Use of Semantic Interoperability to Improve the Urgent Continuity of Care in Danish ERs

Abstract

Reuse of patient data from prehospital electronic health record (EHR) to EHRs in emergency rooms is currently non-existing. In Danish EHRs, access to patient data recorded in prehospital settings is either not available or accessible in a PDF file. The amount of patient and administrative data registered at the prehospital unit is high and includes a rich representation of the accident, the patient and treatment. By applying emphasis framing to the representation of data, information overload can be diminished. Several international studies have investigated the suboptimal reuse of data within this field. Hence, the aim of this pre-study was to develop webservices based on emphasis framing to increase interoperability between the prehospital health record and the emergency room’s EHR. In this study, requirements engineering and emphasis framing was applied. Iterative linear requirement specification process was chosen as a frame to address the aim. The five included phases were revisited due to the iterative nature of this study. Tools used in the requirement engineering process were semi structured interviews and direct observations. The pre-study resulted in 12 Fast Healthcare Interoperability Resources (FHIR) profiles using SNOMED CT terminology bindings. The profiles contained elements which represented primarily patient data recorded in the prehospital setting. The profiles were compared to a case representing the urgent continuity of care to validate their ability to standardize data from prehospital health records. Conclusively, FHIR profiles can be modelled to standardize prehospital urgent patient data to support the patient trajectory. With the applied emphasis framing, the clinical context and content have been maintained.

Semantic Interoperability of EHRs: Review of Approaches for Enhancing the Goals of European Health Data Space

“…In our review, reported clinical benefits of developing semantic interoperability reflect well the major goals of EHDS regulation. Results in our sample show that, an evident goal driving the development in these studies is the following assumption: through increased access to patient information a better quality and outcomes in care can be achieved [21,23,25,27]. Better communication based on easily accessible data across EHRs is facilitated not only between clinicians and but also between professionals and the patients [26,28,30].…”

“…It was also documented that semantic interoperability enables data availability from various EHRs and clinical applications specifically for post-marketing research. [21][22][23][24][25][26][27][28][29][30]. In our analysis, semantic development goals were closely coupled with the need to build towards usable and computable data out of heterogeneous medical information that is accessible through various EHRs and databases, e.g., registers.…”

“…Better communication based on easily accessible data across EHRs is facilitated not only between clinicians and but also between professionals and the patients [26,28,30]. Further advances are related to efficiency and subsequent economic factors, for example, lessening the clinicians' workload related to documenting and evaluating extensive patient data to avoid information overload and to support multi-professional care processes [23][24][25][28][29]. In addition, interoperable patient data provides opportunities for a wide range of EHR-related clinical development, for example, regarding decisionmaking support, clinical research, or other type of secondary use [22,25,[29][30].…”

“…A main goal of semantic interoperability development is to enable patient data usage no matter in which EHRs the data is originated and by what terminologies, classifications, or other semantic features it is supported [14][15][16][17][18]. Of the documented terminologies, SNOMED CT seemed to prevail as the dominant choice for a clinical terminology [21][22][23]27,30]. For international classifications that are typically integrated into EHRs, a selection of well-established classifications was documented [22,[29][30].…”

“…For international classifications that are typically integrated into EHRs, a selection of well-established classifications was documented [22,[29][30]. Likewise, several health care specific standards [21][22][23]25,[29][30] [21,24,[27][28]and data models [22,[24][25][26][27][28][29][30] were presented even though here in a relatively small sample. One possible factor affecting the selection of interoperability features such as international standards may be open availability and level of cost in the standard specific resources and their deployment.…”