Extending i2b2 into a framework for semantic abstraction of EHR to facilitate rapid development and portability of Health IT applications

Abstract

The wide gap between a care provider's conceptualization of electronic health record (EHR) and the structures for electronic health record (EHR) data storage and transmission, presents a multitude of obstacles for development of innovative Health IT applications. While developers model the EHR view of the clinicians at one end, they work with a different data view to construct health IT applications. Although there has been considerable progress to bridge this gap by evolution of developer friendly standards and tools for terminology mapping and data warehousing, there is a need for a simplified framework to facilitate development of interoperable applications. To this end, we propose a framework for creating a layer of semantic abstraction on the EHR and describe preliminary work on the implementation of this framework for management of hyperlipidemia and hypertension. Our goal is to facilitate the rapid development and portability of Health IT applications.

Figure 1:

Methodology for implementing the framework

Figure 2.

Framework construction proceeds from left to right, beginning with definition of clinical variables needed at the point-of-care, and decomposing them into granular concepts that can be expressed in the form of codes using standard coding systems. For instance, the concept of Body Mass Index (BMI) is derived from weight and height concepts that are explicitly recorded in the EHR. The layer of concepts represented with standard codes is connected to a site-specific translation layer that includes the local/proprietary to standard code mappings and the logic to assemble data into meaningful facts. Although the framework is implemented from left to right, the data flows from right to left as shown in the figure.

Figure 3.

Clinical concept Hierarchy