Healthcare Information Management

Barry Smithhttp://ontology.buffalo.edu/smith

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Goals of Electronic Health Records from the clinician’s perspective

Remembering what you did and why Conveying that information to colleagues Justifying billing Legal defense Data for research Clinical decision support

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Goals of Electronic Health Records from a wider community perspective

• Primary uses: billing, billing, billing ...• Secondary uses

– continuity of care (avoiding siloing of data)– evidence-based medicine– diagnostic decision support– support for clinical trials– virtual clinical research– personalized medicine – (Obamacare) save money

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What an EHR requires

• Effective user interfaces

• Trained personnel

• Safety (EHR should help to make your hospital safer; it should not kill your patient)

• Data security

• Controlled vocabulary, and coherent taxonomy (… ontology …)

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Where does an EHR fit ?Basic:

Identity

Patient record

Clinician workflow

Comprehensive:

Notifications

Security / access control

With thanks to Tom Beale / openEHR.org

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© Ocean Informatics 2005

EHRs – some alternatives

• Epic, Allscripts, Eclipsys, Cerner ...

• VA

• OpenEHR / CEN 13606

−EHRs for hospitals

−EHRs for small practices (including dentists, ophthalmologists, …)

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Epic, Allscripts, Eclipsys ...(Examples of commercial products)

PRO: Get the job done

CON: Expensive

Allow only limited secondary uses

– continuity of care X– safety ?– evidence-based medicine ?– diagnostic decision support ?– clinical trials X

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with thanks to http://dbmotion.com 9

the problem of continuity of care: patients move around

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synchronic and diachronic problems of semantic interoperability

(across space and across time)

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The Data Model That Nearly Killed Me

by Joe Bugajski

http://tiny.cc/S1HWo

“If data cannot be made reliably available across silos in a single EHR, then this data cannot be made reliably available to a huge, heterogeneous collection of networked systems.”

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EPIC, etc.

will provide a way to capture and represent some of what is needed in a form that is usable

by computers (somewhat)

by you yourself

but not by other clinics, hospitals and researchers ...

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How to link EHR data?f

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how can we link EHR 1 to EHR 2 in a reliable, trustworthy, useful way, which both systems can

understand ?

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EHR 1 EHR 2