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Towards a Conceptual Framework for Persistent Nova Southeastern University NSUWorks CEC Theses and Dissertations College of Engineering and Computing 2017 Towards a Conceptual Framework for Persistent Use: A Technical Plan to Achieve Semantic Interoperability within Electronic Health Record Systems Shellon Blackman-Lees Nova Southeastern University, [email protected] This document is a product of extensive research conducted at the Nova Southeastern University College of Engineering and Computing. For more information on research and degree programs at the NSU College of Engineering and Computing, please click here. Follow this and additional works at: https://nsuworks.nova.edu/gscis_etd Part of the Computer Sciences Commons Share Feedback About This Item NSUWorks Citation Shellon Blackman-Lees. 2017. Towards a Conceptual Framework for Persistent Use: A Technical Plan to Achieve Semantic Interoperability within Electronic Health Record Systems. Doctoral dissertation. Nova Southeastern University. Retrieved from NSUWorks, College of Engineering and Computing. (998) https://nsuworks.nova.edu/gscis_etd/998. This Dissertation is brought to you by the College of Engineering and Computing at NSUWorks. It has been accepted for inclusion in CEC Theses and Dissertations by an authorized administrator of NSUWorks. For more information, please contact [email protected]. Towards a Conceptual Framework for Persistent Use: A Technical Plan to Achieve Semantic Interoperability within Electronic Health Record Systems By Shellon M. Blackman-Lees A dissertation report submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Computer Information Systems College of Engineering and Computing Nova Southeastern University 2017 An Abstract of a Dissertation Submitted to Nova Southeastern University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Towards a Conceptual Framework for Persistent Use: A Technical Plan to Achieve Semantic Interoperability within Electronic Health Record Systems by Shellon M. Blackman-Lees March 2017 Semantic interoperability within the health care sector requires that patient data be fully available and shared without ambiguity across participating health facilities. The need for the current research was based on federal stipulations that required health facilities provide complete and optimal care to patients by allowing full access to their health records. The ongoing discussions to achieve interoperability within the health care industry continue to emphasize the need for healthcare facilities to successfully adopt and implement Electronic Health Record (EHR) systems. Reluctance by the healthcare industry to implement these EHRs for the purpose of achieving interoperability has led to the current research problem where it was determined that there is no existing single data standardization structure that can effectively share and interpret patient data within heterogeneous systems. The current research used the design science research methodology (DSRM) to design and develop a master data standardization and translation (MDST) model that allowed seamless exchange of healthcare data among multiple facilities. To achieve interoperability through a common data standardization structure, where multiple independent data models can coexist, the translation mechanism incorporated the use of the Resource Description Framework (RDF). Using RDF, a universal exchange language, allowed for multiple data models and vocabularies to be easily combined and interrelated within a single environment thereby reducing data definition ambiguity. Based on the results from the research, key functional capabilities to effectively map and translate health data were documented. The research solution addressed two primary issues that impact semantic interoperability – the need for a centralized standards repository and a framework that effectively maps and translates data between various EHRs and vocabularies. Thus, health professionals have a single interpretation of health data across multiple facilities which ensures the integrity and validity of patient care. The research contributed to the field of design science development through the advancements of the underlying theories, phases, and frameworks used in the design and development of data translation models. While the current research focused on the development of a single, common information model, further research opportunities and recommendations could include investigations into the implementation of these types of artifacts within a single environment at a multi-facility hospital entity. Acknowledgements The completion of this dissertation signals the end of a long and arduous journey filled with tireless dedication, determination, and hard work. This dissertation also marks a significant milestone in my life, education, and career. Throughout this journey, I was privileged to be guided, supported, and encouraged by a remarkable team of knowledgeable and dedicated stalwarts. I stand in awe at their patience, commitment, knowledge, and words of encouragement that they have provided along the way. I would like to express my profound gratitude to Dr. Timothy Ellis, professor at Nova Southeastern University and my Dissertation Committee Chair for accepting the task of guiding me through the process. Dr. Ellis was extremely supportive while providing timely feedback and words of encouragement. Thanks also to my dissertation committee members, Dr. Maxine Cohen and Dr. Francisco Mitropoulos who were part of the supporting team, providing tough critiques whenever necessary. They were instrumental in ensuring that my work was valid and met the expectations of the university. From the bottom of my heart, I salute you. I sincerely thank you. Many family members and friends played a supportive role during this time. I am especially indebted to my late grandmother – Betty, my mom – Brenda, my sisters – Shaundelle and Alta, my nieces – Charissa, Krystel, and Allyssa, my nephews – Wayne, Caleb, and Kayden, and my aunts – Gwennett and Marcia, for their love, patience, and support. To my wonderful cousins, Natasha and Joscelyn, who never allowed me to quit on those tough days. Thank you for the encouraging text messages, telephone calls, and prayerful thoughts. A great deal of credit must also go to my friends Marcos, Joe, Michael, and Denia for their encouragement as well. I could not have done this without you. You Rock! This accomplishment was also made possible by the love and support of my wonderful family. To my darling husband, Lawrence, who supported me over the years in all that I set out to achieve, ensuring that our home remained intact and our children properly cared for. To our beautiful daughters, Kirsten and Asanda, who have made the ultimate sacrifice, giving me the time I needed to complete my dissertation. I love you endlessly. Finally, I give God thanks and praise for providing me with sufficient grace and strength to reach this goal. He has kept me steadfast, lifted me up, and taught me the lessons of humility through this journey. In all things, I give Him thanks! Table of Contents Abstract iii List of Tables viii List of Figures ix Chapters 1. Introduction 1 Introduction 1 Problem Statement 3 Dissertation Goal 7 Research Questions 8 Relevance and Significance 8 Barriers and Issues 10 Data Volume 10 Introduction of New Values 11 Data Standard Mapping 11 Availability of Subject Matter Experts 12 Patient Data Subjectivity 12 Product Testing Bias 13 Hardware and Software Costs 13 Barriers Related to the Access of Data Terminology Repository 13 Assumptions, Limitations, and Delimitations 14 Definitions of Terms 15 Summary 18 2. Review of Literature 20 Introduction 20 Foundation of Semantic Interoperability 21 Semantic Interoperability Chronology 23 Data Standardization 28 Process/Workflow Standardization 37 Technological Optimization and Modification 44 Current EHR Solution Implementation 49 Comparison with Proposed System 54 Summary 55 3. Research Methodology 57 Introduction 57 Research Implementation Framework 59 Step 1: Problem Identification and Motivation 59 Step 2: Objectives of the Solution 60 Step 3: Design and Development 67 v Step 4: Demonstration 71 Step 5: Evaluation 72 Step 6: Communication 72 Resources 73 Summary 74 4. Results 75 Introduction 75 Data Analysis and Findings 76 Expert Selection Process 76 Research Specification Determination and Validation 78 Research Design and Development 86 Phase One: Requirements and Analysis 87 Phase Two: Design 93 Phase Two: Development 105 XDataRDF Unit Test 111 Phase Three: Evaluation 115 Phase Four: Demonstration 117 Summary of Results 118 5. Conclusions, Implications, Recommendations, and Summary 120 Introduction 120 Conclusion 121 Strengths of the Research 122 Weaknesses of the Research 123 Limitations of the Research 124 Implications 124 Practical Applications of the Research Findings 124 Contributions to IS Body of Knowledge 125 Implications for Future Research 126 Recommendations 127 Summary 128 Appendices 135 A. Permission to Use W3C RDF Specification Definitions 136 B. Permission to Use DSRM Model 138 C. DSRM Process Model 140 D. Expert Panel Email Invitation 141 E. Head of Department Email Recommendation Letter 142 F. Expert Peer Recommendation Letter 143 G. Thank You/Introductory Email to Expert Panel 144 H. Requirement Specification Guide 145 I. Informed Consent Letter 147 J. Prototype Development Test Plan 150 K. Prototype Demonstration Invitation 152 vi L. Prototype Design Review Guide
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