Archetype development and governance methodologies for the electronic health record

[ES] La interoperabilidad semántica de la información sanitaria es un requisito imprescindible para la sostenibilidad de la atención sanitaria, y es fundamental para afrontar los nuevos retos sanitarios de un mundo globalizado. Esta tesis aporta nuevas metodologías para abordar algunos de los aspectos fundamentales de la interoperabilidad semántica, específicamente aquellos relacionados con la definición y gobernanza de modelos de información clínica expresados en forma de arquetipo. Las aportaciones de la tesis son: - Estudio de las metodologías de modelado existentes de componentes de interoperabilidad semántica que influirán en la definición de una metodología de modelado de arquetipos. - Análisis comparativo de los sistemas e iniciativas existentes para la gobernanza de modelos de información clínica. - Una propuesta de Metodología de Modelado de Arquetipos unificada que formalice las fases de desarrollo del arquetipo, los participantes requeridos y las buenas prácticas a seguir. - Identificación y definición de principios y características de gobernanza de arquetipos. - Diseño y desarrollo de herramientas que brinden soporte al modelado y la gobernanza de arquetipos. Las aportaciones de esta tesis se han puesto en práctica en múltiples proyectos y experiencias de desarrollo. Estas experiencias varían desde un proyecto local dentro de una sola organización que requirió la reutilización de datos clínicos basados en principios de interoperabilidad semántica, hasta el desarrollo de proyectos de historia clínica electrónica de alcance nacional.[CA] La interoperabilitat semàntica de la informació sanitària és un requisit imprescindible per a la sostenibilitat de l'atenció sanitària, i és fonamental per a afrontar els nous reptes sanitaris d'un món globalitzat. Aquesta tesi aporta noves metodologies per a abordar alguns dels aspectes fonamentals de la interoperabilitat semàntica, específicament aquells relacionats amb la definició i govern de models d'informació clínica expressats en forma d'arquetip. Les aportacions de la tesi són: - Estudi de les metodologies de modelatge existents de components d'interoperabilitat semàntica que influiran en la definició d'una metodologia de modelatge d'arquetips. - Anàlisi comparativa dels sistemes i iniciatives existents per al govern de models d'informació clínica. - Una proposta de Metodologia de Modelatge d'Arquetips unificada que formalitza les fases de desenvolupament de l'arquetip, els participants requerits i les bones pràctiques a seguir. - Identificació i definició de principis i característiques de govern d'arquetips. - Disseny i desenvolupament d'eines que brinden suport al modelatge i al govern d'arquetips. Les aportacions d'aquesta tesi s'han posat en pràctica en múltiples projectes i experiències de desenvolupament. Aquestes experiències varien des d'un projecte local dins d'una sola organització que va requerir la reutilització de dades clíniques basades en principis d'interoperabilitat semàntica, fins al desenvolupament de projectes d'història clínica electrònica d'abast nacional.[EN] Semantic interoperability of health information is an essential requirement for the sustainability of healthcare, and it is essential to face the new health challenges of a globalized world. This thesis provides new methodologies to tackle some of the fundamental aspects of semantic interoperability, specifically those aspects related to the definition and governance of clinical information models expressed in the form of archetypes. The contributions of the thesis are: - Study of existing modeling methodologies of semantic interoperability components that will influence in the definition of an archetype modeling methodology. - Comparative analysis of existing clinical information model governance systems and initiatives. - A proposal of a unified Archetype Modeling Methodology that formalizes the phases of archetype development, the required participants, and the good practices to be followed. - Identification and definition of archetype governance principles and characteristics. - Design and development of tools that provide support to archetype modeling and governance. The contributions of this thesis have been put into practice in multiple projects and development experiences. These experiences vary from a local project inside a single organization that required a reuse on clinical data based on semantic interoperability principles, to the development of national electronic health record projects.This thesis was partially funded by the Ministerio de Economía y Competitividad, ayudas para contratos para la formación de doctores en empresas “Doctorados Industriales”, grant DI-14-06564 and by the Agencia Valenciana de la Innovación, ayudas del Programa de Promoción del Talento – Doctorados empresariales (INNODOCTO), grant INNTA3/2020/12.Moner Cano, D. (2021). Archetype development and governance methodologies for the electronic health record [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/16491

Am J Hypertens

Self-measured blood pressure (SMBP) telemonitoring is the process of securely storing and tele-transmitting reliably measured, patient self-performed blood pressure (BP) measurements to healthcare teams, while ensuring that these data are viewable and clinically actionable for the purposes of improving hypertension diagnosis and management. SMBP telemonitoring is a vital component of an overall hypertension control strategy. Herein, we present a pragmatic guide for implementing SMBP in clinical practice and provide a comprehensive list of resources to assist with implementation. Initial steps include defining program goals and scope, selecting the target population, staffing, choosing appropriate (clinically validated) BP devices with proper cuff sizes, and selecting a telemonitoring platform. Adherence to recommended data transmission, security, and data privacy requirements is essential. Clinical workflow implementation involves patient enrollment and training, review of telemonitored data, and initiating or titrating medications in a protocolized fashion based upon this information. Utilizing a team-based care structure is preferred and calculation of average BP for hypertension diagnosis and management is important to align with clinical best practice recommendations. Many stakeholders in the United States are engaged in overcoming challenges to SMBP program adoption. Major barriers include affordability, clinician and program reimbursement, availability of technological elements, challenges with interoperability, and time/workload constraints. Nevertheless, it is anticipated that uptake of SMBP telemonitoring, still at a nascent stage in many parts of the world, will continue to grow, propagated by increased clinician familiarity, broader platform availability, improvements in interoperability, and reductions in costs that occur with scale, competition, and technological innovation.CC999999/ImCDC/Intramural CDC HHSUnited States

Assessing the Interoperability of mLab and Ushauri mHealth Systems to Enhance Care for HIV/AIDS Patients in Kenya

The core thesis of this study is to explore the legal and technological feasibility to interoperate two mobile health-based solutions in Kenya: Ushauri-Text for Adherence (T4A), and Mobile Laboratory (mLab), to enhance HIV/AIDS care and treatment. This paper focuses on two aspects namely data interoperability by analysing secondary data abstracted from the mLab and the Ushauri databases from June 2017 to June 2018 and doctrinal analysis of the legal and policy environment to support the interoperability. This paper is a case study of the mLab and the Ushauri systems in terms of the technological stack for interoperability which has some legal implications. It includes a pilot study that employed a multistage sampling method in which thirty-nine health facilities in Siaya, Homa bay, Nyeri, and Muranga were selected. Findings show a satisfactory legal environment to augment the interoperability of the two mHealth systems. It is also evident that the two systems were considerably interoperable in terms of technology, semantics, data, and processes. However, interoperating them could largely be compromised by language semantics leading to a discrepancy of characters and numbering in unique identifiers in data entry. Though data in the systems were for the same individuals, it is critical to note that there was a low level of concordance in patient identification numbers in the same facilities where the same patients were receiving clinical services. Additionally, healthcare workers across the various facilities did not follow the NASCOP (2010) eleven-digit unique identifier system. Standardizing human activities while using systems such as the allocation of patient identifiers and following laid down standards while developing systems are critical ways of ensuring interoperability. This paper highlights the need to achieve full-scale implementation of laid down policies and legal requirements such as the systems’ interoperability certification process to standardise the systems and make them interoperable

Doctor of Philosophy

dissertationInadequate care coordination has been identified as a significant problem in patient care, resulting in diminished satisfaction, increased cost, and reduced quality of care. Comprising an estimated 15.6% (approximately 11 million) of the pediatric population, children and youth with special health care needs (CYSHCN) are "those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally". Caring for CYSHCN is often highly complex, time-, effort-, and resource-intensive, due to complex healthcare conditions, comorbidities, and age of patients. Current electronic health record (EHR) and personal health record (PHR) systems do not adequately support the needs of care coordination. The reasons for this include lack of appropriate tools to support complex care coordination tasks, poor usability, and gaps in information essential for providing team-based patient care. The issues are further amplified while coordinating care for CYSHCN because their health records tend to be voluminous, involve a large care team, and are distributed over multiple systems typically with little to no interoperability. To develop tools that promote effective and efficient care coordination, designers must first understand what information is needed, who needs it, when they need it, and how it can be made available. Our first study focused on identifying and describing information needs and associated goals related to coordinating care for CYSHCN. We found that a critical information goal for care coordination is care networking, which includes building a patient's care team; knowing team member identities, roles, and contact information; and sharing pertinent information with the team to coordinate care. In our second study, we designed and developed two versions of a patient-, family-, and clinician-facing tool to support care networking. We then conducted a formative evaluation and compared the usability, usefulness, and efficiency of the two versions. To enable such tools to help with management of information critical to care coordination, information for care networking needs to be obtained from all information sources involved in the patient's care. In our third study, we identified and assessed prevalent and emerging national data standards to support electronic exchange and extraction of patient care team related data. The findings and innovations from this research are envisioned to help guide the design and development of next generation clinician- and patient-/family-facing applications to support care coordination of complex pediatric patients

Implementation of e-health interoperability in developing country contexts : the case of Zimbabwe

The provision of information technology-enabled healthcare services (e-health) has been adopted by numerous public and private facilities in both developing nations and advanced nations. However, one of the obstacles to the adoption of health information systems has been cited as their lack of interoperability resulting in their reduced effectiveness. In view of this, the study sought to explore the interoperability of health information systems employed in the country and then propose a framework to direct the process of implementing e-health interoperability. The study’s methodology was qualitative and a case study was undertaken. Semi-structured interviews were employed to gather data from e-health stakeholders in state-owned institutions and private enterprises. Document review was also conducted to substantiate findings from interviews. Data was analysed using thematic analysis and NVivo 12 software. The study’s findings revealed that several health information systems were implemented and their interoperability was low. Technological, terminology, organizational as well as regulatory and legal barriers were identified as hindrances to interoperability. The enablers for implementing e-health interoperability also revealed by this study include: development of re-usable software components, train the trainer approach to transfer of skills and regional conformance testing. The consequences of lack of interoperability among health information systems reported by this study include: burden on the worker, wastage of resources and high cost. The study also proposed a dual framework to guide the implementation of e-health interoperability. The study’s recommendations include the development of an e-health policy, an e-health strategy and the upgrade of ICT and telecommunication infrastructure to facilitate health information exchange.School of ComputingD. Phil. (Information Systems

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Sistema open-source de registos clínicos de saúde em doenças tropicais

Mestrado em Engenharia de Computadores e TelemáticaLow-resource countries are primarily the ones afected by tropical diseases where environmental factors play a major role. Means for controlling these diseases are often lacking in these countries in part due to their poor support of Health Information Technology. Nowadays, with the advances of standards and software in the health-field, several open-source electronic health record systems (EHR) exist which can assist facilities to capture of information, aiding to research and better health-care of neglected diseases in these countries. In this work, we performed a systematic review of several of such solutions to select the most appropriate candidate to satisfy the requirements of a testbed in a low-resource country - Gondar in Ethiopia. The implementation was conducted with a strong focus on adapting the existing paper-based workflow of the institution to the proposed system, to assure that all the information generated in this center can be captured in a digital way. As a final result, a working prototype was deployed and some conclusions are obtained from all this process.Países sub-desenvolvidos são os principalmente afectados por um conjunto de doenças tropicais onde factores ambientais desempenham uma contribuição maior na sua origem. No geral estes países não dispõem de métodos para controlar estas doenças eficazmente, em parte devido à fraca implementação de Tecnologias da Informação em Saúde. Atualmente, com o avanço em standards e software na área da saúde, existem diversos sistemas opensource de registos clínicos que podem auxiliar centros de cuidados médicos na captura de informação útil à melhoria dos serviços prestados e há investigação de doenças negligenciadas. Nesta dissertação efectuámos uma revisão sistemática de tais soluções de maneira a escolher um candidato apropriado aos requisitos de uma cama de teste de um país sub-desenvolvido - Gondar, Etiópia. A implementação foi conduzida com ênfase à adaptação do fluxo de trabalho baseado em papel da instituição para o sistema proposto, assegurando que toda a informação gerada pelo centro pode ser capturada de forma digital. Como resultado final, um protótipo foi criado e algumas conclusões obtidas de todo este processo