3,153 research outputs found
Electronic health record standards
Objectives: This paper seeks to provide an overview of the initiatives that are proceeding internationally to develop standards for the exchange of electronic health record (EHR) information between EHR systems.Methods: The paper reviews the clinical and ethico-legal requirements and research background on the representation and communication of EHR data, which primarily originates from Europe through a series of EU funded Health Telematics projects over the post thirteen years. The major concept that underpin the information models and knowledge models are summarised. These provide the requirements and the best evidential basis from which HER communications standards should be developed.Results. The main focus of EHR communications standardisation is presently occurring at a European level, through the Committee for European Normalisation (CEN). The major constructs of the CEN 13606 model ate outlined. Complementary activity is taking place in ISO and in HL7, and some of these efforts are also summarised.Conclusior: There is a strong prospect that a generic EHR interoperability standard can be agreed at a European (and hopefully international) level. Parts of the challenge of EHR i interoperability cannot yet he standardised, because good solutions to the preservation of clinical meaning across heterogeneous systems remain to be explored. Further research and empirical projects are therefore also needed
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
Report on the EHCR (Deliverable 26.2)
This deliverable is the second for Workpackage 26. The first, submitted after
Month 12, summarised the areas of research that the partners had identified as
being relevant to the semantic indexing of the EHR. This second one reports
progress on the key threads of work identified by the partners during the project to
contribute towards semantically interoperable and processable EHRs.
This report provides a set of short summaries on key topics that have emerged as
important, and to which the partners are able to make strong contributions. Some of
these are also being extended via two new EU Framework 6 proposals that include
WP26 partners: this is also a measure of the success of this Network of Excellence
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Project Retrosight. Understanding the returns from cardiovascular and stroke research: Case Studies
Copyright @ 2011 RAND Europe. All rights reserved. The full text article is available via the link below.This project explores the impacts arising from cardiovascular and stroke research funded 15-20 years ago and attempts to draw out aspects of the research, researcher or environment that are associated with high or low impact. The project is a case study-based review of 29 cardiovascular and stroke research grants, funded in Australia, Canada and UK between 1989 and 1993. The case studies focused on the individual grants but considered the development of the investigators and ideas involved in the research projects from initiation to the present day. Grants were selected through a stratified random selection approach that aimed to include both high- and low-impact grants. The key messages are as follows: 1) The cases reveal that a large and diverse range of impacts arose from the 29 grants studied. 2) There are variations between the impacts derived from basic biomedical and clinical research. 3) There is no correlation between knowledge production and wider impacts 4) The majority of economic impacts identified come from a minority of projects. 5) We identified factors that appear to be associated with high and low impact. This report presents the key observations of the study and an overview of the methods involved. It has been written for funders of biomedical and health research and health services, health researchers, and policy makers in those fields. It will also be of interest to those involved in research and impact evaluation.This study was initiated with internal funding from RAND Europe and HERG, with continuing funding from the UK National Institute for Health Research, the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada and the National Heart Foundation of Australia. The UK Stroke Association and the British Heart Foundation provided support in kind through access to their archives
Towards an interoperable healthcare information infrastructure - working from the bottom up
Historically, the healthcare system has not made effective use of information technology. On the face of things, it would seem to provide a natural and richly varied domain in which to target benefit from IT solutions. But history shows that it is one of the most difficult domains in which to bring them to fruition. This paper provides an overview of the changing context and information requirements of healthcare that help to explain these characteristics.First and foremost, the disciplines and professions that healthcare encompasses have immense complexity and diversity to deal with, in structuring knowledge about what medicine and healthcare are, how they function, and what differentiates good practice and good performance. The need to maintain macro-economic stability of the health service, faced with this and many other uncertainties, means that management bottom lines predominate over choices and decisions that have to be made within everyday individual patient services. Individual practice and care, the bedrock of healthcare, is, for this and other reasons, more and more subject to professional and managerial control and regulation.One characteristic of organisations shown to be good at making effective use of IT is their capacity to devolve decisions within the organisation to where they can be best made, for the purpose of meeting their customers' needs. IT should, in this context, contribute as an enabler and not as an enforcer of good information services. The information infrastructure must work effectively, both top down and bottom up, to accommodate these countervailing pressures. This issue is explored in the context of infrastructure to support electronic health records.Because of the diverse and changing requirements of the huge healthcare sector, and the need to sustain health records over many decades, standardised systems must concentrate on doing the easier things well and as simply as possible, while accommodating immense diversity of requirements and practice. The manner in which the healthcare information infrastructure can be formulated and implemented to meet useful practical goals is explored, in the context of two case studies of research in CHIME at UCL and their user communities.Healthcare has severe problems both as a provider of information and as a purchaser of information systems. This has an impact on both its customer and its supplier relationships. Healthcare needs to become a better purchaser, more aware and realistic about what technology can and cannot do and where research is needed. Industry needs a greater awareness of the complexity of the healthcare domain, and the subtle ways in which information is part of the basic contract between healthcare professionals and patients, and the trust and understanding that must exist between them. It is an ideal domain for deeper collaboration between academic institutions and industry
Outlook Magazine, Autumn 2017
https://digitalcommons.wustl.edu/outlook/1202/thumbnail.jp
Outlook Magazine, Fall 1989
https://digitalcommons.wustl.edu/outlook/1094/thumbnail.jp
The Role of Complement in Stroke and Traumatic Brain Injury
Brain and neural injury are a non-specific disease category that includes traumatic brain injury (TBI) and stroke. Both TBI and stroke are common, costly, and leading causes of severe disability in adults. Both stroke and TBI are responsible for substantial disability in working age adults, with stroke being the second leading cause of death worldwide [1] and TBI a major cause of disability in people younger than their 40\u27s [2]. The immune response after brain injury is multifactorial and involves both local and systemic events at the cellular and molecular level. The complement system is a component of both the innate and adaptive immune response and can be activated via one of three pathways: the classical, lectin, or alternative pathway. Studies by our lab and by others have established a prominent role for complement in propagating secondary injury after ischemic or traumatic insult to the brain [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]. The complement system is recognized as an early and significant contributor to secondary insult after TBI by promoting neuronal loss, edema, and inflammatory cell infiltrate [14]. Clinical studies have shown that TBI patients have elevated levels of complement activation products (C3 and sC5b-9) in their cerebrospinal fluid and increased deposition of complement activation products in the perilesional brain [7], [15], [16], [17], [18]. The source of complement deposited after a TBI is a combined contribution of systemic complement, leaking to the brain after trauma-induced blood brain barrier dysfunction, and locally produced complement proteins by the brain parenchyma and infiltrating cells [7], [16], [17], [19]. A similar pattern of complement deposition is seen in experimental models of TBI that also implicate complement in the acute neuronal cell death, neutrophil extravasation, and worsening of outcomes after TBI [9], [10], [11], [12], [13], [20], [21], [22], [23], [24], [25]. 4 Complement is also a major mediator of acute pathology after stroke, and previous work from our lab and others have shown that complement serves as the recognition arm of the immune system to detect and respond to cellular stress in the penumbra leading to a robust neuroinflammatory response [26]. In addition, preclinical and clinical studies have shown significant complement activation in the ischemic penumbra, and elevated serum complement is associated with stroke outcomes [26]. We have also shown that complement increases acute neuronal loss, increases distal thrombosis, and promotes a chronic neuroinflammatory response after stroke leading to worsening of acute and chronic outcomes [14], [26]. A challenge in designing medical treatments for TBI and stroke is the location and multifactorial nature of the pathologies, which are complex and involve dysfunction of multiple homeostatic processes. Studies in animal models have greatly enhanced our understanding of the complex pathophysiology that underlies stroke and TBI and has enabled screening of over 1,000 novel therapeutic agents. A major concern in translational stroke research is that therapeutics that are deemed efficacious at the rodent level fail to show efficacy when moved to clinical trials. Reasons for failure of prior therapies include lack of assessment of chronic outcomes, lack of gender consideration, exclusion of age and other co-morbidities, administering therapeutics at time points not clinically relevant, failure to assess risk profile of novel therapies, and lack of significant motor and cognitive behavioral assessment. While it has long been recognized that neuroinflammation is injurious and represents a therapeutic reparative target, only more recently has it been recognized that neuroinflammation can also contribute to homeostatic and reparative mechanisms after brain injury. Consequently, an emerging paradigm is that systemic and complete 5 inhibition of neuroinflammation after brain injury is unlikely to be an optimal approach, and that localized and targeted inhibitory strategies, possibly of limited duration, will provide a better therapeutic approach. The goal of treatment has transitioned from symptomatic management to approaches for neuroprotection and regeneration [27]. The complement system is being discussed as a therapeutic target for TBI as well as stroke, due to data supporting a pivotal role for complement in supporting several downstream activities that promote neuroinflammation and degeneration [27]. An extensive understanding of the acute, subacute, and chronic consequences of complement activation is needed in both stroke and TBI and may lead to new therapeutic strategies, including the ability of targeting selective steps in the complement cascade
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