Review of data quality assessment frameworks experiences around Europe

In the first phase of its work, WP6 has explored and synthesized existing knowledge and experiences on data quality assurance frameworks (DQAFs) in the context of cross-border sharing of federated secondary use health data. Our aim was to identify good practices within this area and develop a first set of corresponding recommendations. The recommendations reflect the synthesis of results from three parallel lines of work, each utilizing a different methodology: a) thematic workshops and partner meetings, b) analysis of existing data-sharing initiatives, and c) a scoping literature review. Our analysis of literature and existing health data initiatives suggest that currently deployed DQAFs cannot as such serve as platforms or models for an EHDS-wide data quality solution. There is an agreement in principle, that reliability, relevance, timeliness, coherence, coverage and completeness should be incorporated in a DQAF as measurable dimensions of data quality. We aim towards a working definition of data quality, which will be able to reflect the reality of the data, as well as its fitness for purpose from the perspective of potential users.

• We recommend focusing efforts on transparency at the level of data holder institutions across Member States in relation to adoption of regular audits, a well-developed DQAF and clear procedures with regard to processing the data.

• In the medium to longer-term EHDS nodes could promote and support the development of a benchmarking process, which will assist data managers and data holder institutions with alignment against a Europe-wide approach to measuring data quality within and across Member States.

Review of interoperability standards as data quality supporting elements

WP6 has approached the target of supporting trustworthy secondary use of health and health care data through two operational objectives: developing the EHDS data quality assurance framework for real-world health data and developing the EHDS secondary use Semantic Interoperability Framework. For the latter objective, several interoperability standards were identified in accordance with the EHDS2 data life cycle and user's journey approach, hence focusing on data discoverability (at data source and variable levels), communication support across nodes and on development of common data models. Selection was based on active participation of WP6 leaders in various pertinent workshops and interactive activities, both in the framework of TEHDAS (Stakeholder and Project Forum meetings) as well as other relevant initiatives (e.g. the PHIRI project). Input was also sought from Commission representatives and EU-level regulatory authorities. In a first step, standards were catalogued based of features such as typology of interest, utility and application domains. In the next phase we organised virtual semi-structured interviews with key representatives of over 20 standards (incl. HL7, SNOMED, CDISC, DCAT, OMOP etc.). The focus of the interviews targeted experiences in standards’ actual use, challenges in their implementation, issues of maintenance and sustainability, as well as undergoing collaborations and developments. Sessions were recorded and subsequently the transcripts of discussion extracted automatically. The process of analysing interview materials is presently ongoing, using an adapted version of the Common Assessment Method for Standards and Specifications (CAMSS) v.4.0.0. toolkit. Interim results will be discussed within the Joint Action meeting activities in June 2022, to produce a version for wider stakeholder dialogue later in the fall. Results and recommendations generated through this process will also be presented for discussion with the workshop audience.

Injuries of adult asylum seekers in Finland: results of the 2018 TERTTU-health and well-being survey

Background

Injuries in refugees and asylum seekers result of accidents, violence or most extremely torture. Research in Finland has shown that many refugees experienced major traumatic events in their former home country, incl. permanent injuries. Our study provides new evidence on asylum seekers, a scarcely studied group.

Methods

Data was collected by structured face-to-face interviews. Healthcare staff asked adult participants if they had a bodily injury or scar. If yes, they pointed the location on a pictogram. Interviewers inquired if the injury was accidental or result of violence and if it happened before or during the fleeing trip. Injuries were classified as head (incl. brain) injuries, injuries of torso/extremities or other body areas.

Results

About half (47, 2 %) of 779 adults reported injuries, men more often than women (55,1 % vs. 35,3 %). Frequency was highest in 18-29-year olds. Close to all respondents (94 %) sustained injuries prior to their journey. Over one in five attributed injuries to accident (men 27 %, women 16 %). 16,6 % reported the torso/extremities as injury location, while 9,4 % had head injuries. Violence was cause of injury in over one fourth of cases (28 %). Every third male and every fifth female were violence victims, with no significant age difference. In both genders odds of violence exposure was highest in asylum seekers from sub-Saharan Africa - over 50 % attributed injury to violence. Violence victims had injuries of torso/extremities in 20,5%, and of the head in 15,3%. Head injuries were more frequent in > 40 year-old violence victims of both genders.

Conclusions

Injuries are common among adult asylum seekers in Finland. Prevalence of violence induced injury, especially in sub-Saharan Africans, is alarming. Training in violence victims’ management is required for professionals receiving asylum seekers. Information on injury severity and functional ability is needed for full impact assessment and service planning (incl. rehabilitation).

Key messages

Injuries are common among adult asylum seekers and often a result of violence, thus requiring of receiving services’ professionals skills and knowledge in violence victims’ management. Health examination protocols of asylum seekers should include injury severity assessment and impact on functional ability.

Internet Health Resources: from Quality to Trust

Objectives: Quality of online health resources remains a much debated topic, despite considerable international efforts. The lack of a systematic and comprehensive conceptual analysis is hindering further progress. Therefore we aim at clarifying the origins, nature and interrelations of pertinent concepts. Further, we claim that quality is neither a necessary nor a sufficient condition for Internet health resources to produce an effect offline. As users’ trust is also required, we examine the relation of quality aspects to trust building online.

Methods: We reviewed and analyzed the key documentation and deliverables of quality initiatives, as well as relevant scientific publications. Using the insights of philosophy, we identified the elementary dimensions which underlie the key concepts and theories presented so far in the context of online health information quality. We examined the interrelations of various perspectives and explored how trust as a phenomenon relates to these dimensions of quality.

Results: Various aspects associated with the quality of online health resources originate from four conceptual dimensions: epistemic, ethical, economic and technological. We propose a conceptual framework that incorporates all these perspectives. We argue that total quality exists only if all four dimensions have been addressed adequately and that high total quality is conducive to warranted trust.

Conclusions: Quality and trust are intertwined, but distinct concepts, and their relation is not always straightforward. Ideally, trust should track quality. Apprehending the composition of these concepts will help to understand and guide the behavior of both users and providers of online information, as well as to foster warranted trust in online resources. The framework we propose provides a conceptual starting point for further deliberations and empirical work.

Electronic discharge summaries in cross-border care in the European Union: How close are we to making it happen?

Introduction

The political drive for cross-border care within the European Union and an increasing focus on integrated care both have implications for electronic health records. The hospital discharge summary is a critical component of systems to ensure quality and continuity of care, and in a cross-border setting would particularly benefit from an electronic version. We have explored the extent to which European Union level policy and practice on electronic health records address issues pertinent to the development and implementation of electronic discharge summaries for patients treated outside their own country.

Methods

We approached the topic by analysing data from two different sources: European Union policy documents on topics relevant to electronic health records and deliverables of European Union-funded electronic health record-focused research and development projects. Elements pertinent to different aspects of interoperability – legal, semantic and technical – were extracted from both sources and their content compared to assess the degree of consistency between policy and implementation targets.

Results

We identified 25 policy documents and 14 European Union-funded projects. Our results show that European legislation is increasingly aligned with projects funded through European Union sources and substantial progress has been accomplished in achieving electronic communication across European health systems. Nevertheless, the achievement of a European level interoperable discharge summary is still a distant goal, while inadequate attention has been paid to the coordination of current discharge summary practices in Member States.

Discussion

If the harmonized European Union patient summary is also to function as an electronic discharge summary, further specific steps are needed that address issues of both content and processes related to communication.

Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care

In this paper, we review the results of BIOINFOMED, a study funded by the European Commission (EC) with the purpose to analyse the different issues and challenges in the area where Medical Informatics and Bioinformatics meet. Traditionally, Medical Informatics has been focused on the intersection between computer science and clinical medicine, whereas Bioinformatics have been predominantly centered on the intersection between computer science and biological research. Although researchers from both areas have occasionally collaborated, their training, objectives and interests have been quite different. The results of the Human Genome and related projects have attracted the interest of many professionals, and introduced new challenges that will transform biomedical research and health care. A characteristic of the 'post genomic' era will be to correlate essential genotypic information with expressed phenotypic information. In this context, Biomedical Informatics (BMI) has emerged to describe the technology that brings both disciplines (BI and MI) together to support genomic medicine. In recognition of the dynamic nature of BMI, institutions such as the EC have launched several initiatives in support of a research agenda, including the BIOINFOMED study.

Internet health resources: from quality to trust

OBJECTIVES

Quality of online health resources remains a much debated topic, despite considerable international efforts. The lack of a systematic and comprehensive conceptual analysis is hindering further progress. Therefore we aim at clarifying the origins, nature and interrelations of pertinent concepts. Further, we claim that quality is neither a necessary nor a sufficient condition for Internet health resources to produce an effect offline. As users' trust is also required, we examine the relation of quality aspects to trust building online.

METHODS

We reviewed and analyzed the key documentation and deliverables of quality initiatives, as well as relevant scientific publications. Using the insights of philosophy, we identified the elementary dimensions which underlie the key concepts and theories presented so far in the context of online health information quality. We examined the interrelations of various perspectives and explored how trust as a phenomenon relates to these dimensions of quality.

RESULTS

Various aspects associated with the quality of online health resources originate from four conceptual dimensions: epistemic, ethical, economic and technological. We propose a conceptual framework that incorporates all these perspectives. We argue that total quality exists only if all four dimensions have been addressed adequately and that high total quality is conducive to warranted trust.

CONCLUSIONS

Quality and trust are intertwined, but distinct concepts, and their relation is not always straightforward. Ideally, trust should track quality. Apprehending the composition of these concepts will help to understand and guide the behavior of both users and providers of online information, as well as to foster warranted trust in online resources. The framework we propose provides a conceptual starting point for further deliberations and empirical work.

Towards personalized Internet health information: the STEPPS architecture

PRIMARY OBJECTIVE

STEPPS (STructured Evaluated Personalized Patient Support) proposes a strategy for integration of electronic patient records with Internet health-related content and its consequent use in personalized information retrieval for patient education. The application domain is the post-discharge support of burn patients in the Netherlands.

MATERIALS AND METHODS

We developed an electronic patient record interface for structured data collection in burn care. The system's thesaurus was projected to UMLS terms and the corresponding codes were incorporated in our software. A list of topics central to burn patient education was identified and a collection of related Web pages was compiled using meta-search software (Copernic2001Pro). The HTML pages were filed into catalogues by the Collexis indexing-matching software, using the UMLS Metathesaurus as indexing vocabulary.

RESULTS

The bilingual (English and Dutch) structured data interface is currently used to create a database of retrospective patient data. Each patient's profile, i.e. set of characteristics employed to personalize information retrieval, can be automatically extracted. We have assembled a collection of more than 2500 Internet pages containing relevant information for burn patients. When patient data is available, the Collexis matching engine will accept the patient's profile as input and retrieve the most relevant HTML documents available in the catalogues.

DISCUSSION

We have addressed some basic issues around the technical feasibility of linking electronic patient record data to online content. Although the functionality of STEPPS is not yet optimal, it contributes to the efforts towards improved relevance of information retrieval. Electronic patient record applications in conjunction with Internet resources can give a significant boost to the availability of tailored health education material. In this context, quality assurance of online health information is an indispensable element.

Structured physical examination data: a modeling challenge

The success of systems facilitating collection of structured data by clinicians is largely dependent on the flexibility of the interface. The Open Record for CAre (ORCA) makes use of a generic model to support knowledge-based structured data entry for a variety of medical domains. An endeavor undertaken recently aimed to cover the broader area of Physical Examination by expanding the contents of the knowledge base. The model was found to be adequately expressive for supporting this task. Maintaining the balance between flexibility of the interface and constraints dictated by reliable retrieval, however, proved to be a considerable challenge. In this paper we illustrate through specific examples the effect of this trade off on the modeling process, together with the rationale for the chosen solutions and suggestions for future research focus.

Rx medication information for the public and the WWW: quality issues

Misuse of prescription medications is a serious problem largely due to lack of information. Lay users are making use of resources available on the World Wide Web in order to bridge this information gap. It has already been noted though that health and medicine oriented sites present serious shortcomings with regard to quality and reliability of their content. In this review, checklists were used to determine to which extent the criteria suggested for quality evaluation of on-line health information are observed by sites offering information on Rx medications to the public. Also evaluated was the sites' comprehensiveness in coverage of important subject specific topics. The reviewed sites met inadequately the proposed quality criteria and presented significant variations in their coverage of the subject. Evaluation of information accuracy remains an unresolved problem in quality assessment, while techniques for automated review and retrieval are urgently needed. In the meantime, though, quality guidelines could prove more useful in getting valuable feedback from information providers and lay users alike, improving quality of information at its point of production.