Electronic antenatal health care records – potentials for structured representation with openEHR archetypes and templates: A qualitative case study
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The primary intention of this work is to provide a starting point for a realisation of an electronic antenatal health record in Norway. Furthermore, the ambition was to conduction an evaluation into the potential for using archetypes for representation of structured clinical information in antenatal health care in Norway. Focus of work has been to investigate former projects in electronic solutions for antenatal health records, to gain knowledge of earlier practical experiences regarding development of archetypes and finally how lessons learnt in both can be applicable and utilised in the development of an electronic antenatal health care record in Norway. To answer these questions a qualitative case study has been performed including a literature review and interviews with informants acting within antenatal health care. As a proof-of-concept for direct reuse of formerly developed archetypes, candidate archetypes have been translated and a template has been designed. In addition all candidate archetypes have been evaluated as to clinical content coverage as regards Norwegian requirements, as well as thoroughly assessed utilising published Archetype Quality Requirements. Through this qualitative case study I have learnt the importance of involving all stakeholders as early as possible in development projects in general as in archetype development specifically. It is also important to sustain stakeholder involvement throughout the development cycle to ensure that the interests of all stakeholders are met. The in-depth validation of clinical content in candidate archetypes shows that Norwegian requirements for clinical content in antenatal health care records are met. Furthermore, the in depth validation of the quality of archetypes has resulted in significant findings for Norwegian stakeholders in antenatal health care; a thorough investigation and clarification process regarding intended use of an electronic antenatal health care record has to be initiated and concluded before development activities can commence. The need for stakeholder inclusion in a development project is also identified for antenatal health records. The identification of clinical content provided by the present project can be seen as a first step in the development of a Norwegian antenatal health record. There has also been identified significant findings regarding how translation of archetypes can be facilitated; by establishing a demonstration archetype including most commonly utilised terms in archetypes, in order to secure consistent translations with good quality in all archetypes. Finally, the in-depth evaluation regarding the metadata quality in archetypes has provided significant results with proposals for additions, specifications and needed alterations of the Archetype Quality Requirements that are published by Kalra et al (2012). To my knowledge, no other project has utilised and thoroughly evaluated these quality requirements.