1. Healthcare Information Management Barry Smith http://ontology.buffalo.edu/smith 1

2. Goals of Electronic Health Records from the clinician’s perspective Remembering what you did and why Conveying that information to colleagues Justifying billing Legal defense Data for research Clinical decision support 2

3. Goals of Electronic Health Records from a wider community perspective Primary uses: billing, billing, billing... Secondary uses –continuity of care (avoiding siloing of data) –evidence-based medicine –diagnostic decision support –support for clinical trials –virtual clinical research –personalized medicine –(Obamacare) save money 3

4. What an EHR requires Effective user interfaces Trained personnel Safety (EHR should help to make your hospital safer; it should not kill your patient) Data security Controlled vocabulary, and coherent taxonomy (… ontology …) 4

5. Where does an EHR fit ? Basic: Identity Patient record Clinician workflow Comprehensive: Notifications Security / access control With thanks to Tom Beale / openEHR.org 5

6. © Ocean Informatics 2005

7. EHRs – some alternatives Epic, Allscripts, Eclipsys, Cerner... VA OpenEHR / CEN 13606 −EHRs for hospitals −EHRs for small practices (including dentists, ophthalmologists, …) 7

8. Epic, Allscripts, Eclipsys... (Examples of commercial products) PRO: Get the job done CON: Expensive Allow only limited secondary uses –continuity of care X –safety ? –evidence-based medicine ? –diagnostic decision support ? –clinical trials X 8

9. with thanks to http://dbmotion.com 9 the problem of continuity of care: patients move around

10. 10 f f f f f synchronic and diachronic problems of semantic interoperability (across space and across time) f

11. The Data Model That Nearly Killed Me by Joe Bugajski http://tiny.cc/S1HWo http://tiny.cc/S1HWo “If data cannot be made reliably available across silos in a single EHR, then this data cannot be made reliably available to a huge, heterogeneous collection of networked systems.” 11

12. EPIC, etc. will provide a way to capture and represent some of what is needed in a form that is usable by computers (somewhat) by you yourself but not by other clinics, hospitals and researchers... 12

13. 13 f f How to link EHR data?f f f how can we link EHR 1 to EHR 2 in a reliable, trustworthy, useful way, which both systems can understand ? f EHR 1 EHR 2