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

Quality of Electronic Health Records - Coverage of Potential Information Weaknesses by Major EHR Quality Seals

Objectives: The Certification Commission for Healthcare Information Technology (CCHIT) and EuroRec offer the most prominent functional approaches to Electronic Health Record quality certification in the US and Europe. The current study aims at the analysis of these approaches from the perspective of weaknesses in information exchange. Furthermore, the implicit coverage of the information dimension within their functional requirements is analyzed. Methods: The quality frameworks from the CCHIT and EuroRec were compared to a comprehensive and universal categorization of communication errors in order to determine the communication problems anticipated by these two approaches. Results: The approaches of the CCHIT and EuroRec anticipate nearly the same communication errors but their number with regard to the error categorization is rather low. The two approaches include problem classes, such as authorization problems, wrong details in data, data loss, and poor quality content. Areas that are not covered include application errors, errors with regard to information transcription, etc. Conclusion: The current study points out that the approaches of the CCHIT and EuroRec only cover a small part of the possible communication errors with their functional requirements. Therefore, an integration of the identified, missing errors in the requirements proposed by CCHIT and EuroRec should be closely considered