Archetype Development Process: A Case Study of Support Interoperability among Electronic Health Record in the State of Minas Gerais, Brazil.

The interoperability among electronic medical records requires a standard that guarantees the semantic persistency of information. The study proposes an archetypes development process to support the Electronic Health Record (EHR) in the State of Minas Gerais, Brazil. It was case study with a qualitative analysis of applied nature with methodological exploratory purposes. For this, there was a literature review on archetypes development processes. The selected studies had their processes compared. Then, an own archetypes development process was proposed, also considering the legislation of Unified Health System in Brazil. The process was tested in a proof of concept, a practical test on a theoretical proposal. The proposed governance model was considered adequate for the organization of EHR at such scenario. It is expected that with its effective implementation, the proposed process supports the interoperability among clinical data arising from different levels of health care services.

Is There Evidence of Cost Benefits of Electronic Medical Records, Standards, or Interoperability in Hospital Information Systems? Overview of Systematic Reviews.

BACKGROUND: Electronic health (eHealth) interventions may improve the quality of care by providing timely, accessible information about one patient or an entire population. Electronic patient care information forms the nucleus of computerized health information systems. However, interoperability among systems depends on the adoption of information standards. Additionally, investing in technology systems requires cost-effectiveness studies to ensure the sustainability of processes for stakeholders. OBJECTIVE: The objective of this study was to assess cost-effectiveness of the use of electronically available inpatient data systems, health information exchange, or standards to support interoperability among systems. METHODS: An overview of systematic reviews was conducted, assessing the MEDLINE, Cochrane Library, LILACS, and IEEE Library databases to identify relevant studies published through February 2016. The search was supplemented by citations from the selected papers. The primary outcome sought the cost-effectiveness, and the secondary outcome was the impact on quality of care. Independent reviewers selected studies, and disagreement was resolved by consensus. The quality of the included studies was evaluated using a measurement tool to assess systematic reviews (AMSTAR). RESULTS: The primary search identified 286 papers, and two papers were manually included. A total of 211 were systematic reviews. From the 20 studies that were selected after screening the title and abstract, 14 were deemed ineligible, and six met the inclusion criteria. The interventions did not show a measurable effect on cost-effectiveness. Despite the limited number of studies, the heterogeneity of electronic systems reported, and the types of intervention in hospital routines, it was possible to identify some preliminary benefits in quality of care. Hospital information systems, along with information sharing, had the potential to improve clinical practice by reducing staff errors or incidents, improving automated harm detection, monitoring infections more effectively, and enhancing the continuity of care during physician handoffs. CONCLUSIONS: This review identified some benefits in the quality of care but did not provide evidence that the implementation of eHealth interventions had a measurable impact on cost-effectiveness in hospital settings. However, further evidence is needed to infer the impact of standards adoption or interoperability in cost benefits of health care; this in turn requires further research.