Palojoki Sari, Lehtonen Lasse, Vuokko Riikka
Department of Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland.
Diagnostic Center, Helsinki University Hospital District, Helsinki, Finland.
JMIR Med Inform. 2024 Apr 25;12:e53535. doi: 10.2196/53535.
Semantic interoperability facilitates the exchange of and access to health data that are being documented in electronic health records (EHRs) with various semantic features. The main goals of semantic interoperability development entail patient data availability and use in diverse EHRs without a loss of meaning. Internationally, current initiatives aim to enhance semantic development of EHR data and, consequently, the availability of patient data. Interoperability between health information systems is among the core goals of the European Health Data Space regulation proposal and the World Health Organization's Global Strategy on Digital Health 2020-2025.
To achieve integrated health data ecosystems, stakeholders need to overcome challenges of implementing semantic interoperability elements. To research the available scientific evidence on semantic interoperability development, we defined the following research questions: What are the key elements of and approaches for building semantic interoperability integrated in EHRs? What kinds of goals are driving the development? and What kinds of clinical benefits are perceived following this development?
Our research questions focused on key aspects and approaches for semantic interoperability and on possible clinical and semantic benefits of these choices in the context of EHRs. Therefore, we performed a systematic literature review in PubMed by defining our study framework based on previous research.
Our analysis consisted of 14 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. All articles reported clinical benefits of the selected approach to enhancing semantic interoperability. We identified 3 main categories: increasing the availability of data for clinicians (n=6, 43%), increasing the quality of care (n=4, 29%), and enhancing clinical data use and reuse for varied purposes (n=4, 29%). Regarding semantic development goals, data harmonization and developing semantic interoperability between different EHRs was the largest category (n=8, 57%). Enhancing health data quality through standardization (n=5, 36%) and developing EHR-integrated tools based on interoperable data (n=1, 7%) were the other identified categories. The results were closely coupled with the need to build usable and computable data out of heterogeneous medical information that is accessible through various EHRs and databases (eg, registers).
When heading toward semantic harmonization of clinical data, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of health care data. Instead of promoting a single approach, semantic interoperability should be assessed through several levels of semantic requirements A dual model or multimodel approach is possibly usable to address different semantic interoperability issues during development. The objectives of semantic interoperability are to be achieved in diffuse and disconnected clinical care environments. Therefore, approaches for enhancing clinical data availability should be well prepared, thought out, and justified to meet economically sustainable and long-term outcomes.
语义互操作性有助于交换和访问电子健康记录（EHR）中记录的具有各种语义特征的健康数据。语义互操作性发展的主要目标是确保患者数据在不同的EHR中可用且不失原意。在国际上，当前的倡议旨在加强EHR数据的语义发展，从而提高患者数据的可用性。健康信息系统之间的互操作性是欧洲健康数据空间监管提案和世界卫生组织《2020 - 2025年数字健康全球战略》的核心目标之一。
为实现综合健康数据生态系统，利益相关者需要克服实施语义互操作性要素所面临的挑战。为研究语义互操作性发展的现有科学证据，我们定义了以下研究问题：构建集成在EHR中的语义互操作性的关键要素和方法有哪些？推动发展的目标有哪些？以及这种发展带来了哪些临床益处？
我们的研究问题聚焦于语义互操作性的关键方面和方法，以及在EHR背景下这些选择可能带来的临床和语义益处。因此，我们在PubMed上进行了系统的文献综述，通过基于先前研究定义我们的研究框架。
我们的分析包括14项研究，这些研究将数据模型、本体、术语、分类和标准应用于构建互操作性。所有文章都报告了所选增强语义互操作性方法的临床益处。我们确定了3个主要类别：提高临床医生的数据可用性（n = 6，43%）、提高护理质量（n = 4，29%）以及增强临床数据用于各种目的的使用和再利用（n = 4，29%）。关于语义发展目标，数据协调以及在不同EHR之间发展语义互操作性是最大的类别（n = 8，57%）。通过标准化提高健康数据质量（n = 5，36%）以及基于可互操作数据开发EHR集成工具（n = 1，7%）是其他确定的类别。结果与从通过各种EHR和数据库（如登记册）可访问的异构医疗信息中构建可用且可计算数据的需求紧密相关。
在迈向临床数据语义协调的过程中，需要更多的经验和分析来评估所选解决方案对医疗保健数据语义互操作性的适用性。不应只推广单一方法，而应通过几个层次的语义要求来评估语义互操作性。在开发过程中，双模型或多模型方法可能适用于解决不同的语义互操作性问题。语义互操作性的目标要在分散且不连贯的临床护理环境中实现。因此，提高临床数据可用性的方法应精心准备、深思熟虑且合理，以实现经济上可持续的长期成果。
