bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acquisition and Analysis of Repeating Patterns in Time-oriented Clinical Data
Authors: Chakravarty S. , Shahar Y. 
Published: March 2018

Summary

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

Summary

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

Summary
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

Summary
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

Summary
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

Summary
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

Summary
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

Summary
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

Summary
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

Summary
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

Summary
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

Summary
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

Summary

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

Summary
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.