Sømløs interoperabilitet mellem EPJ-systemer for patienter med AML i tværregionalt pakkeforløb

Abstract

Problem: Ved udredning og behandling af akut myeloid leukæmi for patientgruppen nul til 18 år foretages en række blodprøver, kliniske undersøgelser samt knoglemarvsundersøgelser, hvilket resulterer i et stort antal registreringer i de elektroniske patientjournalsystemer. Disse registreringer foretages af forskellig sundhedspersonale på forskellige afdelinger tværregionalt, hvorfor der udspringer et behov for at kunne genanvende data registreret på en central afdeling på en decentral afdeling og omvendt. Dette skal foregå via sømløs interoperabilitet. Metode: Ved anvendelse af Hevners framework og Requirements Engineering er et artefakt udviklet med afsæt i behovene indsamlet via to interviews og en litteratursøgning, hvor data i artefaktet er standardiseret. Brugen af Requirements Engineering resulterede i en række system- og leverandørkrav. Artefaktet er udviklet i Forge R4 (v. 4.0.1). Resultat: Artefaktet består af 12 profiler og en extension, hvori der benyttes SNOMED CT-, LOINC- og ICD-10-koder for at opnå semantisk interoperabilitet. Derudover indeholder artefaktet metadata om sundhedspersonalet, hvilket er et essentielt og innovativt bidrag til yderligere registrering i de elektroniske patientjournalsystemer for at opnå sømløs interoperabilitet. Artefaktet valideres ved brug af standarden ISO-13606:2019, og profilerne instantieres med data fra en teoretisk case, der illustrerer et behandlingsforløb for en patient med akut myeloid leukæmi. Herefter oploades profilerne på Simplifier.net, hvor valideringen er succesfuld og således opfylder systemkravene. Leverandørkravene er opfyldt gennem visuelle prototyper, der tager udgangspunkt i data fra casen og de elektroniske patientjournalsystemer. Konklusion: Det kan konkluderes, at der efter implementering af det udviklede artefakt med internationale standarder og metadata skabes et potentiale for at kunne opnå sømløs interoperabilitet. Dette kan opnåes ved at genanvende data, som er essentielt i pakkeforløbet for en patient med akut myeloid leukæmi, hvorved implementering af artefaktet øger national specialisering inden for udredning og initial behandling af akut myeloid leukæmi.

Introduction & aim: During assessment and treatment of acute myeloid leukemia for children and juvenile zero to 18 years, several blood samples, clinical examinations, and bone marrow samples are performed. This results in many registrations in the patient's electronic health record. These registrations can be made by different health professionals in different departments in different regions. There is thus a need to be able to reuse data registered by the responsible department in a supporting department and conversely. The aim of the study is therefore to accommodate this need through seamless interoperability. Method: The use of the Hevner Framework and Requirements Engineering enabled the development of an artefact based on the needs collected in two interviews and a literature search. Data in the artefact was standardized. The use of Requirements Engineering supported the artefact's design, development, and validation in its phases. The artefact was developed in Forge R4 (v. 4.0.1). Results: The artefact consists of 12 profiles and one extension from HL7 FHIR. The artefact uses the semantic standards SNOMED CT, LOINC and ICD-10. The use of the technical and semantic standards ensures the potential for seamless interoperability. The artefact contains metadata about the healthcare professionals, which is an essential and innovative contribution in the electronic health record to achieve seamless interoperability. The artefact is validated using the ISO-standard 13606:2019. The profiles and the extension constitute a prototype that is instantiated using data from a theoretical case about the treatment of a patient with acute myeloid leukemia and registrations regarding the treatment. Furthermore, the profiles are uploaded to Simplifier.net where the validation is successful. To illustrate the reuse of data, visual prototypes are made containing data from the case and electronic health records. Conclusion: It can be concluded that the implementation of the developed artefact with international standards and metadata facilitates the possibility for seamless interoperability. This is achieved by the reuse of data for a patient with acute myeloid leukemia. The implementation of the artefact increases national specialization in the assessment and treatment of acute myeloid leukemia.

A master thesis from Aalborg University

Sømløs interoperabilitet mellem EPJ-systemer for patienter med AML i tværregionalt pakkeforløb

[Seamless interoperability and reuse of data between Danish EHRs for children with AML]