Federated Electronic Health Records Using a Blockchain.

The Valkyrie project aims to develop a demonstration Federated Electronic Health Record for the use of mental health practitioners in Norway. Information for the record is drawn from existing records in Source Systems operating across primary and secondary care. Recording of information in any such system, in response to a healthcare event, triggers the generation of an Encrypted Token, containing summary metadata about the event, clinical coding indicating its clinical context and a locator that can be used to retrieve the full record of the event from the original Source System.

An Ontology-Based Architecture to Support Language Variants of Model-Driven Electronic Health Records.

This paper describes the implementation of tools to support multiple language variants of the clinical information models that are used to define a model-driven EHR system. Beyond that, it describes how a complete EHR system can be created with multiple language variants, using the example of an EHR for clinical management of patients in a Fracture Liaison Service. A clinical information model, represented as ontology, was developed in the English language.

Linking Health Records with Knowledge Sources Using OWL and RDF.

This paper describes a method by which the Web Ontology Language (OWL) can be used to specify a highly structured health record, following internationally recognised standards such as ISO 13606 and HL7 CDA. The structured record is coded using schemes such as SNOMED, ICD or LOINC, with the coding applied statically, on the basis of the predefined structure, or dynamically, on the basis of data values entered in the health record. The highly structured, coded record can then be linked with external knowledge sources which are themselves coded using the Resource Description Framework.

Storing and Querying Longitudinal Data Sets in an Open Source EHR.

The cityEHR is an example of an open source EHR system which stores clinical data as collections of XML documents. The records gathered in routine clinical care are a rich source of longitudinal data for use in clinical studies. We describe how the standard language XQuery can be used to identify cohorts of patients, matching specified criteria.

Patient Access to Their Health Record Using Open Source EHR.

In both Europe and North America, patients are beginning to gain access to their health records in electronic form. Using the open source cityEHR as an example, we have focussed on the needs of clinical users to gather requirements for patient access and have implemented these requirements in a new application called cityEHR-PA. The development of a separate application for patient access was necessary to address requirements for security and ease of use.

Clinician-led development of electronic health records systems.

The open source cityEHR system was evaluated as a toolkit for clinician-led development of an Electronic Health Record for management of patients in the Ponseti clinic of a major London hospital. As a toolkit, it was found that the ontology-driven approach of cityEHR was too complex for clinicians to use. The toolkit was refined to use more familiar spreadsheet s to represent the ontology and was then used successfully to create an effective clinical system, generated automatically from the information model.