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PubMed2002

Consumer Health Informatics--integrating patients, providers, and professionals online.

Consumer Health Informatics (CHI) means different things to patients, health professionals, and health care systems. A broader perspective on this new and rapidly developing field will enable us to understand and better apply its advances. This article provides an overview of CHI discussing its evolution and driving forces, along with advanced applications such as Personal Health Records, Internet transmission of personal health data, clinical e-mail, online pharmacies, and shared decision-making tools. Consumer Health Informatics will become integrated with medical care, electronic medical records, and patient education to impact the whole process and business of health care.

Access to Information↗
PubMed2002

Evaluation in health informatics: social network analysis.

Social network analysis comprises a set of research methods that can be used to analyze the relationships among entities such as people, departments, and organizations. The purpose of the analysis is to discover patterns of relationships that affect both individual and organizational attitudes and behavior such as the adoption, diffusion, and use of new medical informatics applications. This paper presents an introduction to the concepts and methods of social network analysis. Several applications to health informatics are described.

Attitude↗
PubMed2000

[Electronic documentation in medicine; flexible concepts versus isolated solutions].

Computer-based medical documentation so far proved advantageous especially through standardization of data entry and increased access speed. Additional benefits can be achieved through the implementation of integrated, cross-project documentation tools and their integration into the clinical work-flow, which allow data to be used for a wide variety of applications (e.g. quality management, clinical research, clinic management). The presence of incompatible documentation software often complicates the realization of these goals. Implementation of new documentation tools therefore should consider flexibility and multiple-use of data as primary design goals. In the presented paper requirements for flexible documentation tools are introduced. The Entity-Attribute-Value-Model is described as a possible means of implementation. Practical experiences made with a prototype application are reported.

Germany↗
PubMed1995

The development of protocols to cover clinical care in cardiology.

PROCAS (PRofiles Of CAre System) is one of the AIM projects whose objectives are to improve the quality and efficiency of medical treatment. These will be realised in establishing a methodology for defining and developing what are termed "Profiles of Care". These are sets of options for clinicians which are meant to create acceptable ways of managing patients with similar conditions and which represent good clinical practice. Moreover, a prototype system will be realised by the application of informatics and telematics, to enhance the provision of efficient and effective care in both hospitals and outpatient departments. Because of the retrospective nature of the ICD-9-CM system for the classification of cardiological patients, a draft for a Prospective Patient Data Model, which involves the assessment of somatic, psychosocial, environmental and demographic axes, is being presented. This multi-axial evaluation allows for the generation of the smallest unit of diagnostic-therapeutic procedures, based on the definition of the patient's health problem; that is: the patient-orientated diagnosis or the appropriate indication.

Cardiology↗
PubMed1994

Databook: monitoring a critical care unit.

DataBook is a computer application developed to assist the nurse manager in collecting, assessing and monitoring unit data on a day-to-day and summary basis. Once captured, this information can then be presented to create "information snapshots" of unit characteristics. Utilizing a PC-based spreadsheet program, the application is designed to be used by individuals with a modest degree of computer literacy.

Critical Care↗
PubMed2002

The application of the unified modeling language in object-oriented analysis of healthcare information systems.

This paper concerns itself with the beneficial effects of the Unified Modeling Language (UML), a nonproprietary object modeling standard, in specifying, visualizing, constructing, documenting, and communicating the model of a healthcare information system from the user's perspective. The author outlines the process of object-oriented analysis (OOA) using the UML and illustrates this with healthcare examples to demonstrate the practicality of application of the UML by healthcare personnel to real-world information system problems. The UML will accelerate advanced uses of object-orientation such as reuse technology, resulting in significantly higher software productivity. The UML is also applicable in the context of a component paradigm that promises to enhance the capabilities of healthcare information systems and simplify their management and maintenance.

Information Systems↗
PubMed1999

The "mediator service", a component to ease the integration of medical applications in the SynEx framework.

Interoperability is a key issue and a long-term domain of research for distributed healthcare information systems. The European project SynEx provides an open and standard integration platform for both new and legacy medical applications. It allows the collaboration of distributed and heterogeneous healthcare records and services. It aims to provide access to Hospital Information Services, to remote sources of medical data and to medical knowledge, in a seamless way, hiding the distribution aspects and the heterogeneity of systems. In this project, the Medical Informatics Department of the Broussais University Hospital is responsible for the development of the "Mediator Service". It is a software component of the SynEx platform which is used as a "glue" mechanism to provide a flexible way to facilitate the interchange between any pair of systems, with different nomenclatures and data structures. The Mediator Service uses a generic model of mediators to create, through specialization, specific mediators for practical cases. Based on this model, it offers a C++ library to be used as the tool case by the programmers, to reduce the development effort. The use of XML as a powerful data interchange format and as a data structure descriptor is proposed and evaluated.

Computer Communication Networks↗
PubMed1999

Emergency protocols in prehospital emergency medicine in Slovenia.

Emergency medicine is a branch of medicine in which prompt and accurate information is of crucial importance, because a patient's survival and the final outcome of a treatment very often depends on it. Therefore the standardization of prehospital emergency service administration with uniform documentation, methods of annotation of technical data as well as uniform gathering and data analysis are necessary. Wanting to process a fair amount of data and specially to disburden personnel, a need for computer aided processing is evident. Application that was developed in strong collaboration with EMS project team and information science engineers definitely improves data quality. Firstly when team members, especially physicians, are constrained to fulfill paper forms and secondly when data are entered into the computer, because all inconsistencies are being reconsidered and corrected if necessary. The developed application also gave the opportunity to the emergency team for prompt and accurate information.

Data Collection↗
PubMedDate not supplied

[Computers and medico-surgical ethics].

The confidence of physicians and surgeons in computerized medical systems is highly related to data reliability, while the confidence of the public depends on the protection of medical information in automated systems. In order to assure to patients medical data privacy, the MIM is of opinion that deontological and legal rules concerning access to identifiable medical data in automated information systems shall be the same as those that are applicable to conventional medical records. The access to medical data banks should be exclusively reserved to physicians responsible for patient care and to the personnel mandated by them.

Belgium↗
PubMed2005

Advanced and secure architectural EHR approaches.

OBJECTIVES: Electronic Health Records (EHRs) provided as a lifelong patient record advance towards core applications of distributed and co-operating health information systems and health networks. For meeting the challenge of scalable, flexible, portable, secure EHR systems, the underlying EHR architecture must be based on the component paradigm and model driven, separating platform-independent and platform-specific models. METHODS: Allowing manageable models, real systems must be decomposed and simplified. The resulting modelling approach has to follow the ISO Reference Model - Open Distributing Processing (RM-ODP). The ISO RM-ODP describes any system component from different perspectives. Platform-independent perspectives contain the enterprise view (business process, policies, scenarios, use cases), the information view (classes and associations) and the computational view (composition and decomposition), whereas platform-specific perspectives concern the engineering view (physical distribution and realisation) and the technology view (implementation details from protocols up to education and training) on system components. Those views have to be established for components reflecting aspects of all domains involved in healthcare environments including administrative, legal, medical, technical, etc. Thus, security-related component models reflecting all view mentioned have to be established for enabling both application and communication security services as integral part of the system's architecture. Beside decomposition and simplification of system regarding the different viewpoint on their components, different levels of systems' granularity can be defined hiding internals or focusing on properties of basic components to form a more complex structure. The resulting models describe both structure and behaviour of component-based systems. RESULTS: The described approach has been deployed in different projects defining EHR systems and their underlying architectural principles. In that context, the Australian GEHR project, the openEHR initiative, the revision of CEN ENV 13606 "Electronic Health Record communication", all based on Archetypes, but also the HL7 version 3 activities are discussed in some detail. The latter include the HL7 RIM, the HL7 Development Framework, the HL7's clinical document architecture (CDA) as well as the set of models from use cases, activity diagrams, sequence diagrams up to Domain Information Models (DMIMs) and their building blocks Common Message Element Types (CMET) Constraining Models to their underlying concepts. CONCLUSION: The future-proof EHR architecture as open, user-centric, user-friendly, flexible, scalable, portable core application in health information systems and health networks has to follow advanced architectural paradigms.

Computer Security↗
PubMedDate not supplied

An integrated architecture for deploying a virtual private medical network over the web.

In this paper we describe a pilot architecture aiming at protecting Web-based medical applications through the development of a virtual private medical network. The basic technology, which is utilized by this integrated architecture, is the Trusted Third Party (TTP). In specific, a TTP is used to generate, distribute, and revoke digital certificates to/from medical practitioners and healthcare organizations wishing to communicate in a secure way. Digital certificates and digital signatures are, in particular, used to provide peer and data origin authentication and access control functionalities. We also propose a logical Public Key Infrastructure (PKI) architecture, which is robust, scalable, and based on standards. This architecture aims at supporting large-scale healthcare applications. It supports openness, scalability, flexibility and extensibility, and can be integrated with existing TTP schemes and infrastructures offering transparency and adequate security. Finally, it is demonstrated that the proposed architecture enjoys all desirable usability characteristics, and meets the set of criteria, which constitutes an applicable framework for the development of trusted medical services over the Web.

Certification↗
PubMed1996

Formal descriptions and adaptive mechanisms for changes in controlled medical vocabularies.

Standard controlled medical vocabularies are typically based on a coding scheme, while medical informatics applications tend to have a more formal conceptual foundation. When such applications attempt to use data coded with standard vocabularies, problems can arise when the standard vocabulary changes over time. A formal taxonomy is presented for describing the semantic changes which can occur in a vocabulary, such as simple addition, refinement, precoordination, disambiguation, redundancy, obsolescence, discovered redundancy, major name changes, minor name changes, code reuse, and changed codes. The taxonomy is described that used to effect change in one concept-based vocabulary (the Medical Entities Dictionary), and the utility of the approach is demonstrated by applying it to the changes appearing in the 1994 release of the International Classification of Diseases, Ninth Edition, with Clinical Modifications (ICD-9-CM).

Classification↗