Julius – a template based supplementary electronic health record system

We have designed and developed a template based system (called Julius) that was integrated with existing EHR systems. The system is driven by the medical domain knowledge defined by clinicians in the form of templates and variable definitions stored in a common data repository. The system architecture consists of three layers. The presentation layer is purely web-based, which facilitates integration with existing EHR products. The domain layer consists of the template design system, a variable/clinical concept definition system, the transformation and validation logic all implemented in Java. The data source layer utilizes an object relational mapping tool and a relational database.The Julius system has been implemented, tested and deployed to three health care units in Stockholm, Sweden. The initial responses from the pilot users were positive. The template system facilitates patient data collection in many ways. The experience of using the template system suggests that enabling the clinicians to be in control of the system, is a good way to add supplementary functionality to the present EHR systems.The approach of the template system in combination with various local EHR systems can facilitate the sharing and reuse of validated clinical information from different health care units. However, future system developments for these purposes should consider using the openEHR/CEN models with shareable archetypes.Electronic health record (EHR) systems are widely used in hospitals and primary care centres in the Stockholm County Council. Essentially all primary care records and recently almost all hospital medical records are stored electronically in this region. However, within the region there are over twenty-five different EHR systems in use.Since different vendors are using both different proprietary information models and different terminologies when recording the (clinical) data, it's nearly impossible to collect consistent and validated data into centralized databas