EHR-Oriented Knowledge Graph System: Toward Efficient Utilization of Non-Used Information Buried in Routine Clinical Practice

Non-used clinical information has negative implications on healthcare quality. Clinicians pay priority attention to clinical information relevant to their specialties during routine clinical practices but may be insensitive or less concerned about information showing disease risks beyond their specialties, resulting in delayed and missed diagnoses or improper management. In this study, we introduced an electronic health record (EHR)-oriented knowledge graph system to efficiently utilize non-used information buried in EHRs. EHR data were transformed into a semantic patient-centralized information model under the ontology structure of a knowledge graph. The knowledge graph then creates an EHR data trajectory and performs reasoning through semantic rules to identify important clinical findings within EHR data. A graphical reasoning pathway illustrates the reasoning footage and explains the clinical significance for clinicians to better understand the neglected information. An application study was performed to evaluate unconsidered chronic kidney disease (CKD) reminding for non-nephrology clinicians to identify important neglected information. The study covered 71,679 patients in non-nephrology departments. The system identified 2,774 patients meeting CKD diagnosis criteria and 10,377 patients requiring high attention. A follow-up study of 5,439 patients showed that 82.1% of patients who met the diagnosis criteria and 61.4% of patients requiring high attention were confirmed to be CKD positive during follow-up research. The application demonstrated that the proposed approach is feasible and effective in clinical information utilization. Additionally, it's valuable as an explainable artificial intelligence to provide interpretable recommendations for specialist physicians to understand the importance of non-used data and make comprehensive decisions.