microscopic pictures (JPEG only, for microscopic images); Canada was still examining its implementation options for the medications standard; and Norway recorded that it would not implement the messaging standard at all. The document treats this as ordinary: a nation ratifies the STANAG this AMedP sits under and can enter a reservation against any domain it does not yet meet, rather than being blocked from ratifying altogether.

How it comes to bind, and how it is checked

AMedP-5.2 is covered by STANAG 2543. The document's own clause states that "This AMedP is implemented when a nation fulfils its obligations under the STANAG, as described in its ratification reply," not by the publication existing on its own. It names no certification scheme, no notified body and no periodic inspection: what it describes is a nation's own ratification and its own reservations, not a third party checking a system's interchange capability against the document.