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Approaches to learning openEHR: a qualitative survey, observations, and suggestions
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
2016 (English)In: Proceedings from the 14th Scandinavian Conference on Health Informatics 2016: Gothenburg, Sweden, April 6-7 2016 / [ed] Daniel Karlsson, Andrius Budrionis, Ann Bygholm, Mariann Fossum, Conceicao Granja, Gunnar Hartvigsen, Ole Hejlesen, Maria Hägglund, Monika Alise Johansen, Carl E Moe, Luis Marco-Ruiz, Vivian Vimarlund, Kassaye Y Yigzaw, Linköping: Linköping University Electronic Press, 2016, Vol. 122, 29-36 p.Conference paper, Published paper (Refereed)
Abstract [en]

Approaches such as ISO 13606 and openEHR aim to address data reusability by defining clinical data structures called archetypes and templates, based on a reference model. A problem with these approaches is that parts of them currently are rather difficult to learn. It can be hard to imagine what an archetype-based clinical system combined with modern terminology systems will look like and what consequences different modeling choices have, without seeing and experimenting with an operational system. This paper reports findings from a survey among openEHR learners and educators combined with observations of related openEHR mailing list discussions. The paper ends with an opinion piece, where we discuss potentially fruitful ways to learn, explore, and extend archetype-based EHR systems using visualization and examples.The findings highlight potential stumble blocks and solutions and should be of interest for both educators and self-learners.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. Vol. 122, 29-36 p.
Series
Linköping Electronic Conference Proceedings, ISSN 1650-3686 (print), 1650-3740 (online) ; 122
Keyword [en]
Electronic Health Records; Software; Learning; Standards
National Category
Information Systems
Identifiers
URN: urn:nbn:se:liu:diva-87701Libris ID: 19667500ISBN: 9789176857762 (print)OAI: oai:DiVA.org:liu-87701DiVA: diva2:599726
Conference
The 14th Scandinavian Conference on Health Informatics 2016, Gothenburg, Sweden, April 6-7 2016
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2016-09-14Bibliographically approved
In thesis
1. Scalability and Semantic Sustainability in Electronic Health Record Systems
Open this publication in new window or tab >>Scalability and Semantic Sustainability in Electronic Health Record Systems
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This work is a small contribution to the greater goal of making software systems used in healthcare more useful and sustainable. To come closer to that goal, health record data will need to be more computable and easier to exchange between systems.

Interoperability refers to getting systems to work together and semantics concerns the study of meanings. If Semantic interoperability is achieved then information entered in one information system is usable in other systems and reusable for many purposes. Scalability refers to the extent to which a system can gracefully grow by adding more resources. Sustainability refers more to how to best use available limited resources. Both aspects are important.

The main focus and aim of the thesis is to increase knowledge about how to support scalability and semantic sustainability. It reports explorations of how to apply aspects of the above to Electronic Health Record (EHR) systems, associated infrastructure, data structures, terminology systems, user interfaces and their mutual boundaries.

Using terminology systems is one way to improve computability and comparability of data. Modern complex ontologies and terminology systems can contain hundreds of thousands of concepts that can have many kinds of relationships to multiple other concepts. This makes visualization challenging. Many visualization approaches designed to show the local neighbourhood of a single concept node do not scale well to larger sets of nodes. The interactive TermViz approach described in this thesis, is designed to aid users to navigate and comprehend the context of several nodes simultaneously. Two applications are presented where TermViz aids management of the boundary between EHR data structures and the terminology system SNOMED CT.

The amount of available time from people skilled in health informatics is limited. Adequate methods and tools are required to develop, maintain and reuse health-IT solutions in a sustainable way. Multiple levels of modelling including a fixed reference model and another layer of flexible reusable ‘archetypes’ for domain specific data structures, is an approach with that aim used in openEHR and the ISO 13606 standard. This approach, including learning, implementing and managing it, is explored from different angles in this thesis. An architecture applying Representational State Transfer (REST) to archetype-based EHR systems, in order to address scalability, is presented. Combined with archetyping this architecture also aims at enabling a sustainable way of continuously evolving multi-vendor EHR solutions. An experimental open source implementation of it, aimed for learning and prototyping, is also presented.

Manually changing database structures used for storage every time new versions of archetypes and associated data structures are needed is likely not a sustainable activity. Thus storage systems that can handle change with minimal manual interventions are desirable. Initial explorations of performance and scalability in such systems are also reported

Graphical user interfaces focused on EHR navigation, time-perspectives and highlighting of EHR content are also presented – illustrating what can be done with computable health record data and the presented approaches.

Desirable aspects of semantic sustainability have been discussed, including: sustainable use of limited resources (such as available time of skilled people), and reduction of unnecessary risks. A semantic sustainability perspective should be inspired and informed by research in complex systems theory, and should also include striving to be highly aware of when and where technical debt is being built up. Semantic sustainability is a shared responsibility.

The combined results presented contribute to increasing knowledge about ways to support scalability and semantic sustainability in the context of electronic health record systems. Supporting tools, architectures and approaches are additional contributions.

Abstract [sv]

Syftet med denna avhandling är ytterst att göra informationssystem som används i hälso- och sjukvård, särskilt patientjournaler, mer användbara och lättarbetade. Om systemen vore lättare att utveckla och underhålla skulle fler resurser kunna läggas på att tillföra nya och mer användarvänliga funktioner.

Om journalsystem och datorprogram kan ”begripa” vad olika saker i journalen är och betyder så kan de vara till större hjälp, t.ex. genom att visa bättre patientöversikter och bidra med beslutsstöd. En del i att göra journalinnehållet begripligt och hanterbart för datorer är att använda sig av terminologisystem som t.ex. ICD-10 och SNOMED CT. En annan viktig del är datastrukturerna där man stoppar in text, mätvärden, koderna från terminologisystem etc. De flesta journalsystem har någon sorts mallar som datastrukturer. Projektet openEHR har tagit fram ett sätt att dela specifikationer av datastrukturer mellan olika journalsystem så att man lättare kan dela och återanvända dem och den journaldata som matats in i dem. Dessa specifikationer kallas ”arketyper” och arketyp-metoden beskrivs även i standarden ISO 13606.

Om två olika journalsystem använder samma datastruktur, t.ex. med hjälp av samma arketyper, så kan de utväxla patientdata mellan varandra (de uppnår s.k. semantisk interoperabilitet). Begreppet ”Semantic sustainability” definieras i avhandlingen som ett förhållningssätt som är bredare än semantisk interoperabilitet. Det syftar till att möjliggöra långsiktigt hållbar utveckling av semantik (betydelse) i journalsystem och genom att hantera risker och resurser förståndigt. Förhållningssättet baserar sig på forskning och erfarenheter från systemutveckling och hantering av komplexa system och är avsett att stödja beslutsfattare, och de som utvecklar och underhåller journalsystem, relaterade system och strukturer.

För att datorsystem ska kunna växa vid ökad användning ,utan att hamna i återvändsgränder avseende prestanda, så bör vissa designprinciper för skalbarhet följas. Avhandlingen presenterar en systemarkitektur baserad på sådana principer och på arketyp-metoden. Denna arkitektur gör det möjligt att bygga system med delsystem från flera olika leverantörer. Skalbarheten i några lagringslösningar redovisas också.

Slutligen redovisas prototyper av gränssnitt för patientöversikter och journalläsning.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 204 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1499
National Category
Information Systems Other Medical Sciences not elsewhere specified Other Computer and Information Science Human Computer Interaction
Identifiers
urn:nbn:se:liu:diva-87702 (URN)978-91-7519-699-2 (ISBN)
Public defence
2013-02-15, Berzeliussalen, Campus US, Universitetssjukhuset, Linköping, 09:15 (English)
Opponent
Supervisors
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2014-10-08Bibliographically approved

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