Universidade do Porto Faculdade de Medicina SERVIÇO DE BIOESTATÍSTICA E INFORMÁTICA MÉDICA AGUIAR, Filipa,; CORDEIRO, Amilcar; DIAS, André; DUARTE, Mariana; FONSECA, Raquel; FRANÇA, Cíntia; MACEDO, Luís; MELO, Luís; PINTO, Joana; PIRES, Sara; RODRIGUES, Pedro; SANTOS, Paulo; SOUSA, Manuel; TELES, Ana; VIANA, João Mestrado Integrado em Medicina 1º ano - Turma 14 Introdução à Medicina I SBIM – FMUP Dezembro 2008 Systematic review on the use of openEHR in healthcare Final version of written protocol proposal

I. Background: EHR The evolution of data management systems for health should focus on the user, improving the quality of delivery of health services in an integrated management of the disease. Management, storage and exchange standard of information in healthcare. Increasing number of available clinical data TIC Medical software Informatic data bases Thus… No communication between systems openEHR norms creation

I. Background: EHR Diversity of terms Multiplicity of hardware and software Need to communicate and exchange information Improve of clinical decision support systems

I. Background: openEHR A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a. System aim Development of an interoperable computing plataform for the field of medicine, whose basic principal is based on intercomunication between tecnical activities and medical records. Characteristics Construction duality Essencial information codification Terminology: aplication of ontologies (SNOMED-CT, LOINC e ICDx). Long term eficiency openEHR Revolutionary system Medical community involved in platform construction

II. Justification A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a. As medicine students and future professionals, its crucial to be actualized and conscious about the constants mutations on the health domain Sharing of clinical information is an emerging reality that, certainly, will be an integrant part of our workflow Lack of similar works in this domain Improvement of our skills, namely in the development of a scientific project and communication capabilities

III. Research question and aims A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? The current picture of implementation of the standard openEHR: what about its evolution, barriers and application fields in healthcare? Understand the structure and functionality of the openEHR system, particularly with regard to its capability of interoperability. Determine the extent of current application of the standard to the various hospital sectors. Evaluate advantages and discuss limitations inherent to the system. Draw conclusions about its future potential as a major standard for managing clinical data.

IV. Participants and methods: study participants A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? 1. Target population Given the nature of the proposed work - the systematic review article - the study will be developed not around a direct target population, but around previously published articles. Obtain all studies that refer to EHR or openEHR, in different data bases; New querie included – gEHR 2. Sampling methods As we are working in a sistematic review, it will not be needed to define sampling methods. Actually, all the population will be submited to inclusion/exclusion criteria.

IV. Participants and methods: study participants A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? 3. Inclusion/exclusion criteria, characteristics of participants/units of analysis Inclusion Criteria -Inovations in openEHR -Implementation of openEHR -clinical aspects - Technical aspects -Effectiveness and efficiency of openEHR Inclusion Criteria -Inovations in openEHR -Implementation of openEHR -clinical aspects - Technical aspects -Effectiveness and efficiency of openEHR Inclusion Criteria Do not talk directly to the open EHR, but pointed out other similar systems: Implementation in the area of health: -advantages/disadvantages -exemplification with systems already implemented (products) in other countries -semantic interoperability of OpenEHR in comparison to other systems Inclusion Criteria Do not talk directly to the open EHR, but pointed out other similar systems: Implementation in the area of health: -advantages/disadvantages -exemplification with systems already implemented (products) in other countries -semantic interoperability of OpenEHR in comparison to other systems 2 1 Exclusion Criteria -About technical details -Irrelevant issue Exclusion Criteria -About technical details -Irrelevant issue 3

IV. Participants and methods: study participants A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? 3. Inclusion/exclusion criteria, characteristics of participants/units of analysis Inclusion Criteria Do not talk directly to the open EHR, but pointed out other similar systems: Implementation in the area of health: -advantages/disadvantages -exemplification with systems already implemented (products) in other countries -semantic interoperability of OpenEHR in comparison to other systems Inclusion Criteria Do not talk directly to the open EHR, but pointed out other similar systems: Implementation in the area of health: -advantages/disadvantages -exemplification with systems already implemented (products) in other countries -semantic interoperability of OpenEHR in comparison to other systems Inclusion Criteria -Inovations in openEHR -Implementation of openEHR -clinical aspects - Technical aspects -Effectiveness and efficiency of openEHR Inclusion Criteria -Inovations in openEHR -Implementation of openEHR -clinical aspects - Technical aspects -Effectiveness and efficiency of openEHR Exclusion Criteria -About technical details -Irrelevant issue Exclusion Criteria -About technical details -Irrelevant issue 123

VII. Participants and methods: medical search engines A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? Primary research (openEHR) (query: openEHR, without using any MeSH term due to being not available in the subject) [Scopus]: 43 published articles [ISI Web of Knowledge]: 37 published articles [Pubmed]: 31 published articles [ACM]: 24 published articles [IEEE Xplore]: 1 published article Primary research (gEHR) (query: gEHR, without using any MeSH term due to being not available in the subject) [Scopus]: 54 published articles [ISI Web of Knowledge]: 56 published articles [Pubmed]: 22 published articles [ACM]: 27 published articles [IEEE Xplore]: 0 published articles

VII. Participants and methods: study participants A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? The results obtained in [Scopus] were statistically analyzed and treated as observable in the following charts.Scopus

VII. Participants and methods: study participants A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? The results obtained in [Scopus] were statistically analyzed and treated as observable in the following charts.Scopus

VII. Participants and methods: study participants A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? Articles obtained for gEHR query were not analised because they werent relevant for our aim.

VII. Participants and methods: study participants A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? First selection (repeated articles from primary research for the query openEHR were eliminated) There were only selected 75 articles. Second selection – (articles that couldnt be accessed were eliminated) There were only selected 70. Third selection – (using including and excluding criteria) There were only selected 29.

V. Participants and methods: study design A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? 1. Study design Systematic review article Longitudinal Retrospective Secondary data research Identify/choose database Pubmed SCOPUS ISI Web ACM IEE Xplore Insert query EHR openEHR open AND EHR gEHR Use inclusion/exclusion criteria Fluxogram I

VI. Participants and methods: data collection methods A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? 1. Software Microsoft Word Microsoft Excel Microsoft Office Visio Microsoft PowerPoint Microsoft Project 2. Search engines Google Scholar Scopus ISI Web of Knowledge Pubmed ACM IEEE Xplore

VII. Participants and methods: variables description A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? General Study Identification Author Publication year Nationality Journal Type of Article Comparative Study Clinical Trial Meta-Analysis Review … Type of study Retrospective Prospective Specific variables Subset Clinical Type of institution Medical area Kind of data Technological Development level [Study, Beta Application or Product] Evaluation Benefits Limitations Implications

VIII. Participants and methods: planned statistical analysis A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? Authors Evaluate if the authors are the same Nationality Analyze the origin country of the study Time Verify the time incidence of the articles collected

VIII. Participants and methods: planned statistical analysis A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? Application areas Determine in which medical area openEHR is applied and what kind of information is treated Level of development Development level of the standard described in which article Evaluation Guess about benefits, limitations and implications brought about openEHR.

IX. Expected results A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.Panorama actual de aplica ç ão do sistema openEHR em á reas cl í nicas: quais as vantagens e limita ç ões? Discover future applications that shall be referred in the articles Open EHR is a useful and well referenced program that can be used in medical care in order to facilitate the work in through institutions Which services use Open EHR the most The use of Open EHR has increased during the years (number of articles published has increased in the recent years) Analyse the use of Open EHR in hospitals (countries, medical services)

X. References A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a. 1.BEALE, T.; HEARD, S. - OpenEHR Architecture Overview, Abril 2007 (Consultar: BEALE, T.; HEARD, S. – Archetype Definitions and Principles, Março 2007 (Consultar: INGRAM, David – Introducing openEHR, 2003 – 2007 (Consultar: PETRY, Karine; LOPES, Paula; WANGENHEIM, Aldo – Padrões para a Interoperabilidade na Saúde, Cyclops, UFSC, Brasil (Consultar: 5.As normas europeias relativas à informática na saúde, SBIM – FMUP (Consultar: %BAde#OpenEHR_e_padr.C3.B5es) %BAde#OpenEHR_e_padr.C3.B5es 6.LESLIE, H. - International developments in openEHR archetypes and templates - PMID: HOY, D.; HARDHIKER, NR. et al. - A feasibility study on clinical templates for the National Health Service in Scotland - PMID: SCHULER, T. et al. – Towards automatically generating graphical user interfaces from openEHR archetypes- PMID: GARDE S. et al. – Can openEHR archetypes empower multi-centre clinical research? - PMID: HOY, D. et al. – Collaborative development of clinical templates as a national resource – PMID: GARDE, S. et al. – Ubiquitous information for ubiquitous computing: expressing clinical data sets with openEHR archetypes – PMID:

Thank you. Questions? A evolu ç ão dos sistemas de gestão de dados no dom í nio da sa ú de deve centrar-se no utente, melhorando a qualidade da presta ç ão de servi ç os de sa ú de, numa gestão integrada da doen ç a.