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Towards a rule-based support system for the coding of health conditions in the Patient Summary

In the frame of federated and interoperable Electronic Health Rec-ords (EHRs), specific coding systems are mandatory for filling out healthcare documents such as the Patient Summary (PS). PS cannot be automatically gen-erated from the patient’s EHR data, because of the sensitivity of its content. For this reason it needs to be validated by a General Practitioner (GP), who is the sole responsible of this document. The literature shows that the practice of cod-ing is recognized as a difficult task for GPs and it often generates coding errors and misspecifications of clinical data. To overcome this issue, a support system based on standardized and formalized coding rules for the domain of applica-tion is proposed, to facilitate a more accurate coding process without breaking the law.

International Workshop on Biomedical Data Mining, Modeling, and Semantic Integration: A Promising Approach to Solving Unmet Medical Needs (BDM2I 2015) joint with ISWC 2015, Bethlehem, Pennsylvania (USA), 2015

Autori IIT:

Tipo: Articolo in Atti di convegno internazionale con referee
Area di disciplina: Information Technology and Communication Systems

Attività: Interventi a supporto della realizzazione del fascicolo sanitario elettronico