4. Supporting healthcare professionals' daily work and facilitating better data quality through e-Health standards

e-Health standards are - and should be used - as a solid foundation in patient-centred healthcare. The standards should be used in a way which reduces healthcare professionals’ burden in the daily documentation work. There are several other benefits regarding the use of e-Health standards in documentation of patient care. e-Health standards can reduce administrative data entry given that administrative reports may be generated automatically or with reduced re-entry of data using e-Health standards. Healthcare professionals can save time by having the ability to access more complete and comprehensive information in one place. The standards can contribute to less duplication in documentation (sematic interaction ability), more user-friendly designs (for example rules regarding universal design), more automated workflow and in addition simplify quality assurance work and research work (for example, standards can make it easier to retrieve variables).

Interoperability in general can improve communication between care teams across the health systems, improve confidence in decision making and increase the amount of time available spent on direct patient care.

Healthcare professionals' needs

e-Health standards in health care should be developed and used based on healthcare professionals’ needs. That means meeting the need for high quality data for primary and secondary use and supporting healthcare professionals’ daily documentation work. However, it is challenging to understand healthcare professionals’ needs correctly. In addition, different needs exist for different purposes in both primary and secondary use, and high-quality data for one purpose is not automatically usable or high-quality for other purposes. Healthcare professionals do not necessarily have sufficient knowledge of design or IT technology either.

The teams who are working with usability and user interfaces should be composed of a multiprofessional working group incorporating healthcare professionals, designers, and technologists. One of the most important milestones for working with system usability is to prepare common requirements for system usability.

There are, however, some challenges like high dependencies on contexts, different roles and user preferences. Those require a thorough understanding of the task that should be supported. In addition, the usability features and the user interface are often system specific. Therefore, it is important that teams who will work with system usability and user interface spend adequate time together to create supportive collaboration between all participants in the initial phase of the work. The team should also spend time on a good system design that combines clinical, cognitive, and clinical workflow needs.

e-Health standards’ effects on usability

As mentioned earlier, it is challenging if data entry must be duplicated or repeated. It is frustrating for healthcare professionals in an already busy work situation. Valuable patient time is wasted if same information elements must be re-entered in different data systems. It can also have a negative effect on patient treatment. E-Health standards aim to ensure data exchange between systems and reduce duplicate data entry. The national infrastructures are also helpful in ensuring data is retrievable and accessible using common e-health standards. The repeated collection of data for secondary use should (as far as possible) be incorporated as a part of primary data entry, instead of being an act of separate data collection.

One of the challenges is that the code systems are reflected in user interfaces with poor usability for data entry. The solution can be to use “smart search”, based on commonly agreed metadata (e.g., automatically performing keyword searches for related word and synonyms of the original query), supported by standard terminologies, synonyms, and standardized use of terminology services.

Rigid information structures with many mandatory elements are also challenging for usability. One solution can be to separate mandatory information elements from optional ones in specifications, including in implementation guidelines of e-Health standards. It is also possible to design flexible user interfaces and mappings between vocabularies which may improve usability and flexibility in data entry, instead of forcing the user to use only one coding system.

e-Health standards’ effect on user know-how and motivation

The challenge is that there are varying levels of professional documentation and data entry, misunderstandings, and use of abbreviations in data entry. Healthcare professionals’ needs and requirements should always be viewed as a starting point in the specifications and implementation guides of e-Health standards. The guidelines for professionals for data entry are needed. A common professional education, with a focus on increasing the knowledge about benefits of e-Health standards, of everyone who participates in the work. In addition, collaboration with healthcare professionals by arranging network meetings and e-forums may be considered. Economic rewards for high-quality data entry can also be considered as a part of healthcare professionals’ salaries.

Increasing the knowledge about e-Health standards can contribute to increased motivation among healthcare professionals.

e-Health standards’ effect in information systems and applications

User interfaces are unfortunately sometimes perceived as clumsy and counterintuitive. Good user interfaces and high-quality data are a competitive advantage for systems. Features of systems should be developed to encourage high-quality data entry. An example would be in-built reminders or proposing the right codes based on synonyms. Systems can access data and vocabularies through standards-based interfaces. It is advantageous if the features of systems reward immediately for high-quality data entry (decision support, comparison with similar patient cases). These features can be considered in addition to speech recognition or natural language processing. As an example, the identification of SNOMED CT terms from transcribed text or mapping to codes for symptoms and diagnoses could be helpful.

Data quality

Technical and conceptual quality of data contributes to the practical quality and usefulness of data. E-Health standards contribute to data capture, storage and sharing, as well as data quality across the entire life cycle of data.

E-Health standards’ effect on data quality

Interoperability e-Health standards are a key prerequisite to the availability of data from multiple sources, across systems and organizations. This is a prerequisite for both primary and secondary use of information. It also enables data quality properties such as completeness, accuracy, timeliness, consistency, and reliability.

Completeness:

In-care activities and service provision (primary use), availability of patient-level data through interoperability e-Health standards are an enabler for improved completeness of patient data for clinical decision making. E-Health standards must be used to relieve challenges related to unavailable or incomplete data.
In secondary use such as health services management, public health surveillance and research, availability of data through interoperability e-Health standards promote completeness across populations, organizations, and systems.

Accuracy:

Structured data as well as well-defined code systems and terminologies are used for accurate representation of semantic meaning of data. This contributes to correct interpretation of data in clinical care decisions by professionals and reliable automated decision support, including artificial intelligence.
Coherent semantic e-Health standards used across different organizations and populations provide accuracy which supports comparability and consistency for decision making or research.
Interoperability e-Health standards promote validation of data and testing of solutions in relation to desired quality level of data and gradual improvement of key elements.

Timeliness:

e-Health standards for interoperability are utilized to support timely availability of relevant data for care decisions. Timely availability of patient-specific historical and status data promotes high-quality care and patient safety.
Availability of timely information for secondary use, e.g., management of health services makes it possible to make decisions based on up-to-date understanding of current situation regarding needs of patients and situation in service provision.

Consistency:

Consistency of data enforced by e-Health standards for interoperability across individuals and systems enables clinical decision support and population-level recommendations in care of individual patients.
In secondary use, consistency of data through e-Health standards enable comparability of data across time and across organizations. This is crucial in understanding the trends in population health and service provision which are needed for policy and resource decisions.

Reliability:

E-Health standards promote uniform and accurate data capture which together with timely availability provide basis for reliable information which directly affects the quality and safety of patient care. E-Health standards also support traceability of data across its life cycle which is needed for assessment of reliability of data.
In health care management and research, reliable information about patient needs, resource utilization and operational performance supports effective resource allocation, development of appropriate policies and procedures, identification of areas for improvement, and development of effective interventions and treatments.