HL7 Fast Healthcare Interoperability Resources (HL7 FHIR) in digital healthcare ecosystems for chronic disease management: Scoping review.

BACKGROUND: The prevalence of chronic diseases has shifted the burden of disease from incidental acute inpatient admissions to long-term coordinated care across healthcare institutions and the patient's home. Digital healthcare ecosystems emerge to target increasing healthcare costs and invest in standard Application Programming Interfaces (API), such as HL7 Fast Healthcare Interoperability Resources (HL7 FHIR) for trusted data flows. OBJECTIVES: This scoping review assessed the role and impact of HL7 FHIR and associated Implementation Guides (IGs) in digital healthcare ecosystems focusing on chronic disease management. METHODS: To study trends and developments relevant to HL7 FHIR, a scoping review of the scientific and gray English literature from 2017 to 2023 was used. RESULTS: The selection of 93 of 524 scientific papers reviewed in English indicates that the popularity of HL7 FHIR as a robust technical interface standard for the health sector has been steadily rising since its inception in 2010, reaching a peak in 2021. Digital Health applications use HL7 FHIR in cancer (45 %), cardiovascular disease (CVD) (more than 15 %), and diabetes (almost 15 %). The scoping review revealed that references to HL7 FHIR IGs are limited to âˆ¼ 20 % of articles reviewed. HL7 FHIR R4 was most frequently referenced when the HL7 FHIR version was mentioned. In HL7 FHIR IGs registries and the internet, we found 35 HL7 FHIR IGs addressing chronic disease management, i.e., cancer (40 %), chronic disease management (25 %), and diabetes (20 %). HL7 FHIR IGs frequently complement the information in the article. CONCLUSIONS: HL7 FHIR matures with each revision of the standard as HL7 FHIR IGs are developed with validated data sets, common shared HL7 FHIR resources, and supporting tools. Referencing HL7 FHIR IGs cataloged in official registries and in scientific publications is recommended to advance data quality and facilitate mutual learning in growing digital healthcare ecosystems that nurture interoperability in digital health innovation.

A State-of-the Art Review of SNOMED CT Terminology Binding and Recommendations for Practice and Research.

BACKGROUND: Unambiguous sharing of data requires information models and terminology in combination, but there is a lack of knowledge as to how they should be combined, leading to impaired interoperability. OBJECTIVES: To facilitate creation of guidelines for SNOMED CT terminology binding we have performed a literature review to find existing recommendations and expose knowledge gaps. The primary audience is practitioners and researchers working with terminology binding. METHODS: PubMed, Scopus, and Web of Science were searched for papers containing "terminology binding," "subset," "map," "information model" or "implement" and the term "SNOMED." RESULTS: The search yielded 616 unique papers published from 2004 to 2020, from which 55 papers were selected and analyzed inductively. Topics described in the papers include problems related to input material, SNOMED CT, information models, and lack of appropriate tools as well as recommendations regarding competence. CONCLUSION: Recommendations are given for practitioners and researchers. Many of the stated problems can be solved by better co-operation between domain experts and informaticians and better knowledge of SNOMED CT. Settings where these competences either work together or where staff with knowledge of both act as brokers are well equipped for terminology binding. Tooling is not thoroughly researched and might be a possible way to facilitate terminology binding.

Clinical features of patients with non-metastatic lung cancer in primary care: a case-control study.

BACKGROUND: Lung cancer (LC) kills more people than any other cancer globally, mainly due to the late stage of diagnosis. AIM: To identify and quantify the prediagnostic features of non-metastatic lung cancer (nMLC) and to compare the clinical features in GPs' chest X-ray referral letters with the clinical features (expressed as diagnostic codes) in medical records. DESIGN & SETTING: A population-based case-control study was conducted using diagnostic codes from national and regional healthcare databases in Sweden. METHOD: In total, 373 patients diagnosed with LC in 2011 (of which 132 had nMLC) and 1472 controls were selected from the Swedish Cancer Register (SCR) and regional healthcare database, respectively. Diagnostic codes registered in medical records from primary care consultations in the year before LC diagnosis were collected from the regional healthcare database. Odds ratios (OR) were calculated for variables associated with nMLC. The GPs' referral letters for chest X- ray were retrieved from the regional repository for radiology. RESULTS: Clinical features with the highest OR were vitamin B12 deficiency anaemia (OR 6.7, 95% confidence interval [CI] = 1.6 to 27.9), dyspnoea (OR 5.0, 95% CI = 2.0 to 12.7), and chronic bronchitis (OR 5.0, 95% CI = 1.3 to 18.6). Clinical features that were GPs' reasons for requesting chest X-ray were almost three times more frequent in referral letters compared to the corresponding diagnostic codes in the medical records. CONCLUSION: Patients with nMLC could not be identified by symptoms. The clinical features in referral letters for X-ray were more frequent than corresponding diagnostic codes from medical records.

Cross-organizational workflow in radiology: an empirical study of the quality of shared metadata elements in Region Västra Götaland, Sweden.

BACKGROUND: Challenges related to the cross-organizational access of accurate and timely information about a patient's condition has become a critical issue in healthcare. Interoperability of different local sources is necessary. PURPOSE: To identify and present missing and semantically incorrect data elements of metadata in the radiology enterprise service that supports cross-organizational sharing of dynamic information about patients' visits, in the Region Västra Götaland, Sweden. MATERIAL AND METHODS: Quantitative data elements of metadata were collected yearly from the first Wednesday in March from 2006 to 2011 from the 24 in-house radiology departments in Region Västra Götaland. These radiology departments were organized into four hospital groups and three stand-alone hospitals. Included data elements of metadata were the patient name, patient ID, institutional department name, referring physician's name, and examination description. RESULTS: The majority of missing data elements of metadata was related to the institutional department name for Hospital 2, from 87% in 2007 to 25% in 2011. All data elements of metadata except the patient ID contained semantic errors. For example, for the data element "patient name", only three names out of 3537 were semantically correct. CONCLUSION: This study shows that the semantics of metadata elements are poorly structured and inconsistently used. Although a cross-organizational solution may technically be fully functional, semantic errors may prevent it from serving as an information infrastructure for collaboration between all departments and hospitals in the region. For interoperability, it is important that the agreed semantic models are implemented in vendor systems using the information infrastructure.

Simulation of radiology workflow and throughput.

Emerging electronic health technologies create an unending transformation process. This calls for new ways to plan and prepare the radiology department for these changes. There is a lack of literature addressing ways to predict the effects of implementing and using new technologies in healthcare. Innovative services by means of simulation is a technique that could predict effects of changes beforehand. The aim of this study was to validate the use of discrete event simulation to plan future examination throughput changes in the radiology department of Alingsås Hospital in Sweden after both the investment in a new MRI suite and the closing down of two old rooms. The simulation scenario presented here was based on real life local examination throughput in combination with the total examination throughput from other radiology departments in the region already having MRI suites in use.

Better quality in healthcare through gamified simulation based skill training application.

Although the screening of abdominal aortic diameter helps to identify men with abdominal aortic aneurysm and saves lives, there is need to coordinate and synchronize screening personnel's way to work. This article describes the design of a game based skill training application that could give the screening personnel an additional opportunity to refine measuring of abdominal aortic diameter in ultrasound images. The design work follows the steps of the Goal Directed design process. Consequently, the design activities are divided into six phases: the Research, Modelling, Requirements Definition, Framework Definition, Refinement and Development support. The design process described in this paper finishes with usability testing of an interactive prototype. The evaluation of the design was conducted with end users by studying their subjective ratings and performance on given tasks. The overall results of the usability testing show that the interactive prototype of the skill training application is not yet fully usable. Consequently, further improvement of the interface design is needed. The identified usability issues and collected qualitative and quantitative material about the interaction between test participants and the interface can guide the next design iteration and lead to more usable design.

The use of simulation in radiology.

The aim of this study is to analyze how simulation has been used in healthcare (radiology, in particular) to predict the outcome of work practice changes. This is a literature study concerning different simulation models as a planning tool prior to changes in work practice. The radiology organization is in a transformation process. There is a lack of existing literature addressing ways to predict or imagine new technology in the context of its use in radiology work practice. Yet, studies also illustrate that data collection and mining is an excellent investment in understanding complex systems and how simulation models can be applied for change in radiology. If changes in work practices are a result of changing ourselves and the way we think about our work, simulation could be a technique to help the individual understand changes in the healthcare process.

The impact of PACS on radiologists' work practice.

This paper identifies and analyzes how the implementation and use of picture archiving and communication system impacts radiologists' work practice. The study is longitudinal from 1999 to 2005 and have a qualitative perspective were data were collected by structured interviews in a total of 46. The interviews were transcribed, analyzed, and coded using grounded theory as an organizing principle. In radiologists' work practice, three main categories were defined: professional role, diagnostic practice, and technology in use. The changing trends within the professional role indicated that radiologists moved from a more individual professional expertise to become more of an actor in a network. The diagnostic practice changed, as reading x-ray films was seen as an art form in 1999, requiring years of training. Once everyone could view digital images, including 3-dimensional technology, it was easier for other clinicians to see and interpret the images and the skills become accessible to everyone. The change in technology in use as a result of the shift to digital images led to an increased specialization of the radiologist.