Sam Heard

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Papers by Sam Heard

Managing Archetypes for Sustainable and Semantically Interoperable Electronic Health Records

Electronic Journal of Health Informatics, 2007

Background: With the release of openEHR Version 1.0 a common Electronic Health Records (EHR) arch... more Background: With the release of openEHR Version 1.0 a common Electronic Health Records (EHR) architecture has been defined to pursue the aim of semantic interoperability of Electronic Health Records. Archetypes as clinical content models play a key role in this approach, but their development and maintenance needs to be managed by Knowledge Governance in order to avoid incompatibilities. Objectives: To analyse the functional requirements for supporting Domain Knowledge Governance with Information Technology (like authoring or updating archetypes) and present a prototype implementation. Methods: Requirements analysis using the Unified Modeling Language (UML) and incremental prototyping. A series of archetype workshops were also conducted. Results: For a web-based Archetype Repository, a total of four top-level use cases and 23 refining use cases for 5 different actors were found to be essential. A prototype implementing some of these use cases has been developed and an example process for the coordinated development of archetypes defined. Discussion: We believe that Domain Knowledge Governance is necessary independent of the actual approach and methodology chosen for EHR systems. Appropriate information technology is required to support a clear process for authoring archetypes. Conclusion: Highquality archetypes with high-quality clinical content are the key to semantic interoperability of clinical systems. Domain Knowledge Governance is the key to high quality archetypes. A comprehensive Archetype Repository will render comprehensive Domain Knowledge Governance feasible and efficient.

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Guest Editorial- Special Issue - Knowledge Management in Healthcare

Acj, 2003

RS001 Beyond Ivory Towers: Refining the "Specialist Model" for the Australasian Setting

Nursing constraint models for electronic health records: A vision for domain knowledge governance

International Journal of Medical Informatics, 2006

Various forms of electronic health records (EHRs) are currently being introduced in several count... more Various forms of electronic health records (EHRs) are currently being introduced in several countries. Nurses are primary stakeholders and need to ensure that their information and knowledge needs are being met by such systems information sharing between health care providers to enable them to improve the quality and efficiency of health care service delivery for all subjects of care. The latest international EHR standards have adopted the openEHR approach of two-level modelling. The first level is a stable information model determining structure, while the second level consists of constraint models or 'archetypes' that reflect the specifications or clinician rules for how clinical information needs to be represented to enable unambiguous data sharing. The current state of play in terms of international health informatics standards development activities is providing the nursing profession with a unique opportunity and challenge. Much work has been undertaken internationally in the area of nursing terminologies and evidence-based practice. This paper argues that to make the most of these emerging technologies and EHRs we must now concentrate on developing a process to identify, document, implement, manage and govern our nursing domain knowledge as well as contribute to the development of relevant international standards. It is argued that one comprehensive nursing terminology, such as the ICNP or SNOMED CT is simply too complex and too difficult to maintain. As the openEHR archetype approach does not rely heavily on big standardised terminologies, it offers more flexibility during standardisation of clinical concepts and it ensures open, future-proof electronic health records. We conclude that it is highly desirable for the nursing profession to adopt this openEHR approach as a means of documenting and governing the nursing profession's domain knowledge. It is essential for the nursing profession to develop its domain knowledge constraint models (archetypes) collaboratively in an international context.

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The use of standard content specifications in a national health interoperability framework

Electronic Journal of Health Informatics, Oct 5, 2009

... to more traditional proc-ess-oriented approaches to health informatics standards setting, ope... more

openEHR Release 1.0: Archetype Definitions and Principles

openEHR Architecture - Architecture Overview

E-health records and future healthcare

Studies in health technology and informatics, 2010

This chapter gives an educational overview of: * Data collected, stored in health records and use... more This chapter gives an educational overview of: * Data collected, stored in health records and used for multiple purposes * Electronic health records and how these are likely to influence our future * Personal health records * Clinical systems and their relationship to national data collections * Potential future use of new technologies.

Pruritus ani

Australian family physician, 2004

Pruritus ani is a common presenting problem in general practice, one that is particularly distres... more Pruritus ani is a common presenting problem in general practice, one that is particularly distressing to patients. However, there is little available research on which to base management This article discusses the causes and management of this distressing symptom based on thecurrent available evidence. Perianal itch probably arises from localised inflammation. This may be the result of anorectal disease, skin disorders, excessive cleaning, application of local irritants or other causes. In children, perianal itch may be caused by intestinal hermetic Infection such as pinworm. Whatever the initial cause, the problem may at times become chronic, with scratching inflaming the area and more itching resulting. Avoiding trauma from excess washing, toilet paper and topical agents is important. Treatments likely to be effective are emollients such as sorbolene, a short course of topical hydrocortisone cream and capsaicin cream.

General practice education in Australia. Current issues

Australian family physician, 2004

General practice education is rapidly changing. Medical students now have exposure to general pra... more General practice education is rapidly changing. Medical students now have exposure to general practice at most year levels, vocational training has been opened to competition, and continuing professional development is a mandatory requirement for maintenance of Health Insurance Commission recognition, and increasingly for state registration. This article outlines the foundations for, and challenge to, building a framework for quality general practice education in Australia.

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An ontology-based model of clinical information

Studies in health technology and informatics, 2007

In this paper we describe a model of clinical information designed to make health information sys... more In this paper we describe a model of clinical information designed to make health information systems properly interoperable and safely computable. The model is a response to a number of categories of requirements, ranging from the semantic to the performance of software at runtime. We argue that the starting point of a successful model must be an ontological analysis of the process of clinical care delivery, seen as a scientific problem-solving process. From this approach we develop a classification of types of clinical information called the Clinical Investigator Record (CIR) ontology.

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Archetype Definitions and Principles

Practice Based Teaching: A Guide for General Practitioners

Australian Journal of Rural Health, 2000

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Access to rural general practice and primary care: Time now for more equitable and sustainable solutions?

Australian Journal of Primary Health, 2004

Australia has the resources to provide reasonable primary medical and health care to all of its p... more Australia has the resources to provide reasonable primary medical and health care to all of its population. It is a particularly worthwhile expense, with positive social and biophysical outcomes (Jarman et al., 1999; Starfield, 1998). In many aspects of health care, primary care provides most of the benefit and almost all of the value. Why, then, don?t we provide this basic service to all Australians?

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Towards a revised CEN standard for Electronic Health RecordCommunication

ABSTRACT In December 2001 CEN TC/251 confirmed a new Task Force, EHRcom, to review and revise the... more ABSTRACT In December 2001 CEN TC/251 confirmed a new Task Force, EHRcom, to review and revise the four-part pre-standard ENV 13606 relating to Electronic Healthcare Record Communications. The intention of this work is to propose a revision that could be adopted by CEN as a formal standard (EN). The Task Force intends to base the revision of ENV 13606 on the practical experience that has been gained through commercial systems and demonstrator pilots in the communication of whole or part of patients’ EHRs. This paper summarises reasons for seeking such a standard, outlines the parts of the existing pre-standard , and describes the vision of EHR communication that the Task Force proposes as its present scope. The paper also lists the key tasks that comprise its technical approach, and discusses some of the issues that have to be considered in formulating a new and definitive standard.

EHR Design Principles

The Good Electronic Health Record in Australian General Practice: Towards a Trial Implementation

by Thomas W Beale and Sam Heard

Efficacy of Pulse Oximetry and Capnometry in Postoperative Ventilatory Weaning

Survey of Anesthesiology, 1989

We examined the ability of capnometry and pulse oximetry to identify potential respiratory proble... more We examined the ability of capnometry and pulse oximetry to identify potential respiratory problems by comparing oxyhemoglobin saturation (O2Sat) as measured by pulse oximetry and end-tidal CO2 (PetCO2) with arterial blood gas (ABG) determinations in 40 mechanically ventilated ICU patients. Hemoglobin saturation as measured by pulse oximetry correlated significantly with PaO2 (r = .65, p less than .0001); more importantly, an oximeter O2 Sat less than 95% showed 100% sensitivity in identifying hypoxemia (i.e., PaO2 less than 70 torr). PetCO2 tended to correlate strongly with PaCO2 for individual patients, but not when evaluated as a screening tool for identifying ventilatory abnormalities in the overall group (r = .52, p less than .0001). A PetCO2 less than 26 torr identified hypocarbia (defined as PaCO2 less than 30 torr) with a sensitivity of 85%. However, a PetCO2 of greater than 40 torr predicted hypercarbia (PaCO2 greater than 45 torr) with a sensitivity of only 28%. The efficacy of pulse oximetry and capnometry in monitoring respiratory status during postoperative ventilatory weaning was examined in a subset of 24 patients who had undergone elective cardiac surgery. All patients were weaned by intermittent mandatory ventilation, but each was assigned randomly to either a control group monitored with periodic ABG sampling or to an experimental group, monitored by following PetCO2 and O2 Sat via pulse oximetry. In the experimental group, ABG values were obtained on ICU admission, but thereafter only if a) O2 Sat less than 95%, b) PetCO2 less than 26 or greater than 40 torr, or c) felt to be clinically indicated by ICU staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Importing Clinical Data into Electronic Health Records-Lessons Learnt from the First Australian GEHR Trials

by Sam Heard and Andrew Goodchild

One of the many features of an Electronic Health Record (EHR) is that it can be used as an accumu... more One of the many features of an Electronic Health Record (EHR) is that it can be used as an accumulator of clinical information from a number of other clinical applications. In this paper, we present the outcomes of two General Practice Computing Group (GPCG) funded trials (run under the "Trials of IM/IT clinical integration activities within the health sector" RFT). Both of these trials explored using an EHR as an accumulator of clinical information by investigating the process of exporting clinical information from existing applications into a 'Good Electronic Health Record' (GEHR) based repository. Once the clinical information was uploaded into the GEHR repository, the data could then be validated, viewed and queried. The two projects that will be discussed are:

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Data Structures Information Model

Sam Heard

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