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Biomedical subjects

Arie Hasman

Publications and source records attributed to Arie Hasman.

At least 19 recordsLinked to original sources
PubMed2006

Towards patient-related information needs.

The quality of health care depends, among other factors, on the quality of a physician's domain knowledge. Since it is impossible to keep up with all new findings and developments, physicians usually have gaps in their domain knowledge. To handle exceptional cases, access to the full range of medical literature is required. The specific literature needed for appropriate treatment of the patient is described by a physician's information need. Physicians are often unaware of their information needs. To support them, this paper presents a first step towards automatically formulating patient-related information needs. We start investigating how we can model a physician's information needs in general. Then we propose an approach to instantiate the model into a representation of a physician's information needs using the patient data as stored in a medical record. Our experiments show that this approach is feasible. Since the number of formulated patient-related information needs is rather high, it has to be reduced. To reduce the number of formulated information needs we propose the use of additional knowledge. Four types of knowledge are discussed, viz. (a) knowledge about temporal aspects, (b) domain knowledge, (c) knowledge about a physician's specialism, and (d) a user model. Future research has to clarify which type of knowledge (or combination thereof) is most appropriate for our purpose. It is expected that the resultant set of information needs will have a manageable size and contributes to the quality of health care.

Humans↗
PubMed2006

Ten years of teledermatology.

Using telemedicine health professionals can communicate with each other and with their patients over a distance. Teledermatology, dermatology application of telemedicine, is one of the most often applied telemedicine applications worldwide. Various studies have been performed to evaluate the effectiveness and efficiency of and satisfaction with teledermatology. Up to now no or limited valid scientific evidence has been found that teledermatology is beneficial for any group of users. This study aimed to perceive insight into the evolution of evaluation studies of teledermatology over the past ten years in terms of the telemedicine evaluation framework by Holle and Zahlmann consisting of four continuous phases. We added the phase "post implementation studies" that evaluate teledermatology as a fully integrated service in regular care. Retrieved literature from Medline was reviewed by two reviewers independently in order to include studies and classify them into the five phases. Ninety-nine studies out of 372 found unique references were included and classified into the phases. Most represented phase was phase II with 72 (72%) studies. The number of phase II studies is continuously growing since the introduction of evaluation in teledermatology. There were eight reported RCTs found (two in phase III, six in phase IV). The number of phase III and IV studies is too low to draw conclusions about the trends in their publication and stress the need for more such studies. Phase I and post implementations studies are probably under-represented as they might often not be published separately in scientific journal papers.

Dermatology↗
PubMed2006

Avoiding literature overload in the medical domain.

The retrieval of patient-related literature is hampered by the large size of medical literature. Various computer systems have been developed to assist physicians during information retrieval. However, in general, physicians lack the time and skills required to employ such systems effectively. Our goal is to investigate to what extent a physician can be provided with patient-related literature without spending extra time and without acquiring additional skills. In previous research we developed a method to formulate a physician's patient-related information needs automatically, without requiring any interaction between the physician and the system. The formulated information needs can be used as a starting point for literature retrieval. As a result we found that the number of information needs formulated per physician was quite high and had to be reduced to avoid a literature overload. In this paper we present four types of knowledge that may be used to accomplish a reduction in the number of information needs. The usefulness of each of these knowledge types depends heavily on the specific cause underlying the multitude of information needs. To determine the nature of the cause, we performed an experimental analysis. The results of the analysis led us to conclude that the knowledge types can be ordered according to their appropriateness as follows: (1) knowledge concerning temporal aspects, (2) knowledge concerning a physician's specialism, (3) domain knowledge, and (4) a user model. Further research has to be performed, in particular on precisely assessing the performance of each type of knowledge within our domain.

Information Management↗
PubMed2006

With good Intentions.

The use of intentions in computer-based guidelines may help to make them more flexible, easier to adapt to local standards, easier to evaluate and to improve. We see possibilities of using intentions in several areas: as a generator of actions which could be performed and then compared with the decision of the physician, as a method for pruning proposed actions based on current and previous patient data. In this contribution we present our approach to intention-based guidelines.

Decision Support Systems, Clinical↗
PubMed2006

The redesign of the Medical Informatics Master of Science course at the University of Amsterdam.

OBJECTIVES: To describe our new two years Master of Science (MSc) program starting in September 2006 at the University of Amsterdam- Academic Medical Center, The Netherlands. METHODS: We elaborate shortly on the mission, organizational structure and new contents of this new MSc course in medical informatics. RESULTS: Through the years, our medical informatics university program underwent some major revisions of which the transition from a four years course into a three years BSc program and a two years MSc program has been the most fundamental. The new MSc program is aimed at (international) baccalaureates in medical informatics, computer science, medicine, health sciences, and biology. Besides, health care professionals or professionals with a background in computer science may enter the program. The program length is two years, comprising four study semesters of 30 European Credits each (EC, 1 EC corresponding to 27 hours study load), equalizing 120 EC in total of which 48 EC are reserved for the master's thesis. CONCLUSIONS: With the new set up of the MSc program, that will be offered in English, we hope to both accommodate the learning needs of our own baccalaureates and to attract international baccalaureates and other professionals to this course. Our ultimate aim is to bring forth medical informatics specialists who are well equipped to make significant contributions to the field.

Curriculum↗
PubMed2005

PropeR revisited.

INTRODUCTION: The PropeR EHR system (PropeRWeb) is a multidisciplinary electronic health record (EHR) system for multidisciplinary use in extramural patient care for stroke patients. DESIGN: The system is built using existing open source components and is based on open standards. It is implemented as a web application using servlets and Java Server Pages (JSP's) with a CORBA connection to the database servers, which are based on the OMG HDTF specifications. PropeRWeb is a generic system which can be readily customized for use in a variety of clinical domains. EVALUATION: The system proved to be stable and flexible, although some aspects (a.o. user friendliness) could be improved. These improvements are currently under development in a second version.

Computer Systems↗
PubMed2005

Towards patient-related information needs.

The quality of health care depends, among others, on the quality of a physician's domain knowledge. Since it is impossible to keep up with all new findings and developments, physicians usually have gaps in their domain knowledge. To handle exceptional cases, access to the full range of medical literature is required. The specific literature needed for appropriate treatment of the patient is described by a physician's information need. Physicians are often unaware of their information needs. To support them, this paperThis research is part of the MIA project (Medical Information Agent), which is funded by NWO (grant number 634.000.021). aims at presenting a first step towards automatically formulating patient-related information needs. We start investigating how we can model a physician's information needs in general. Then we propose an approach to instantiate the model into a representation of a physician's information needs using the patient data as stored in a medical record. Our experiments show that this approach is feasible. Since the number of formulated patient-related information needs is rather high, we propose the use of filters. Future research will focus on the combination of personalization and filtering. It is expected that the resultant set of information needs will have a manageable size and contributes to the quality of health care.

Forecasting↗
PubMed2004

Enterprise resource planning for hospitals.

Integrated hospitals need a central planning and control system to plan patients' processes and the required capacity. Given the changes in healthcare one can ask the question what type of information systems can best support these healthcare delivery organizations. We focus in this review on the potential of enterprise resource planning (ERP) systems for healthcare delivery organizations. First ERP systems are explained. An overview is then presented of the characteristics of the planning process in hospital environments. Problems with ERP that are due to the special characteristics of healthcare are presented. The situations in which ERP can or cannot be used are discussed. It is suggested to divide hospitals in a part that is concerned only with deterministic processes and a part that is concerned with non-deterministic processes. ERP can be very useful for planning and controlling the deterministic processes.

Delivery of Health Care, Integrated↗
PubMed2004

Approaches for creating computer-interpretable guidelines that facilitate decision support.

During the last decade, studies have shown the benefits of using clinical guidelines in the practice of medicine. Although the importance of these guidelines is widely recognized, health care organizations typically pay more attention to guideline development than to guideline implementation for routine use in daily care. However, studies have shown that clinicians are often not familiar with written guidelines and do not apply them appropriately during the actual care process. Implementing guidelines in computer-based decision support systems promises to improve the acceptance and application of guidelines in daily practice because the actions and observations of health care workers are monitored and advice is generated whenever a guideline is not followed. Such implementations are increasingly applied in diverse areas such as policy development, utilization management, education, clinical trials, and workflow facilitation. Many parties are developing computer-based guidelines as well as decision support systems that incorporate these guidelines. This paper reviews generic approaches for developing and implementing computer-based guidelines that facilitate decision support. It addresses guideline representation, acquisition, verification and execution aspects. The paper describes five approaches (the Arden Syntax, GuideLine Interchange Format (GLIF), PROforma, Asbru and EON), after the approaches are compared and discussed.

Artificial Intelligence↗
PubMed2004

Evaluation of an automated test ordering and feedback system for general practitioners in daily practice.

OBJECTIVE: To evaluate the use of an automated test ordering and feedback system (named GRIF) in daily practice. The system produces recommendations to general practitioners (GPs) to improve the application of accepted practice guidelines for test ordering. METHODS: A randomised controlled trial with balanced block design was carried out in general practices in two regions of the Netherlands from August 2000 to July 2001. We implemented the GRIF system on the workstations at the offices of the participating GPs. The GPs (n=11) were asked to use GRIF during patient consultation instead of filling in the paper request form. The system displayed critical comments about their non-adherence to the guidelines as apparent from the request forms. RESULTS: The median time of producing the comments plus the response time of the GP was 13s. Of the 2780 presented recommendations, 4.3% were accepted. Advice of the GRIF system that presents a concrete test to request in a particular situation is adhered to most frequently. Finally, there seems to be a decrease of accepted comments over the trial period. CONCLUSION: Computerised recommendations should contain, if possible, suggestions for alternative tests to improve the application of these recommendations. Furthermore, creative solutions must be developed to avoid that GPs get used to the recommendations of critiquing systems and to stimulate a better adherence to these recommendations.

Adult↗
PubMed2004

Predicting capacities required in cardiology units for heart failure patients via simulation.

The management of a department of cardiology has to plan the capacity of both elective and non-elective patients. Heart failure (HF) patients are admitted to the hospital in a non-elective way. The precision with which the capacity needed for non-elective patients can be predicted determines the degree of flexibility in planning the admission of elective patients. In this study we want to determine how accurately we can predict the bed occupancy of HF patients using a simulation model. Data of the year 2000 were used to obtain the necessary probability distribution functions. Data from the year 2001 were used for determining the prediction accuracy. The results show that the arrival of new HF patients can be adequately predicted. However, the bed occupancy by new and especially current patients is predicted less accurately. Still in 70% (90%) of the days of a 5-day-prediction interval the error is at most one (two) bed(s). The results may improve if the cardiologist is asked to predict the length of stay of the current patients.

Bed Occupancy↗
PubMed2004

Experiences with the development, implementation and evaluation of automated decision support systems.

A framework for the implementation of guidelines--GASTON--was developed. Its functions range from the definition of guidelines (using a GLIF like approach) to the implementation of a DSS that can be coupled to existing information systems. This paper discusses experiences with the development of three systems in different domains. It is concluded that the toolbox corresponding to the framework could be successfully used to develop these systems.

Decision Making, Computer-Assisted↗
PubMed2004

Archetypes: the PropeR way.

The PropeR project studies the effect of Decision Support in an Electronic Health Record system (EHR) on the quality of care. One of the applications supports a multidisciplinary primary care team rehabilitating stroke patients in their home environment. This project required an EHR system that could handle information of multiple disciplines and multiple, distributed data sources. It should also be flexible enough to handle an entirely different domain with only minor modifications. The resulting EHR system is a distributed system based on international standards and reusable components. It is generic in nature since all references to the domain are stored in separate XML documents: the clinical data are defined through a modified version of the OpenEHR archetypes, described in XML and views on the data, either for review or for data entry are also described in XML documents. Currently, the system is being evaluated by a care team using laptops with a wireless internet connection. The use of standards greatly improves the quality and reusability of the resulting software system, but they do not solve the issues that surface during implementation, such as context and screen representation.

Computer Communication Networks↗
PubMed2004

Curricula in medical informatics.

Education in medical informatics is needed not only for those who want to become specialist in this area but also for health professionals. Since students, depending on the program they are enlisted in, require different types of knowledge and skills in medical informatics, curricula should be adapted to those needs. The curriculum structure also depends on the expert level the students want to attain. This contribution presents the knowledge and skills levels for different groups of students and presents two examples of curricula.

Curriculum↗
PubMed2004

From patient data to information needs.

The goal of this paper is to contribute to the improvement of the quality of care. For physicians, it is a problem that they are often not aware of gaps in their knowledge and the corresponding information needs. Our research aim is to resolve this problem by formulating information needs automatically. Based on these information needs, patient-specific literature can be retrieved. As a first step, we investigate how to model a physician's information needs. Thereafter, we design and analyse an approach to instantiate the model with patient data, resulting in information-need templates that are able to represent patient-specific information needs. Our experiments show that a physician's information needs can be modelled adequately and can be substantiated into patient-specific information needs. Since the number of formulated information needs is rather high, future research will focus on methods that restrict the set of automatically formulated information needs to a more specialized set.

Information Storage and Retrieval↗
PubMed2003

Automated quantitative evaluation of diseased and nondiseased renal transplants with MR renography.

PURPOSE: To present a method of automated parametric quantification of dynamic MR enhancement curves of renal transplants and evaluate the disease-discriminating properties of the resulting MR renography (MRR) data. MATERIALS AND METHODS: This study included 27 patients with nondiseased renal transplants and eight patients with diseased renal transplants. The examination was repeated in 10 patients and the reproducibility of the enhancement parameters was estimated by analysis of variance (ANOVA). The disease-discriminating properties of the transplant volumes and enhancement parameters were tested with t-tests and logistic regression analysis. RESULTS: The enhancement parameters were reproducible. The mean medullary nephronal washout rate (lambda1) and cortical arterial blood volume (mu0) were lower in diseased renal transplants. The combination of these parameters was a strong predictor of renal transplant disease (area under ROC curve 0.98; 95% confidence interval 0.96-1.0). CONCLUSION: Automated parametric quantification of cortical and medullary enhancement is feasible and allows the accurate detection of nonsurgical disease in renal transplants by MRR.

Analysis of Variance↗