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Analysis and evaluation of EHR approaches
Abstract
EHR systems are core applications in any eHealth/pHealth environment and represent basic services for health telematics platforms. Many projects are performed at the level of Standards Developing Organizations or national programs, respectively, for defining EHR architectures as well as related design, implementation, and deployment processes. Claiming to meet the challenge for semantic interoperability and offering the right pathway, the resulting documents and specifications are sometimes controversial and even inconsistent. Based on a long tradition in the EHR domain, on the collective experience of academic groups such as the EFMI EHR Working Group, and on an active involvement at CEN, ISO, HL7 and several national projects around the globe, an analysis and evaluation study has been performed using the Generic Component Model reference architecture. Strengths and weaknesses of the different approaches as well as migration pathways for re-using and harmonizing the available materials are offered.
... Similarly, there is a need to achieve timely and consistent access to EHRs. Currently, there is no single universally accepted clinical data model that will be adhered to by all [Blobel and Pharow 2008]. Figure 1 illustrates why standardization is needed in interorganization transfer of data. ...
... However, the major problem is the huge amount of different (proprietary or standardized) interfaces that are in use [Bott 2004]. For example, A recent study compares the available EHR standards [Blobel and Pharow 2008], and there are mappings being developed among standards. For example, ISO 13606-1 is the model to enable data to be shared between different EHR systems [ISO 13606-1 2008]. ...
Different clinics and hospitals have their own information systems to maintain patient data. This hinders the exchange of data among systems (and organizations). Hence there is a need to provide standards for data exchange. In digitized form, the individual patient's medical record can be stored, retrieved, and shared over a network through enhancement in information technology. Thus, electronic health records (EHRs) should be standardized, incorporating semantic interoperability. A subsequent step requires that healthcare professionals and patients get involved in using the EHRs, with the help of technological developments. This study aims to provide different approaches in understanding some current and challenging concepts in health informatics. Successful handling of these challenges will lead to improved quality in healthcare by reducing medical errors, decreasing costs, and enhancing patient care. The study is focused on the following goals: (1) understanding the role of EHRs; (2) understanding the need for standardization to improve quality; (3) establishing interoperability in maintaining EHRs; (4) examining a framework for standardization and interoperability (the openEHR architecture; (5) identifying the role of archetypes for knowledge-based systems; and (6) understanding the difficulties in querying HER data.
... El estándar EN/ISO EN13606 (B. G. M. E. Blobel & Pharow, 2008) es una norma desarrollada por el Comité Europeo de Normalización (CEN) que proporciona un modelo para especificar de información clínica de la HCE. ...
En el contexto de los sistemas de información de historia clínica electrónica en Colombia, se encuentra
que una parte importante de estos han sido desarrollados para intercambiar información solo a
nivel de unidades de negocio en las instituciones prestadoras de servicios de salud IPS, y en pocos
casos dichos sistemas están preparados para operar bajo modelos de comunicación B2B (Business
to Business). Esta falta de comunicación puede generar complicaciones para que la información clínica
de un paciente pueda ser compartida de forma oportuna y útil en el momento de desarrollar un
procedimiento médico, lo que a su vez hace que se presenten riesgos inherentes a la seguridad de
los pacientes. En este artículo se hace una caracterización de las implicaciones que tiene la interoperabilidad
en el contexto de la Historia Clínica Electrónica (HCE) , presenta los avances logrados por
el sistema de salud Colombiano en este tema y presenta una propuesta que consiste en el desarrollo
de una arquitectura de software para un componente que mejora la interoperabilidad entre sistemas
HCE. Para el desarrollo del proyecto se han tomado en cuenta las directrices del Instituto de Ingeniería
del Software además de las buenas prácticas propuestas por el Proceso Unificado de Desarrollo de
Software y el método de evaluación de arquitecturas ATAM como marco de trabajo aplicado para el
aseguramiento de la calidad del producto.
... EHR systems are core applications in any eHealth environment and represent basic services for health telematics platforms. Many projects are performed at the level of Standards Developing Organizations or national programs, respectively, for defining EHR architectures as well as related design, implementation, and deployment processes [5]. The vision of the EHR is not fixed. ...
Introduction: With the many advances in information technology over the past 20 years, particularly in healthcare, a number of different forms of electronic health records have been discussed, developed, and implemented. The vision of the EHR is not fixed. This is both its challenge and its strength in different communities. In this paper we present the opportunities of EHR implementation in Isfahan. Methods: This is a qualitative study and we used the method of phenomenology, a in-depth semistructured interviews were conducted with 15 of Physicians, Managers and Clear Sighted persons who had experiences regarding with electronic health record. Conclusion: Based on the comments made by interviewees, the researcher divided the Opportunities into two categories of clinical including Continuous access to the record, 24 hours a day.Prevention of medication error, ongoing education for healthcare professionals, timely and effective care and financial including reduce waiting time for admission and discharge and release the required information for timely reimbursement.
... Motivated by meeting the challenges for implementing semantic interoperability of EHR systems [3], in 2007, we started a joint-research initiative on EHR called mCHAS with the Guangdong Hospital of Traditional Chinese Medicine (GDHTCM), one of the largest hospital enterprises in China. The major goals of mCHAS include: N Implement a patient-centric data model for EHR based on HL7 CDA standard which provides a flexible and extensible document architecture that supports both syntactical and semantic interoperability; N Provide profession-friendly semantic search against patient data for clinical workers and researchers; N Enable cross-institution health care information sharing through EHR system. ...
Building up Electronic Health Record (EHR) systems is considered a promising approach to improve health care quality in China. In order to meet the challenges of EHR semantic interoperability, we present a HL7 Clinical Document Architecture (CDA) R2 based EHR system prototype developed for Guangdong Hospital of Traditional Chinese Medicine (GDHTCM). In particular, we demonstrate how semantic technologies are leveraged to benefit EHR users from enabling semantic search against an EHR repository. Pilot users of the system deemed it clinically useful, which encourages us to develop more capabilities based on EHR in future, like cross-institution sharing and integration with a clinical decision support system.
Objectives:
To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care.
Methods:
This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics into an HL7v2 message as an eXtensible Markup Language (XML) file, which was validated against an XML schema that defines constraints on a common reference model. This message was exchanged with a second prototype application, developed on the Mirth middleware, which was also used to parse and validate both the original and the hybrid messages.
Results:
Both versions of the data instance (one pure XML, one embedded in the HL7v2 message) were equally validated and the RDF-based semantics recovered by the receiving side of the prototype from the shared XML schema.
Conclusions:
This study demonstrated the semantic enrichment of HL7v2 messages for intensive-software telemedicine systems for trauma care, by validating components of extracts generated in various computing environments. The adoption of the method proposed in this study ensures the compliance of the HL7v2 standard in Semantic Web technologies.
Multilevel modeling has been proven in software as a viable solution for semantic interoperability, without imposing any specific programming languages or persistence models. The Multilevel Healthcare Information Modeling (MLHIM) specifications have adopted the XML Schema Definition 1.1 as the basis for its reference implementation, since XML technologies are consistent across all platforms and operating systems, with tools available for all mainstream programming languages. In MLHIM, the healthcare knowledge representation is defined by the Domain Model, expressed as Concept Constraint Definitions (CCDs), which provide the semantic interpretation of the objects persisted according to the generic Reference Model classes. This paper reports the implementation of the MLHIM Reference Model in XML Schema Definition language version 1.1 as well as a set of examples of CCDs generated from the National Cancer Institute – Common Data Elements (NCI CDE) repository. The set of CCDs was the base for the simulation of semantically coherent data instances, according to independent XML validators, persisted on an eXistDB database. This paper shows the feasibility of adopting XML technologies for the achievement of semantic interoperability in real healthcare scenarios, by providing application developers with a significant amount of industry experience and a wide array of tools through XML technologies.
Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited.
The present paper aims at the description and comparison of the current major quality certification approaches to EHRs.
A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis.
The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance.
The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems.
Sharing personal health information among healthcare providers is a crucial business process not only for saving limited healthcare resources but also for increasing patient's healthcare quality. Building an effective personal health information sharing process from established healthcare systems is a challenge in terms of coordination different business operations among healthcare providers and restructuring technical details existed in different healthcare information systems. This study responds this challenge with a service-oriented approach and develops a business software application to describe how the challenge can be alleviated from both managerial and technical perspectives. The software application in this study depicts personal health information sharing process among different providers in a long-term care setting. The information sharing scenario is based on an industrial initiative, such as Integrating the Healthcare Enterprise (IHE) from healthcare domain and the technologies for implementing the scenario are Web Service technologies from Service-oriented computing paradigm. The implementation in this study can inform healthcare researchers and practitioners applying technologies from service-oriented computing to design and develop healthcare collaborative systems to meet the increasing need for personal health information sharing.
Introduction: Today, eHealth is base of health services around the world, and electronic health records as an essential core element and its basic architecture for telehealth is considered. EHR offers many potential opportunities for healthcare systems we must focus on its challenges and related guidelines but for EHR deployment. The purpose of this paper is exploration challenges of EHR implementation and related guidelines in Isfahan. Methods: This is a qualitative study and we used the method of phenomenology, a in-depth semi-structured interviews were conducted with 15 of Physicians, Managers and Clear Sighted persons who had experiences regarding with electronic health record. Conclusion: The researcher divided challenges into two areas of infrastructure and structural. Challenges of electronic health records infrastructure are due to information technology, lack of uniform definitions and concepts, cultural problems, and lack of needs assessment before implementation and the challenges of structural are due to instability enforced, violations of privacy and legal cases, compromise getting information management, and lack of integration and sharing of enterprise-level.
ISO/TR 20514:2005 describes a pragmatic classification of electronic health records, provides simple definitions for the main categories of EHR and provides supporting descriptions of the characteristics of electronic health records and record systems
Forming the informational reflection of the patients and their care, the Electronic Health Record (EHR) is the core application of any complex health information system or health network. Such an ideally lifelong history file must be reliable, flexible, adaptable to new concepts and technologies, and robust, to allow for sharing knowledge over its lifetime. A sophisticated architecture must be chosen for meeting this challenge.
An advanced EHR architecture for designing and implementing future-proof EHR systems must be a model of generic properties required for any Electronic Patient Record to provide communicable, comprehensive, useful, effective, and legally binding records that preserve their integrity over the time, independent of platforms and systems as well as of national specialties. the resulting approach is based on the ISO Reference Model-Open Distributed Processing.
Based on advanced architectural principles introduced in the paper, a new generation of HER systems has been designed and implemented for demonstrating the feasibility of the approach. This result is presented and evaluated regarding the achievements and problems using the component-based paradigm of model-driven health information system architectures.
The future-proof EHR approach that has been established has been shortly evaluated. Advantages regarding flexibility, reliability, and portability of policy-driven, highly secure, role-dependent applications have to be considered in the light of performance as well as of the availability of network and application services.
As health care develops from an organization-centered via service-centered (disease management) towards a person-centered system (favored homecare, patient monitoring, body area networks), information systems involved have to be semantically interoperable, process-related, decision-supportive, context-sensitive, user-oriented, and trustworthy.
The aforementioned paradigm shift requires highly flexible solutions based on knowledge concepts, provided by a service-oriented and model-driven approach.
Information systems' design, implementation and maintenance have to be realized based on formal grammar. This is true for all considered aspects and views of the system and its components, using metalanguages and reflecting all domains touched.
For meeting the challenge, involvement of, and close collaboration between, experts from different domains as well as knowledge and tooling regarding formal modeling and model interchange are required.
For improving quality and efficiency of health delivery under the well-known burdens, the health service paradigm has to change from organization-centered over process-controlled to personal health. The growing complexity of highly distributed and fully integrated healthcare settings can only be managed through an advanced architectural approach, which has to include all dimensions of personal health. Here, ICT, medicine, biomedical engineering, bioinformatics and genomics, legal and administrative aspects, terminology and ontology have to be mentioned. The Generic Component Model allows for different domains' concept representation and aggregation. Framework, requirements, methodology and process design possibilities for such a future-proof and meanwhile practically demonstrated approach are discussed in detail. The deployment of the Generic Component Model and the concept representation to biomedical engineering aspects of eHealth are touched upon as essential issues.
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