Pulse+IT Magazine - April 2014

Page 58




IT’S ALL ABOUT THE DATA Interoperable EHRs are the holy grail of eHealth, but most remain a closed shop. The development of archetypes – discretely defined clinical concepts – and the sharing of them through a Clinical Knowledge Manager (CKM) such as that hosted by NEHTA and used to inform the PCEHR, and in clinical use in the Northern Territory, means real interoperability is possible.

DR HEATHER LESLIE MB BS, Dip.Obs (RACOG), FRACGP, FACHI Director of Clinical Modelling, Ocean Informatics heather.leslie@oceaninformatics.com

Electronic health records (EHRs) have been around for over 30 years now, but it is still hard to share information between health software programs. Traditionally, we have had vendors develop electronic health record software applications created entirely from scratch ‘in house’. Each one has been proprietary and the result has been a data structure that is unique for each software application. The data within each vendor EHR are effectively silos of health information, with clinical content as simple as blood pressure represented differently in each system. Interoperability – the ability to unambiguously share health information between different EHR systems – has been elusive.

About the author Dr Heather Leslie practiced for 15 years as a GP before taking up full-time work in health informatics. She is the director of clinical modelling at Ocean Informatics, and the clinical program lead at the openEHR Foundation. Heather has advised national eHealth programs in Australia and Europe, and provided training here and overseas.

As a means to bridge the gap between each EHR, for more than a decade there has been a gradual growth in the development of agreed, standardised messages, documents and/or profiles. Each of these have been mapped or transformed from the EHR’s proprietary data patterns to the agreed data pattern, so that they can be sent to other healthcare providers or exchanged with other EHR systems. This solution has enabled some success in simple health information sharing, mostly documents or reports such as discharge summaries or pathology results.

The downside to this approach is that each document or message can take years to reach consensus, so the process is effectively glacial and the amount of information available for sharing is limited to the sole purpose of these documents or messages. The unresolved question is whether this is a scalable approach as we want to share greater amounts of health information in finer granularity, and whether this is sustainable. In order to try to change this paradigm, there has been a slowly emerging international approach to provide clinical leadership for defining the clinical data patterns, rather than leaving it to each vendor to ‘reinvent the wheel’. This has originated from over 20 years of research and development into electronic health records, and has been championed by the openEHR Foundation In the openEHR approach, clinical data patterns are known as archetypes. The development of archetypes is cliniciandriven to ensure that the data patterns represent the clinical data we require for direct patient care, health information exchange, clinical decision support, research data aggregation and analysis and population health. Clinicians are starting to have some control over the data, potentially overturning the traditional, vendor-driven approach.

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