Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606

Introduction of new medicines in Sweden

Payers and providers face challenges in enabling appropriate and sustainable access to new medicines. To help enable rational use of new medicines various policy options exist. In Sweden, horizon scanning, forecasting, value-based pricing and reimbursement, treatment recommendations, and assessment of drug utilization patterns and patient outcomes in routine clinical practice have been used to facilitate rational introduction of new medicines. Such activities, however, should be informed by research and be subject to continuous evaluation. This thesis aims to examine selected elements of the process for managed introduction of new medicines. Study I provides an evaluation of the Swedish Horizon Scanning System. Study II assesses the impact of treatment recommendations on the use of new medicines in the specialized care setting. Finally, studies III and IV explore the utility of healthcare databases in the assessment of real-world use and outcomes of two specialist medicines prioritized for managed introduction. Different types of data were used in these studies, including public assessment reports published by the European Medicines Agency, early assessment reports prepared by the Swedish Horizon Scanning System, national sales data on all inpatient and outpatient medicines, regional administrative healthcare services data, and national registers of Statistics Sweden and the National Board of Health and Welfare. The evaluation of the Swedish Horizon Scanning System demonstrates that all innovative medicines that had substantial economic impact were identified and assessed prior to their introduction. The assessment of the impact of treatment recommendations shows that both local and regional treatment recommendations were associated with changes in the use of new medicines. Both regional and national healthcare databases provide the opportunity to study the use and outcomes of new medicines in routine clinical practice. The findings indicate that healthcare decision makers can rely on the outputs of the Swedish Horizon Scanning System to keep informed of new medicines. Moreover, treatment recommendations appear to influence the uptake and utilization of new specialist medicines. Finally, even though the existing Swedish data sources provide unique research opportunities, the assessment of appropriate use and relevant outcomes of the growing number of new specialist medicines may still be impeded by a lack of fit-for-purpose data

Healthcare provision in the Gambia : the role of health informatics

While technological advances in computing and telecommunications are revolutionising the way many organisations work, healthcare systems in The Gambia are very much lagging behind. No proper patient records or filing systems are in place. Delivery of effective healthcare depends on availability of routinely collected, good quality health data to provide useful information that is accessible when and where it is needed. Presently, in The Gambia, there is considerable scope for improvement in relation to such data. Electronic patient record system is long overdue. This research, focuses on the development of a Health Information System (HIS) capable of providing doctors, nurses and other healthcare professionals with quick and easy access to the appropriate information needed to care for their patients. A systems analysis has been undertaken to identify the full need for patient health data, the range of users and the extent of present paper-based provision. From this analysis, a requirements specification has been produced for a proposed health information and administration system (HIAS) to become operational and also successful in terms of efficiency and effectiveness. The requirements specification has taken the form of a series of precise statements of needs, buttressed with a corresponding justification in each case. By assessing what information and communication technology (lCT) is required and feasible, affordable and available in The Gambia, based on the extensive fieldwork involving interviews, observational study and questionnaires, a design specification (the logical and physical framework for the proposed ,IUAS) has also been produced as a precursor to the development of the proposed HIAS prototype. The approach,used will aid any implementor to progress from the proposed system to a fully functional one in an efficient and timely manner. Constraints in the programme of research were such that it was not possible to continue on with a prototype implementation based on this design. Hence it is now for The Gambia government to study and implement the proposed system. Several recommendations have been made in the areas of policies to be implemented, resources needed and training and motivation. In conclusion, the study has demonstrated the value or role of health informatics in the provision of health care in a developing country. It has contributed in the understanding of the complexities of the problems in The Gambia and developing countries, building this understanding in terms of requirements analysis and design specification and in methodological issues

A strategic roadmap for achieving the potential benefits of electronic health record system in the state of Kuwait

This research investigates the desired benefits of using an Electronic Health Record (EHR) in Kuwait Primary Health Care Centers and the perceived barriers to its successful adoption. From this, a set of key strategic capabilities are proposed, ranked for priority and urgency as a roadmap for EHR adoption in the State of Kuwait. This thesis examines the organization of the health care system in Kuwait and important issues related to primary health care, including the implementation and current use of the EHR system at Kuwait primary health care centers. International evidence of the EHR system benefits, barriers and capabilities such as interoperability, confidentiality and security were used as the basis for user surveys. The research applied domain theory and research-based improvement strategy as a means of identifying the stakeholders and the priorities area of investigation. The research utilized a quantitative research design focusing on multiple case studies as the survey methodology. Two case study surveys were conducted to identify the main benefits and barriers that affect the adoption of the EHR at international and national (Kuwaiti) levels. The first survey involved international and national decision makers. The second survey involved healthcare professionals working in Kuwait primary health care to assess their view regarding the features of the current system, the benefits and barriers of more complete EHRs. The results of first and second surveys were used to develop a list of key EHR system capabilities and adoption requirements relevant to Kuwait primary care. This list was used for the design of a third survey, for senior stakeholders at the Kuwait Ministry of Health, to identify their strategic roadmap priorities. This research, drawing on the literature of the EHR design and implementation, a study of international initiatives of the EHR adoption and outputs of three case studies, has emphasized the importance of developing a strategic roadmap for Kuwait to achieve the potential benefits of EHRs

Proceedings of the Eighth Italian Conference on Computational Linguistics CliC-it 2021

The eighth edition of the Italian Conference on Computational Linguistics (CLiC-it 2021) was held at Università degli Studi di Milano-Bicocca from 26th to 28th January 2022. After the edition of 2020, which was held in fully virtual mode due to the health emergency related to Covid-19, CLiC-it 2021 represented the first moment for the Italian research community of Computational Linguistics to meet in person after more than one year of full/partial lockdown

Unmet goals of tracking: within-track heterogeneity of students' expectations for

Educational systems are often characterized by some form(s) of ability grouping, like tracking. Although substantial variation in the implementation of these practices exists, it is always the aim to improve teaching efficiency by creating homogeneous groups of students in terms of capabilities and performances as well as expected pathways. If students’ expected pathways (university, graduate school, or working) are in line with the goals of tracking, one might presume that these expectations are rather homogeneous within tracks and heterogeneous between tracks. In Flanders (the northern region of Belgium), the educational system consists of four tracks. Many students start out in the most prestigious, academic track. If they fail to gain the necessary credentials, they move to the less esteemed technical and vocational tracks. Therefore, the educational system has been called a 'cascade system'. We presume that this cascade system creates homogeneous expectations in the academic track, though heterogeneous expectations in the technical and vocational tracks. We use data from the International Study of City Youth (ISCY), gathered during the 2013-2014 school year from 2354 pupils of the tenth grade across 30 secondary schools in the city of Ghent, Flanders. Preliminary results suggest that the technical and vocational tracks show more heterogeneity in student’s expectations than the academic track. If tracking does not fulfill the desired goals in some tracks, tracking practices should be questioned as tracking occurs along social and ethnic lines, causing social inequality

ATEE Spring Conference 2020-2021

This book collects some of the works presented at ATEE Florence Spring Conference 2020-2021. The Conference, originally planned for May 2020, was forcefully postponed due to the dramatic insurgence of the pandemic. Despite the difficulties in this period, the Organising Committee decided anyway to keep it, although online and more than one year later, not to disperse the huge work of authors, mainly teachers, who had to face one of the hardest challenges in the last decades, in a historic period where the promotion of social justice and equal opportunities – through digital technologies and beyond – is a key factor for democratic citizenship in our societies. The Organising Committee, the University of Florence, and ATEE wish to warmly thank all the authors for their commitment and understanding, which ensured the success of the Conference. We hope this book could be, not only a witness of these pandemic times, but a hopeful sign for an equal and inclusive education in all countries

Esa 12th Conference: Differences, Inequalities and Sociological Imagination: Abstract Book

Esa 12th Conference: Differences, Inequalities and Sociological Imagination: Abstract Boo