Standardizing Primary Healthcare referral datasets: Interviews, form-reviews, and FHIR profiling (Preprint)

BACKGROUND Referral linkages are crucial for efficient functioning of Primary Health Care (PHC) systems. Fast Healthcare Interoperability Resource (FHIR) is an open global standard that facilitates structuring health information for coordinated exchange amongst stakeholders. OBJECTIVE The objective of this study is to profile, present methodology and the profiled FHIR resource for Maternal and Child Health (MNCH) referral use case in a typical Low-and-Middle-Income-Country (LMIC). METHODS Practicing doctors, midwives, and nurses were interviewed, and different referral forms reviewed. In this study, we have introduced the FHIR and its relation to the WHO International Classification for Disease (ICD). The union of datasets were aggregated and mapped to base patient FHIR resource elements, and extensions were created for datasets not in the core FHIR specification. RESULTS We found that there were many different data elements from the referral forms and interview responses. The resulting FHIR standard profile is published on GitHub for adaptation or adoption as necessary. Understanding datasets used in healthcare and clinical practice for information sharing is crucial in properly standardizing information sharing particularly as the world manage COVID-19 and other infectious diseases. This methodology and profiled dataset can be used by development organizations, and governments to fast-track FHIR standards adoption for paper and electronic information sharing at PHCs in LMICs. CONCLUSIONS We presented our methodology for profiling the referral resource crucial for the standardized exchange of new and expectant moms’ information. Using data from frontline providers and mapped to the FHIR profile helped contextualize the standardized profile.

Improving Oral–Systemic Healthcare through the Interoperability of Electronic Medical and Dental Records: An Exploratory Study

Objectives Electronic health records (EHRs) are rarely shared among medical and dental providers. The purpose of this study was to assess current information sharing and the value of improved electronic information sharing among physicians and dentists in Germany and the United States. Materials and Methods A survey was validated and distributed electronically to physicians and dentists at four academic medical centers. Respondents were asked anonymously about EHR use and the medical and dental information most valuable to their practice. Results There were 118 responses, a response rate of 23.2%. The majority (63.9%) of respondents were dentists and the remainder were physicians. Most respondents (66.3%) rated the importance of sharing information an 8 or above on a 1-to-10 Likert scale. Dentists rated the importance of sharing clinical information significantly higher than physicians (p = 0.0033). Most (68.5%) providers could recall an instance when access to medical or dental information would have improved patient care. Dentists were significantly more likely to report this than physicians (p = 0.008). Conclusion Physicians would value a standardized measure of “oral health” in their EHR. Dentists were less likely to find specific medical diagnostic test results of value. Both dentists and physicians agreed that oral–systemic health was important; interoperable EHRs could facilitate information transfer between providers and enhance research on oral–systemic health connections. Both dentists and physicians believed that an interoperable EHR would be useful to practice, but desired information was different between these groups. Refinement of the information needed for shared practice is required.