Clinical Knowledge Platform (CKP): a collaborative ecosystem to share interoperable clinical forms, viewers, and order sets with various EMRs

International audienceA large number of Electronic Medical Records (EMR) are currently available with a variety of features and architectures. Existing studies and frameworks presented some solutions to overcome the problem of specification and application of clinical guidelines toward the automation of their use at the point of care. However, they could not yet support thoroughly the dynamic use of medical knowledge in EMRs according to the clinical contexts and provide local application of international recommendations. This study presents the development of the Clinical Knowledge Platform (CKP): a collaborative interoperable environment to create, use, and share sets of information elements that we entitled Clinical Use Contexts (CUCs). A CUC could include medical forms, patient dashboards, and order sets that are usable in various EMRs. For this purpose, we have identified and developed three basic requirements: an interoperable, inter-mapped dictionary of concepts leaning on standard terminologies, the possibility to define relevant clinical contexts, and an interface for collaborative content production via communities of professionals. Community members work together to create and/or modify, CUCs based on different clinical contexts. These CUCs will then be uploaded to be used in clinical applications in various EMRs. With this method, each CUC is, on the one hand, specific to a clinical context and on the other hand, could be adapted to the local practice conditions and constraints. Once a CUC has been developed, it could be shared with other potential users that can consume it directly or modify it according to their needs

Evaluation of natural language processing from emergency department computerized medical records for intra-hospital syndromic surveillance

<p>Abstract</p> <p>Background</p> <p>The identification of patients who pose an epidemic hazard when they are admitted to a health facility plays a role in preventing the risk of hospital acquired infection. An automated clinical decision support system to detect suspected cases, based on the principle of syndromic surveillance, is being developed at the University of Lyon's Hôpital de la Croix-Rousse. This tool will analyse structured data and narrative reports from computerized emergency department (ED) medical records. The first step consists of developing an application (UrgIndex) which automatically extracts and encodes information found in narrative reports. The purpose of the present article is to describe and evaluate this natural language processing system.</p> <p>Methods</p> <p>Narrative reports have to be pre-processed before utilizing the French-language medical multi-terminology indexer (ECMT) for standardized encoding. UrgIndex identifies and excludes syntagmas containing a negation and replaces non-standard terms (abbreviations, acronyms, spelling errors...). Then, the phrases are sent to the ECMT through an Internet connection. The indexer's reply, based on Extensible Markup Language, returns codes and literals corresponding to the concepts found in phrases. UrgIndex filters codes corresponding to suspected infections. Recall is defined as the number of relevant processed medical concepts divided by the number of concepts evaluated (coded manually by the medical epidemiologist). Precision is defined as the number of relevant processed concepts divided by the number of concepts proposed by UrgIndex. Recall and precision were assessed for respiratory and cutaneous syndromes.</p> <p>Results</p> <p>Evaluation of 1,674 processed medical concepts contained in 100 ED medical records (50 for respiratory syndromes and 50 for cutaneous syndromes) showed an overall recall of 85.8% (95% CI: 84.1-87.3). Recall varied from 84.5% for respiratory syndromes to 87.0% for cutaneous syndromes. The most frequent cause of lack of processing was non-recognition of the term by UrgIndex (9.7%). Overall precision was 79.1% (95% CI: 77.3-80.8). It varied from 81.4% for respiratory syndromes to 77.0% for cutaneous syndromes.</p> <p>Conclusions</p> <p>This study demonstrates the feasibility of and interest in developing an automated method for extracting and encoding medical concepts from ED narrative reports, the first step required for the detection of potentially infectious patients at epidemic risk.</p

Indexing grey multilingual literature in General Practice: Family medicine in the era of semantic web

peer reviewedProblem/Goal: Sharing the results of research with General Practitioners (GPs) is crucial for the survival of the discipline of General Practice / Family Medicine (GP/FM). The production of abstracts in GP/FM probably exceeds 15,000 per year worldwide. Each abstract often represents two years of work for its authors and is expressed in local languages. Only 45% of them are published in indexed medical journals. Usual indexing systems like MeSH are not multilingual nor adapted to the particular field of GP/FM. Consequently, these abstracts are lacking bibliographic control and more than half of the research presented by GPs at congresses is lost. Considering the absence of appropriate domain-specific terminologies or classification systems, we propose a new multilingual indexing system. The existing International Classification of Primary Care (ICPC) is currently used for clinical purposes and has now been expanded with a taxonomy related to contextual aspects (called Q-Codes) such as education, research, practice organization, ethics or policy in GP/FM, currently not captured. The set is proposed under the name Core Content Classification in General Practice (3CGP). The aim is to facilitate indexing of GP/FM specific scientific work and to improve performance in information storage and retrieval for research purposes in this field. Research Method/Procedure: Using qualitative analysis, a corpus of 1,702 abstracts from six GP/FM- related European congresses was analyzed to identify main themes discussed by GPs (e.g., continuity, accessibility or medical ethics), handled in a domain-specific taxonomy called Q-Codes and translated in 8 languages. In addition, a methodology for building a lightweight ontology (in OWL-2) was applied to Q-Codes, adding object and datatype properties to the hierarchical relations, including mapping to the MeSH thesaurus, Babelnet (www.babelnet.org) and Dbpedia. Finally, the Q-Codes in 8 languages have been integrated healthcare terminology service (www.hetop.eu/q) with a companion website (http://3cgp.docpatient.net). Anticipated Results of the Research: The creation and the on-line publication of this multilingual terminological resource, for indexing abstracts and for facilitating Medline searches, could reduce loss of knowledge in the domain. In addition, through better indexing of the grey literature (congress abstracts, master’s and doctoral thesis), we hope to enhance the accessibility of research results of GP/FM domain and promote the emergence of networks of researchers. First result of experimental implementations of the new indexing system will be presented. Indication of costs related to the project: This project has not been funded. 3CGP is placed under Attribution-Non-Commercial-Share-Alike 4.0 International (CC BY-NC-SA 4.0). ICPC is copyrighted by WONCA. © 2018 Oriental Scientific Publishing Company. All rights reserved

On line clinical reasoning assessment with Script Concordance test in urology: results of a French pilot study

BACKGROUND: The Script Concordance test (SC) test is an assessment tool that measures the capacity to solve ill-defined problems, that is, reasoning in a context of uncertainty. This study assesses the feasibility, reliability and validity of the SC test made available on the Web to French urologists. METHODS: A 97 items SC test was developed based on major educational objectives of French urology training programmes. A secure Web site was created with two sequential modules: a) The first one for the reference panel to elaborate the scoring system; b) The second for candidates with different levels of experience in urology: Board certified urologists, chief-residents, residents, medical students. All participants were recruited on a voluntary basis. Statistical analysis included descriptive statistics of the participants' scores and factorial analysis of variance (ANOVA) to study differences between groups' means. Reliability was evaluated with Cronbach's alpha coefficient. RESULTS: The on line SC test has been operational since June 2004. Twenty-six faculty members constituted the reference panel. During the following 10 months, 207 participants took the test online (124 urologists, 29 chief-residents, 38 residents, 16 students). No technical problem was encountered. Forty-five percent of the participants completed the test partially only. Differences between the means scores for the 4 groups were statistically significant (P = 0.0123). The Bonferroni post-hoc correction indicated that significant differences were present between students and chief-residents, between students and urologists. There were no differences between chief-residents and urologists. Reliability coefficient was 0.734 for the total group of participants. CONCLUSION: Feasibility of Web-based SC test was proved successful by the large number of participants who participated in a few months. This Web site has permitted to quickly confirm reliability of the SC test and develop strategy to improve construct validity of the test when applied in the field of urology. Nevertheless, optimisation of the SC test content, with a smaller number of items will be necessary. Virtual medical education initiative such as this SC test delivered on the Internet warrants consideration in the current context of national pre-residency certification examination in France

Online clinical reasoning assessment with the Script Concordance test: a feasibility study

BACKGROUND: The script concordance (SC) test is an assessment tool that measures capacity to solve ill-defined problems, that is, reasoning in context of uncertainty. This tool has been used up to now mainly in medicine. The purpose of this pilot study is to assess the feasibility of the test delivered on the Web to French urologists. METHODS: The principle of SC test construction and the development of the Web site are described. A secure Web site was created with two sequential modules: (a) The first one for the reference panel (n = 26) with two sub-tasks: to validate the content of the test and to elaborate the scoring system; (b) The second for candidates with different levels of experience in Urology: Board certified urologists, residents, medical students (5 or 6(th )year). Minimum expected number of participants is 150 for urologists, 100 for residents and 50 for medical students. Each candidate is provided with an individual access code to this Web site. He/she may complete the Script Concordance test several times during his/her curriculum. RESULTS: The Web site has been operational since April 2004. The reference panel validated the test in June of the same year during the annual seminar of the French Society of Urology. The Web site is available for the candidates since September 2004. In six months, 80% of the target figure for the urologists, 68% of the target figure for the residents and 20% of the target figure for the student passed the test online. During these six months, no technical problem was encountered. CONCLUSION: The feasibility of the web-based SC test is successful as two-thirds of the expected number of participants was included within six months. Psychometric properties (validity, reliability) of the test will be evaluated on a large scale (N = 300). If positive, educational impact of this assessment tool will be useful to help urologists during their curriculum for the acquisition of clinical reasoning skills, which is crucial for professional competence