Daily Archives: April 18, 2017

The Argonaut Project

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The Argonaut project is a project by private vendors to create a FHIR API and data services specification to facilitate interoperability for health information technology. There is a page on the HL7 FHIR wiki (FHIR, Argonaut Project, 2017).

FHIR Basics

Fast Healthcare Interoperability Resources (FHIR) describes a set of standards that facilitate the transfer of healthcare information between electronic healthcare systems. The video above is from the QVera clips YouTube channel. FHIR has been developed by HL7.

HL7 have produce a Wiki on FHIR which provides a very helpful overview of the values associated with FHIR (FHIR, Principles, 2017). From this Wiki (at the time of writing) these include but are not limited to

  • Applications should be useful for 80% of scenarios and extensions can be used for the remaining 20% of scenarios
  • FHIR emphasises flexibility over tight specifications
  • FHIR utilises open source development principles
  • FHIR should be free to use
  • FHIR is backward and forward compatible
  • Use of web tools
  • FHIR is designed for use across a large variety of environments

FHIR Overview for Clinicians

There is a useful overview of FIHR for clinicians which provides a non-technical overview (FHIR Overview Clinicians, 2017). This overview explains the terminology of FIHR. The FIHR ‘mindset’ involves thinking about electronic patient records in a very different way from paper based records. The section on REST simplifies the basic processes that are involved in managing records in an electronic patient record (EPR) system and more specifically with the FIHR specifications. The RESTful API utilises a specific set of transactions for accessing data such as reading and updating a record.

What is an API?

API stands for Application Programming Interface. An API can be thought of as the providing the building blocks for creating a software program. These include protocols and code and make it easier for the programmer to develop a program.

HL7

HL7 is described in the NHS interoperability handbook as applying to the Interoperability Framework. HL7 is an organisation that develops a framework and standards for interoperability of health information systems. Their website can be found here and the organisation also has a well established social media presence.

Patient Records

Patient records are central to the delivery of healthcare and serve a number of functions including the recording of clinical assessments and interventions. Aggregated data is also utilised at a local and national level to inform commissioning.

Electronic Patient Records

The digitisation of patient records offers a number of advantages over paper based records. These advantages include automated backup of records, reduced use of physical storage space (since paper based notes are switched to servers), off-site access to records using mobile devices and the potential to develop analytical clinical support tools which use computers to process clinical data to help improve clinical decisions. Not all healthcare services have electronic patient records but most providers are moving in this direction.

Getting Electronic Patient Records to Talk to Each Other

When patients move between healthcare providers – for instance between primary care and the hospital – they may find that one provider does not have information that the other provider has. There are many providers and many electronic paper record systems. For two systems to talk to each other they have to solve a number of problems. When these problems are solved a patient can move between providers and healthcare information can be accessed by the different providers. A key solution to this problem of health information gaps is the Health Information Exchange (HIE).

The Health Information Exchange

There are many definitions of what a Health Information Exchange is. (Hersh et al, 2015) define a HIE as follows:

Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations’

Whilst this definition is simple, the process of sharing clinical information between healthcare organisations is technically complex and encompasses a range of software, hardware and governance issues. The process of helping systems to talk to each other is helped by the development of standards. A set of standards is outlined in the NHS interoperability framework.

The Interoperability Framework

A digital copy of the Interoperability Handbook can be found at the NHS England website (NHS England, 2017). The handbook explains how an interoperability framework can support an interoperability strategy. The Interoperability Framework has three layers – a governance layer, an exchange layer and an interpretation layer.

The Standards Applicable to the Interoperability Framework

Appendix A in the Interoperability Handbook shows how various standards map onto the Interoperability Framework (NHS England, 2017).

Citations

https://www.england.nhs.uk/digitaltechnology/info-revolution/interoperability/, accessed 8.4.17

(FHIR Principles, 2017). http://wiki.hl7.org/index.php?title=Fundamental_Principles_of_FHIR, accessed 17th April 2017.

(FHIR Overview Clinicians, 2017). https://www.hl7.org/fhir/overview-clinical.html, accessed 16th April 2017.

(FHIR, Argonaut Project, 2017). http://argonautwiki.hl7.org/index.php?title=Main_Page

There is also an NHS Digital Twitter account here.

Links to Other Posts in the Health Information Exchange Series

General Posts to Date on Health Information Exchanges

Posts on Examples of Health Information Exchanges

SNOMED CT®/ICD Mapping and Harmonisation Posts

SNOMED CT® Posts

ICD 1-10 Posts

ICD-11 Posts

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section

The Brain Hypometabolism Hypothesis Part 45: Primary Brain Injury in Hypoxia

Model Brain

In Sekhon, Ainslie and Griesdale’s model they discuss primary and secondary brain injury following a cardiac arrest. Looking more closely at the primary brain injury they state that with a reduction in cerebral oxygen ATP production decreases and there is a switch to anaerobic respiration. This in turn leads to a reduction in ATP dependent ion channel action. There are three main effects

  1. Accumulation of Na+ ions
  2. Accumulation of lactate with acidosis
  3. An influx of Calcium ions into the cells

 Hypoxic Ischaemic Brain Injury

Sekhon, Ainslie and Griesdale have written an open access article on hypoxic ischaemic brain injury titled “Clinical Pathophysiology of Hypoxic Ischemic Brain Injury after Cardiac Arrest:A “two-hit” Model“. This paper can be used as a starting point for discussion of the events that lead to brain injury following hypoxia. This in turn is relevant to the question of energy usage in the Brain Hypometabolism Hypothesis.

Sekhon, Ainslie and Griesdale posit a simple two stage model of brain injury following cardiac arrest in which injury results from

  1. Primary cerebral hypoxia
  2. Secondary mechanisms after return of cerebral perfusion

What is the Brain Hypometabolism Hypothesis?

The Brain Hypometabolism Hypothesis broadly states that

Hypometabolism in the brain leads to neuropathology

Human_Metabolism_-_Pathways

Human Metabolism by Frozen Man (CC BY 4.0)

What is Metabolism?

Metabolism can be defined as the chemical processes that occur in living organisms. There are three types of metabolic processes

(a) Generation of energy

(b) Generation of basic chemicals including fatty acids, amino acids and sugars

(c) Elimination of Nitrogen waste products

Restating the Brain Hypometabolism Hypothesis

The Brain Hypometabolism Hypothesis focuses on energy metabolism. More specifically the hypothesis states that

Energy hypometabolism in the brain leads to neuropathology

Glycolysis

Glycolysis by Dr Thomas Shafee (CC BY 4.0)

Glycolysis

Glycolysis is one of the key pathways for energy metabolism in the human body. In this metabolic pathway the molecule Glucose is converted into Pyruvate. This pathway generates energy in the form of ATP. This pathway however does not use oxygen although the products generated are metabolised using oxygen. This is relevant to the bigger picture of energy metabolism in the brain.

Citations

Sekhon MS, Ainslie PN, Griesdale DE. Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a “two-hit” model. Crit Care. 2017 Apr 13;21(1):90. doi: 10.1186/s13054-017-1670-9.

Thorens B, Mueckler M. Glucose transporters in the 21st Century. American Journal of Physiology – Endocrinology and Metabolism. 2010;298(2):E141-E145. doi:10.1152/ajpendo.00712.2009.

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About sections.jpg”