bluuebunny/crossref_metadata_2025 huggingface dataset:
Where to in the Next Ten Years of Health Informatics Education?
Authors: Moehr J. R.
Published: March 2018

Objectives:
To explore whether education in health/ medical informaticsa should continue to evolve along the lines pursued since the early seventies, or whether a change is advisable.

Methods:
Roots and key resulting characteristics for European and US American approaches HI education are identified. In Europe holistic approaches based on a synthesis of medicine and informatics (= computer science) with programs ranging from vocational training through university programs to doctoral and postdoctoral programs were characteristic. The US American approaches emphasized the higher levels of education and a diverse selection of specialized subjects. Changes in health and health informatics are summarized.

Results:
Two types of changes are identified: high-tech applications arising at the interface of imaging, robotics, and the -omics (genomics, proteomics, metabolomics), and invasive applications centering on consumer health informatics and a move from curative to prospective health care.

Conclusions:
It is proposed that curative medicine is adequately served by current educational approaches, but that the move towards prospective health care requires a move towards education and change management for health professionals and health informatics professionals.
Isolation to Interface to Integration
Authors: Eng C. , Roberts J. M.
Published: March 2018

Objectives:
Over thirty years both divergence and synergy have been seen in the health informatics (HI) domain; to the point where aspiration is towards a collective environment recognising HI as a mature discipline internationally. The author considers catalysts and inhibitors to this goal over 30 years, and asks the question – is one professional identity achievable and desirable?

This review of development of HI aims to promote reflection of the status, value and attributable influence with a view to recognising an internationally entity. Aspects of professionalism, practice, regulation and registration can then be refined to produce a universally understood inclusive community without loss of distinction to sub-specialties within it.

Methods:
The author utilised literature searches, research studies, domain knowledge and cooperative inquiries as context. Evaluation of issues is grounded in learned society investigations of professionalism and commitment to development of professional registration of those in informatics for the care domain.

Results
: Transition from isolated applications through interfaced ‘best of breed’ solutions working together to integrated closely coupled single-vendor solutions is mirrored by professional groups, established through special interests, working together on big initiatives and then formally benefiting from a cohesive group. Phasing of such staged development is different by country or by focus/topic.

Conclusions:
The global HI situation will never again be as diverse as historically it was. Recognition of the lifecycle of the interacting factors explored in this paper will help HI to assume a world-wide brand identity whilst sustaining the subsidiarity of specialist cohorts within it.
Medical Informatics in Medical Research
Authors: Missinou M. A. , Issifou S. , Anane-Sarpong E. , Abubakar I. , Gandi J. N. , Chagomerana M. , Pinder M. , Agbenyega T. , Kremsner P. G. , Newton C. R. J. C. , Wypij D. , Taylor T. E. ,   on Behalf of the SMAC Network, Olola C. H. O.
Published: March 2018

Objectives:
Computers are widely used for data management in clinical trials in the developed coutries, unlike in developing countries. Dependable systems are vital for data management, and medical decision making in clinical research. Monitoring and evaluation of data management is critical.

In this paper we describe database structures and procedures of systems used to implement, coordinate, and sustain data management in Africa. We outline major lessons, challenges and successes achieved, and recommendations to improve medical informatics application in biomedical research in sub-Saharan Africa.

Methods:
A consortium of experienced research units at five sites in Africa in studying children with disease formed a new clinical trials network, Severe Malaria in African Children. In December 2000, the network introduced an observational study involving these hospital-based sites. After prototyping, relational database management systems were implemented for data entry and verification, data submission and quality assurance monitoring.

Results:
Between 2000 and 2005, 25,858 patients were enrolled. Failure to meet data submission deadline and data entry errors correlated positively (correlation coefficient, r = 0.82), with more errors occurring when data was submitted late. Data submission lateness correlated inversely with hospital admissions (r = –0.62).

Conclusions:
Developing and sustaining dependable DBMS, ongoing modifications to optimize data management is crucial for clinical studies. Monitoring and communication systems are vital in multi-center networks for good data management. Data timeliness is associated with data quality and hospital admissions.
“You Have a Message Here”: Enhancing Interpersonal Communication in a Hospital Ward with Location-based Virtual Notes
Authors: Dahl Y.
Published: March 2018

Objectives:
This paper aims to explore how computerized interpersonal information can be mediated through the physical environment of hospital wards. Specifically, it focuses on a communication service (location-based virtual notes) that allows hospital workers to leave short digital messages at relevant physical locations (e.g. by a patient bed), so that intended colleagues can pick them up later when entering such a location. In a work setting where personnel move between various locations mainly as a result of work priority, improving timeliness of information and reducing the number of work interruptions is essential. Our objective is to provide a set of user-motivated design guidelines that address important usability aspects of the proposed communication service.

Methods:
To get end user feedback, a prototype was built and tested in simulated scenarios with real hospital workers. The material gathered from the usability testing and following interviews was reviewed to identify critical usability issues.

Results:
We identified a number of relevant usability issues concerning the applied design metaphor, posting of digital messages, role-based contact, and user control. These issues formed the basis for a set of preliminary design principles.

Conclusions:
We view the preliminary usability guidelines as an incentive for more extensive research. Based on feedback from the test participants, we conclude that the location-based virtual notes have promising potential to improve timeliness of ad hoc information exchange between hospital workers.
Use of Statistical Techniques to Synthesize Explicit Criteria Developed by an Expert Panel
Authors: Quintana J. M. , Urkaregi A. , Arostegui I.
Published: March 2018

Objectives:
Methodology based on expert panels has been commonly used to evaluate the appropriateness of interventions. An important issue is the adequate synthesis of the generated information in an applicable way to clinical decision making. This paper shows how statistical procedures help synthesize the results of an expert panel.

Methods:
Three statistical techniques were applied to an expert panel that developed explicit criteria to assess the appropriateness of total hip joint replacement: classification tree, regression tree and multiple correspondence analysis combined with automatic classification.

Results:
Results provided by the three models were shown in graphical displays and were compared to the original panel results using crude and weighted probability of misclassification. Results were also applied to real interventions in order to know the implication of the misclassification on real patients.

Conclusions:
The statistical techniques help summarize data from panels of experts and provide useful decision models for clinical practice, especially when the number of indications is big. However, degree of misclassification and its implication should be taken into account.
Triangulation Applied to Jan H. van Bemmel
Authors: Hasman A. , Bergemann D. , McCray A. T. , Talmon J. L. , Zvárová J.
Published: March 2018

Objective:
To describe the person of Jan H. van Bemmel from different points of view.

Method:
Triangulation.

Results and Conclusions:
Jan H. van Bemmel successfully contributed to research and education in medical informatics. He inspired a lot of people in The Netherlands and internationally.
Classifying Vertical Facial Deformity using Supervised and Unsupervised Learning
Authors: Hutton T. J. , Nelson-Moon Z. L. , Hunt N. P. , Madgwick A. J. A. , Hammond P.
Published: March 2018

Objectives:
To evaluate the potential for machine learning techniques to identify objective criteria for classifying vertical facial deformity.

Methods:
19 parameters were determined from 131 lateral skull radiographs. Classifications were induced from raw data with simple visualisation, C5.0 and Kohonen feature maps; and using a Point Distribution Model (PDM) of shape templates comprising points taken from digitised radiographs.

Results:
The induced decision trees enable a direct comparison of clinicians’ idiosyncrasies in classification. Unsupervised algorithms induce models that are potentially more objective, but their blackbox nature makes them unsuitable for clinical application. The PDM methodology gives dramatic visualisations of two modes separating horizontal and vertical facial growth. Kohonen feature maps favour one clinician and PDM the other. Clinical response suggests that while Clinician 1 places greater weight on 5 of 6 parameters, Clinician 2 relies on more parameters that capture facial shape.

Conclusions:
While machine learning and statistical analyses classify subjects for vertical facial height, they have limited application in their present form. The supervised learning algorithm C5.0 is effective for generating rules for individual clinicians but its inherent bias invalidates its use for objective classification of facial form for research purposes. On the other hand, promising results from unsupervised strategies (especially the PDM) suggest a potential use for objective classification and further identification and analysis of ambiguous cases. At present, such methodologies may be unsuitable for clinical application because of the invisibility of their underlying processes. Further study is required with additional patient data and a wider group of clinicians.
Acceptance of Rules Generated by Machine Learning among Medical Experts
Authors: Mani S. , Shankle W. R. , Pazzani M. J.
Published: March 2018

Objectives:
The aim was to evaluate the potential for monotonicity constraints to bias machine learning systems to learn rules that were both accurate and meaningful.

Methods:
Two data sets, taken from problems as diverse as screening for dementia and assessing the risk of mental retardation, were collected and a rule learning system, with and without monotonicity constraints, was run on each. The rules were shown to experts, who were asked how willing they would be to use such rules in practice. The accuracy of the rules was also evaluated.

Results:
Rules learned with monotonicity constraints were at least as accurate as rules learned without such constraints. Experts were, on average, more willing to use the rules learned with the monotonicity constraints.

Conclusions:
The analysis of medical databases has the potential of improving patient outcomes and/or lowering the cost of health care delivery. Various techniques, from statistics, pattern recognition, machine learning, and neural networks, have been proposed to “mine” this data by uncovering patterns that may be used to guide decision making. This study suggests cognitive factors make learned models coherent and, therefore, credible to experts. One factor that influences the acceptance of learned models is consistency with existing medical knowledge.
Acquisition and Analysis of Repeating Patterns in Time-oriented Clinical Data
Authors: Chakravarty S. , Shahar Y.
Published: March 2018

Objectives:
(1) Creation of an expressive language for specification of temporal patterns in clinical domains, (2) Development of a graphical knowledge-acquisition tool allowing expert physicians to define meaningful domain-specific patterns, (3) Implementation of an interpreter capable of detecting such patterns in clinical databases, and (4) Evaluation of the tools in the domains of diabetes and oncology.

Methods:
We describe a constraint-based language, named CAPSUL, for specification of temporal patterns. We implemented a knowledge-acquisition tool and a temporal-pattern interpreter within Résumé, a larger temporal-abstraction architecture. We evaluated the knowledge-acquisition process with the help of domain experts. In collaboration with the Rush Presbyterian/St. Luke’s Medical Center, we analyzed data of bone-marrow transplantation patients. The expert compared the detected patterns to a manual inspection of the data, with the help of an experimental information-visualization tool we are developing in a related project.

Results:
The CAPSUL language was expressive enough during the knowledge-acquisition process to capture almost all of the patterns that the experts found useful. The patterns detected in the data by the pattern interpreter were all verified as correct. Completeness (whether all correct patterns were found) was difficult to assess, due to the size of the database.

Conclusions:
The CAPSUL language enables medical experts to express temporal patterns involving multiple levels of abstraction of clinical data. The ability to reuse both domain-patterns and abstract constraints seems highly useful. The Résumé interpreter, augmented by the CAPSUL semantics, finds the complex patterns within a clinical time-oriented database in a sound fashion.
Support for Fast Comprehension of ICU Data: Visualization using Metaphor Graphics
Authors: Popow C. , Unterasinger L. , Horn W.
Published: March 2018

Objectives:
The time-oriented analysis of electronic patient records on (neonatal) intensive care units is a tedious and time-consuming task. Graphic data visualization should make it easier for physicians to assess the overall situation of a patient and to recognize essential changes over time.

Methods:
Metaphor graphics are used to sketch the most relevant parameters for characterizing a patient’s situation. By repetition of the graphic object in 24 frames the situation of the ICU patient is presented in one display, usually summarizing the last 24 h.

Results:
VIE-VISU is a data visualization system which uses multiples to present the change in the patient’s status over time in graphic form. Each multiple is a highly structured metaphor graphic object. Each object visualizes important ICU parameters from circulation, ventilation, and fluid balance.

Conclusion:
The design using multiples promotes a focus on stability and change. A stable patient is recognizable at first sight, continuous improvement or worsening condition are easy to analyze, drastic changes in the patient’s situation get the viewers attention immediately.
Building a Comprehensive Clinical Information System from Components
Authors: Narus S.P. , Huff S.M. , Pryor T.A. , Haug P.J. , Larkin T. , Matney S. , Evans R.S. , Rocha B.H. , Bowes W.A. , Holston F.T. , Gundersen M.L. , Clayton P.D.
Published: March 2018

Objectives: To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture.

Methods: After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well as acute care. We now seek to interface applications from a variety of sources (including some that we build ourselves) to a clinical data repository that contains a longitudinal electronic patient record.

Results: We have a total of 820 instances of interfaces to 51 different applications. We process nearly 2 million transactions per day via our interface engine and feel that the reliability of the approach is acceptable. Interface costs constitute about four percent of our total information systems budget. The clinical database currently contains records for 1.45 m patients and the response time for a query is 0.19sec.

Discussion: Based upon our experience with both integrated (monolithic) and interfaced approaches, we conclude that for those with the expertise and resources to do so, the interfaced approach offers an attractive alternative to systems provided by a single vendor. We expect the advantages of this approach to increase as the costs of interfaces are reduced in the future as standards for vocabulary and messaging become increasingly mature and functional.
Cerner Millennium™: The Innsbruck Experience
Authors: Pfeiffer K.-P. , Wilhelmy I. , Ball M. , Lechleitner G.
Published: March 2018

Objectives: A Clinical Information System, serving more than 2,000 users was to be implemented at three hospitals of TILAK (Tiroler Landeskrankenanstalten GmbH), including the University Hospital of Innsbruck. The system was intended to integrate data from radiology, laboratory, and pathology subsystems with patient data.

Methods: Using Cerner Millennium™ software and Health Level 7 standards, the first stage of an Electronic Patient Record (EPR) was built. Direct data entry was facilitated using either a Microsoft Word text processor (with subsequent authentication workflow) or structured forms. An enterprise-wide scheduling module allows coordination and storage of patient appointments directly in the EPR. As required by security policy, the Cerner software regulates the varying degrees of information exchange among organizations and departments within the enterprise.

Results: First experiences indicate satisfactory acceptance of system functionalities. The introduction of Cerner Millennium at TILAK has achieved essential goals defined at the beginning of the project. Basic functionalities – free text documentation, standardized documentation, scheduling, and some parts of order entry – are offered in a user friendly manner. Integration with existing systems to complete the EPR has been successful using standard interfaces (HL7).

Conclusion: TILAK concluded that it was possible to successfully implement a Clinical Information System (CIS) developed mainly for the American market in a European healthcare environment. Some adaptations and functional extensions were necessary (e.g., the discharge summary “Arztbrief”). The system had enough flexibility to meet the requirements and specifications of European healthcare processes. A key factor of success was the establishment of a basic level of understanding and communication between the software vendor and the TILAK user community.
Soarian™ – Workflow Management Applied for Health Care
Authors: Haux R. , Seggewies C. , Baldauf-Sobez W. , Kullmann P. , Reichert H. , Luedecke L. , Seibold H.
Published: March 2018

Objectives: To describe and comment on functionality and architecture of the software product Soarian™ developed by Siemens, to identify key differentiators to related products, and to comment on predecessor systems and beta versions. This has been done in the framework of a conference on health information systems of the IMIA.

Methods: Analyzing existing literature. Site visit of a predecessor system at Haukeland Sykehus, Bergen. Pilot of a beta version at the Erlangen University Medical Center, elaborating on major characteristics in discussion rounds.

Results: Soarian is a functional comprehensive, clinically oriented software product to support health care processes and to be used for health care professional workstations. It is a software product, designed and written completely new. Three major key differentiators were identified in comparison to related software products: Soarian’s workflow engine, its embedded analytics, and its ‘smart’ user interface. The targeted reduced installation time is stated to be 12 months or less.

Conclusions: Soarian has good chances to become one of the major software products for health care professional workstations in the international market to support patient-centered, shared care. Its global design may help to better support and maintain national or language specific versions. The first installations of Soarian will be critical, as they will show how the system will be accepted. To use such software products efficiently, organizational aspects within hospitals as well as between health care institutions have to be considered, e.g. strategic IT planning.
Provider Order Entry with Integrated Decision Support: from Academia to Industry
Authors: Giuse D.A.
Published: March 2018

Objectives: To describe the evolution of a provider order entry system with integrated decision support, from a research prototype to full implementation at one academic center, and finally to a commercial product.

Methods: Describe the institutional environment and planning process in which the system originated. Highlight the historical evolution of the provider entry system, and analyze its system architecture and functionality. Describe the requirements for successful design and deployment both within a single health care organization and as part of a commercial product line.

Results: Over a period of eight years the system evolved from a research prototype to a fully integrated order entry system in routine use on most inpatient units of a large academic medical center. Around 12,000 orders are entered every day into the computer system; 70% of those are entered directly by the responsible physician. The system embeds best-of-care practice guidelines, and is used to reduce resource utilization by limiting unnecessary testing and suggesting more effective or less costly therapeutic replacements. The system was recently acquired by a large HIS software vendor and is being rapidly implemented at numerous customer sites.

Conclusions: Large-scale development or deployment of complex health information systems requires considerable organizational agreement and resources, as well as close attention to iterative system design that explicitly includes constant feedback from the user community. The transformation of such a system from a single-site success to a widely deployed product requires convergence of resources and needs.
Text Generation in Clinical Medicine – a Review
Authors: Hüske-Kraus D.
Published: March 2018

Objectives: This article aims at an analysis of ways of producing documents (such as findings or referral letters) in clinical medicine. Special emphasis is given to the question of whether the field of “Natural Language Generation” (NLG) can provide new approaches to ameliorate the current situation.

Methods: In order to assess the currently used techniques in text production, an analysis of commercially available systems was performed in addition to an extensive review of the literature. The sketch of current NLG approaches is also based on a literature review.

To estimate the applicability of several techniques to clinical documents, a typology of documents in clinical medicine was developed, based on rhetorical structure theory, speech act theory and certain recurrent linguistic phenomena exposed in the said documents. Results: Current ways of producing text for documents in medicine are less than optimal in several respects. The field of NLG draws on the idea of generating text from a conceptual representation of not only certain facts, but also knowledge about how to express them via (written) language.

Unfortunately, NLG does not yet offer “ready-to-run” solutions for the automatic production of most of the document types in the given typology.

It seems, however, highly plausible that the demands of medical informatics for these kinds of systems will be satisfiable as NLG matures.

Conclusions: NLG offers a promising way of generating text for clinical documents, a problem of enormous economical importance. The medical informatics community should therefore commit itself to the idea of NLG in medicine.
Direct Text Entry in Electronic Progress Notes
Authors: Hurdle J.F. , Felgar M.A. , Hoffman J.M. , Roth B. , Nebeker J.R. , Weir C.R.
Published: March 2018

Objectives: It is not uncommon that the introduction of a new technology fixes old problems while introducing new ones. The Veterans Administration recently implemented a comprehensive electronic medical record system (CPRS) to support provider order entry. Progress notes are entered directly by clinicians, primarily through keyboard input. Due to concerns that there may be significant, invisible disruptions to information flow, this study was conducted to formally examine the incidence and characteristics of input errors in the electronic patient record.

Methods: Sixty patient charts were randomly selected from all 2,301 inpatient admissions during a 5-month period. A panel of clinicians with informatics backgrounds developed the review criteria. After establishing inter-rater reliability, two raters independently reviewed 1,891 notes for copying, copying errors, inconsistent text, inappropriate object insertion and signature issues.

Results: Overall, 60% of patients reviewed had one or more input-related errors averaging 7.8 errors per patient. About 20% of notes showed evidence of copying, with an average of 1.01 error per copied note. Copying another clinician’s note and making changes had the highest risk of error. Templating resulted in large amounts of blank spaces. Overall, MDs make more errors than other clinicians even after controlling for the number of notes.

Conclusions: Moving towards a more progressive model for the electronic medical record, where actions are recorded only once, history and physical information is encoded for use later, and note generation is organized around problems, would greatly minimize the potential for error.
Diagnosis of Glaucoma by Indirect Classifiers
Authors: Peters A. , Lausen B. , Michelson G. , Gefeller O.
Published: March 2018

Objectives: Demonstration of the applicability of a framework called indirect classification to the example of glaucoma classification. Indirect classification combines medical a priori knowledge and statistical classification methods. The method is compared to direct classification approaches with respect to the estimated misclassification error.

Methods: Indirect classification is applied using classification trees and the diagnosis of glaucoma. Misclassification errors are reduced by bootstrap aggregation. As direct classification methods linear discriminant analysis, classification trees and bootstrap aggregated classification trees are utilized in the problem of glaucoma diagnosis. Misclassification rates are estimated via 10-fold cross-validation.

Results: Indirect classification techniques reduce the misclassification error in the context of glaucoma classification compared to direct classification methods.

Conclusions: Embedding a priori knowledge into statistical classification techniques can improve misclassification results. Indirect classification offers a framework to realize this combination.
Health Care in the Information Society: What Should Be the Role of Medical Informatics?1
Authors: Haux R.
Published: March 2018

Objective: To discuss the consequences for medical informatics in encouraging and advancing the development of information processing methodology (IPM) and information and communication technology (ICT) to contribute to high-quality and efficient health care.

Methods: Characterization of the current state of ICT, commenting on literature.

Results and conclusions: Medical informatics is the discipline, concerned with the systematic processing of data, information, and knowledge in medicine and health care. Our societies are continuously being influenced by modern IPM and ICT. It can be expected that these developments, leading us into an “information society”, will continue. Three factors may significantly influence health care in the near future: the development of the population towards an aging society, progress in medicine, and progress in informatics. The major aims that will have to be achieved are the (1) patient-centered use of medical data, (2) process-integrated decision support, using high-quality medical knowledge, and (3) comprehensive use of patient data for clinical research and health reporting. Medical informatics research is needed on the electronic patient record, modern architectures for health information systems, and medical knowledge bases. In order to adequately pursue the goal of “transforming health care through innovative use of ICT for the 21st century”, health care professionals are needed, who are well-trained in medical informatics, respectively health informatics. Medical informatics must offer such educational programs and assure a sufficiently high quality of education.
Design Participation as an Insurance: Risk-management and End-user Participation in the Development of Information Systems in Healthcare Organizations
Authors: Timpka T. , Vimarlund V.
Published: March 2018

Objectives: The aim of this paper is to build a theoretical framework for analysis of when decision-makers should use end-user participation as a form of insurance for unforeseen consequences of implementing information systems in healthcare organizations.

Method: Data were collected in a case study of an information system development project in a small clinical setting. During the initial phase, the future end-users of the system were allowed to actively influence the system design and test every new tool that was considered for implementation.

Results: The results of the case study suggest that when time and effort are invested in allowing health-care staff to participate in information system development processes, the benefits can well exceed the costs throughout the life cycle of the project. Risk-averse decision-makers fearing negative secondary consequences of a HIS, with regard to clinical work flow, will always adopt measures to prevent future failures, if they can find a possibility of shifting these risks. Therefore, they calculate the present discounted value of the effects accrued over time to the unit and predict the amount of resources they are willing to pay to acquire an insurance (such as design participation) that will protect the organization from future losses.

Conclusions: End-user participation in the design process can be the key positive influence on the quality of the service and, thereby, organizational effectiveness. Investments in broad design participation can, consequently, be a productive activity that transforms potential current income into future benefits.
Information Technology Can Enhance Quality in Regional Health Delivery
Authors: Chouvarda I. , Koutkias V. , Meletiadis S. , Haris K. , Balas E. A. , Maglaveras N.
Published: March 2018

Objectives: a) The use of information technology (IT) based solutions for quality health delivery in regional health information networks and the study of the enabling factors for their use in a regional health care network from key classes of users such as the medical personnel and the citizens. b) Identification of potential technologies for usage from all citizens and health providers in a regional environment, in all aspects of everyday life. c) Presentation of a generic user model for reference when developing and assessing IT based health delivery solutions.

Methods: After defining the major questions to be addressed, an overview of tele-health and tele-medicine technologies and solutions currently available shall be presented. Further, a generic user model applied to the use of IT based regional health delivery solutions both for the daily life and home care, and for research and clinical routine purposes are presented. Enabling technologies for integration of different IT modules, medical data processing and management procedures and the wireless application protocol (WAP) technology is discussed.

Results: Different levels of user applications are presented such as mobile telephony driven health information monitoring and systems integrating electronic health care records with multimedia medical information management and processing modules.

Conclusions: Although IT solutions are advanced and continue to evolve, still the user acceptance and user friendliness issues are unresolved. Mobile telecommunication solutions however may hold the key for wide scale implementation of IT solutions in regional health information networks and increased quality of health services.
Opinion Paper: Ethical Problems in Health Information Systems
Authors: Grémy F. , Fessler J.-M.
Published: March 2018

Objectives:
To introduce term and concept of infoethics and to argue on its importance for health information systems.

Methods:
To argue about our viewpoint of the dominance of the human component, which has been discussed at an IMIA working conference held in Helsinki, Finland (February 1998) devoted to the evaluation of health information systems.

Results and conclusions:
Any technology sets a relationship between human beings and their environment, both physical and human. No technology can be seen as merely instrumental. This is especially relevant when dealing with large automatic information systems, developed to contribute to the management and integration of large organizations, such as hospitals. In such a context, the environment is mainly made up of humans. In evaluating such information systems, human factors preside over merely technical factors. Even if satisfying the latter is mandatory, they are never really sufficient. A perfect hard- and software system can be an absolute failure in everyday use. In any information system, the human factor is, of course, human-computer interaction, which always occurs when one person interacts with the machinery. However, in a simultaneous multi-user context, human-human interaction is the main question to tackle. The evaluation of large information systems, such as those found in hospitals, is founded in the whole concept of inter-human relationships which underlie the design and use of the system. Indeed, such an information system predominately appears as a social system, with its psychological, sociological and ethical features.
Healthcare Telematic Applications in Cyprus
Authors: Pattichis C. S. , Schizas C. N. , Andreou A. S.
Published: March 2018

Objectives: a) To present a review of ongoing health telematic applications in Cyprus. b) To promote the use of these health telematic applications in the Cyprus region. c) To help in the spin off of other health telematic applications thus enabling the offering of a better health service to the citizens. Methods and Results: The health telematics applications include a medical system for emergency telemedicine (AMBULANCE and EMERGENCY-112 projects), a system for the evaluation of the risk of stroke by telemedicine (EROS), a diagnostic telepathology network in gynaecological cancer (TELEGYN), a collaborative virtual medical team for home healthcare of cancer patients (DITIS), and a health telematics training network (HEALTHNET). The paper refers to the set-up and characteristics of these applications and tries to relate them with the health policies that should be applied in Cyprus.

Conclusions: It is anticipated that this paper will promote the importance of health telematics applications for Cyprus and increase the awareness on the possibilities that these applications offer for health policies in all levels of health related human resources.
Standards to Support Development of Terminological Systems for Healthcare Telematics
Authors: Consorti F. , Galeazzi E. , Rossi Mori A.
Published: March 2018

The Technical Committee on “Medical Informatics” of the European Committee for Standardization (CEN{TC251) is supporting developers ofterminological systems in healthcare by a series of standards. The dream of “universal” coding system was abandoned in favor of a coherent family of terminologies, diversified according to tasks; two ideas were introduced: (1) the “categorical structure”, i.e. a model of semantic categories and their relations within a subject field and (2) the “cross-thesaurus”, i.e. a system of descriptors to build a systematic representation (called here “dissection") for each terminological phrase, coherent across diverse terminologies on a given subject field.

The goal is to assure coexistence and interoperability (and reciprocal support for development and maintenance) to three generations of systems: (1) traditional paper-based systems (first generation); (2) compositional systems built according to a categorical structure and a cross-thesaurus (second generation) and (3) formal models (third generation).

Various scenarios are presented, on the exploitation of computer-based terminological systems. The idea of “operational meaning” of terminological phrases within administrative and organizational contexts and the idea of “task-oriented details” are also introduced, to justify and exploit design constraints on terminological systems.
Rationale and Design Considerations for a Semantic Mediator in Health Information Systems
Authors: Sauquet D. , Jaulent M.-C. , Zapletal E. , Lavril M. , Degoulet P.
Published: March 2018

Rapid development of community health information networks raises the issue of semantic interoperability between distributed and heterogeneous systems. Indeed, operational health information systems originate from heterogeneous teams of independent developers and have to cooperate in order to exchange data and services. A good cooperation is based on a good understanding of the messages exchanged between the systems. The main issue of semantic interoperability is to ensure that the exchange is not only possible but also meaningful. The main objective of this paper is to analyze semantic interoperability from a software engineering point of view. It describes the principles for the design of a semantic mediator (SM) in the framework of a distributed object manager (DOM). The mediator is itself a component that should allow the exchange of messages independently of languages and platforms. The functional architecture of such a SM is detailed. These principles have been partly applied in the context of the HEllOS object-oriented software engineering environment. The resulting service components are presented with their current state of achievement.
Thesauri and Formal Classifications: Terminologies for People and Machines
Authors: Rector A. L.
Published: March 2018

Terminologies are now software. They are key components of the integration of electronic patient records, decision support systems and information retrieval systems. To be used as software, the different types of content in traditional terminologies must be separated, which we term here: conceptual, linguistic, inferential and pragmatic. The conceptual knowledge at the heart of the terminology needs to be expressed formally in order to provide a dependable framework for the other types of knowledge. Information left implicit in most existing coding and classification systems must be made explicit. The test of the resulting terminologies is how well they support software for key functions: including data entry, information retrieval, mediation, indexing, and authoring.
Evaluation of a Semantic Data Model for Chest Radiology: Application of aNew Methodology
Authors: Huff S. M. , Haug P. J. , Evans D. A. , Bray B. E. , Rocha R. A.
Published: March 2018

An essential step toward the effective processing of the medical language is the development of representational models that formalize the language semantics. These models, also known as semantic data models, help to unlock the meaning of descriptive expressions, making them accessible to computer systems. The present study tries to determine the quality of a semantic data model created to encode chest radiology findings . The evaluation methodology relied on the ability of physicians to extract information from textual and encoded representations of chest X-ray reports, whilst answering questions associated with each report. The evaluation demonstrated that the encoded reports seemed to have the same information content of the original textual reports. The methodology generated useful data regarding the quality of the data model, demonstrating that certain segments were creating ambiguous representations and that some details were not being represented.
Scalable Methodologies for Distributed Development of Logic-Based Convergent Medical Terminology
Authors: Cohn S. P. , Chute C. G. , Shortliffe E. H. , Rennels G. , Campbell K. E.
Published: March 2018

As the size and complexity of medical terminologies increase, terminology modelers are increasingly hampered by lack of tools and methods to manage the development process. This paper presents our use and ongoing evaluation of a description-logic classifier to support cognitive scalability of the underlying terminology and our enhancements to that classifier to support concurrent development utilizing semantics-based concurrency control methods. Our enhancements, collectively referred to as the Galapagos, consist of several applications that take locally-developed terminology enhancements from multiple sites, identify conflicting design decisions, support the modelers' reconciliation of the conflicting designs, and efficiently disseminate updates tailored for locally enhanced terminologies. We have tested our ideas through concurrent evolutionary enhancement of SNOMED International at three Kaiser Permanente regions and the Mayo Clinic. We have found that the underlying environment has met our design objectives, and supports semantic-based concurrency control, and identification and resolution of conflicting design decisions.
Semantic Definition of Disorders in Version 3 of the Read Codes
Authors: O'Neil M. , Price C. , Brown P. J. B.
Published: March 2018

The disorder chapter of Version 3 of the Read codes is a rich source of clinically derived terminology. The file structure has been designed to meet a clinical need to support both enumerated and compositional taxonomy. This requirement coupled with the maintenance of multiple classification necessitates a mechanism to identify consistent hierarchical placement and equivalence between concepts. The early work on the semantic definition of the disorder chapter, to support these requirements, is outlined and the attributes that have been found to be important are presented. We also describe different categories of completeness of definition that have been identified, and the scope of those that are likely to remain incompletely characterised.
Evaluating Natural Language Processors in the Clinical Domain
Authors: Hripcsak G. , Friedman C.
Published: March 2018

Evaluating natural language processing (NLP) systems in the clinical domain is a difficult task which is important for advancement of the field. A number of NLP systems have been reported that extract information from free-text clinical reports, but not many of the systems have been evaluated. Those that were evaluated noted good performance measures but the results were often weakened by ineffective evaluation methods. In this paper we describe a set of criteria aimed at improving the quality of NLP evaluation studies. We present an overview of NLP evaluations in the clinical domain and also discuss the Message Understanding Conferences (MUC) [1-41. Although these conferences constitute a series of NLP evaluation studies performed outside of the clinical domain, some of the results are relevant within medicine. In addition, we discuss a number of factors which contribute to the complexity that is inherent in the task of evaluating natural language systems.
The Distinction between Linguistic and Conceptual Semantics in Medical Terminology and its Implication for NLP-Based Knowledge Acquisition
Authors: Buekens F. , De Moor G. , Waagmeester A. , Ceusters W.
Published: March 2018

Natural language understanding systems have to exploit various kinds of knowledge in order to represent the meaning behind texts. Getting this knowledge in place is often such a huge enterprise that it is tempting to look for systems that can discover such knowledge automatically. We describe how the distinction between conceptual and linguistic semantics may assist in reaching this objective, provided that distinguishing between them is not done too rigorously. We present several examples to support this view and argue that in a multilingual environment, linguistic ontologies should be designed as interfaces between domain conceptualizations and linguistic knowledge bases.
Automated Coding of Patient Discharge Summaries Using Conceptual Graphs
Authors: Burgun A. , Seka L. P. , Delamarre D. , Le Beux P.
Published: March 2018

In medicine, as in other domains, indexing and classification is a natural human task which is used for information retrieval and representation. In the medical field, encoding of patient discharge summaries is still a manual time-consuming task. This paper describes an automated coding system of patient discharge summaries from the field of coronary diseases into the ICD-9-CM classification. The system is developed in the context of the European AIM MENELAS project, a natural-language understanding system which uses the conceptual-graph formalism. Indexing is performed by using a two-step processing scheme; a first recognition stage is implemented by a matching procedure and a secondary selection stage is made according to the coding priorities. We show the general features of the necessary translation of the classification terms in the conceptual-graph model, and for the coding rules compliance. An advantage of the system is to provide an objective evaluation and assessment procedure for natural-language understanding.
The Feasibility and Accuracy of Anonymized Record Linkage to Estimate Shared Clientele among Three Health and Social Service Agencies
Authors: Roberts J. , Browne G. , Jamieson E.
Published: March 2018

This study was designed to test the effectiveness of three computerized methods of record linkage, using minimal identifiers. The goal of the linkage was to determine the proportion of persons receiving Public Health Nursing Services (n = 5,749) who also receive income assistance from the region (n = 38,800) or the province (n = 16,741). The first linkage method was based on full agreement of a number of variables (deterministic matching) and the second was based on the likelihood of the match (probabilistic matching). The third method combined information from methods 1 and 2. Method 3 proved to be the most effective linkage technique, with a specificity of 0.98 and sensitivity of 0.94. The linkage showed that only 17% of the Public Health clientele received income assistance from the region or province, much lower than expected. Factors which have probably led to an underestimate are discussed.
Performance of Multi-Layer Feedforward Neural Networks to Predict Liver Transplantation Outcome
Authors: Subotin M. , Marsh W. , McMichael J. , Fung J. J. , Dvorchik I.
Published: March 2018

A novel multisolutional clustering and quantization (MCO) algorithm has been developed that provides a flexible way to preprocess data. It was tested whether it would impact the neural network’s performance favorably and whether the employment of the proposed algorithm would enable neural networks to handle missing data. This was assessed by comparing the performance of neural networks using a well-documented data set to predict outcome following liver transplantation. This new approach to data preprocessing leads to a statistically significant improvement in network performance when compared to simple linear scaling. The obtained results also showed that coding missing data as zeroes in combination with the MCO algorithm, leads to a significant improvement in neural network performance on a data set containing missing values in 59.4% of cases when compared to replacement of missing values with either series means or medians.