The Electronic Discharge Letter Mobile App

Clinical handovers, and in particular discharge letters, are very important issues to consider when ensuring the continuity of patient care. The fact that the patient itself frequently acts as the carrier of his/her discharge information between hospitals and general practitioners, combined to the absence of a widely adopted standard to guarantee the semantic interoperability in such exchange,make discharge letters a breakpoint in the clinical information workflow that must be addressed. The lack of homogeneity between healthcare information systems regarding the syntaxes and semantics of clinical information artifacts such as electronic health records, clinical terminologies, ontologies, etc., is especially notorious in the discharge stage of patient care. Given the increasing popularity of mobile devices as part of the everyday life of European societies, the objective of the present research is to encourage further standardization of discharge letters by replacing the traditional handwritten or printed letter by an electronic version (eDL) exchanged between mobile devices. A completely seamless exchanged is of the eDL is technically supported by Near Field Communication (NFC) standards. In contrast to Bluetooth or any kind of messaging application through Internet such as email, NFC does not require the devices to pair before communicating nor sender and receiver addresses to be defined. The only requirement is maximum distance of 4cm between devices. As well as semantic interoperability is being reached between EHR systems, this “eDL app” enables the same goal to be addressed during eDLs exchange by means of clinical terminologies that accurately define diseases, diagnosis, etc. and enabling the integration of an eDL standard that is yet to be agreed. The eDL app removes the rest of traditional interoperability obstacles such as handwritten text, unstructured information, paper based letters, etc. Also, the app encourages the continuity of care from patient’ s perspective by automatically scheduling appointments and medications, based on the prescriptions and follow-up information digitally contained in the eDL. In addition to bridging the communication gap between primary and secondary care and the advantages of eDLs pointed out above, the eDL app provides a semantic enrichment feature that offers descriptions of the clinical concepts contained in the eDL in order to improve the patient understandability of the diagnose. Also, greater data security than paper based discharge letters can be provided (electronic signature). Due to time constraints, teaching is usually not considered a primary goal of handover sessions, but a valuable by-product. With the increase of medical workforce shortages, increased teaching demands and doctor workloads, the eDL app integration may assist doctors to cope with service demands while meeting the educational goals of the handover process. In order to improve the app usability, as well as the feasibility of its integration in the handover workflow, 15 hospitals and healthcare organizations are being surveyed.