Biomedical subjects

T Bürkle

Publications and source records attributed to T Bürkle.

At least 19 recordsLinked to original sources

PubMed2002

Integrated decision support in a hospital cancer registry.

In this paper we present (a) a shell for integrated knowledge-based functions that is destined to support decision processes of the users of the Giessener Tumordokumentationssystem (GTDS) and (b) some results we obtained during a 6-month observation period at one of the customers of the GTDS. A special characteristic of the provided decision support is the high degree of integration in the underlying information system GTDS, i.e. the functions are triggered by events in the patient database, existing patient data is reused as input for the reasoning process and generated alerts are presented instantly to the end-user. The first routine field of application was supporting registrars to adhere to integrity constraints as defined by the International Agency of Research on Cancer (IARC) during the documentation process. This information is important for the registrars since the checks of the IARC are an accepted standard for data quality in cancer registries. The expected benefit of this application area is less effort in achieving adherence to the specification of the IARC by preventing the costly rectification at a later time. During the last 5 months of the observation period 164 alerts were displayed. About 65% of the assessed alerts were considered to be correct. Especially, the analysis of the incorrect alerts revealed some shortcomings in the knowledge behind some of the integrity constraints of the IARC. The general feedback from the end-users indicate positive user satisfaction. Currently, the shell is in use in six hospital cancer registries.

Artificial Intelligence↗

PubMed2001

Evaluation of clinical information systems. What can be evaluated and what cannot?

The evaluation of clinical information systems is essential as they are increasingly used in clinical routine and may even influence patient outcome on the basis of reminder functions and decision support. Therefore we try to answer three questions in this paper: what to evaluate; how to evaluate; how to interpret the results. Those key questions lead to the discussion of goals, methods and results of evaluation studies in a common context. We will compare the objectivist and the subjectivist evaluation approach and illustrate the evaluation process itself in some detail, discussing different phases of software development and potential evaluation techniques in each phase. We use four different practical examples of evaluation studies that were conducted in various settings to demonstrate how defined evaluation goals may be achieved with a limited amount of resources. This also illustrates advantages, limitations and costs of the different evaluation methods and techniques that may be used when evaluating clinical information systems.

Decision Support Systems, Clinical↗

PubMed2001

Bioinformatics in medical practice: what is necessary for a hospital?

Building bioinformatic facilities for a university hospital is pretty similar to using standardized building blocks to construct a house. Starting with the intention to built a dwelling house, a factory or just a shelter the architect draws a construction plan and determines the material to be used. In general, the building is then constructed by the workmen following exactly the plan. However, for particular reasons, minor alterations may be needed to improve the construction of the building. Here we use the metaphor of constructing a "bio-informatics building" to describe the steps needed to support the daily tasks of a university hospital medical microbiology department which uses genomic methods quite extensively for pathogen identification. Today the Giessen "bioinformatics building" is not yet complete but we have been able to lay solid foundations and erect the ground floor which is functional already. Using a combination of standard tools, internet accessible genomic databases and some own software tools we can support genome sequencing from the raw sequence to pathogen identification.

Computational Biology↗

PubMed2000

An object-oriented design for automated navigation of semantic networks inside a medical data dictionary.

In this paper we present a data dictionary server for the automated navigation of information sources. The underlying knowledge is represented within a medical data dictionary. The mapping between medical terms and information sources is based on a semantic network. The key aspect of implementing the dictionary server is how to represent the semantic network in a way that is easier to navigate and to operate, i.e. how to abstract the semantic network and to represent it in memory for various operations. This paper describes an object-oriented design based on Java that represents the semantic network in terms of a group of objects. A node and its relationships to its neighbors are encapsulated in one object. Based on such a representation model, several operations have been implemented. They comprise the extraction of parts of the semantic network which can be reached from a given node as well as finding all paths between a start node and a predefined destination node. This solution is independent of any given layout of the semantic structure. Therefore the module, called Giessen Data Dictionary Server can act independent of a specific clinical information system. The dictionary server will be used to present clinical information, e.g. treatment guidelines or drug information sources to the clinician in an appropriate working context. The server is invoked from clinical documentation applications which contain an infobutton. Automated navigation will guide the user to all the information relevant to her/his topic, which is currently available inside our closed clinical network.

Automation↗

PubMed2000

Two years of German summer school of nursing informatics: Did we reach the goals?

This paper describes a continuous effort to improve the knowledge of nursing informatics among German nurses. The authors have co-operated in the nursing informatics working group of the German Medical Informatics Association GMDS. Besides, one of the authors has been active in the European summer school of nursing informatics (Essoni) for several years. The authors have now established a national counterpart to the Essoni program, the German summer school of nursing informatics. This event in German language is centred around nursing informatics topics. Students may opt for one of the several study tracks to gain insight in topics such as nursing classifications and nursing terminologies, clinical information systems and their implementation or teaching requirements in nursing informatics. They go through a 5-day curriculum consisting of plenary sessions, lectures and opportunities for self learning and self teaching. At the end they demonstrate to the fellow students from the other tracks what they have achieved in their own field of study. The German Summer School is open to interested nurses, nurse executives and nurse teachers. In this paper, we will describe the curriculum, talk about the participants and show results of the questionnaire-based evaluation for the first two events in 1998 and 1999.

Curriculum↗

PubMed2000

A dictionary server for supplying context sensitive medical knowledge.

The Giessen Data Dictionary Server (GDDS), developed at Giessen University Hospital, integrates clinical systems with on-line, context sensitive medical knowledge to help with making medical decisions. By "context" we mean the clinical information that is being presented at the moment the information need is occurring. The dictionary server makes use of a semantic network supported by a medical data dictionary to link terms from clinical applications to their proper information sources. It has been designed to analyze the network structure itself instead of knowing the layout of the semantic net in advance. This enables us to map appropriate information sources to various clinical applications, such as nursing documentation, drug prescription and cancer follow up systems. This paper describes the function of the dictionary server and shows how the knowledge stored in the semantic network is used in the dictionary service.

Decision Support Systems, Clinical↗

PubMed2000

Can we classify medical data dictionaries?

Medical Data Dictionaries enable a clinical information system to maintain a controlled vocabulary, to store descriptive knowledge about terms, to map between those terms and from those terms to external classifications. They support a variety of functions in the information system, ranging from structured documentation to knowledgebased functions. This paper derives a multi-axial classification for medical data dictionaries. Dictionaries are classified along 4 axes, a vocabulary axis defining vocabulary properties, an application axis which characterises the degree of linkage between dictionary and information system, a semantic axis defining the quality of inter-term relationships and finally a language axis which classifies rules for inter-term relationships in semiotic theory. As an example two existing dictionaries are classified in the model and reference is taken to the design of future dictionaries.

Artificial Intelligence↗

PubMed2000

Decision support for infectious diseases--a working prototype.

This paper presents a decision support system for nosocomial infections and its integration in the large HIS of the University Hospital of Giessen. The model comprises five different engines and a data dictionary. It is designed to detect hospital acquired infections even in a situation where only a restricted amount of clinical data is available (the data is split up in different information systems). Furthermore the model prevents time consuming manual data entry. The five engines split the main task into 1) a preselection, which sort out patients who definitely do not have a nosocomial infection; 2) a rule based reasoning process which detects patients likely to have such an infection; 3) an alarm process which is responsible for the presentation of the alert; 4) an explanation process to follow up the reasoning and 5) statistic tools to answer specific hygienic questions. A data dictionary supplies the controlled vocabulary, but it is also required to understand datastructures used in the different clinical subsystems.

Artificial Intelligence↗

PubMed2000

XML structured clinical information: a practical example.

At Giessen university, a drug formulary comprising drug data and treatment guidelines is supplied to clinical users who can access the drug information by an index of drug substances and drug substance groups. The guideline itself is a textual description with related information such as drug substances and drug brand names. Since clinical users also want to access the information by drug names, we had to extract this information from the textual descriptions. The extraction however caused some effort. In order to not repeat this effort in the future, we used the eXtensible Markup Language (XML) to restructure the information sources. This paper describes our experiences with this kind of legacy to XML conversion and outlines a possible migration path towards the XML technology.

Drug Information Services↗

PubMed1999

Stepwise evaluation of information systems in an university hospital.

A prospective intervention study with historical control has been performed at Giessen University Hospital, Germany, to investigate the influence of electronic data processing systems on nurses' working environment. Two wards of the medical department were selected for this study, using the combined approach of work-sampling methods and questionnaires. In the first intervention a central information system with restricted functions was introduced. For the second intervention an additional nursing information system was installed. The distribution of nurses' worktime into the fields of general nursing care, specific nursing care and administrative activities was not influenced by electronic data processing. No time saving could be measured. Results of the questionnaires did, however, indicate a positive influence of the hospital information system on nurses' working environment.

Adult↗

PubMed1999

How to structure clinical information: a practical example.

In the frame of an European telemedicine project, we have designed and implemented an Andrology server that provides the user (e.g. physicians, students) with a set of anonymized andrology cases. Within this context we faced the problem of re-structuring existing clinical information sources and gained some experience on how much of the problem might be solved by the software engineer. This paper presents a method that partially automates the maintenance of the andrology case collection. Moreover, the potential benefit of XML for information representation will be discussed.

Humans↗

PubMed1999

How can we improve informatics education for German nurses? Statements derived from the first German nursing informatics summer school.

For German nurses it is difficult to join training in health informatics besides their professional activity. The authors have successfully established a German nursing informatics summer school in shape of a 5 day intensive curriculum which they offer to German nurses during the summer holidays. The summer school introduces nurses into health informatics and nursing informatics. It targets interested nursing staff, nurse executives, and nurse teachers. It promotes self learning abilities for continued self education of the participants. One of its goals is to enable participants to formulate their own requirements in health information processing and to influence system design and system introduction. The paper presents the curriculum, talks about first experiences, and demonstrates the results of an evaluation among the participants. Conclusions are drawn in a set of statements on informatics education of nurses.

Curriculum↗

PubMed1999

Transferring data from one EPR to another: content--syntax--semantic.

When data are transmitted between electronic patient record (EPR) systems, we can distinguish several tasks. One task is the definition of structure and semantic content of the data in a message structure. Another task is the mapping of the sending EPR's structure to this message structure. A third task is the mapping of the message structure to the receiving EPR's structure. We describe an approach, which distinguishes clearly between these different tasks and activities. Using this approach we have implemented a data transfer procedure between a cancer registry application and a middleware for healthcare information systems. Our experience showed that the proposed systematic approach helped identify problems for data transfer in an early design phase. It also allowed us to limit modifications of the data exchange procedure to certain tasks or activities when one of the EPR applications was updated. In the end, we could even exchange the underlying message format without having to reimplement the complete interface.

Humans↗

PubMed1998

On the way to a Web based hospital information system: concepts for the use of a medical data dictionary to present context sensitive information in an intranet environment.

Many authors have promoted the www-paradigm to build modern hospital information systems. However currently web-based applications are better suited to information "browsing" than to build complex data entry features. This prompted us to start with our first web based developments inside the Giessen University Hospital Information System in the field of pure presentation of stored knowledge and information. This article describes the concepts which will be used in Giessen to convert available information sources to the www paradigm and to implement context-sensitive knowledge presentation mechanisms inside the clinical information system. The approach is based upon a web-based medical data dictionary server. The data dictionary is used to map terms of interest, chosen from the clinical user during work with a HIS-application, to a semantic network of relationships. The dictionary server will follow those semantic links in order to find and display the webpages, which are linked to the subject.

Dictionaries as Topic↗

PubMed1998

Plug and play--fiction or reality?

This paper discusses some experiences with the integration of a tumor documentation system into a distributed healthcare environment using a new European middleware technology. Although the middleware already offers a considerable support to the software engineer, further facilities have been suggested and partially implemented in order to accelerate integration scenarios.

Computer Communication Networks↗

PubMed1998

Data dictionaries at Giessen University Hospital: past--present--future.

The concept of maintaining a medical data dictionary as a HIS core component was fundamental for all HIS development phases since the mid eighties at Giessen University Hospital. Being influenced by an early experimental installation of the HELP hospital information system and its PTXT data dictionary, we kept this approach through a number of development cycles of our own hospital information system. While our first data dictionary implementation (GMDD) was still very close to the PTXT structure (polyhierarchical design with an eight level hierarchy), the second generation dictionary (MDD-GIPHARM) has already been designed using a more flexible semantic network model. GMDD was a mainframe development (realized on Tandem Computers) based on the Tandem Nonstop SQL RDBMS. The major clinical applications established on top of the GMDD were laboratory results review, diagnosis documentation and physician discharge summaries. The MDD-GIPHARM development was initiated on PC-basis as the core of a rheumatology departmental system using MS-Access and then further enhanced within a research project to build knowledge-based functions for drug therapy. A first set of such functions based on MDD-GIPHARM is in routine use since 1996. Our current focus is to enhance MDD-GIPHARM towards an application independent vocabulary server (GDDS), which may be used for a variety of applications with the intranet of Giessen University Hospital. In this paper the evolutionary development of those data dictionary concepts at Giessen University Hospital is illustrated and compared with international activities in the last decade.

Hospital Information Systems↗

PubMed1997

Plug and play integration into a healthcare information system.

This paper discusses some experiences with the integration of a tumor documentation system into a distributed healthcare environment using a new European middleware technology. Although the middleware already offers a considerable support to the software engineer further facilities have been developed in order to accelerate integrations. Such facilities arised from the software engineering principle of separating reusable parts and non-reusable parts.

Computer Communication Networks↗

PubMed1997

Does TISS pave a way towards the nurses care documentation?

New functions have been integrated in the Giessen Hospital Information System WING to support the classification of all intensive care patients into the Therapeutic Intervention Scoring System TISS. The use of those functions has been pushed by legal requirements which made it essential to assess the staffing of intensive care wards in comparison with the accumulated TISS scores. This paper describes the experiences made within two years of TISS scoring. We think that TISS gave a major impact to the construction and implementation of nursing documentation into our HIS.

Forms and Records Control↗