상호운용성과 환자안전을 위한 전자건강기록시스템 연구개발사업
Research and Development Efforts Aimed at Implementing Electronic Health Record Systems with Interoperability and Patient Safety
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Electronic health records(EHR) hold promise in improving the quality and efficiency of health care, yet the health care system remains years behind other industries with respect to the adoption of information technology(IT). Stakeholders in the medical community, including government and tertiary hospitals, have emphasized the urgent need to adopt IT systems. This paper reviews the current research and development efforts related to EHR in Korea, which have been supported by the government since December 2005, on the basis of the following core EHR components: EHR architectures that incorporate an external, implementation-independent view of a complete EHR; EHR functionality for defining tasks that an EHR system should perform; semantic ontology for developing standard vocabularies at the national level; EHR messaging standards for exchanging data; and clinical decision support systems for improving patient safety. Recent international work on EHR systems and the underlying trends are described, and suitable directions for research and development are suggested under relevant subtopics. Advances in the relevant areas will greatly facilitate our ability to achieve interoperability and promote patient safety. However, EHR systems will perform optimally only if we improve our understanding of the political, structural, and technical foundations for EHR, and reach consensus via collaborations between all the stakeholders in the health care system. (Journal of Korean Society of Medical Informatics 12-2,115-132, 2006)
Abstract
Electronic health records(EHR) hold promise in improving the quality and efficiency of health care, yet the health care system remains years behind other industries with respect to the adoption of information technology(IT). Stakeholders in the medical community, including government and tertiary hospitals, have emphasized the urgent need to adopt IT systems. This paper reviews the current research and development efforts related to EHR in Korea, which have been supported by the government since December 2005, on the basis of the following core EHR components: EHR architectures that incorporate an external, implementation-independent view of a complete EHR; EHR functionality for defining tasks that an EHR system should perform; semantic ontology for developing standard vocabularies at the national level; EHR messaging standards for exchanging data; and clinical decision support systems for improving patient safety. Recent international work on EHR systems and the underlying trends are described, and suitable directions for research and development are suggested under relevant subtopics. Advances in the relevant areas will greatly facilitate our ability to achieve interoperability and promote patient safety. However, EHR systems will perform optimally only if we improve our understanding of the political, structural, and technical foundations for EHR, and reach consensus via collaborations between all the stakeholders in the health care system. (Journal of Korean Society of Medical Informatics 12-2,115-132, 2006)
참고문헌 (68)
- "Health informatics-requirements for an electronic health record architecture" (2009)[URL]
- "Health Level Seven’s CD", HL7 Version 3 Normative Edition, ~ (2005)
- Kai U’s presentation material, "Version 3 XML ITS", HL7 Working Group Meeting (2005), Orlando(USA)
- "Health Level 7" (2009)[URL]
- CN, Mead, "Data interchange standards in healthcare IT-Computable semantic interoperability: Now possible but still difficult, do we really need a better mousetrap?", J Health Inf Manag, 20(1), pp.71~78 (2006)
- R, Alan, "Ontological & practical issues in using a description logic to represent medical concepts: experience from GALEN,University of Manchester School of Computer Science Preprint", CSPP, 35, pp.1~35 (2005)
- Fv, Harmelen, "Ontology mapping: a way out of the medical tower of babel? In artificial intelligence in medicine", 10th Conference on Artificial Intelligence in Medicine (2005), Aberdeen, UK
- B, Smith, "Relations in biomedical ontologies", Genome Biol, 6(5), pp.46~ (2005)
- LT, Kohn, "To err is human; building a safer healthcare system", pp.17~68 (2000), Washington, D.C.:National Academy Press
- DW, Bates, "Patient safety through smart U- Healthcare for the innovative digital world", KOSMI Fall Conference (2005), Seoul, Korea
- "EHRS blueprint-an inoperable EHR framework, v2.2.10.", pp.41~91 (2006), Montreal:Canada Health Infoway Inc
- "GEHR (Good European Health Record)" (2009)[URL]
- G, Dickinson, "EHR system functional model (Draft Standard for Trial Use)", pp.10~71 (2004), Ann Arbor:HL7
- "Electronic health care record architecture: consolidated list of requirements. ECHR-SupA" (2009)[URL]
- D, Karla, "Clinical foundations and information architecture for the implementation of a federated health record service", B, pp.2002
- "EHRS blueprint-an inoperable EHR framework. V1.0.", pp.35~48 (2003), Montreal:Canada Health Infoway Inc.
- Connecting for Health Implementation Guide Team, "The national programme for information technology guide. V4.", pp.25~ (2006), London:NHS Connecting for Health
- "Spine" (2009)[URL]
- HealthConnect, "business architecture. V1.9.", pp.101~146 (2004), Canberra:Commonwealth of Australia
- "Summary of Nationwide Health Information Natwork (NHIN) Request for Information (RFI) responses", pp.33~41 (2005), US:Dept. Of Health and Human Services
- R, Doin, "HL7 clinical document architecture release 2.", J Am Med Inform Assoc, 13(1), pp.30~39 (2006)
- Standard specification for Continuity of Care Record (CCR), "United States:ASTM International’s Subcommittee E31.", 28 on Continuity of Care Record Work Group, pp.1~8 (2005)
- "A CDA Template for Continuity of Care. Powerpoint presentation made at HIMSS;2005." (2009)[URL]
- J, Ferranti, "The clinical document architecture and the continuity of care record: a critical analysis", J Am Med Inform Assoc, 13(3), pp.245~252 (2006)
- "National programme for information technology; integrated care records service Part 3-common requirements output based specification V2.0.", pp.4~16 (2004), London:NHS
- "HealthConnect system architecture v0.9.", pp.7~19 (2003), Canberra:NEHTA
- "HL7 Version 3." (2009)[URL]
- Institute of Medicine, "The Computer-based patient record: an essential technology for health care", pp.13~ (1991), Washington, D.C: National Academy Press
- "Key capabilities of an electronic health record system. Letter Report. July, 2003. Committee on Data Standards for Patient Safety, Institute of Medicine" (2009)[URL]
- "The International Organization for Standardization. Health informatics-requirements for an electronic health record architecture. ISO/TS 18308" (2009)[URL]
- HC, Jerome, "Electronic medical records: a guide for clinicians and administrators", pp.112~149 (2001), New York: American College of Physicians
- Pohl, Klaus, "Software product line engineering : foundations, principles and techniques.", pp.216~ (2005), New York:Springer
- S, Kim, "Implementing a universal interface for clinical devices using HL7 protocol; interface of pulmonary function test device and blood test device", J Kor Soc of Med Informatics, 12(1), pp.77~80 (2006)
- Kim, H, "The architecture design and development of the HL7 message toolkit generating the HL7 engine that processes HL7 messages", J Kor Soc of Med Informatics, 12(1), pp.73~76 (2006)
- JG, Gong, "Health Level Seven(HL7) and development tool 1st", pp.47~73 (2002), Korea:Mun Yong Sa
- Um, KS, "Development a new HL7 interface engine and practical using for large scale message transferring based on tree structure and streaming algorithm", B, pp.2004
- "René Spronk - Sr.Consultant, Ringholm GmbH, Navigating the pitfalls: Implementing HL7 version 3." (2009)[URL]
- "InterSystems, ensemble ? universal integration platform" (2009)[URL]
- DS, Cannon, "A comparison of the effects of computer and manual reminders on compliance with a mental health clinical practice guideline", J Am Med Inform Assoc, 7(2), pp.196~203 (2000)
- DL, Schriger, "Enabling the diagnosis of occult psychiatric illness in the emergency department: a randomized, controlled trial of the computerized, self-administered PRIME-MD diagnostic system", Ann Emerg Med, 37, pp.132~140 (2001)
- BL, Rollman, "A randomized trial using computerized decision support to improve treatment of major depression in primary care", J Gen Intern Med, 17, pp.493~503 (2002)
- A, Bogusêvicîius, "Prospective randomised trial of computer-aided diagnosis and contrast radiography in acute small bowel obstruction", Eur J Surg, 168(2), pp.78~83 (2002)
- RC, Burack, "The effect on patient and physician reminders on use of screening mammography in a health maintenance organization: results of a randomized controlled trial", Cancer, 78(8), pp.1708~1721 (1996)
- JG, Demakis, "Improving residents’ compliance with standards of ambulatory care: results from the VA cooperative study on computerized reminders", JAMA, 284(11), pp.1411~1416 (2000)
- PR, Dexter, "A computerized reminder system to increase the use of preventive care for hospitalized patients", N Engl J Med, 345(13), pp.965~970 (2001)
- VM, Montori, "The impact of planned care and a diabetes electronic management system on community- based diabetes care: the mayo health system diabetes translation project", Diabetes Care, 25(11), pp.1952~1957 (2002)
- A, Filippi, "Effects of an automated electronic reminder in changing the antiplatelet drug-prescribing behavior among Italian general practitioners in diabetic patients: an intervention trial", Diabetes Care, 26(5), pp.1497~1500 (2003)
- JB, Meigs, "A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project", Diabetes Care, 26(3), pp.750~757 (2003)
- AA, Montgomery, "Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: Randomised controlled trial", BMJ, 30(7236), pp.686~690 (2000)
- HP, Selker, "Use of the electrocardiograph-based thrombolytic predictive instrument to assist thrombolytic and reperfusion therapy for acute myocardial infarction: a multicenter, randomized, controlled, clinical effectiveness trial", Ann Intern Med, 137(87)통권 : 95 (2002)
- M, Ansari, "Improving guideline adherence: a randomized trial evaluating strategies to increase β-blocker use in heart failure", Circulation, 107(22), pp.2799~8204 (2003)
- WM, Tierney, "Effects of computerized guidelines for managing heart disease in primary care: a randomized, controlled trial", J Gen Intern Med, 18(12), pp.967~976 (2003)
- CJ, Weir, "Cluster-randomized, controlled trial of computer-based decision support for selecting long-term anti-thrombotic therapy after acute ischaemic stroke", QJM - Monthly Journal of the Association of Physicians, 96(2), pp.143~153 (2003)
- MD, Murray, "Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial", Pharmacotherapy, 24(3), pp.324~337 (2004)
- DA, Christakis, "A randomized controlled trial of point-of-care evidence to improve the antibiotic prescribing practices for otitis media in children", Pediatrics, 107(2) (2001)
- C, McCowan, "Lessons from a randomized controlled trial designed to evaluate computer decision support software to improve the management of asthma", Med Inform Internet, 26(3), pp.191~201 (2001)
- M, Eccles, "Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial", BMJ, 325(7370), pp.941~944 (2002)
- F, Lesourd, "computerized decision support system for ovarian stimulation by gonadotropins", Fertil Steril, 77(3), pp.456~460 (2002)
- DA, Fitzmaurice, "Oral anticoagulation management in primary care with the use of computerized decision support and near- patient testing: a randomized, controlled trial", Arch Intern Med, 160(15), pp.2343~2348 (2000)
- C, Manotti, "Effect of computer-aided management on the quality of treatment in anticoagulated patients: a prospective, randomized, multicenter trial of APROAT (Automated Program for Oral Anticoagulant Treatment)", Haematologica, 86(10), pp.1060~1070 (2001)
- W, Horn, "Development and evaluation of VIE-PNN, a knowledge-based system for calculating the parenteral nutrition of newborn infants", Artif Intell Med, 24(3), pp.217~228 (2002)
- "National programme for information technology; integrated care records service: Part 2-LSP services: output based specification second iteration, Final 1.0a", pp.4~41 (2004), London:NHS
- "The Decade of health information technology; delivering consumer-centric and information- rich health care: framework for strategic action", pp.9~26 (2004), Washington D.C.:Dept. of Health and Human Services
- "Health Level Seven. HL7 EHR system functional model: a major development towards consensus on electronic health record system functionality a white pape" (2009)[URL]
- "un microsystems, see beyond." (2009)[URL]
- MK, Goldstein, "atient safety in guideline-based decision support for hypertension management: ATHENA DSS.", J Am Med Inform Assoc, pp.11~16 (2002)
- TD, Sequist, "A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease", J Am Med Inform Assoc, 12, pp.431~437 (2005)
- I, Sim, "Clinical decision support systems for the practice of evidence- based medicine", J Am Med Inform Assoc, 8, pp.527~534 (2001)
