The qualculative dimension of healthcare data interoperability

Data work and practices in healthcare: A scoping review

CONTEXT

In healthcare, digitization has been widespread and profound, entailing a deluge of data. This has spurred ambitions for healthcare to become data-driven to improve efficiency and quality, and within medicine itself to improve diagnosing and treating diseases. The generation and processing of data requires human intervention and work, though this is often not acknowledged.

PURPOSE

The paper investigates who, where, by which means, and for which purposes data work is conducted which is crucial for healthcare managers and policy makers if ambitions to become data-driven are to succeed. To guide further research, it also provides an overview of existing research on data work and practices.

METHODS

We conducted a scoping review based on a search for papers including the terms healthcare or health care combined with at least one of the following terms: data work, data worker*, data practice*, data practitioner* in Scopus and Web of Science. 74 papers on data work or practices in healthcare were included.

ANALYSIS

The 74 papers were coded and analyzed regarding the following themes: the kind of data workers and practitioners, organizational settings, involved technologies, purposes, data work tasks, theories and concepts, and definitions of data work and practice.

RESULTS

Data work is pervasive in healthcare and conducted by various professions and people and in various contexts. The field researching data work and practices is emerging, with publications spread across multiple venues. and there is a need for more precise definitions of data work. Further, data work and practices are useful concepts that have enabled the exploration of those efforts and tasks in detail.

CONCLUSION

The research on data work and practices in healthcare is emerging and promising. We call for more research to consolidate the field and to better understand and support the work needed for healthcare to become data-driven.

Wireless standard-compliant e-health solution for elderly people with multiuser identification

Objective

One of the main problems in e-health environments for developing an accurate multiuser identification is in the large number of patients, especially with itinerant medical devices and elderly people. This paper aims to contribute with two approaches to be included in ISO/IEEE 11073 family of standards as a standardized procedure for multiuser identification that can be used for a large variety of medical devices, regardless of their brand or model. From this contribution and to validate it, this work proposes a standardized e-health solution, including multiuser identification, implementing it in real health environments for elderly people, and evaluating their usability, interoperability, and adoption in daily living.

Materials and methods

This works implements the internationally recommended Personal Health Devices ISO/IEEE 11073 standards as a multiplatform environment (Windows/Linux/Mac OS) and fulfils the paradigms of scalability, modularity, portability, maintainability, and robustness. The standard e-health solution has been implemented in 26 health environments in several cities in Spain (Madrid, Barcelona, Sevilla, Zaragoza, etc.), consisting of 118 health professionals, 319 senior patients, and 18 technical professionals.

Results

The proposed multiuser identification reduces the human error rate (from 13.3% to less than 5%) with positive evaluation: almost 70% of users are satisfied, with usability and time savings that are more than 50% in all the groups (nursing, medicine, and caregiving) and environments (residences, health centres, and hospitals).

Discussion

The use of e-health solutions within multiuser identification, as it is proposed through two standard-compliant approaches, permits advanced services and data analysis for a large variety of medical devices, regardless of their brand or model.

Conclusion

This paper contributes an open interoperable e-health solution as alternative to the closed and commercial solutions and enables third-party developers to work collaboratively and extend the already implemented features, owing to the design based on plugins, value-added services, and multiple transport technologies and protocols.

Interoperability of heterogeneous health information systems: a systematic literature review

BACKGROUND

The lack of interoperability between health information systems reduces the quality of care provided to patients and wastes resources. Accordingly, there is an urgent need to develop integration mechanisms among the various health information systems. The aim of this review was to investigate the interoperability requirements for heterogeneous health information systems and to summarize and present them.

METHODS

In accordance with the PRISMA guideline, a broad electronic search of all literature was conducted on the topic through six databases, including PubMed, Web of science, Scopus, MEDLINE, Cochrane Library and Embase to 25 July 2022. The inclusion criteria were to select English-written articles available in full text with the closest objectives. 36 articles were selected for further analysis.

RESULTS

Interoperability has been raised in the field of health information systems from 2003 and now it is one of the topics of interest to researchers. The projects done in this field are mostly in the national scope and to achieve the electronic health record. HL7 FHIR, CDA, HIPAA and SNOMED-CT, SOA, RIM, XML, API, JAVA and SQL are among the most important requirements for implementing interoperability. In order to guarantee the concept of data exchange, semantic interaction is the best choice because the systems can recognize and process semantically similar information homogeneously.

CONCLUSIONS

The health industry has become more complex and has new needs. Interoperability meets this needs by communicating between the output and input of processor systems and making easier to access the data in the required formats.

Standard Document Development for Health Information Exchange in Korea

BACKGROUND

Health information exchange (HIE) allows healthcare providers to access a patient's medical information to improve patient care continuity. The standardized data realize the HIE values. Since the Health Level 7 Clinical Document Architecture (CDA) is flexible, implementation guides (IG) are needed for use cases. Although many CDA IGs have been developed, they did not describe how these CDA IGs were developed. A national CDA IG that meets the local requirements is demanded since the data differs according to the digital divide and social-cultural background of the country that wants to establish HIE. Due to their localized contents, other countries cannot directly adopt the published CDA IGs.

OBJECTIVES

We developed the national CDA IG, namely, Korean (K)-CDA IG that meets the local requirement, including reusable structured templates, value sets, and object identifiers (OIDs). We present a detailed description of the development process and the technical methods of the national CDA IG in the Korean context.

METHODS

The K-CDA IG was developed in the following stages: analysis, development, and evaluation. First, we investigated the health information environment and electronic health record (EHR) systems and conducted a gap analysis with published CDA IGs. Second, a templated CDA approach was taken for designing modular. Lastly, we consulted a technical advisory group for comments on the validity of the K-CDA IG.

RESULTS

A total of 35 CDA templates were developed. We improved 28 value sets of which 13 were Korea specific and 15 were based on the ones used in other IGs, and made a set of rules to establish the OID structure.

CONCLUSION

We presented the development process and the technical specifications of K-CDA IG. We explored how the results can be used as interoperability criteria in the national EHR systems certification program. Finally, we provided recommendations that could guide other entities planning their HIE programs.

'Is this something I should be worried about?': A study of nurses' recontextualisation work when making clinical decisions based on patient reported outcome data

As clinical care practices are becoming more digitalised, information about patients is increasingly being encoded as quantified data, and the processes of sorting data are often supported by algorithmic computations. One such practice becoming more prevalent across Western countries is the clinical use of Patient Reported Outcome (PRO) data. Drawing on ethnographic fieldwork carried out in a Danish setting among nurses managing PRO-based breast cancer follow-up, we examine how clinical decisions are made on the basis of PRO-data and what this requires from the nurses. By applying the concept of recontextualisation work as an analytical perspective, we shed light on the efforts of nurses when mobilising complementary information about patients in order to recontextualise the otherwise decontextualised data, thereby giving data practical value in clinical decision-making. Recontextualisation work, we show, is shaped by organisational structure, available resources, and nurses' professional capacity. Drawing analytical attention to the work of recontextualisation allows for a nuanced understanding of the efforts required to make data workable and hence what it takes to carry out clinical decisions in today's datafied healthcare system.