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We present a model for architectural strategies and issues regarding health information exchange (HIE). This model is a continuum of options, between separated systems and a monolithic approach. We discuss characteristics, examples and potential impacts of each approach, based on generalized observations of practical implementations. The continuum model(More)
Several groups are currently working on defining detailed clinical models (also called templates or archetypes) that are refinements of abstract medical models like the HL7 (Health Level Seven) Reference Information Model. At IHC, we have created over 3,000 detailed clinical models in the last five years. These models have become an essential part of the(More)
Provision of query systems which are intuitive for non-experts has been recognized as an important informatics challenge. We developed a prototype of a flowchart-based analytical framework called RetroGuide that enables non-experts to formulate query tasks using a step-based, patient-centered paradigm inspired by workflow technology. We present results of(More)
Management of chronic disease is performed inadequately in the United States in spite of the availability of beneficial, effective therapies. Successful programs to manage patients with these diseases must overcome multiple challenges, including the recognized fragmentation and complexity of the healthcare system, misaligned incentives, a focus on acute(More)
OBJECTIVES To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture. METHODS After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well(More)
The rapid advance of gene sequencing technologies has produced an unprecedented rate of discovery of genome variation in humans. A growing number of authoritative clinical repositories archive gene variants and disease phenotypes, yet there are currently many more gene variants that lack clear annotation or disease association. To date, there has been very(More)
Intermountain Health Care has integrated the electronic medical record (EMR) with online information resources in order to create easy access to a knowledge base which practicing physicians can use at the point of care. When a user is reviewing problems/diagnosis, medications, or clinical laboratory test results, they can conveniently access a "pertinent(More)
We present a software architecture that federates data from multiple heterogeneous health informatics data sources owned by multiple organizations. The architecture builds upon state-of-the-art open-source Java and XML frameworks in innovative ways. It consists of (a) federated query engine, which manages federated queries and result set aggregation via a(More)
At Intermountain Health Care, we evaluated whether physicians in an ambulatory setting will voluntarily choose to enter data directly into an electronic health record (EHR). In this paper we describe the benefits of an EHR, as they exist in the current IHC application and the ways in which we have sought to minimize obstacles to physician data entry.(More)