Open data models for smart health interconnected applications: the example of openEHR.

Background: Smart Health is known as a concept that enhances networking, intelligent data processing and combining patient data with other parameters. Open data models can play an important role in creating a framework for providing interoperable data services that support the development of innovative Smart Health applications profiting from data fusion and sharing.

Methods: This article describes a model-driven engineering approach based on standardized clinical information models and explores its application for the development of interoperable electronic health record systems.

Clinical knowledge governance: the international perspective.

As a basis for semantic interoperability, ideally, a Clinical Knowledge Resource for a clinical concept should be defined formally and defined once in a way that all clinical professions and all countries can agree on. Clinical Knowledge Governance is required to create high-quality, reusable Clinical Knowledge Resources and achieve this aim. Traditionally, this is a time-consuming and cumbersome process, relying heavily on face-to-face meetings and being able to get sufficient input from clinicians.

Facilitating secondary use of medical data by using openEHR archetypes.

Clinical trials are of high importance for medical progress. But even though more and more clinical data is available in electronic patient records (EPRs) and more and more electronic data capture (EDC) systems are used in trials, there is still a gap which makes EPR / EDC interoperability difficult and hampers secondary use of medical routine data. The openEHR architecture for Electronic Health Records is based on a two level modeling approach which makes use of 'archetypes'.

Change management - an overview.

This chapter gives an educational overview of: * The need for systematic and comprehensive change management in health that involves everybody * Various change management types, models, best practices, and techniques, and how to plan and execute change management * Some of the common mistakes with change management in healthcare.

Health informatics - an introduction.

This chapter gives an educational overview of: * the scope of the health informatics discipline * health informatics and e-health definitions * health informatics professional networks * potential benefits of applying health informatics technologies.

Archetype-based knowledge management for semantic interoperability of electronic health records.

Formal modeling of clinical content that can be made available internationally is one of the most promising pathways to semantic interoperability of health information. Drawing on the extensive experience from openEHR archetype research and implementation work, we present the latest research and development in this area to improve semantic interoperability of Electronic Health Records (EHRs) using openEHR (ISO 13606) archetypes. Archetypes as the formal definition of clinical content need to be of high technical and clinical quality.

Engaging clinicians in clinical content: herding cats or piece of cake?

It is essential that clinicians are able to contribute to the development of clinical content for electronic health records. Clinicians are able to participate meaningfully when the technical focus on the process and the clinical models are reduced or removed. In the openEHR approach - from the original design specification through to the clinical modelling tools - clinicians feature as the primary drivers of clinical content models.

Towards a comprehensive electronic patient record to support an innovative individual care concept for premature infants using the openEHR approach.

Purpose: This paper introduces the modelling of a prototype neonatology electronic patient record (EPR) using openEHR archetypes. The EPR is necessary to support the complex communication tasks of the innovative concept of 'Developmental, Family-Centred, Individual Care of Premature Infants and Newborns' established for the Department of Neonatology at Heidelberg University Hospital.

Methods: The data to be documented was analysed and modelled using the five step openEHR data modelling approach (odma).

Facilitating the openEHR approach - organizational structures for defining high-quality archetypes.

Using openEHR archetypes to establish an electronic patient record promises rapid development and system interoperability by using or adopting existing archetypes. However, internationally accepted, high quality archetypes which enable a comprehensive semantic interoperability require adequate development and maintenance processes. Therefore, structures have to be created involving different health professions.

An archetype-based testing framework.

With the introduction of EHR two-level modelling and archetype methodologies pioneered by openEHR and standardized by CEN/ISO, we are one step closer to semantic interoperability and future-proof adaptive healthcare information systems. Along with the opportunities, there are also challenges. Archetypes provide the full semantics of EHR data explicitly to surrounding systems in a platform-independent way, yet it is up to the receiving system to interpret the semantics and process the data accordingly.

Electronic patient records: moving from islands and bridges towards electronic health records for continuity of care.

Objectives: Electronic patient record (EPR) systems are increasingly used and have matured sufficiently so as to contribute to high quality care and efficient patient management. Our objective is to summarize current trends and major achievements in the field of EPR in the last year and to discuss their future prospects.

Results: Integrating health data from a variety of sources in a comprehensive EPR is a major prerequisite for e-health and e-research.

Towards sustainability of health information systems: how can we define, measure and achieve it?

Health information systems (HIS) in their current form are rarely sustainable. In order to sustain our health information systems and with it our health systems, we need to focus on defining and maintaining sustainable Health Information System building blocks or components. These components need to be easily updatable when clinical knowledge (or anything else) changes, easily adaptable when business requirements or processes change, and easily exchangeable when technology advances.

Towards semantic interoperability for electronic health records.

Objectives: In the field of open electronic health records (EHRs), openEHR as an archetype-based approach is being increasingly recognised. It is the objective of this paper to shortly describe this approach, and to analyse how openEHR archetypes impact on health professionals and semantic interoperability.

Methods: Analysis of current approaches to EHR systems, terminology and standards developments.

Expressing clinical data sets with openEHR archetypes: a solid basis for ubiquitous computing.

Purpose: The purpose of this paper is to analyse the feasibility and usefulness of expressing clinical data sets (CDSs) as openEHR archetypes. For this, we present an approach to transform CDS into archetypes, and outline typical problems with CDS and analyse whether some of these problems can be overcome by the use of archetypes.

Methods: Literature review and analysis of a selection of existing Australian, German, other European and international CDSs; transfer of a CDS for Paediatric Oncology into openEHR archetypes; implementation of CDSs in application systems.

Towards automatically generating graphical user interfaces from openEHR archetypes.

One of the main challenges in the field of Electronic Health Records (EHRs) is semantic interoperability. To utilise the full potential of interoperable EHR systems they have to be accepted by their users, the health care providers. Good Graphical User Interfaces (GUIs) that support customisation and data validation play a decisive role for user acceptance and data quality.

Ubiquitous information for ubiquitous computing: expressing clinical data sets with openEHR archetypes.

Ubiquitous computing requires ubiquitous access to information and knowledge. With the release of openEHR Version 1.0 there is a common model available to solve some of the problems related to accessing information and knowledge by improving semantic interoperability between clinical systems.

Systematic planning of patient records for cooperative care and multicenter research.

Purpose: The purpose of this paper is to introduce a method for systematically planning patient records for structured data entry that can be used in cooperative environments (e.g. cooperative care, multicenter trials) in a way that enables multipurpose use and shared data entry.

Can design principles of traditional learning theories be fulfilled by computer-based training systems in medicine: the example of CAMPUS.

Purpose: Computer-based training (CBT) systems offer the potential to efficiently support modern teaching and learning. However, it is still unknown if a similar efficient learning experience built on sound learning theories and corresponding design principles can be created in the complex health care environment. The purpose of this paper is to analyse to what extent learning theories and corresponding design principles are relevant and can successfully be applied in computer-based training in medicine.

Building health informatics skills for health professionals: results from the Australian Health Informatics Skill Needs Survey.

Objective: To ascertain health professionals' perceptions of health informatics skills required in their roles.

Design: A paper-based survey with a stratified random sample of Australian health professionals and a web-based survey open to all Australian health professionals were conducted.

Measurement: A questionnaire on the health professionals' perceived degree of competency required for a total of 69 specific skills in five skill categories based on the International Medical Informatics Association's (IMIA) set of recommendations on education and IMIA's scientific map.

Can openEHR Archetypes Empower Multi-Centre Clinical Research?

The Electronic Health Record is of utmost importance to enable the provision of high-quality collaborative care; one prominent development is openEHR. On the other hand, a systematic approach to support the use of routine data for multi-centre clinical research is becoming increasingly important. One example of this is the extensible architecture for using routine data for additional purposes (eardap) which features comprehensive terminological support.

Preparing the Electronic Patient Record for Collaborative Environments and eHealth.

In the era of eHealth the electronic patient record is increasingly regarded as part of a collaborative environment. To efficiently support the documentary tasks and analyses a cooperative documentation infrastructure which allows multiple use and shared entry of data is necessary. The objective of this paper is to introduce a method for systematically planning such a cooperative documentation environment.

Computer-based Training in Medicine and Learning Theories.

Computer-based training (CBT) systems can efficiently support modern teaching and learning environments. In this paper, we demonstrate on the basis of the case-based CBT system CAMPUS that current learning theories and design principles (Bloom's Taxonomy and practice fields) are (i) relevant to CBT and (ii) are feasible to implement using computer-based training and adequate learning environments. Not all design principles can be fulfilled by the system alone, the integration of the system in adequate teaching and learning environments therefore is essential.

Nursing constraint models for electronic health records: a vision for domain knowledge governance.

Various forms of electronic health records (EHRs) are currently being introduced in several countries. Nurses are primary stakeholders and need to ensure that their information and knowledge needs are being met by such systems information sharing between health care providers to enable them to improve the quality and efficiency of health care service delivery for all subjects of care. The latest international EHR standards have adopted the openEHR approach of two-level modelling.

Towards shared patient records: an architecture for using routine data for nationwide research.

Ubiquitous information is currently one of the most challenging slogans in medical informatics research. An adequate architecture for shared electronic patient records is needed which can use data for multiple purposes and which is extensible for new research questions. We introduce eardap as architecture for using routine data for nationwide clinical research in a multihospital environment.

Skill needs for nurses in their role as health informatics professionals: a survey in the context of global health informatics education.

In the process of developing global health informatics education, a common understanding of educational outcomes is required. Therefore, an educational framework for health informatics professionals is desirable to support student mobility, trans-national and borderless education. Nurses form a significant part of the health workforce and need to be properly educated for their roles in health informatics.