Biomedical subjects

William T F Goossen

Publications and source records attributed to William T F Goossen.

11 recordsLinked to original sources

PubMed2006

Intelligent semantic interoperability: Integrating knowledge, terminology and information models to support stroke care.

INTRODUCTION: Electronic patient record (EPR) systems for the continuity of care for stroke patient are under development. These systems are based on standards such as for clinical practice, vocabularies, and the HL7 information model. PROBLEM STATEMENT: In order to achieve intelligent semantic interoperability, knowledge about evidence based patient care, vocabulary and information models need to be integrated. METHODOLOGY: A format was developed in which the clinical knowledge, clinical terminology, and standard information models are integrated as specification for the technical implementation of electronic health systems and electronic messages. This format is verified by clinicians and technicians. RESULTS: The document structure consists of meta-information such as version control and changes, purpose of the clinical content, evidence from the literature, variables and values, terminology used, guidelines for application and interpretation, HL7 message models, coding, and technical data specification. Further, XML message excerpts, archetypes and screen designs are developed from these documents to facilitate implementation. CONCLUSION: The combination of these aspects in one document creates valuable content for intelligent semantic interoperability by means of development of messages and systems.

Continuity of Patient Care↗

PubMed2006

Evaluation of documents that integrate knowledge, terminology and information models.

Healthcare depends on evidence for practice and for electronic exchange of clinical patient information. To standardize the information that is being exchanged we created a format for describing care related information: a care information model. This model integrates knowledge, terminology and an information model. During a meeting between experts on nursing, standards and electronic patient records we evaluated the format of the care information model by use of an evaluation form and a group discussion. In general, the experts were enthusiastic about the format of the care information model. However they missed specific information about the purpose of the documents, and clarity on copyright issues. In addition, detailed comments on the existing structure and suggestions for additional categories were given. Also, experts suggested representing the integration in both HL7 message model format and in OpenEHR archetype format to allow different implementations of the same intelligence. From this we can conclude that the combination of these aspects in one document creates a valuable content for development of messages and systems. However, some adjustments are needed.

Evaluation Studies as Topic↗

PubMed2006

Using SNOMED CT codes for coding information in electronic health records for stroke patients.

For a project on development of an Electronic Health Record (EHR) for stroke patients, medical information was organised in care information models (templates). All (medical) concepts in these templates need a unique code to make electronic information exchange between different EHR systems possible. When no unique code could be found in an existing coding system, a code was made up. In the study presented in this article we describe our search for unique codes in SNOMED CT to replace the self made codes. This to enhance interoperability by using standardized codes. We wanted to know for how many of the (self made) codes we could find a SNOMED CT code. Next to that we were interested in a possible difference between templates with individual concepts and concepts being part of (scientific) scales. Results of this study were that we could find a SNOMED CT code for 58% of the concepts. When we look at the concepts with a self made code, 54.9% of these codes could be replaced with a SNOMED CT code. A difference could be detected between templates with individual concepts and templates that represent a scientific scale or measurement instrument. For 68% of the individual concepts a SNOMED CT could be found. However, for the scientific scales only 26% of the concepts could get a SNOMED CT code. Although the percentage of SNOMED CT codes found is lower than expected, we still think SNOMED CT could be a useful coding system for the concepts necessary for the continuity of care for stroke patients, and the inclusion in Electronic Health Records. Partly this is due to the fact that SNOMED CT has the option to request unique codes for new concepts, and is currently working on scale representation.

Forms and Records Control↗

PubMed2005

Linking nursing care to medical diagnoses: heterogeneity of patient groups.

AIM: The new budget system for Dutch hospitals makes use of patient groups that are highly homogeneous in terms of diagnosis and treatment combinations (diagnose behandeling combinaties (DBC)). These DBCs are the Dutch DRG variants. The DBC mainly concerns medical care; nursing care is almost regarded as a constant factor. In this study the DBC is linked to the nursing minimum data set for The Netherlands (NMDSN), to explore the degree of homogeneity in terms of nursing care for patient groups that are homogeneous in terms of the DBC. METHOD: In nine Dutch hospitals, patient information was collected by means of the NMDSN. To answer the question, we performed a secondary data analysis on the NMDSN. First, groups were formed in terms of medical diagnoses as defined in the DBC. Next, explorative statistical analyses were used to form homogeneous groups in terms of nursing diagnoses. These groups were compared in terms of the nursing care interventions and in terms of medical diagnoses. FINDING: Some medical diagnoses seem to be homogeneous, others more heterogeneous in terms of nursing care. DISCUSSION AND CONCLUSION: Limitations in the study design hinder a firm conclusion. However, the results discourage the use of the medical DBC for nursing care.

Diagnosis↗

PubMed2004

Development of a provisional domain model for the nursing process for use within the Health Level 7 reference information model.

OBJECTIVE: Since 1999, the Nursing Terminology Summits have promoted the development, evaluation, and use of reference terminology for nursing and its integration into comprehensive health care data standards. The use of such standards to represent nursing knowledge, terminology, processes, and information in electronic health records will enhance continuity of care, decision support, and the exchange of comparable patient information. As part of this activity, working groups at the 2001, 2002, and 2003 Summit Conferences examined how to represent nursing information in the Health Level 7 (HL7) Reference Information Model (RIM). DESIGN: The working groups represented the nursing process as a dynamic sequence of phases, each containing information specific to the activities of the phase. They used Universal Modeling Language (UML) to represent this domain knowledge in models. An Activity Diagram was used to create a dynamic model of the nursing process. After creating a structural model of the information used at each stage of the nursing process, the working groups mapped that information to the HL7 RIM. They used a hierarchical structure for the organization of nursing knowledge as the basis for a hierarchical model for "Findings about the patient." The modeling and mapping reported here were exploratory and preliminary, not exhaustive or definitive. The intent was to evaluate the feasibility of representing some types of nursing information consistently with HL7 standards. MEASUREMENTS: The working groups conducted a small-scale validation by testing examples of nursing terminology against the HL7 RIM class "Observation." RESULTS: It was feasible to map patient information from the proposed models to the RIM class "Observation." Examples illustrate the models and the mapping of nursing terminology to the HL7 RIM. CONCLUSION: It is possible to model and map nursing information into the comprehensive health care information model, the HL7 RIM. These models must evolve and undergo further validation by clinicians. The integration of nursing information, terminology, and processes in information models is a first step toward rendering nursing information machine-readable in electronic patient records and messages. An eventual practical result, after much more development, would be to create computable, structured information for nursing documentation.

Feasibility Studies↗

PubMed2003

Electronic patient records: domain message information model perinatology.

PURPOSE: The Netherlands is developing a set of national domain information models to support electronic information exchange and electronic patient records (EPR). These domain information models aim to support the development, adoption, implementation and maintenance of the EPR in Dutch healthcare practice. This article describes the modelling for a pilot for mother- and childcare (perinatology). METHODOLOGY: Cases' from perinatology are modelled using the Health Level 7 version 3 Reference Information Model (HL7 RIM) as the methodology and tools. RESULTS: Results include descriptions of care processes, communication and information that are broken down into interaction tables and tables with information. Next several domain information models for perinatology are drawn up. These models allow healthcare professionals to recognise their communication, content and work. Currently, the models facilitate discussion and critique by clinician and informaticians. CONCLUSION: The perinatology domain information models facilitate in building implementations because they contain sufficient details for EPR developers and for developers of messages for information exchange. The first results of the project are useful, despite the fact that HL7 RIM modelling methodology is still not finalized. The approach bridges professional content, technical implementation of messages, and future EPR development.

Adult↗

PubMed2002

Statistical analysis of the nursing minimum data set for The Netherlands.

The purpose of this overview is to examine and illustrate the feasible options for the statistical analysis of nursing minimum data sets (NMDSs). After explaining the need for these data collections, examples from different countries are discussed and examples of the methods used for statistical analysis are summarized. Distinct purposes for information uses and for the presentation of information requires different approaches for data collection and statistical analysis. The feasible options for the nursing minimum data set for the Netherlands (NMDSN) have been described to illustrate the different methods available. Six studies are discussed, illustrating their goals, data collection methods, data analysis, and results. These studies include visualizing nursing care by means of frequencies of nursing diagnoses and interventions, RIDIT (relative to an identified distribution) analysis, fingerprints, and graphs from multidimensional scaling techniques. In addition, using data sets for workload measurement and testing of instruments is presented. The overview ends with general recommendations for data collection and analysis of NMDSs.

Data Collection↗

PubMed2002

Further psychometric testing of the Dutch Care Dependency Scale on two different patient groups.

The Care Dependency Scale (CDS) is an instrument for assessing functional care demands of psychogeriatric nursing home patients. The purpose of this study was to examine whether the CDS can be used on institutionalized elderly people other than psychogeriatric nursing home patients. Therefore, data were gathered on two different populations: residential home patients and somatic (high care) nursing home patients. Psychometric evaluations of the CDS were carried out for each population separately. These data offer additional support for the reliability of the scale in terms of internal consistency and inter-item correlation. The measures among separate groups of nurses show fair to moderate agreement. The criterion-related validity of the instrument was investigated by studying the relationship between the CDS and four other instruments. One of the main outcomes of the study is that the CDS can be used appropriately in residential home practice and in somatic nursing home practice.

Activities of Daily Living↗

PubMed2002

Human interaction.

Explore the source record for details and available documents.

Communication↗

PubMed2002

Electronic patient records: Dutch domain information model perinatology.

Currently a national domain information model is developed to support information exchange via electronic patient records (EPR), and to support the adoption of the EPR in Dutch healthcare practice. This article describes a pilot for the domain information model for mother- and childcare (perinatology) that serves as a first 'use case'. The 'use case' is modeled using the Health Level 7 version 3 Reference Information Model (HL7 RIM) as the methodology and modeling tool. The first results are promising, despite the fact that HL7 RIM is still in a draft version up to formal vote. The models of the 'use case' are both specific and generic at the same time, allowing professionals to recognize their domain specific content and work, and the EPR developers, or developers of messages for information exchange, to build practical implementations. The approach bridges professional content and technical issues.

Child↗

PubMedDate not supplied

Modeling nursing care in health level 7 reference information model.

This article describes the attempt that was made to fit nursing knowledge into the Reference Information Model developed by Health Level 7 (HL 7 RIM). A part of nursing knowledge concerning pressure ulcer was used to show the possibilities of modeling nursing knowledge, terminology, and information in the Health Level 7 Reference Information Model. The purpose of this modeling work was to allow the integration of nursing information in electronic patient records and to ensure the interoperability and exchange of nursing information. Based on earlier reviews of pressure ulcer literature, an overview was made of relevant variables, coding, and information required for nursing care for pressure ulcer. Next, a use case was made and followed by modeling the required information in the Unified Modeling Language. It is possible to integrate nursing knowledge, terminology, and information requirements in the Health Level 7 Reference Information Model.

Humans↗