The reuse of electronic health records information models in the oncology domain: Studies with the bioframe framework

Objective:

The reuse of Electronic Health Records (EHR) information models (e.g., templates and archetypes) may bring various benefits, including higher standardization, integration, interoperability, increased productivity in developing EHR systems, and unlock potential Artificial Intelligence applications built on top of medical records. The literature presents recent advances in standards for modeling EHR, in Knowledge Organization Systems (KOS) and EHR data reuse. However, methods, development processes, and frameworks to improve the reuse of EHR information models are still scarce. This study proposes a software engineering framework, named BioFrame, and analyzes how the reuse of EHR information models can be improved during the development of EHR systems.

Methods:

EHR standards and KOS, including ontologies, identified from systematic reviews were considered in developing the BioFrame framework. We used the structure of the OpenEHR to model templates and archetypes, as well as its relationship to international KOS used in the oncology domain. Our framework was applied in the context of pediatric oncology. Three data entry forms concerning nutrition and one utilized during the first pediatric oncology consultations were analyzed to measure the reuse of information models.

Results:

There was an increase in the adherence rate to international KOS of 18% to the original forms. There was an increase in the concepts reused in all 12 scenarios analyzed, with an average reuse of 6.55% in the original forms compared to 17.1% using BioFrame, resulting in significant differences.

Conclusions:

Our results point to higher reuse rates achieved due to an engineering process that provided greater adherence to EHR standards combined with semantic artifacts. This reveals the potential to develop new methods and frameworks aimed at EHR information model reuse. Additional research is needed to evaluate the impacts of the reuse of the EHR information model on interoperability, EHR data reuse, and data quality and assess the proposed framework in other health domains.