Clustering clinical models from local electronic health records based on semantic similarity.

BACKGROUND: Clinical models in electronic health records are typically expressed as templates which support the multiple clinical workflows in which the system is used. The templates are often designed using local rather than standard information models and terminology, which hinders semantic interoperability. Semantic challenges can be solved by harmonizing and standardizing clinical models. However, methods supporting harmonization based on existing clinical models are lacking. One approach is to explore semantic similarity estimation as a basis of an analytical framework. Therefore, the aim of this study is to develop and apply methods for intrinsic similarity-estimation based analysis that can compare and give an overview of multiple clinical models. METHOD: For a similarity estimate to be intrinsic it should be based on an established ontology, for which SNOMED CT was chosen. In this study, Lin similarity estimates and Sokal and Sneath similarity estimates were used together with two aggregation techniques (average and best-match-average respectively) resulting in a total of four methods. The similarity estimations are used to hierarchically cluster templates. The test material consists of templates from Danish and Swedish EHR systems. The test material was used to evaluate how the four different methods perform. RESULT AND DISCUSSION: The best-match-average aggregation technique performed better in terms of clustering similar templates than the average aggregation technique. No difference could be seen in terms of the choice of similarity estimate in this study, but the finding may be different for other datasets. The dendrograms resulting from the hierarchical clustering gave an overview of the templates and a basis of further analysis. CONCLUSION: Hierarchical clustering of templates based on SNOMED CT and semantic similarity estimation with best-match-average aggregation technique can be used for comparison and summarization of multiple templates. Consequently, it can provide a valuable tool for harmonization and standardization of clinical models.

SNOMED CT adoption in Denmark--why is it so hard?

What prevents the National Health Care Terminology based on SNOMED CT from being implemented in the EHR systems and ongoing EHR implementations in Denmark? SNOMED CT was translated into Danish language from 2006-2009 and by 2013 it is not yet implemented in a clinical information system. Fourteen key persons broadly representing all major stakeholders in the process of system configuration accepted an invitation to discuss questions about what kind of challenges they experience in handling terminology in clinical information systems today and what they expect from a future implementation of a SNOMED CT based national terminology. Three types of challenges of terminology implementations resulted from two parallel focus group interviews: 1. Methods to manage terminology-implementation like preventing inconsistency and redundant representations of identical information. 2. The existing terminology and classifications used are sufficient to accommodate the required governance and 3. SNOMED CT is expected to be immature for system-implementation. These results suggest further research in methods to facilitate implementation of a complex terminology and studies that evaluate SNOMED CT in clinical use; but the results also support national and regional decision makers regarding what kind of challenges they must manage.

Interaction between COPD patients and healthcare professionals in a cross-sector tele-rehabilitation programme.

This paper explores how technology affects the interaction between chronic obstructive pulmonary disease (COPD) patients and healthcare professionals in a cross-sector tele-rehabilitation programme. The qualitative analysis has shown that a community of rehabilitation can be created despite the presence of long-distance technology. In the tele-rehabilitation programme, the interaction between the COPD patients at home and the healthcare professionals at the clinic has evolved with dialogue as the basis for mutual learning processes and new relationships. Managed properly, rehabilitation at a distance can be both effective and satisfying.

Balancing centralised and decentralised EHR approaches to manage standardisation.

Balancing regional and national electronic health record (EHR) approaches requires cooperation between clinical and technical experts at different organisational levels. Bridging is necessary to achieve interoperability between regional EHR systems, without neglecting the clinical usefulness. This study has investigated the approaches chosen in modelling the clinical content of EHRs in two out of five regions in Denmark. Based on the knowledge obtained in these studies a 'clinical content format' was developed to facilitate the work of the regions, where the clinical content of EHR systems is modelled. The objective of the clinical content format is to enable share and reuse across organisations, furthermore an objective is to gradually introduce standards. The results of the first iteration of a 'clinical content format' are presented and future adjustments are discussed based on the results.

Under surveillance, yet looked after: telehomecare as viewed by patients and their spouse/partners.

INTRODUCTION: In this research project, a group of heart patients were transferred from traditional hospital settings to home hospitalisation across sectors. The project involved patients with heart failure and arrhythmia. AIM: The aim was to understand the experiences and attitudes of patients and their spouses/partners with regard to the application of telehomecare technology as an option within home hospitalisation. METHODS: A phenomenological hermeneutic approach was used to collect and interpret the findings and data. A triangulation of data collection techniques was applied using participation observation and qualitative interviews with patients and spouse/partner. Data were analysed from the perspective of the sociology of everyday life. FINDINGS: The impact of home hospitalisation on patients is described according to several themes: security, freedom, increased awareness of own symptoms, being 'looked after' but annoyed with their spouse/partner. The patients experience a seamless cross-sector patient care process. The impact on the spouse/partner includes elements of increased responsibility, nervous tension, and invasion of privacy. CONCLUSION: Patients believe that home hospitalisation speeds up the process of returning to everyday life, both physically and mentally. It is important to be aware of certain anxieties experienced by the patient's spouse/partner about home hospitalisation, and these anxieties may also affect the patient.

Diffusion of electronic health records--six years of empirical data.

The Danish EHR-Observatory has monitored Danish EHR projects since 2000 with respect to a number of parameters such as diffusion, diffusion rate and the hospital owners expectations. On the basis of the data and a model for technology diffusion three scenarios for future diffusion are built. The results show that the national goal to have EHRs fully implemented in hospitals by 2008 will not be reached. The scenarios built from empirical data provide a useful benchmarking tool for planning and evaluating the EHR implementation programs in hospitals.

Implementation of the concept of home hospitalisation for heart patients by means of telehomecare technology: integration of clinical tasks.

PURPOSE: To explore how the implementation of the concept 'Home hospitalisation of heart patients' by means of telehomecare technology influences the integration of clinical tasks across healthcare sectors. THEORY: Inter-organisational theory. METHODS: The case study approach was applied. Triangulations of data collection techniques were used: documentary materials, participant observation, qualitative and focus group interviews. RESULTS: The clinical decision-making and task solving became multidisciplinary and integrated with the implementation of telehomecare and, therefore, complex in terms of the prescription and adjustment of patient medicine. Workflows between healthcare professionals across sectors changed from sequential to collective client flows. Pre-existing procedures for patient care, treatment, and responsibility were challenged. In addition, the number of tasks for the district nurses increased. Integration in the clinical task-solving area increases fragmentation in the knowledge technologies in a network perspective. CONCLUSIONS: Implementing the concept of 'Home hospitalisation of heart patients' by means of telehomecare technology will result in a more integrated clinical task-solving process that involves healthcare professionals from various sectors. Overall, the integration of clinical tasks between hospital and district nursing will result in a direct benefit for the heart patients.

Quality labelling and certification of electronic health record systems.

The Danish Health IT strategy 2003-2007 demands implementation of Electronic Health Records (EHR) in all Hospitals based on common standards. The aim is to achieve integration and semantic interoperability between different EHR systems in order to support a better communication and coherence between the health care parties. The National Board of Health has developed a common model, which is a prerequisite for the development and implementation of interoperable EHR systems. The adoption of the common EHR model has been promoted and validated through a number of pilot projects in different Hospitals. The Danish EHR Observatory, which has been monitoring the development of EHR in Denmark since 1998, have developed a methodology for Quality labelling and certification of EHR systems. The methodology for certification of EHR systems has been used to validate EHR systems from different vendors to document to which extent the systems are based on the national requirements for EHR.

Modelling and implementing electronic health records in Denmark.

The Danish Health IT strategy [Danish Ministry of Interior and Health, National Strategy for IT in the Health Sector 2003-2007, Copenhagen, 2003 (in Danish). http://www.im.dk/publikationer/itstrategi/itstrategi.pdf. notes that integration between electronic health records (EHR) systems has a high priority. A prerequisite for real integration and semantic interoperability is agreement of the data content and the information models. The National Board of Health is working on a common model for EHR, and its adoption is now being promoted through pilot projects. At the same time, several development and implementation projects are taking place at a regional level. These EHRs are built on information models from different vendors and are based on different integration platforms. The Danish EHR observatory, which has been monitoring the development of EHRs in Denmark since 1998, has analysed the challenges of using different information models and integration platforms. This paper also maps the development in Denmark to the new paradigms in modelling techniques and integration technology.

Development, implementation and diffusion of EHR systems in Denmark.

The Danish EHR-Observatory has monitored Danish EHR projects for several years with respect to a number of parameters such as diffusion, diffusion rate, barriers and limitations, and experience gained. The results of the 2002 monitoring reveal that investment in IT is relatively low and the diffusion rate is below the estimated level. The EHR projects gain a lot of valuable experience, but the coordination of evaluation results should be improved.

Modelling and implementing electronic health records in Denmark.

The Danish Health IT strategy [1] points out that integration between electronic health records (EHR) systems has a high priority. A prerequisite for real integration and semantic interoperability is agreement of the data content and the information models. The National Board of Health is working on a common model for EHR, but it is not yet fully developed. At the same time several development and implementation projects are taking place at a regional level. These EHRs are built on information models from different vendors and are based on different integration platforms. The Danish EHR observatory, which has been monitoring the development of EHRs in Denmark since 1998, have analysed the challenges of using different information models and integration platforms. This paper also reports new tendencies in modelling and integration platforms globally and how this is reflected in the National development.

Monitoring the development and diffusion of EHR systems in Denmark.

The Danish EHR Observatory has monitored Danish EHR projects for several years with respect to a number of parameters such as diffusion, diffusion rate, barriers and limitations, and experience gained. The results of the 2002 monitoring reveal that investment in IT is relatively low and the diffusion rate is below the estimated level. The EHR projects gain a lot of valuable experience, but the coordination of evaluation results should be improved.

A comparative study of EPR projects in Denmark.

The EPR-Observatory--a public funded project organization--has monitored Danish EPR-projects with respect to various parameters such as diffusion and diffusion rate, barriers and limitations, experience gained. Furthermore, the Observatory has aggregated and disseminated the results and has established a constructive dialogue between the Danish EPR projects. The Observatory has also focused in the later years on analysis of common frames of reference for EPR systems. The National Board of Health and some of the larger counties have developed such frames. First generation systems have been implemented in a few counties with moderate coverage, but a number of projects developing second generation systems are making progress, and the market situation is quickly maturing. There are still, however, major problems in the practical implementation of the systems.