Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support

In pursuing personalized medicine, pharmacogenomic (PGx) knowledge may help guide prescribing drugs based on a person’s genotype. Here we evaluate the feasibility of incorporating PGx knowledge, combined with clinical data, to support clinical decision-making by: 1) analyzing clinically relevant knowledge contained in PGx knowledge resources; 2) evaluating the feasibility of a rule-based framework to support formal representation of clinically relevant knowledge contained in PGx knowledge resources; and, 3) evaluating the ability of an electronic medical record/electronic health record (EMR/EHR) to provide computable forms of clinical data needed for PGx clinical decision support. Findings suggest that the PharmGKB is a good source for PGx knowledge to supplement information contained in FDA approved drug labels. Furthermore, we found that with supporting knowledge (e.g. IF age <18 THEN patient is a child), sufficient clinical data exists in University of Washington’s EMR systems to support 50% of PGx knowledge contained in drug labels that could be expressed as rules

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

Personalized patient education and the internet : Linking health information to the Electronic Patient Record : STEPPS in burn care

Väitöskirja, sis. artikkelitSTEPPS = STructured Evaluated Personalized Patient Support = Rakenteinen, arvioitu ja yksilöllistetty potilastuk

Valoración de las necesidades de información de los médicos: publicaciones en el periodo 1990-1998 y estudio de un caso

RESUMEN Los estudios de necesidades de información aportan una metodología con lo cual investigar, de manera sistemática, las características de los usuarios con relación a la información que necesitan para el desarrollo de su trabajo. Igualmente proporcionan criterios objetivos para tomar decisiones a la hora de planificar nuevos sistemas de información o adecuar los ya existentes. Esta tesis ha profundizado en los estudios de necesidades de información en el entorno hospitalario desde dos puntos de vista. Por una parte, se ha establecido un marco teórico de referencia que guíe las investigaciones en este campo. Para ello se ha buscado exhaustivamente la información publicada sobre la materia aportando el procedimiento que se ha empleado. De los trabajos recuperados, se ha realizado el análisis tanto del modo de producción y consumo como de su contenido. En segundo lugar, se ha realizado el estudio de las necesidades de información de los médicos del Hospital Clínico Universitario de Valencia utilizando como método de recogida de información la Técnica del Incidente Crítico. ____________________________________________________________________________________________________Information needs studies provide a methodology to investigate, systematically, the characteristics of users in relation to the information they need to develop their work. Also it provides criteria for making decisions when planning new information systems or adapting the existing ones. This thesis focuses on information needs studies in hospital setting and has developed two complementary strategies. First, it has established a theoretical framework to guide research in this field. This has been an exhaustively searched of published information on the matter by providing the procedure to be used. Of retrieved papers, it has conducted the analysis of both production and contents. Secondly, a study has been made of the doctorâs information needs in the Hospital Clinico Universitario in Valencia and the critical incident methodology has been used for data collection

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606