Requirements engineering in health care : the example of chemotherapy-planning in paediatric oncology

Health care is characterized by highly complex processes of patient care that require unusual amount of communication between different health care professionals of different institutions. Sub-optimal processes can significantly impact on the patient’s health, increase the consumption of services and resources and in severe cases can lead to the patient death. For these reasons, requirements engineering for the development of information technology in health care is a complex process as well: without constant and rigorous evaluation, the impact of new systems on the quality of care is unknown and it is possible that badly designed systems significantly harm patients. To overcome these limitations, we present and discuss an approach to requirements engineering that we applied for the development of applications for chemotherapy planning in paediatriconcology. Chemotherapy planning in paediatric oncology is complex and time-consuming and errors must be avoided by all means. In the multi-hospital/multi-trial centre environment of paediatric oncology, it is especially difficult and time-consuming to analyse requirements. Our approach combines a grounded theory approach with evolutionary prototyping based on the constant development and refinement of a generic domain model, in this case a domain model for chemotherapy planning in paediatric oncology. The prototypes were introduced in medical centres and final results show that the developed generic domain model is adequate

OpenEHR archetypes in electronic health records : the path to semantic interoperability?

A myriad of reasons ranging from physician concerns about workflow to broad environmental issues are still inhibiting the adoption of Electronic Health Record (EHR) systems [Ref. 1]. Some argue the most important reason why clinicians are reluctant to adopt clinical IT systems is a perceived lack of added value [Ref. 2] The UK Royal College of Nursing finds in a recent study that 93% of nurses believe that training for EHRs is very important, but over 50% received no training [Ref. 3]. Clinicians commonly feel that it is others who benefit from their keyboard labours – health system administrators, payors, and – hopefully – the patient [Ref. 2]. To really add value for the clinician it is still a necessity to develop best-of-breed systems (e.g. [Ref. 4]) commonly by circumventing existing systems with a strong administrative focus. Best-of-breed systems are at best awkwardly integrated, often maintained with minimum resources, and not interoperable with other systems. Further complicating this matter, health care is constantly changing in three ways (breadth, depth, complexity): new information, information in finer-grained detail, and new relationships are always being discovered or becoming relevant. Therefore, knowledge inherent in EHR systems will eventually become irrelevant or wrong. The openEHR archetype methodology (http://www.openEHR.org) is a possible solution to this dilemma as it claims to empower the clinician and ensure seamless integration and semantic interoperability. The aim of this paper is to shortly present the openEHR approach, analyse to what extend it empowers the clinician and what impact openEHR archetypes have on semantic interoperability

Nursing constraint models for electronic health records : a vision for domain knowledge governance

Various forms of electronic health records (EHRs) are currently being introduced in several countries. Nurses are primary stakeholders and need to ensure that their information and knowledge needs are being met by such systems information sharing between health care providers to enable them to improve the quality and efficiency of health care service delivery for all subjects of care. The latest international EHR standards have adopted the openEHR approach of two-level modelling. The first level is a stable information model determining structure, while the second level consists of constraint models or ‘archetypes’ that reflect the specifications or clinician rules for how clinical information needs to be represented to enable unambiguous data sharing. The current state of play in terms of international health informatics standards development activities is providing the nursing profession with a unique opportunity and challenge. Much work has been undertaken internationally in the area of nursing terminologies and evidence-based practice. This paper argues that to make the most of these emerging technologies and EHRs we must now concentrate on developing a process to identify, document, implement, manage and govern our nursing domain knowledge as well as contribute to the development of relevant international standards. It is argued that one comprehensive nursing terminology, such as the ICNP or SNOMED CT is simply too complex and too difficult to maintain. As the openEHR archetype approach does not rely heavily on big standardised terminologies, it offers more flexibility during standardisation of clinical concepts and it ensures open, future-proof electronic health records. We conclude that it is highly desirable for the nursing profession to adopt this openEHR approach as a means of documenting and governing the nursing profession’s domain knowledge. It is essential for the nursing profession to develop its domain knowledge constraint models (archetypes) collaboratively in an international context

Systematic planning of patient records for cooperative care and multicenter research

Purpose: The purpose of this paper is to introduce a method for systematically planning patient records for structured data entry that can be used in cooperative environments (e.g. cooperative care, multicenter trials) in a way that enables multipurpose use and shared data entry. Methods: Design research, formal logic. Results: The method suggests five steps: analyze the prevailing documentation infrastructure,provide terminology management system (TMS), provide documentation management system (DMS), plan the logical architecture, provide all necessary tools. Conclusions: The era of eHealth enables cooperative care and collaborative documentation.This can only be efficient if a multiple use and shared entry of data is realized. The task of the medical informatics community is to plan these environments systematically especiallyin complex environments which are enabled by emerging technologies

Applying knowledge discovery in healthcare repositories : towards multi-agents collaboration

This paper presents a case for an intelligent agent based framework for knowledge discovery in a distributed environment comprising multiple heterogeneous data repositories. Data-mediated knowledge discovery, especially from multiple heterogeneous data resources, is a tedious process and imposes significant operational constraints on end-users. We demonstrate that autonomous, reactive and proactive intelligent agents provide an opportunity to generate end-user oriented, packaged, value-added decision-support/strategic planning services for professionals, managers and policy makers of an organization, without the need for a priori technical knowledge. Since effective progress of an organization is grounded in good communication, experience sharing, continuous learning and proactive actions, we present an Agent-based Data Mining Info-structure (ADMI) that deploys a suite of Data Mining (DM) algorithms coupled with intelligent agents to facilitate data access, DM query specification, DM algorithm selection and DM result visualization—i.e. automated generation of data-mediated decision-support/strategic-planning services

Preparing the electronic patient record for collaborative environments and ehealth

In the era of eHealth the electronic patient record is increasingly regarded as part of a collaborative environment. To efficiently support the documentary tasks and analyses a cooperative documentation infrastructure which allows multiple use and shared entry of data is necessary. The objective of this paper is to introduce a method for systematically planning such a cooperative documentation environment. It consists of the steps: analyse the prevailing documentation infrastructure, provide terminology, provide documentation management, plan the logical architecture and provide all necessary tools. The steps can be formally specified so that parameters can be automatically controlled and the environment can be updated more easily

Archetypes in electronic health records : making the case and showing the path for domain knowledge governance

Objective: To make the case and show the path for domain knowledge governance in health care. Background: In the field of open Electronic Health Records (EHRs), openEHR as an archetype-based approach is becoming increasingly recognised. Results: The adoption of an archetypes-based approach – clearly separating knowledge and information – is essential to enable semantic interoperability in health care. To avoid significant overlaps and ‘rank growth’ during the archetype development, archetype development needs to be coordinated nationwide and beyond and also across the various health professions. Archetypes need to be easily accessible and need to be maintained after creation. Domain knowledge governance comprises all of the above tasks. Essentially, we propose a health-wide umbrella organisation to coordinate the archetype development and to organise domain experts in inter-disciplinary archetype development teams. Discussion: The dimensions of domain knowledge governance have huge implications for the health industry. The adoption of a set of processes that enable the creation, organisation, dissemination and use of knowledge is required. Collectively this will create the knowledge environment required to effectively foster semantic interoperability between EHR systems. Conclusion: We conclude that we should no longer be concentrating on the development of standard terminologies alone but we should divert our efforts toward the development of archetypes. The development of terminologies remains crucial as part of this effort

Skill needs for nurses in their role as health informatics professionals : a survey in the context of global health informatics education

In the process of developing global health informatics education, a common understanding of educational outcomes is required. Therefore, an educational framework for health informatics professionals is desirable to support student mobility, trans-national and borderless education. Nurses form a significant part of the health workforce and need to be properly educated for their roles in health informatics. To ascertain their perceptions of needs and priorities, we developed a web-based questionnaire and surveyed Australian nurses on the preferred knowledge/skills set for health informatics professionals. Among others, the questionnaire is based on the International Medical Informatics Association’s (IMIA) set of recommendations on education and IMIA’s scientific map. Benner’s five levels of competencies were applied to measure the degree of competency required for each skill/ knowledge. Altogether, 82 Australian nurses completed the questionnaire. The nurses’ perceived degree of competency required for a total of 74 specific skills and knowledge in five skill categories is presented in this paper as well as the overall results for each of the five categories. Further, significant differences between the nurses’ primary roles and primary interest in health informatics are discussed. The development of a comprehensive health informatics education framework needs to take into account nurses as well as other health professionals. Repeating the survey in other countries and for various professions is essential to develop an international educational framework

Towards automatically generating graphical user interfaces from openEHR archetypes

One of the main challenges in the field of Electronic Health Records (EHRs) is semantic interoperability. To utilise the full potential of interoperable EHR systems they have to be accepted by their users, the health care providers.Good Graphical User Interfaces (GUIs) that support customisation and data validation play a decisive role for user acceptance and data quality. This study investigatesthe use of openEHR archetypes to automatically generate coherent, customizable,data-validating GUIs. Using the Mozilla XML User Interface Language (XUL) a series of prototypes has been developed. The results show that the automatic generation of GUIs from openEHR archetypes is feasible in principle. Although XUL revealed some problems, the advantages of XML-based GUI languages are evident

Towards semantic interoperability for electronic health records : domain knowledge governance for openEHR archetypes

Objectives: In the field of open electronic health records (EHRs), openEHR as an archetype-based approach is being increasingly recognised. It is the objective of this paper to shortly describe this approach, and to analyse how openEHR archetypes impact on health professionals and semantic interoperability. Methods: Analysis of current approaches to EHR systems, terminology and standards developments. In addition to literature reviews, we organised face-to-face and additional telephone interviews and tele-conferences with members of relevant organisations and committees. Results: The openEHR archetypes approach enables syntactic interoperability and semantic interpretability – both important prerequisites for semantic interoperability. Archetypes enable the formal definition ofclinical content by clinicians. To enable comprehensive semantic interoperability, the development and maintenance of archetypes needs to be coordinated internationally and across health professions. Domain knowledge governance comprises a set of processes that enable the creation, development, organisation, sharing, dissemination, use and continuous maintenance of archetypes. It needs to be supported by information technology. Conclusions: To enable EHRs, semantic interoperability is essential. The openEHR archetypes approach enables syntactic interoperability and semantic interpretability. However, without coordinated archetype development and maintenance, ‘rank growth’ of archetypes would jeopardize semantic interoperability. We therefore believe that openEHR archetypes and domain knowledge governance together create the knowledge environment required to adopt EHRs