EVICARE - Evidence-based care processes: Integrating knowledge in clinical information systems

In 2014, many of the goals for the Evicare project were completed. Specifically, a machine-readable guideline on antithrombotic therapy and prevention was authored and published using the MAGIC authoring tool. This guideline is integrated with the DIPS electronic record system where it is managed and presented as a part of the overall system content. The Norwegian Directorate of Health is currently considering the MAGIC guideline authoring system for use nationally. The project has produced a framework for characterizing and evaluating authoring tools for guidelines and recommendations in the context of decision support systems. This framework is an influential instrument used by Norwegian National Health ICT to inform decisions related to knowledge-based patient planning (Activity 50). As a part of work package 4, several software utilities were verified and tested extensively for automated capture of patient history elements, including conditions/disease-related information from free-text in patient records. The main focus is on implementing valid and reliable reasoning with the help of semantic web technology. A prototype patient-physician shared decision-making tool was developed. A Ukrainian firm was responsible for the programming tasks in a collaborative effort. This tool is currently a support system as well as a decision aid for the given target patient population and health professionals involved in the treatment process. The tool helps to improve communication about available treatment alternatives as well as the consequences of the different alternatives. In cooperation with Akershus University Hospital, patient medical records are examined with the help of newly developed software that produces a summary of the relevant patient trajectory data. This software makes it possible to analyze patient trajectories and includes the interval of days spent in hospital, the ability to determine the probability of a patient having an inserted central venous catheter, and a calculation of risk for sepsis. This software will be in production use by the end of 2015. http://si.prod.fpl.nhn.no/omoss_/avdelinger_/stab-helse_/Sider/Evicare.aspx

RELEVANCE TO VERDIKT OBJECTIVES: - technology for advanced collaboration - improved quality through advanced IT - efficient health care IT RESULTS AND EFFECTS IN SELECTED PROBLEM AREAS *Guideline use Today: not practically available, not updated, nonexi sting Project result: interface to guidelines at point of care Effect: improved guideline compliance and guideline validity *Process support Today: lacking in EHR systems Project result: guideline representations integrated with EHR Effect: non-intrusi ve process awareness and support *Documentation practice Today: narrative, not process-related, difficult to navigate Project result: simple guideline semantics and corresponding guideline tags (automatic tagging) Effect: EHR documentation can refer to guidelines, making later navigation and analysis simpler *Care quality Today: only endpoint and resource/intervention indicators Project result: better instruments for comparing and care based on the chosen guideline(s) and treatment Effect: better o verview of guidelines and treatment effects/patient outcomes *Guideline quality Today: no systematic evaluation of care quality related to guidelines Project result: will enable documentation of guideline use in everyday care Effect: empirically valida ted guidelines WORK PACKAGES The project has work packages that will explore, develop and evaluate (responsible partner in paranthesis) : WP2. Representations and tools for authoring computer-interpretable clinical guidelines and care process models (HI) WP3. Automated, context-sensitive lookup and visualization of guidelines in a modern health record system (NTNU) WP4. Guidelines integrated in mobile clinical information systems at point of care as process and documentation support (DIPS ASA) W P5. Patient-oriented guideline representations and interfaces (NTNU) WP6. Quality indicators based on guideline compliance and process proper (Helse Innlandet)