Pathways to interoperable electronic patient records for health and social care: Part 1: for those involved directly in care.

Here, we illustrate the clinical and technical implementation of interoperable health data for direct care from the viewpoint of practicing clinicians using examples from primary care. Interoperability allows people involved in the provision and receipt of care to seamlessly exchange and use the coded, free text and documentary data they need to inform care decisions. The pathway toward NHS interoperability to support direct care has been long, but substantial progress has been made. GP computer systems and data-recording standards, national infrastructure and hospital trusts have come a long way on the journey to fully interoperable records. GPs can now receive and utilise laboratory data; via GP2GP, they can transfer full electronic patient records when patients move practice; share health data with other health organisations through GP Connect to support patient care; and provide patients with online access to their full GP record, a cornerstone of person-centred care. Here, we describe the effective technical assets and standards that have been developed to enable electronic patient record data to be shared reliably and securely.

Learning from disease registries during a pandemic: Moving toward an international federation of patient registries.

High-quality dermatology patient registries often require considerable time to develop and produce meaningful data. Development time is influenced by registry complexity and regulatory hurdles that vary significantly nationally and institutionally. The rapid emergence of the coronavirus disease 2019 (COVID-19) global pandemic has challenged health services in an unprecedented manner. Mobilization of the dermatology community in response has included rapid development and deployment of multiple, partially harmonized, international patient registries, reinventing established patient registry timelines. Partnership with patient organizations has demonstrated the critical nature of inclusive patient involvement. This global effort has demonstrated the value, capacity, and necessity for the dermatology community to adopt a more cohesive approach to patient registry development and data sharing that can lead to myriad benefits. These include improved utilization of limited resources, increased data interoperability, improved ability to rapidly collect meaningful data, and shortened response times to generate real-world evidence. We call on the global dermatology community to support the development of an international federation of patient registries to consolidate and operationalize the lessons learned during this pandemic. This will provide an enduring means of applying this knowledge to the maintenance and development of sustainable, coherent, and impactful patient registries of benefit now and in the future.

openEHR Based Contextual Problem List.

The problem list is a key facet of the digital patient record that has historically been difficult to curate. This paper presents an implementation of a contextual problem list using openEHR. It describes the modelling approach, key model elements, and how these are assembled to underpin a Problem Oriented Medical Record. Finally, it discusses issues associated with how problem lists may be used.

Defining the Contextual Problem List.

The Problem Oriented Medical Record (POMR) is considered a key charting method to support clinical care. Although not uniformly represented amongst digital health systems, this paper presents a clinical model to represent multiple clinical perspectives from a single problem list. The contextual problem list model is defined according to primary diagnosis, comorbidities and problems arising from the primary condition. It is represented within the patient record as a single composition according to the prescribed context. The model pattern could help alleviate the traditional criticisms of paper and digitally based problem records.

Developing the First Generally-Available openEHR Archetypes and Templates for Physiotherapy: An Example of Building Clinical Models and Modelling Capacity via Student-Led Academic-Industrial Collaboration.

We present the first public openEHR archetypes and templates for physiotherapy, and the context of multidisciplinary academic-industry partnership that has enabled their production by a team led by a clinically trained student on the UCL health informatics MSc programme.

Slit molecules prevent entrance of trunk neural crest cells in developing gut.

Neural crest cells emerge from the dorsal neural tube early in development and give rise to sensory and sympathetic ganglia, adrenal cells, teeth, melanocytes and especially enteric nervous system. Several inhibitory molecules have been shown to play important roles in neural crest migration, among them are the chemorepulsive Slit1-3. It was known that Slits chemorepellants are expressed at the entry to the gut, and thus could play a role in the differential ability of vagal but not trunk neural crest cells to invade the gut and form enteric ganglia. Especially since trunk neural crest cells express Robo receptor while vagal do not. Thus, although we know that Robo mediates migration along the dorsal pathway in neural crest cells, we do not know if it is responsible in preventing their entry into the gut. The goal of this study was to further corroborate a role for Slit molecules in keeping trunk neural crest cells away from the gut. We observed that when we silenced Robo receptor in trunk neural crest, the sympathoadrenal (somites 18-24) were capable of invading gut mesenchyme in larger proportion than more rostral counterparts. The more rostral trunk neural crest tended not to migrate beyond the ventral aorta, suggesting that there are other repulsive molecules keeping them away from the gut. Interestingly, we also found that when we silenced Robo in sacral neural crest they did not wait for the arrival of vagal crest but entered the gut and migrated rostrally, suggesting that Slit molecules are the ones responsible for keeping them waiting at the hindgut mesenchyme. These combined results confirm that Slit molecules are responsible for keeping the timeliness of colonization of the gut by neural crest cells.

Engaging clinicians in clinical content: herding cats or piece of cake?

It is essential that clinicians are able to contribute to the development of clinical content for electronic health records. Clinicians are able to participate meaningfully when the technical focus on the process and the clinical models are reduced or removed. In the openEHR approach - from the original design specification through to the clinical modelling tools - clinicians feature as the primary drivers of clinical content models. As tooling develops and matures to support authoring, reviewing and publishing of openEHR knowledge artefacts, clinicians are increasingly able to be involved - resulting in significant contributions to the development of standardized clinical content models which will support quality of care for their patients.

Archetype-based knowledge management for semantic interoperability of electronic health records.

Formal modeling of clinical content that can be made available internationally is one of the most promising pathways to semantic interoperability of health information. Drawing on the extensive experience from openEHR archetype research and implementation work, we present the latest research and development in this area to improve semantic interoperability of Electronic Health Records (EHRs) using openEHR (ISO 13606) archetypes. Archetypes as the formal definition of clinical content need to be of high technical and clinical quality. We will start with a brief introduction of the openEHR architecture followed by presentations on specific topics related to the management of a wide range of clinical knowledge artefacts. We will describe a web-based review process for archetypes that enables international involvement and ensures that released archetypes are technically and clinically correct. Tools for validation of archetypes will be presented, along with templates and compliance templates. All this in combination enables the openEHR computing platform to be the foundation for safely sharing the information clinicians need, using this information within computerized clinical guidelines, for decision support as well as migrating legacy data.

Collaborative development of clinical templates as a national resource.

There is growing interest in the development of standards which structure information round discrete clinical concepts, in a way that supports system development and interoperability. Most notable are the openEHR Archetypes and Templates, and HL7 Templates. A project is described which explored the potential for these to engage and support clinical practitioners in developing clinical information standards in an open and accessible way. The project defined a clinical template as a clinical information model, which could be used to define the content of a form in a health record system, for example a continence assessment. The project followed three phases: professional development, including networking for content development; library implementation, including modelling and processes for managing content and relating to information standards; and implementation in working systems in a manner that is professionally acceptable. The project findings are encouraging although there remain some important issues to be explored in further work. The topic has now emerged as an important area of standards development, and a useful focus for international cooperation.

A feasibility study on clinical templates for the National Health Service in Scotland.

There is growing interest in the development of standards which structure information round discrete clinical concepts, in a way that supports system development and interoperability. Most notable are the openEHR Archetypes and Templates, and HL7 Templates. A project is described which explored the potential for these to engage and support clinical practitioners in developing clinical information standards in an open and accessible way. The project followed three phases: professional development, including networking for content development; library implementation, including modelling and processes for managing content and relating to information standards; and implementation in working systems in a manner that is professionally acceptable. The project findings are encouraging although there remain some important issues to be explored in further work. The topic has now emerged as an important area of standards development, and a useful focus for international cooperation.