Bente Christensen

Evaluating Model-Driven Development for large-scale EHRs through the openEHR approach

PURPOSE In healthcare, the openEHR standard is a promising Model-Driven Development (MDD) approach for electronic healthcare records. This paper aims to identify key socio-technical challenges when the openEHR approach is put to use in Norwegian hospitals. More specifically, key fundamental assumptions are investigated empirically. These assumptions promise a clear separation of technical and domain concerns, users being in control of the modelling process, and widespread user commitment. Finally, these assumptions promise an easy way to model and map complex organizations. METHODS This longitudinal case study is based on an interpretive approach, whereby data were gathered through 440h of participant observation, 22 semi-structured interviews and extensive document studies over 4 years. RESULTS The separation of clinical and technical concerns seemed to be aspirational, because both designing the technical system and modelling the domain required technical and clinical competence. Hence developers and clinicians found themselves working together in both arenas. User control and user commitment seemed not to apply in large-scale projects, as modelling the domain turned out to be too complicated and hence to appeal only to especially interested users worldwide, not the local end-users. Modelling proved to be a complex standardization process that shaped both the actual modelling and healthcare practice itself. CONCLUSION A broad assemblage of contributors seems to be needed for developing an archetype-based system, in which roles, responsibilities and contributions cannot be clearly defined and delimited. The way MDD occurs has implications for medical practice per se in the form of the need to standardize practices to ensure that medical concepts are uniform across practices.

Towards a Structured Electronic Patient Record for Supporting Clinical Decision-Making

At present, Electronic Patient Record systems (EPRs) in Western hospitals are mainly stores of free-text patient information and lack utility for purposes other than accessing such information. The need to improve support for clinical work processes and decision-making has put pressure on vendors and decision makers to put forward a strategy for enhancing the structure of EPR content. This paper reports on the first attempt to implement a structured EPR using a two-level modeling approach in Norwegian hospitals. Taking a work practice perspective, we show that implementing this new EPR in patient care planning implicates several socio-technical challenges that need to be solved in the process.

Towards an "empowered" user role in the design of large-scale electronic patient records

We report from a large-scale Electronic Patient Record (EPR) project in Northern Norway where the goal is to design a new type of configurable EPRs that allow users in hospitals to tailor the software to their specific needs. This ability appears to challenge the traditional user role as what we usually understand as ordinary users increasingly undertake a designer role, hence dissolving the boundaries between users and designers. Still, the configurability of the software is not straightforward as it is not obvious who is going to decide how the final design should look like, how much tailoring should be possible and in which situations.

Complex integrations in health care

Integrations in health care are hard to manage in practice due to their complex organizational realities. To categorise the integrations as syntactic, semantic or pragmatic may help to better plan the process in developing them, and deciding how to manage them in a good way and hence obtain well-functioning integrations.