Browsing by Author "Amlung, Joseph"

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    Enhancing narrative clinical guidance with computer-readable artifacts: Authoring FHIR implementation guides based on WHO recommendations
    (Elsevier, 2021) Shivers, Jennifer; Amlung, Joseph; Ratanaprayul, Natschja; Rhodes, Bryn; Biondich, Paul; Herron School of Art and Design
    Introduction: Narrative clinical guidelines often contain assumptions, knowledge gaps, and ambiguities that make translation into an electronic computable format difficult. This can lead to divergence in electronic implementations, reducing the usefulness of collected data outside of that implementation setting. This work set out to evolve guidelines-based data dictionaries by mapping to HL7 Fast Health Interoperability Resources (FHIR) and semantic terminology, thus progressing toward machine-readable guidelines that define the minimum data set required to support family planning and sexually transmitted infections. Material and methods: The data dictionaries were first structured to facilitate mapping to FHIR and semantic terminologies, including ICD-10, SNOMED-CT, LOINC, and RxNorm. FHIR resources and codes were assigned to data dictionary terms. The data dictionary and mappings were used as inputs for a newly developed tool to generate FHIR implementation guides. Results: Implementation guides for core data requirements for family planning and sexually transmitted infections were created. These implementation guides display data dictionary content as FHIR resources and semantic terminology codes. Challenges included the use of a two-dimensional spreadsheet to facilitate mapping, the need to create FHIR profiles and resource extensions, and applying FHIR to a data dictionary that was created with a user interface in mind. Conclusions: Authoring FHIR implementation guides is a complex and evolving practice, and there are limited examples for this groundbreaking work. Moving toward machine-readable guidelines by mapping to FHIR and semantic terminologies requires a thorough understanding of the context and use of terminology, an applied information model, and other strategies for optimizing the creation and long-term management of implementation guides. Next steps for this work include validation and, eventually, real-world application. The process for creating the data dictionary and for generating implementation guides should also be improved to prepare for this expanding work.
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    Modernizing health information technology: lessons from healthcare delivery systems
    (Oxford University Press, 2020-09) Amlung, Joseph; Huth, Hannah; Cullen, Theresa; Sequist, Thomas; Medicine, School of Medicine
    Objective: To identify recurrent themes, insights, and process recommendations from stakeholders in US organizations during the health information technology (HIT) modernization of an existing electronic health record (EHR) to a commercial-off-the-shelf product in both resource-plentiful settings and in a resource-constrained environment, the US Indian Health Service. Materials and methods: Thirteen qualitative interviews with stakeholders in various organizations were conducted about HIT modernization efforts. Using a Theory of Change framework, recurring themes were identified and analyzed. Results: The interviewees emphasized the importance of organizational and process revision during modernization, converting historical data, and clinical and leadership involvement. HIT implementation required technological and infrastructure redesign, additional training, and workflow reconfiguration. Motivations for modernization included EHR usability dissatisfaction, revenue enhancements, and improved clinical operations. Decision-making strategies, primarily during HIT selection, included meetings with stakeholders. Successful modernization resulted in improvements in clinical operations, patient experience, and financial outlay. Discussion: Existing implementation frameworks fail to provide experiential feedback, such as implementation challenges, like data conversion, regulatory, functionality, and interoperability requirements. Regardless of the healthcare environment, HIT modernization requires the engagement of leadership and end-users during HIT selection and through all stages of the implementation to prepare people, processes, and technology. Organizations must iteratively define the technological, infrastructure, organizational, and workflow changes required for a successful HIT modernization effort. Conclusions: HIT modernization is an opportunity for organizational and technological change. Successful modernization requires a comprehensive, intentional, well-communicated, and multidisciplinary approach. Resource-constrained environments have the additional challenges of financial burdens, limited staffing, and unstable infrastructure.