Semantically oriented EHR navigation with a patient specific knowledge base and a clinical context ontology.

Widespread adoption of electronic health records (EHR) in the U.S. has been followed by unintended consequences, overexposing clinicians to widely reported EHR limitations. As an attempt to fixing the EHR, we propose the use of a clinical context ontology (CCO), applied to turn implicit contextual statements into formally represented data in the form of concept-relationship-concept tuples. These tuples form what we call a patient specific knowledge base (PSKB), a collection of formally defined tuples containing facts about the patient's care context. We report the process to create a CCO, which guides annotation of structured and narrative patient data to produce a PSKB. We also present an application of our PSKB using real patient data displayed on a semantically oriented patient summary to improve EHR navigation. Our approach can potentially save precious time spent by clinicians using today's EHRs, by showing a chronological view of the patient's record along with contextual statements needed for care decisions with minimum effort. We propose several other applications of a PSKB to improve multiple EHR functions to guide future research.

Physicians' perceptions about a semantically integrated display for chart review: A Multi-Specialty survey.

OBJECTIVE: To assess physicians' perceptions about integrated displays for chart review based on a formal representation of patients' care context. METHODS: We iteratively designed a conceptual prototype of an integrated patient summary and conducted an online survey with a multi-specialty panel of outpatient physicians from a large health system to collect their perceptions of the usefulness of our prototype. Survey questions were responded with a 7-point Likert scale and include two open-ended questions for comments on challenges and suggestions related to electronic health record (EHR) navigation, with which a thematic analysis was performed. RESULTS: Forty-nine physicians completed the survey. The usefulness of our integrated display was rated slightly positive, and respondents did not consider it confusing. Challenges related to EHR navigation frequently reported by physicians included the need to navigate between multiple functionalities and to manually search for relevant data. The most common suggestions were related to facilitating integration of data from multiple parts of the record to facilitate data visualization and comprehension. CONCLUSION: Physicians' rating of usefulness was slightly positive, and several insights to improve EHR navigation were derived from their comments. More effective EHR navigation may be achieved through facilitating integration of data from multiple parts of the record to simplify data retrieval and synthesis.