ELGA Terminology Server for Clinical Decision Support: A Case-Study Using an Existing Knowledge Base, CDS Hooks and FHIR

BACKGROUND

There are many medical knowledge bases with potential for supporting medical professionals in their decision-making during routine care, yet usage of these sources remains low. Standardized linking of Clinical Decision Support (CDS) applications and existing medical knowledge bases is not a common practice.

OBJECTIVES

Using existing eHealth standards to increase the utilization of knowledge bases and implement a prototype.

METHODS

Linking an existing online knowledge base via a FHIR CodeSystem supplement to the Austrian national EHR (ELGA) terminology server and accessing these data using CDS Hooks and FHIR.

RESULTS

We tested the approach by incorporating photosensitivity data of medications into a local copy of the Austrian terminology server. These data are directly used by a CDS Hooks compliant CDS service.

CONCLUSION

The Austrian Terminology Server could be an important interface to access existing knowledge bases from within EHR systems. FHIR and CDS Hooks could lead the way for a simple and open integration of CDS services into EHR systems.

The experiences of hospitals in changing the function of a non-teaching hospital to a teaching hospital: Short-Communication

Background

In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran.

Methods

A Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis.

Results

According to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client's costs, considering increase management team' legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of non-teaching to teaching hospital.

Conclusion

Important matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals.

The Iranian Integrated Care Electronic Health Record

E-health plays a crucial role in E-government by proposing healthcare services based on information technology. However, the way to administer these services by using E-health solutions is one of the challenging issues. One of these significant challenges is how one integrates heterogeneous healthcare information of the different point of care systems. This paper introduces the Iranian integrated care electronic health record using the information gathered from several point-of-care systems in healthcare enterprises in Iran. This service-oriented architecture has a remarkable characteristic - its accessibility to medical knowledge and medical concepts through archetypes and ontology, respectively. The Ministry of Health and Medical Education of the Islamic Republic of Iran has designed and implemented this national architecture.

Interactive Machine Learning for Laboratory Data Integration

Laboratory data collected in the electronic health record as part of routine care can be used in secondary research. For example, the US Department of Veterans Affairs maintains a data warehouse covering over 20 million individuals and 6.6 billion lab tests. However, data aggregation in such a data warehouse can be difficult. In order to retrieve all or nearly all of one type of lab result with a high degree of precision, we perform clinical concept adjudication, which is the process of an expert determining which database records correspond to a target clinical concept. In this work, we develop an interactive machine learning tool to "extend the reach" of expert laboratory test adjudicators. Our tool provides access to automatic laboratory classification in a user-facing front end that covers all steps in an adjudication workflow, in order to lower barriers to collaboration, increase transparency of adjudication, and to promote efficiencies and data reuse.

Using Health Information Exchange: Usability and Usefulness Evaluation

Health information exchange (HIE) is implemented in Quebec, Canada to improve the exchange and use of clinical information for decision making in the province's health care system. The objective of this mixed-method approach study was to evaluate the usage, usability, and usefulness of an electronic health record (EHR) to access and import clinical information from a centralized HIE. First, a heuristic analysis was performed of three different commercial EHRs, using end users to analyze the integration feature through think aloud protocols. Second, interviews were conducted with advanced users to describe the usefulness. Third, usage data were analyzed to describe the level of use of each data domain, per EHR and user. The results show that usefulness is high for medication data; leading to greater use of this domain, its relation to integration, and meets the needs of general practitioners. Difficulties in the implementation processes reduced the potential of this system.

Next Generation EHRs - What Problems Are These Systems Aiming to Solve?

EHRs elicit an array of different aspirations all underpinned by the widely held conviction that they can deliver benefits for patients, clinicians, researchers, IT vendors, policy-makers and society as a whole. While techno-centric visions abound, reflection on their history, the challenges evident in their design, implementation and evaluation and the limited evidence of their beneficial impacts over time is instructive. From a socio-technical perspective EHRs appear to be a set of 'wicked problems' unlikely to be resolved in favor of one position or another, but rather requiring judgement, nuance and negotiation around the kinds of problems we want these systems to solve. This paper presents some perspectives on important potential features for next generation EHRs and on the types of problems that these systems could aspire to solve. The focus is not on prediction but rather on actively shaping the kind of future that we desire and how EHRs will support its achievement.

Successful Public Health Information System Database Integration Projects: A Qualitative Study

Objective

To explore the most important public health information system database integration project success factors to include: technological, organizational, project-specific, or external.

Methods

This study involved a cross-case design. Cases were identified through literal replication logic and screened through a survey and review of available literature. Study participants were interviewed through hour-long sessions steered by a semi-structured guide. Survey responses, interview transcripts and available documents were coded and analyzed deductively, and matrices were developed to illustrate relationships.

Results

Leadership among the project’s participants is the most important integration project success factor. This leadership factor manifests in the following ways. Executive sponsors champion the initiative. Informaticians facilitate communication and system requirement collection. Program directors contribute substantive energy to the project and remove obstacles. Some other factors also contribute to project success. For example, strong Financial Management and Support promotes project initiation. Technological aspects impact the final product’s quality. Utilizing formal project management techniques, particularly the Agile software development methodology, contributes to successful project resolution by ensuring daily operational effectiveness.

Discussion

The principal finding illustrates important contributions by project leaders, transcending those of the executive sponsor. Other participants, notably informaticians and program directors, substantially contribute to the project’s success. Additionally, the Agile software development methodology is emerging as a successful approach to project management for these and related projects.

Conclusion

Investing in the leadership and project management skills of database integration project participants could improve the success of future projects. State health department staff considering these projects should carefully select project participants and train them accordingly.

Li2b2-Façade: Simulation of i2b2 Data Warehouse Server and Client for Interaction with Other Systems

Since its release in 2004, the i2b2 data warehouse software has become a valuable tool for clinical researchers. Physicians can use its browser-based query frontend intuitively without additional training or reading through documentation. While the i2b2 software describes it's API as "REST", it is neither stateless nor does it follow the common guidelines for RESTful APIs. Thus, interfacing other software with i2b2's custom RPC-style XML-API is a very cumbersome process. To overcome these issues, we developed a lightweight software abstraction layer "lightweight i2b2 façade" (li2b2-façade).

Implementation of hospital examination reservation system using data mining technique

Objectives

New methods for obtaining appropriate information for users have been attempted with the development of information technology and the Internet. Among such methods, the demand for systems and services that can improve patient satisfaction has increased in hospital care environments.

Methods

In this paper, we proposed the Hospital Exam Reservation System (HERS), which uses the data mining method. First, we focused on carrying clinical exam data and finding the optimal schedule for generating rules using the multi-examination pattern-mining algorithm. Then, HERS was applied by a rule master and recommending system with an exam log. Finally, HERS was designed as a user-friendly interface.

Results

HERS has been applied at the National Cancer Center in Korea since June 2014. As the number of scheduled exams increased, the time required to schedule more than a single condition decreased (from 398.67% to 168.67% and from 448.49% to 188.49%; p < 0.0001). As the number of tests increased, the difference between HERS and non-HERS increased (from 0.18 days to 0.81 days).

Conclusions

It was possible to expand the efficiency of HERS studies using mining technology in not only exam reservations, but also the medical environment. The proposed system based on doctor prescription removes exams that were not executed in order to improve recommendation accuracy. In addition, we expect HERS to become an effective system in various medical environments.

Taking advantage of continuity of care documents to populate a research repository

OBJECTIVE

Clinical data warehouses have accelerated clinical research, but even with available open source tools, there is a high barrier to entry due to the complexity of normalizing and importing data. The Office of the National Coordinator for Health Information Technology's Meaningful Use Incentive Program now requires that electronic health record systems produce standardized consolidated clinical document architecture (C-CDA) documents. Here, we leverage this data source to create a low volume standards based import pipeline for the Informatics for Integrating Biology and the Bedside (i2b2) clinical research platform. We validate this approach by creating a small repository at Partners Healthcare automatically from C-CDA documents.

MATERIALS AND METHODS

We designed an i2b2 extension to import C-CDAs into i2b2. It is extensible to other sites with variances in C-CDA format without requiring custom code. We also designed new ontology structures for querying the imported data.

RESULTS

We implemented our methodology at Partners Healthcare, where we developed an adapter to retrieve C-CDAs from Enterprise Services. Our current implementation supports demographics, encounters, problems, and medications. We imported approximately 17 000 clinical observations on 145 patients into i2b2 in about 24 min. We were able to perform i2b2 cohort finding queries and view patient information through SMART apps on the imported data.

DISCUSSION

This low volume import approach can serve small practices with local access to C-CDAs and will allow patient registries to import patient supplied C-CDAs. These components will soon be available open source on the i2b2 wiki.

CONCLUSIONS

Our approach will lower barriers to entry in implementing i2b2 where informatics expertise or data access are limited.

Query Health: standards-based, cross-platform population health surveillance

OBJECTIVE

Understanding population-level health trends is essential to effectively monitor and improve public health. The Office of the National Coordinator for Health Information Technology (ONC) Query Health initiative is a collaboration to develop a national architecture for distributed, population-level health queries across diverse clinical systems with disparate data models. Here we review Query Health activities, including a standards-based methodology, an open-source reference implementation, and three pilot projects.

MATERIALS AND METHODS

Query Health defined a standards-based approach for distributed population health queries, using an ontology based on the Quality Data Model and Consolidated Clinical Document Architecture, Health Quality Measures Format (HQMF) as the query language, the Query Envelope as the secure transport layer, and the Quality Reporting Document Architecture as the result language.

RESULTS

We implemented this approach using Informatics for Integrating Biology and the Bedside (i2b2) and hQuery for data analytics and PopMedNet for access control, secure query distribution, and response. We deployed the reference implementation at three pilot sites: two public health departments (New York City and Massachusetts) and one pilot designed to support Food and Drug Administration post-market safety surveillance activities. The pilots were successful, although improved cross-platform data normalization is needed.

DISCUSSIONS

This initiative resulted in a standards-based methodology for population health queries, a reference implementation, and revision of the HQMF standard. It also informed future directions regarding interoperability and data access for ONC's Data Access Framework initiative.

CONCLUSIONS

Query Health was a test of the learning health system that supplied a functional methodology and reference implementation for distributed population health queries that has been validated at three sites.

Auditing the multiply-related concepts within the UMLS

OBJECTIVE

This work focuses on multiply-related Unified Medical Language System (UMLS) concepts, that is, concepts associated through multiple relations. The relations involved in such situations are audited to determine whether they are provided by source vocabularies or result from the integration of these vocabularies within the UMLS.

METHODS

We study the compatibility of the multiple relations which associate the concepts under investigation and try to explain the reason why they co-occur. Towards this end, we analyze the relations both at the concept and term levels. In addition, we randomly select 288 concepts associated through contradictory relations and manually analyze them.

RESULTS

At the UMLS scale, only 0.7% of combinations of relations are contradictory, while homogeneous combinations are observed in one-third of situations. At the scale of source vocabularies, one-third do not contain more than one relation between the concepts under investigation. Among the remaining source vocabularies, seven of them mainly present multiple non-homogeneous relations between terms. Analysis at the term level also shows that only in a quarter of cases are the source vocabularies responsible for the presence of multiply-related concepts in the UMLS. These results are available at: http://www.isped.u-bordeaux2.fr/ArticleJAMIA/results_multiply_related_concepts.aspx.

DISCUSSION

Manual analysis was useful to explain the conceptualization difference in relations between terms across source vocabularies. The exploitation of source relations was helpful for understanding why some source vocabularies describe multiple relations between a given pair of terms.

Web-based integrated public healthcare information system of Korea: development and performance

OBJECTIVES

The Web-based integrated public healthcare information system (PHIS) of Korea was planned and developed from 2005 to 2010, and it is being used in 3,501 regional health organizations. This paper introduces and discusses development and performance of the system.

METHODS

We reviewed and examined documents about the development process and performance of the newly integrated PHIS. The resources we analyzed the national plan for public healthcare, information strategy for PHIS, usage and performance reports of the system.

RESULTS

The integrated PHIS included 19 functional business areas, 47 detailed health programs, and 48 inter-organizational tasks. The new PHIS improved the efficiency and effectiveness of the business process and inter-organizational business, and enhanced user satisfaction. Economic benefits were obtained from five categories: labor, health education and monitoring, clinical information management, administration and civil service, and system maintenance. The system was certified by a patent from the Korean Intellectual Property Office and accredited as an ISO 9001. It was also reviewed and received preliminary comments about its originality, advancement, and business applicability from the Patent Cooperation Treaty. It has been found to enhance the quality of policy decision-making about regional healthcare at the self-governing local government level.

CONCLUSIONS

PHIS, a Web-based integrated system, has contributed to the improvement of regional healthcare services of Korea. However, when it comes to an appropriate evolution, the needs and changing environments of community-level healthcare service and IT infrastructure should be analyzed properly in advance.