Development, implementation and evaluation of an information model for archetype based user responsive medical data visualization

BACKGROUND When medical data have been successfully recorded or exchanged between systems there appear a need to present the data consistently to ensure that it is clearly understood and interpreted. A standard based user interface can provide interoperability on the visual level. OBJECTIVES The goal of this research was to develop, implement and evaluate an information model for building user interfaces for archetype based medical data. METHODS The following types of knowledge were identified as important elements and were included in the information model: medical content related attributes, data type related attributes, user-related attributes, device-related attributes. In order to support flexible and efficient user interfaces an approach that represents different types of knowledge with different models separating the medical concept from a visual concept and interface realization was chosen. We evaluated the developed approach using Guideline for Good Evaluation Practice in Health Informatics (GEP-HI). RESULTS We developed a higher level information model to complement the ISO 13606 archetype model. This enabled the specification of the presentation properties at the moment of the archetypes' definition. The model allows realizing different users' perspectives on the data. The approach was implemented and evaluated within a functioning EHR system. The evaluation involved 30 patients of different age and IT experience and 5 doctors. One month of testing showed that the time required reading electronic health records decreased for both doctors (from average 310 to 220s) and patients (from average 95 to 39s). Users reported a high level of satisfaction and motivation to use the presented data visualization approach especially in comparison with their previous experience. CONCLUSION The introduced information model allows separating medical knowledge and presentation knowledge. The additional presentation layer will enrich the graphical user interface's flexibility and will allow an optimal presentation of medical data considering the different users' perspectives and different media used for data presentation.

[1]  Elske Ammenwerth,et al.  Applying GEP-HI for the Planning of an Evaluation Study: A Case Study Walkthrough (Workshop) , 2012, EFMI-STC.

[2]  Georgy Kopanitsa.  Standard Based Multiclient Medical Data Visualization , 2012, MIE.

[3]  Andjela Drincic,et al.  The relationship between physician practice characteristics and physician adoption of electronic health records. , 2010, Health care management review.

[4]  Nicolette de Keizer,et al.  Guideline for good evaluation practice in health informatics (GEP-HI) , 2011, Int. J. Medical Informatics.

[5]  Georgy Kopanitsa,et al.  Analysis of Metrics for the Usability Evaluation of Electronic Health Record Systems , 2012, EFMI-STC.

[6]  Bernd Blobel,et al.  Architectural Approach to eHealth for Enabling Paradigm Changes in Health , 2010, Methods of Information in Medicine.

[7]  Georgy Kopanitsa,et al.  Analysis of Metrics for the Usability Evaluation of EHR Management Systems , 2012, MIE.

[8]  William T. F. Goossen,et al.  Bridging the HL7 Template - 13606 Archetype gap with Detailed Clinical Models , 2010, MedInfo.

[9]  Hans Demski,et al.  Standardized EHR interoperability - preliminary results of a German pilot project using the archetype methodology. , 2012, Studies in health technology and informatics.

[10]  R. D. White,et al.  Patient empowerment and optimal glycemic control , 2012, Current medical research and opinion.

[11]  R. Edsall,et al.  The 2012 EHR User Satisfaction Survey: responses from 3,088 family physicians. , 2012, Family practice management.

[12]  France Légaré,et al.  Users' perspectives of barriers and facilitators to implementing EHR in Canada: A study protocol , 2009, Implementation science : IS.

[13]  Sameer Malhotra,et al.  Physician experiences transitioning between an older versus newer electronic health record for electronic prescribing , 2012, Int. J. Medical Informatics.

[14]  Robert Ian Bull,et al.  Model driven visualization: towards a model driven engineering approach for information visualization , 2008 .

[15]  G Demiris,et al.  Health Providers’ Perceptions of Novel Approaches to Visualizing Integrated Health Information , 2013, Methods of Information in Medicine.

[16]  Malte Kelm,et al.  Clinical research for patient empowerment--a qualitative approach on the improvement of heart health promotion in chronic illness. , 2008, Medical science monitor : international medical journal of experimental and clinical research.

[17]  Linda Bird,et al.  A Logical Approach to Semantic Interoperability in Healthcare , 2011, HIC.

[18]  M. Boaz,et al.  Using electronic health records to save money. , 2013, Journal of the American Medical Informatics Association : JAMIA.

[19]  Rong Chen,et al.  Generic Screen Representations for Future Proof Systems - Is It Possible? Two-model approach to a generic GUI , 2007, MedInfo.

[20]  W. V. van Harten,et al.  A Systematic Review of Web-Based Interventions for Patient Empowerment and Physical Activity in Chronic Diseases: Relevance for Cancer Survivors , 2013, Journal of medical Internet research.

[21]  John B. Smelcer,et al.  Usability of Electronic Medical Record System: An Application in Its Infancy with a Crying Need , 2007, HCI.

[22]  M. Gagnon,et al.  Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review , 2011, BMC medicine.

[23]  Rong Chen,et al.  Julius – a template based supplementary electronic health record system , 2007, BMC Medical Informatics Decis. Mak..

[24]  Reuben R. McDaniel,et al.  Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting , 2011, J. Am. Medical Informatics Assoc..

[25]  Evelyn J. S. Hovenga,et al.  Expressing clinical data sets with openEHR archetypes: A solid basis for ubiquitous computing , 2007, Int. J. Medical Informatics.

[26]  A McKinlay,et al.  Design Issues for Socially Intelligent User Interfaces , 2009, Methods of Information in Medicine.

[27]  Georg Duftschmid,et al.  Extraction of standardized archetyped data from Electronic Health Record systems based on the Entity-Attribute-Value Model , 2010, Int. J. Medical Informatics.

[28]  Dipak Kalra,et al.  A Data Types Profile Suitable for Use with ISO EN 13606 , 2012, Journal of Medical Systems.

[29]  G Duftschmid,et al.  Semantic Validation of Standard-based Electronic Health Record Documents with W3C XML Schema , 2010, Methods of Information in Medicine.

[30]  Anthony C. Atkinson,et al.  Optimum Experimental Designs, with SAS , 2007 .

[31]  W O Hackl,et al.  “Why the Hell Do We Need Electronic Health Records?” , 2010, Methods of Information in Medicine.

[32]  Arild Faxvaag,et al.  Research Management in Healthcare Informatics - Experiences from Norway , 2011, MIE.

[33]  Gerd Gigerenzer,et al.  Making sense of health statistics. , 2009, Bulletin of the World Health Organization.

[34]  Joseph Goedert.  Wishing for a better EHR. Electronic health records users share their wish lists for added functionality. , 2008, Health data management.

[35]  M. Johansen,et al.  An Exploratory Study of Patient Attitudes towards Symptom Reporting in a Primary Care Setting , 2010, Methods of Information in Medicine.

[36]  Georgy Kopanitsa.  Evaluating study for a multiuser oriented medical data visualization method. , 2014, Studies in health technology and informatics.

[37]  Shailesh Kumar,et al.  Client Empowerment in Psychiatry and the Professional Abuse of Clients: Where Do We Stand? , 2000, International journal of psychiatry in medicine.

[38]  Krzysztof J. Cios,et al.  Uniqueness of medical data mining , 2002, Artif. Intell. Medicine.

[39]  Yuval Shahar,et al.  Intelligent Interactive Visual Exploration of Temporal Associations among Multiple Time-oriented Patient Records , 2009, Methods of Information in Medicine.

[40]  Cristina Ribeiro,et al.  Vital Signs in Intensive Care: Automatic Acquisition and Consolidation into Electronic Patient Records , 2009, Journal of Medical Systems.

[41]  Anderson Maciel,et al.  Surgical model-view-controller simulation software framework for local and collaborative applications , 2011, International Journal of Computer Assisted Radiology and Surgery.

[42]  H Müller,et al.  Health information search to deal with the exploding amount of health information produced. , 2012, Methods of information in medicine.

[43]  Opher Caspi,et al.  Participatory medicine and patient empowerment towards personalized healthcare in multiple sclerosis , 2012, Expert review of neurotherapeutics.

[44]  K H Englmeier,et al.  Visualization of Medical Data Based on EHR Standards , 2012, Methods of Information in Medicine.

[45]  Anders Grimsmo,et al.  Instant availability of patient records, but diminished availability of patient information: A multi-method study of GP's use of electronic patient records , 2008, BMC Medical Informatics Decis. Mak..

[46]  Catalina Martínez-Costa,et al.  Towards ISO 13606 and openEHR Archetype-Based Semantic Interoperability , 2009, MIE.

[47]  Ann Blandford,et al.  Making sense of personal health information: Challenges for information visualization , 2013, Health Informatics J..

[48]  Georgy Kopanitsa.  Evaluation study for a multi-user oriented medical data visualization method. , 2014, Studies in health technology and informatics.

[49]  Georg Duftschmid,et al.  HL7 Template Model and EN/ISO 13606 Archetype Object Model - A Comparison , 2009, MIE.

[50]  S. Intille,et al.  User-adaptive reminders for home-based medical tasks. A case study. , 2008, Methods of information in medicine.

[51]  Tony Austin,et al.  Generic screen representations for future-proof systems, is it possible?: There is more to a GUI than meets the eye , 2009, Comput. Methods Programs Biomed..

[52]  Jock D. Mackinlay,et al.  The structure of the information visualization design space , 1997, Proceedings of VIZ '97: Visualization Conference, Information Visualization Symposium and Parallel Rendering Symposium.