EHR
Electronic Health Record
Australia Denmark Greek
Student : Hamid Esmailzadeh ( 83233502 )
EHR….. Australia
One of the most significant activities of the healthcare industry is information management. Anenormous amount of data is collected about patients for storage and analysis. For this reason,information technology is an extremely useful tool for the healthcare industry. However, there aremany challenges which must be overcome before information technology solutions can be successfullydeployed in the healthcare environment. These challenges relate to a wide variety of issues, includingprivacy, medico-legal requirements and the effect on existing clinical practices. With this in mind, thispaper describes work done towards developing an Electronic Health Record (EHR) architecture. EHRscontain clinical information about patients and therefore form a critical part of a healthcare system.
An EHR system allows clinical information about patients to be stored and transmittedelectronically. Currently, many doctors keep paper records about their patients. When clinical patientdata is exchanged, for example between a hospitals and a GP, it is usually done manually through thepost, or at best by fax or phone. This makes it difficult to obtain accurate information in a timelyfashion.
Most modern hospitals have computerized records. However, these systems are usually proprietaryand often only serve one specific department within the hospital. Hospitals can have dozens ofindividual systems which do notinteroperate with each other. A patient’s health information profilecan be spread out over a number of disparate systems, making it difficult for clinicians to capture acomplete clinical history of a patient.
An interoperable electronic health record system has the potential to improve the provision of heathcare. It would allow clinicians to be able to access a more timely and complete picture of a patient’sclinical history. Therefore, clinicians can make better informed healthcare decisions. Furthermore, astest results could be more easily shared between healthcare providers, costly duplication of tests andservices could be avoided.
For interoperable electronic health records to become a reality, a common EHR standard isrequired. This paper describes a new approach to EHRs using the Good Electronic Health Record(GEHR) architecture. This approach makes use of XML Schema at two different levels. This paper
introduces the GEHR framework in Section 2, and XML Schema in Section 3. We then describe howXML Schema is being used within the GEHR framework: at the level of the GEHR object model insection 4, and at the clinical archetype level in section 5. Concluding remarks are made in section 6.
The use of Electronic Health Records (EHRs) to store patient health information is becomingincreasingly prevalent. In today’s distributed healthcare environment, there are obvious benefits to begained from being able to store, query and exchange this information between different health caresites. The information contained in these EHRs varies greatly in type - ranging from simple quantityvalues through to medical images. The clinical data models used to represent health data also variesgreatly due to the different legislation, standards and health practices of different countries, states andhealth care facilities.
One approach to implementing EHRs is based on the Good Electronic Health Record (GEHR)architecture. This approach introduces the concept of ‘clinical archetypes’ to handle the variety inclinical data models. These clinical data models can be standardized independently of the HER framework.
This paper describes the current Australian GEHR trial. In this trial, XML Schema is being used torepresent the GEHR object model as well as the clinical archetypes. This paper describes how XMLSchema is being used in the trial and the issues that are faced.
HER…… Denmark
In 1996 and 1999 The Danish Ministry of Health launched national strategies for the developmentof EPR (Electronic Patient Record) in the Danish health care sector (1,2), thelast covering the period 2000 - 02. With a basis in these strategies, the EPJ-observatory (3)was launched as a horizontal activity to collect and disseminate experiences from the regionalEPR-projects. The EPR Observatory has collected data: in 1998 focus was on theexpectations and in 1999 focus was on the experiences. These results are published in twoAnnual Reports (4,5) (in Danish) and summarized in (6). For the period 2000 – 02, theEPR Observatory focuses on the analysis of EPR-development and implementation in theDanish healthcare sector. This work is paying attention to:
1.Implementation and dissemination issues:
·Diffusion and diffusion rate of EPR-systems
· Experience among the different stakeholders
· Factors that increase diffusion and use of EPR-systems
· General barriers for diffusion and use of EPR-systems
· Assessment of selected EPR projects
2.Issues related to common frame of reference for EPR-systems:
· To uncover differences and compatibilities between regional data models
· To communicate consequences of using incompatible data models, and to assessthe demand for a common frame of reference.
The EPR Observatory has established networks, knowledge exchange and dialogue betweenthe various EPR-development projects, local decision makers in the hospitals andthe central health authorities. Initial transfer of strategic EPR-experience from the otherNordic countries has also been carried out. Finally, results of the above activities havebeen disseminated to all groups in the Danish health care sector through a national conferenceas well as through an annual report 2001(7) (in Danish). This paper gives a summaryof the main results from this report.
The EPR-Observatory – a public funded project organization - has monitored DanishEPR-projects with respect to various parameters such as diffusion and diffusion rate, barriersand 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 referencefor EPR systems. The National Board of Health and some of the larger counties have developedsuch frames. First generation systems have been implemented in a few counties with moderatecoverage, 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 thepractical implementation of the systems.
EHR …. Greek
This article address data quality issues relatingto electronic health records (EHRs). It discussesthe nature of the problem of supporting EHRs at national and international levels, and examines the dataquality issues. In particular, the discussionfocuses on the role of intelligent interfaces, structured dataentry and mobile computing within this context.The problems are then made tangible by consideringthe implementation of a Greek national EHR system. The article concludes by recommending an adaptationframework that will enable a stepwise approachin the development of EHRs for the Greek health system whichtakes into account the data quality issuesconsidered.
References :
1-Describing Electronic Health Records Using XML Schema
Bird LJ, Goodchild A and Sue H
CRC for Enterprise Distributed Systems (DSTC Pty Ltd)
Level 7, GP South, The University of Queensland, Qld, 4072, Australia.
Web:
E-mail: {bird, andrewg, hoylen}@dstc.edu.au.
2-A comparative study of EPR projects in Denmark
Stig Kjær Andersen 1, Christian Nøhr 1, Søren Vingtoft 2,
Knut Bernstein 3, Morten Bruun Rasmussen 3
Virtual Centre of Health Informatics,
(1) Aalborg University, Denmark(2) MEDIQ, Denmark,
(3) Danish Centre for Health Telematics, Denmark
3- Data Quality Issues in Electronic Health Records: An Adaptation Framework for the Greek Health System : Health Informatics Journal, Vol. 10, No. 1, 23-36 (2004)DOI: 10.1177/1460458204040665© 2004 SAGE Publications
Hamid Esmailzadeh
Date : Shahrivar 84
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