STANAG 2231 patient data exchange format for common core information

What it is

STANAG 2231 is a NATO Standardization Agreement, currently Edition 1, promulgated 2 April 2014. It is not a technical specification. It is the agreement by which NATO nations commit to implement AMedP-5.1, Edition A, the Allied Medical Publication that sets out the patient data exchange format for common core information. The interoperability requirement behind it is stated plainly: "Technical aspects, business practices, and operational requirements needed for interoperability of national Electronic Medical Record Systems, and for the ability to transfer data between nations when used," plus a separate requirement "to provide medical reports in electronic format from nations to NATO Command Structures, which will be enhanced by this agreement." Read on its own, STANAG 2231 requires almost nothing of a supplier or a health service directly. Its obligations run to nations, and it reaches a military health organisation only once a nation has implemented it and a specific tasking or contract invokes the format it commits to.

Who it binds, and how

STANAG 2231 is explicit that it binds nations rather than organisations. Its letter of promulgation describes the enclosed agreement as one "which has been ratified by member nations, as reflected in the NATO Standardization Document Database (NSDD), is promulgated herewith." Under "Agreement," participating nations agree to implement AMedP-5.1, Edition A - a national commitment made by ratification, not a duty a supplier or a hospital signs up to by reading this document. Partner nations are separately "invited to adopt this STANAG." Ratification and implementation are separate steps in how a STANAG works generally, and a nation can ratify one with reservations, though this document names none of its own. So "is STANAG 2231 mandatory" has no single answer: it depends on whether a given nation has ratified and implemented it, and, for a health service organisation, on whether a specific tasking or contract then invokes the format that implementation puts in place.

What the agreement actually commits nations to

The stated aim is to respond to an interoperability requirement covering national Electronic Medical Record Systems and the transfer of patient data between nations, plus "a requirement to provide medical reports in electronic format from nations to NATO Command Structures, which will be enhanced by this agreement." The STANAG states it "is effective upon receipt and ready to be used by the implementing nations and NATO bodies" - a NATO-wide mechanism, not a national or civil one. None of this is written as a duty on a supplier; it is a duty on the nation, and on the national Electronic Medical Record Systems and NATO Command Structures that actually exchange the data.

A cover agreement, not the format itself

A reader who only has STANAG 2231 in hand does not yet have the data exchange format it points to. The actual substance - what "common core information" is and how it is structured for exchange - sits in AMedP-5.1, Edition A. Other related documents named alongside it are STANAG 5524 (which covers ADatP-34, NATO Interoperability Standards and Profiles), STANAG 2228 (which covers AJP-4.10, Allied Joint Doctrine for Medical Support), STANAG 2230 (which covers AJP-4.6, Multinational Joint Logistics Centre Doctrine), STANAG 2034 (NATO Standard Procedures for Mutual Logistic Assistance), STANAG 2061 (Procedures for Disposition of Allied Patients by Medical Installations), STANAG 2132 (which covers AMedP-8.1, on documentation for initial medical treatment and evacuation), and STANAG 2348 (which covers AMedP-8.2, on basic military hospital clinical records).

Reporting and review

National decisions on ratification and implementation are provided to the NSA and recorded in the NSDD. Nations are invited to report their effective implementation using the form in Annex H to AAP-03(J), and partner nations their adoption using Annex G to AAP-03(J). The STANAG itself "is to be reviewed at least once every three years," with the result recorded in the NSDD - a check on whether the agreement is still current, not an audit of any organisation. Nations and NATO bodies may propose changes at any time through a standardization proposal to the tasking authority.

What it does not cover

STANAG 2231 names no data field, code list or message structure of its own - that detail sits entirely in AMedP-5.1. It also names no assessment or certification scheme: the only stated check is that the STANAG itself is reviewed periodically, not that an organisation or a national Electronic Medical Record System is certified.

Standards it references

• STANAG 5524Background
• STANAG 2228Background
• STANAG 2230Background
• AJP-4.6Background
• STANAG 2034Background
• STANAG 2132Background
• AMedP-8.1Background
• STANAG 2348Background
• AMedP-8.2Background