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

Comparative study of healthcare messaging standards for interoperability in ehealth systems

Advances in the information and communication technology have created the field of "health informatics," which amalgamates healthcare, information technology and business. The use of information systems in healthcare organisations dates back to 1960s, however the use of technology for healthcare records, referred to as Electronic Medical Records (EMR), management has surged since 1990’s (Net-Health, 2017) due to advancements the internet and web technologies. Electronic Medical Records (EMR) and sometimes referred to as Personal Health Record (PHR) contains the patient’s medical history, allergy information, immunisation status, medication, radiology images and other medically related billing information that is relevant. There are a number of benefits for healthcare industry when sharing these data recorded in EMR and PHR systems between medical institutions (AbuKhousa et al., 2012). These benefits include convenience for patients and clinicians, cost-effective healthcare solutions, high quality of care, resolving the resource shortage and collecting a large volume of data for research and educational needs. My Health Record (MyHR) is a major project funded by the Australian government, which aims to have all data relating to health of the Australian population stored in digital format, allowing clinicians to have access to patient data at the point of care. Prior to 2015, MyHR was known as Personally Controlled Electronic Health Record (PCEHR). Though the Australian government took consistent initiatives there is a significant delay (Pearce and Haikerwal, 2010) in implementing eHealth projects and related services. While this delay is caused by many factors, interoperability is identified as the main problem (Benson and Grieve, 2016c) which is resisting this project delivery. To discover the current interoperability challenges in the Australian healthcare industry, this comparative study is conducted on Health Level 7 (HL7) messaging models such as HL7 V2, V3 and FHIR (Fast Healthcare Interoperability Resources). In this study, interoperability, security and privacy are main elements compared. In addition, a case study conducted in the NSW Hospitals to understand the popularity in usage of health messaging standards was utilised to understand the extent of use of messaging standards in healthcare sector. Predominantly, the project used the comparative study method on different HL7 (Health Level Seven) messages and derived the right messaging standard which is suitable to cover the interoperability, security and privacy requirements of electronic health record. The issues related to practical implementations, change over and training requirements for healthcare professionals are also discussed

A Two-Level Identity Model To Support Interoperability of Identity Information in Electronic Health Record Systems.

The sharing and retrieval of health information for an electronic health record (EHR) across distributed systems involves a range of identified entities that are possible subjects of documentation (e.g., specimen, clinical analyser). Contemporary EHR specifications limit the types of entities that can be the subject of a record to health professionals and patients, thus limiting the use of two level models in healthcare information systems that contribute information to the EHR. The literature describes several information modelling approaches for EHRs, including so called “two level models”. These models differ in the amount of structure imposed on the information to be recorded, but they generally require the health documentation process for the EHR to focus exclusively on the patient as the subject of care and this definition is often a fixed one. In this thesis, the author introduces a new identity modelling approach to create a generalised reference model for sharing archetype-constrained identity information between diverse identity domains, models and services, while permitting reuse of published standard-based archetypes. The author evaluates its use for expressing the major types of existing demographic reference models in an extensible way, and show its application for standards-compliant two-level modelling alongside heterogeneous demographics models. This thesis demonstrates how the two-level modelling approach that is used for EHRs could be adapted and reapplied to provide a highly-flexible and expressive means for representing subjects of information in allied health settings that support the healthcare process, such as the laboratory domain. By relying on the two level modelling approach for representing identity, the proposed design facilitates cross-referencing and disambiguation of certain demographics standards and information models. The work also demonstrates how it can also be used to represent additional clinical identified entities such as specimen and order as subjects of clinical documentation

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

An Interoperable Clinical Cardiology Electronic Health Record System - a standards based approach for Clinical Practice and Research with Data Reuse

Currently in hospitals, several information systems manage, very often autonomously, the patient’s personal, clinical and diagnostic data. This originates a clinical information management system consisting of a myriad of independent subsystems which, although efficient in their specific purpose, make the integration of the whole system very difficult and limit the use of clinical data, especially as regards the reuse of these data for research purposes. Mainly for these reasons, the management of the Genoese ASL3 decided to commission the University of Genoa to set up a medical record system that could be easily integrated with the rest of the information system already present, but which offered solid interoperability features, and which could support the research skills of hospital health workers. My PhD work aimed to develop an electronic health record system for a cardiology ward, obtaining a prototype which is functional and usable in a hospital ward. The choice of cardiology was due to the wide availability of the staff of the cardiology department to support me in the development and in the test phase. The resulting medical record system has been designed “ab initio” to be fully integrated into the hospital information system and to exchange data with the regional health information infrastructure. In order to achieve interoperability the system is based on the Health Level Seven standards for exchanging information between medical information systems. These standards are widely deployed and allow for the exchange of information in several functional domains. Specific decision support sections for particular aspects of the clinical life were also included. The data collected by this system were the basis for examples of secondary use for the development of two models based on machine learning algorithms. The first model allows to predict mortality in patients with heart failure within 6 months from their admission, and the second is focused on the discrimination between heart failure versus chronic ischemic heart disease in the elderly population, which is the widest population section served by the cardiological ward

A Task-based Support Architecture for Developing Point-of-care Clinical Decision Support Systems for the Emergency Department

Objectives: The purpose of this study was to create a task-based support architecture for developing clinical decision support systems (CDSSs) that assist physicians in making decisions at the point-of-care in the emergency department (ED). The backbone of the proposed architecture was established by a task-based emergency workflow model for a patient-physician encounter. Methods: The architecture was designed according to an agent-oriented paradigm. Specifically, we used the O-MaSE (Organization-based Multi-agent System Engineering) method that allows for iterative translation of functional requirements into architectural components (e.g., agents). The agent-oriented paradigm was extended with ontology-driven design to implement ontological models representing knowledge required by specific agents to operate. Results: The task-based architecture allows for the creation of a CDSS that is aligned with the task-based emergency workflow model. It facilitates decoupling of executable components (agents) from embedded domain knowledge (ontological models), thus supporting their interoperability, sharing, and reuse. The generic architecture was implemented as a pilot system, MET3-AE – a CDSS to help with the management of pediatric asthma exacerbation in the ED. The system was evaluated in a hospital ED. Conclusions: The architecture allows for the creation of a CDSS that integrates support for all tasks from the task-based emergency workflow model, and interacts with hospital information systems. Proposed architecture also allows for reusing and sharing system components and knowledge across disease-specific CDSSs

Computer-supported cooperative work in tele home care : architecture design, implementation and evaluation

With the development of healthcare service and computer networks, the healthcare providers are focusing on how to implant new technologies into health sections. These instant messaging techniques can lead healthcare service more efficienct than before. It is necessary to design and construct a cooperative work platform for patients and healthcare providers. They are able to communicate with each other, share information or documents and access into health records. This project will concentrate on the system design, implementation and evaluation to achieve a better performance platform. The underlying data repository will encompass distributed system aspects and data warehousing approach to promote the functions of this healthcare system. This platform will be deployed to the tele home care service and in-depth study on the healthcare services. Some of the innovations will be included in system design. The target of this project is to design the architecture of collaborative workspace for healthcare personnel and implement a prototype with useful functions. The evaluation will be conducted to validate the efficiency of proposed distributed database for patient records. In addition, it will be more flexible and less data redundant. Meanwhile, a demo system will be deployed in order to show and define the implemented functions

Issues of the adoption of HIT related standards at the decision-making stage of six tertiary healthcare organisations in Saudi Arabia

Due to interoperability barriers between clinical information systems, healthcare organisations are facing potential limitations with regard to acquiring the benefits such systems offer; in particular, in terms of reducing the cost of medical services. However, to achieve the level of interoperability required to reduce these problems, a high degree of consensus is required regarding health data standards. Although such standards essentially constitute a solution to the interoperability barriers mentioned above, the level of adoption of these standards remains frustratingly low. One reason for this is that health data standards are an authoritative field in which marketplace mechanisms do not work owing to the fact that health data standards developed for a particular market cannot, in general, be applied in other markets without modification. Many countries have launched national initiatives to develop and promote national health data standards but, although certain authors have mapped the landscape of the standardisation process for health data in some countries, these studies have failed to explain why the healthcare organisations seem unwilling to adopt those standards. In addressing this gap in the literature, a conceptual model of the adoption process of HIT related standards at the decision-making stage in healthcare organisations is proposed in this research. This model was based on two predominant theories regarding IT related standards in the IS field: Rogers paradigm (1995) and the economics of standards theory. In addition, the twenty one constructs of this model resulted from a comprehensive set of factors derived from the related literature; these were then grouped in accordance with the Technology-Organisation Environment (TOE), a well-known taxonomy within innovation adoption studies in the IS field. Moving from a conceptual to an empirical position, an interpretive, exploratory, multiple-case study methodology was conducted in Saudi Arabia to examine the proposed model. The empirical qualitative evidence gained necessitated some revision to be made to the proposed model. One factor was abandoned, four were modified and eight new factors were added. This consistent empirical model makes a novel contribution at two levels. First, with regard to the body of knowledge in the IS area, this model offers an in-depth understanding of the adoption process of HIT related standards which the literature still lacks. It also examines the applicability of IS theories in a new area which allows others to relate their experiences to those reported. Secondly, this model can be used by decision makers in the healthcare sector, particularly those in developing countries, as a guideline while planning for the adoption of health data standards