Design and implementation of a standards-based interoperable clinical decision support architecture in the context of the Korean EHR
Design and implementation of a standards-based interoperable clinical decision support architecture in the context of the Korean EHR
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DOI：
10.1016/j.ijmedinf.2010.06.002
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发表时间：
2010-09-01
影响因子：
4.9
通讯作者：
Kim, Yoon
中科院分区：
文献类型：
--
作者：
Cho, InSook;Kim, JeongAh;Kim, Yoon
背景：2000 年，韩国政府于 2010 年底开始努力通过全国医疗信息系统确保随时随地的医疗保健可及性和效率。根据总体规划，电子健康记录 (EHR) 研究和开发项目于 2005 年设计。其中一个子项目是在 EHR 系统背景下设计和实施基于标准的可互操作临床决策支持 (CDS) 功能。 目的：本研究的目的是描述定义和实施电子健康记录 (EHR) 的挑战、过程和结果。实施国家 CDS 架构，以刺激和激励 CDS 服务在韩国的广泛采用。方法：通过选择性文献综述以及对临床医生、管理人员、医院和工业健康信息技术工程师关于 CDS 架构相关问题的调查，确定 CDS 要求和设计原则。美国医学信息协会、医疗保健信息与管理系统协会、Health Level Seven之前的相关工作被用来验证服务架构的范围和主题。 Arden Syntax、基于标准的可共享主动指南环境、First DataBank 和 SEBASTIAN 方法用于评估如此定义的应用程序架构的覆盖范围。在模拟实验环境中实现并评估了门诊高血压管理系统的 CDS 原型，以评估所提出架构的可行性。结果：确定了四个 CDS 服务特征：知识应用、知识管理、审计和评估以及 CDS 和知识治理。还确定了CDS应用架构的五个核心组件：知识执行组件、知识创作组件、数据接口组件、知识存储库和服务接口组件。发现本文确定的架构的覆盖范围和特征与之前描述的那些相当。在韩国医疗保健的背景下确定了两种部署架构场景。初步可行性测试表明，该架构表现出良好的性能，并且可以轻松集成患者数据。我们描述了在韩国 EHR 背景下实现 CDS 服务功能、核心组件、应用程序和部署架构所做的努力。这些成果表明有可能有助于在国家层面采用 CDS。 (C) 2010 Elsevier Ireland Ltd. 保留所有权利。
Background: In 2000 the Korean government initiated efforts to secure healthcare accessibility and efficiency anytime and anywhere via the nationwide healthcare information system by the end of 2010. According to the master plan, electronic health record (EHR) research and development projects were designed in 2005. One subproject was the design and implementation of standards-based interoperable clinical decision support (CDS) capabilities in the context of the EHR system.Objective: The purpose of this study was to describe the challenges, process, and outcomes of defining and implementing a national CDS architecture to stimulate and motivate the widespread adoption of CDS services in Korea.Methods: CDS requirements and design principles were established by conducting a selective literature review and a survey of clinicians, managers, and hospital and industrial health information technology engineers regarding issues related to CDS architectures. The previous relevant works of the American Medical Informatics Association, the Healthcare Information and Management Systems Society, and Health Level Seven were used to validate the scope and themes of the service architecture. The Arden Syntax, Standards-Based Sharable Active Guideline Environment, First DataBank, and SEBASTIAN approaches were used to assess the coverage of the application architecture thus defined. A CDS prototype of an outpatient hypertension management system was implemented and assessed in a simulated experimental setting to evaluate the feasibility of the proposed architecture.Results: Four CDS service features were identified: knowledge application, knowledge management, audit and evaluation, and CDS and knowledge governance. Five core components of CDS application architecture were also identified: knowledge-execution component, knowledge-authoring component, data-interface component, knowledge repository, and service-interface component. The coverage and characteristics of the architecture identified herein were found to be comparable with those described previously. Two scenarios of deployment architecture were identified in the context of Korean healthcare. The preliminary feasibility test revealed that the architecture exhibited good performance and made it easy to integrate patient data.We have described the efforts that have been made to realize CDS service features, core components, application, and deployment architectures in the context of the Korean EHR. These outcomes showed the potential to contribute to the adoption of CDS at the national level. (C) 2010 Elsevier Ireland Ltd. All rights reserved.