Julius--a template based supplementary electronic health record system

Introduction: Different proprietary information models and inconsistent data quality from electronic health record solutions in Stockhom led the authors to develop a “template-EHR solution.” Clinicians enter there own predefined terminologies (data types and semantic links) in a template graphical user interface web service compatible with existing EHR solutions. Objective: To resolve inconsistent clinical data acquisition and quality from local EHR solutions in Stockhom Sweden. Methods: Design Considerations: Medical terminologies are required to be entered (data types, names/labels, conceptual definitions) by clinicians interested in creating a template; this requires specialized knowledge of the reference terminologies. Design considerations also require that clinicians have expertise in the medical domain sufficient for re-use of templates. System Description: The template based supplementary EHR system is comprised of three subsystems: 1) a system where terminologies are defined [“Concept Data Service”]; 2) a system where the user interface (layout) for new templates is determined (“Template Data Service”) - by grouping desired variables; and 3) a system for making web forms (for data entry) from a template created from the Template Data Service. Results: A Julius system template with 50 data variables was used in a pilot study. 250 patients’ data were recorded. The authors report positive feedback from clinicians. The reason cited for this feedback is that Julius “empowers them in deciding what and how the clinical information should be collected.” Comments: This is certainly not a turn-key solution. Successful integration of Julius into the Swedestar EHR solution system during a pilot study may not translate to the other EHR solutions in other countries. Template construction and integration of a web based service into arbitrary EHR systems remains a primary obstacle for Julius. As clinical user groups are required to author complex variable definitions for each new template (each new *experiment*), a prohibitively high degree of technical expertise may be required to obtain new research data from new templates. Also, it remains unclear how the authors intend to avoid duplicating data already in local EHR systems.