Hi Thomas, lakewood at copper.net wrote:
>Hi All, > >Been off looking at some operational considerations associated with >supporting, maintaining and updating global EHRs. > What was your study to do with? Our analysis of possible EHR users is that most people would use regional EHRs, i.e. EHRs which are embedded in the healthcare network in which they normally live. Issues of consent, privacy, security, as well as technical and clinical issues can be determined in advance on a regional basis, and set up wiith appropriate contracts. When such patients have a health problem outside this jurisdiction, e.g on holiday overseas, and ad hoc requeest for health data needs to be possible - where there will be no advance contracts, security clearances etc. However, some patients are always on the move. Military, aid workers, elite athletes, conference speakers, entertainers, airline staff and so on. THey can routinely have a problem anywhere in the world. So their EHR needs to be set up in a different way - probably served from a secure webportal which the network of carers for that kind of person will have secure access, also set up in advance. But these people can also need medical help outside their routiine care network, and communications of part of the EHR will again devolve to ad hoc requests and replies, where security and privacy have to be worked out on the spot. >The following types of >users were considered: >1)CREATORS >-individual, groups or organizations that must, or want to, generate new or >updated EHRs >2)REVIEWERS >-overseers, peers and formal reviewers > can you define this role in more detail to do with EHRs? Do you mean senior medical staff? >3)ADMINISTRATORS >-Data management/processing >4)CERTIFIERS >-Handles tasks associated with correctness, e.g., prior to use or archiving > also this role >There has to be user toolkits, possibly with custom components, available >for the EHRs, and perhaps many different implementations of EHRs. There must >also be administrative (e.g., configuration management), > you will see that the basic of configuration management are in the COmmon RM (http://www.openehr.org/Doc_html/Model/Reference/common_rm.htm) >QA (e.g., does it >work), evaluation (e.g., workflow) > clinical workflow is a big area, and will most likely have its own services, but very closely bound in with the EHR > and performance (e.g., does it take less >time to perform a task using pen and paper?) tools to address related >operations (note that the supporting networks and systems have been left >out). > I think all of what you are saying relates to IT / software engineering quality assurance measures? >What kind of tools? >SUGGESTION: graphical, possibly remote access and possibly wireless enabled. > >WHY? Not everyone loves computers, scripting and software plus is willing to >dedicate the time and energy to get some script to play right. > >OPINION: Would like to see a tool that can access/breakdown different types >of EHRs, support information transfer and synthesis of additional records, >even a modified EHR. > there are two approaches to this. One is where the source "EHR" systems are legacy databases, and don't obey any models. THere are approaches to getting data using archetypes to model it, but of course they are not completely simple - most legacy databases have different, annoying schemas....you have to extract the raw data, match columns and rows to target structures, synthesis missing bits etc etc. The other approach is when we are talking about moving information from/to EHR systems which obey openEHR or some other accepted standard for which we can write interoperability software much more easily. Then interoperability is largely a matter of archetypes. - thomas - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
