Institute for Medical Information Management and Imaging, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria.
Int J Med Inform. 2013 Dec;82(12):1195-207. doi: 10.1016/j.ijmedinf.2013.08.002. Epub 2013 Aug 14.
While contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers' information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment.
Using methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study.
We identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8-14min versus 20min or more).
Our results show that for an efficient satisfaction of health care providers' information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is superior to a conventional metadata-based XDS search.
虽然共享电子健康记录（EHR）系统有助于改善医疗服务的连续性，但也可能导致医疗服务提供者面临信息过载的问题。面向文档的架构，例如通常采用的 IHE XDS 配置文件，仅支持在文档级别进行信息检索，因此特别容易出现这个问题。EHR-ARCHE 项目的目标是开发一种方法和原型，以便在治疗情况下访问患者的共享 EHR 时，有效地满足医疗服务提供者的信息需求。我们特别旨在研究通过将 EHR 原型集成到 IHE XDS 环境中是否可以达到此目标。
我们首先使用系统的方法学分析，分析医疗服务提供者的信息需求，重点关注治疗糖尿病患者的应用领域。然后，我们设计了涵盖已识别信息需求的 ISO/EN 13606 原型。为了支持在 EHR 文档内的精细粒度信息项的基于内容的搜索，我们在 IHE XDS 环境中添加了两个额外的参与者。最后，我们在一项对照研究中对我们的方法进行了形成性和总结性评估。
我们确定了 446 个经常需要的特定于糖尿病的信息项，这些信息项代表了医疗服务提供者的典型信息需求。然后，我们为两个虚构的患者创建了 128 个原型和 120 个 EHR 文档。七位评估我们方法的糖尿病专家都更喜欢基于内容的搜索而不是传统的 XDS 搜索。基于内容的搜索找到相关信息的成功率更高（100%对 80%），而且后者的效率也更高（8-14 分钟对 20 分钟或更长时间）。
我们的结果表明，为了有效地满足医疗服务提供者的信息需求，基于集成原型到基于 IHE XDS 的共享 EHR 系统的基于内容的搜索优于传统的基于元数据的 XDS 搜索。
