RESUMEN
The Valkyrie project aims to develop a demonstration Federated Electronic Health Record for the use of mental health practitioners in Norway. Information for the record is drawn from existing records in Source Systems operating across primary and secondary care. Recording of information in any such system, in response to a healthcare event, triggers the generation of an Encrypted Token, containing summary metadata about the event, clinical coding indicating its clinical context and a locator that can be used to retrieve the full record of the event from the original Source System. The Valkyrie architecture consists of a number of interlinked Security Domains, each with its own private and public keys, through which the Encrypted Tokens are passed. Each Security Domain performs a specific function on a set of Tokens and only has access to the information within each Token that is necessary to perform that function. This paper describes the structure of the Encrypted Token, the function of each Security Domain and the orchestration of the flow of Tokens through the Domains. Together this allows a user to run a Valkyrie Session, in which they can view the content of a patient record, where all content has been drawn in real-time from heterogenous Source Systems (ISO13606- and openEHR-based) and is destroyed when the session terminates.
Asunto(s)
Cadena de Bloques , Seguridad Computacional , Registros Electrónicos de Salud , Noruega , Humanos , Registro Médico Coordinado/métodosRESUMEN
Despite learning health systems' focus on including the patients in improving healthcare services, research shows they are still considered participants, not partners. This article aims to provide practical guidance for recognizing and including the Voice of the Patient (VoP) as data in a continuous LHS by describing how the VoP can present itself, how it can be incorporated into the LHS and the barriers and enablers for doing so. Five key domains were identified to consider when including the patient perspective. The use of technology could be a facilitator for patients to provide their perspectives. However, there is a risk of increased health inequity by reducing the VoP of patients with low health or digital literacy.
Asunto(s)
Aprendizaje del Sistema de Salud , Voz , Humanos , Alfabetización , Pacientes , TecnologíaRESUMEN
Learning Health System (LHS) and integrated care are challenged due to a fragmented health data landscape. An information model is agnostic to the underlying data structures and can potentially contribute to mitigating some of the gaps. In a research project, Valkyrie, we are exploring how metadata can be organized and used to promote service coordination and interoperability across levels of care. An information model is viewed as central in this context and as a future integrated LHS support. We examined the literature regarding property requirements for data, information and knowledge models in the context of semantic interoperability and an LHS. The requirements were elicited and synthesized into five guiding principles as a vocabulary to inform the information model design of Valkyrie. Further research on requirements and guiding principles for information model design and evaluation are welcomed.
Asunto(s)
Aprendizaje del Sistema de Salud , Conocimiento , Metadatos , Proyectos de InvestigaciónRESUMEN
Learning Health Systems (LHS) are challenged by fragmented health data. In Valkyrie, information models (IM) are explored as translators for the underlying, fragmented data structures and can potentially extend to support a future LHS. In this paper, a literature review was performed to search for property requirements for semantic interoperable IMs in the context of an LHS. The literature was examined and property requirements elicited in the context of an LHS.