title: Early experiences in evolving an enterprise-wide information model for laboratory and clinical observations.
abstract: As Electronic Healthcare Records become more prevalent, there is an increasing need to ensure unambiguous data capture, interpretation, and exchange within and across heterogeneous applications. To address this need, a common, uniform, and comprehensive approach for representing clinical information is essential. At Partners HealthCare System, we are investigating the development and implementation of enterprise-wide information models to specify the representation of clinical information to support semantic interoperability. This paper summarizes our early experiences in: (1) defining a process for information model development, (2) reviewing and comparing existing healthcare information models, (3) identifying requirements for representation of laboratory and clinical observations, and (4) exploring linkages to existing terminology and data standards. These initial findings provide insight to the various challenges ahead and guidance on next steps for adoption of information models at our organization.
authors.affiliation: Clinical Informatics Research & Development, Partners HealthCare System, Wellesley, MA, USA.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Chen
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.forename: Vipul
authors.initials: V
authors.lastname: Kashyap
authors.forename: Molly
authors.initials: M
authors.lastname: Schaeffer
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Dykes
authors.forename: Howard S
authors.initials: HS
authors.lastname: Goldberg
mesh_terms: D057205:Automation, Laboratory / Q000379:methods*; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D016247:Information Storage and Retrieval / Q000379:methods*; D008404:Massachusetts; D008490:Medical Informatics / Q000458:organization & administration*; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D010865:Pilot Projects; D018511:Systems Integration