Representing Knowledge Consistently Across Health Systems

Abstract

Objectives: Electronic health records (EHRs) have increasingly emerged as a powerful source of clinical data that can be leveraged for reuse in research and in modular health apps that integrate into diverse health information technologies. A key challenge to these use cases is representing the knowledge contained within data from different EHR systems in a uniform fashion. Method: We reviewed several recent studies covering the knowledge representation in the common data models for the Observational Medical Outcomes Partnership (OMOP) and its Observational Health Data Sciences and Informatics program, and the United States Patient Centered Outcomes Research Network (PCORNet). We also reviewed the Health Level 7 Fast Healthcare Interoperability Resource standard supporting app-like programs that can be used across multiple EHR and research systems. Results: There has been a recent growth in high-impact efforts to support quality-assured and standardized clinical data sharing across different institutions and EHR systems. We focused on three major efforts as part of a larger landscape moving towards shareable, transportable, and computable clinical data. Conclusion: The growth in approaches to developing common data models to support interoperable knowledge representation portends an increasing availability of high-quality clinical data in support of research. Building on these efforts will allow a future whereby significant portions of the populations in the world may be able to share their data for research.

Fig. 1 Representation of the PCORnet and OMOP Common Data Model (CDM) domains alongside the FHIR interoperability standard. CDMs are filled with clinical data derived from EHR systems via an extract, transform, and load (ETL) procedure. Clinical data domains are stored as tables within each of the CDMs, noted by the interior boxes. In the figure, the horizontal boxes presented in gray shading connect overlapping domain groupings between the models. Both CDMs also include data domains not represented here, such as cohort definitions. The FHIR standard allows transmission among EHRs, CDMs, Electronic Data Warehouses (EDWs), and data lakes

. * Patient-Reported Outcome Common Measures** The Observation domain allows storage of data not represented elsewhere in the CDM.