Přehled článků

Summary

The article is devoted to the real working ELECTRONIC HEALTH RECORD (EHR) for the purposes of Bulgarian Occupational Health Services. This product was ordered by the Private Health - insurance Company, which maintains Occupational Health Services (OHSs) for insured persons. The functions, described in this Ordinance, are used in the elaborated Medical Information System (MIS). Below we introduce

• Main screen for work, structured by activity types : for patients - in the left and for experts, working in Occupational Health Services (OHSs) - in the right area;
• Passport – professional data screen – constant administrative-passport data and professional characteristics;
• “Health Condition” screen - current health and medical information;
• Information inquire and health indicators;

Keywords: Electronic Patient Record (EPR), Occupational Health Services, Medical Information System (MIS), OHS specialists

 celý článek

 български

Summary

This paper describes, from a practitioner’s point of view, the concepts, methods and tools involved in the design of a practical and potentially low cost distributed information system, with web-based capabilities, for monitoring glaucoma.

Our experience with existing Hospital Information Systems (HISs) found them unsuitable in the very important monitoring process of patients with glaucoma. Actual Electronic Patient Record (EPR) schemes are more to do with management and appointment simple aspects than with clinical and decision-making processes. In a closer relationship to the specific of the affection, we found that demographic patient databases, usually known as Patient Administration Systems (PASs), have not been designed for being shared or concurrently exploited by different programs or even several replicas of the same program.

Many of the early deficiencies in the process of following-up glaucoma patients by dozens of different ophthalmologists in many independent offices from different clinics (with heterogeneous information recording, not very well managed by the existing office capabilities) could only be solved by specifying, designing and implementing a new EPR scheme in a mixed distributed environment, based on a distributed database as a demographic core (or PAS) of patients with glaucoma. A specialized health record management system, with core functionality in monitoring glaucoma, and core data organized as a distributed database system, has been designed in a bottom-up manner to meet the immediate needs. Its pilot implementation was intentionally kept flexible, taking in account developing standards, to accommodate any anticipated future requirements. Among many other benefits, the new EPR allowed medical doctors (ophthalmologists) to view and modify patient information and records in a safe, flexible and efficient manner. Improvements in all the managerial and decisional aspects (regarding costs and time delays) could also be remarked rapidly.

Keywords: medical databases, Electronic Patient Record (EPR), glaucoma management

 celý článek

 Român

Summary

Keywords: Biomedical Informatics, Bioinformatics, Medical Informatics, Neuroinformatics

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 Español

Summary

Possibilities of introduction of distance learning in medical curriculum are the title of project which has been realizing at Department of Medical Informatics, Medical Faculty since year 2002. The Project is approved by Federal and Cantonal ministries of science and education. The purpose of this project is to support improvement educational process at biomedical faculties using contemporary methods, methodologies and information technologies in accordance with strategy and objectives given by Bologna declaration. The pilot project is realized during three years, the theoretical and practical parts of the subject Medical Informatics are adapted to modern concepts of education using world trends of distance learning. One group of students from the Medical Faculty was involved in this project, which was finalized by electronic registration of an exam and electronic testing on 20 June 2005, in public in the Physiological amphitheatre of the Medical faculty in Sarajevo. In this article we have given description of the project and phases of its realization, and basic adventages and disadvantages we have noticed so far.

Keywords: distance learning, biomedicine, medical curriculum

 celý článek

 Na bosanskom

Summary

In this paper, a new web solution for administering allergies, asthma and rhinitis in a pan-European level is described. The proposed system was designed to provide: professionals with easy workload and access educational and informational material; sufferers with personalised management tools and educational sources; and citizens with rich informational material. The IREMMA system architecture embeds the existing information networks and data sources on allergy by offering high data integration and multi-modal access to its users, through a multi-service tool and high-distributed architecture. Hence, IREMMA sets the ground for establishing a wide integrated network for environmental monitoring and diffusion of health information. User feedback was collected through extensive pilot trials with real users and the results were used to improve the IREMMA services and the designing and the content specification.

Keywords: telematic services, allergies, environmental monitoring, web applications

 celý článek

 Greek

Souhrn

Formalizace lékařských doporučení pomocí obecného grafického GLIF modelu je prezentována na formalizovaných Evropských doporučeních pro prevenci kardiovaskulárních chorob v klinické praxi z roku 2003 a Evropských (ESH/ESC) hypertenzních doporučeních z roku 2003 (HLD). Model vede uživatele rozhodovacími algoritmy pro diagnostiku několika chorob, stanovení celkového kardiovaskulárního rizika a výběr příslušné léčby. Navíc může ukázat jak základní informaci, tak příslušnou část kompletního textu lékařských doporučení (LD), která se týká vybraného elementu GLIF modelu. Formalizace LD lze použít jako zpětné vazby pro autory k odstranění nejasností a informačních nekonzistencí LD. Stanovení celkového kardiovaskulárního rizika a výběr lékové třídy je snažší ve srovnání s časově náročnou manipulací s tabulkami papírových LD. Lékářům nabízí systém pro podporu rozhodování a kontroluje jejich rozhodovací algoritmy ve srovnání s algoritmy LD. V budoucnosti by mohl sloužit jako nástroj pro audit práce lékařů jejich odbornou společností především jako automatický systém s přímou extrakcí dat ze strukturovaného zdravotního záznamu. Počítačová prezentace LD má potenciál pro snažší implementaci znalostí LD než klasická papírová forma LD, a může tak zlepšit primární péči u kardiovaskulárních chorob.

Klíčová slova: GLIF model, formalizace lékařských doporučení, prevence kardiovaskulárních chorob

 celý článek

Souhrn

Revaskulatizace myokardu patří mezi nejčastější kardiochirurgické zákroky. Perioperační i dlouhodobá úspěšnost revaskularizace koronárního řečiště závisí na průchodnosti použitého štěpu a kvalitě anastomózy. Hemodynamické charakteristiky měřené peroperačně pomáhají ověřit kvalitu anastomózy a ovlivňují i dlouhodobou průchodnost použitého štěpu. Při operacích bypassu v mimotělním oběhu chirurg měří průtok krve štěpem v době, kdy je na aortě naložená svorka (do srdce nepřichází krev prostřednictvím koronárních cév, ale pouze měřeným štěpem), a později měří na tomtéž místě průtok po povolení svorky na aortě. Cílem této práce je nalézt model s jehož pomocí bude možné předpovědět průtok krve štěpem po povolení svorky na aortě na základě prvního měření při naložené svorce. Při spolehlivé predikci by bylo možné snížit počet měření se současným zachováním informace o objektu.

Klíčová slova: revaskularizace myokardu, predikce průtoku a tlaku krve, vícerozměrná lineární regrese, nelineární regresní model, linearizace, lineární regresní model s podmínkami, outlier, leverage

 celý článek

Souhrn

Techniky strojového učení jsou metody, které umožní vytvořit z trénovací množiny případů model pro kategorie dat tak, že mohou být nové (neznámé) případy zařazeny do jedné nebo více kategorií schématem odpovídajícím modelu. Pro tento typ analýzy jsou velmi vhodná data ze studií sledujících určitou skupinu osob s opakovaným sběrem dat stejného typu. K vyhledávání znalostí z medicínských dat bylo užito různých algoritmů strojového učení. Bylo testováno několik algoritmů tak, aby bylo možno pokrýt většinu způsobů učení s učitelem. Byly provedeny dva typy pokusů. Jeden hledal vztahy mezi atributy, druhý testoval predikci budoucích příhod. Pro pokusy v tomto sdělení byla užita data z dvacet let trvající longitudinální primárně preventivní studie rizikových faktorů (RF) aterosklerózy u mužů středního věku. Studie se nazývá STULONG (LONGitudinal STUdy). Výsledky ukazují, že některé metody předpovídají některé poruchy lépe než jiné a že je tedy vhodné použít všechny algoritmy najednou a posuzovat spolehlivost výsledku na základě známého trendu každé metody. Algoritmy strojového učení byly také použity k předpovědi příčiny úmrtí. V tomto případě byly výsledky nevalné, pravděpodobně pro malé množství informace ve vstupních položkách v datového souboru.

Klíčová slova: dobývání znalostí, strojové učení s učitelem, vytěžování z biomedicínských dat, rizikové faktory aterosklerózy

 celý článek

 Español

Souhrn

Pružná registrace obrazů je klíčovou technikou ve výpočetní neuroanatomii. V tomto článku je navržena registrace metodou iterativního lícování podobrazů s několika vylepšeními z oblastí mnohorozměrné multimodální registrace a registrace založené na význačných bodech. Je zde použita symetrická multimodální podobnostní metrika, díky které je možno registrovat obrazy různých subjektů na libovolný digitální atlas mozku. Výsledné deformace jsou získány pomocí interpolační techniky založené na radiálních bázových funkcích. Deformace potlačují v obrazech pouze hrubé tvarové rozdíly mezi různými subjekty a ponechávají v nich jemnou anatomickou variabilitu, která bývá předmětem následného zkoumání vybranými morfometrickými metodami. Součástí příspěvku jsou kvantitativní výsledky z experimentálního ověření navržené metody se čtyřmi různými podobnostními metrikami na obrazových datech ze simulátoru obrazů mozku.

Klíčová slova: zpracování obrazů, registrace obrazů, MRI, výpočetní neuroanatomie, radiální bázové funkce

 celý článek

Summary

Family practice was the first privatized part of the health care system in Croatia. Recently, 84 % of family practices are privatized. Other 16% of them left within health centers. In order to assess current status of use of the information and communication technology (ICT) in family practice, physicians specializing in the family medicine, being also the postgraduate students of the University of Zagreb, School of Medicine in the year 2004/05, have been surveyed. The sample consisted of 159 physicians. Some kind of information system (IS) exists in 62 % of family practices under lease, 42 % within health centers, and 91 % of completely private offices. Having IS in their offices, physicians use it primarily for administration: reporting, prescriptions, sick leaves, referrals and for billing. Usage of ICT in medical work, electronic medical records, was found at about 50 % of physicians. Doing research based on information stored in e-format, is conducting by 31 % of physicians. Based on e-information 35 % of physicians evaluate their work. About using e-sources of medical knowledge (bibliographic data bases, e-journals): 86 % physicians from private offices, 79% physicians working within health centers, 60 % physicians from offices under lease. Satisfaction with current information system is small (19 %). Their information needs are covered partially. 32 % of physicians said they can get enough information by using their information system. 40 % of physicians feel that ICT gave more efficiency to their work, and 25 % of physicians feel their patients are more satisfied since the IS was put into function. Considering different types of practices – young physicians working in health centers are less satisfied with their ISs than the other two groups of physicians coming from private practice. Data security was practiced by using a password, physical protection, and by daily archiving of data .

Keywords: information system, family practice, electronic medical record, Internet, computer security, bibliographic databases, consumer satisfaction

 celý článek

 Hrvatski

Summary

The electrocardiogram (ECG) is one of the most common ways to record, in an non-invasive manner, a patient’s cardiac activity. Once recorded the information can be pre-processed and subsequently analyzed to assess if the patient is suffering from any forms of cardiac abnormality which may require clinical intervention. In the current study we investigate ways in which more can be obtained from the ECG through analysis of the diagnostic properties of body surface potential maps (BSPM). A set of 192 lead BSPMs recorded from a mixture of 116 normal and abnormal subjects (59 normal vs 57 old myocardial infarction) were analyzed. For each patient, diagnostic features were obtained by calculating isointegral measurements from the QRS, STT, and entire QRST segments. These isointegrals provide a measure of the mean distribution of potential during ventricular depolarization, repolarisation, and a combination of both, respectively. For each isointegral type, 192 discrete measurements, and hence 192 features, were obtained; these correspond with the 192 leads recorded. Subsequent to this a signal-to-noise ratio-based feature ranking methodology was applied to select subsets of the best three, six and ten measurements (features) from the 192 available for each isointegral. These subsets of features were then applied to four different classifiers Naïve Bayes (NB), support vector machine (SVM), multi-layer perceptron (MLP) and random forest (RF) and in each application ten-fold cross validation was employed. It was found that when using the subsets of features obtained from the STT or QRST isointegrals, classification results in excess of 80% were attainable. This was in contrast to the results obtained using the QRS isointegral features where poorer performance (between 62.9% and 74.1%) was observed. The results from this study have illustrated that, for the studied dataset, the mean distribution of potentials during ventricular depolarization, and during ventricular repolarization and depolarization combined possessed greater diagnostic information. Overall it was concluded that this approach to BSPM analysis does provide a useful means for illustrating the usefulness of various features in diagnostic classification.

Keywords: electrocardiogram, body surface potential map, myocardial infarction, feature selection

 celý článek

Summary

Ranked model in the form of linear transformation of multivariate feature vectors on a line can reflect a causal order between liver diseases. A priori medical knowledge about order between liver diseases and clinical data sets has been used in the definition of the convex and piecewise linear (CPL) criterion function. The linear ranked transformations have been designed here through minimization of such CPL criterion functions.

Keywords: sequential patterns, ranked linear transformations, convex and piecewise linear (CPL) criterion functions, linear separability of data sets, sequence of liver diseases

 celý článek

 Polski

Souhrn

Model reprezentace znalostí obsažených v lékařských doporučeních GLIKREM (GuideLInes Knowledge REpresentation Model) vychází z GLIF modelu, který byl publikován ve specifikaci GLIF3.5. GLIKREM obsahuje některé změny a rozšíření definice a implementace původního GLIF modelu. Cílem tohoto příspěvku je popis znalostního modelu GLIKREM, jeho konstrukce, implementace v XML, realizace datového rozhraní a použití výsledného modelu.

Klíčová slova: reprezentace znalostí, GLIF model, doporučení

 celý článek

Souhrn

Pozadí: Česká republika patří mezi země s vysokou úmrtnostní na ischemickou chorobu srdeční (ICHS). Cílem bylo analyzovat specifickou úmrtnost na ICHS podle věku, období a kohorty narození u mužů v České republice.

Design a metody: Analyzovala se národní data úmrtnosti mužů (30-74 let) v České republice v letech 1980-2004. K hodnocení vlivu věku, období a kohorty na úmrtnost se použil Poissonův regresní model.

Výsledky: Úmrtnost na ICHS u mužů adekvátně popisoval model zahrnující věk, období a kohortu (p=0,121). Poměr úmrtností věkových skupin 45-49 k 40-44 byl o 17 % nižší než odpovídající poměr věkových skupin 40-44 k 35-39. Poměr relativních rizik v obdobích 1995-1999 k 1990-1994 byl o 19 % nižší než odpovídající poměr v obdobích 1990-1994 k 1985-1989. Poměry relativních rizik mezi sousedícími kohortami kolísaly kolem hodnoty 1.

Závěry: Riziko úmrtnosti na ICHS bylo u mužů v České republice významně závislé na věku (riziko se zvyšovalo s věkem), kalendářním období (riziko se snížilo v posledních letech) a kohortě narození (riziko se snižovalo s kohortou narození). Zásadní pozitivní změna ve vývoji úmrtnosti na ICHS nastala po pádu komunismu v roce 1989 a u mužů po 40. roce věku.

Klíčová slova: ischemická choroba srdeční, kardiovaskulární, úmrtnost, riziko

 celý článek

Souhrn

Článek se věnuje návrhu automatického detektoru vybraných arytmií. Navržený algoritmus využívá spojitou vlnkovou transformaci (CWT) v kombinaci s analýzou její konturové obálky. Vlnková transformace byla využita v detektoru R vln, k rozlišení normálních a abnormálních stahů a pro detekci předčasných atriálních kontrakcí (APC) a předčasných komorových kontrakcí (PVC). Algoritmus byl ověřen rozsáhlým testováním na MIT/BIH databázi. Hledáním lokálních maxim ve vlnkové konturové obálce jsou účinně detekovány R vlny. Celková úspěšnost detekce testovaná na 48 půlhodinových signálech je 99,5 %. Byly otestovány dva typy klasifikace: 1. klasifikace založená na konturové obálce a detekci význačných bodů s celkovou úspěšností 94,6 %, 96,1 % pro sinusový rytmus (SR), 30,4 % pro APC, 71,2 % pro PVC a 2. lokalizace maxima umocněných koeficientů spojité vlnkové transformace v oblasti QRS komplexu k určení PVC mezi SR, blokádou pravého Tawarova raménka (RBBB), APC a dalšími arytmiemi s úzkým QRS komplexem s přesností 96,8 %.

Klíčová slova: arytmie, EKG signál, vlnková transformace, kontury

 celý článek

Summary

The article focuses on object oriented technologies and the usage of these technologies, how to create an information system (IS) for applications in medicine, specifically in ophthalmology. The rapid evolution of medical data standards, concepts and technologies has created a problem – how to develop a system that would be flexible enough to work with evolving data. After the analysis of object-oriented technologies: Java 2 Platform, Enterprise Edition (J2EE) and Microsoft .NET and open source object-oriented data base management systems (OODBMS) we have proposed and created a system based on .NET and OODBMS db4o. Results include the developed system with proposed architecture and used techniques, also the advantages of object-oriented data bases (OODB), the systems’ possible interoperability with the National Electronic Health Record system. Developed IS should help medical specialists to reach important information from any computer in any hospital.

Keywords: object-oriented technology, object-oriented data base, information system, data storing standards

 celý článek

 Lithuanian

Souhrn

Cíl: Vytvořit podporu pro vkládání strukturovaných dat do elektronické zdravotnické dokumentace u poruch temporomandibulárního kloubu.

Metody: Jsou popsány metody stukturování dat ve stomatologii a je představena interaktivní DentCross komponenta. Na několika případech je demonstrováno hlasem ovládané vkládání strukturovaných dat do zdravotnické dokumentace ve stomatologii. Dále je vysvětleno propojení této komponenty s elektronickým zdravotním záznamem MUDRLite.

Výsledky: Představujeme použití aplikace DentVoice složené z elektronického zdravotnického záznamu MUDRLite a hlasem kontrolované interaktivní komponenty DentCross ke sběru stomatologických informací nutných pro léčbu poruch temporomandibulárního kloubu.

Závěry: Aplikace DentVoice s komponentou DentCross prokázala praktické využití pro podporu léčení temporomandibulárních poruch.

Klíčová slova: elektronická zdravotnická dokumentace, ukládání strukturovaných dat, stomatologie, poruchy temporomandibulárního kloubu

 celý článek

Summary

Objectives: A significant portion of care related to cardiorespiratory diseases is provided at home, usually but not exclusively, after the discharge of a patient from hospital. It is the purpose of the present study to present the technical means which we have developed, in order to support the adaptation of the continuity of care of cardiorespiratory diseases at home.

Methods: We have developed an integrated system that includes: first, a prototype laptop-based portable monitoring system that comprises low-cost commercially available components, which enable the periodical or continuous monitoring of vital signs at home; second, software supporting medical decision-making related to tachycardia and ventricular fibrillation, as well as fuzzy-rules-based software supporting home-ventilation optimization; third, a typical continuity of care record (CCR) adapted to support also the creation of a homecare plan; and finally, a prototype ontology, based upon the HL7 clinical document architecture (CDA), serving as basis for the development of semantically annotated web services that allow for the exchange and retrieval of homecare information.

Results: The flexible design and the adaptable data-exchange mechanism of the developed system result in a useful and standard-compliant tool, for cardiorespiratory disease-related homecare.

Conclusions: The ongoing laboratory testing of the system shows that it is able to contribute to an effective and low-cost package solution, supporting patient supervision and treatment. Furthermore, semantic web technologies prove to be the perfect solution for both the conceptualization of a continuity of care data exchange procedure and for the integration of the structured medical data.

Keywords: continuity of care, Homecare, cardiorespiratory diseases, semantically annotated web-services

DOI

10.3414/ME9305

The full English version can be found in Methods of Information in Medicine 2010 49 2: 156-160 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12616/show.html.

 celý článek

 Greek

Summary

Objectives: Achieving semantic interoperability requires not only the use of communication standards like HL7 with its underlying models and specifications, but also to constrain those models to instances including permitted attributes, data types, values and code systems. Even the application of both strategies may lead to different modeling approaches and therefore incompatible results, however.

Methods: This paper analyzes the different ways to create a model exemplified at score and assessment systems.

Results: The different approaches have advantages and disadvantages. The presented results allow for transmitting the same basic information facilitating HL7 v2.x and V3 in a way reducing implementation efforts.

Conclusions: Establishing a generic approach to communicate the details of score systems driven by an appropriate set of codes is the best solution for implementers.

Keywords: HL7, Health telematics, semantic interoperability, communication standard, conformance, implementation guides, scores and assessments

DOI

10.3414/ME9304

The full English version can be found in Methods of Information in Medicine 2010 49 2: 148-155 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12618/show.html.

 celý článek

 Deutsch

Summary

Background: Cardiac output is controlled by the autonomic nervous system by changing the heart rate and/or the contractions of the heart muscle in response to the hemodynamic needs of the whole body. Malfunction of these mechanisms causes the postural orthostatic tachycardia syndrome and/or the chronic fatigue syndrome. Evaluation of functionality and efficiency of the control mechanisms could give valuable diagnostic information in the early stages of dysfunction of the heart control systems and help to monitor the healing process in rehabilitation period after interventions.

Objectives: In this study we demonstrate how P-wave changes evoked by an orthostatic test could be quantitatively evaluated by using the method based on the principal component analysis.

Methods: ECG signals were recorded during an orthostatic test performed according to the typical protocol in three groups of volunteer subjects representing healthy young and older persons, part of which had transient periods of supraventricular arrhythmias. Quantitative evaluation of P-wave morphology changes was performed by means of principal component analysis-based method.

Results: Principal component-based estimates showed certain variety of P-wave shape during orthostatic test, what revealed a possibility to evaluate the properties of parasympathetic heart control.

Conclusions: Quantitative evaluation of ECG P-wave changes evoked by an orthostatic test by using a newly developed method provides a quantitative estimate for functionality and efficiency of the heart rate control mechanisms. The method could be used in eHealth systems.

Keywords: principal component analysis, autonomic heart control, ECG P-wave

DOI

10.3414/ME9306

The full English version can be found in Methods of Information in Medicine 2010 49 2: 161-167 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12758/show.html.

 celý článek

 Lithuanian

Summary

Objective: Information systems integration is hard, especially when semantic and business process interoperability requirements need to be met. To succeed, a unified methodology, approaching different aspects of systems architecture such as business, information, computational, engineering and technology viewpoints, has to be considered. The paper contributes with an analysis and demonstration on how the HL7 standard set can support health information systems integration.

Methods: Based on the Health Information Systems Development Framework (HIS-DF), common architectural models for HIS integration are analyzed. The framework is a standard-based, consistent, comprehensive, customizable, scalable methodology that supports the design of semantically interoperable health information systems and components.

Results: Three main architectural models for system integration are analyzed: the point to point interface, the messages server and the mediator models. Point to point interface and messages server models are completely supported by traditional HL7 version 2 and version 3 messaging. The HL7 v3 standard specification, combined with service-oriented, model-driven approaches provided by HIS-DF, makes the mediator model possible. The different integration scenarios are illustrated by describing a proof-of-concept implementation of an integrated public health surveillance system based on Enterprise Java Beans technology.

Conclusion: Selecting the appropriate integration architecture is a fundamental issue of any software development project. HIS-DF provides a unique methodological approach guiding the development of healthcare integration projects. The mediator model – offered by the HIS-DF and supported in HL7 v3 artifacts – is the more promising one promoting the development of open, reusable, flexible, semantically interoperable, platform-independent, service-oriented and standard-based health information systems.

Keywords: Systems Integration, HL7, semantic interoperability, system architectures, middleware, J2EE

DOI

10.3414/ME09-02-0012

The full English version can be found in Methods of Information in Medicine 2010 49 2: 196-204 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12775/show.html.

 celý článek

 Español

Summary

Objectives: The data interchange in the Czech healthcare environment is mostly based on national standards. This paper describes a utilization of international standards and nomenclatures for building a pilot semantic interoperability platform (SIP) that would serve to exchange information among electronic health record systems (EHR-Ss) in Czech healthcare. The work was performed by the national research project of the „Information Society" program.

Methods: At the beginning of the project a set of requirements the SIP should meet was formulated. Several communication standards (openEHR, HL7 v3, DICOM) were analyzed and HL7 v3 was selected to exchange health records in our solution. Two systems were included in our pilot environment: WinMedicalc 2000 and ADAMEKj EHR. Results: HL7-based local information models were created to describe the information content of both systems. The concepts from our original information models were mapped to coding systems supported by HL7 (LOINC, SNOMED CT and ICD-10) and the data exchange via HL7 v3 messages was implemented and tested by querying patient administration data. As a gateway between local EHR systems and the HL7 message-based infrastructure, a configurable HL7 Broker was developed.

Conclusions: A nationwide implementation of a full-scale SIP based on HL7 v3 would include adopting and translating appropriate international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our pilot study showed that our approach is feasible but it would demand a huge effort to fully integrate the Czech healthcare system into the European e-health context.

Keywords: information storage and retrieval, Electronic health record, HL7, semantic interoperability, communication standards

DOI

10.3414/ME09-02-0018

The full English version can be found in Methods of Information in Medicine 2010 49 2: 186-195 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12381/show.html.

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 Slovensky

Summary

Objectives: The increasing amount of electronically available documents in bibliographic databases and the clinical documentation requires user-friendly techniques for content retrieval.

Methods: A domain-specific approach on semantic text indexing for document retrieval is presented. It is based on a subword thesaurus and maps the content of texts in different European languages to a common interlingual representation, which supports the search across multilingual document collections.

Results: Three use cases are presented where the semantic retrieval method has been implemented: a bibliographic database, a department EHR system, and a consumer-oriented Web portal. Conclusions: It could be shown that a semantic indexing and retrieval approach, the performance of which had already been empirically assessed in prior studies, proved useful in different prototypical and routine scenarios and was well accepted by several user groups.

Keywords: Consumer Health Informatics, Electronic health record, cross-language information retrieval, Thesauri, semantic information retrieval, document indexing, bibliographic databases

DOI

10.3414/ME9303

The full English version can be found in Methods of Information in Medicine 2010 49 2: 141-147 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12759/show.html.

 celý článek

 Português

Summary

Objectives: Biomedical ontologies exist to serve integration of clinical and experimental data, and it is critical to their success that they be put to widespread use in the annotation of data. How, then, can ontologies achieve the sort of user-friendliness, reliability, cost-effectiveness, and breadth of coverage that is necessary to ensure extensive usage?

Methods: Our focus here is on two different sets of answers to these questions that have been proposed, on the one hand in medicine, by the SNOMED CT community, and on the other hand in biology, by the OBO Foundry. We address more specifically the issue as to how adherence to certain development principles can advance the usability and effectiveness of an ontology or terminology resource, for example by allowing more accurate maintenance, more reliable application, and more efficient interoperation with other ontologies and information resources.

Results: SNOMED CT and the OBO Foundry differ considerably in their general approach. Nevertheless, a general trend towards more formal rigor and cross-domain interoperability can be seen in both and we argue that this trend should be accepted by all similar initiatives in the future. Conclusions: Future efforts in ontology development have to address the need for harmonization and integration of ontologies across disciplinary borders, and for this, coherent formalization of ontologies is a pre-requisite.

Keywords: Quality Assurance, SNOMED CT, Biomedical ontologies, ontology harmonization

DOI

10.3414/ME9302

The full English version can be found in Methods of Information in Medicine 2010 49 2: 135-140 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12619/show.html.

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 Deutsch

Summary

Objectives: For improving safety and quality of care as well as efficiency of health delivery under the well-known burdens, health services become specialized, distributed, and therefore collaborative, thereby changing the health service paradigm from organization-centered over process-controlled to personal health (pHealth).

Methods: Personalized eHealth services provided independent of time and location have to be based on advanced technical paradigms of mobile, pervasive and autonomous computing, enabling ubiquitous health services. Personalized eHealth systems require a multidisciplinary approach including medicine, informatics, biomedical engineering, bioinformatics and the omics disciplines but also legal and regulatory affairs, administration, security, privacy and ethics, etc. Interoperability between different components of the intended system must be provided through an architecture-centric, model-driven, formalized process.

Results: In order to analyze, design, specify, implement and maintain such an interactive environment impacted by so many different domains, a formal and unified methodology for system analysis and design has been developed and deployed, based on an overall architectural framework. The paper introduces the underlying paradigms, requirements, architectural reference models, modeling and formalization principles as well as development processes for comprehensive service-oriented personalized eHealth interoperability chains, thereby exploiting all interoperability levels up to service interoperability. A special focus is put on ontologies and knowledge representation in the context of eHealth and pHealth solutions. Furthermore, EHR solutions, security requirements, existing and emerging standards, and educational challenges for realizing personalized pHealth are briefly discussed. Conclusion: For personal health, bridging between disciplines including ontology coordination is the crucial demand. All aspects of the design and development process have to be considered from an architectural viewpoint.

Keywords: Ontology, Knowledge Representation, semantic interoperability, Personal health, system architecture, universal logic, ubiquitous care

DOI

10.3414/ME9308

The full English version can be found in Methods of Information in Medicine 2010 49 2: 123-134 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12617/show.html.

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 Deutsch

Souhrn

Cíle: Poslední významné pokroky v lidské genomice a postgenomických „omics“ nyní přinášejí nové možnosti zdravotní péče, kterou nazýváme „medicína založená na omics vědách“. V tomto článku jsme zkoumali vývoj a budoucí možnosti medicíny založené na omics vědách.

Metody: Rozdělili jsme vývoj medicíny založené na omics vědách do tří generací za účelem ujasnění hlavních klinických cílů a charakterizace informačních metod každé generace spolu s jejich budoucími možnostmi.

Výsledky: První generace medicíny založené na omics vědách, začala s „genomickou medicínou“, založenou na vrozených individuálních rozdílech v genomu. Toto otevřelo studování genetických polymorfismů nemocí a napomohlo vývoji personalizovaných léků založených na farmakogenetických/ farmakogenomických rozdílech v reakci na lék. Ve druhé generaci omicsové medicíny, díky pokroku v technologii vysokorychlostního sekvencování, byl otevřen přístup k obrovskému množství různých omicsových dat postgenomických nemocí, obsahujících vyčerpávající molekulární informace o nemocech somatických buněk. Zobrazení průběžného stavu nemoci je tak mnohem věrnější a umožňuje tak prediktivní medicíně předpovězení prognózy nemoci uplatněním datové analýzy. A také, díky rychle se rozvíjejícím znalostem o buňkové molekulární síti, je nyní umožněno porozumět nemoci na systémové úrovni pomocí nového oboru, zvaného systémová patologie. Může plně využít významné znalosti omicsu nemoci a povede ke komplexnímu porozumění postupu nemoci použitím datové analýzy.

Závěr: Omicsová medicína a systémová patologie umožní nový druh personalizované a prediktivní medicíny.

Klíčová slova: Medicína založená na omics vědách, systémová patologie, genomika, omics vědy, farmakogenomika

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