Abstract
Background Secondary use of electronic health record (EHR) data can reduce costs of research
and quality reporting. However, EHR data must be consistent within and across organizations.
Flowsheet data provide a rich source of interprofessional data and represents a high
volume of documentation; however, content is not standardized. Health care organizations
design and implement customized content for different care areas creating duplicative
data that is noncomparable. In a prior study, 10 information models (IMs) were derived
from an EHR that included 2.4 million patients. There was a need to evaluate the generalizability
of the models across organizations. The pain IM was selected for evaluation and refinement
because pain is a commonly occurring problem associated with high costs for pain management.
Objective The purpose of our study was to validate and further refine a pain IM from EHR flowsheet
data that standardizes pain concepts, definitions, and associated value sets for assessments,
goals, interventions, and outcomes.
Methods A retrospective observational study was conducted using an iterative consensus-based
approach to map, analyze, and evaluate data from 10 organizations.
Results The aggregated metadata from the EHRs of 8 large health care organizations and the
design build in 2 additional organizations represented flowsheet data from 6.6 million
patients, 27 million encounters, and 683 million observations. The final pain IM has
30 concepts, 4 panels (classes), and 396 value set items. Results are built on Logical
Observation Identifiers Names and Codes (LOINC) pain assessment terms and extend the
need for additional terms to support interoperability.
Conclusion The resulting pain IM is a consensus model based on actual EHR documentation in the
participating health systems. The IM captures the most important concepts related
to pain.
Keywords
pain management - nursing informatics - electronic health records and systems - knowledge
modeling and representation - secondary use - efficiency improvement
