A Prototype Model Using Clinical Document Architecture (CDA) with a Japanese Local Standard : Designing and Implementing a Referral Letter System

Since clinical document architecture (CDA) became an American National Standards Institute (ANSI)-approved health level seven (HL7) Standard, many countries have begun making an eff ort to make local standards conform to CDA. In order to make CDA compatible with the many diff erent local standards existing in diff erent countries, we designed a prototype model using HL7 CDA R2 with medical markup language (MML), a Japanese medical data exchange standard. Furthermore, a referral letter system based on this model was developed. Archetypes were used to express medical concepts in a formal manner and to make 2 diff erent standards work collaboratively. We share herein the experience gathered in designing and implementing a referral letter system based on HL7 CDA, Release 2 (CDA R2). We also outline the challenges encountered in our project and the opportunities to widen the scope of this approach to other clinical documents.</p

Current status of urban wastewater treatment plants in China

© 2016 Elsevier Ltd. The study reported and analyzed the current state of wastewater treatment plants (WWTPs) in urban China from the perspective of treatment technologies, pollutant removals, operating load and effluent discharge standards. By the end of 2013, 3508 WWTPs have been built in 31 provinces and cities in China with a total treatment capacity of 1.48 × 108 m3/d. The uneven population distribution between China's east and west regions has resulted in notably different economic development outcomes. The technologies mostly used in WWTPs are AAO and oxidation ditch, which account for over 50% of the existing WWTPs. According to statistics, the efficiencies of COD and NH3-N removal are good in 656 WWTPs in 70 cities. The overall average COD removal is over 88% with few regional differences. The average removal efficiency of NH3-N is up to 80%. Large differences exist between the operating loads applied in different WWTPs. The average operating loading rate is approximately 83%, and 52% of WWTPs operate at loadings of <80%, treating up to 40% of the wastewater generated. The implementation of discharge standards has been low. Approximately 28% of WWTPs that achieved the Grade I-A Discharge Standard of Pollutants for Municipal Wastewater Treatment Plant (GB 18918-2002) were constructed after 2010. The sludge treatment and recycling rates are only 25%, and approximately 15% of wastewater is inefficiently treated. Approximately 60% of WWTPs have capacities of 1 × 104 m3/d-5 × 104 m3/d. Relatively high energy consumption is required for small-scale processing, and the utilization rate of recycled wastewater is low. The challenges of WWTPs are discussed with the aim of developing rational criteria and appropriate technologies for water recycling. Suggestions regarding potential technical and administrative measures are provided

Automation of a problem list using natural language processing

BACKGROUND: The medical problem list is an important part of the electronic medical record in development in our institution. To serve the functions it is designed for, the problem list has to be as accurate and timely as possible. However, the current problem list is usually incomplete and inaccurate, and is often totally unused. To alleviate this issue, we are building an environment where the problem list can be easily and effectively maintained. METHODS: For this project, 80 medical problems were selected for their frequency of use in our future clinical field of evaluation (cardiovascular). We have developed an Automated Problem List system composed of two main components: a background and a foreground application. The background application uses Natural Language Processing (NLP) to harvest potential problem list entries from the list of 80 targeted problems detected in the multiple free-text electronic documents available in our electronic medical record. These proposed medical problems drive the foreground application designed for management of the problem list. Within this application, the extracted problems are proposed to the physicians for addition to the official problem list. RESULTS: The set of 80 targeted medical problems selected for this project covered about 5% of all possible diagnoses coded in ICD-9-CM in our study population (cardiovascular adult inpatients), but about 64% of all instances of these coded diagnoses. The system contains algorithms to detect first document sections, then sentences within these sections, and finally potential problems within the sentences. The initial evaluation of the section and sentence detection algorithms demonstrated a sensitivity and positive predictive value of 100% when detecting sections, and a sensitivity of 89% and a positive predictive value of 94% when detecting sentences. CONCLUSION: The global aim of our project is to automate the process of creating and maintaining a problem list for hospitalized patients and thereby help to guarantee the timeliness, accuracy and completeness of this information

Non-invasive lightweight integration engine for building EHR from autonomous distributed systems

[EN] In this paper we describe Pangea-LE, a message-oriented lightweight data integration engine that allows homogeneous and concurrent access to clinical information from disperse and heterogeneous data sources. The engine extracts the information and passes it to the requesting client applications in a flexible XML format. The XML response message can be formatted on demand by appropriate Extensible Stylesheet Language (XSL) transformations in order to meet the needs of client applications. We also present a real deployment in a hospital where Pangea-LE collects and generates an XML view of all the available patient clinical information. The information is presented to healthcare professionals in an Electronic Health Record (EHR) viewer Web application with patient search and EHR browsing capabilities. Implantation in a real setting has been a success due to the non-invasive nature of Pangea-LE which respects the existing information systems.This work was partially funded by the Spanish Ministry of Science and Technology (MEC-TSI2004-06475-102-01) and the Spanish Ministry of Health (PI052245)Angulo Fernández, C.; Crespo Molina, PM.; Maldonado Segura, JA.; Moner Cano, D.; Perez Cuesta, D.; Abad, I.; Mandingorra Gimenez, J.... (2007). Non-invasive lightweight integration engine for building EHR from autonomous distributed systems. International Journal of Medical Informatics. 76(Supplement 3):417-424. https://doi.org/10.1016/j.ijmedinf.2007.05.002S41742476Supplement

Performance Analysis of a Medical Record Exchanges Model(SCI)

[[abstract]]Electronic medical record exchange among hospitals can provide more information for physician diagnosis and reduce costs from duplicate examinations. In this paper, we proposed and implemented a medical record exchange model. According to our study, exchange interface servers (EISs) are designed for hospitals to manage the information communication through the intra and interhospital networks linked with a medical records database. An index service center can be given responsibility for managing the EIS and publishing the addresses and public keys. The prototype system has been implemented to generate, parse, and transfer the health level seven query messages. Moreover, the system can encrypt and decrypt a message using the public-key encryption algorithm. The queuing theory is applied to evaluate the performance of our proposed model. We estimated the service time for each queue of the CPU, database, and network, and measured the response time and possible bottlenecks of the model. The capacity of the model is estimated to process the medical records of about 4000 patients/h in the 1-MB network backbone environments, which comprises about the 4% of the total outpatients in Taiwan. Performance Analysis of a Medical Record Exchanges Model (PDF Download Available). Available from: https://www.researchgate.net/publication/51375541_Performance_Analysis_of_a_Medical_Record_Exchanges_Model [accessed Jan 15, 2016]

Challenges for IT-supported shared care: a qualitative analyses of two shared care initiatives for diabetes treatment in Denmark “I'll never use it” (GP5).

<b>Purpose:</b> To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care.<br><br> <b>Case study:</b> The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care.<br><br> <b>Discussion and conclusion:</b> The two cases faced the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general practitioners which hinder bridging the primary sector (general practitioners) and the secondary sector (hospitals and outpatient clinics). Especially the needs associated with the primary sector were not being satisfied. We discovered three main challenges related to bridging the gap between the two sectors: (1) Poor integration with the general practitioners' existing IT systems; (2) low compatibility with general practitioners' work ethic; (3) and discrepancy between the number of diabetes patients and the related need for shared care. We conclude that development of IT-supported shared care must recognise the underlying and significant differences between the primary and secondary care sectors: If IT-supported shared care does not meet the needs of the general practitioners as well as the needs of the secondary care sector the initiative will fail

Konzepte zur elektronischen Arztbriefschreibung und -Übermittlung:Verbesserung der interinstitutionellen Kommunikationsstrukturen im Gesundheitswesen mit der Clinical Document Architecture (CDA)

Trotz der wachsenden Notwendigkeit einer effektiven und zeitnahen Kommunikation zwischen Leistungserbringern in den verschiedenen Bereichen des Gesundheitswesens, finden wir eine vornehmlich papier-basierte Dokumentation vor. Fehlende Standards und die Heterogenität der IT-Landschaft verhindern eine echte Interoperabilität. Im Rahmen dieser Arbeit wurde die Verbesserung der Kommunikation zwischen Krankenhäusern und niedergelassenen Ärzten durch die Einführung strukturierter, elektronischer Arztbriefe und ihrer Übermittlung demonstriert. Als Standard wurde die auf XML basierende HL7 Clinical Document Architecture (CDA) ausgewählt. Nach Analyse der mit dem Arztbrief verbundenen Prozesse wurde der Arbeitsablauf im Krankenhausinformationssystem (KIS) abgebildet. Weiterhin wurde ein Mechanismus entwickelt, der nach Transformierung und Verschlüsselung den Versand über ein email-basiertes Versandsystem realisierte. Anschließend wurden die empfangenen Daten in das Zielsystem importiert

Semantic Interoperability in electronic health record: a standardised approach

The main objective of this study is to compare two major international standardisation approaches that enable semantic interoperability in electronic health record (EHR) , to identify harmonisation efforts between the two approaches and to suggest possibilities on future harmonisation. Archetypes and HL7 are the two major approaches in current Electronic Health Record development, but their approaches to semantic interoperability are very different. Many countries, organisations, and companies have adopted the overlapping approaches. It is very difficult for systems adopting different approaches to communicate. Harmonisation is one possible way other than replacing each other to settle this issue. The thesis first presents overviews on semantic interoperability in information system, electronic health records and international interoperability standards. Then, detail studies in the two approaches are conducted by reviewing articles and international standards. A set of prerequisites of semantic interoperability is used to evaluate the approaches. Finally, differences between the two approaches and harmonisation efforts are identified. The result suggests that both approach are sufficient to support semantic interoperability. Despite their incompatibility harmonisation efforts have appeared to alleviate the problem. Further harmonisation is essential and experiences may be adopted from other industries