Design of a Decision Support System for an Electronic Medical Record System

Abstract

The intent of the internship was to attempt the design and implementation of a Decision Support System (DSS) in support of the Primary Healthcare Information Management (PHIM) program, an initiative within the Nova Scotia Department of Health and Wellness. The PHIM program supports the deployment of an Electronic Medical Record (EMR) system to primary healthcare practitioners throughout the province of Nova Scotia. The EMR system is used to capture information that is related to patient encounters with primary healthcare providers and community based specialists. The EMR data store represents a rich source of primary healthcare data that is sought after by many healthcare stakeholder groups across the province. The primary goal of the internship was to attempt to design and implement a DSS using primary healthcare data extracted from the PHIM. Implementation of the DSS would facilitate improved access to primary healthcare data which would provide unique opportunities to improve efficiency and decision-making in a wide range of areas including public and population health (eg chronic disease monitoring), clinical research, resource utilization and public health planning. This internship was completed in co-ordination with Concertia Technologies Inc (Concertia), which was contracted by the Nova Scotia Department of Health and Wellness to design and implement the DSS for the PHIM program. All work was completed within the offices of Concertia in Halifax, Nova Scotia. The author was responsible for completing the following tasks: 1. Understanding the business requirements of the PHIM program as they pertained to primary care reporting requirements 2. Reverse engineering of the internal data structures of the Nightingale EMR data store 3. Development of a data mapping document 4. Completion of a high-level technical design for a DSS Masters of Health Informatics Internship Report Dalhousie University 4 5. Implementation of some or all of the DSS The design and implementation of the DSS was only partially completed during the course of internship engagement due to unforeseen constraints beyond the control of the author and the project team. Specifically, the project team was not able to gain access to the EMR production database or a representative thereof, which prevented the author from performing a definitive data analysis, validation of the design of the Change Data Capture (CDC) mechanism and stress test of the proposed DSS schema design. As a result, the internship was limited to the design and partial implementation of the Primary Operational Decision Support System (PODSS) and to research into the approach for de-identification of patient data for eventual transfer to the Health System Decision Support System (HSDSS). Upon completion of the internship, the student was able to gain knowledge and experience in the following areas of health informatics: 1. Electronic Medical Record systems. 2. Data Warehouse Design (Normalized versus Dimensional). 3. Data anonymization.