Towards Interoperability in E-health Systems: a three-dimensional approach based on standards and semantics

Proceedings of: HEALTHINF 2009 (International Conference on Helath Informatics), Porto (Portugal), January 14-17, 2009, is part of BIOSTEC (Intemational Joint Conference on Biomedical Engineering Systems and Technologies)The interoperability problem in eHealth can only be addressed by mean of combining standards and technology. However, these alone do not suffice. An appropiate framework that articulates such combination is required. In this paper, we adopt a three-dimensional (information, conference and inference) approach for such framework, based on OWL as formal language for terminological and ontological health resources, SNOMED CT as lexical backbone for all such resources, and the standard CEN 13606 for representing EHRs. Based on tha framewok, we propose a novel form for creating and supporting networks of clinical terminologies. Additionally, we propose a number of software modules to semantically process and exploit EHRs, including NLP-based search and inference, wich can support medical applications in heterogeneous and distributed eHealth systems.This work has been funded as part of the Spanish nationally funded projects ISSE (FIT-350300-2007-75) and CISEP (FIT-350301-2007-18). We also acknowledge IST-2005-027595 EU project NeO

An ontology co-design method for the co-creation of a continuous care ontology

Ontology engineering methodologies tend to emphasize the role of the knowledge engineer or require a very active role of domain experts. In this paper, a participatory ontology engineering method is described that holds the middle ground between these two 'extremes'. After thorough ethnographic research, an interdisciplinary group of domain experts closely interacted with ontology engineers and social scientists in a series of workshops. Once a preliminary ontology was developed, a dynamic care request system was built using the ontology. Additional workshops were organized involving a broader group of domain experts to ensure the applicability of the ontology across continuous care settings. The proposed method successfully actively engaged domain experts in constructing the ontology, without overburdening them. Its applicability is illustrated by presenting the co-created continuous care ontology. The lessons learned during the design and execution of the approach are also presented

Diffusion of Electronic Health Records in Rural Primary Care Clinics

By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants\u27 experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices

Growing an information infrastructure for healthcare based on the development of large-scale Electronic Patient Records

The papers of this thesis are not available in Munin. Paper 1. Silsand, L., Ellingsen, G. (2014). Generification by Translation: Designing Generic Systems in Context of the Local. Available in: Journal of Association for Information Systems, vol. 15(4): 3. Paper 2. Christensen, B., Silsand, L., Wynn, R. and Ellingsen, G. (2014). The biography of participation. In Proceedings of the 13th Participatory Design Conference, 6-10 Oct. Windhoek, Namibia. ACM Digital Library. Paper 3. Silsand, L. and Ellingsen, G. (2016). Complex Decision-Making in Clinical Practice. In: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM Digital Library. ISBN: 978-1-4503-3592-8. Paper 4: Silsand, L., Ellingsen, G. (2017). Governance of openEHR-based information Infrastructures. (Manuscript). Paper 5. Silsand, L. (2017). The ‘Holy Grail’ of Interoperability of Health Information Systems: Challenges and Implications. Available in: Stigberg S., Karlsen J., Holone H., Linnes C. (eds) Nordic Contributions in IS Research. SCIS 2017. Lecture Notes in Business Information Processing, vol 294. Springer, Cham. This thesis provides empirical insights about socio-technical interdependencies affecting the making and scaling of an Information Infrastructure (II) for healthcare based on the development of large-scale Electronic Patient Records. The Ph.D. study is an interpretive case study, where the empirical data has been collected from 2012 to 2017. In most developed countries, the pressures from politicians and public in general for better IT solutions have grown enormously, not least within Electronic Patient Record (EPR) systems. Considerable attention has been given to the proposition that the exchange of health information is a critical component to reach the triple aim of (1) better patient experiences through quality and satisfaction; (2) better health outcomes of populations; and (3) reduction of per capita cost of health care. A promising strategy for dealing with the challenges of accessibility, efficiency, and effective sharing of clinical information to support the triple aim is an open health-computing platform approach, exemplified by the openEHR approach in the empirical case. An open platform approach for computing EPR systems addresses some vital differences from the traditional proprietary systems. Accordingly, the study has payed attention to the vital difference, and analyze the technology and open platform approach to understand the challenges and implications faced by the empirical process. There are two main messages coming out of this Ph.D. study. First, when choosing an open platform approach to establish a regional or national information infrastructure for healthcare, it is important to define it as a process, not a project. Because limiting the realization of a large-scale open platform based infrastructure to the strict timeline of a project may hamper infrastructure growth. Second, realizing an open platform based information infrastructure requires large structural and organizational changes, addressing the need for integrating policy design with infrastructure design

Ontological Meta-Analysis and Synthesis

We present ontological meta-analysis and synthesis as a method for reviewing, mapping, and visualizing the research literature in a domain cumulatively, logically, systematically, and systemically. The method will highlight the domain’s bright spots which are heavily emphasized, the light spots which are lightly emphasized, the blank spots which are not emphasized, and the blind spots which have been overlooked. It will highlight the biases and asymmetries in the domain’s research; the research can then be realigned to make it stronger and more effective. We illustrate the method using the emerging domain of Public Health Informatics (PHI). We present an ontological framework for the domain, map the literature onto the framework, and highlight its bright, light, and blank/blind spots. We conclude with a discussion of how (a) the results can be used to realign PHI research, and (b) the method can be used in other information systems domains

Development, evaluation and patient experiences of eHealth in the care of abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a weakening and widening of the abdominal aorta to a diameter of 30 mm or more. It is a fairly common condition among older men, and rarely occurs in women. The condition is generally asymptomatic with a slow expansion rate over time. However, AAA rupture is associated with a high mortality and immediate surgical intervention is required. Patients with larger AAA are offered surgical repair to prevent future rupture. Diagnosis, surveillance and surgical treatment impact patients’ wellbeing negatively, and previous studies have highlighted the need for adequate and timely information to prepare patients for the surgical care trajectory. However, patients’ learning needs and perceptions of methods for patient education had not been clarified. Furthermore, little was known about the utilization of modern technology for learning among patients with AAA. The overall aim of this thesis was to investigate the perceived need of learning and psychosocial support in patients with AAA, and evaluate methods to accommodate these needs in a clinical setting. The thesis comprises four scientific papers. Studies I and IV are qualitative interview studies, study II uses mixed methodology and study III is a randomized, controlled trial. Study I aimed to describe AAA patients’ perceived learning needs and explore their experience of different methods for patient education. Our results show that patients’ learning needs are not met by the health care staff, and that they therefore refer to other sources for information. Participants warranted continuous contact with a trusted person for follow-up and support. In study II, an eHealth tool was developed and validated for patients with AAA using a participatory design process. Patients, eHealth developers and health care staff were engaged in the design process, and readability analyses were performed. The final version of the eHealth tool was deemed accurate and relevant, and the language was perceived as understandable. However, the readability analyses produced readability scores exceeding the average literacy levels of older adults. Study III was a randomized, controlled trial with 120 patients scheduled for AAA repair. In the study, the eHealth tool and tailored psychosocial support was evaluated as an adjunct to standard care. The intervention was evaluated by repeated measurements with validated instruments (HADS and SF-12) to assess symptoms of anxiety and depression, and healthrelated quality of life. In the intervention group, 30 participants (50%) used the eHealth tool. App users were younger and had higher educational level than non-users. No significant difference was noted in anxiety mean score analyses between the whole intervention group and the control group. Those who utilized the complete intervention had markedly lower anxiety mean scores at the postoperative follow-up compared to the control group. Patients with low educational level had sustained high anxiety levels postoperatively. In study IV, a qualitative evaluation of the intervention by individual, in-depth interviews with 12 participants from the intervention group in study III was performed. When offered the eHealth tool, participants familiarity with modern technology was influential in their decision to engage in the tool. Those who were unfamiliar with this technology refrained from using the eHealth tool. Furthermore, their mental state at baseline, one week prior to surgery, hindered them to partake in the intervention. The implication and relevance of psychosocial support was not evident to the participants during the perioperative phase but could be understood in retrospect. Adjustment of information to the patient’s mental state and learning needs was believed to quench anxiety. In summary, this thesis provides insight into patients’ perspective on learning and psychosocial support in the AAA care trajectory. It also elucidates the feasibility and effects of an eHealth intervention to decrease anxiety. The studies also shed light on vulnerable groups which risk negative consequences of the digitalization of healthcare, such as those with low educational level and older patients. For successful implementation of eHealth services, future research and quality improvement initiatives should include targeted initiatives to strengthen these groups

Mobilizing medicine: a design response to the accessibility and cost issues in health care

textNationally, there is increasing concern over the accessibility, cost, and quality of the American health care system. While the quality of the care given is generally out of the control of designers, it has received increased attention in recent years, as is evidenced in the trends of healing gardens, private patient rooms, and improved social settings. As beneficial as these trends are to the patients they serve, they often have a negative effect on overall accessibility and cost of care due to the constant construction and renovations needed and their largely urban presence. While quality health care is very important and should not suffer as a result, how can designers address nonenvironmental sustainability issues of cost and access in the American healthcare system? Due to the trend in increasing cases of chronic illness, as opposed to more pathogenic ailments of the past, the necessity for all healthcare settings to be highly controlled and sterile environments should be reevaluated. While less popular and not as fully developed as the typical facilities most Americans are familiar with, an increase in mobilized health care units could be a solution to the lack of economic and social access and sustainability in the current healthcare model while still providing safe, quality care. By examining current instances of mobile clinics, I will explore the design requirements necessary to make mobile clinics accessible and cost effective. In addition, I will look for facilitators and barriers to these systems, such as improvements in mobile communication technologies and lack of stakeholder support.Architectur