From a conceptual problem-oriented electronic patient record model to running systems: A nationwide assessment

Abstract

Background The development of problem-oriented conceptual models for electronic patient record (EPR) systems can improve data communication between health professionals. But little has been done so far to investigate to what extent it is possible to implement such models in operational EPR systems. Objective In this paper, we measure the conformance between a conceptual model and the various ways it is implemented within general practitioners’ (GPs’) electronic patient records. Methods We started from a simple problem-oriented conceptual model and we defined an original discriminating method to assess its implementation. This method is scenario-based (dummy patient), functional, and relative (comparison between software systems). Each implementation is assessed by two evaluators and the final result is a “success/failure” score. The assessment was performed within the scope of the official Belgian accreditation procedure for GPs’ electronic patient records, which is voluntary, publicly funded, and based on a dynamic quality improvement paradigm. Almost all Belgian GPs’ software systems (17) were assessed. The robustness of our results was assessed through a sensitivity analysis. Results We found that 65% (11/17) of the software systems currently used succeeded in implementing the problem-oriented conceptual model with a high confidence level (error rate <10%). The results were widely accepted by the software developers. Conclusions A problem-oriented conceptual model can be successfully implemented in many operational EPR systems. The quality of the implementation can be assessed. Our results could be used at the international level to improve semantic interoperability between patient information systems, for instance in relation to broader conceptual models such as the European CONTsys pre-norm.