Linked Data based Health Information Representation, Visualization and Retrieval System on the Semantic Web

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.To better facilitate health information dissemination, using flexible ways to represent, query and visualize health data becomes increasingly important. Semantic Web technologies, which provide a common framework by allowing data to be shared and reused between applications, can be applied to the management of health data. Linked open data - a new semantic web standard to publish and link heterogonous data- allows not only human, but also machine to brows data in unlimited way. Through a use case of world health organization HIV data of sub Saharan Africa - which is severely affected by HIV epidemic, this thesis built a linked data based health information representation, querying and visualization system. All the data was represented with RDF, by interlinking it with other related datasets, which are already on the cloud. Over all, the system have more than 21,000 triples with a SPARQL endpoint; where users can download and use the data and – a SPARQL query interface where users can put different type of query and retrieve the result. Additionally, It has also a visualization interface where users can visualize the SPARQL result with a tool of their preference. For users who are not familiar with SPARQL queries, they can use the linked data search engine interface to search and browse the data. From this system we can depict that current linked open data technologies have a big potential to represent heterogonous health data in a flexible and reusable manner and they can serve in intelligent queries, which can support decision-making. However, in order to get the best from these technologies, improvements are needed both at the level of triple stores performance and domain-specific ontological vocabularies

Development of the Lymphoma Enterprise Architecture Database: A caBIG(tm) Silver level compliant System

Lymphomas are the fifth most common cancer in United States with numerous histological subtypes. Integrating existing clinical information on lymphoma patients provides a platform for understanding biological variability in presentation and treatment response and aids development of novel therapies. We developed a cancer Biomedical Informatics Grid™ (caBIG™) Silver level compliant lymphoma database, called the Lymphoma Enterprise Architecture Data-system™ (LEAD™), which integrates the pathology, pharmacy, laboratory, cancer registry, clinical trials, and clinical data from institutional databases. We utilized the Cancer Common Ontological Representation Environment Software Development Kit (caCORE SDK) provided by National Cancer Institute’s Center for Bioinformatics to establish the LEAD™ platform for data management. The caCORE SDK generated system utilizes an n-tier architecture with open Application Programming Interfaces, controlled vocabularies, and registered metadata to achieve semantic integration across multiple cancer databases. We demonstrated that the data elements and structures within LEAD™ could be used to manage clinical research data from phase 1 clinical trials, cohort studies, and registry data from the Surveillance Epidemiology and End Results database. This work provides a clear example of how semantic technologies from caBIG™ can be applied to support a wide range of clinical and research tasks, and integrate data from disparate systems into a single architecture. This illustrates the central importance of caBIG™ to the management of clinical and biological data

Towards a Learning Health System: a SOA based platform for data re-use in chronic infectious diseases

Abstract Information and Communication Technology (ICT) tools can efficiently support clinical research by providing means to collect automatically huge amount of data useful for the management of clinical trials conduction. Clinical trials are indispensable tools for Evidence-Based Medicine and represent the most prevalent clinical research activity. Clinical trials cover only a restricted part of the population that respond to particular and strictly controlled requirements, offering a partial view of the overall patients\u2019 status. For instance, it is not feasible to consider patients with comorbidities employing only one kind of clinical trial. Instead, a system that have a comprehensive access to all the clinical data of a patient would have a global view of all the variables involved, reflecting real-world patients\u2019 experience. The Learning Health System is a system with a broader vision, in which data from various sources are assembled, analyzed by various means and then interpreted. The Institute of Medicine (IOM) provides this definition: \u201cIn a Learning Health System, progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural by-product of the care experience, and seamlessly refine and deliver best practices for continuous improvement in health and health care\u201d. The final goal of my project is the realization of a platform inspired by the idea of Learning Health System, which will be able to re-use data of different nature coming from widespread health facilities, providing systematic means to learn from clinicians\u2019 experience to improve both the efficiency and the quality of healthcare delivery. The first approach is the development of a SOA-based architecture to enable data collection from sparse facilities into a single repository, to allow medical institutions to share information without an increase in costs and without the direct involvement of users. Through this architecture, every single institution would potentially be able to participate and contribute to the realization of a Learning Health System, that can be seen as a closed cycle constituted by a sequential process of transforming patient-care data into knowledge and then applying this knowledge to clinical practice. Knowledge, that can be inferred by re-using the collected data to perform multi-site, practice-based clinical trials, could be concretely applied to clinical practice through Clinical Decision Support Systems (CDSS), which are instruments that aim to help physicians in making more informed decisions. With 4 this objective, the platform developed not only supports clinical trials execution, but also enables data sharing with external research databases to participate in wider clinical trials also at a national level without effort. The results of these studies, integrated with existing guidelines, can be seen as the knowledge base of a decision support system. Once designed and developed, the adoption of this system for chronical infective diseases management at a regional level helped in unifying data all over the Ligurian territory and actively monitor the situation of specific diseases (like HIV, HCV and HBV) for which the concept of retention in care assumes great importance. The use of dedicated standards is essential to grant the necessary level of interoperability among the structures involved and to allow future extensions to other fields. A sample scenario was created to support antiretroviral drugs prescription in the Ligurian HIV Network setting. It was thoroughly tested by physicians and its positive impact on clinical care was measured in terms of improvements in patients\u2019 quality of life, prescription appropriateness and therapy adherence. The benefits expected from the employment of the system developed were verified. Student\u2019s T test was used to establish if significant differences were registered between data collected before and after the introduction of the system developed. The results were really acceptable with the minimum p value in the order of 10 125 and the maximum in the order of 10 123. It is reasonable to assess that the improvements registered in the three analysis considered are ascribable to this system introduction and not to other factors, because no significant differences were found in the period before its release. Speed is a focal point in a system that provides decision support and it is highly recognized the importance of velocity optimization. Therefore, timings were monitored to evaluate the responsiveness of the system developed. Extremely acceptable results were obtained, with the waiting times of the order of 10 121 seconds. The importance of the network developed has been widely recognized by the medical staff involved, as it is also assessed by a questionnaire they compiled to evaluate their level of satisfaction

Provenance of "after the fact" harmonised community-based demographic and HIV surveillance data from ALPHA cohorts

Background: Data about data, metadata, for describing Health and Demographic Surveillance System (HDSS) data have often received insufficient attention. This thesis studied how to develop provenance metadata within the context of HDSS data harmonisation - the network for Analysing Longitudinal Population-based HIV/ AIDS data on Africa (ALPHA). Technologies from the data documentation community were customised, among them: A process model - Generic Longitudinal Business Process Model (GLBPM), two metadata standards - Data Documentation Initiative (DDI) and Standard for Data and Metadata eXchange (SDMX) and a data transformations description language - Structured Data Transform Language (SDTL). Methods: A framework with three complementary facets was used: Creating a recipe for annotating primary HDSS data using the GLBPM and DDI; Approaches for documenting data transformations. At a business level, prospective and retrospective documentation using GLBPM and DDI and retrospectively recovering the more granular details using SDMX and SDTL; Requirements analysis for a user-friendly provenance metadata browser. Results: A recipe for the annotation of HDSS data was created outlining considerations to guide HDSS on metadata entry, staff training and software costs. Regarding data transformations, at a business level, a specialised process model for the HDSS domain was created. It has algorithm steps for each data transformation sub-process and data inputs and outputs. At a lower level, the SDMX and SDTL captured about 80% (17/21) of the variable level transformations. The requirements elicitation study yielded requirements for a provenance metadata browser to guide developers. Conclusions: This is a first attempt ever at creating detailed metadata for this resource or any other similar resources in this field. HDSS can implement these recipes to document their data. This will increase transparency and facilitate reuse thus potentially bringing down costs of data management. It will arguably promote the longevity and wide and accurate use of these data

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

Rsquared: researching the researchers. A study into how the researchers at the University of New South Wales use and share research data

This paper presents a research study of data usage, creation and sharing within different research communities at UNSW. The study identifies emerging data usage and management needs within the e-research life cycle of diverse research communities. Comparison is made with the outcomes of other studies that have examined e-researcher work practices in relation to their data. The paper examines the findings to understand what role researchers see libraries having, and discusses the development of a framework that libraries can use to support the curation and management of data and the development of tools and library support services that can be used across disciplines

The Secondary Use of Longitudinal Critical Care Data

Aims To examine the strengths and limitations of a novel United Kingdom (UK) critical care data resource that repurposes routinely collected physiological data for research. Exemplar clinical research studies will be developed to explore the unique longitudinal nature of the resource. Objectives - To evaluate the suitability of the National Institute for Health Research (NIHR) Critical Care theme of the Health Informatics Collaborative (CCHIC) data model as a representation of the Electronic Health Record (EHR) for secondary research use. - To conduct a data quality evaluation of data stored within the CC-HIC research database. - To use the CC-HIC research database to conduct two clinical research studies that make use of the longitudinal data supported by the CC-HIC: - The association between cumulative exposure to excess oxygen and outcomes in the critically ill. - The association between different morphologies of longitudinal physiology—in particular organ dysfunction—and outcomes in sepsis. The CC-HIC The EHR is now routinely used for the delivery of patient care throughout the United Kingdom (UK). This has presented the opportunity to learn from a large volume of routinely collected data. The CC-HIC data model represents 255 distinct clinical concepts including demographics, outcomes and granular longitudinal physiology. This model is used to harmonise EHR data of 12 contributing Intensive Care Units (ICUs). This thesis evaluates the suitability of the CC-HIC data model in this role and the quality of data within. While representing an important first step in this field, the CC-HIC data model lacks the necessary normalisation and semantic expressivity to excel in this role. The quality of the CC-HIC research database was variable between contributing sites. High levels of missing data, missing meta-data, non-standardised units and temporal drop out of submitted data are amongst the most challenging features to tackle. It is the principal finding of this thesis that the CC-HIC should transition towards implementing internationally agreed standards for interoperability. Exemplar Clinical Studies Two exemplar studies are presented, each designed to make use of the longitudinal data made available by the CC-HIC and address domains that are both contemporaneous and of importance to the critical care community. Exposure to Excess Oxygen Longitudinal data from the CC-HIC cohort were used to explore the association between the cumulative exposure to excess oxygen and outcomes in the critically ill. A small (likely less than 1% absolute risk reduction) dose-independent association was found between exposure to excess oxygen and mortality. The lack of dosedependency challenges a causal interpretation of these findings. Physiological Morphologies in Sepsis The joint modelling paradigm was applied to explore the different longitudinal profiles of organ failure in sepsis, while accounting for informative censoring from patient death. The rate of change of organ failure was found to play a more significan't role in outcomes than the absolute value of organ failure at a given moment. This has important implications for how the critical care community views the evolution of physiology in sepsis. DECOVID The Decoding COVID-19 (DECOVID) project is presented as future work. DECOVID is a collaborative data sharing project that pools clinical data from two large NHS trusts in England. Many of the lessons learnt from the prior work with the CC-HIC fed into the development of the DECOVID data model and its quality evaluation