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 (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，其内容由携带数据的消费者控制和管理。近年来，PHR 引起了媒体的广泛关注，许多国家的行业和政府都将其视为医疗保健领域许多 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)，以研究和提高其实用性、减少其使用障碍、确定最佳实践并提供平台和测试床对于高级应用程序。该开发基于一组由卫生与公众服务部和 NLM 支持的现有消息和词汇标准，以及现有的（Ruby on Rails、Scriptaculous 和 Dojo）和 NLM 开发的开源软件构建块，其中一些将具有广泛的医学信息学应用。它是一个基于内部开发的表单生成器的网络应用程序，具有基于规则的跳过逻辑（例如，如果该人是男性，它不会询问怀孕史）、编辑检查和自动完成输入。它采用AJAX技术，因此响应时间非常快。 NLM PHR 提供了用于管理来自许多不同家庭成员的临床信息的工具，因此母亲可以维护自己和每个孩子的免疫记录，和/或跟踪她生病的父亲的药物治疗。它提供了记录药物、医疗问题、手术、免疫（疫苗）、血压和实验室结果（例如血糖）等重要测量结果的场所。它旨在对主要事实的名称进行编码 - 例如药物、问题、手术、免疫接种——它所携带的。该编码将名称转换为联邦支持的编码系统，例如用于药物的 RxTerms（RxNorm 的子集，为本项目开发并由医疗保险和医疗补助服务中心 (CMS) 用于其急性后护理项目）、用于测量的逻辑观察标识符名称和代码 (LOINC)、中心用于免疫接种的疾病控制 (CDC) 疫苗代码、用于诊断的系统化医学命名法 (SNOMED)。它的大部分数据结构和所有数据类型均采用健康级别 7 (HL7)。这两种功能都有助于从广泛使用的 HL7 消息中导入临床数据。 自动编码的方向使 NLM PHR 能够提供两种特殊功能：1）决策支持规则和 2）一键访问记录中记录的有关编码概念的信息。 2010 财年，我们审查了编码系统中的所有医疗状况、外科手术和疫苗术语，对每个术语应用了统一的样式，添加了同义词和消费者名称，并将概念数量扩大了 50%。 我们还创建了一个表单，使临床医生能够使用类似英语的语法来编写和编辑规则，这些规则可以检查 PHR 中的患者数据模式并做出反应。此规则可用于隐藏或跳过主表单上的输入字段、生成字段的默认值和/或建议美国预防服务工作组或 CDC 等权威机构推荐的预防性护理干预措施。 下面显示了用于生成结肠癌筛查提醒的八个案例中两个案例的排除规则和提醒文本的第一部分。 结肠癌筛查 排除标准：年龄 < 50 岁或年龄 >= 86 或 (Years_since_ last_colonoscopy <= 10) OR (Years_since_last_ flexsig <= ) OR Years_since_last _FOBT < =1 规则 无 FOBT、无 Flexsig、无结肠镜检查且年龄 < 76 提醒文字 美国预防服务工作组建议对性别年龄人群进行常规结肠癌筛查 http://www.ahrq.gov/clinic/uspstf/uspscolo.htm）因为筛查可以减少该年龄段的结肠癌死亡率。 ... 规则 结肠镜检查年数 > 10 且年龄 < 76 提醒文字 根据人口统计_infoPHR 记录名称的 PHR，Gender_possesive 上次结肠镜检查是在 10 多年前的 Late_colonoscopyDate。美国预防服务工作组建议 50 至 75 岁的人群定期进行结肠癌筛查（参见 http://www.ahrq.gov/clinic/uspstf/uspscolo.htm）因为筛查可以减少该年龄段的结肠癌死亡率。 ... 每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发送给患者的提醒文本。该表的操作就像计算机选择语句一样，只有满足规则的第一行才会触发提醒。 请注意，每对花括号代表一项患者特定信息，这些信息将插入文本中以适合患者。因此，如果患者是男性，则性别所有格将成为“他”，如果患者是女性，则“她”。可以在提醒文本中插入 URL，用户可以单击 URL 来访问存储在各个站点上的专着。 我们已经编写并测试了超过 15 项预防干预措施的规则，包括癌症筛查和免疫接种，并且我们正在制定另外 20 项规则。 PHR 将所有编码概念、药物、医疗状况和过敏与可信信息源（包括 MedlinePlus、Genetics Home Reference、CDC 和美国预防性健康服务工作组）联系起来，并填充决策支持提醒和消费者- 量身定制的信息。 去年，我们还创建了安全所需的所有基础工具，例如验证码，用于检测用户何时使用新计算机的机制，因此有义务重新输入其秘密问题的答案，以防止超时。多次失败的登录尝试以及用户忘记的 ID 和密码的恢复。我们还重建了字段输入和菜单显示算法，使其更快、更简单，并且符合常见的网站协议，并且添加了到期日提醒和流程图显示功能。 这是一个年轻的项目，旨在产生 NLM 长期感兴趣的东西，并且是 NLM 战略计划的一部分。它将使用和调整 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切入点。早期的研究项目将重点关注用户的需求、可用性和使用模式，以指导下一轮的开发和研究。 经高级管理人员审查后，贝塞斯达斯郊区医院已初步同意安装和运营 NLM PHR，为社区居民提供服务。