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Jan Talmon

Publications and source records attributed to Jan Talmon.

10 recordsLinked to original sources

PropeR revisited.

INTRODUCTION: The PropeR EHR system (PropeRWeb) is a multidisciplinary electronic health record (EHR) system for multidisciplinary use in extramural patient care for stroke patients. DESIGN: The system is built using existing open source components and is based on open standards. It is implemented as a web application using servlets and Java Server Pages (JSP's) with a CORBA connection to the database servers, which are based on the OMG HDTF specifications. PropeRWeb is a generic system which can be readily customized for use in a variety of clinical domains. EVALUATION: The system proved to be stable and flexible, although some aspects (a.o. user friendliness) could be improved. These improvements are currently under development in a second version.

Computer Systems↗

Towards a Generic Connection of EHR and DSS.

Decision Support Systems (DSS) are typically integrated in Electronic Health Record systems (EHR). By removing this integration full reuse of a DSS system is possible. The connection between the EHR and the DSS system should be standards-based and generic. We intend to demonstrate the viability of this setup by implementing it using PropeRWeb as EHR system, Gaston as DSS system, HL7v3 messages and the SOAP protocol.

Computer Systems↗

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↗

Evaluation of an automated test ordering and feedback system for general practitioners in daily practice.

OBJECTIVE: To evaluate the use of an automated test ordering and feedback system (named GRIF) in daily practice. The system produces recommendations to general practitioners (GPs) to improve the application of accepted practice guidelines for test ordering. METHODS: A randomised controlled trial with balanced block design was carried out in general practices in two regions of the Netherlands from August 2000 to July 2001. We implemented the GRIF system on the workstations at the offices of the participating GPs. The GPs (n=11) were asked to use GRIF during patient consultation instead of filling in the paper request form. The system displayed critical comments about their non-adherence to the guidelines as apparent from the request forms. RESULTS: The median time of producing the comments plus the response time of the GP was 13s. Of the 2780 presented recommendations, 4.3% were accepted. Advice of the GRIF system that presents a concrete test to request in a particular situation is adhered to most frequently. Finally, there seems to be a decrease of accepted comments over the trial period. CONCLUSION: Computerised recommendations should contain, if possible, suggestions for alternative tests to improve the application of these recommendations. Furthermore, creative solutions must be developed to avoid that GPs get used to the recommendations of critiquing systems and to stimulate a better adherence to these recommendations.

Adult↗

Archetypes: the PropeR way.

The PropeR project studies the effect of Decision Support in an Electronic Health Record system (EHR) on the quality of care. One of the applications supports a multidisciplinary primary care team rehabilitating stroke patients in their home environment. This project required an EHR system that could handle information of multiple disciplines and multiple, distributed data sources. It should also be flexible enough to handle an entirely different domain with only minor modifications. The resulting EHR system is a distributed system based on international standards and reusable components. It is generic in nature since all references to the domain are stored in separate XML documents: the clinical data are defined through a modified version of the OpenEHR archetypes, described in XML and views on the data, either for review or for data entry are also described in XML documents. Currently, the system is being evaluated by a care team using laptops with a wireless internet connection. The use of standards greatly improves the quality and reusability of the resulting software system, but they do not solve the issues that surface during implementation, such as context and screen representation.

Computer Communication Networks↗

PropeR and archetypes.

UNLABELLED: The PropeR project studies a genric combination of an electronic health record (EHR) and decision support software (DSS). This study comprises different medical domains. GOAL: Develop a distributed EHR system that is flexible enough to be used in different domains without major modifications. METHODS: Use of standards and standardized specification and available open source components to develop an EHR system that meets the goals. RESULT: PropeRWeb is a generic webbased EHR system that is flexible enough to easily accommodate different domains. DISCUSSION: Discussion of some of the problems encountered in the development of the EHR system.

Computer Simulation↗

PropeR: a multi disciplinary EPR system.

This article describes the architecture of an EPR system developed for the PropeR project. This EPR system not only aims at supporting home care of stroke patients, but is also designed in such a way that it can be ported to other medical services without much effort. We will briefly describe the Stroke Service and the related PropeR project. Starting from a list of requirements to construct a generic EPR system we will outline the architecture and describe the standards and methods used. Subsequently we describe the implementation and the problems encountered. In the discussion, we will go into the advantages and disadvantages of the tools and techniques we have used.

Computer Systems↗

Towards a PropeR combination of patient records and protocols.

PROBLEM: The combination of a computer-based patient record and a decision-support system (DSS) may give physicians the decisive push they need to accept such systems. In the PropeR-project we determine the requirements for a generic interface between both these systems and evaluate its potential impact on patient care. This article reports results from the first year in one of the domains under study. It also provides background information about the project, including design considerations and experimental approach of forthcoming years. PURPOSE: The objectives of the first year were to determine bottlenecks of the current situation and to determine expected improvements and conditions for implementation of a future situation with computer support. METHODS: These topics were investigated in general by literature review and in the local situation by a requirements analysis. For the analysis we used a combination of observation, interviews, and patient record study. For the literature survey we searched for reviews, meta-analyses and original studies concerning experiences with computer-based patient records and DSSs in conventional settings and in integrated care. RESULTS: Main bottleneck was the poor use of shared patient record and paper guidelines. Expected improvements were better protocol adherence and communication. Conditions for implementation of computer support were a proper system interface and adoption by the user. CONCLUSION: Our main conclusion was that the aspect of cooperation needs more decision support than the clinical work itself.

Clinical Protocols↗

PropeR revisited.

The PropeR EHR is a multidisciplinary EHR system that is built using existing open source components. This paper discusses the implementation of this system and the advantages and challenges encountered when using open source components.

Computers↗

Towards a PropeR combination of patient records and protocols.

The combination of a computer-based patient record system with a decision support system may give physicians the decisive push they need to accept such systems. In the PropeR-project we determine the requirements for a generic interface between both such systems and measure its potential impact on patient care. In this overview we describe the objectives, the experimental approach, and the current state of the PropeR-project. We also discuss the original positions behind the project.

Clinical Protocols↗