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Healthcare Information Management
Barry Smithhttp://ontology.buffalo.edu/smith
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Goals of Electronic Health Records from the clinician’s perspective
Remembering what you did and why Conveying that information to colleagues Justifying billing Legal defense Data for research Clinical decision support
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Goals of Electronic Health Records from a wider community perspective
• Primary uses: billing, billing, billing ...• Secondary uses
– continuity of care (avoiding siloing of data)– evidence-based medicine– diagnostic decision support– support for clinical trials– virtual clinical research– personalized medicine – (Obamacare) save money
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What an EHR requires
• Effective user interfaces
• Trained personnel
• Safety (EHR should help to make your hospital safer; it should not kill your patient)
• Data security
• Controlled vocabulary, and coherent taxonomy (… ontology …)
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Where does an EHR fit ?Basic:
Identity
Patient record
Clinician workflow
Comprehensive:
Notifications
Security / access control
With thanks to Tom Beale / openEHR.org
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© Ocean Informatics 2005
EHRs – some alternatives
• Epic, Allscripts, Eclipsys, Cerner ...
• VA
• OpenEHR / CEN 13606
−EHRs for hospitals
−EHRs for small practices (including dentists, ophthalmologists, …)
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Epic, Allscripts, Eclipsys ...(Examples of commercial products)
PRO: Get the job done
CON: Expensive
Allow only limited secondary uses
– continuity of care X– safety ?– evidence-based medicine ?– diagnostic decision support ?– clinical trials X
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with thanks to http://dbmotion.com 9
the problem of continuity of care: patients move around
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f
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synchronic and diachronic problems of semantic interoperability
(across space and across time)
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The Data Model That Nearly Killed Me
by Joe Bugajski
http://tiny.cc/S1HWo
“If data cannot be made reliably available across silos in a single EHR, then this data cannot be made reliably available to a huge, heterogeneous collection of networked systems.”
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EPIC, etc.
will provide a way to capture and represent some of what is needed in a form that is usable
by computers (somewhat)
by you yourself
but not by other clinics, hospitals and researchers ...
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How to link EHR data?f
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how can we link EHR 1 to EHR 2 in a reliable, trustworthy, useful way, which both systems can
understand ?
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EHR 1 EHR 2
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