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AMIA Annu Symp Proc. 2005; 2005: 1066.
PMCID: PMC1560813
Smart Forms: Building Condition-Specific Documentation and Decision Support Tools for Ambulatory EHR
Maya Olsha-Yehiav,a Matvey B. Palchuk, MD, MS,a Frank Y. Chang,a David P. Taylor, MS,a Jeffrey L. Schnipper, MD, MPH,b Jeffrey A. Linder, MD, MPH,b Qi Li, MD, MBA,a and Blackford Middleton, MD, MPH, MScab
a Clinical Informatics Research and Development, Partners HealthCare, Boston, MA
b Division of General Medicine, Brigham and Women’s Hospital, Boston, MA
Abstract
Smart Forms are condition-specific documentation tools that integrate pertinent data review, guideline-based decision support, ambulatory order entry, patient education and coded data capture capabilities. Smart Forms are being developed as Web applications in a service oriented architecture and employ a rules engine for dynamic content generation.
Smart Forms are applications designed to consolidate data review, decision support and documentation requirements for particular medical conditions into an easy to use tool. We have designed them to fit into providers’ workflow before, during, or after a patient visit. Smart Forms are Web applications that closely integrate with an ambulatory electronic health record (EHR) system. The goals of Smart Forms are to improve documentation, patient safety, and quality of care by incorporating clinical decision support into workflow. Each condition-specific Smart Form displays pertinent data in an aggregated and easy to use fashion. Clinical decision support promotes adherence to clinical guidelines. Recommended orders can be entered or patient handouts easily accessed. Smart Forms create a documentation trail and improve coded data capture for use in quality dashboards.
Background
Partners HealthCare System is a recognized leader in developing and implementing integrated EHR solutions for delivery of care. The Longitudinal Medical Record (LMR) – the ambulatory EHR used across the Partners network – captures a variety of structured clinical data, and utilizes tools such as charting, results management, referral management, and order entry. Smart Forms are being built to seamlessly integrate into Partners’ systems by relying on LMR as well as other enterprise data sources.
Smart Forms face twin integration challenges: to consolidate rules engine output and data from multiple sources into a single view, and to be perceived by users as a seamless extension of the LMR. The architectural and technical approaches to meet these challenges are presented.
Service Oriented Architecture
Smart Form data requirements are satisfied via a series of Web services made available by various sources of clinical information at Partners. Data from services are consumed to dynamically generate individual Form elements. Data generated by Form users flows back into repositories also by way of services. Using existing services allows for high degree of reusability, faster development and seamless integration.
Data Access Layer
The data access layer normalizes various data types into a common format. When considering encapsulation of data from different sources, such an intermediate layer is necessary to capture data, convert them to a standard representation, and aggregate for ease of use.
Pertinent Patient Data
Access to disparate data is required to manage a particular condition. Vital signs, lab results, medication lists, etc. are presented. Users are able to review as well as enter relevant data.
Decision Support
A rules engine (an example of artificial intelligence technology) allows for externalization of knowledge resources and provides the user with a set of evidence-based, context-specific recommendations that are generated at run time and can be acted upon.
Documentation
Interactive Form components allow for flexible capture of coded data. Smart Form output can then be integrated into a structured or unstructured encounter note.
Technical Considerations
As a standard Web application, the Smart Form code is easy to maintain and reuse. All aspects of the Smart Form are dynamically driven by Extensible Markup Language (XML) and the Extensible Stylesheet Language Transformation (XSLT) technologies.
Conclusion
Smart Forms are complex clinical tools that encapsulate a variety of data presentation and capture methods as well as run time decision support. They integrate seamlessly into an existing environment by taking advantage of industry standard approaches to building Web applications. Relying on data services and utilizing XML/XSLT technologies results in a flexible, easy to maintain, efficient set of tools.
Articles from AMIA Annual Symposium Proceedings are provided here courtesy of
American Medical Informatics Association