Det är glädjande att myndigheter nu äntligen tittar mer på internationellt delade detaljerade dokumentationsmodeller för innehåll i journaler. Vi hoppas att de ger tillräckligt kraftfulla och tydliga budskap så att de upphandlande vårdgivarna också ser vikten av detta. Om vi ska bli världsbäst på eHälsa krävs internationellt samarbete, skriver flera forskare i medicinsk informatik.

This study provides an experimental performance evaluation on population-based queries of NoSQL databases storing archetype-based Electronic Health Record (EHR) data. There are few published studies regarding the performance of persistence mechanisms for systems that use multilevel modelling approaches, especially when the focus is on population-based queries. A healthcare dataset with 4.2 million records stored in a relational database (MySQL) was used to generate XML and JSON documents based on the openEHR reference model. Six datasets with different sizes were created from these documents and imported into three single machine XML databases (BaseX, eXistdb and Berkeley DB XML) and into a distributed NoSQL database system based on the MapReduce approach, Couchbase, deployed in different cluster configurations of 1, 2, 4, 8 and 12 machines. Population-based queries were submitted to those databases and to the original relational database. Database size and query response times are presented. The XML databases were considerably slower and required much more space than Couchbase. Overall, Couchbase had better response times than MySQL, especially for larger datasets. However, Couchbase requires indexing for each differently formulated query and the indexing time increases with the size of the datasets. The performances of the clusters with 2, 4, 8 and 12 nodes were not better than the single node cluster in relation to the query response time, but the indexing time was reduced proportionally to the number of nodes. The tested XML databases had acceptable performance for openEHR-based data in some querying use cases and small datasets, but were generally much slower than Couchbase. Couchbase also outperformed the response times of the relational database, but required more disk space and had a much longer indexing time. Systems like Couchbase are thus interesting research targets for scalable storage and querying of archetype-based EHR data when population-based use cases are of interest.

Background: Growing populations of elderly patients with advanced stages of COPD or heart failure (HF) urge the need for specialized health care in the patients' home. A telemonitoring study has been initiated including patients using digital pens. Health care was provided by the specialized home care unit at a university hospital. Through an IT system the staff checked all daily patient reports. We hypothesized that the two groups of patients, advanced COPD or HF, would exhibit differences regarding exacerbations and the need of health care.

Objective: To study exacerbations of COPD or HF, and patient health care consumption.

Methods: A tele-monitoring system, the Health diary, which is based on digital pen technology, was employed. Exacerbations were identified using information provided through the telemonitoring system. Consumed health care was assessed as the number of patient contacts (home visits or telephone consultations).

Results: Presently, 33 patients with advanced disease are enrolled (13 COPD and 20 HF patients) of which 11 patients (6 COPD and 5 HF patients) have completed the 1-yr study period or have died during the study period (2 COPD and 4 HF patients). Exacerbations were 2.8 and 0.8 and patient contacts were 96 and 42 per COPD and HF patient, respectively. While HF patients were significantly older than COPD patients, the two groups demonstrated no difference regarding gender distribution and comorbidity.

Conclusions: COPD patients exhibit exacerbations more frequently and demand much more home health care than patients with HF do. It seems that this difference of health care consumption is mainly due to disease characteristics.

Objective To improve semantic interoperability of electronic health records (EHRs) by ontology-based mediation across syntactically heterogeneous representations of the same or similar clinical information. Materials and Methods Our approach is based on a semantic layer that consists of: (1) a set of ontologies supported by (2) a set of semantic patterns. The first aspect of the semantic layer helps standardize the clinical information modeling task and the second shields modelers from the complexity of ontology modeling. We applied this approach to heterogeneous representations of an excerpt of a heart failure summary. Results Using a set of finite top-level patterns to derive semantic patterns, we demonstrate that those patterns, or compositions thereof, can be used to represent information from clinical models. Homogeneous querying of the same or similar information, when represented according to heterogeneous clinical models, is feasible. Discussion Our approach focuses on the meaning embedded in EHRs, regardless of their structure. This complex task requires a clear ontological commitment (ie, agreement to consistently use the shared vocabulary within some context), together with formalization rules. These requirements are supported by semantic patterns. Other potential uses of this approach, such as clinical models validation, require further investigation. Conclusion We show how an ontology-based representation of a clinical summary, guided by semantic patterns, allows homogeneous querying of heterogeneous information structures. Whether there are a finite number of top-level patterns is an open question.

The relation between an information entity and its referent can be described as a second-order statement, as long as the referent is a type. This is typical for medical discourse such as diagnostic statements in electronic health records (EHRs), which often express hypotheses or probability assertions about the existence of an instance of, e.g. a disease type. This paper presents several approximations using description logics and a query language, the entailments of which are checked against a reference standard. Their pros and cons are discussed in the light of formal ontology and logic.

National eHealth – the strategy for accessible and secure information in health and social care – is a Swedish initiative aiming at improving information management within the healthcare and social services sector. SNOMED CT is one tool in this strategy. To gain experience from SNOMED CT implementation, the National Board of Health and Welfare (host of the National Release Center of SNOMED CT) funded a number of pilot projects during 2013. Our project was one of these, focusing on facilitation of information sharing by using SNOMED CT in two application areas as described below. Furthermore, the project initiated a dialog with the EHR vendor concerning future SNOMED CT implementation.

One area was transfer of discharge summaries from hospital care at Östergötland County Council to municipal home care. A discharge summary consists of a template with encoded headings, associated free text fields, and instructions about intended content. These headings were mapped to SNOMED CT.

The other area was transfer of information from the EHR system at hospitals in three counties to the Swedish Stroke Register, a national quality register. The specification of information requested by the register was analyzed. Then, an EHR template was outlined, taking into account the clinical stroke process requirements, quality register requirements, and the information model of the EHR system. The draft template was based on mappings to SNOMED CT to facilitate a mutually agreed template. That means a template common for the three county councils, as well as information transfer to the register, and at the same time reduce the need for double documentation, information searching and other manual routines.

Lessons learned include that mapping EHR template components and other EHR objects to SNOMED CT concepts holds potential benefits, regardless of whether one’s EHR system can handle mappings. Mapping activities may aid review and management of existing and development of new templates. Furthermore, mappings may be used as a common point of reference when information is shared. Mapping ambiguous template headings to SNOMED CT concepts was found to be time consuming and uncertain and mapping seems to be most useful when EHR contents are structured. These mapping source prerequisites imply that existing documentation practice needs to be revised and that organizations must support end users in that process. The project also concluded that mappings would be even more advantageous if EHR systems can handle mappings of different objects types. Organizations also need to allocate adequate resources for managing its own mappings as well as contributing to the development of SNOMED CT as such.

Finally, the project found that training of mapping personnel benefits from integrating theoretical instruction and practical use of SNOMED CT, and that finding the correct concept in SNOMED CT calls for clinical expertise in order to be successful.

Semantic interoperability requires consistency in use of terminologies such as SNOMED CT. Inter-rater agreement measurement can be used to quantify this consistency among terminology users. Increasingly, studies of SNOMED CT include inter-rater agreement measures. However, published studies do not consider distance between concepts when calculating the inter-rater agreement measures. In this paper we propose a semantic inter-rater agreement measure for use with SNOMED CT encoded data. A semantic Krippendorff's α measure is implemented using a path-length based difference function. The measure is tested using three different datasets. Results show that the proposed semantic measure is sensitive to seriousness of coding differences whereas a nominal measure is not. The proposed measure reflects the intuition that distance matters when comparing uses of SNOMED CT.

Telehealth solutions should be available also for elderly patients with nointerest in using, or capacity to use, computers and smartphones. Fourteen elderly,severely ill heart failure patients in home care participated in a telehealth study andused digital pens for daily reporting of their health state—a technology never usedbefore by this patient group. After the study seven patients and two spouses wereinterviewed face-to-face. A qualitative content analysis of the interview materialwas performed. The informants had no experience of computers or the Internet andno interest in learning. Still, patients found the digital pen and the health diaryform easy to use, thus effortlessly adopting to changes in care provision. Theyexperienced an improved contact with the caregivers and had a sense of increasedsecurity despite a multimorbid state. Our study shows that, given that technologiesare tailored to specific patient groups, even “the digital illiterate” may use theInternet.