The EHR-ARCHE project: Satisfying clinical information needs in a Shared Electronic Health Record System based on IHE XDS and Archetypes

AbstractPurposeWhile contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers’ information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment.MethodsUsing methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study.ResultsWe identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8–14min versus 20min or more).ConclusionsOur results show that for an efficient satisfaction of health care providers’ information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is superior to a conventional metadata-based XDS search

How sick is Austria? – A decision support framework for different evaluations of the burden of disease within the Austrian population based on different data sources

ABSTRACT Objectives In healthcare it is crucial to have a fundamental knowledge of the burden of diseases within the population. Therefore we aimed to develop an Atlas of Epidemiology to gain better insight on the epidemiological situation. Based on primary and secondary health care data, we aimed to present results in interactive charts and maps, comprehensible to experts and the general public. The atlas builds a framework for rapid deployment of new data and results in a reproducible and efficient way. As a first use case three methods based on two different databases for the estimation of diabetes prevalence in Austria are compared. Approach Datasources: (i) reimbursement data 2006/2007 (GAP-DRG); (ii) national routine health survey (ATHIS) for 2006/2007. Methods for diabetes prevalence estimation: 1) ATC-ICD statistically relates pseudonymized data on medications to data on diagnoses from hospitalizations and sick leaves. 2) With the method Experts, medical experts assign specific medications to diabetes diagnoses. Patients with these medications are identified together with hospitalized diabetes diagnosed patients in GAP-DRG. 3) In ATHIS a sample of 15.000 persons was questioned if they a) ever had diabetes and b) were treated against diabetes in the last 12 months. Results are projected onto the Austrian population. Patients are divided by 10-year age-classes, gender and state. For the publicly online framework, implemented in html and javascript, pre-processed data in different granularity is required and used. Results Maps of Austria represent the prevalence of diabetes for each method and granularity level. The difference of the methods can be seen by clicking on the next map. For different age-classes (resp. different gender) the three methods can be compared directly within a bar chart. The technology for a rapid deployment of new data is now developed. For the use case first results have already been presented to decision makers, and feedback has been incorporated. Conclusion Besides depicting disease prevalence, the atlas of epidemiology also allows to visualize health care service data and results of simulation models in a fast and efficient way, which is important for decision makers. Soon the results of the ATC-ICD project on the prevalence of different diseases based on ICD9 diagnoses and medication data will be published in an aggregated form. This project is part of the K-Project dexhelpp in COMET – Competence Centers for Excellent Technologies that is funded by BMVIT, BMWGJ and transacted by FFG

Knowledge-based verification of clinical guidelines by detection of anomalies

Within the last decade, clinical guidelines have gained more and more importance in the medical domain, as they provide an efficient means to standardize health care. As a result, the medical community has recently been confronted with numerous approaches, aiming at the automated management of clinical guidelines [e.g. Musen et al., 1996; Ohno-Machado et al., 1997]. Despite the general eagerness in this field, one aspect has been widely neglected by now: Most approaches are lacking mechanisms, which allow for the assurance of a high level of quality for their products. This situation is undesirable insofar, as reliability and quality are critical factors for the successful use of guidelines in real-world applications. In the domain of Software Engineering in general and in the domain of Knowledge-Based Systems in particular, a common strategy to enhance the quality of a system consists in its verification. Therefore, one way out of an imminent quality-crisis in the domain of clinical guidelines is the provision of an effective verification mechanism, appropriate for the analysis of clinical guidelines. Objectives The focus of our work is to develop an approach, which helps to contribute to th

Multi-Level Verification of Clinical Protocols

. In the medical domain, clinical practice guidelines and protocols build a commonly accepted way to improve patient health care. During the last years various approaches have been presented to support the computerization of such guidelines and protocols. However, the verification of clinical protocols has not become an extensive research topic yet. In this paper we will present a partial and domain-specific verification approach to identify particular anomalies in protocols. Our approach is oriented on a plan-representation language of clinical protocols given as temporal, skeletal plans, called Asbru. Asbru provides the necessary hierarchical structure and task-specific knowledge roles, which are needed to divide the whole verification process in subtasks. Our verification approach examines three levels of a plan: the plan itself, all its knowledge roles and all its subplans. The final aim is to arrive at legal or meaningful plans, instead of complete or totally correct plans. 1 INTR..

Towards plug-and-play integration of archetypes into legacy electronic health record systems: the ArchiMed experience

Abstract Background The dual model approach represents a promising solution for achieving semantically interoperable standardized electronic health record (EHR) exchange. Its acceptance, however, will depend on the effort required for integrating archetypes into legacy EHR systems. Methods We propose a corresponding approach that: (a) automatically generates entry forms in legacy EHR systems from archetypes; and (b) allows the immediate export of EHR documents that are recorded via the generated forms and stored in the EHR systems’ internal format as standardized and archetype-compliant EHR extracts. As a prerequisite for applying our approach, we define a set of basic requirements for the EHR systems. Results We tested our approach with an EHR system called ArchiMed and were able to successfully integrate 15 archetypes from a test set of 27. For 12 archetypes, the form generation failed owing to a particular type of complex structure (multiple repeating subnodes), which was prescribed by the archetypes but not supported by ArchiMed’s data model. Conclusions Our experiences show that archetypes should be customized based on the planned application scenario before their integration. This would allow problematic structures to be dissolved and irrelevant optional archetype nodes to be removed. For customization of archetypes, openEHR templates or specialized archetypes may be employed. Gaps in the data types or terminological features supported by an EHR system will often not preclude integration of the relevant archetypes. More work needs to be done on the usability of the generated forms.</p

Verification of Temporal Scheduling Constraints in Clinical Practice Guidelines

The computerization of clinical practice guidelines is a significant scientific challenge for the medical informatics community. One frequently reported factor hindering this objective is the existence of deficiencies within guideline knowledge. In this paper, we focus on the detection of flaws within temporal scheduling constraints. Temporal scheduling constraints are important elements of therapy management, and are frequently incorporated in clinical practice guidelines. We present a suitable verification method that is based on calculating the minimal network of temporal constraints on the execution of guideline activities. Our method serves three purposes: (1) it checks whether temporal scheduling constraints are consistent with scheduling constraints implied by control flow operators and the hierarchical structuring of a guideline; (2) it yields suggestions for an equivalent, yet more explicit representation of non-minimal constraints; (3) it can be used by the guideline interpreter to assemble feasible time intervals for the execution of each guideline activity. We evaluate our approach by applying it to a guideline specified in the Asbru language. For this purpose, we implemented a prototype verifier. Although we concentrate on the guideline representation language Asbru as the demonstration medium of our method within this paper, our approach can be reused to verify several alternative guideline-representation formats

BMC Medical Informatics and Decision Making / Readiness to use telemonitoring in diabetes care: a cross-sectional study among Austrian practitioners

Background Telemonitoring services could dramatically improve the care of diabetes patients by enhancing their quality of life while decreasing healthcare expenditures. However, the potential for implementing innovative treatment options in the Austrian public and private health system is not known yet. Thus, we analyzed the readiness to use telemonitoring in diabetes care among Austrian practitioners. Methods We conducted an online survey among a purposive sample of Austrian practitioners (n = 41) using an adapted German version of the practitioner telehealth readiness assessment tool. We assessed three readiness domains for telemonitoring in the context of diabetes care, i.e. core readiness, engagement readiness, and structural readiness, and validated the German tool using principal components analysis. Results Study subjects perceived themselves as open to innovations and also expressed optimistic attitudes towards telemonitoring in general and offering telemonitoring-based services for their patients. Participants achieved a medium average readiness level for telemonitoring (58.2, 95% CI 53.962.5) and were thus in a good position to use telemonitoring, although some arguments may adversely affected its use. The top three perceived benefits of telemonitoring were enhanced quality of treatment, better therapy adjustment, and reduced travel and waiting times for patients. The top three barriers were reduced personal communication, practitioner time expenditure and equally placed poor financial compensation as well as data security and privacy issues. Conclusion Our data revealed that Austrian practitioners showed a quite moderate readiness to use telemonitoring in diabetes care. To further advance telemonitoring readiness among all pillars of diabetes care in Austria, joint efforts among healthcare stakeholders are required to overcome existing financial, organizational, and technical obstacles.(VLID)488926