Designing and using an information infrastructure in radiology : prepare - share - compare IT

Radiology informatics is changing the way that work practice and planning of work are conducted in the radiology department and between radiology departments. Today, the need for sharing of information between organizations is increasing in parallel with the growth in both patient mobility and healthcare specialization. This sets demands on the information infrastructure in use regarding interoperability issues as well as distribution problems with the focus on metadata quality in the information shared. The new shared approach marks the beginning of a change from a local to an enterprise workflow. The challenges are to develop useful and secure services for different groups related to the radiological information infrastructure. It involves continuous negotiation with people concerning how they should collaborate within the enterprise. Therefore qualitative action research methods and quantitative methods were used in this thesis. The objective of this research was to understand how to use distributed information in a change process where radiology departments needed to invest in and use new technology that had not been used before in their local workflow, using simulation as a tool for changes in work practice. A further objective was to understand what types of metadata were needed for a radiology enterprise workflow across organizational boundaries. The quality of metadata used in the information infrastructure is critical to the use and benefits this enterprise workflow will gain throughout the patient healthcare process. It is concluded that only a few items of shared metadata are needed to support an effective enterprise workflow. This means that the technical fully working cross-organizational solution is hindered to function as an information infrastructure for collaboration between all departments and hospitals in the region if the quality of metadata elements is poor. It would thus be warranted that as many elements of metadata that has a national semantic definition taken by agencies become mandatory across the society. All semantic standardization initiatives, e.g. Snomed CT are enablers for cross-organizational workflow. It is of importance for interoperability that the agreed semantic models are implemented both in vendor systems and in local workflow so they can support new cross-organizational services around the patient’s health as shown in VGR. In conclusion, this thesis shows that the transformation of digital data in local systems into virtual information in an information infrastructure creates greater potential for using the digital information to improve planning and logistics within the information infrastructure in use, regardless of the local systems involved. Quality control and management of the data make it possible to derive information from it. Quality work should be done based on an information model grounded in useable standards and legal sources for metadata elements. The key success factor seems to be creating and holding an information infrastructure with quality of the metadata elements. Implementing an information infrastructure takes time and therefore needs special attention from a strategic viewpoint

Clinical features of patients with non-metastatic lung cancer in primary care: a case-control study

Background: Lung cancer (LC) kills more people than any other cancer globally, mainly due to the late stage of diagnosis. Aim: To identify and quantify the prediagnostic features of non-metastatic lung cancer (nMLC) and to compare the clinical features in GPs’ chest X-ray referral letters with the clinical features (expressed as diagnostic codes) in medical records. Design & setting: A population-based case-control study was conducted using diagnostic codes from national and regional healthcare databases in Sweden. Method: In total, 373 patients diagnosed with LC in 2011 (of which 132 had nMLC) and 1472 controls were selected from the Swedish Cancer Register (SCR) and regional healthcare database, respectively. Diagnostic codes registered in medical records from primary care consultations in the year before LC diagnosis were collected from the regional healthcare database. Odds ratios (OR) were calculated for variables associated with nMLC. The GPs’ referral letters for chest X- ray were retrieved from the regional repository for radiology. Results: Clinical features with the highest OR were vitamin B12 deficiency anaemia (OR 6.7, 95% confidence interval [CI] = 1.6 to 27.9), dyspnoea (OR 5.0, 95% CI = 2.0 to 12.7), and chronic bronchitis (OR 5.0, 95% CI = 1.3 to 18.6). Clinical features that were GPs’ reasons for requesting chest X-ray were almost three times more frequent in referral letters compared to the corresponding diagnostic codes in the medical records. Conclusion: Patients with nMLC could not be identified by symptoms. The clinical features in referral letters for X-ray were more frequent than corresponding diagnostic codes from medical records

On-Site Visualization of Ballistocardiography Data

Albrecht U-V, Kulau U. On-Site Visualization of Ballistocardiography Data. In: Hägglund M, Blusi M, Bonacina S, et al., eds. Caring is Sharing – Exploiting the Value in Data for Health and Innovation. Proceedings of MIE 2023. Studies in Health Technology and Informatics. IOS Press; 2023.We describe the background, features and functions of a custom application for the acquisition, live presentation, and convenient recording of ballistocardiography data acquired by external accelerometric sensors

Medical Apps for Android and iOS: Differences and Similarities

Pustozerov E, Von Jan U, Lawin D, Albrecht U-V. Medical Apps for Android and iOS: Differences and Similarities. In: Hägglund M, Blusi M, Bonacina S, et al., eds. Caring is Sharing – Exploiting the Value in Data for Health and Innovation. Proceedings of MIE 2023. Studies in Health Technology and Informatics. IOS Press; 2023.Google Play and Apple’s App Store dominate the mobile health app market. We analyzed the metadata and descriptive texts of apps in the medical category using semi-automated retrospective app store analysis (SARASA) and compared the store offerings in terms of their number, descriptive texts, user ratings, medical device status, diseases, and conditions (both keyword-based). Relatively speaking, the store listings for the selected items were comparable

Evidence of Digital Health Applications from a State-Regulated Repository for Reimbursable Health Applications in Germany

Albrecht U-V, Von Jan U, Lawin D, Pustozerov E, Dittrich F. Evidence of Digital Health Applications from a State-Regulated Repository for Reimbursable Health Applications in Germany. In: Hägglund M, Blusi M, Bonacina S, et al., eds. Caring is Sharing – Exploiting the Value in Data for Health and Innovation. Proceedings of MIE 2023. Studies in Health Technology and Informatics. IOS Press; 2023.17 RCTs for 15 digital health applications (DiGA) permanently listed in the state-regulated register were analyzed descriptively for methodological study aspects relevant to evidence analysis. The analysis revealed that several underlying studies had limitations, at least worthy of discussion, in terms of their power concerning sample size, intervention and control group specifications, drop-out rates, and blinding

The Impact of PACS on Radiologists’ Work Practice

This paper identifies and analyzes how the implementation and use of picture archiving and communication system impacts radiologists’ work practice. The study is longitudinal from 1999 to 2005 and have a qualitative perspective were data were collected by structured interviews in a total of 46. The interviews were transcribed, analyzed, and coded using grounded theory as an organizing principle. In radiologists’ work practice, three main categories were defined: professional role, diagnostic practice, and technology in use. The changing trends within the professional role indicated that radiologists moved from a more individual professional expertise to become more of an actor in a network. The diagnostic practice changed, as reading x-ray films was seen as an art form in 1999, requiring years of training. Once everyone could view digital images, including 3-dimensional technology, it was easier for other clinicians to see and interpret the images and the skills become accessible to everyone. The change in technology in use as a result of the shift to digital images led to an increased specialization of the radiologist