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PubMed1995

Integrating guidelines and the clinical record: the role of semantically constrained terminologies.

The extent to which protocols and guidelines will be used depends critically on how well they are integrated with existing medical records and each other. Effective integration requires consistent information structures and content, but if the union between components becomes too intimate it may restrict interaction with other applications. Such isolation leads to operational inefficiencies and can be financially unattractive. Systematic representation methods for protocols address part of the problem but are hampered by the unsuitability of existing medical terminologies; the effort required for bespoke development is prohibitive. Unifying and generalising terminological functions in a single "Terminology Server" that can support both construction of systems and their operational use promises to reduce development effort whilst allowing individual designers considerable independence. However, significant theoretical and practical questions remain about how far the problems of communication can be mitigated by a generalised, use-independent terminological system.

England↗
PubMed1993

Earthbound applications for NASA's physician workstation.

The dream of a space probe to Mars or an astronaut colony on the moon persists. Despite years of setbacks and delays, NASA continues to lay the foundation for a new frontier in space. The necessity of a self contained health maintenance facility is an integral part of this stellar venture. As a subsystem of this health maintenance facility, the physician or astronaut workstation was envisioned as the vehicle of interface between the computer resources of the space station and the care provider. Our efforts to define and build this interface have resulted in a series of programs which can now be tested and refined using earth-based applications. The modules which have dual-use application from the NASA workstation include: patient scheduling and master patient index, pharmacy, laboratory, medical library, problem list/progress notes, and digital medical records. Our current plan is to develop these tools as objects that can be assembled in a variety of configurations. This will allow the technology to be used by the private sector where each doctor can select the starting point of his outpatient office system and add modules as he makes progress in system integration and training.

Aerospace Medicine↗
PubMed2002

Visualization methods for data analysis and planning in medical applications.

Time plays an important role in medicine, both the past and the future. The medical history of a patient represents the past, which needs to be understood by the physician to make the right decisions. The past contains two different kinds of information: measured data (such as blood pressure) and incidents (such as seizures). Planning therapies, on the other hand, requires looking into the future to a certain extent. Visual representations exist for both the past and the future, and they are very useful for getting a better understanding of data or a plan. This paper surveys visualization techniques for both data analysis and planning, and compares them based on a number of criteria.

Computer Graphics↗
PubMedDate not supplied

Telehealth: passing fad or lasting benefits?

Advocates of telehealth argue that the delivery of health services by means of communications technologies is both feasible and desirable. Nevertheless, the benefits of telehealth, due to the variety of its applications and their uneven development, are not self-evident. The goal of this paper is to reflect on the processes by which telehealth applications do or do not contribute to the delivery of health services. We propose a framework structuring a preliminary analysis of the match between needs and the possibilities offered by telehealth. Four mechanisms of expected benefits are discussed: 1) decreasing patient transfers; 2) decreasing trips by providers and patients; 3) meeting the needs of underserved populations; and 4) building providers' and patients' knowledge and reducing rural isolation. We conclude by stressing that the participation of providers is crucial, both in the research on telehealth and in the steering of its evolution.

Delivery of Health Care↗
PubMed2005

Flexible information storage in MUDR(II) EHR.

An important research task of the EuroMISE Centre is the applied research in the field of electronic health record (EHR) design including electronic medical guidelines and intelligent systems for data mining and decision support. The research in this field was inspired by several European projects. We have proposed a mathematical meta-description of a flexible information storage model based on the experience gathered in cooperation in those projects. In this model, we use two basic structures called a knowledge base and data files. We describe those two structures using the graph theory concepts. Furthermore, we use logical formulas to express conditions that should be valid. Additionally, we present a description of a global system architecture of a 3-tier EHR application with interfaces based on the latest technologies; predominately on Web Services, SOAP, XML, HTTP, CORBA, etc. According to our experience and test results gained from the MUDR EHR usage, we describe an open universal solution, which can be applied as the EHR kernel of hospital information systems. To realize this approach in a daily practice for health professionals we have started a co-operative project with clinical information systems developers. Within that project we are developing a new system for continual shared health care.

Biomedical Research↗
PubMed1999

Hospital information systems: chances and obstacles on the way to integration.

Today, most large hospital information systems (HIS) comprise many heterogeneous application systems, loosely coupled via interfaces. Integration could offer many advantages, like the support of interdepartmental workflows or a consistent patient record. This cannot be achieved, however, by simply interfacing originally unrelated component systems. In this paper, we present relevant concepts of integration, the autonomy/consistency tradeoff, and technical alternatives in some detail. Based on our recent experiences in analyzing an existing HIS and selecting adequate vendors for the needs of our 1250-bed hospital, we then discuss strategies and tradeoffs on the way to a HIS that utilizes state-of-the-art technology to fill the users' needs.

Hospital Information Systems↗
PubMed2000

Integration of medical applications: the 'mediator service' of the SynEx platform.

Interoperability is a key issue and a long-term domain of research for distributed healthcare information systems. The SynEx European project provides open and standard integration platform for both new and legacy medical applications. It aims to provide access to hospital information services, patient records, and to medical knowledge, in a seamless way, hiding the distribution aspects and the heterogeneity of the underlying systems. In this study, we describe the SynEx 'mediator service', a software engineering component, that is used to facilitate the development of mediators between any pair of SynEx components and to manage the corresponding interchange messages. Both a C++ library and a Java package of a generic mediator model are provided with several ready-to-use specialisations for well-defined use. The use of the XML technology as a powerful data interchange format and as an efficient data structure converter is proposed and discussed.

Computer Communication Networks↗
PubMed1997

Clinical applications of an ATM/Ethernet network in departments of neuroradiology and radiotherapy.

An integrated system for the multimedia management of images and clinical information has been developed at the Isituto Nazionale Neurologico C. Besta in Milan. The Institute physicians have the daily need of consulting images coming from various modalities. The high volume of archived material and the need of retrieving and displaying new and past images and clinical information has motivated the development of a Picture Archiving and Communication System (PACS) for the automatic management of images and clinical data, related not only to the Radiology Department, but also to the Radiotherapy Department for 3D virtual simulation, to remote teleconsulting, and in the following to all the wards, ambulatories and labs.

Computer Communication Networks↗
PubMed2004

The asthma kiosk: a patient-centered technology for collaborative decision support in the emergency department.

The authors report on the development and evaluation of a novel patient-centered technology that promotes capture of critical information necessary to drive guideline-based care for pediatric asthma. The design of this application, the asthma kiosk, addresses five critical issues for patient-centered technology that promotes guideline-based care: (1) a front-end mechanism for patient-driven data capture, (2) neutrality regarding patients' medical expertise and technical backgrounds, (3) granular capture of medication data directly from the patient, (4) formal algorithms linking patient-level semantics and asthma guidelines, and (5) output to both patients and clinical providers regarding best practice. The formative evaluation of the asthma kiosk demonstrates its ability to capture patient-specific data during real-time care in the emergency department (ED) with a mean completion time of 11 minutes. The asthma kiosk successfully links parents' data to guideline recommendations and identifies data critical to health improvements for asthmatic children that otherwise remains undocumented during ED-based care.

Algorithms↗
PubMed2006

Comparing approaches for advanced e-health security infrastructures.

OBJECTIVES: The healthcare systems of all developed countries face the challenge for improving quality, efficiency and safety of patients' care. For meeting this challenge, health is moving from being organisation-centred to process-based care. This process will continue in the future turning health towards person-centred architectures. This system transformation is combined with extended and advanced communication and collaboration supported and enabled by appropriate information and communication technologies (ICT), also called e-health. The resulting solutions have to be trustworthy. METHODS: There is a set of security services needed for realising trustworthy e-health solutions. Those security services must be comprehensively integrated in the e-health application. Furthermore, a set of infrastructure services has to be specified and implemented. For keeping the solutions future-proof, they have to comply with architectural principles and paradigms. RESULTS: After shortly introducing meanwhile internationally acknowledged architectural paradigms for applications, means and infrastructures providing security services, existing, or specified advanced solutions are described and compared. In that context, the Electronic Health Record as e-health core application has been especially considered. Based on published work as well as on explored solutions, the security services needed are summarised and evaluated. The pros and cons of investigated examples are collected and interpreted. In that context, especially the German health telematics framework architecture and security infrastructure and the corresponding implementable solutions on the one hand and the USA Veterans Health Administration approach to security have been carefully considered. CONCLUSION: Processes and systems are determined by policies, which define and distinguish constraints for communication and collaboration. Therefore, formally modelling policies and performing policy bridging are the main challenges to be met. As result of investigations, recommendations have been derived for establishing the trustworthiness required for any e-health solution at different level from regional to national, European, and even global scale, which are included in the conference summary.

Computer Security↗
PubMed2000

A multimedia approach to raising awareness of information and communications technology amongst healthcare professionals.

This study is concerned with the application of advanced multimedia technology to the development of a programme aimed at raising awareness of information and communications technology (ICT) amongst health professionals in Ireland. The programme is delivered in the form of a symposium supplemented by a multimedia CD and associated web site. It examines how ICT can be used effectively in healthcare across all sectors - primary, secondary and tertiary - with a strong emphasis on supporting shared care. The aim is to empower users to make informed technological choices and to actively participate in the exploitation of ICT in the health sector. The programme was successfully completed and delivered to over 2300 health professionals across Ireland and follow-up activities include the active encouragement of leaders and champions within the sector. This will be supported by interactive web-based education and training material focused on specialised topics of particular interest within the broader context of continuing medical education (CME).

Computer Literacy↗
PubMed1990

Computer applications in orthopaedics.

With the rapid developments in microprocessors, the widespread availability of computers has brought about broad applications in the field of orthopaedics. The present technology enables large quantities of data to be logically processed in a very short span of time. This has led to the development of information management database systems where relevant medical information may be retrieved very quickly and effectively. The analytical power of the computer has also been utilised in expert systems to assist in clinical-decision making process. Computer graphics have revolutionised the visualisation of physical features of internal and external body parts, providing new and improved modalities of diagnosis. In some centres, surgical planning and rehearsals are already being carried out at the computer terminal with the use of animation and computer graphics. Computer technology has also played an active role in the field of prosthetics and rehabilitation. Intelligent robotic systems and microprocessor with functional neuromuscular stimulation have been applied to benefit, and in some cases restore some motor functions to the physically disabled. With more collaboration between engineers, scientists and the medical community, several prototypes of computer-controlled prostheses and prosthesis designed and manufactured by Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technology are available today to assist the amputees in their daily living and ambulatory activities.

Computer Graphics↗
PubMed2005

Why are structured data different? Relating differences in data representation to the rationale of OpenSDE.

OpenSDE is an application that supports clinicians with structured recording of narrative patient data to enable use of data in both clinical practice and research. OpenSDE is based on a rationale and requirements for structured data entry. In this study, we analyse the impact of the rationale and the requirements on data representation using OpenSDE. Three paediatricians transcribed 20 paper patient records using OpenSDE. The transcribed records were compared; the findings that were the same in content but differed in representation (e.g. recorded as free text instead of in a structured manner) were categorized in one of three categories of difference in representation. The transcribed records contained 1764 findings in total. The medical content of 302 of these findings was represented differently by at least one clinician and was thus included in this study. In OpenSDE, clinicians are free to determine the degree of detail at which patient data are described. This flexibility accounts for 87% of the differences in data representation. Thirteen per cent of the differences are due to clinicians interpreting and translating phrases from the source text and transcribing these to (different) concepts in OpenSDE. The differences in data representation largely result from initial design decisions for OpenSDE.

Data Interpretation, Statistical↗
PubMed2006

Six methodological steps to build medical data warehouses for research.

PURPOSE: We propose a simple methodology for heterogeneous data collection and central repository-style database design in healthcare. Our method can be used with or without other software development frameworks, and we argue that its application can save a relevant amount of implementation effort. Also, we believe that the method can be used in other fields of research, especially those that have a strong interdisciplinary nature. BACKGROUND: The idea emerged during a healthcare research project, which consisted among others in grouping information from heterogeneous and distributed information sources. We developed this methodology by the lessons learned when we had to build a data repository, containing information about elderly patients flows in the UK's long-term care system (LTC). DESIGN: We explain thoroughly those aspects that influenced the methodology building. The methodology is defined by six steps, which can be aligned with various iterative development frameworks. We describe here the alignment of our methodology with the RUP (rational unified process) framework. The methodology emphasizes current trends, as early identification of critical requirements, data modelling, close and timely interaction with users and stakeholders, ontology building, quality management, and exception handling. RESULTS: Of a special interest is the ontological engineering aspect, which had the effects with the highest impact after the project. That is, it helped stakeholders to perform better collaborative negotiations that brought better solutions for the overall system investigated. An insight into the problems faced by others helps to lead the negotiators to win-win situations. We consider that this should be the social result of any project that collects data for better decision making that leads finally to enhanced global outcomes.

Computer Communication Networks↗
PubMed1998

Canopy computing: using the Web in clinical practice.

The rain forest canopy is a seamless web through which arboreal creatures efficiently move to reach the edible fruits without any attention to the individual trees. Individual health care computer systems are rich with patient data, but rather than a canopy linking all the trees in the forest, the data "fruit" come from a diverse forest of individual computer "trees"-laboratory systems, word processing systems, pharmacy systems, and the like. These different sources of patient information are difficult or impossible to reach by individual physicians, especially from their offices. The World Wide Web and other standardization technology provide physicians and their institutions the tools needed for seamless and secure access to their patients' data and to medical information, when and where they need it. We and others have adopted these tools to combine independent sources of clinical data. Physicians who assist in the purchase of clinical information systems should demand products in their practice settings that are Web enabled, use standard coding systems, and communicate with other computer systems via broadly accepted protocols.

Clinical Medicine↗