Electronic Patient Record: dealing with numbers or with words? Christian Lovis, M.D. Health Services Research and Development Veterans Affairs, Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA christian.lovis@dim.hcuge.ch and Robert Baud, Ph.D. Division of Medical Informatics University Hospital of Geneva 21, Micheli-du-Crest, 1211 Geneva 4, Switzerland robert.baud@dim.hcuge.ch ABSTRACT The Electronic Patient Record (EPR) can be organized either on a document-based backbone, or on a structured database system. Both alternatives have been used in the world to implement EPR. We report the experience held at the Geneva University Hospital, which is original regarding the fact that both approach are used, according to the source and the use of data. However, whatever the organization of information behind the scene, the user interface and the data entry system are key components of the EPR. Some pragmatic solutions available to implement an efficient data entry system based on natural language technologies in order to decrease the burden of care providers are presented. We tried to have this paper more a useful and practical guideline support for those that faces such problems than a basic and conceptual discussion on the subject. Keywords: Electronic Patient Record, Natural Language Processing, Database Management 1. INTRODUCTION The Diogene Hospital Information System (IS) is running since the seventies. Administrative information, laboratory, patient encoding, discharge letters and imaging (PACS) are supported within a distributed relational database framework (essentially Ingres). Since five years, the increasing needs of clinicians for more liberty in their ability to enter patient-related information has lead to a deep and major restructuration of our vision of the EPR [1, 2]. Database and structured driven form entry system have shown their power, but also their limitations. There is a clear benefit to have structured data that can be easily analyzed. However, this benefit has an increasing cost for the care-provider that must face the burden of complex data entry systems. Moreover, the wide use of standardized often-prefilled form for many parts of the EPR, like patient history or current medical history, may Data providers Structured databases Document management Hospital Management System & R&D Ressources allocations, costs, ... Care Providers EPR, guidelines, litterature, ... Expert Systems Users Figure 1: Documents and structured databases Publication Lovis C. Baud RH. Electronic Patient Record: dealing with numbers or with words? World Multiconference on Systemics, Cybernetics and Informatics. Edited by Torres M, Sanchez B, Wills E. ISBN 980-07- 5919-0, vol 8:181-197, 1999