Julius – a template based supplementary electronic health record system

<p>Abstract</p> <p>Background</p> <p>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. 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.</p> <p>Methods</p> <p>We 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.</p> <p>Results</p> <p>The 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.</p> <p>Conclusion</p> <p>The 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.</p

Design and Implementation of a Collaborative Clinical Practice and Research Documentation System Using SNOMED-CT and HL7-CDA in the Context of a Pediatric Neurodevelopmental Unit

This paper introduces a prototype for clinical research documentation using the structured information model HL7 CDA and clinical terminology (SNOMED CT). The proposed solution was integrated with the current electronic health record system (EHR-S) and aimed to implement interoperability and structure information, and to create a collaborative platform between clinical and research teams. The framework also aims to overcome the limitations imposed by classical documentation strategies in real-time healthcare encounters that may require fast access to complex information. The solution was developed in the pediatric hospital (HP) of the University Hospital Center of Coimbra (CHUC), a national reference for neurodevelopmental disorders, particularly for autism spectrum disorder (ASD), which is very demanding in terms of longitudinal and cross-sectional data throughput. The platform uses a three-layer approach to reduce components’ dependencies and facilitate maintenance, scalability, and security. The system was validated in a real-life context of the neurodevelopmental and autism unit (UNDA) in the HP and assessed based on the functionalities model of EHR-S (EHR-S FM) regarding their successful implementation and comparison with state-of-the-art alternative platforms. A global approach to the clinical history of neurodevelopmental disorders was worked out, providing transparent healthcare data coding and structuring while preserving information quality. Thus, the platform enabled the development of user-defined structured templates and the creation of structured documents with standardized clinical terminology that can be used in many healthcare contexts. Moreover, storing structured data associated with healthcare encounters supports a longitudinal view of the patient’s healthcare data and health status over time, which is critical in routine and pediatric research contexts. Additionally, it enables queries on population statistics that are key to supporting the definition of local and global policies, whose importance was recently emphasized by the COVID pandemic.info:eu-repo/semantics/publishedVersio

Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems

In the foreseeable future, it is likely that the familiar, paper-based patient medical files will become a thing of the past. On April 26, 24, President George W. Bush announced a plan to ensure that all Americans\u27 health records are computerized within ten years and to establish a National Health Information Network. Many advocates are enthusiastically promoting the adoption of health information technology (HIT) and electronic health record (HER) systems as a means to improve U.S. health care. HER systems often not only serve as record-keeping systems, but also have multiple capabilities, including drug ordering, decision support, alerts concerning patient allergies and potential drug interactions, reminders concerning routine tests, and various treatment management and data analysis tools. Because these capabilities require sophisticated software, significant risks of software failure exist, which can lead to life-threatening medical errors. Thus far, scholars have not provided a comprehensive assessment of the benefits and risks of this complex technology and evaluated the need for careful regulatory oversight akin to that required, in principle, by the FDA for life-critical medical devices. This paper begins to fill that gap. It analyzes HER systems from both legal and technical perspectives and focuses on how the law can be used as a tool to promote HIT. It is the first law journal article to provide an extensive proposal for regulations to maximize the technology\u27s benefits and reliability. We argue that the advantages of HER systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering and medical informatics practices. To ensure that these goals are achieved, regulatory intervention is needed. The paper carefully delineates recommendations that address the questions of who should regulate HER systems and how they should be regulated, including their approval and continual monitoring. It also proposes requirements for several significant features, including decision support mechanisms, audit trails, and interoperability. Because HER systems are safety-critical, the public\u27s health and welfare will depend upon their effective oversight

Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems

In the foreseeable future, it is likely that the familiar, paper-based patient medical files will become a thing of the past. On April 26, 24, President George W. Bush announced a plan to ensure that all Americans\u27 health records are computerized within ten years and to establish a National Health Information Network. Many advocates are enthusiastically promoting the adoption of health information technology (HIT) and electronic health record (HER) systems as a means to improve U.S. health care. HER systems often not only serve as record-keeping systems, but also have multiple capabilities, including drug ordering, decision support, alerts concerning patient allergies and potential drug interactions, reminders concerning routine tests, and various treatment management and data analysis tools. Because these capabilities require sophisticated software, significant risks of software failure exist, which can lead to life-threatening medical errors. Thus far, scholars have not provided a comprehensive assessment of the benefits and risks of this complex technology and evaluated the need for careful regulatory oversight akin to that required, in principle, by the FDA for life-critical medical devices. This paper begins to fill that gap. It analyzes HER systems from both legal and technical perspectives and focuses on how the law can be used as a tool to promote HIT. It is the first law journal article to provide an extensive proposal for regulations to maximize the technology\u27s benefits and reliability. We argue that the advantages of HER systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering and medical informatics practices. To ensure that these goals are achieved, regulatory intervention is needed. The paper carefully delineates recommendations that address the questions of who should regulate HER systems and how they should be regulated, including their approval and continual monitoring. It also proposes requirements for several significant features, including decision support mechanisms, audit trails, and interoperability. Because HER systems are safety-critical, the public\u27s health and welfare will depend upon their effective oversight

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Creating archetypes for patient assessment with nurses to facilitate shared patient centred care in the older person

The process of what information is captured in documenting patient care assessment and how it is summarised, communicated and interpreted by nurses across different healthcare services is the main focus of this thesis. Currently in Ireland, systems within the domain of healthcare are undergoing transformation. Existing practices where health information is collected at one local health organisation level and often duplicated across differing services will not support the strategic goals of the newly established clinical directorates. The political vision is simple: Ireland must move towards a nationally integrated electronic record to support patient centred care. Whilst the political vision may be simple, the process of implementation is not and forms the main topic of this thesis. Strategic goals to move nationally towards integrated electronic records are motivated by the global concerns of an ageing population associated with an increase in the prevalence of chronic illness and co-morbidity. The main objective of this thesis is to evaluate the impact of a pilot study which identified the semantic and syntactic clinical requirements for the testing and implementation of a shared discharge/transfer summary assessment record for persons over the age of 65. This summary record was designed in accordance with ISO 13606, the International standard for Electronic Healthcare Record (EHR) communication and is underpinned by ISO 18104, the international standard for Categorial Structures for Representation of Nursing Diagnosis and Nursing Actions in Terminological Systems. A participatory action research approach was adopted, using an exploratory mixed methods research study design. This translational study was completed in two local health organisation areas in Dublin with six service providers across the primary, acute and continuing care services over a two year period. The qualitative element of the study involved 17 interviews, 7 focus group sessions with participants including policy makers and nurses from each of the participating services. Quantitative data included questionnaires from nurses (n = 14) and patients (n=5) evaluating the effectiveness of the summary record. The quantitative data also analysed information from a set of cumulative assessment records (n = 16) which were interpreted in tandem with the qualitative data and then analysed statistically. The shared discharge/transfer summary care record was piloted on 16 patients over an extended timeframe. The quantitative data showed a statistical significance commensurate with the qualitative data collected on patient participants. An evaluation of the pilot study produced qualitative data which was used to gain insight into the differing contexts that healthcare professionals practice within. This data was illustrated in graphical configurations to make evident to policy makers the various roles that nurses engage with in the course of their care delivery. Data collected from both the qualitative and quantitative analysis suggest that the test implementation of the record template was fit for purpose. Identification of the clinical requirements and testing of the summary record over a two year period was a labour intensive process which was logistically difficult to implement. One consequence of this study was the education of the nursing participants on gaining a common understanding of what needs to be measured in patient assessment to inform future theory testing for outcome based research. A second consequence was the empowerment of the nursing participants to develop archetypes for inclusion in future electronic healthcare records in Ireland. The prototype archetypes designed for assessment of the older person in this study are at present informing a number of practical applications within the nursing community in Ireland. Over the course of the study the participatory action research design altered in its focus and emerged as a dominant qualitative mixed methods study

Desarrollo y evaluación de una aplicación Web estandarizada para el almacenamiento e intercambio de Historiales Clínicos Electrónicos (HCEs) en oftalmología: TeleOftalWeb

El objetivo de la presente Tesis es el desarrollo, puesta en marcha y evaluación de la aplicación Web, TeleOftalWeb, en sus cuatro versiones, destinada al almacenamiento e intercambio de Historiales Clínicos Electrónicos (HCEs) y retinografías. Cada una de las versiones está desarrollada con diferentes modelos de bases de datos (BDs): dbXML 2.0 más MySQL 5.0, eXist 1.1.1 más MySQL, Xindice 1.2. más MySQL 5.0 y Oracle 10g. A su vez, se estudiarán los estándares de HCE más relevantes entre ellos: Health Level 7 (HL7) y Digital Imaging Communications in Medicine (DICOM). Los resultados de la investigación han sido publicados en revistas indexadas en el Journal Citation Report (JCR), entre ellas Journal of Medical Systems. Mediante el empleo de TeleOftalWeb por oftalmólogos del Instituto de Oftalmobiología Aplicada (IOBA) de la Universidad de Valladolid se comprueba su correcto funcionamiento con la inserción de más de 1000 HCs y más de 2000 retinografías.Departamento de Teoría de la Señal y Comunicaciones e Ingeniería Telemátic