title: Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.
abstract: Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements.
authors.affiliation: Fundación de Investigación Biomédica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040, Madrid, Spain. arturogf@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: González-Ferrer
authors.affiliation: Department of Information Systems, University of Haifa, Haifa, Israel, 3498838.
authors.forename: M
authors.initials: M
authors.lastname: Peleg
authors.affiliation: Department of Computer Engineering and Science, Universitat Jaume I, Av. de Vicent Sos Baynat s/n, 12071, Castellón, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Marcos
authors.affiliation: Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Valencia, Spain.|VeraTech for Health SL, Valencia, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Maldonado
mesh_terms: D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration; D008962:Models, Theoretical; D018511:Systems Integration; D014584:User-Computer Interface
keywords: Clinical decision-support systems; Clinical guidelines; Computer-interpretable guidelines; Data integration; HL7 virtual Medical Record (vMR); openEHR archetypes