Abstract
BackgroundEHR systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research. This is partly due to the different proprietary information models and inconsistent data quality. Our objective was to provide a more flexible solution enabling the clinicians to define which data to be recorded and shared for both routine documentation and clinical studies. The data should be possible to reuse through a common set of variable definitions providing a consistent nomenclature and validation of data. Another objective was that the templates used for the data entry and presentation should be possible to use in combination with the existing EHR systems.MethodsWe have designed and developed a template based system (called Julius) that was integrated with existing EHR systems. The system is driven by the medical domain knowledge defined by clinicians in the form of templates and variable definitions stored in a common data repository. The system architecture consists of three layers. The presentation layer is purely web-based, which facilitates integration with existing EHR products. The domain layer consists of the template design system, a variable/clinical concept definition system, the transformation and validation logic all implemented in Java. The data source layer utilizes an object relational mapping tool and a relational database.ResultsThe Julius system has been implemented, tested and deployed to three health care units in Stockholm, Sweden. The initial responses from the pilot users were positive. The template system facilitates patient data collection in many ways. The experience of using the template system suggests that enabling the clinicians to be in control of the system, is a good way to add supplementary functionality to the present EHR systems.ConclusionThe approach of the template system in combination with various local EHR systems can facilitate the sharing and reuse of validated clinical information from different health care units. However, future system developments for these purposes should consider using the openEHR/CEN models with shareable archetypes.
Highlights
Electronic health record (EHR) systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research
The system should be possible to integrate with the local EHR systems in clinical environment, preferably using the same Graphical User Interface (GUI) as the existing EHR system
Over 250 patients have been recorded with the Julius system and reported to the National diabetes registry
Summary
EHR systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research. This is partly due to the different proprietary information models and inconsistent data quality. The data should be possible to reuse through a common set of variable definitions providing a consistent nomenclature and validation of data Another objective was that the templates used for the data entry and presentation should be possible to use in combination with the existing EHR systems. There are more than 50 national quality registries in Sweden, collecting patient data from health care units for quality control and clinical research, which have similar problems with different information models and terminologies. The required format includes a list of predefined variables which needs to be mapped to the local variables within EHR system, before transferring the data automatically
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