Use of EHRs in a Tertiary Hospital During COVID-19 Pandemic: A Multi-Purpose Approach Based on Standards

Pedrera, Miguel; García, Noelia; Blanco, Alvar; Terriza, Ana Isabel; Cruz, Jaime; López, E. Alted; Calvo, Fernando García; Jiménez, María Jesús Turrero; González, Patricia I. Sosa; Quirós, V.; Cruz, Juan Luis de la; Bernal, José Luis; Serrano, Pablo E.

doi:10.3233/shti210114

Cited by 6 publications

(13 citation statements)

References 9 publications

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“…We identified 14 articles describing semantic interoperability in EHRs, published between 2011 and 2022, as shown in Multimedia Appendix 1 [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. The results revealed predominantly European advances in the study topic.…”

Section: Contextual Resultsmentioning

confidence: 99%

Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability

Palojoki,

Lehtonen,

Vuokko

2024

JMIR Med Inform

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Background 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. Objective 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? Methods 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. Results 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). Conclusions 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.

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Section: Contextual Resultsmentioning

confidence: 99%

Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability

Palojoki,

Lehtonen,

Vuokko

2024

JMIR Med Inform

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“…This study allowed H12O to participate, during the COVID-19 pandemic, in different international health data initiatives such as the ISARIC Consortium, the EHDEN Consortium, the 4CE Consortium, and the TriNetX Platform, 9 10 11 12 without requiring manual recording effort parallel to COVID-19 patient health care. 20 However, it is necessary to continue its development to improve each of its component phases. Thus, in this work the third phase of this methodology is expanded, with the aim of making the ETL processes for EHR reuse understandable, auditable, and reproducible, 16 a fundamental requirement for relying on studies that use nonmanually collected data in a controlled and audited manner into study-specific information systems.…”

Section: Discussionmentioning

confidence: 99%

“…23 24 The choice of this standard is due to the fact that: (1) it defines a formal, rigorous, and stable information architecture for the definition of clinical domain concepts and the communication of the EHR 25 ; (2) it allows the extension of the clinical concept model without altering the structure of the databases, which is fundamental for providing flexibility to the reuse processes in the face of changes in the output specifications 26 ; (3) it has been successfully applied in different scenarios to achieve semantic interoperability of the information 27 28 ; (4) it is recommended by the Spanish Ministry of Health as a standard for the definition of interchangeable EHR extracts between the different autonomous regions that compose the country, 29 and (5) it has been adopted by H12O as a base standard for the management and governance of clinical concepts, interoperability, and reuse of the EHR. 30…”

Section: Methodsmentioning

confidence: 99%

“…The application of these principles to EHR implies a paradigm shift in the conception of EHR, moving from a design focused on the production of clinical documents to one based on the value of health data in patient health care and additional uses, such as research. 20 ►Table 1 describes and compares, briefly, the traditional paradigm based on clinical documents versus the paradigm based on the FAIR Principles.…”

Section: Applying the Fair Principles To The Ehrmentioning

confidence: 99%

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TransformEHRs: a flexible methodology for building transparent ETL processes for EHR reuse

et al. 2022

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Background During the COVID-19 pandemic, several methodologies were designed for obtaining electronic health record (EHR)-derived datasets for research. These processes are often based on black boxes, on which clinical researchers are unaware of how the data were recorded, extracted, and transformed. In order to solve this, it is essential that extract, transform, and load (ETL) processes are based on transparent, homogeneous, and formal methodologies, making them understandable, reproducible, and auditable. Objectives This study aims to design and implement a methodology, according with FAIR Principles, for building ETL processes (focused on data extraction, selection, and transformation) for EHR reuse in a transparent and flexible manner, applicable to any clinical condition and health care organization. Methods The proposed methodology comprises four stages: (1) analysis of secondary use models and identification of data operations, based on internationally used clinical repositories, case report forms, and aggregated datasets; (2) modeling and formalization of data operations, through the paradigm of the Detailed Clinical Models; (3) agnostic development of data operations, selecting SQL and R as programming languages; and (4) automation of the ETL instantiation, building a formal configuration file with XML. Results First, four international projects were analyzed to identify 17 operations, necessary to obtain datasets according to the specifications of these projects from the EHR. With this, each of the data operations was formalized, using the ISO 13606 reference model, specifying the valid data types as arguments, inputs and outputs, and their cardinality. Then, an agnostic catalog of data was developed through data-oriented programming languages previously selected. Finally, an automated ETL instantiation process was built from an ETL configuration file formally defined. Conclusions This study has provided a transparent and flexible solution to the difficulty of making the processes for obtaining EHR-derived data for secondary use understandable, auditable, and reproducible. Moreover, the abstraction carried out in this study means that any previous EHR reuse methodology can incorporate these results into them.

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“…This work was carried out at Hospital Universitario 12 de Octubre (H12O) in Madrid (Spain), as part of its research line on the effective reuse of EHRs [4,7,8].…”

Section: Methodsmentioning

confidence: 99%

Making EHRs Reusable: A Common Framework of Data Operations

Pedrera

García

Rubio

et al. 2021

Applying the FAIR Principles to Accelerate Health Research in Europe in the Post COVID-19 Era

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Reuse of EHRs requires data extraction and transformation processes are based on homogeneous and formalized operations in order to make them understandable, reproducible and auditable. This work aims to define a common framework of data operations for obtaining EHR-derived datasets for secondary use. Thus, 21 operations were identified from different data-driven projects of a 1,300-beds tertiary Hospital. Then, ISO 13606 standard was used to formalize them. This work is the starting point to homogenize ETL processes for the reuse of EHRs, applicable to any condition and organization. In future studies, defined data operations will be implemented and validated in projects of different purposes.

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Use of EHRs in a Tertiary Hospital During COVID-19 Pandemic: A Multi-Purpose Approach Based on Standards

Cited by 6 publications

References 9 publications

Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability

Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability

TransformEHRs: a flexible methodology for building transparent ETL processes for EHR reuse

Making EHRs Reusable: A Common Framework of Data Operations

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