Towards Interoperability in E-health Systems: a three-dimensional approach based on standards and semantics

Proceedings of: HEALTHINF 2009 (International Conference on Helath Informatics), Porto (Portugal), January 14-17, 2009, is part of BIOSTEC (Intemational Joint Conference on Biomedical Engineering Systems and Technologies)The interoperability problem in eHealth can only be addressed by mean of combining standards and technology. However, these alone do not suffice. An appropiate framework that articulates such combination is required. In this paper, we adopt a three-dimensional (information, conference and inference) approach for such framework, based on OWL as formal language for terminological and ontological health resources, SNOMED CT as lexical backbone for all such resources, and the standard CEN 13606 for representing EHRs. Based on tha framewok, we propose a novel form for creating and supporting networks of clinical terminologies. Additionally, we propose a number of software modules to semantically process and exploit EHRs, including NLP-based search and inference, wich can support medical applications in heterogeneous and distributed eHealth systems.This work has been funded as part of the Spanish nationally funded projects ISSE (FIT-350300-2007-75) and CISEP (FIT-350301-2007-18). We also acknowledge IST-2005-027595 EU project NeO

Quality Control Measures over 30 Years in a Multicenter Clinical Study: Results from the Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study.

Implementation of multicenter and/or longitudinal studies requires an effective quality assurance program to identify trends, data inconsistencies and process variability of results over time. The Diabetes Control and Complications Trial (DCCT) and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study represent over 30 years of data collection among a cohort of participants across 27 clinical centers. The quality assurance plan is overseen by the Data Coordinating Center and is implemented across the clinical centers and central reading units. Each central unit incorporates specific DCCT/EDIC quality monitoring activities into their routine quality assurance plan. The results are reviewed by a data quality assurance committee whose function is to identify variances in quality that may impact study results from the central units as well as within and across clinical centers, and to recommend implementation of corrective procedures when necessary. Over the 30-year period, changes to the methods, equipment, or clinical procedures have been required to keep procedures current and ensure continued collection of scientifically valid and clinically relevant results. Pilot testing to compare historic processes with contemporary alternatives is performed and comparability is validated prior to incorporation of new procedures into the study. Details of the quality assurance plan across and within the clinical and central reading units are described, and quality outcomes for core measures analyzed by the central reading units (e.g. biochemical samples, fundus photographs, ECGs) are presented

A SOA-Based Platform to Support Clinical Data Sharing

The eSource Data Interchange Group, part of the Clinical Data Interchange Standards Consortium, proposed five scenarios to guide stakeholders in the development of solutions for the capture of eSource data. The fifth scenario was subdivided into four tiers to adapt the functionality of electronic health records to support clinical research. In order to develop a system belonging to the \u201cInteroperable\u201d Tier, the authors decided to adopt the service-oriented architecture paradigm to support technical interoperability, Health Level Seven Version 3 messages combined with LOINC (Logical Observation Identifiers Names and Codes) vocabulary to ensure semantic interoperability, and Healthcare Services Specification Project standards to provide process interoperability. The developed architecture enhances the integration between patient-care practice and medical research, allowing clinical data sharing between two hospital information systems and four clinical data management systems/clinical registries. The core is formed by a set of standardized cloud services connected through standardized interfaces, involving client applications. The system was approved by a medical staff, since it reduces the workload for the management of clinical trials. Although this architecture can realize the \u201cInteroperable\u201d Tier, the current solution actually covers the \u201cConnected\u201d Tier, due to local hospital policy restrictions

The Mission System: An Electronic Health Record for Medical Treatment in Guatemala

Abstract Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is necessary. Methods: A system development framework was used to help identify the elements necessary for successful EHR workflow development for NHI. Focused interviews were conducted using structured interview guides with questions targeted towards EHR system design from first-hand observation from volunteers and staff members. Results: All the participants agreed that an EHR system would benefit NHI and will provide the ability to monitor patient trends over time, but will need to be simple, and have the ability to use in areas with no Wi-Fi. Implications for Practice: Using the information obtained from the structured interview guides, first-hand observation, aggregate data from NHI, and IT considerations, a set of elements and data were identified, and a series of recommendations established for a more streamlined method of collecting patient data for NHI

Effects of Pediatric Emergence Delirium Education on Analgesic Administration by PACU Nurses

Emergence delirium (ED) is a behavioral disturbance as a result of general anesthesia that commonly occurs in pediatric patients. Adverse effects of ED lead to a complicated recovery from anesthesia due to the risk of self-inflicted injury of patients, the disturbance of surgical incisions, the development of postoperative maladaptive behaviors, and the increased use of sedatives and analgesics resulting in prolonged recovery time and delayed discharge from the post-anesthesia care unit (PACU). Due to the multiple ramifications of ED, appropriate care is needed to promote a safe recovery from anesthesia and an optimum perioperative experience for these patients. As PACU nurses are the primary providers of care to this population group during the occurrence of ED, it is imperative they are able to recognize and manage ED appropriately. The goal of this evidence-based practice project was to increase the knowledge of ED among PACU nurses and determine its effects on analgesic usage among pediatric surgical patients in the PACU. Using the Iowa model of evidence-based practice in developing quality care, an educational session on ED was developed and provided to PACU nurses of a large, Midwestern hospital in regards to the identification of the occurrence, associated risk factors, multifactorial causes, and effective treatment options for ED. A two-group comparative design was used based on medical records selected using a convenience sampling. Pre-intervention group data was collected from 28 samples prior to the educational sessions and post intervention group data was collected from 24 samples after the implementation. Findings revealed an overall decrease in analgesic use with a significant decrease in the use of stadol, while the use of acetaminophen and fentanyl increased. Data also demonstrated higher PAED scores correlated positively with weight and being of Hispanic race. The results of this EBP project lend limited support for the use of ED education to affect analgesic usage among PACU nurses

Simple Strategic Analysis Tools at SMEs in Ecuador

This article explores the possible applications of Strategic Analysis Tools (SAT) in SMEs located in emerging countries such as Ecuador (where there are no formal studies on the subject). It is intended to analyze if whether or not it is feasible to effectively apply a set of proposed tools to guide mental map decisions of executives when decisions on strategy have to be made.Through an in-depth review of the state of the art in regards to SAT and interviews performed to main participants such as chambers and executives of different firms, it is shown the feasibility of their application. This analysis is complemented with specialists´ interviews to deepen our insights and obtaining valid conclusions. Our conclusion is that SMEs can smoothly develop and apply an appropriate set of SAT when opting for very relevant choices. However, there are some inconveniences to be solved which are connected with resources (such as peoples’ abilities and technology) and behavioral (cultural factors and methodological processes).Once these barriers are knocked down, it would be more likely to enrich current approaches to make strategic decisions even more effective.This is a qualitative investigation and the research design is not experimental (among them it is transversal as it relates to a specific moment in time)