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

Workshop on the EHCR

This deliverable provides a summary report of a workshop on Electronic Health Records that was organised and delivered as the main focus of Workpackage 16 of the Semantic Mining project. The workshop was held as day three of a three-day series of events held in Brussels in late November 2004, under the umbrella and with kind support of the EUROREC organisation. This report provides a brief summary of that event, and includes in Annex 1 the complete delegate pack as printed and issued to all persons attending the event, This delegate pack included printed copies of all slides and screenshots used throughout the day. The workshop was well attended, and in particular the organisers are pleased to report that some very productive discussions took place that will act as the stimulus for new threads of research collaboration between various Semantic Mining partners, under the work plan of Workpackage 26. The organisers are grateful for the support of the EUROREC organisation in facilitating the organisation of this workshop and for lending their support to it through their web site and a personal endorsement of the event

Clinical Data Reuse or Secondary Use: Current Status and Potential Future Progress

Objective: To perform a review of recent research in clinical data reuse or secondary use, and envision future advances in this field. Methods: The review is based on a large literature search in MEDLINE (through PubMed), conference proceedings, and the ACM Digital Library, focusing only on research published between 2005 and early 2016. Each selected publication was reviewed by the authors, and a structured analysis and summarization of its content was developed. Results: The initial search produced 359 publications, reduced after a manual examination of abstracts and full publications. The following aspects of clinical data reuse are discussed: motivations and challenges, privacy and ethical concerns, data integration and interoperability, data models and terminologies, unstructured data reuse, structured data mining, clinical practice and research integration, and examples of clinical data reuse (quality measurement and learning healthcare systems). Conclusion: Reuse of clinical data is a fast-growing field recognized as essential to realize the potentials for high quality healthcare, improved healthcare management, reduced healthcare costs, population health management, and effective clinical research

Methods to Facilitate the Capture, Use, and Reuse of Structured and Unstructured Clinical Data.

Electronic health records (EHRs) have great potential to improve quality of care and to support clinical and translational research. While EHRs are being increasingly implemented in U.S. hospitals and clinics, their anticipated benefits have been largely unachieved or underachieved. Among many factors, tedious documentation requirements and the lack of effective information retrieval tools to access and reuse data are two key reasons accounting for this deficiency. In this dissertation, I describe my research on developing novel methods to facilitate the capture, use, and reuse of both structured and unstructured clinical data. Specifically, I develop a framework to investigate potential issues in this research topic, with a focus on three significant challenges. The first challenge is structured data entry (SDE), which can be facilitated by four effective strategies based on my systematic review. I further propose a multi-strategy model to guide the development of future SDE applications. In the follow-up study, I focus on workflow integration and evaluate the feasibility of using EHR audit trail logs for clinical workflow analysis. The second challenge is the use of clinical narratives, which can be supported by my innovative information retrieval (IR) technique called “semantically-based query recommendation (SBQR)”. My user experiment shows that SBQR can help improve the perceived performance of a medical IR system, and may work better on search tasks with average difficulty. The third challenge involves reusing EHR data as a reference standard to benchmark the quality of other health-related information. My study assesses the readability of trial descriptions on ClinicalTrials.gov and found that trial descriptions are very hard to read, even harder than clinical notes. My dissertation has several contributions. First, it conducts pioneer studies with innovative methods to improve the capture, use, and reuse of clinical data. Second, my dissertation provides successful examples for investigators who would like to conduct interdisciplinary research in the field of health informatics. Third, the framework of my research can be a great tool to generate future research agenda in clinical documentation and EHRs. I will continue exploring innovative and effective methods to maximize the value of EHRs.PHDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135845/1/tzuyu_1.pd

Construction de modèles de données relationnels temporalisés guidée par les ontologies

Au sein d’une organisation, de même qu’entre des organisations, il y a plusieurs intervenants qui doivent prendre des décisions en fonction de la vision qu’ils se font de l’organisation concernée, de son environnement et des interactions entre les deux. Dans la plupart des cas, les données sont fragmentées en plusieurs sources non coordonnées ce qui complique, notamment, le fait de retracer leur évolution chronologique. Ces différentes sources sont hétérogènes par leur structure, par la sémantique des données qu’elles contiennent, par les technologies informatiques qui les manipulent et par les règles de gouvernance qui les contrôlent. Dans ce contexte, un système de santé apprenant (Learning Health System) a pour objectif d’unifier les soins de santé, la recherche biomédicale et le transfert des connaissances, en offrant des outils et des services pour améliorer la collaboration entre les intervenants ; l’optique sous-jacente à cette collaboration étant de fournir à un individu de meilleurs services qui soient personnalisés. Les méthodes classiques de construction de modèle de données sont fondées sur des règles de pratique souvent peu précises, ad hoc, non automatisables. L’extraction des données d’intérêt implique donc d’importantes mobilisations de ressources humaines. De ce fait, la conciliation et l’agrégation des sources sont sans cesse à recommencer parce que les besoins ne sont pas tous connus à l’avance, qu’ils varient au gré de l’évolution des processus et que les données sont souvent incomplètes. Pour obtenir l’interopérabilité, il est nécessaire d’élaborer une méthode automatisée de construction de modèle de données qui maintient conjointement les données brutes des sources et leur sémantique. Cette thèse présente une méthode qui permet, une fois qu’un modèle de connaissance est choisi, la construction d’un modèle de données selon des critères fondamentaux issus d’un modèle ontologique et d’un modèle relationnel temporel basé sur la logique des intervalles. De plus, la méthode est semi- automatisée par un prototype, OntoRelα. D’une part, l’utilisation des ontologies pour définir la sémantique des données est un moyen intéressant pour assurer une meilleure interopérabilité sémantique étant donné que l’ontologie permet d’exprimer de façon exploitable automatiquement différents axiomes logiques qui permettent la description de données et de leurs liens. D’autre part, l’utilisation d’un modèle relationnel temporalisé permet l’uniformisation de la structure du modèle de données, l’intégration des contraintes temporelles ainsi que l’intégration des contraintes du domaine qui proviennent des ontologies.Within an organization, many stakeholders must make decisions based on their vision of the organization, its environment, and the interactions between these two. In most cases, the data are fragmented in several uncoordinated sources, making it difficult, in particular, to trace their chronological evolution. These different sources are heterogeneous in their structure, in the semantics of the data they contain, in the computer technologies that manipulate them, and in the governance rules that control them. In this context, a Learning Health System aims to unify health care, biomedical research and knowledge transfer by providing tools and services to enhance collaboration among stakeholders in the health system to provide better and personalized services to the patient. The implementation of such a system requires a common data model with semantics, structure, and consistent temporal traceability that ensures data integrity. Traditional data model design methods are based on vague, non-automatable best practice rules where the extraction of data of interest requires the involvement of very important human resources. The reconciliation and the aggregation of sources are constantly starting over again because not all needs are known in advance and vary with the evolution of processes and data are often incomplete. To obtain an interoperable data model, an automated construction method that jointly maintains the source raw data and their semantics is required. This thesis presents a method that build a data model according to fundamental criteria derived from an ontological model, a relational model and a temporal model based on the logic of intervals. In addition, the method is semi-automated by an OntoRelα prototype. On the one hand, the use of ontologies to define the semantics of data is an interesting way to ensure a better semantic interoperability since it automatically expresses different logical axioms allowing the description of data and their links. On the other hand, the use of a temporal relational model allows the standardization of data model structure and the integration of temporal constraints as well as the integration of domain constraints defines in the ontologies

A pilot ontology for a large, diverse set of national health service healthcare quality indicators

Objectives: This project seeks to reduce duplication of effort in finding data for NHS healthcare quality indicators, to resolve issues identified in previous efforts to develop quality-monitoring ontologies and to identify areas for future computer-interpretable quality indicator development for the United Kingdom’s Department of Health and National Health Service (NHS). Outcomes will include specification of inclusion and exclusion criteria for a set of healthcare quality indicators, along with categorisation beyond screening and prevention and identification of levels of indicator relationships Methodology: Following an exploration of potential methods for ontology development, Methontology was the method chosen to develop the ontology. This involved a conceptual analysis to inform the development of an ontology for a 2009 set of healthcare quality indicators made available on the NHS Information Centre website. Indicators were categorised by NHS Dimension, NHS-specified clinical pathway and by United States Institute of Medicine purpose. Relationships between indicators were identified, as well as an initial set of inclusion and exclusion criteria. Protégé 3.4.1 was the platform used to develop a pilot ontology. Results: NHS quality indicators that share some of the same criteria were made searchable, along with broader and narrower related criteria. Up to six layers of inclusion and exclusion criteria were specified and incorporated into the ontology. Search capabilities were created for indicators originating from the same source and from more than one source, along with indicators assigned to specific care pathways. It was shown that indicators have purposes other than prevention and screening, rendering Arden Syntax, intended for computer-interpretable guidelines and previously tested on a specialised set of healthcare quality indicators, unsuitable for a large, diverse set of quality indicators. A large number, 222, of quality indicators with different purposes justified the development of a separate ontology. Conclusions: This ontology could reduce duplication of effort in finding data for NHS healthcare quality indicators. There is potential to link to components of queries currently in use in the NHS, as an interim step away from the need to develop separate queries for each indicator. Areas for future computer- interpretable quality indicator development include resolving Electronic Health Record compatibility issues and improved indicator metadata quality. The ontology could be useful to NHS indicator developers, NHS data xtractors and vendors of electronic health records who supply to the NHS

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe