Modelling Knowledge Represented in Clinical Action Using a Boundary Objects Approach

Clinical documents contain statements and facts about patients under treatment. They help to coordinate care and transmit knowledge among the clinicians contributing to patient care. However, studies show that documentation of important clinical information is generally poor and miscommunication is a leading cause of adverse events. The discharge summary is a formal message between the hospital and the family physician. It has an informational role and serves as a boundary object for coordinating care. The research goal is to create an electronic discharge summary that improves the quality of the data and its interpretation. The method uses the same semantic markup standard, Clinical Document Architecture (CDA) from Health Level 7 (HL7), for structuring clinical and reference documents. It supports coding concurrent with composition of a clinical document. The coding systems and reference documents are building blocks. They function as boundary objects for representing, learning about and transmitting knowledge via the discharge summary. The hypothesis is that an infostructure based on boundary objects will improve the quality and interpretation of data used in patient care.