NLM's Personal Health Record and Consumer Service R&D

NLM 的个人健康记录和消费者服务 R

• 批准号: 8158049
• 负责人: Clement McDonald
• 金额: $ 97.01万
• 依托单位: NATIONAL LIBRARY OF MEDICINE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8158049
• 关键词: Personal Health Records; Services; research and development; Personal Health Records; Services; research and development

Personal health records (PHRs) are electronic medical records whose contents are controlled and managed by the consumers whose data they carry. PHRs have attracted much press attention in recent years, and both industry and governments in many countries see them as potential solutions to many IT problems in health care. The National Library of Medicine (NLM) has embarked on the development and deployment of a Personal health record (PHR) in order to study and improve their utility, reduce the barriers to their use, identify best practices, and provide a platform and test bed for advanced applications. The development is based on a set of existing messages and vocabulary standards that are supported by the Department of Health and Human Services and the NLM and on both existing (Ruby on Rails, Scriptaculous, and Dojo) and NLM-developed open source software building blocks, some of which will have broad medical informatics applications. It is a web application based on an internally developed forms generator with rule-based skip logic (e.g. if the person is male, it does not ask about pregnancy history), edit checks and auto complete input. It uses AJAX techniques, so the response time is very fast. The NLM PHR provides tools for managing clinical information from many different family members, so a mother can maintain immunization records for herself and each of her children, and/or keep track of her ailing father's medications. It provides places for recording medications, medical problems, surgeries, immunizations (vaccines), important measurements such as blood pressure and laboratory results (e.g. serum glucose). It is designed to encode the names of the major facts - e.g. drugs, problems, surgeries, immunizations - that it carries. The encoding translates names into federally-supported coding systems, e.g. RxTerms (a Subset of RxNorm that was developed for this project and adopted by The Centers for Medicare and Medicaid Services (CMS) for their post-acute care project) for drugs, Logical Observation Identifiers Names and Codes (LOINC) for measurements, the Centers for Disease Control's (CDC) vaccine codes for immunizations, Systematized Nomenclature of Medicine (SNOMED) for diagnoses. It adopts Health Level 7 (HL7) for much of its data structure and all of its data types. Both of these capabilities facilitate the importation of clinical data from widely available HL7 messages. The orientation toward automatic coding enables the NLM PHR to provide two special capabilities: 1) decision support rules and 2) one-click access to information about coded concepts recorded in the record. During FY2010 we reviewed all of the medical conditions, surgical interventions and vaccines- terms in the coding system, applied uniform styles to each, added synonyms and consumer names and expanded the number of concepts by 50%. We also created a form that enables clinicians to use an English-like Syntax to author and edit rules that can examine and react to patterns of patient data in the PHR. This rule can be used to hide or skip input fields on the main form, to generate default value for fields and/or to suggest preventive care interventions recommended by authoritative bodies such as the US Preventive Services Task Force, or the CDC. The following shows the exclusion rules and the first portion of the reminder text for two of the eight cases used to generate reminders for colon cancer screening. Colon_Cancer_Screening Exclusion Criteria: age < 50 OR age >= 86 OR (Years_since_ last_colonoscopy <= 10) OR (Years_since_last_ flexsig <= ) OR Years_since_last _FOBT < =1 Rule NO FOBT AND NO Flexsig and No Colonoscopy and age < 76 Reminder text The U.S. Preventive Services Task Force recommends routine colon cancer screening for people of Gender_possesive age http://www.ahrq.gov/clinic/uspstf/uspscolo.htm) because screening reduces death from colon cancer in this age group. ... Rule Years_since_colonoscopy > 10 AND age < 76 Reminder text According to demographic_infoPHR Record Name's PHR, Gender_possesive last colonoscopy was more than 10 years ago, on Latest_colonoscopyDate. The U.S. Preventive Services Task Force recommends regular colon cancer screening for people 50 to 75 years old ( see http://www.ahrq.gov/clinic/uspstf/uspscolo.htm) because screening reduces death from colon cancer in this age group. ... The first cell in each row contains a Rule and the second cell contains the Reminder text that will be delivered to the patient when the rule is satisfied. The table operates like a computer choice statement, and only the first row that has a rule that is satisfied will trigger a reminder. Note that each pair of curlicue brackets represents an item of patient-specific information that will be inserted into the text to tailor it to the patient. So Gender possessive will become his if the patient is a male and her if a female. URLS can be inserted in the reminder text and users can click on the URL to get to the monographs stored on the respective sites. We have written and tested rules for more than 15 preventive interventions including cancer screening and immunization and we are working on another 20. The PHR links all of the coded concepts, drugs, medical conditions, and allergies to sources of trusted information, including MedlinePlus, Genetics Home Reference, the CDC, and the US Preventive Health Service Task Force, and populates the decision support reminders and the consumer-tailored information. In the last year we also created all of the base tools needed for security, e.g., CAPTCHA, machinery for detecting when the user is using a new computer and thus is obliged to re-enter the answer to their secrete questions, for timing out after a number of failed log on attempts and for user recovery of their ID and passwords if forgotten. We also rebuilt the field entry and menu display algorithms to make them faster, simpler, and conformant with common web site protocols, and we added due date reminders and a flow sheet display capability. This is a young project to produce something that has been a longstanding NLM interest and is part of the NLM strategic plan. It will use and tune the message and vocabulary standards that NLM has supported and also provide another consumer entry point to NLM's rich trove of patient-oriented data. Early research projects will be focused on users' needs, usability, and usage patterns to guide the next round of development and research. Subject to review by senior administration, Bethesdas Suburban Hospital has tentatively agreed to install and operate the NLM PHR as a service to people in their community.

个人健康记录（PHR）是电子医疗记录，其内容受其数据携带的消费者控制和管理。近年来，PHR引起了很多新闻界的关注，许多国家的行业和政府都将其视为解决医疗保健中许多IT问题的潜在解决方案。 国家医学图书馆（NLM）已着手开发和部署个人健康记录（PHR），以研究和改善其实用性，减少其使用的障碍，确定最佳实践，并为高级应用程序提供平台和测试床。该开发基于卫生和公共服务部以及NLM以及现有的现有消息和词汇标准以及现有的（Ruby on Rail，Scriptaculous和Dojo）以及NLM开发的开源软件构建块，其中一些将具有广泛的医疗信息应用程序。它是一个基于内部开发的形式生成器的Web应用程序，具有基于规则的SKIP逻辑（例如，如果该人是男性，则不会询问有关怀孕历史的信息），编辑检查和自动完成输入。它使用AJAX技术，因此响应时间非常快。 NLM PHR提供了用于管理许多不同家庭成员的临床信息的工具，因此母亲可以为自己和她的每个孩子维持免疫记录，并//或跟踪她生病的父亲的药物。它为记录药物，医疗问题，手术，免疫接种（疫苗），重要测量（例如血压和实验室结果（例如血清葡萄糖））提供了场所。它旨在编码主要事实的名称 - 例如药物，问题，手术，免疫接种 - 它带有。编码将名称转换为联邦支持的编码系统，例如rxterms（为该项目开发的RXNORM子集，并由医疗保险和医疗补助中心（CMS）用于药物，用于药物后的急性护理项目），用于测量的逻辑观察标识符名称和代码（LOIINC），用于疾病控制中心（CDC）的疫苗（CDC）疫苗（用于免疫原化的药物）的诊断（诊断）。它采用健康级别7（HL7）的大部分数据结构及其所有数据类型。这两种功能都有助于从广泛可用的HL7消息中进口临床数据。 自动编码的方向使NLM PHR能够提供两个特殊功能：1）决策支持规则和2）一键式访问记录中记录的有关编码概念的信息。在2010财年期间，我们审查了编码系统中的所有医疗条件，手术干预和疫苗术语，对每种均采用统一样式，添加了同义词和消费者名称，并将概念数量扩大了50％。 我们还创建了一种表格，使临床医生能够使用类似英语的语法来撰写和编辑可以检查和对PHR中患者数据模式做出反应的规则。该规则可用于隐藏或跳过主形式的输入字段，以生成字段的默认值和/或建议由美国预防服务工作组或CDC等权威机构建议的预防性护理干预措施。 以下显示了用于生成结肠癌筛查的八个案例中的两个案例中的两个案件的排除规则和提醒文本的第一部分。 colon_cancer_screening 排除标准：年龄<50或年龄> = 86或（lays_since_ last_colonoscopy <= 10）或（lye_since_last_ flexsig <=）或lays_since_last _fobt _fobt <= 1 规则 没有fobt，否屈曲，没有结肠镜检查，年龄<76 提醒文字 美国预防服务工作队建议对性别人士的常规结肠癌筛查 http://www.ahrq.gov/clinic/uspstf/uspscolo.htm），因为筛查减少了这个年龄段的结肠癌死亡。 ... 规则 年_SINCE_COLOSOSCOPY> 10岁，年龄<76 提醒文字 根据人口统计学唱片名称的PHR，Gender_possesive最后的结肠镜检查是10年前的最新_colonoscopydate。美国预防服务工作队建议对50至75岁的人进行定期结肠癌筛查（请参阅 http://www.ahrq.gov/clinic/uspstf/uspscolo.htm），因为筛查减少了这个年龄段的结肠癌死亡。 ... 每一行中的第一个单元格包含一个规则，第二个单元格包含在满足规则时将交付给患者的提醒文本。该表像计算机选择语句一样运行，只有一个具有满足规则的第一行才会触发提醒。 请注意，每对结构支架代表一项特定于患者的信息，该信息将插入文本中以量身定制为患者。因此，如果患者是男性，如果是女性，则性别所有权将成为他的。可以将URL插入提醒文本中，用户可以单击URL以获取存储在各个站点上的专着。 我们已经为15多种预防干预措施编写和测试了规则，包括癌症筛查和免疫，我们正在研究另外20条。 PHR将所有编码概念，药物，医疗状况和过敏症与可信赖信息的来源联系起来，包括Medlineplus，Genetics Home Refersion，CDC和美国预防性卫生服务工作组，并填充决策支持提醒和消费者销售的信息。 在过去的一年中，我们还创建了安全性所需的所有基本工具，例如Captcha，用于检测用户何时使用新计算机的机械，因此有义务重新输入其分泌问题的答案，以便在尝试失败的登录失败之后，以及未遗忘的ID和密码后进行的，如果未遗忘。我们还重建了字段条目和菜单显示算法，以使其更快，更简单且符合常见的网站协议，并添加了截止日期提醒和流平面显示功能。 这是一个年轻的项目，旨在产生长期以来一直具有NLM兴趣的东西，并且是NLM战略计划的一部分。它将使用并调整NLM支持的消息和词汇标准，并为NLM丰富的以患者为导向的数据提供另一个消费者的入口点。早期的研究项目将集中在用户的需求，可用性和使用模式上，以指导下一轮开发和研究。 在接受高级政府审查的前提下，贝塞斯达斯郊区医院暂时同意安装和操作NLM PHR，以服务其社区中的人们。