Determination of user requirements for the secure communication of electronic medical record information.

Health professionals need to have accurate patient data in order to make the right diagnosis and to give an optimal treatment. In many cases, the 'medical' record, whether in electronic form or paper form is distributed over several health care providers and health care enterprises. Technically, there are several ways to provide access to remote record information or parts thereof. Legislation however puts restrictions on the communication of personal information in order to protect the privacy of the patient. This paper gives an overview of requirements and constraints when communicating electronic medical record information and summarises the findings of the SEMRIC project in determining requirements from a number of practical cases.

Functional requirements for IT support for nursing information systems integrated in electronic healthcare record systems (EHCRS).

This paper focuses on the functional requirements that support the activities performed by healthcare professionals, i.e. functions performed in the healthcare enterprise which result in requirements for IT support. The emphasis is on IT support for nursing activities as a part of general IT support for the whole care process realized through EHCRS. We argue that a standard for functionality (including user interface and functions supporting information security) would benefit manufacturers by giving them a well-defined target to aim for and give purchasers and users of EHCRS a foundation on which to base their specifications. Quality would be enhanced by ensuring that all EHCRS contained a standard core functionality and were compliant with basic structural requirements. To get a comprehensive list of requirements to ensure that EHCRS with IT support for nursing activities serve as an aid to the process of care it is essential that nurses get directly involved in the process of defining the requirements. In this paper we also give some examples of requirements that are candidates for standardisation.

Constructing scenarios for validating the electronic health care record architecture.

The CEN TC 251 Electronic Health Care Record Architecture is the first part of a four part communication prestandard intended to facilitate the safe communication of clinical information, irrespective of circumstances related to time, distance, and responsibility. The work has important implications for a diversity of stakeholders and must embody clinical principles if it is to succeed. The issue at hand is how to enable clinicians to validate the reference architecture, which is necessarily a technical document, so that they have confidence that it can meet the clinical requirement for safe communication. A model of communication that has been used to ground the architecture is shown to be useful in creating relevant clinical scenarios to permit the first steps towards coherent validation in a systematic way.

A case study: business process re-engineering (BPR) of the order-/delivery process at the pediatric clinic at the University Hospital of Lund.

The traditional order and delivery activities have been characterized by manual routines and a paper-based workflow management. Problems such as the time consuming processes in which a laboratory service order is created or that of getting the laboratory service report with results from the requested investigations from the laboratories and the entry of the same information by different persons at different points in the workflow with the possibilities of transfer errors are well known. The development of modern information technology, along with the developing of standards for communication protocols and the message structure for the electronic interchange of information (EDI) gives us the tools to change the way we work and manage workflow. An important input to the business process reengineering process is a thorough knowledge of the context within which the order-/delivery activities exist. One has to take into account that the activities are: 1) heavily integrated in the whole treatment and care process, 2) together with routines and the taking of samples and related requests many times are a part of the daily work of a ward, and 3) many decisions about the treatment of a patient are based on the results in the laboratory service report from the laboratories.