Overview
The ambulatory oncology electronic health record being developed by the National Cancer Institute (caEHR) in collaboration with the community cancer centers is a cornerstone application for demonstrating the value of computable semantics that enable interoperability and runtime clinical decision support. The ambulatory oncology electronic health record has several semantic infrastructure requirements and these are highlighted below using a high level use case.
caEHR Clinical Forms Use Case
The Electronic Health Record (EHR) is a form driven system for data entry by physicians, nursing staff, and ancillary providers. Data captured through forms may be repurposed for business analysis at the institutional level and personal physician level. The data may also be used for adverse event reporting, public health reporting of communicable diseases, and automated reporting to cancer registries. The data may be released for insurance and claims payment and may also be provided to the patient for a longitudinal medical history. Data is exchanged between healthcare providers at the time of referral of the patient for additional care. The electronic health record should also participate in providing data to aggregated and de-identified repositories to better understand healthcare outcomes and best practices.
To serve these many uses, it is critical to make sure that the context and semantics of data entry is captured and persisted to a backend data store without loss of meaning. To enable this goal of robust data capture, the forms used to capture the data elements must be semantically structured and linked in context using standards based information models and explicit terminology with traceability through value set identifiers and coded concept identifiers to allow aggregation and disambiguation of the captured data. The diagram below shows actors and use cases involved with form design and the data entry using these forms.
The caEHR Clinical Forms use case has two primary goals. The first goal involves a form designer and the construction of a clinical data entry form for use in the GUI of the caEHR application that is semantically consistent and based on HL7 RIM objects, HL7 structural vocabulary, and ONC required code systems for meaningful use. The second goal involves the data entry person (a physician, nurse or other health care provider) that defines the value set requirements for the form elements, identifies the rules for skip patterns and form element arrangement, and eventually enters and persists clinical data.
caEHR Use Case Description
Form Design: The form design scenario aims to enable the construction of a form model based on semantic HL7 RIM objects, allow binding of appropriate code systems and value sets to the form controls of the object, and add rules for skip patterns and data entry flow. This will allow data capture at the point of care. The forms, their construction objects, and the bound value sets must be persisted for reused, and the forms are made available to a user for data entry.
- A Data Entry Form builder gathers requirements for forms from end users who will enter data into the system. They build a form by retrieving form components and value sets from a repository and/or the terminology services. The end result of the build process is a Semantically Aware Form and its schema and terminology requirements.
- The form definition is eventually stored on a server, the form metadata is stored in a repository.
- The form definitions are retrieved and a user uses the form to create a CDA document.
- The document is either persisited or exchanged with a external system.
