Knowledge and the electronic health record
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Knowledge and the Electronic Health Record. Health Informatics. Tends to talk about knowledge in the context of ontologies and guideline formalisms Tends to focus on clinician decision support at the time of patient care (diagnostic support, guideline support) See www.openclinical.org

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Knowledge and the Electronic Health Record

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Knowledge and the electronic health record

Knowledge and the Electronic Health Record


Health informatics

Health Informatics

  • Tends to talk about knowledge in the context of ontologies and guideline formalisms

  • Tends to focus on clinician decision support at the time of patient care (diagnostic support, guideline support)

    • See www.openclinical.org

  • Remarkably unsuccesful


Knowledge management

Knowledge management

  • Learning

  • Negotiation


Learning

Learning

  • Meta-cognition

  • Experience

  • Individuality

  • Culture

    • Professional

    • Sociological


Negotiation

Negotiation

  • Knowledge exchange

    • Team, inter-professional,organisational inter-dependence

  • Contextual

  • Priorities

    • Agendas

  • Choice

  • Decisions

    • Iteration, decision inter-dependence


Domains of knowledge and patient care

Domains of Knowledge and Patient Care

  • Clinical knowledge

    • Disease evolution

    • Diagnosis, treatment, outcome

  • Contributing knowledge

    • Physiology, engineering, etc

  • Organisational knowledge

    • Work flow, planning


Why distinguish domains of knowledge

Why distinguish domains of knowledge

  • Natural knowledge growth

    • Recognised specialisation, specific journals

  • Knowledge closest to main decision making needs

  • Knowledge domains have their own characteristics and dynamic

  • Articulates where knowledge can be shared between domains


Knowledge representation of the clinical domain

Knowledge representation of the clinical domain

  • Syntax

  • Semantics


Knowledge and the electronic health record

Syntax


Env13606 a practical generic ehcr standard

folder

EHCR

composition

original component complex

headed section

cluster

record component

link item

data item

ENV13606 a practical generic EHCR Standard

contains

Are types of

1

1..*

1..*

Are types of

Various

specialised

types of

data item


Semantic

Semantic

  • Care strategies

    • According to clinical problem(s)

    • Diagnosis – therapy – outcome

    • Problem definition, risk analysis, treatment selection


2 papers comparison of guideline formalisms

2 papers comparison of guideline formalisms

  • Approaches for creating computer-interpretable guidelines that facilitate decision support

    • Paul A. de Clercq, Johannes A. Blomb, Hendrikus H.M. Korsten, Arie Hasmana

    • Artificial Intelligence in Medicine (2004) 31, 1—27

  • Comparing Computer-interpretable Guideline Models:A Case-study Approach

    • MOR PELEG, PHD, SAMSON TU, MS, JONATHAN BURY, MBCHB,PAOLO CICCARESE, MSC, JOHN FOX, PHD, ROBERT A. GREENES, MD, PHD, RICHARD HALL, MSC, PETER D. JOHNSON, MBBS, NEILL JONES, MBBS,, ANAND KUMAR, MBBS, SILVIA MIKSCH, PHD, SILVANA QUAGLINI, PHD, ANDREAS SEYFANG, MSC, EDWARD H. SHORTLIFFE, MD, PHD,MARIO STEFANELLI, PHD

    • J Am Med Inform Assoc. 2003;10:52–68


Computer based clinical guidelines

Computer based clinical guidelines

  • Redundancy and overlap

  • Little standardisation to facilitate sharing


Formalisms reviewed by de clercq et al

Formalisms reviewed by De Clercq et al

  • The Arden Syntax

  • GLIF

    • Guideline interchange format

  • PROforma

  • Asbru

  • EON


Critique of guideline formalisms and current application aims

Critique of Guideline formalisms and current application aims

  • Do not adequately address guideline root knowledge

    • Tend to relate to existing guidelines and their current inherent variation rather than guideline knowledge sources

  • Do not well take into account different characteristics of different domain knowledge

    • Clinical versus organisational

  • Do not take into account basic requirements of knowledge management

    • Contextual learning and decision making


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