Information Technology Reference
In-Depth Information
is quite difficult to find proposals that really face its whole extent. Most of them just
focus on the definition of data structures and documents to organize the information
provided by the EHR, offering navigation systems on it, like [30] and [38]. How-
ever they don't constitute a solution, since they allow logical and structured access
to the information, but they don't avoid the uncomfortable selections steps and the
successive screen-shots to reach the desired information [53].
In the medical research community it is clear that “having a good access to the
information needed benefits the quality of the attention received by the patients” [1].
In addition, it is being pointed the importance of taking into account the situation or
context
from which the access is being performed [55], as a means to improve the
access to the EHRs.
As an example, [16] propose to use an
infobutton
engine to manage the clini-
cian and patient context in order to provide concise answers to frequent questions
posed by clinicians. “Infobuttons are information retrieval tools that help clinicians
to fulfill their information needs by providing links to on-line health information
resources from within an electronic medical record (EMR) system” [18]. These
models are usually based on classification models to predict clinician's decisions.
However, these models are restricted to very concrete topics like the “medication
infobutton data, used to predict medication-related content topics (e.g., dose, ad-
verse effects, drug interactions, patient education) that a clinician is most likely to
choose while entering medication orders in a particular clinical context” [18].
Other proposals related to the definition of contexts don't face explicitly nor di-
rectly the problem posed. They are mainly focused on the knowledge mobilization
[47] and the the ubiquitous computation [32, 34]; or on the standardization of Hospi-
tal Information Systems and the exchange on information between them [10, 26, 40].
Proposals in the first cases, can rarely be applied to the Hospital Information Sys-
tems, since they are mainly based in the use of sensors to identify the context [34]
or to provide information according to the device used so other applications can per-
form pervasive computing [32]. In addition, none of these proposals are designed
nor useful for the immense databases of EHR. Proposals in the second case, instead
of focusing on identifying the information that is really needed to be exchanged, are
centered on adapting the system, its structures, contents and interfaces to different
regulations and standards like HL7 [17], DICOM [27], [42], SNOMED-CT [41], or
the most recent proposal of the European Committee for Standardization: the ISO
13606 regulation. It leads them to forget and even obviate the needs of the health
professionals, who are the real users of the system, and whose work improvements
have more repercussion and impact in the quality of the medical assistance provided
to the patients.
Nevertheless, the problem of the access to concrete information items of interest
in huge databases, do is addressed explicitly in other environments, like business,
legacy and e-government (in [11, 37] and [6], respectively). A German office of
digital services to the citizens has detected the problem through deep studies [6],
but still hasn't proposed a solution to it. In the business framework this situation has
also arose, as indicated by [11] and [8], and the proposals to solve it are based on
the improvement of the information retrieval by the definition of different contexts
