Prescriptive Grammar for Clinical Prescribing Workflow

Prescriptive Grammar for Clinical Prescribing Workflow

Kalle Kauranen (Lakehead University, Thunder Bay, Canada), Arnold Kim (Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada) and Phillip Osial (Lakehead University, Thunder Bay, Canada)
DOI: 10.4018/IJEACH.2019010109
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Health information technology is being increasingly introduced into the healthcare environment with its benefits of providing safer and more effective practices. However, the new solutions are brought in issues of implementing them with existing clinical workflows and presents a variety of solutions that do not work well together. For healthcare professionals that want total control over their work, existing solutions can appear rigid and inflexible for their needs. Other solutions can also appear cumbersome as they take user experience for granted with their focus on ease of access. This research presents a prescriptive grammar for prescribing of medications which address the problems of fractured clinical workflow and rigid design of current prescribing tools. The author's solution uses a fully validated Parser Combinator Grammar with an Integrated Development Environment for the construction of prescriptions that once completed, are entered into an electronic health record using the HL7 standard.
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The increasingly high cost of healthcare has cast a spotlight on hospital inefficiencies (Born & Levinson, 2017; MacMillan, Slessarev, & Etchells, 2016), and a search for solutions to allow for the efficient use of hospital resources. Inefficiencies in healthcare settings can lead to a variety of problems including patient safety concerns, wasted resources, and long wait times. To combat these problems, a renewed interest in researching clinical workflow has taken hold. A workflow is defined as an ordered procedure of tasks followed by an individual in an environment (Brixey, Robinson, Turley, & Zhang, 2010). Examining a prescription with this definition, the researchers can observe that a medication prescription is a workflow. A prescription is a set of instructions for in this case a patient and a pharmacist to follow. When analyzing current clinical prescribing workflows in place, there can be observed that there are many existing problems and routes to optimize current routines. Current clinical prescribing workflows involve a variety of paper and digital solutions fractured by being spread across a variety of programs and documents. These environments are still using a variety of paper and electronic methods for storing patient information despite the clear benefits of moving to entirely computerized implementations. Research into the effects of Health Information Technology (HIT) on the current workflow shows that much of the time is spent on redundant data entry tasks (MacMillan, Slessarev, & Etchells, 2016).

This research attempts to model a clinical prescribing workflow to a textual Domain Specific Language (DSL). The researcher’s Parser Combinator Grammar (PCG) will use direct and indirect mapping of medical concepts to the researcher's syntax as shown in Figure 1. The grammar, along with the authors Integrated Development Environment (IDE) will allow for the creation of prescriptions while maintaining the Electronic Health Record (EHR). The researcher's solution will look to implement itself in the existing workflow as in Figure 2.

Figure 1.

Mapping of medication concepts

Figure 2.

Prescribing workflow


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