Biomedical subjects

Hans-Ulrich Prokosch

Publications and source records attributed to Hans-Ulrich Prokosch.

12 recordsLinked to original sources

PubMed2005

Cross-institutional data exchange using the clinical document architecture (CDA).

PROBLEM: Although electronic communication of clinical data between various actors in the healthcare domain seems crucial for a cost-effective patient treatment, it is mostly restricted to paper based documents. In order to meet the growing need for improved data communication, it is necessary to overcome the barriers of software heterogeneity and lack of standards, especially in cross-institutional shared care communication. HL7's clinical document architecture (CDA) is a new and promising tool to exchange any clinical document. In this paper we show how CDA can be used to (1) share electronic discharge letters and other clinical data generated and stored in the hospitals electronic patient record (EPR) with general practitioners and (2) to transfer these clinical data to a personal electronic health record (EHR). The latter scenario is in routine use. Ease-of-use and data security and integrity were the main design principles in both scenarios. METHODS: Within the electronic patient record a data extraction and exporting mechanism has been built. For both scenarios appropriate data processing and transmission methods have been developed, and the receiving information systems have been prepared for the CDA based data input. RESULTS: Although there still remain technical and organizational issues to be solved, this is a promising method in order to enhance data exchange between hospital and primary care and to move towards an electronic patient record (EPR) and an electronic health record (EHR) crossing institutional borders. This paper describes the design and current implementation and discusses our experiences.

Germany↗

PubMed2005

Computed Quality Assessment of MPEG4-compressed DICOM Video Data.

Digital Imaging and Communication in Medicine (DICOM) has become one of the most popular standards in medicine. This standard specifies the exact procedures in which digital images are exchanged between devices, either using a network or storage medium. Sources for images vary; therefore there exist definitions for the exchange for CR, CT, NMR, angiography, sonography and so on. With its spreading, with the increasing amount of sources included, data volume is increasing, too. This affects storage and traffic. While for long-time storage data compression is generally not accepted at the moment, there are many situations where data compression is possible: Telemedicine for educational purposes (e.g. students at home using low speed internet connections), presentations with standard-resolution video projectors, or even the supply on wards combined receiving written findings. DICOM comprises compression: for still image there is JPEG, for video MPEG-2 is adopted. Within the last years MPEG-2 has been evolved to MPEG-4, which squeezes data even better, but the risk of significant errors increases, too. Within the last years effects of compression have been analyzed for entertainment movies, but these are not comparable to videos of physical examinations (e.g. echocardiography). In medical videos an individual image plays a more important role. Erroneous single images affect total quality even more. Additionally, the effect of compression can not be generalized from one test series to all videos. The result depends strongly on the source. Some investigations have been presented, where different MPEG-4 algorithms compressed videos have been compared and rated manually. But they describe only the results in an elected testbed. In this paper some methods derived from video rating are presented and discussed for an automatically created quality control for the compression of medical videos, primary stored in DICOM containers.

Algorithms↗

PubMed2005

Semantic challenges in database Federation: lessons learned.

In this project an integrated analysis of data from disparate surgery and anaesthesiology departmental information systems was carried out. Due to the lack of shared primary keys, a multi-stage "soft" matching method was implemented. Results of the matching steps are described in detail. Inconsistencies were shown to exist for identifying data, semantic definition of documentation content and documented data itself. Minimum requirements for interdisciplinary documentation in autonomous systems should include shared semantic definitions of documentation content as well as robust and regularly validated interfaces for identifying data.

Database Management Systems↗

PubMed2005

Standardized exchange of medical data between a research database, an electronic patient record and an electronic health record using CDA/SCIPHOX.

The exchange of medical data from research and clinical routine across institution borders in a structured way, based on national and international standards, is essential to build an integrated and connected health platform. In this project we developed a HL7 CDA/SCIPHOX based integration platform to exchange data between a research database, an electronic health record and an electronic patient record (Soarian).

Biomedical Research↗

PubMed2004

Visions and strategies to improve evaluation of health information systems. Reflections and lessons based on the HIS-EVAL workshop in Innsbruck.

BACKGROUND: Health care is entering the Information Society. It is evident that the use of modern information and communication technology offers tremendous opportunities to improve health care. However, there are also hazards associated with information technology in health care. Evaluation is a means to assess the quality, value, effects and impacts of information technology and applications in the health care environment, to improve health information applications and to enable the emergence of an evidence-based health informatics profession and practice. OBJECTIVE: In order to identify and address the frequent problems of getting evaluation understood and recognised, to promote transdisciplinary exchange within evaluation research, and to promote European cooperation, the Exploratory Workshop on "New Approaches to the Systematic Evaluation of Health Information Systems" (HIS-EVAL) was organized by the University for Health Sciences, Medical Informatics and Technology (UMIT), Innsbruck, Austria, in April 2003 with sponsorship from the European Science Foundation (ESF). METHODS: The overall program was structured in three main parts: (a). discussion of problems and barriers to evaluation; (b). defining our visions and strategies with regard to evaluation of health information systems; and (c). organizing short-term and long-term activities to reach those visions and strategies. RESULTS: The workshop participants agreed on the Declaration of Innsbruck (see ), comprising four observations and 12 recommendations with regard to evaluation of health information systems. Future activities comprise European networking as well as the development of guidelines and standards for evaluation studies. CONCLUSION: The HIS-EVAL workshop was intended to be the starting point for setting up a network of European scientists working on evaluation of health information systems, to obtain synergy effects by combining the research traditions from different evaluation fields, leading to a new dimension and collaboration on further research on information systems' evaluation.

Education↗

PubMed2004

The Clinical Document Architecture (CDA) enables electronic medical records to wireless mobile computing.

The Clinical Document Architecture (CDA) has proved to be a valuable and powerful standard for a structured exchange of clinical documents between heterogeneous software systems like a Hospital Information System and a Physician Office System. In this paper we want to show how the CDA can additionally be used in order to enhance the Hospital Information System's functionality: each patient related document contained in or generated from the HIS can be converted to a CDA/XML document. With the XML/XSLT-based transformation methods, those documents can be device-specifically transformed. We use this method to display HIS-content on mobile devices like Personal Digital Assistants (PDAs) by extracting the respective data fields from the HIS database, converting them to a CDA/XML document, which is transformed and sent to the mobile devices using a wireless intranet connection. Preliminary results and users' comments are promising, but further evaluation will be necessary. Our approach shows a generic model how clinical data can be dis-played on different devices independently from the underlying HIS using CDA.

Computer Communication Networks↗

PubMed2003

The diagnosis related groups enhanced electronic medical record.

PROBLEM: The introduction of Diagnosis Related Groups as a basis for hospital payment in Germany announced essential changes in the hospital reimbursement practice. A hospital's economical survival will depend vitally on the accuracy and completeness of the documentation of DRG relevant data like diagnosis and procedure codes. In order to enhance physicians' coding compliance, an easy-to-use interface integrating coding tasks seamlessly into clinical routine had to be developed. A generic approach should access coding and clinical guidelines from different information sources. METHODS: Within the Electronic Medical Record (EMR) a user interface ('DRG Control Center') for all DRG relevant clinical and administrative data has been built. A comprehensive DRG-related web site gives online access to DRG grouping software and an electronic coding expert. Both components are linked together using an application supporting bi-directional communication. Other web based services like a guideline search engine can be integrated as well. RESULTS: With the proposed method, the clinician gains quick access to context sensitive clinical guidelines for appropriate treatment of his/her patient and administrative guidelines for the adequate coding of the diagnoses and procedures. This paper describes the design and current implementation and discusses our experiences.

Diagnosis-Related Groups↗

PubMed2003

Empowerment of patients and communication with health care professionals through an electronic health record.

OBJECTIVE: The aim of this project was to design and develop a personal electronic health record (EHR) in order to support patient empowerment and additionally to enhance their communication and information exchange with health professionals through this EHR. METHOD: The functionality of a personal Electronic Healthcare Record (EHR) may vary from a simple web-based interface for interactive data entry and data review up to a much more powerful system additionally supporting electronic data/document communication between clinical information systems of primary care practitioners or hospitals and even reminder based support for the empowered citizen, to actively take care of his health, based on relevant disease management programs. It is one means to support patient empowerment, additionally supported by tools for building a patient community. Since storage and communication of data in an EHR comprises sensible personal health data, each of those functions needs specific security and access management requirements to be considered and implemented. RESULT: Clinical pilot projects are already done or under development.

Communication↗

PubMed2003

Electronic discharge letters using the Clinical Document Architecture (CDA).

Communication between hospitals and general practitioners is often restricted to paper-based discharge letters. In order to meet the growing need for improved data communication between various actors in the healthcare domain, it is necessary to overcome the barriers of software heterogeneity and lack of standards. HL7's clinical document architecture (CDA) is a new tool to exchange clinical documents. In this paper we show how CDA can be used to share electronic discharge letters generated in the hospital information system with general practitioners. Ease-of-use and data security and integrity were the main design principles. Although there still remain technical and organizational issues to be solved, this is a promising method in order to enhance data exchange between hospital and primary care and to move towards an electronic patient record (EPR) crossing institutional borders.

Computer Communication Networks↗

PubMed2002

Implementing security and access control mechanisms for an electronic healthcare record.

Personal Electronic Health Records (EHR) have recently been published as one means to support patient empowerment and patient control over their personal health record. The functionality of such an EHR may vary from a simple web-based interface for interactive data entry and data review up to a much more powerful system additionally supporting electronic data/document communication between clinical information systems of primary care practitioners or hospitals and even reminder based support for the empowered citizen, to actively take care of his health, based on relevant disease management programs. Since storage and communication of data in an EHR comprises sensible personal health data, each of those functions need specific security and access management requirements to be considered and implemented. In this article the most critical requirements for these aspects will be classified and respective mechanisms to provide secure data storage and communication as well as flexible access management functions will be presented.

Computer Security↗

PubMed2002

Guideline based structured documentation: the final goal?

Structured documentation of medical procedures facilitates information retrieval for research and therapy and may help to improve patient care. Most medical documents until today however consist mainly of unstructured narrative text. Here we present an application for endoscopy which is not only fully integrated into a comprehensive clinical information system, but which also supports various degrees of structuring examination reports. The application is used routinely in a German University hospital since summer 2000. We present the first unstructured version which permits storage of a free text report together with selected examination images. The next step added improved structure to the document using a catalogue of index terms. The practical advantages of selective patient retrieval are described. Today we use a version which supports fully structured, guideline based documentation of endoscopy reports in order to automatically generate essential classification codes and the narrative examination report All versions have advantages and disadvantages and we conclude that guideline based documentation may not be suitable for all endoscopy cases.

Documentation↗

PubMed2002

Akteonline-an electronic healthcare record as a medium for information and communication.

The functionality of a personal Electronic Healthcare Record (EHR) may vary from a simple web-based interface for interactive data entry and data review up to a much more powerful system additionally supporting electronic data/document communication between clinical information systems of primary care practitioners or hospitals and even reminder based support for the empowered citizen, to actively take care of his health, based on relevant disease management programs. It is one means to support patient empowerment. Since storage and communication of data in an EHR comprises sensible personal health data, each of those functions need specific security and access management requirements to be considered and implemented.

Access to Information↗