The CliniCon framework for context representation in electronic patient records

A well-known problem of current electronic patient records in that they usually fail to represent the semantic relationships between the involved clinical data. This has to be viewed as a problem especially in the domains characterized by a complex and long-term treatment, as the medical decision making process may not be comprehensible anymore from the data entries themselves. Context representation can overcome these limitations, enabling the record to express causality, revisions, conflicts, or individual heuristics explicitly. This article introduces CLINICON which is a formal framework for domain-independent context representation based on Sowa's conceptual graphs

Using conceptual graphs for clinical guidelines representation and knowledge visualization

The intrinsic complexity of the medical domain requires the building of some tools to assist the clinician and improve the patient’s health care. Clinical practice guidelines and protocols (CGPs) are documents with the aim of guiding decisions and criteria in specific areas of healthcare and they have been represented using several languages, but these are difficult to understand without a formal background. This paper uses conceptual graph formalism to represent CGPs. The originality here is the use of a graph-based approach in which reasoning is based on graph-theory operations to support sound logical reasoning in a visual manner. It allows users to have a maximal understanding and control over each step of the knowledge reasoning process in the CGPs exploitation. The application example concentrates on a protocol for the management of adult patients with hyperosmolar hyperglycemic state in the Intensive Care Unit

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

Costs of quality assurance in the German medical market.

The central subject of this dissertation, combined with a methodological study, is the economic analysis of Quality Assurance in the German health care system. With the help of the study an estimate of the total costs in the German health care market shall be given. The focus of the analysis is on Companies, Political Bodies, Liberal Professions and Public Corporations which are part of the health care system including Certification Bodies, which lead to costs from using Quality Assurance and interacting with the health care system. First, a systematic literature search was conducted to determine the costs. It was found that there are no articles or publications that address the topic of total cost of quality assurance. A continuation/update of existing studies was therefore not possible. To be able to estimate the total costs of Quality Assurance in the German health care market, the Quality Assurance costs were surveyed using a bottom-up analysis. After identifying organizations and collecting relevant data, the total costs of quality assurance in the German healthcare market were estimated using a mathematical calculation. In general, ensuring quality is an original part of the actions of all professional groups and institutions working in the health care system. Due to this importance, it is remarkable that an economic analysis of the total costs has never taken place before. One reason for this may be the "complexity of the German health care system". Furthermore, the costs of quality assurance are not listed separately, but as part of general administrative expenses. Controlling and transparent presentation of the costs is therefore not possible. The cost estimation and the database created for this study about the parties involved in quality assurance in the German health care market can be a useful support for further studies in this field of research.Medicin

Event-Oriented Dynamic Adaptation of Workflows: Model, Architecture and Implementation

Workflow management is widely accepted as a core technology to support long-term business processes in heterogeneous and distributed environments. However, conventional workflow management systems do not provide sufficient flexibility support to cope with the broad range of failure situations that may occur during workflow execution. In particular, most systems do not allow to dynamically adapt a workflow due to a failure situation, e.g., to dynamically drop or insert execution steps. As a contribution to overcome these limitations, this dissertation introduces the agent-based workflow management system AgentWork. AgentWork supports the definition, the execution and, as its main contribution, the event-oriented and semi-automated dynamic adaptation of workflows. Two strategies for automatic workflow adaptation are provided. Predictive adaptation adapts workflow parts affected by a failure in advance (predictively), typically as soon as the failure is detected. This is advantageous in many situations and gives enough time to meet organizational constraints for adapted workflow parts. Reactive adaptation is typically performed when predictive adaptation is not possible. In this case, adaptation is performed when the affected workflow part is to be executed, e.g., before an activity is executed it is checked whether it is subject to a workflow adaptation such as dropping, postponement or replacement. In particular, the following contributions are provided by AgentWork: A Formal Model for Workflow Definition, Execution, and Estimation: In this context, AgentWork first provides an object-oriented workflow definition language. This language allows for the definition of a workflow\u92s control and data flow. Furthermore, a workflow\u92s cooperation with other workflows or workflow systems can be specified. Second, AgentWork provides a precise workflow execution model. This is necessary, as a running workflow usually is a complex collection of concurrent activities and data flow processes, and as failure situations and dynamic adaptations affect running workflows. Furthermore, mechanisms for the estimation of a workflow\u92s future execution behavior are provided. These mechanisms are of particular importance for predictive adaptation. Mechanisms for Determining and Processing Failure Events and Failure Actions: AgentWork provides mechanisms to decide whether an event constitutes a failure situation and what has to be done to cope with this failure. This is formally achieved by evaluating event-condition-action rules where the event-condition part describes under which condition an event has to be viewed as a failure event. The action part represents the necessary actions needed to cope with the failure. To support the temporal dimension of events and actions, this dissertation provides a novel event-condition-action model based on a temporal object-oriented logic. Mechanisms for the Adaptation of Affected Workflows: In case of failure situations it has to be decided how an affected workflow has to be dynamically adapted on the node and edge level. AgentWork provides a novel approach that combines the two principal strategies reactive adaptation and predictive adaptation. Depending on the context of the failure, the appropriate strategy is selected. Furthermore, control flow adaptation operators are provided which translate failure actions into structural control flow adaptations. Data flow operators adapt the data flow after a control flow adaptation, if necessary. Mechanisms for the Handling of Inter-Workflow Implications of Failure Situations: AgentWork provides novel mechanisms to decide whether a failure situation occurring to a workflow affects other workflows that communicate and cooperate with this workflow. In particular, AgentWork derives the temporal implications of a dynamic adaptation by estimating the duration that will be needed to process the changed workflow definition (in comparison with the original definition). Furthermore, qualitative implications of the dynamic change are determined. For this purpose, so-called quality measuring objects are introduced. All mechanisms provided by AgentWork include that users may interact during the failure handling process. In particular, the user has the possibility to reject or modify suggested workflow adaptations. A Prototypical Implementation: Finally, a prototypical Corba-based implementation of AgentWork is described. This implementation supports the integration of AgentWork into the distributed and heterogeneous environments of real-world organizations such as hospitals or insurance business enterprises

Making Government Work: Electronic Delivery of Federal Services

This report focuses on key topics and issues that are central to the successful use of electronic deli very by government. This report provides Congress with alternative strategies for improving the performance of government by using modern information technologies

Catalog (Florida International University). [1977-1978]

https://digitalcommons.fiu.edu/catalogs/1054/thumbnail.jp

Bulletin of The University of New Hampshire. Undergraduate Catalog 1989-1990

The Bulletin of the University of New Hampshire Undergraduate Catalog contains general information about the university. It is published twice in December, January, and February, and once each in March, April, July, and August