Generic screen representations for future-proof systems, is it possible? There is more to a GUI than meets the eye.

BACKGROUND: Future-proof EHR systems must be capable of interpreting information structures for medical concepts that were not available at the build-time of the system. The two-model approach of CEN 13606/openEHR using archetypes achieves this by separating generic clinical knowledge from domain-related knowledge. The presentation of this information can either itself be generic, or require design time awareness of the domain knowledge being employed. OBJECTIVE: To develop a Graphical User Interface (GUI) that would be capable of displaying previously unencountered clinical data structures in a meaningful way. METHODS: Through "reasoning by analogy" we defined an approach for the representation and implementation of "presentational knowledge". A proof-of-concept implementation was built to validate its implementability and to test for unanticipated issues. RESULTS: A two-model approach to specifying and generating a screen representation for archetype-based information, inspired by the two-model approach of archetypes, was developed. There is a separation between software-related display knowledge and domain-related display knowledge and the toolkit is designed with the reuse of components in mind. CONCLUSIONS: The approach leads to a flexible GUI that can adapt not only to information structures that had not been predefined within the receiving system, but also to novel ways of displaying the information. We also found that, ideally, the openEHR Archetype Definition Language should receive minor adjustments to allow for generic binding.

Inter-organizational future proof EHR systems. A review of the security and privacy related issues.

OBJECTIVES: Identification and analysis of privacy and security related issues that occur when health information is exchanged between health care organizations. METHODS: Based on a generic scenario questions were formulated to reveal the occurring issues. Possible answers were verified in literature. RESULTS: Ensuring secure health information exchange across organizations requires a standardization of security measures that goes beyond organizational boundaries, such as global definitions of professional roles, global standards for patient consent and semantic interoperable audit logs. CONCLUSION: As to be able to fully address the privacy and security issues in interoperable EHRs and the long-life virtual EHR it is necessary to realize a paradigm shift from storing all incoming information in a local system to retrieving information from external systems whenever that information is deemed necessary for the care of the patient.

Generic screen representations for future proof systems--is it possible? Two-model approach to a generic GUI.

Semantic interoperability should not only cover system interpretation of incoming information, but should be extended to include screen representation. This article describes a two-model approach to generate a screen representation for archetype-based information, which is inspired by the two-model approach used by openEHR for their archetypes. It provides a separation between software-related display knowledge and domain-related display knowledge and is designed with reuse of components in mind. This approach leads to a flexible GUI that can adapt not only to information structures that are not predefined within the receiving system and display them in a meaningful way, but also to novel ways of displaying the information. We are working on a proof of concept implementation to validate the approach.

Towards a Generic Connection of EHR and DSS.

Decision Support Systems (DSS) are typically integrated in Electronic Health Record systems (EHR). By removing this integration full reuse of a DSS system is possible. The connection between the EHR and the DSS system should be standards-based and generic. We intend to demonstrate the viability of this setup by implementing it using PropeRWeb as EHR system, Gaston as DSS system, HL7v3 messages and the SOAP protocol.

PropeR revisited.

INTRODUCTION: The PropeR EHR system (PropeRWeb) is a multidisciplinary electronic health record (EHR) system for multidisciplinary use in extramural patient care for stroke patients. DESIGN: The system is built using existing open source components and is based on open standards. It is implemented as a web application using servlets and Java Server Pages (JSP's) with a CORBA connection to the database servers, which are based on the OMG HDTF specifications. PropeRWeb is a generic system which can be readily customized for use in a variety of clinical domains. EVALUATION: The system proved to be stable and flexible, although some aspects (a.o. user friendliness) could be improved. These improvements are currently under development in a second version.

Archetypes: the PropeR way.

The PropeR project studies the effect of Decision Support in an Electronic Health Record system (EHR) on the quality of care. One of the applications supports a multidisciplinary primary care team rehabilitating stroke patients in their home environment. This project required an EHR system that could handle information of multiple disciplines and multiple, distributed data sources. It should also be flexible enough to handle an entirely different domain with only minor modifications. The resulting EHR system is a distributed system based on international standards and reusable components. It is generic in nature since all references to the domain are stored in separate XML documents: the clinical data are defined through a modified version of the OpenEHR archetypes, described in XML and views on the data, either for review or for data entry are also described in XML documents. Currently, the system is being evaluated by a care team using laptops with a wireless internet connection. The use of standards greatly improves the quality and reusability of the resulting software system, but they do not solve the issues that surface during implementation, such as context and screen representation.

PropeR and archetypes.

UNLABELLED: The PropeR project studies a genric combination of an electronic health record (EHR) and decision support software (DSS). This study comprises different medical domains. GOAL: Develop a distributed EHR system that is flexible enough to be used in different domains without major modifications. METHODS: Use of standards and standardized specification and available open source components to develop an EHR system that meets the goals. RESULT: PropeRWeb is a generic webbased EHR system that is flexible enough to easily accommodate different domains. DISCUSSION: Discussion of some of the problems encountered in the development of the EHR system.

PropeR revisited.

The PropeR EHR is a multidisciplinary EHR system that is built using existing open source components. This paper discusses the implementation of this system and the advantages and challenges encountered when using open source components.

Towards a PropeR combination of patient records and protocols.

PROBLEM: The combination of a computer-based patient record and a decision-support system (DSS) may give physicians the decisive push they need to accept such systems. In the PropeR-project we determine the requirements for a generic interface between both these systems and evaluate its potential impact on patient care. This article reports results from the first year in one of the domains under study. It also provides background information about the project, including design considerations and experimental approach of forthcoming years. PURPOSE: The objectives of the first year were to determine bottlenecks of the current situation and to determine expected improvements and conditions for implementation of a future situation with computer support. METHODS: These topics were investigated in general by literature review and in the local situation by a requirements analysis. For the analysis we used a combination of observation, interviews, and patient record study. For the literature survey we searched for reviews, meta-analyses and original studies concerning experiences with computer-based patient records and DSSs in conventional settings and in integrated care. RESULTS: Main bottleneck was the poor use of shared patient record and paper guidelines. Expected improvements were better protocol adherence and communication. Conditions for implementation of computer support were a proper system interface and adoption by the user. CONCLUSION: Our main conclusion was that the aspect of cooperation needs more decision support than the clinical work itself.

PropeR: a multi disciplinary EPR system.

This article describes the architecture of an EPR system developed for the PropeR project. This EPR system not only aims at supporting home care of stroke patients, but is also designed in such a way that it can be ported to other medical services without much effort. We will briefly describe the Stroke Service and the related PropeR project. Starting from a list of requirements to construct a generic EPR system we will outline the architecture and describe the standards and methods used. Subsequently we describe the implementation and the problems encountered. In the discussion, we will go into the advantages and disadvantages of the tools and techniques we have used.

Towards a PropeR combination of patient records and protocols.

The combination of a computer-based patient record system with a decision support system may give physicians the decisive push they need to accept such systems. In the PropeR-project we determine the requirements for a generic interface between both such systems and measure its potential impact on patient care. In this overview we describe the objectives, the experimental approach, and the current state of the PropeR-project. We also discuss the original positions behind the project.