An OpenEHR adoption in a portuguese healthcare facility

The quality and safety of clinical decisions depend to a large extent on the knowledge acquired by the records of health professionals. However, a traditional Electronic Health Record (EHR) has become insufficient in terms of knowledge acquisition and clinical decision support. The development of these aspects may bring marked improvements in the quality and safety of health care. The usage of open models promotes interoperability between systems, minimizing the impact of information systems on the efficient production of knowledge useful for clinical decisions. In this sense, this article describes an implementation project of a system that support the production and use of knowledge in clinical environments, based on OpenEHR two levels modelling open data approach, in a healthcare facility on the north of Portugal.he work has been supported by FCT – Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/202

Prediction of COVID-19 diagnosis based on openEHR artefacts

Nowadays, we are facing the worldwide pandemic caused by COVID-19. The complexity and momentum of monitoring patients infected with this virus calls for the usage of agile and scalable data structure methodologies. OpenEHR is a healthcare standard that is attracting a lot of attention in recent years due to its comprehensive and robust architecture. The importance of an open, standardized and adaptable approach to clinical data lies in extracting value to generate useful knowledge that really can help healthcare professionals make an assertive decision. This importance is even more accentuated when facing a pandemic context. Thus, in this study, a system for tracking symptoms and health conditions of suspected or confirmed SARS-CoV-2 patients from a Portuguese hospital was developed using openEHR. All data on the evolutionary status of patients in home care as well as the results of their COVID-19 test were used to train different ML algorithms, with the aim of developing a predictive model capable of identifying COVID-19 infections according to the severity of symptoms identified by patients. The CRISP-DM methodology was used to conduct this research. The results obtained were promising, with the best model achieving an accuracy of 96.25%, a precision of 99.91%, a sensitivity of 92.58%, a specificity of 99.92%, and an AUC of 0.963, using the Decision Tree algorithm and the Split Validation method. Hence, in the future, after further testing, the predictive model could be implemented in clinical decision support systems.This work is funded by "FCT-Fundacao para a Ciencia e Tecnologia" within the R &D Units Project Scope: UIDB/00319/2020. D.F. thanks the FundacAo para a Ciencia e Tecnologia (FCT), Portugal for the Grant 2021.06308.BD

Steps towards an Healthcare Information Model based on openEHR

During COVID-19 pandemic crisis, healthcare institutions globally were experiencing a VUCA - Volatile, Uncertain, Complex, and Ambiguous - environment. Efficient clinical and administrative management had never been so emergent. To achieve this goal, different components of the Healthcare Information System (HIS) must cooperate and interoperate flawlessly. Data standardization is a necessary step towards normalization and interoperability between existing Legacy Systems (LSs), and provides for longitudinal, highly reliable and persistent Electronic Health Records (EHRs). The openEHR standard was chosen for its overall dual domain architecture, where the more dynamic clinical information model may evolve independently from the relatively stable Reference Model (RM). Its Information Model (IM) comprises demographic, administrative and clinical systems. Critical clinical terms have been aligned to the FHIR HL7 standard, as to further support interoperability.This work has been supported by FCT -Fundacao para a Ciencia e Tecnologia within the R&D Units Project Scope: UIDB/00319/2020

OpenEHR modeling: improving clinical records during the COVID-19 pandemic

The COVID-19 pandemic had put pressure on various national healthcare systems, due to the lack of health professionals and exhaustion of those avaliable, as well as lack of interoperability and inability to restructure their IT systems. Therefore, the restructuring of institutions at all levels is essential, especially at the level of their information systems. Furthermore, the COVID-19 pandemic had arrived in Portugal at March 2020, with a breakout on the northern region. In order to quickly respond to the pandemic, the CHUP healthcare institution, known as a research center, has embraced the challenge of developing and integrating a new approach based on the openEHR standard to interoperate with the institution’s existing information and its systems. An openEHR clinical modelling methodology was outlined and adopted, followed by a survey of daily clinical and technical requirements. With the arrival of the virus in Portugal, the CHUP institution has undergone through constant changes in their working methodologies as well as their openEHR modelling. As a result, an openEHR patient care workflow for COVID-19 was developed.This work has been supported by FCT - Fundacao para a Ciuencia e Tecnologia within the R&D Units Project Scope: UIDB/00319/2020

Avaliação do Plano Nacional de Saúde Mental 2007-2016 e propostas prioritárias para a extensão a 2020

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Portuguese mental health system: critical evaluation of the providers’ payment mode

RESUMO - O Plano Nacional de Saúde Mental 2007–2016 aponta várias limitações ao sistema português de saúde mental, como a falta de acesso, os cuidados excessivamente centrados nos hospitais, a falta de recursos e a prevenção insuficiente. Uma das formas de atacar estes problemas é o desenho de um novo modelo de pagamento aos prestadores de cuidados de saúde mental, o que apenas é possível conhecendo em detalhe o modelo atual, os seus pontos fortes e fracos e os incentivos que cria. É isso que fazemos, com especial enfoque nos cuidados de saúde primários e hospitalares, com base nos resultados da literatura teórica e empírica, e na realização de um grupo focal com peritos das áreas da saúde mental e financiamento em Portugal. Concluímos que os cuidados de saúde primários não são incentivados a envolver-se na prevenção e tratamento de perturbações mentais, por beneficiarem da realização de um grande número de consultas de curta duração e do cumprimento de objetivos que negligenciam a saúde mental. Já o pagamento dos hospitais Entidade Pública Empresarial é muito focado no nível de atividade e não na integração de cuidados. É prevista uma remuneração por dias ou episódio de internamento, ou por serviço médico prestado, o que dificulta uma visão global do estado de saúde de cada doente. No entanto, os indicadores definidos para estes prestadores e a ausência de um mecanismo de reembolso de custos privilegia a eficiência na prestação de cuidados. Os cuidados prestados na comunidade, cuja eficácia é defendida pela literatura, são incentivados por uma remuneração que lhes é específica, mas que parece ainda não ter sido atribuída na prática. Em geral, apesar de ter alguns aspetos positivos, o modelo de pagamento aos prestadores de cuidados de saúde mental beneficiará de um novo desenho, que envolva mais os cuidados de saúde primários, que incentive uma visão global do estado de saúde de cada doente e que torne mais efetivo o tratamento na comunidade.ABSTRACT -.The 2007–2016 National Plan of Mental Health points out several limitations of the mental health Portuguese system, such as bad access, a healthcare excessively concentrated on hospitals, lack of resources, and insufficient prevention. One way of dealing with such problems is to design a new model of payment to mental healthcare providers, which is only possible if we know the current model, its strengths and weaknesses, and the incentives it creates. That is what we do in this paper, with a special focus on primary and secondary care, on the basis of the theoretical and empirical literature, and the realization of a focus group with national mental health and financing experts. We conclude that primary care services have few incentives to be involved in the prevention and treatment of mental health disorders, as they benefit from conducting a large number of short-duration consultations and from reaching goals not related to mental health. The payment of “Entidade Pública Empresarial” hospitals is highly focused on the activity level and less on care integration. It includes a fee that depends on the number of days or episodes of inpatient stays, or on the number of medical acts, which makes it difficult for hospitals to have a global view of the patients’ health status. However, the indicators defined for these providers and the inexistence of a cost reimbursement mechanism favor efficiency in healthcare provision. Community healthcare, which the literature defends to be effective, is incentivized by a specific fee, which, however, does not seem to be used in practice. In general, although having some interesting features, the current payment model for mental healthcare providers will benefit from a redesign which leads providers to have a global view of the patients’ health status and to make an effective use of community care.info:eu-repo/semantics/publishedVersio

Screening of Dementia in Portuguese Primary Care: Methodology, Assessment Tools, and Main Results

The objectives of this article are as follows: (1) to describe the assessment protocol used to outline people with probable dementia in Primary Health Care; (2) to show the methodological design and procedure to obtain a representative sample of patients with probable dementia; and (3) to report the main characteristics of the sample collected in the context of the study “Characteristics and needs of people with probable dementia.” The study protocol was based on the “Community Assessment of Risk and Treatment Strategies (CARTS) Program” and is composed by a set of instruments that allow the assessment of older adults with probable dementia in several areas (health, psychological, functionality, and other). Descriptive analysis was used to characterize the final sample (n = 436). The study protocol as well as the methodological procedure to obtain the referral of research participants and data collection on the condition of people with probable dementia in Primary Health Care proved to be a valuable tool to obtain a sample of patients distributed by the full range of probable dementia in a large geographical area. Results may allocate the design of care pathways for old people with cognitive disorders to prevent, delay impairment, and/or optimize quality of life of patients