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
This paper describes the implementation of tools to support multiple language variants of the clinical information models that are used to define a model-driven EHR system. Beyond that, it describes how a complete EHR system can be created with multiple language variants, using the example of an EHR for clinical management of patients in a Fracture Liaison Service. A clinical information model, represented as ontology, was developed in the English language. This model was translated into Spanish and Mandarin, and the modeling tools were refined, on the basis of the experience gained. A workshop was then held, where participants used the EHR tools to create additional language variants in German, French, Portuguese, Arabic, Farsi, Urdu and Somali. The results from the workshop are presented here, with a brief summary of the lessons learned; further work will focus on improving the tools in response to those lessons.
Asunto(s)
Registros Electrónicos de Salud , Fracturas Óseas , Humanos , Lenguaje , EtnicidadRESUMEN
This paper describes a method by which the Web Ontology Language (OWL) can be used to specify a highly structured health record, following internationally recognised standards such as ISO 13606 and HL7 CDA. The structured record is coded using schemes such as SNOMED, ICD or LOINC, with the coding applied statically, on the basis of the predefined structure, or dynamically, on the basis of data values entered in the health record. The highly structured, coded record can then be linked with external knowledge sources which are themselves coded using the Resource Description Framework. These methods have been used to implement dynamic decision support in the open source cityEHR health records system. The effectiveness of the decision support depends on the scope and quality of the clinical coding and the sophistication of the algorithm used to match the structured record with knowledge sources.
Asunto(s)
Ontologías Biológicas , Logical Observation Identifiers Names and Codes , Sistemas de Registros Médicos Computarizados , Web Semántica , Systematized Nomenclature of Medicine , Algoritmos , Codificación ClínicaRESUMEN
The cityEHR is an example of an open source EHR system which stores clinical data as collections of XML documents. The records gathered in routine clinical care are a rich source of longitudinal data for use in clinical studies. We describe how the standard language XQuery can be used to identify cohorts of patients, matching specified criteria. We discuss methods for ensuring good data quality and the issues in implementing XML queries on longitudinal data sets.
Asunto(s)
Registros Electrónicos de Salud/organización & administración , Estudios Longitudinales , Estudios de Cohortes , Documentación/métodos , Registros Electrónicos de Salud/estadística & datos numéricos , Humanos , Almacenamiento y Recuperación de la Información/métodosRESUMEN
In both Europe and North America, patients are beginning to gain access to their health records in electronic form. Using the open source cityEHR as an example, we have focussed on the needs of clinical users to gather requirements for patient access and have implemented these requirements in a new application called cityEHR-PA. The development of a separate application for patient access was necessary to address requirements for security and ease of use. The use of open standards throughout the design of the EHR allows the possibility of third parties to develop applications for patient access, consuming the individual patient record extracted from the full EHR.
Asunto(s)
Confidencialidad/normas , Registros Electrónicos de Salud/normas , Estándar HL7/normas , Acceso de los Pacientes a los Registros/normas , Portales del Paciente/normas , Guías de Práctica Clínica como Asunto , Reino UnidoRESUMEN
The open source cityEHR system was evaluated as a toolkit for clinician-led development of an Electronic Health Record for management of patients in the Ponseti clinic of a major London hospital. As a toolkit, it was found that the ontology-driven approach of cityEHR was too complex for clinicians to use. The toolkit was refined to use more familiar spreadsheet s to represent the ontology and was then used successfully to create an effective clinical system, generated automatically from the information model.