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Representing a chemotherapy guideline using openEHR and rules
Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska högskolan.
Department of Oncology, Uppsala University, Sweden.
Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska högskolan.
2009 (Engelska)Ingår i: Medical Informatics in a United and Healthy Europe / [ed] Klaus-Peter Adlassnig, Bernd Blobel, John Mantas, Izet Masic, IOS Press, 2009, Vol. 150, s. 653-657Konferensbidrag, Publicerat paper (Refereegranskat)
Abstract [en]

Computerized guidelines can provide decision support and facilitate the use of clinical guidelines. Several computerized guideline representation models (GRMs) exist but the poor interoperability between the guideline systems and the Electronic Health Record (EHR) systems limits their clinical usefulness. In this study we analyzed the clinical use of a published lymphoma chemotherapy guideline. We found that existing GRMs have limitations that can make it difficult to meet the clinical requirements. We hypothesized that guidelines could be represented as data and logic using openEHR archetypes, templates and rules. The design was tested by implementing the lymphoma guideline. We conclude that using the openEHR models and rules to represent chemotherapy guidelines is feasible and confers several advantages both from a clinical and from an informatics perspective.

Ort, förlag, år, upplaga, sidor
IOS Press, 2009. Vol. 150, s. 653-657
Serie
Studies in Health Technology and Informatics, ISSN 0926-9630 ; 150
Nationell ämneskategori
Data- och informationsvetenskap Medicinsk laboratorie- och mätteknik
Identifikatorer
URN: urn:nbn:se:liu:diva-21864DOI: 10.3233/978-1-60750-044-5-653ISI: 000326889500137ISBN: 978-1-60750-044-5 (tryckt)OAI: oai:DiVA.org:liu-21864DiVA, id: diva2:241840
Konferens
MIE 2009 – The XXIInd International Congress of the European Federation for Medical Informatics
Tillgänglig från: 2009-10-06 Skapad: 2009-10-06 Senast uppdaterad: 2018-01-13Bibliografiskt granskad
Ingår i avhandling
1. Towards interoperable and knowledge-based electronic health records using archetype methodology
Öppna denna publikation i ny flik eller fönster >>Towards interoperable and knowledge-based electronic health records using archetype methodology
2009 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The use of Electronic Health Records (EHR) is wide spread in healthcare today. EHRs are not only used to support daily care but also used to support important secondary uses, e.g. clinical research, quality assurance and education. Although considered advantageous compared to paper-based records, EHRs still have a long way to go in realizing its full potential as an integral part of a safe, effective and efficient health care system.

Making EHRs interoperable is a prerequisite to support increasingly distributed and diverse healthcare. Bringing up-to-date knowledge into EHRs for decision support is a critical step to foster evidence based care. EHR data from different sources need to be analyzed in research in order to find new evidence for improvement of the current practice. Knowledge in the form of guidelines needs to be disseminated and applied in practice through continuous education. This cyclic flow of information and knowledge between care, research and education must be facilitated in order to achieve a safer and more efficient healthcare. An interoperable EHR framework can facilitate the sharing of information and knowledge between not only human users but also participating software systems. This is the aim of this thesis, which is built upon the research in the field of semantic interoperability, in particular the pioneering work by the openEHR Foundation.

The journey of this thesis started with a template-based supplementary EHR system - Julius, which allows clinicians to define and share record structures for care and research. The formalism behind Julius is comparable to the openEHR archetype formalism but less expressive and without the backing of international standards. This finding led to an open source implementation of the openEHR design, which in turn initiated the validation and further improvements of the archetype formalism. The software components made the archetype formalism more accessible to academic and commercial projects around the world.

The investigation of the convertibility between a legacy EHR content model and the archetype model showed that the archetype format is more expressive and thus can be used to preserve legacy EHR content definitions. A general strategy for migration from legacy EHRs to archetype-based EHRs was formulated. A novel way of representing clinical practice guidelines using archetype formalism was proposed and tested on a lymphoma chemotherapy guideline. The implication of this study is improved interoperability between guidelines and EHRs that could facilitate both clinical decision support and guideline-compliance checking. Maintainability of guidelines could be increased through reuse of EHR content models as building blocks of guidelines. In the last part of the research, a way of expressing fully structured care plans using openEHR and CONTsys has been explored based on the requirements for elderly home care. A sharable and semantically well-defined care plan could contribute to the coordination of shared care.

The key contribution of the thesis can be summarized as the validation and further improvement of the openEHR archetype formalism through software implementation and the explorations on clinical guidelines, shared care plans and legacy EHR content models in relation to archetypebased EHR framework.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2009. s. 44
Serie
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1280
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-54822 (URN)978-91-7393-504-3 (ISBN)
Disputation
2009-11-05, Eken, Campus US, Linköpings universitet, Linköping, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2010-04-14 Skapad: 2010-04-14 Senast uppdaterad: 2012-11-15Bibliografiskt granskad

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Chen, RongÅhlfeldt, Hans

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Data- och informationsvetenskapMedicinsk laboratorie- och mätteknik

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