Use of Semantic Interoperability to Improve the Urgent Continuity of Care in Danish ERs

Reuse of patient data from prehospital electronic health record (EHR) to EHRs in emergency rooms is currently non-existing. In Danish EHRs, access to patient data recorded in prehospital settings is either not available or accessible in a PDF file. The amount of patient and administrative data registered at the prehospital unit is high and includes a rich representation of the accident, the patient and treatment. By applying emphasis framing to the representation of data, information overload can be diminished. Several international studies have investigated the suboptimal reuse of data within this field. Hence, the aim of this pre-study was to develop webservices based on emphasis framing to increase interoperability between the prehospital health record and the emergency room's EHR. In this study, requirements engineering and emphasis framing was applied. Iterative linear requirement specification process was chosen as a frame to address the aim. The five included phases were revisited due to the iterative nature of this study. Tools used in the requirement engineering process were semi structured interviews and direct observations. The pre-study resulted in 12 Fast Healthcare Interoperability Resources (FHIR) profiles using SNOMED CT terminology bindings. The profiles contained elements which represented primarily patient data recorded in the prehospital setting. The profiles were compared to a case representing the urgent continuity of care to validate their ability to standardize data from prehospital health records. Conclusively, FHIR profiles can be modelled to standardize prehospital urgent patient data to support the patient trajectory. With the applied emphasis framing, the clinical context and content have been maintained.