Information Technology Reference
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and business models (as in [33]), changing the actual access mode and adapting it
to the real information needs of the acceding user. However, these proposals are
too young and are still in their first development phases, so it is soon to extend and
adapt them to other type of systems.
This is why we propose to analyze the daily practice of the medical staff, and
follow the same philosophy as these solutions, to improve their access to the infor-
mation in the EHR based on the information they usually request in each assistance
act. Following the work of a doctor we can find a great variety of situations with
different purposes: from a deep study of a complex diagnosis process in his office,
to a simple revision of the last consultation inform in a control of evolution pro-
cess, passing through the requirement of very concrete data in the response to an
emergency. As can be seen, we face a wide variety of activity contexts, with quite
different requirements of information. In other words, we have different sets of rel-
evant documents or information items of the EHR, depending on the
context
we are
involved in.
Our proposal is based on the study of the access patterns so the information
showed to the user can be
context-sensitive
. This way the system would only show
to the doctor the information that is relevant to his/her present context. However it
must be taken into account that the information needs are not static, and they may
change along the time, so it is possible that a piece of information that today is im-
portant will be useless in the future. Moreover, the age of the data has influence too:
there are cases like some analysis that must be repeated if the last result of the same
type of analysis is older than a few months, since the results may change. Hence, all
of these aspects must be considered when defining the
pertinence
of the information
items to the
contexts
.
According to all of it three problems must be faced. First, it is necessary to iden-
tify the contexts of access. Second, the information relevant for each of them must
be identified. And last, the information must be accessible to remote systems. To
solve the first problem can be found some proposals focused on the context mod-
eling like [5, 11, 19, 23] and [15]; but most of them are just theoretical models too
complicated to be integrated in an existing system, and also require such complex
algorithms that make them not suitable for an hospital information system. Even
more if the system has to be updated continually to adapt to new needs. Proposals
to face the second problem are mainly oriented to identify the relevant information
inside documents as [9, 29, 31] and [35] propose; but due to the great amount of
data involved in the Hospital Information Systems (hundreds of millions of records)
it is not possible to use them. We need a very efficient way to contextualize the
access and decide which information is relevant on each situation. The third one,
the interoperability, has been faced separated from the other with solution that allow
the system to understand each others.
In this chapter we present a proposal to faced the three problems inside an unify
solution that is compatible with the new interoperability regulations. Next section
present the background of the proposal presenting the system used for the devel-
opment and the normal structure of the EHR systems.
The next one present the
