bluuebunny/crossref_metadata_2025 huggingface dataset:
Design as Bootstrapping. On the Evolution of ICT Networks in Health Care
Authors: Aanestad M. , Hanseth O.
Published: March 2018

Objectives: This paper assumes that in addressing major challenges related to telemedicine as networks enabling huge improvements of heath services we need to move beyond complexity and rather focus on the very nature of such networks.

Methods: The results of this paper are based on an interpretive analysis of three case studies involving telemedicine, i.e. broadband networks in minimal invasive surgery, EDI infrastructures and telemedicine in ambulances.

Results and Conclusion: The well-known concept of “critical mass” focuses on the number of users as a significant factor of network growth. We argue however, that we should not only consider the size of the network, but also the heterogeneity of its elements. In order to discuss heterogeneity along several dimensions, we find Granovetter’s and Schelling’s models of diversity in individual preferences helpful. In addition to the heterogeneity of the individual users, we discuss heterogeneity related to use areas and situation, to technologies, etc. The interdependencies and possible conflicts between these dimensions are discussed, and we suggest “bootstrapping” as a concept to guide the navigation/exploitation in/of these dimensions.
Managers See the Problems Associated with Coding Clinical Data as a Technical Issue whilst Clinicians also See Cultural Barriers
Authors: Wells S. E. , Hague N. J. , Thiru K. , de Lusignan S.
Published: March 2018

Objective: In UK general practice, the coding of clinical data (Read Coding) is far from universal. This study set out to examine the barriers to recording structured information in computerised medical records; and to explore whether managers and clinicians had different perspectives in how these barriers should be overcome.

Method: A qualitative study, using semi-structured interviews of general practitioners, primary care nurses and practice managers. The interviews were recorded verbatim, and then underwent thematic analysis; additional interviews were conducted until thematic saturation was achieved.

Results: For clinicians the recording of structured data within a consultation is not a neutral activity, they are highly aware of diagnostic uncertainty and sensitive to the potential impact of both a correct and incorrect diagnostic label on their relationship with their patient. Clinicians accept that data has to be coded if they are to demonstrate that appropriate evidence based care has been provided to populations; but alongside this they require free-text as a more powerful reminder of the individual human encounter. Managers felt that they could encourage clinicians to code data for re-use as part of population data or as quality target indicators rather than as an enabler of the next consultation. Conclusions: The primary care consultation is a complex social interaction, and coding of the medical diagnosis in itself imposes the bio-medical model, carries assumptions about certainty, and is perceived by clinicians to potentially jeopardise their relationships with their patient. Further research to elicit patients’ views may help clarify the magnitude of this barrier.
Medicine and Aviation: A Review of the Comparison
Authors: Randell R.
Published: March 2018

Objective: This paper aims to understand the nature of medical error in highly technological environments and argues that a comparison with aviation can blur its real understanding.

Methods: This study is a comparative study between the notion of error in health care and aviation based on the author’s own ethnographic study in intensive care units and findings from the research literature on errors in aviation.

Results and Conclusions: Failures in the use of medical technology are common. In attempts to understand the area of medical error, much attention has focused on how we can learn from aviation. This paper argues that such a comparison is not always useful, on the basis that (i) the type of work and technology is very different in the two domains; (ii) different issues are involved in training and procurement; and (iii) attitudes to error vary between the domains. Therefore, it is necessary to look closely at the subject of medical error and resolve those questions left unanswered by the lessons of aviation.
“We Fill in Our Working Understanding”: On Codes, Classifications and the Production of Accurate Data
Authors: Winthereik B. R.
Published: March 2018

Objectives: This paper describes differences in the way general practitioners in Denmark, The Netherlands and Great Britain make codes fit into the local conditions under which they work.

Methods: An ethnographic study method has been used to collect data in Dutch, British and Danish general practices.

Results and Conclusions: The paper argues that what counts as “accurate data” is locally constructed. As codes are produced in local networks of human and technological actors, the way accuracy is constructed is dependent on the extra work that is carried out (by actors inside the clinic as well as outside of it). On the basis of differences between coding practices and classification systems the paper discusses how inherent tensions between coding for primary and secondary purposes can be solved. The paper concludes that instead of evaluating data in terms of how accurate they are in general, they should be looked at in terms of pertinence to specific research questions.
Evaluation of Techniques for the Presentation of Laboratory Data: Support of Pattern Recognition
Authors: Hoeke J. O. O. , Bonke B. , van Strik R. , Gelsema E. S.
Published: March 2018

Two tabular and two graphical techniques for the presentation of laboratory test results were compared in a reaction-time experiment with 22 volunteers. The experimental setup was designed to determine whether one or more of the presentation techniques facilitated the recognition of four predefined combinations of abnormal test results. Using a conventional, tabular presentation technique as a reference, faster median response times were obtained with each of the other three presentation techniques, irrespective of pattern. The effect on accuracy was less clear, possibly due to the small number of errors made.
Spatio-Temporal Nonlinear Modeling of Gastric Myoelectrical Activity
Authors: Cheung J. Y. , Gao S. K. , Chen J. D. Z. , Wang Z. S.
Published: March 2018

The accomplishment of a complete digestive process of human stomach is regulated by a spatio-temporally-coordinated electric pattern called gastric myoelectrical activity (GMA). The normal patterns of GMA present temporal evolution from endogenous rhythmic oscillation to bursting of spikes associated with contractions, and also ordered spatial propagation of the oscillating waves. The abnormal patterns of GMA have been observed in temporal dysrhythmia, such as tachygastria, bradygastria and arrhythmia, and in spatial propagation failure, such as retrograde propagation and uncoupling. Different GMA patterns are associated with different gastric symptoms and there exist some nonlinear mechanisms to govern the formation and dynamic evolution of these patterns. However, these mechanisms are so complex that few of them are known by medical observations. The aim of this study is to explore these mechanisms by spatio-temporal modeling of GMA. The single-cell model simulating the formation process of slow waves and spikes, the multi-cell model simulating the propagation process of GMA and the extracellular model simulating the formation of bipolar recordings are presented.
Analysis of Acceleration Signals using Wavelet Transform
Authors: Tamura T. , Akay M. , Togawa T. , Fukui Y. , Sekine M.
Published: March 2018

In this study, we attempted to discriminate the acceleration signal for horizontal level and stairway walking using wavelet-based fractal analysis method. The acceleration signal was measured close to the center of gravity of the body, while the subjects walked continuously in the corridor and up and down the stairs. We used the wavelet-based fractal analysis method to discriminate walking pattern. The parameter H which is related directly to the fractal dimension was estimated by the wavelet coefficient and was changed into low value during walking upstairs. By manually setting the threshold level for individual, it was possible to discriminate walking upstairs from the other walking type. However, the common feature among subjects was not shown between level walking and walking downstairs.
Integration of High Resolution EEG and Functional Magnetic Resonance in the Study of Human Movement-Related Potentials
Authors: Carducci F. , Cincotti F. , Del Gratta C. , Roberti G. M. , Romani G. L. , Rossini P. M. , Babiloni C. , Babiloni F.
Published: March 2018

Cortical sources of human movement-related potentials (i.e. unilateral finger extension) were modeled using functional magnetic resonance imaging (fMR) data as a constraint of a linear inverse source estimation from highly sampled (128 channels) EEG data. Remarkably, this estimation was performed within realistic subject’s MR-constructed head models by boundary element techniques. An appropriate figure of merit served to set the optimal amount of fMR constraints. With respect to standard linear inverse source estimates, fMR-constrained ones presented increased spatial detail and provided a more reliable timing of activation in bilateral sensorimotor cortical regions of interest.
Event-Related Brain Potentials: Laplacian Transformation for Multichannel Time-Frequency Analysis
Authors: Locatelli T. , Mainardi L. T. , Cursi M. , Comi G. , Cerutti S. , Bianchi A. M.
Published: March 2018

During a visual-motor task the movement strategies and the learning processes are investigated. A group of 10 normal young volunteers underwent the experiment. The EEG signal was recorded through the 10-20 acquisition system during the execution of a task after a visual input. Each subject repeated the movement several times in three different conditions: i) without knowledge of the performance; ii) with visual feedback; iii) with knowledge of the result. The signal was transformed through Laplacian operator in order to eliminate the spurious coherence and then time-variant coherence was calculated. Different trends of the coherence function have been evidenced in subjects learning and not learning the better movement strategy. In particular, relations have been found between frontal, central and occipital electrodes in medium and high frequency ranges.
Differentiation of Physiological States under Sensory Deprivation
Authors: Nakao M. , Yamamoto M. , Kimura M. , Iwata K.
Published: March 2018

We attempt to differentiate the physiological state during sensory deprivation (SD) from normal sleep and wakefulness in terms of electroencephalogram (EEG) and heart rate variability (HRV) dynamics. KullbackLeibler (K-L) divergence is employed to quantify differences between their state-dependent dynamics. As a result, the dynamics of EEG and HRV during SD are found to be far distant from any representative dynamics of natural states of sleep and wakefulness. However, relatively speaking, the findings in SD can be categorized into two patterns. (a) The dynamics of HRV during SD is similar to that of rapid eye movement (REM) sleep, and the dynamics of EEG during SD is similar to that of wakefulness. (b) The dynamics of both HRV and EEG during SD are similar to that of REM. Such dissociation between states classified by EEG and HRV dynamics frequently takes place during SD. These findings suggest the peculiarity of the physiological state during the SD distinct from sleep and wakefulness.
Analysis of Respiratory Sinus Arrhythmia with Respect to Respiratory Phase
Authors: Kotani K. , Hidaka I. , Yamamoto Y. , Ozono S.
Published: March 2018

We evaluated the respiratory modulation of heart rate, i.e., respiratory sinus arrhythmia (RSA), with respect to respiratory phase derived from an analytic signal from the lung volume curve, during spontaneous breathing and paced breathing with different patterns. The magnitudes and waveforms of RSA in the phase domain were similar regardless of breathing pattern, even including spontaneous breathing. An examination of the occurrence of heart beats with respect to the respiratory phase revealed that synchronized patterns recently reported in the literature (Nature 392: 239, 1998) were observed during paced breathing with breath holding periods whereby the respiratory phase advanced more slowly. It was concluded that the phase domain approach might be useful in extracting RSA during spontaneous breathing and for elucidating detailed mechanisms for RSA. However, the use of this technique for studies investigating cardio-respiratory coupling should be approached cautiously, as the results may be influenced by breathing patterns.
EEG/MEG Error Bounds for a Dynamic Dipole Source with a Realistic Head Model
Authors: Muravchik C. , Bria O. , Nehorai A.
Published: March 2018

This work presents the background and derivation of Cramér-Rao bounds on the errors of estimating the parameters (moment and location) of a dynamic current dipole source using data from electro- and magneto-encephalography. A realistic head model, based on knowledge of surfaces separating tissues of different conductivities, is used.
Computational Model of DIC Microscopy for Reconstructing 3-D Specimens
Authors: Lanni F. , Kanade T. , Kagalwala F.
Published: March 2018

Differential Interference Contrast (DIC) microscopy is a powerful visualization tool used to study live biological cells. Its use, however, has been limited to qualitative observations. The inherent non-linear relation between the object properties and the image intensity makes quantitative analysis difficult. As a first step towards measuring optical properties of objects from DIC images, we develop a model for the image formation process using methods consistent with energy conservation laws. We verify our model by comparing real image data of manufactured specimens to simulated images of virtual objects. As the next step, we plan to use this model to reconstruct the three-dimensional properties of unknown specimens.
Analysis of the Process of Encoding Guidelines: A Comparison of GLIF2 and GLIF3
Authors: Branch T. , Wang D. , Peleg M. , Boxwala A. , Patel V. L.
Published: March 2018

Objectives:
This study aims to evaluate the use of a modified version of the Guideline Interchange Format (GLIF), GLIF3, in the translation of clinical practice guidelines into an electronically encoded form such that they may be shared among various clinical institutions and settings.

Methods:
Based on theories and methods from cognitive science, the encoding of two clinical practice guidelines into two guideline modeling methods (GLIF3 and an earlier version, GLIF2) by two medical informaticians was captured on video and transcribed and annotated for analysis.

Results:
Differing in both content and structure, the representations developed in GLIF3 were found to contain a greater level of representational detail and less ambiguity than those developed in GLIF2.

Conclusions:
The use of GLIF3 in the encoding of clinical guidelines offers significant improvements due to its greater formality as compared to earlier versions of GLIF.
Medical Imaging Informatics and Medical Informatics: Opportunities and Constraints
Authors: Kulikowski C. , Bohne A. , Ganser K. , Haux R. , Knaup P. , Maier C. , Michel A. , Singer R. , Wolff A. C. , Ammenwerth E.
Published: March 2018

Objectives:
The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of recent excellent papers on medical informatics research (http://www.yearbook.uni-hd.de). The 2002 Yearbook of Medical Informatics took as its theme the topic of Medical Imaging Informatics. In this paper, we will summarize the contributions of medical informatics researchers to the development of medical imaging informatics, discuss challenges and opportunities of imaging informatics, and present the lessons learned from the IMIA Yearbook 2002.

Results and Conclusions:
Medical informatics researchers have contributed to the development of medical imaging methods and systems since the inception of this field approximately 40 years ago. The Yearbook presents selected papers and reviews on this important topic.

In addition, as usual, the Yearbook 2002 also contains a variety of papers and reviews on other subjects relevant to medical informatics, such as Bioinformatics, Computer-supported education, Health and clinical management, Health information systems, Knowledge processing and decision support, Patient records, and Signal processing.
Subjective Symptoms Acquisition System in a Health Promotion System for the Elderly
Authors: Shibata S. , Ohtuka Y. , Hattori M. , Aoshima T. , Tohyama S. , Uchiyama A. , Kashihara H. , Tamura M. , Tsuchiya A. , Yoshida K. , Sasamori N. , Tanaka Y. ,   Committee of System Development, Council of Japan AMHTS Institutions
Published: March 2018

A previous report was concerned with the evaluation of quality of life using a Health Promotion System for the Elderly. In the present report, we describe one part of that system: a subjective symptoms acquisition and reporting system.

The main purpose of this system is to permit any physician or nurse to uniformly employ questionnaires to acquire accurate subjective symptoms. This system is applied in three steps. First, the subjective answers to 21 questions displayed on a personal computer are obtained. These answers correspond to the basic subjective symptoms. Second, if a basic subjective symptom is “positive”, more detailed questions are automatically generated. Finally, clear sentences regarding subjective symptoms are generated and output as a “finding report”.

This information is helpful to physicians and nurses in their health-counseling work. An artificial intelligence (AI) program based on “XpertRule” produces detailed questions which are generated by an interactive questionnaire using branching logical rules.
Significance of Measuring the Quality of Life in Health Evaluation
Authors: Koyama W. , Kohashi N. , Hayashi T. , Iida N.
Published: March 2018

To evaluate the QUIK-R, a revised self-completed questionnaire for the quality of life (QOL), and to clarify the significance of measuring QOL in health evaluations, the results of 1,017 office workers were analyzed. The QUIK-R showed a high reliability and a high validity. There were significant correlations between the total score and the subject’s age, sex, smoking habit, sleeping time, and exercise. Forty-two subjects with a good QUIK-R score had poor physical examination results. Our results show the usefulness of the QUIK-R and the importance of measuring the QOL in health evaluations.
Historical Evolution of Preventive Medical Informatics in the USA
Authors: Collen M. F.
Published: March 2018

A major reorganization of healthcare services is occurring in the United States. It has evolved from the solo- and group-practice models of the 1940s with fee-for-service and insurer-indemnification financing that used paper-based information systems to support preventive medical services. In the 1990s there emerged nation-wide, managed-care plans employing enhanced computer-based information systems with online preventive medical practice guidelines and Internet-supported home-care telemedicine. It is helpful to review how this major reengineering of medicine has come about.
Patient Reports as Stories of Clinical Work: Narrative and Work in Neuroradiology
Authors: Rooksby J. , Kay S.
Published: March 2018

Objective: This paper describes the connections between the radiology report and clinical work and considers the implications for computerisation.

Method: A story representation is described that allows consideration of the radiology report as an active unit of narrative rather than a passive collection of data. This paper draws upon the results of a qualitative study of a neuroradiology department.

Results and Conclusion: Radiology reports recount a patient condition but also represent and influence clinical work.
Teleconsultation: Rejected and Emerging Uses
Authors: Lehoux P. , Sicotte C.
Published: March 2018

Objective: The aim of this paper is to analyse telemedicine as a new means to improve health care accessibility.

Method: A case study design was used to understand how medical specialists perceived, made sense of, and appropriated a teleconsultation system.

Results and Conclusions: The technology was used neither in the manner nor to the extent anticipated by its designers. A fundamental modification to the traditional medical consultation process has emerged. Unable to be used as a substitute to the traditional medical consultation process, the teleconsultation system imposes a greater burden on the shoulders of participating physicians who, after a few trials, returned to their traditional mode of practice.
Leveraging Information Technology Towards Enhancing Patient Care and a Culture of Safety in the U.S.
Authors: Garets D. E. , Handler T. J. , Ball M. J.
Published: March 2018

Objectives:
To heighten awareness about the critical issues currently affecting patient care and to propose solutions based on leveraging information technologies to enhance patient care and influence a culture of patient safety.

Methods:
Presentation and discussion of the issues affecting health care today, such as medical and medication-related errors and analysis of their root causes; proliferation of medical knowledge and medical technologies; initiatives to improve patient safety; steps necessary to develop a culture of safety; introduction of relevant enabling technologies; and evidence of results.

Results and Conclusion:
Medical errors affect not only mortality and morbidity, but they also create secondary costs leading to dissatisfaction by both provider and patient. Health care has been slow to acknowledge the benefits of enabling technologies to affect the quality of care. Evaluation of recent applications, such as the computerized patient record, physician order entry, and computerized alerting systems show tremendous potential to enhance patient care and influence the development of a culture focused on safety. They will also bring about changes in other areas, such as workflow and the creation of new partnerships among providers, patients, and payers.
Modeling Hospital Information Systems (Part 1): The Revised Three-layer Graph-based Meta Model 3LGM2
Authors: Brigl B. , Wendt T. , Winter A.
Published: March 2018

Objectives:
Not only architects but also information managers need models and modeling tools for their subject of work. Especially for supporting strategic information management in hospitals, the meta model 3LGM2 is presented as an ontological basis for modeling the comprehensive information system of a hospital (HIS).

Methods:
In a case study, requirements for modeling HIS have been deduced. Accordingly 3LGM2 has been designed to describe HIS by concepts on three layers. The domain layer consists of enterprise functions and entity types, the logical tool layer focuses on application components and the physical tool layer describes physical data processing components. In contrast to other approaches a lot of inter-layer-relationships exist. 3LGM2 is defined using the Unified Modeling Language (UML).

Results:
Models of HIS can be created which comprise not only technical and semantic aspects but also computer-based and paper-based information processing. A software tool supporting the creation of 3LGM2 compliant models in a graphical way has been developed. The tool supports in detecting those shortcomings at the logical or the physical tool layers which make it impossible to satisfy the information needs at the domain layer. 3LGM2 can also be used as an ontology for describing HIS in natural language.

Conclusions:
Strategic information management even in large hospitals should be and can be supported by dedicated methods and tools. Although there have been good experiences with 3LGM2 concerning digital document archiving at the Leipzig University Hospital, which are presented in part 2, the benefit of the proposed method and tool has to be further evaluated.
Role of the Electronic Patient Record in the Development of General Practice in the Netherlands
Authors: Knottnerus J. A.
Published: March 2018

From the end of the seventies practice computer systems have been introduced in Dutch general practice. In 1998 90% of the GPs had a practice computer and 60% used it for medical purposes, with good patient acceptance. Collaboration between pioneer GPs, professional organizations, academic institutions and software manufacturers has been of decisive importance. While the practice computer is early recognized as a powerful tool for administrative purposes, it is increasingly supporting clinical and preventive care, quality of care improvement, clinical training of students and vocational training of general practice trainees. Also for scientific research and practice supporting research, automatization has proven to be innovating. Much attention is paid to designing valid databases and database-related research. In addition, practice automatization has opened new perspectives for health policy and management. Further development of technical and methodological issues is needed, and, very importantly, of patients‘ and consumers’ involvement. EPR technology in general practice does not optimally work without good numerator and denominator data, and a good quality patient-doctor relationship over time. While the EPR is a useful tool to facilitate a better performance, it may enable the doctor to focus more on the health care essentials.
Design of a Decision Support System for Test Ordering in General Practice: Choices and Decisions to Make
Authors: Mosseveld M. , van der Lei J. , van Wijk M.
Published: March 2018

The increased availability of tests in the past years has been accompanied by an increased number of blood tests ordered by general practitioners. Dutch investigators report a lack of general practitioners’ knowledge concerning the indications for blood tests leading to inappropriate and inadequate use of diagnostic tests. Taking advantage of the use of electronic patient records by Dutch general practitioners, the authors replaced the traditional paper forms for test ordering by a decision-support system. The objective of the decision-support system is to change test-ordering behavior. Designing a system to change test-ordering behavior, however, required the selection of a method to provide support. To study different methods for changing test-ordering behavior, the authors developed two versions of the decision-support system BloodLink. The first version, Blood-Link-Restricted, is based on the notion of restricting the number of choices presented to the general practitioners. The second version, BloodLink-Guideline, is based on the guidelines provided by the Dutch college of general practitioners.
A Decision Support System for Diabetes Care: Ethical Aspects
Authors: Shahsavar N. , Gill H. , Collste G.
Published: March 2018

In this paper the design and implementation of a decision support system for diabetes care is examined from an ethical perspective. It is noted that the system creates potential for enhancing the realization of the principle of autonomy through improved information to patients and participation by patients. However, there is also potential for using the system in a way that is contrary to good health care. It may provide patients with information they are unable to interpret and handle, and it may be used by healthcare authorities for controlling their personnel in ways contrary to good quality working conditions. In order for a decision support system to function as a well-integrated element in ethically based health care, different ethical aspects have to be taken into account during the design of the system. The ethical aspects also constitute one perspective of a systematic re-evaluation and re-design process.
Changes regarding Age and Correlations between Serum Lipids and Body Mass Index in Humankind
Authors: Yamasawa I. , Kamohara S. , Shiota M. , Komori T. , Watanabe Y. , Nakano M. , Matsubara T. , Nagashima K.
Published: March 2018

Objectives:
To improve insight into age and gender related distributions of serum lipids and their correlation with body mass index (BMI).

Methods:
Serum lipids embracing atherogenic index (AI) and BMI were analyzed from the results obtained in 19,823 men and 14,788 women undergoing a health examination between 1986 and 1996.

Results:
The changes in total cholesterol (TC), triglyceride (TG), AI and BMI differed regarding gender. Although high-density lipoprotein-cholesterol (HDL-C) showed a flat pattern for all ages in both genders, its level in women was higher than in men. The ratio of the number in the unsuitable range to those in the suitable range increased with age as to TC in both sexes, then more than half of the population have an unsuitable level in the sixth decade. As for the correlation between serum lipids and BMI: TC, TG and AI correlated positively, but HDL-C correlated negatively. There were significant gaps between both age and gender.

Conclusions:
We suggest that the normal range of values of serum lipids needs to be revised according to gender and age to evaluate the risk status for a cardio-cerebrovascular disease more precisely in the field of preventive medicine. Simpler guidelines are preferable in specialized care as well as in general practice, particularly since computer technology is not yet universally adapted. In the near future, when computed information technology will be as common as the electricity and the telephone are current on the whole earth, all guidelines will have to be computed on the spot and personally.
Vicissitudes of Preventive Medicine and a New Challenge
Authors: Collen M. F.
Published: March 2018

Objectives:
Significant changes in mortality patterns are part of the changing population demographics. This paper explores their implications for health evaluation and screening programs.

Methods:
A review of selected age-adjusted mortality rates from the National Vital Statistics Reports of the USA was undertaken and their change over the last five decades analyzed.

Results:
The review shows a continued decline in mortality rates from leading causes of death, such as heart disease, cancer, stroke, pneumonia and influenza, and a sharp rise in the death rates from Alzheimer’s disease. Available means for detection of Alzeimer’s disease are summarized.

Conclusion:
Given the emerging possibilities for the treatment and prevention of the progression of Alzheimer’s disease, tests for early detection of Alzheimer’s should be included in health screening examinations.
A Humanist’s Legacy in Medical Informatics: Visions and Accomplishments of Professor Jean-Raoul Scherrer
Authors: Lovis C. , Spahni S. , Appel R. D. , Ratib O. , Boyer C. , Hochstrasser D. F. , Baud R. , Geissbühler A.
Published: March 2018

Objective:
To report about the work of Prof. Jean-Raoul Scherrer, and show how his humanist vision, his medical skills and his scientific background have enabled and shaped the development of medical informatics over the last 30 years.

Results:
Starting with the mainframe-based patient-centered hospital information system DIOGENE in the 70s, Prof. Scherrer developed, implemented and evolved innovative concepts of man-machine interfaces, distributed and federated environments, leading the way with information systems that obstinately focused on the support of care providers and patients. Through a rigorous design of terminologies and ontologies, the DIOGENE data would then serve as a basis for the development of clinical research, data mining, and lead to innovative natural language processing techniques. In parallel, Prof. Scherrer supported the development of medical image management, ranging from a distributed picture archiving and communication systems (PACS) to molecular imaging of protein electrophoreses. Recognizing the need for improving the quality and trustworthiness of medical information on the Web, Prof. Scherrer created the Health-On-the-Net (HON) foundation.

Conclusions:
These achievements, made possible thanks to his visionary mind, deep humanism, creativity, generosity and determination, have made of Prof. Scherrer a true pioneer and leader of the human-centered, patient-oriented application of information technology for improving healthcare.
A Randomized Evaluation of a Computer-Based Nursing Documentation System
Authors: Eichstädter R. , Haux R. , Pohl U. , Rebel S. , Ziegler S. , Ammenwerth E.
Published: March 2018

A two-month randomized, controlled trial based on 60 patients has been performed on a ward of the Department of Psychiatry at Heidelberg University Medical Center, Germany, to investigate the influence of computer-based nursing documentation on time investment for documentation, quality of documentation and user acceptance. Time measurements, questionnaires, documentation analysis and interviews were used to compare patients documented with the computer-based system (PIK group) with the control group (patients documented with the paper-based system). The results showed the advantages and disadvantages of computer-based nursing documentation. Time needed for nursing care planning was lower in the PIK group. Some formal aspects of quality were considerably better in the PIK group. On the other hand, time required for documentation of tasks and for report writing was greater in the PIK group. User acceptance increased significantly during the study. The interviews indicated a positive influence of PIK on the cooperation between nurses and physicians.
Intranet Meets Hospital Information Systems: The Solution to the Integration Problem?
Authors: Kuhn K. A. , Lenz R.
Published: March 2018

Based on the results of an extensive market analysis and technology assessment, this paper summarizes the state of the art in web technology and compares it with the needs of integration in hospital information systems. Web technology and intranet have evolved to a core technology for distributed computing and distributed information systems. The advantage of platform independent distribution of information has led to euphoric visions of future integrated systems. However, true integration takes more than transparent access to heterogeneous information sources. To overcome the essential problems related to integration of autonomous systems it is important to find a common ontological basis for future component based systems.
Childhood Leukaemia Clustering – Fact or Artefact?
Authors: Bithell J. F.
Published: March 2018

There is a general belief that the clustering of childhood leukaemia is a widespread phenomenon and that it provides evidence for appreciable environmental influence on the incidence of the disease. We discuss this issue critically, identifying different kinds of clustering and their possible aetiological mechanisms and examining some analyses of British data. We argue that, in some cases, analyses have been used which lead to dubious conclusions, and that, allowing for multiple testing and anecdotal reporting, the total evidence for clustering is at best weak.
Deficits and Remedy of the Standard Random Effects Methods in Meta-analysis
Authors: Koch A. , Victor N. , Ziegler S.
Published: March 2018

The random effects model is often used in meta-analyses. A corresponding significance test based on a normal approximation has been established. Its type I error is derived in this article by theoretical considerations and computer simulations. The test can be conservative as well as unacceptably anti-conservative. The anti-conservatism increases with the increasing number of patients and the decreasing number of studies. A modification is proposed, which keeps the nominal level asymptotically as the number of patients approaches infinity. Simulations show that the modified test is often conservative, but its conservatism is small in those situations where the standard test is highly anti-conservative.
Best-Link Matching of Scottish Health Data Sets
Authors: Douglas M. M. , Gardner D. , Hucker D. , Kendrick S. W.
Published: March 2018

Methods are described used to link the Community Health Index and the National Health Service Central Register (NHSCR) in Scotland to provide a basis for a national patient index. The linkage used a combination of deterministic and probability matching techniques. A best-link principle was used by which each Community Health Index record was allowed to link only to the NHSCR record with which it achieved the highest match weight. This strategy, applied in the context of two files which each covered virtually the entire population of Scotland, increased the accuracy of linkage approximately a thousand-fold compared with the likely results of a less structured probability matching approach. By this means, 98.8% of linkable records were linked automatically with a sufficient degree of confidence for administrative purposes.
Diagnosis of Acute Appendicitis in Two Databases. Evaluation of Different Neighborhoods with an LVQ Neural Network
Authors: Ohmann C. , Eskelinen M. , Juhola M. , Pesonen E.
Published: March 2018

The use of an artificial neural network system was studied in the diagnosis of acute abdominal pain, especially acute appendicitis, with patients from Finland and Germany. Separate Learning Vector Quantization (LVQ) neural networks were trained with a training set from each database and also with a combined database. Each neural network was evaluated separately with a test set of cases from each database. With the combined database different neighborhood methods were compared to find the optimal choice for this decision-making problem. The acute appendicitis cases of the Finnish test data set were classified well with all the networks, but the cases of the German test set were difficult to classify for the Finnish network. The use of larger neighborhoods increased the sensitivity of the classification by nearly 10%. The differences in the results of the Finnish and German databases suggest that there are differences in the data collection or patient populations between centers. Therefore, care must be taken when using decision-support systems which have been developed in other centers. Neural networks offer a method to evaluate differences between databases. With the use of larger neighborhoods, the effects of the differences on the accuracy of the classification can be partly diminished.
Effects of Record Linkage Errors on Disease Registration
Authors: Schmidtmann I. , Brenner H.
Published: March 2018

Reliable record linkage is a prerequisite for high-quality population-based disease registration. Rapid developments in computer processing have made record linkage both more efficient and more reliable in recent years. At the same time, concerns about confidentiality increasingly hinder record linkage in many disease registries. This paper provides basic algebraic models describing the effects of record linkage errors on monitoring disease incidence. Homonym errors, that is, erroneous linkage of records that pertain to distinct individuals, lead to underestimation of incidence in the registry population. The degree of underestimation strongly depends on the discriminating power of personal identifiers and the record linkage procedure on the one hand, and the number of registered cases on the other hand. Synonym errors, that is, failure to link notifications on the same individual, lead to overestimation of incidence in the population base. The combined effects of record linkage errors are illustrated with empirical examples. We conclude that it is the largest and most informative disease registries that are potentially affected most by impediments of record linkage procedures due to unduly restrictive confidentiality rules.
Implementing HL7: from the Standard's Specification to Production Application
Authors: Föhring U. , Tolxdorff Th. , Schadow G.
Published: March 2018

A C++ implementation of the HL7 health-care data interchange standard was developed by automatic methods applied to the authoritative specification of the standard. The reusable class library th us created presents an intuitive, flexible, and easy-to-use application programming interface to the HL7 protocol. This allows HL7 applications to be developed quickly while a high conformance to the standard is ensured.
Automatic Coding of Diagnostic Reports
Authors: Hasman A. , Arends J. W. , de Bruijn L. M.
Published: March 2018

A method is presented for assigning classification codes to pathology reports by searching similar reports from an archive collection. The key for searching is textual similarity, which estimates the true, semantic similarity. This method does not require explicit modeling, and can be applied to any language or any application domain that uses natural language reporting. A number of simulation experiments was run to assess the accuracy of the method and to indicate the role of size of the archive and the transfer of document collections across laboratories. In at least 63% of the simulation trials, the most similar archive text offered a suitable classification on organ, origin and diagnosis. In 85 to 90% ofthe trials, the archive's best solution was found within the first five similar reports. The results indicate that the method is suitable for its purpose: suggesting potentially correct classifications to the reporting diagnostician.
Computer-based Decision Support in the Management of Primary Gastric non-Hodgkin Lymphoma
Authors: Boot H. , Taal B. G. , Lucas P. J. F.
Published: March 2018

Primary non-Hodgkin lymphoma of the stomach is a rare disorder for which clinical management has not yet been settled completely. Faced with the many uncertainties associated with the selection of a treatment for a patient with this disorder, it is difficult to determine the treatment that is optimal for the patient, as well as the prognosis to be expected. The development of a decision-theoretic model of non-Hodgkin lymphoma of the stomach is described. The model aims to assist the clinician in exploring various clinical questions, among others questions concerning prognosis and optimal treatment. Central to the model is a probabilistic network that offers an explicit representation of the uncertainties underlying the decision-making process. The model has been incorporated in a decisionsupport system. Preliminary evaluation results indicate that the performance ofthe model in its present form matches the performance of experienced clinicians.
Formalising and Acquiring Modelbased Hypertext in Medicine: an Integrative Approach
Authors: Spreckelsen C. , Spitzer K.
Published: March 2018

Combining a knowledge acquisition methodology with a powerful data model we present an approach to the acquisition, maintenance and browsing of scientific medical hypertext. The hypergraph-based data model supports the consistent treatment of cyclic data structures, the nesting of complex object and provides an elegant way of path declaration to represent time-dependent medical processes or large hypertext tours. It encourages a stepwise schema design and therefore supports a spiral-shaped acquisition process. We formally define view mechanisms on the basis of a rule-based query and modification language. The views enable a context-sensitive presentation of medical knowledge according to the informational needs of the physician.

Our approach has been applied to the implementation of an authoring and tutoring environment for a computer-based hypermedia reference book for cerebrovascular diseases (NeuroN). During the acquisition process the expressive power and flexibility of the representational formats have been evaluated.
Risk Perception during Information System Development in Non-Profit Health Care Organizations
Authors: Timpka T. , Ljunggren M. , Vimarlund V.
Published: March 2018

The perception of risk exposure among design team members during the early phases of information system development projects can provide valuable strategic information for clinical organizations. To develop a typology of perceived risks during information system development projects in health care, interviews were performed with key team members from a specialist clinic, primary health care, and an informatics research group, during the requirements specification. Phenomenological data analysis and secondary integration of the results in available theories were performed. System objectives, the user requirements definition procedure, the communication pattern between design team members and project management were found to be perceived as the main risk areas. In the secondary analysis, the technical factors, identified as preventing a maximization of the use of the resources, were lack of informatics knowledge among economic decision makers and differences between customers and suppliers regarding their views on the nature of system design. During the implementation of a given strategy, decision makers may consider the requests of their own sponsors in the first place and maximize the use ofthe project resources in the second place. Informatics knowledge plays a key role in risk perception during the development of an information system in health care. Political considerations by team members are important to take into regard, since these may influence technical and economic decisions.
Transforming a Hospital through Growing, not Building, an Electronic Patient Record System
Authors: Atkinson C. J. , Peel V. J.
Published: March 2018

The benefits for any health care provider of successfully introducing an Electronic Patient Record System (EPRS) into their organisation can be considerable. It has the potential to enhance both clinical care and managerial processes, as well as producing more cost-effective care and care programmes across clinical disciplines and health care sectors. However, realising an EPRS's full potential can be a long and difficult process and should not be entered into lightly. Introducing an EPR System involves major personnel, organisational and technological changes. These changes must be interwoven and symbiotic and must be managed so that they grow together in stages towards a vision created and shared by all clinical professional staff, other staff, and managers in that process. The use of traditional “building” or “journey” metaphors inadequately reflects the complexity, uncertainty and, therefore, the unpredictability of the process. We propose that a more useful metaphor may be of “growing” a progressively more united, unified information system and health care organisation. We suggest this metaphor better recognises that the evolutionary process appears to be more organic than predictable and more systemic than mechanistic. An illustration is given of how these organisational clinical and technical issues might evolve and interweave in a hospital setting through a number of stages.
Read Codes Version 3: A User Led Terminology
Authors: O’Neil M. , Payne C. , Read J.
Published: March 2018

Version 3 of the Read Codes was designed in response to a new set of requirements generated by three new terming initiatives in the UK, the Clinical Terms Project, the Professions Allied to Medicine Terms Project and the Nursing Terms Project. The challenge was to cope with the detail required by clinical specialists for maintaining a computerised record, to capture the natural language used by clinicians in their everyday work, and to support efficient analysis across medical records required to extract information from clinicians’ individual patient data. The structure of Version 3 allows a directed acyclic graph to replace the traditional hierarchy; permits multiple such graphs if necessary; introduces qualifiers, embedding these in an information model to support analysis; introduces one-to-many mapping to external classifications where this is necessary; and maintains the tradition of a dynamic terminology that stresses the inclusion of natural clinical terms.