Towards a Clinically Meaningful Model to Structure the Development of Interoperable Order Sets, Applicable to the Point of Care in Any EMR.

Standardized order sets are a pragmatic type of clinical decision support that can improve adherence to clinical guidelines with a list of recommended orders related to a specific clinical context. We developed a structure facilitating the creation of order sets and making them interoperable, to increase their usability. Various orders contained in electronic medical records in different hospitals were identified and included in different categories of orderable items. Clear definitions were provided for each category. A mapping to FHIR resources was performed to relate these clinically meaningful categories to FHIR standards to assure interoperability. We used this structure to implement the relevant user interface in the Clinical Knowledge Platform. The use of standard medical terminologies and the integration of clinical information models like FHIR resources are key factors for creating reusable decision support systems. The content authors should be provided with a clinically meaningful system to use in a non-ambiguous context.

Clinical Knowledge Platform (CKP): A Collaborative Ecosystem to Share Interoperable Clinical Forms, Viewers, and Order Sets with Various EMRs.

A large number of Electronic Medical Records (EMR) are currently available with a variety of features and architectures. Existing studies and frameworks presented some solutions to overcome the problem of specification and application of clinical guidelines toward the automation of their use at the point of care. However, they could not yet support thoroughly the dynamic use of medical knowledge in EMRs according to the clinical contexts and provide local application of international recommendations. This study presents the development of the Clinical Knowledge Platform (CKP): a collaborative interoperable environment to create, use, and share sets of information elements that we entitled Clinical Use Contexts (CUCs). A CUC could include medical forms, patient dashboards, and order sets that are usable in various EMRs. For this purpose, we have identified and developed three basic requirements: an interoperable, inter-mapped dictionary of concepts leaning on standard terminologies, the possibility to define relevant clinical contexts, and an interface for collaborative content production via communities of professionals. Community members work together to create and/or modify, CUCs based on different clinical contexts. These CUCs will then be uploaded to be used in clinical applications in various EMRs. With this method, each CUC is, on the one hand, specific to a clinical context and on the other hand, could be adapted to the local practice conditions and constraints. Once a CUC has been developed, it could be shared with other potential users that can consume it directly or modify it according to their needs.

The HEGP component-based clinical information system.

OBJECTIVES: The opening of the Georges Pompidou University Hospital (HEGP) in southwest Paris from the merging of three aging facilities was the opportunity to conceive and deploy a brand new clinical information system (CIS) based on a component-based approach. This paper describes the process of selection of the business components, the main functions currently in use, and the technical infrastructure that proved necessary. METHODS: The HEGP CIS features generic and healthcare-related components. The generic components include a reference manager, a security manager, a document manager, a Corba bus, and various mediation and supervision tools. The healthcare-related components include the patient, healthcare record, act management, and resource scheduler components. RESULTS: Major functions of CIS were operational at the opening of the hospital in July 2000. Two years later, the unique patient record and the provider order entry system were used in 96% of the concerned healthcare units. Sixty-five percent of the biological orders and 55% of the imaging orders were directly entered by the physicians. Access to investigation results including on-line availability of images is used by physicians in 100% of the units. DISCUSSION AND CONCLUSION: A component-based approach was found to be high-performing and cost-effective for the design and deployment of HEGP CIS.