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It is observed that clinical decision support (CDS) and electronic health records (EHR) should be integrated so that their contribution to improving the quality of health care is enhanced. In this paper, we present results from a review on the related literature. The aim of this review was to find out to what extent CDS developers have actually con...
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Objective:
We sought to demonstrate applicability of user stories, progressively elaborated by testable acceptance criteria, as lightweight requirements for agile development of clinical decision support (CDS).
Materials and methods:
User stories employed the template: As a [type of user], I want [some goal] so that [some reason]. From the "so t...
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Computerized provider order entry (CPOE) with clinical decision support (CDS) can help hospitals improve care. Little is known about what CDS is presently in use and how it is managed, however, especially in community hospitals. This study sought to address this knowledge gap by identifying standard practices related to CDS in US community hospital...
In two landmark reports on Quality and Information Technology, the Institute of Medicine described a 21st century healthcare delivery system that would improve the quality of care while reducing its costs. To achieve the improvements envisioned in these reports, it is necessary to increase the efficiency and effectiveness of the clinical decision s...
Rationale:
The nature, variability and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently employed in acute care settings for clinical care or research is unknown.
Objectives:
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Citations
... The use of semantic resources, such as ad hoc ontologies, and data correctness verification based on semantic processing has been proposed to achieve data quality in the big data scenario of EHR (Gai et al. 2015). The alignment of the semantic expectations with the actual data extracted from the EHR annotations allows detection of errors at a much more abstract level, before their exploitation by decision support systems' (Kashfi 2011) data mining. Also, paying special attention to usability issues has been pointed out as a way to achieve much better quality data (Villa and Cabezas 2014). ...
you can download this paper using the following link (50 downloads are available)
http://www.tandfonline.com/eprint/3SVz9xibkdcA3zv9eJnf/full
The Electronic Health Record (EHR) groups all digital documents related to a given patient such as anamnesis, results of the laboratory tests, prescriptions, recorded medical signals as ECG or images, etc. Dealing with such data representation incurs a plethora of problems, such as different data types, even unstructured data (i.e., doctor’s notes), huge and fast-growing volume, etc. Therefore. EHR should be considered as one of the most
complex data objects in the information processing industry. Accordingly, taking into consideration its complexity, heterogeneity, fast growth, and size, the analysis of EHR data increasingly needs big data tools. Such tools should be able to analyze datasets characterized by the so-called 4Vs (volume, velocity, variety,
and veracity). These notwithstanding, we should also add the fifth V—value—because analytics tool deployment makes sense only if it leads to health-care improvement (as personalized patient care, decreasing unnecessary hospitalization, or reducing patient readmissions). In this study, we focus on the selected aspects of
EHR analysis from the big data perspective.
... First, the described system relies in OpenEHR EHRs to fetch the information and concepts needed by the CDSS. Nevertheless, despite several countries are building archetype repositories to make public their clinical concepts [26][27][28] the adoption of archetype-based EHRs is still low [29] and the medical data contained in most systems is not standardized. Second, complex queries will need to be defined in AQL. ...
Clinical Decision Support Systems (CDSS) are software applications that support clinicians in making health care decisions for individual patients. Such systems have been shown to improve care delivery and reduce costs. However, the lack of integration with Electronic Health Record systems and their high cost of maintenance have been identified as important barriers to their adoption. This paper aims, first, to describe a meta-architecture to seamlessly interoperate non-rule-based CDSS with archetype-based Electronic Health Records and, second, to allow the CDSS to perform self-maintenance tasks over its knowledge and inference engine. To achieve these objectives the Dual-Model Approach, in combination with clinical terminologies have been used to define a system capable to be plugged into any OpenEHR system and maintain its knowledge by using the semantics described through clinical terminologies.
... EHR standards must be considered in CDSS in order to facilitate the exchange of information in a machine-readable format [7]. The adoption of standardised EHR allows processing the information more effectively across multiple Hospital Information Systems (HIS) and care settings. ...
More and more the continuum of care is replacing the traditional way of treating the subjects of care putting
people in the centre of the healthcare process. Currently clinicians start treatment after a problem occurs due to the low adoption of Clinical Decision Support Systems (CDSS) integrated with standardised Electronic Health Record (EHR) systems; The volume to value revolution in the healthcare (from stakeholder-centric to patient-centric) will allow doctors to follow the evolution of the individual before a medical episode
happens, treating the patient based on statistical trends to forecast the future. The CDSS techniques applied on telemonitoring tools permit the doctors to predict forthcoming events, improve the diagnosis and avoid continuous visits to the hospital, therefore saving costs. Advanced Medical Expert Support Tool is a step towards achieving the patient-centric approach by incorporating the health information into the EHR using European standards (ISO/EN 13606) to provide semantic interoperability by means of the dual model approach (reference model and archetypes). Three different CDSS modules have been implemented and contextualised publications are provided to the cardiologist to facilitate their daily work. A person-centric Graphical User Interface (GUI) facilitates the visualization of the health status of the patients providing meaningful information to the cardiologists. The use of archetypes allows scalability, transparency and efficiency to the hospital environment.
... Regarding the use of information models in rehabilitation CDSSs, vMR is still in process of improvement and evolution by VMR Project Team [10], and there are several CDSSs that use it [11]. Moreover, VMR is designed to reduce development costs and time responses in CDSSs. ...
... The epSOS' main objective is to assist practitioners in unscheduled care and its general policy is to adopt international standards, such as HL7 v2. vMR, a simplified view of HL7 v3, is still in the process of improvement and evolution by the vMR Project Team [15], and there are several CDSSs that use it [16]. vMR is designed to reduce development costs and time responses in CDSSs. ...
... Regarding the use of information models in rehabilitation CDSSs, vMR is still in process of improvement and evolution by VMR Project Team [10], and there are several CDSSs that use it [11]. Moreover, VMR is designed to reduce development costs and time responses in CDSSs. ...
In this article, key points are discussed concerning knowledge representation for clinical decision support systems in the domain of physical medicine and rehabilitation. Information models, classifications and terminologies, such as the “virtual medical record” (vMR), the “international classification of functioning, disability and health” (ICF), the “international classification of diseases” (ICD) and the “systematized nomenclature of medicine—clinical terms” (SNOMED CT), are used for knowledge integration and reasoning. A system is described that supports the measuring of functioning status, diversity, prognosis and similarity between patients in the post-acute stage, thus helping health professionals’ prescription of recommendations.
... The epSOS' main objective is to assist practitioners in unscheduled care and its general policy is to adopt international standards, such as HL7 v2. vMR, a simplified view of HL7 v3, is still in the process of improvement and evolution by the vMR Project Team [15], and there are several CDSSs that use it [16]. vMR is designed to reduce development costs and time responses in CDSSs. ...
International standards and standard proposals of nomenclatures, ontologies and information models exist in medicine, but the scope of most of them is overly general to cope with the specificities that characterize rehabilitation. Here we carry out an ontology-based exploration of the concepts and relationships in the rehabilitation domain, integrating clinical practice, the clinical investigator record ontology and international standards. The aim of the analysis is to identify potential logical problems with the use of existing models and international standards in representing and reasoning with real clinical data, and to understand whether and how these data might be defined more formally than in the current practice. Our analysis of the relationships among rehabilitation concepts revealed issues related to confusion among classes and their properties, incorrect classifications, overlaps and loss of information. It also suggested properties that should be included in a formal model suitable to be used by decision support systems.
Background
According to European legislation, a clinical trial is research involving patients, which also includes a research end-product. The main objective of the clinical trial is to prove that the research product, i.e. a proposed medication or treatment, is effective and safe for patients. The implementation, development, and operation of a patient database, which will function as a matrix of samples with the appropriate parameterization, may provide appropriate tools to generate samples for clinical trials.
Aim
The aim of the present work is to review the literature with respect to the up-to-date progress on the development of databases for clinical trials and patient recruitment using free and open-source software in the field of endocrinology.
Methods
An electronic literature search was conducted by the authors from 1984 to June 2019. Original articles and systematic reviews selected, and the titles and abstracts of papers screened to determine whether they met the eligibility criteria, and full texts of the selected articles were retrieved.
Results
The present review has indicated that the electronic health records are relating with both the patient recruitment and the decision support systems in the domain of endocrinology. The free and open-source software provides integrated solutions concerning electronic health records, patient recruitment, and the decision support systems.
Conclusions
The patient recruitment relates closely to the electronic health record. There is maturity at the academic and research level, which may lead to good practices for the deployment of the electronic health record in selecting the right patients for clinical trials.
A manutencao em longo prazo dos registros eletronicos de saude dentro de seu contexto original de informacao e uma exigencia etica que conflita com a necessidade constante de migracao das informacoes para novos sistemas, quando eles sao desenvolvidos e melhorados. As especificidades de cada estabelecimento de saude em particular excluem a viabilidade de um registro de saude monolitico, e garantir a interoperabilidade entre os sistemas e o principal desafio enfrentado pelos pesquisadores da area de informatica em saude. Diferentes abordagens de modelagem multinivel tem sido desenvolvidas para lidar com essa complexidade. No entanto, as especificacoes originais de modelagem multinivel sao direcionadas para o desenvolvimento de prontuarios eletronicos de base hospitalar, o que dificulta sua adocao para o desenvolvimento de aplicativos mais simples, com propositos especificos, para uso em situacoes de saude extra-hospitalares. Este artigo apresenta a engenharia do conhecimento de um modelo multinivel minimalista que pode ser implementado por desenvolvedores para todo o espectro mais amplo de aplicacoes na area de saude. Ao utilizar padroes da industria de tecnologia da informacao, esta abordagem permite uma maior adocao de tecnologias interoperaveis em saude.
Potential benefits of the e-health system do not ignore the challenges that prevent the system from being fairly used. Security and privacy challenges of the e-health system need to be understood and resolved. The aim of this paper is to explore and analyze the current state of e-health systems security and privacy of patient records. Main focus is on security at the policy level in order to protect electronic patient record. (C) 2013 The Authors. Published by Elsevier Ltd. Selection and peer-review under responsibility of the Faculty of Information Science & Technology, Universiti Kebangsaan Malaysia.
