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International interoperability of healthcare and research data requires a commitment to standards. To this end, SNOMED CT was evaluated for representing questionnaire items of the European Registry of Stroke Care Quality using a complex annotation protocol. The agreement between validators and annotators was 72.4%. At least 64% of the information could be represented by using SNOMED CT only, including complex post-coordinations. 9% of the information would require an information model, and 14% the addition of new content to SNOMED CT. Next steps will be the creation of an annotation guideline for questionnaires, a specific reference set, and the combination of both with an information model such as HL7 FHIR. [ABSTRACT FROM AUTHOR]

Learning Health System (LHS) and integrated care are challenged due to a fragmented health data landscape. An information model is agnostic to the underlying data structures and can potentially contribute to mitigating some of the gaps. In a research project, Valkyrie, we are exploring how metadata can be organized and used to promote service coordination and interoperability across levels of care. An information model is viewed as central in this context and as a future integrated LHS support. We examined the literature regarding property requirements for data, information and knowledge models in the context of semantic interoperability and an LHS. The requirements were elicited and synthesized into five guiding principles as a vocabulary to inform the information model design of Valkyrie. Further research on requirements and guiding principles for information model design and evaluation are welcomed. [ABSTRACT FROM AUTHOR]

CLABSIs are one of the most lethal and costly types of healthcare associated infections (HAIs). Regulatory organizations have mandated hospitals to submit monthly surveillance reports. However, there is an inaccuracy of presenting this report because of the lack of data standardization. This descriptive qualitative study aimed to develop a CLABSI prevention Information Model (IM) so the CLABSI prevention guidelines can be incorporated into structured nursing documentations. The flowsheet metadata stored in the Clinical Decision Repository was analyzed using an advanced analytics tool. The CLABSI prevention flowsheet data were mapped to 25 concepts, 45 data attributes and over 200 data value sets after organizing hierarchical structures. Seven domains of CLABSI prevention were identified in a CLABSI prevention IM. It would provide tangible benefits to create a practice reminder of the high risk for CLABSIs based on the nursing flowsheet data sets and multidisciplinary Electronic Health Record (EHR). [ABSTRACT FROM AUTHOR]

This work aims to describe how EHRs have been used to meet the needs of healthcare providers and researchers in a 1,300-beds tertiary Hospital during COVID-19 pandemic. For this purpose, essential clinical concepts were identified and standardized with LOINC and SNOMED CT. After that, these concepts were implemented in EHR systems and based on them, data tools, such as clinical alerts, dynamic patient lists and a clinical follow-up dashboard, were developed for healthcare support. In addition, these data were incorporated into standardized repositories and COVID-19 databases to improve clinical research on this new disease. In conclusion, standardized EHRs allowed implementation of useful multi-purpose data resources in a major Hospital in the course of the pandemic. [ABSTRACT FROM AUTHOR]

Learning Health Systems (LHS) are challenged by fragmented health data. In Valkyrie, information models (IM) are explored as translators for the underlying, fragmented data structures and can potentially extend to support a future LHS. In this paper, a literature review was performed to search for property requirements for semantic interoperable IMs in the context of an LHS. The literature was examined and property requirements elicited in the context of an LHS. [ABSTRACT FROM AUTHOR]

Written text has been the preferred medium for storing health data ever since Hippocrates, and the medical narrative is what enables a humanized clinical relationship. Can't we admit natural language as a user-accepted technology that has stood against the test of time? We have previously presented a controlled natural language as a human-computer interface for semantic data capture already at the point of care. Our computable language was driven by a linguistic interpretation of the conceptual model of the Systematized Nomenclature of Medicine -- Clinical Terms (SNOMED CT). This paper presents an extension that allows the capture of measurement results with numerical values and units. We discuss the relation our method can have with emerging clinical information modelling. [ABSTRACT FROM AUTHOR]

This is a project proposal derived from an urge to re-define the governance of ICT in healthcare towards regional and national standardization of the patient pathways. The focus is on a two-levelled approach for governing EPR systems where the clinicians' model structured variables and patient pathways. The overall goal is a patient centric EPR portfolio. This paper define and enlighten the need for establishing the socio-technical architect role necessary to obtain the capabilities of a modern structured EPR system. Clinicians are not capable to moderate between the technical and the clinical. [ABSTRACT FROM AUTHOR]

The template information model in [2] includes the function description (corresponding to the macro-level) and the initial elaboration of the 1st fractal level (corresponding to the first micro-level). The purpose here is to develop the 2nd micro-level of the template information model, however delimited to include only the function addressed in this study. This is accomplished by systematic elaboration of the initial micro-level description for the model on human molecular genetics to match the characteristics identified in the knowledge domain, followed by reverse transformation of results into a generic system version. [ABSTRACT FROM AUTHOR]

Current systems that target Patient Safety (PS) like mandatory reporting systems and specific vigilance reporting systems share the same information types but are not interoperable. Ten years ago, WHO embarked on an international project to standardize quality management information systems for PS. The goal is to support interoperability between different systems in a country and to expand international sharing of data on quality and safety management particularly for less developed countries. Two approaches have been used: (i) a bottom-up one starting with existing national PS reporting and international or national vigilance systems, and (ii) a top-down approach that uses the Patient Safety Categorial Structure (PS-CAST) and the Basic Formal Ontology (BFO) upper level ontology versions 1 and 2. The output is currently tested as an integrated information system for quality and PS management in four WHO member states. [ABSTRACT FROM AUTHOR]

The panel focuses on Point-of-Care (POC) solutions for the documentation of nursing practice in electronic health record (EHR) and/or healthcare information technology (HIT) systems using the Clinical Care Classification (CCC) System. The CCC System was developed by Dr. Saba and Colleagues for the electronic documentation of patient care by nurses and allied health professionals and has been approved by American Nurses Association and U.S. Department of Health and Human Services as an interoperable, standardized nursing terminology The unique POC solutions will be described by different nursing informaticians, designers, and implementers who will describe how they document patient care using the CCC System and their impact on care outcomes. Also the Nursing Informatics (NI) Experts will discuss the effects of POC solutions on care quality and safety, as well as highlight how the data analytics are used to measure and predict workload, staffing, and cost. They will also describe how the information is used to support evidence-based practice and advance nursing knowledge. [ABSTRACT FROM AUTHOR]

Quality management information systems for safety as a whole or for specific vigilances share the same information types but are not interoperable. An international initiative tries to develop an integrated information model for patient safety and vigilance reporting to support a global approach of heath care quality. [ABSTRACT FROM AUTHOR]

A feasibility analysis has been performed to study the applicability of privacy attributes with a developed wellness information model. Information privacy concerns specifically access to individually identifiable personal information and one's ability to control information about oneself. We carried out a user scenario walk-through of the privacy attributes related to the wellness components. The walk-through showed a need to relate self-regulating privacy policies to the pervasive context so that during various trust-building processes, a person is aware and can control the use, disclosure and even secondary use of his personal, private wellness information. [ABSTRACT FROM AUTHOR]

Under the ARCHITRAVE programme aimed at redesigning the regional health and social information system, the alpha version of a new web application was developed using the International Classification of Functioning, Disability and Health (ICF) and other medical terminology systems as a basis for a flexible electronic standards-based bio-psycho-social record. The web application was developed in order to collect information according to a multiaxial assessment framework consistent with the model of functioning adopted by the ICF. The web application translates information collected in natural language into ICF and releases outputs at different stages of the assessment process useful in evaluating clinical and social outcomes, distinguishing between functioning and disability in the same functioning profile and planning reasonable adaptations to overcome disability. The alpha version works in Italian and was adapted to the Italian welfare system/services/policies, but an international version working in other languages/welfare systems can be designed. The first field trial is ongoing in the Friuli Venezia Giulia Region, implementing the regional Health and Social Action Plan 2010-2012. [ABSTRACT FROM AUTHOR]

Semantic interoperability, a prerequisite to eHealth projects, relies on sharing both information and knowledge models between information systems. Two of the standards of information models are HL7 v3 and the European norm, EN13606/OpenEHR. The paper compares both standards on a fragment of the prenatal medical record, the APGAR score. Two factors are compared: the formal representation of both information models, and the binding to knowledge models. The HL7v3 perinatality DMIM specification and the OpenEHR APGAR archetype were used. HL7v3 appears to be more formal than OpenEHR and able to represent in an easier way the clinical context. For both standards, the binding to reference terminologies such as LOINC is poor. We provide recommendations to improve the standards. [ABSTRACT FROM AUTHOR]

This work aims to define a standardized information model for representation of multiple data sources in breast cancer. A set of data elements has been identified using ICHOM Breast Cancer as the minimum data set and adapting it to the needs of Hospital Universitario 12 de Octubre. With this, an information model has been defined according to ISO 13606 and SNOMED CT standards. [ABSTRACT FROM AUTHOR]

Introduction: Electronic patient record (EPR) systems for the continuity of care for stroke patient are under development. These systems are based on standards such as for clinical practice, vocabularies, and the HL7 information model. Problem statement: In order to achieve intelligent semantic interoperability, knowledge about evidence based patient care, vocabulary and information models need to be integrated. Methodology: A format was developed in which the clinical knowledge, clinical terminology, and standard information models are integrated as specification for the technical implementation of electronic health systems and electronic messages. This format is verified by clinicians and technicians. Results: The document structure consists of meta-information such as version control and changes, purpose of the clinical content, evidence from the literature, variables and values, terminology used, guidelines for application and interpretation, HL7 message models, coding, and technical data specification. Further, XML message excerpts, archetypes and screen designs are developed from these documents to facilitate implementation. Conclusion: The combination of these aspects in one document creates valuable content for intelligent semantic interoperability by means of development of messages and systems. [ABSTRACT FROM AUTHOR]

Healthcare depends on evidence for practice and for electronic exchange of clinical patient information. To standardize the information that is being exchanged we created a format for describing care related information: a care information model. This model integrates knowledge, terminology and an information model. During a meeting between experts on nursing, standards and electronic patient records we evaluated the format of the care information model by use of an evaluation form and a group discussion. In general, the experts were enthusiastic about the format of the care information model. However they missed specific information about the purpose of the documents, and clarity on copyright issues. In addition, detailed comments on the existing structure and suggestions for additional categories were given. Also, experts suggested representing the integration in both HL7 message model format and in OpenEHR archetype format to allow different implementations of the same intelligence. From this we can conclude that the combination of these aspects in one document creates a valuable content for development of messages and systems. However, some adjustments are needed. [ABSTRACT FROM AUTHOR]

Electronic Health Record (EHR) systems are being developed to improve the communication of patient data. The health care domain includes many different types of data and concepts, of which some are constantly changing, and some are more lasting. This makes the development of an EHR a complex task. In order to improve the handling of this complexity, a new two-level modelling approach in EHR system development has emerged, using a concept of archetypes as the pivot in the representation of the health care knowledge. The key issue in this approach involves dividing the problem field into two separate models: A generic information model and a domain knowledge model. By analysis of how this layering has been carried out in two different two-level EHR systems – the OpenEHR (formerly the Australian GEHR, Good Electronic Health Record) and the EHR project of Aarhus County, Denmark. We have identified critical meta model parameters influencing the ability of the modelling paradigm to meet the expectation for easy handling of the development process (flexibility) and the capability to manage changing models (dynamics). The OpenEHR has defined the division line in such a way that it makes the generic model small and the domain model large. The opposite is the case of the Aarhus EHR system, where the information model is large, and the knowledge model is small. A small information model and a large knowledge model make more of the system changeable, but it also makes it less flexible to develop. The opposite is the case for a large information model and a small knowledge model. [ABSTRACT FROM AUTHOR]

HL7 is the commonly accepted messaging standard for achieving interoperability among information systems. Until now, no analysis has been done on how poison control data can be matched in HL7 messages. The purpose of this study was to create a preliminary domain analysis model which can be used to identify the data required to message poison control data in HL7 messages. [ABSTRACT FROM AUTHOR]

Brazil has a long tradition in the use of health information systems, however - until now - there is no consensus on the minimum data set from which to compose discharge summaries. This article describes the metdodology used by a group of experts - members of WG1 of ISOTC 215 Health Informatics Brazilian mirror committe -- to define the information model of the discharge summary. This paper describes the current status of the standardization process and the first pilot tests with this information content. [ABSTRACT FROM AUTHOR]