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Building a Shared, Scalable, and Sustainable Source for the Problem-Oriented Medical Record: Developmental Study

BACKGROUND: Since the creation of the problem-oriented medical record, the building of problem lists has been the focus of many studies. To date, this issue is not well resolved, and building an appropriate contextualized problem list is still a challenge. OBJECTIVE: This paper aims to present the p...

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Autores principales: Gaudet-Blavignac, Christophe, Rudaz, Andrea, Lovis, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552094/
https://www.ncbi.nlm.nih.gov/pubmed/34643542
http://dx.doi.org/10.2196/29174
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author Gaudet-Blavignac, Christophe
Rudaz, Andrea
Lovis, Christian
author_facet Gaudet-Blavignac, Christophe
Rudaz, Andrea
Lovis, Christian
author_sort Gaudet-Blavignac, Christophe
collection PubMed
description BACKGROUND: Since the creation of the problem-oriented medical record, the building of problem lists has been the focus of many studies. To date, this issue is not well resolved, and building an appropriate contextualized problem list is still a challenge. OBJECTIVE: This paper aims to present the process of building a shared multipurpose common problem list at the Geneva University Hospitals. This list aims to bridge the gap between clinicians’ language expressed in free text and secondary uses requiring structured information. METHODS: We focused on the needs of clinicians by building a list of uniquely identified expressions to support their daily activities. In the second stage, these expressions were connected to additional information to build a complex graph of information. A list of 45,946 expressions manually extracted from clinical documents was manually curated and encoded in multiple semantic dimensions, such as International Classification of Diseases, 10th revision; International Classification of Primary Care 2nd edition; Systematized Nomenclature of Medicine Clinical Terms; or dimensions dictated by specific usages, such as identifying expressions specific to a domain, a gender, or an intervention. The list was progressively deployed for clinicians with an iterative process of quality control, maintenance, and improvements, including the addition of new expressions or dimensions for specific needs. The problem management of the electronic health record allowed the measurement and correction of encoding based on real-world use. RESULTS: The list was deployed in production in January 2017 and was regularly updated and deployed in new divisions of the hospital. Over 4 years, 684,102 problems were created using the list. The proportion of free-text entries decreased progressively from 37.47% (8321/22,206) in December 2017 to 18.38% (4547/24,738) in December 2020. In the last version of the list, over 14 dimensions were mapped to expressions, among which 5 were international classifications and 8 were other classifications for specific uses. The list became a central axis in the electronic health record, being used for many different purposes linked to care, such as surgical planning or emergency wards, or in research, for various predictions using machine learning techniques. CONCLUSIONS: This study breaks with common approaches primarily by focusing on real clinicians’ language when expressing patients’ problems and secondarily by mapping whatever is required, including controlled vocabularies to answer specific needs. This approach improves the quality of the expression of patients’ problems while allowing the building of as many structured dimensions as needed to convey semantics according to specific contexts. The method is shown to be scalable, sustainable, and efficient at hiding the complexity of semantics or the burden of constraint-structured problem list entry for clinicians. Ongoing work is analyzing the impact of this approach on how clinicians express patients’ problems.
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spelling pubmed-85520942021-11-10 Building a Shared, Scalable, and Sustainable Source for the Problem-Oriented Medical Record: Developmental Study Gaudet-Blavignac, Christophe Rudaz, Andrea Lovis, Christian JMIR Med Inform Original Paper BACKGROUND: Since the creation of the problem-oriented medical record, the building of problem lists has been the focus of many studies. To date, this issue is not well resolved, and building an appropriate contextualized problem list is still a challenge. OBJECTIVE: This paper aims to present the process of building a shared multipurpose common problem list at the Geneva University Hospitals. This list aims to bridge the gap between clinicians’ language expressed in free text and secondary uses requiring structured information. METHODS: We focused on the needs of clinicians by building a list of uniquely identified expressions to support their daily activities. In the second stage, these expressions were connected to additional information to build a complex graph of information. A list of 45,946 expressions manually extracted from clinical documents was manually curated and encoded in multiple semantic dimensions, such as International Classification of Diseases, 10th revision; International Classification of Primary Care 2nd edition; Systematized Nomenclature of Medicine Clinical Terms; or dimensions dictated by specific usages, such as identifying expressions specific to a domain, a gender, or an intervention. The list was progressively deployed for clinicians with an iterative process of quality control, maintenance, and improvements, including the addition of new expressions or dimensions for specific needs. The problem management of the electronic health record allowed the measurement and correction of encoding based on real-world use. RESULTS: The list was deployed in production in January 2017 and was regularly updated and deployed in new divisions of the hospital. Over 4 years, 684,102 problems were created using the list. The proportion of free-text entries decreased progressively from 37.47% (8321/22,206) in December 2017 to 18.38% (4547/24,738) in December 2020. In the last version of the list, over 14 dimensions were mapped to expressions, among which 5 were international classifications and 8 were other classifications for specific uses. The list became a central axis in the electronic health record, being used for many different purposes linked to care, such as surgical planning or emergency wards, or in research, for various predictions using machine learning techniques. CONCLUSIONS: This study breaks with common approaches primarily by focusing on real clinicians’ language when expressing patients’ problems and secondarily by mapping whatever is required, including controlled vocabularies to answer specific needs. This approach improves the quality of the expression of patients’ problems while allowing the building of as many structured dimensions as needed to convey semantics according to specific contexts. The method is shown to be scalable, sustainable, and efficient at hiding the complexity of semantics or the burden of constraint-structured problem list entry for clinicians. Ongoing work is analyzing the impact of this approach on how clinicians express patients’ problems. JMIR Publications 2021-10-13 /pmc/articles/PMC8552094/ /pubmed/34643542 http://dx.doi.org/10.2196/29174 Text en ©Christophe Gaudet-Blavignac, Andrea Rudaz, Christian Lovis. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 13.10.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on https://medinform.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Gaudet-Blavignac, Christophe
Rudaz, Andrea
Lovis, Christian
Building a Shared, Scalable, and Sustainable Source for the Problem-Oriented Medical Record: Developmental Study
title Building a Shared, Scalable, and Sustainable Source for the Problem-Oriented Medical Record: Developmental Study
title_full Building a Shared, Scalable, and Sustainable Source for the Problem-Oriented Medical Record: Developmental Study
title_fullStr Building a Shared, Scalable, and Sustainable Source for the Problem-Oriented Medical Record: Developmental Study
title_full_unstemmed Building a Shared, Scalable, and Sustainable Source for the Problem-Oriented Medical Record: Developmental Study
title_short Building a Shared, Scalable, and Sustainable Source for the Problem-Oriented Medical Record: Developmental Study
title_sort building a shared, scalable, and sustainable source for the problem-oriented medical record: developmental study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552094/
https://www.ncbi.nlm.nih.gov/pubmed/34643542
http://dx.doi.org/10.2196/29174
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