Panel: Problems with Existing EHR Paradigms

and How OntologyCan Solve Them

Roberto A. Rocha, MD, PhD, FACMISr. Corporate Manager

Clinical Knowledge Management and Decision Support,Clinical Informatics Research and Development, Partners Healthcare

SystemLecturer in Medicine

Division of General Internal Medicine and Primary Care, Department ofMedicine, Brigham and Women’s Hospital, Harvard Medical School

International Conference on Biomedical OntologyJuly 28-30, 2011

Buffalo, New York, USA

Panel: Problems with Existing EHR Paradigms

and How OntologyCan Solve Them

Roberto A. Rocha, MD, PhD, FACMISr. Corporate Manager

Clinical Knowledge Management and Decision Support,Clinical Informatics Research and Development, Partners Healthcare

SystemLecturer in Medicine

Division of General Internal Medicine and Primary Care, Department ofMedicine, Brigham and Women’s Hospital, Harvard Medical School

International Conference on Biomedical OntologyJuly 28-30, 2011

Buffalo, New York, USA

Opportunity

• New generation of clinical systems beyond efficient record storage and communication– New paradigm with pervasive computerized data analysis

and decision support– Widespread use of interoperable services and data, with

advanced functions that enable team-based care

Example: Simple ‘If - Then’ rule

4

Example: Simple ‘If - Then’ rule

Patient data

Concepts Knowledge

LOINC?

Problem list?

Coded values?

SNOMED CT?

Bedside measurements?

Lab results?

Medications?

Rules? Formulas?

Classifications?

Availability of data

• Availability of structured and coded clinical data determines the feasibility of CDS interventions– Data is expensive to generate at the point-of-care (systematically)– Benefits frequently not tangible to data “producers” (extra incentives)

• Dissemination and exchange of knowledge assets depends on data standardization (structure & semantics)

Health IT Data Standards!

Natural language processing?

Voice recognition?

Mobile devices?

Knowledge-driven documentation?

Semantic expressivity (adaptive)?

Efficient dissemination strategy

Stead WW and Lin HS, editors. Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. National Research

Council, 2009.

Similar model for a Personal Health Records

(individuals)

Current dissemination barriers

Large scale CDS

What will differentiate clinical systems? Process automation?

Ease of use?Advanced CDS functions?

How ontologies can help?

• Shared concepts and logical models (data & knowledge)– Proper domain coverage, but without compromising

extensibility and innovation– More accessible methods and tools to enable widespread

adoption– Training and demonstration projects

• Cost-effective semantic interoperability– Lower the cost and overhead of the data & knowledge

‘translation’ every time exchange is necessary• Clinical systems that can seamlessly represent and

process a complete electronic patient care record– Move beyond interoperability space and start

influencing/guiding transactional data and knowledge representation models

Thank you!

Roberto A. Rocha, MD, PhDrarocha@partners.org