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临床决策支持系统和电子健康记录使用原型进行互操作性:临床试验资格案例研究。

Interoperability of clinical decision-support systems and electronic health records using archetypes: a case study in clinical trial eligibility.

机构信息

Dept. of Computer Engineering and Science, Universitat Jaume I, Av. de Vicent Sos Baynat s/n, 12071 Castellón, Spain.

出版信息

J Biomed Inform. 2013 Aug;46(4):676-89. doi: 10.1016/j.jbi.2013.05.004. Epub 2013 May 22.

Abstract

Clinical decision-support systems (CDSSs) comprise systems as diverse as sophisticated platforms to store and manage clinical data, tools to alert clinicians of problematic situations, or decision-making tools to assist clinicians. Irrespective of the kind of decision-support task CDSSs should be smoothly integrated within the clinical information system, interacting with other components, in particular with the electronic health record (EHR). However, despite decades of developments, most CDSSs lack interoperability features. We deal with the interoperability problem of CDSSs and EHRs by exploiting the dual-model methodology. This methodology distinguishes a reference model and archetypes. A reference model is represented by a stable and small object-oriented model that describes the generic properties of health record information. For their part, archetypes are reusable and domain-specific definitions of clinical concepts in the form of structured and constrained combinations of the entities of the reference model. We rely on archetypes to make the CDSS compatible with EHRs from different institutions. Concretely, we use archetypes for modelling the clinical concepts that the CDSS requires, in conjunction with a series of knowledge-intensive mappings relating the archetypes to the data sources (EHR and/or other archetypes) they depend on. We introduce a comprehensive approach, including a set of tools as well as methodological guidelines, to deal with the interoperability of CDSSs and EHRs based on archetypes. Archetypes are used to build a conceptual layer of the kind of a virtual health record (VHR) over the EHR whose contents need to be integrated and used in the CDSS, associating them with structural and terminology-based semantics. Subsequently, the archetypes are mapped to the EHR by means of an expressive mapping language and specific-purpose tools. We also describe a case study where the tools and methodology have been employed in a CDSS to support patient recruitment in the framework of a clinical trial for colorectal cancer screening. The utilisation of archetypes not only has proved satisfactory to achieve interoperability between CDSSs and EHRs but also offers various advantages, in particular from a data model perspective. First, the VHR/data models we work with are of a high level of abstraction and can incorporate semantic descriptions. Second, archetypes can potentially deal with different EHR architectures, due to their deliberate independence of the reference model. Third, the archetype instances we obtain are valid instances of the underlying reference model, which would enable e.g. feeding back the EHR with data derived by abstraction mechanisms. Lastly, the medical and technical validity of archetype models would be assured, since in principle clinicians should be the main actors in their development.

摘要

临床决策支持系统(CDSS)包括各种系统,如存储和管理临床数据的复杂平台、提醒临床医生出现问题情况的工具,或协助临床医生做出决策的工具。无论 CDSS 应该执行哪种类型的决策支持任务,它都应该能够顺利地集成到临床信息系统中,与其他组件交互,特别是与电子健康记录(EHR)交互。然而,尽管经过几十年的发展,大多数 CDSS 仍然缺乏互操作性功能。我们通过利用双模型方法来解决 CDSS 和 EHR 的互操作性问题。该方法区分了参考模型和原型。参考模型由一个稳定的小型面向对象模型表示,该模型描述了健康记录信息的通用属性。而原型则是以结构化和受约束的方式组合参考模型实体的可重用和特定于领域的临床概念定义。我们依赖原型使 CDSS 与来自不同机构的 EHR 兼容。具体来说,我们使用原型来为 CDSS 所需的临床概念建模,同时结合一系列知识密集型映射,将原型与它们所依赖的数据来源(EHR 和/或其他原型)联系起来。我们引入了一种全面的方法,包括一套工具和方法指南,以基于原型解决 CDSS 和 EHR 的互操作性问题。原型用于在 EHR 之上构建虚拟健康记录(VHR)的概念层,需要将其集成并在 CDSS 中使用,同时将其与基于结构和术语的语义相关联。随后,使用表达性映射语言和特定用途的工具将原型映射到 EHR。我们还描述了一个案例研究,其中在 CDSS 中使用了工具和方法来支持结直肠癌筛查临床试验中的患者招募。使用原型不仅可以满足 CDSS 和 EHR 之间互操作性的要求,而且还具有各种优势,特别是从数据模型的角度来看。首先,我们处理的 VHR/数据模型具有较高的抽象级别,并可以包含语义描述。其次,由于原型与参考模型的刻意独立,它们有可能处理不同的 EHR 架构。第三,我们获得的原型实例是底层参考模型的有效实例,这将使得例如通过抽象机制反馈 EHR 数据成为可能。最后,原型模型的医学和技术有效性将得到保证,因为原则上临床医生应该是其开发的主要参与者。

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