Electronic Healthcare Record Systems Research Articles

Role of OpenEHR as an open source solution for the regional modelling of patient data in obstetrics

This work investigates, whether openEHR with its reference model, archetypes and templates is suitable for the digital representation of demographic as well as clinical data. Moreover, it elaborates openEHR as a tool for modelling Hospital Information Systems on a regional level based on a national logical infrastructure. OpenEHR is a dual model approach developed for the modelling of Hospital Information Systems enabling semantic interoperability. A holistic solution to this represents the use of dual model based Electronic Healthcare Record systems. Modelling data in the field of obstetrics is a challenge, since different regions demand locally specific information for the process of treatment. Smaller health units in developing countries like Brazil or Malaysia, which until recently handled automatable processes like the storage of sensitive patient data in paper form, start organizational reconstruction processes. This archetype proof-of-concept investigation has tried out some elements of the openEHR methodology in cooperation with a health unit in Colombo, Brazil. Two legal forms provided by the Brazilian Ministry of Health have been analyzed and classified into demographic and clinical data. LinkEHR-Ed editor was used to read, edit and create archetypes. Results show that 33 clinical and demographic concepts, which are necessary to cover data demanded by the Unified National Health System, were identified. Out of the concepts 61% were reused and 39% modified to cover domain requirements. The detailed process of reuse, modification and creation of archetypes is shown. We conclude that, although a major part of demographic and clinical patient data were already represented by existing archetypes, a significant part required major modifications. In this study openEHR proved to be a highly suitable tool in the modelling of complex health data. In combination with LinkEHR-Ed software it offers user-friendly and highly applicable tools, although the complexity built by the vast specifications requires expert networks to define generally excepted clinical models. Finally, this project has pointed out main benefits enclosing high coverage of obstetrics data on the Clinical Knowledge Manager, simple modelling, and wide network and support using openEHR. Moreover, barriers described are enclosing the allocation of clinical content to respective archetypes, as well as stagnant adaption of changes on the Clinical Knowledge Manager leading to redundant efforts in data contribution that need to be addressed in future works.

Transformation of standardized clinical models based on OWL technologies: from CEM to OpenEHR archetypes

The semantic interoperability of electronic healthcare records (EHRs) systems is a major challenge in the medical informatics area. International initiatives pursue the use of semantically interoperable clinical models, and ontologies have frequently been used in semantic interoperability efforts. The objective of this paper is to propose a generic, ontology-based, flexible approach for supporting the automatic transformation of clinical models, which is illustrated for the transformation of Clinical Element Models (CEMs) into openEHR archetypes. Our transformation method exploits the fact that the information models of the most relevant EHR specifications are available in the Web Ontology Language (OWL). The transformation approach is based on defining mappings between those ontological structures. We propose a way in which CEM entities can be transformed into openEHR by using transformation templates and OWL as common representation formalism. The transformation architecture exploits the reasoning and inferencing capabilities of OWL technologies. We have devised a generic, flexible approach for the transformation of clinical models, implemented for the unidirectional transformation from CEM to openEHR, a series of reusable transformation templates, a proof-of-concept implementation, and a set of openEHR archetypes that validate the methodological approach. We have been able to transform CEM into archetypes in an automatic, flexible, reusable transformation approach that could be extended to other clinical model specifications. We exploit the potential of OWL technologies for supporting the transformation process. We believe that our approach could be useful for international efforts in the area of semantic interoperability of EHR systems.

European Network of Bipolar Research Expert Centre (ENBREC): a network to foster research and promote innovative care.

Bipolar disorders rank as one of the most disabling illnesses in working age adults worldwide. Despite this, the quality of care offered to patients with this disorder is suboptimal, largely due to limitations in our understanding of the pathology. Improving this scenario requires the development of a critical mass of expertise and multicentre collaborative projects. Within the framework of the European FP7 programme, we developed a European Network of Bipolar Research Expert Centres (ENBREC) designed specifically to facilitate EU-wide studies. ENBREC provides an integrated support structure facilitating research on disease mechanisms and clinical outcomes across six European countries (France, Germany, Italy, Norway, Spain and the UK). The centres are adopting a standardised clinical assessment that explores multiple aspects of bipolar disorder through a structured evaluation designed to inform clinical decision-making as well as being applicable to research. Reliable, established measures have been prioritised, and instruments have been translated and validated when necessary. An electronic healthcare record and monitoring system (e-ENBREC©) has been developed to collate the data. Protocols to conduct multicentre clinical observational studies and joint studies on cognitive function, biomarkers, genetics, and neuroimaging are in progress; a pilot study has been completed on strategies for routine implementation of psycho-education. The network demonstrates ‘proof of principle’ that expert centres across Europe can collaborate on a wide range of basic science and clinical programmes using shared protocols. This paper is to describe the network and how it aims to improve the quality and effectiveness of research in a neglected priority area.

Medication errors associated with reconciliation in a hospital with computerised physician order entry system with access to primary care treatment

BackgroundA recently introduced computerised physician order entry system (CPOES) in hospital and a primary care electronic record system help prescribing and provide information about patients' medicines. These tools should improve...

A Data Types Profile Suitable for Use with ISO EN 13606

ISO EN 13606 is a five part International Standard specifying how Electronic Healthcare Record (EHR) information should be communicated between different EHR systems and repositories. Part 1 of the standard defines an information model for representing the EHR information itself, including the representation of types of data value. A later International Standard, ISO 21090:2010, defines a comprehensive set of models for data types needed by all health IT systems. This latter standard is vast, and duplicates some of the functions already handled by ISO EN 13606 part 1. A profile (sub-set) of ISO 21090 would therefore be expected to provide EHR system vendors with a more specially tailored set of data types to implement and avoid the risk of providing more than one modelling option for representing the information properties. This paper describes the process and design decisions made for developing a data types profile for EHR interoperability.

Strategies for maintaining patient privacy in i2b2

The re-use of patient data from electronic healthcare record systems can provide tremendous benefits for clinical research, but measures to protect patient privacy while utilizing these records have many challenges. Some of these challenges arise from a misperception that the problem should be solved technically when actually the problem needs a holistic solution. The authors' experience with informatics for integrating biology and the bedside (i2b2) use cases indicates that the privacy of the patient should be considered on three fronts: technical de-identification of the data, trust in the researcher and the research, and the security of the underlying technical platforms. The security structure of i2b2 is implemented based on consideration of all three fronts. It has been supported with several use cases across the USA, resulting in five privacy categories of users that serve to protect the data while supporting the use cases. The i2b2 architecture is designed to provide consistency and faithfully implement these user privacy categories. These privacy categories help reflect the policy of both the Health Insurance Portability and Accountability Act and the provisions of the National Research Act of 1974, as embodied by current institutional review boards. By implementing a holistic approach to patient privacy solutions, i2b2 is able to help close the gap between principle and practice.

Greenway Medical Technologies: The Pace-Setting David of Electronic Health Records

This teaching case updates a previous study of Greenway Medical Technologies, a software company delivering electronic healthcare record (EHR) solutions to physicians. The current EHR marketplace is considered, including global trends as well as the impact of U.S. government funded monetary incentives. Greenway continues to build on its best-in-class software application and find ways to provide new enticements to medical practices and improvements to the broader medical community. The case also describes the EHR systems industry and explores the reasons for Greenway’s continued success and growth that surpasses its competitors.

SU‐FF‐T‐481: Computerized Implementation of Radiation Treatment Planning Directives

Purpose: This presentation describes the implementation of a system for capturing radiation treatment planning directives. These directives capture site and protocol specific requirements for the various processes required for planning namely imaging studies, registration, contouring, and specification of target goals, and planning objectives. Method and Materials: The computer software used for this work is based on an open‐source electronic healthcare record (EHR) system . The software is based on industry standards and runs on a windows server, is written in Java, a standard database, and provides a web‐based user interface. The system uses a data model based on the HL7 V3 and continuity of care records. Patient related information (documents) trigger a rules‐based decision support engine that is used to maintain lists and initiate messaging to external systems. Documents can also be fed to the system via messages from external system. Customizations of this system have been made to capture and manage template treatment planning directives that are then selected and modified to create patient specific directives. Rules have been created and are triggered by completing various components of the planning directives. Over 50 treatment planning directives have been developed using paper forms and these have served as a guide for the development of the data requirements and user input styles. Extensive processes mapping has been undertaken to determine the best ways to implement this system within our clinical environment. Results: The resulting system has been used to implement most of our current planning directives. Messages from the hospital's HL7 feed provide basic patient identification information and clinical results as needed. Various worklists are maintained along with e‐mail notifications, and communications with our planning system are used to initialize planning parameters. Conclusion: This system for computer‐supported management of treatment planning directives has proven to be flexible and extensible.

Implementation of a query interface for a generic record server

Introduction This paper presents work to define a representation for clinical research queries that can be used for the design of generic interfaces to electronic healthcare record (EHR) systems. Given the increasing prevalence of EHR systems, with the potential to accumulate life-long health records, opportunities exist to analyse and mine these for new knowledge. This potential is presently limited by many factors, one of which is the challenge of extracting information from them in order to execute a research query. Method There is limited pre-existing work on the generic specification of clinical queries. Sets of example queries were obtained from published studies and clinician reference groups. These were re-represented as structured logical expressions, from which a generalisable pattern (information model) was inferred. An iterative design and implementation approach was then pursued to refine the model and evaluate it. Results This paper presents a set of requirements for the generic representation of clinical research queries, and an information model to represent any arbitrary such query. A middleware component was implemented as an interface to an existing system that holds 20,000 anonymised cancer EHRs in order to validate the model. This component was interfaced in turn to a query design and results presentation tool developed by the Open University, to permit end user demonstrations and feedback as part of the evaluation. Conclusion Although it is difficult to separate cleanly the evaluation of a theoretical model from its implementation, the empirical evaluation of the query-execution interface revealed that clinical queries of the kinds studied could all be represented and executed successfully. However, performance was a problem and this paper outlines some of the challenges faced in building generic components to handle specialised data structures on a large scale. The limitations of this work are also discussed. The work complements many years of European research and standardisation on the interoperable communication of electronic health records, by proposing a way in which one or more EHR systems might be queried in a standardised way.

Realization of a Universal Patient Identifier for Electronic Medical Records Through Biometric Technology

The technology exists for the migration of healthcare data from its archaic paper-based system to an electronic one, and, once in digital form, to be transported anywhere in the world in a matter of seconds. The advent of universally accessible healthcare data has benefited all participants, but one of the outstanding problems that must be addressed is how the creation of a standardized nationwide electronic healthcare record system in the United States would uniquely identify and match a composite of an individual's recorded healthcare information to an identified individual patients out of approximately 300 million people to a 1:1 match. To date, a few solutions to this problem have been proposed that are limited in their effectiveness. We propose the use of biometric technology within our fingerprint, iris, retina scan, and DNA (FIRD) framework, which is a multiphase system whose primary phase is a multilayer consisting of these four types of biometric identifiers: 1) fingerprint; 2) iris; 3) retina scan; and 4) DNA. In addition, it also consists of additional phases of integration, consolidation, and data discrepancy functions to solve the unique association of a patient to their medical data distinctively. This would allow a patient to have real-time access to all of their recorded healthcare information electronically whenever it is necessary, securely with minimal effort, greater effectiveness, and ease.

The impact of electronic patient records on workflow in general practice

The Patient Access to Electronic Healthcare Records System (PAERS) allows patients to register their arrival at a GP's surgery and to view their healthcare record electronically whilst in the waiting area. The research reported in this short article was carried out to identify potential changes in clinical and administrative workflow resulting from the introduction of the system. The study considers workflow pre and post the implementation of PAERS. It also makes comparisons between two UK London-based surgeries, one with PAERS (Wells Park Practice) and one without such a system (South Lewisham Group Practice). The impact of PAERS on workflow and the potential benefits for GPs, administrative staff and patients are highlighted.

Delivering the electronic healthcare record for the 21st century

In spite of over four decades of research into Electronic Healthcare Record Systems, the penetration of records which incorporate more than simply basic information, into the working life of healthcare organisations is relatively small. This paper discusses some of the key impediments to progress including in particular, the lack of application of software engineering methodologies, the absence of usable standards, and the failure to acknowledge the impact of record systems on the healthcare system itself. However, Health Informatics researchers need to be preparing for the next generation of systems which will be triggered by the twin revolutions of the Internet and Genetic Medicine. This next generation of EHCR will be a longitudinal cradle-to-the-grave active record readily accessible and available via the Internet, and which will be linked to clinical protocols and guidelines to drive the delivery of healthcare to the individual citizen. Post-genomic research will unravel the link between genes, disease, treatment and the environment and this information will be used to promote health and individualise care. A number of key research issues are identified which need to be addressed in order to realise the delivery of the next generation of EHCR Systems.

CIS6/413: Design of a Computer-Based Patient Record System (ARISTOPHANES) for Medical Departments: Implementation for Surgery Wards

IntroductionToday, the demand for computer-based patient records to improve the quality of patient care and to reduce costs in health services is generally recognized. The new electronic patient record system (ARISTOPHANES) is based on a self-developed relational data model with a star-shaped topology. An hierarchical structure has been chosen for the user interface. ARISTOPHANES has been developed for use in clinical workstations taking into account varied requirements, user acceptance, and future extension.MethodsFor the design of the electronic patient records was used the software "Oracle Forms 5.0". An Oracle database has been generated and loaded with test data. The designed forms are currently being implemented using "SQL*Plus 8.0" by Oracle.ResultsWe used a self-developed star-shaped relational data model, which is highly flexible with regard to the modification and extension of the data structure. The design of the electronic patient records has taken into account the varied demands of the medical partners in order to guarantee user acceptance. The hierarchical topology that has been chosen renders the designed electronic patient record system flexible and efficient, such that further departments and regulatory changes can be integrated within a short time. General functions required by all departments are contained in the main menu. These include patient data, case details, medical documentation, care documentation, personnel details, and business partners. Specific functions are included at lower levels for the demands of the surgery departments, such as anaesthesia record, operation record, present status record.DiscussionThe complexity of user acceptance is reflected by (i) the different groups of users of Electronic Healthcare Record systems (physicians, nurses, managers, researchers) together with their various requirements, and (ii) the different contexts of use (e.g., support in normal or emergency situations, access for research, and mobile access). Commercial providers have developed electronic patient record systems, that often turn out to be too inflexible for the requirements of a university setting and need to be customized considerably. To ensure user acceptance, we analyzed the demands together with clinical partners from the surgery departments. It is expected that the ARISTOPHANES system will also be attractive to other medical departments in light of the overall advantages such as paperless documentation, reliable patient data transfer, improved settlement of accounts, and easing the burden on care personnel.

Evaluation of Nurses' Use of an Electronic Health Care Record System

Evaluation of Nurses' Use of an Electronic Health Care Record System

Combining a scientific approach and prototyping in the design of EHCR systems.

In this paper, it is emphasized that electronic medical record systems cannot totally be developed in the traditional way. The underlying process of how physicians or nurses are searching for information is not fully understood. Therefore, a method that combines a scientific approach and prototyping is advocated. With the help of this advocated approach, these questions could be answered in a way that was also scientifically sound. In this contribution, two examples of the use of this method are presented. One concerns the determination of the optimum granularity of the narrative parts of the electronic healthcare record (EHCR) and the other concerns the use and impact of stand-alone protocol systems.