Articles catalogue 2009

Summary

Objectives: For improving safety and quality of care as well as efficiency of health delivery under the well-known burdens, health services become specialized, distributed, and therefore collaborative, thereby changing the health service paradigm from organization-centered over process-controlled to personal health (pHealth).

Methods: Personalized eHealth services provided independent of time and location have to be based on advanced technical paradigms of mobile, pervasive and autonomous computing, enabling ubiquitous health services. Personalized eHealth systems require a multidisciplinary approach including medicine, informatics, biomedical engineering, bioinformatics and the omics disciplines but also legal and regulatory affairs, administration, security, privacy and ethics, etc. Interoperability between different components of the intended system must be provided through an architecture-centric, model-driven, formalized process.

Results: In order to analyze, design, specify, implement and maintain such an interactive environment impacted by so many different domains, a formal and unified methodology for system analysis and design has been developed and deployed, based on an overall architectural framework. The paper introduces the underlying paradigms, requirements, architectural reference models, modeling and formalization principles as well as development processes for comprehensive service-oriented personalized eHealth interoperability chains, thereby exploiting all interoperability levels up to service interoperability. A special focus is put on ontologies and knowledge representation in the context of eHealth and pHealth solutions. Furthermore, EHR solutions, security requirements, existing and emerging standards, and educational challenges for realizing personalized pHealth are briefly discussed. Conclusion: For personal health, bridging between disciplines including ontology coordination is the crucial demand. All aspects of the design and development process have to be considered from an architectural viewpoint.

Keywords: Ontology, Knowledge Representation, semantic interoperability, Personal health, system architecture, universal logic, ubiquitous care

DOI

10.3414/ME9308

The full English version can be found in Methods of Information in Medicine 2010 49 2: 123-134 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12617/show.html.

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 Deutsch

Summary

Objectives: Biomedical ontologies exist to serve integration of clinical and experimental data, and it is critical to their success that they be put to widespread use in the annotation of data. How, then, can ontologies achieve the sort of user-friendliness, reliability, cost-effectiveness, and breadth of coverage that is necessary to ensure extensive usage?

Methods: Our focus here is on two different sets of answers to these questions that have been proposed, on the one hand in medicine, by the SNOMED CT community, and on the other hand in biology, by the OBO Foundry. We address more specifically the issue as to how adherence to certain development principles can advance the usability and effectiveness of an ontology or terminology resource, for example by allowing more accurate maintenance, more reliable application, and more efficient interoperation with other ontologies and information resources.

Results: SNOMED CT and the OBO Foundry differ considerably in their general approach. Nevertheless, a general trend towards more formal rigor and cross-domain interoperability can be seen in both and we argue that this trend should be accepted by all similar initiatives in the future. Conclusions: Future efforts in ontology development have to address the need for harmonization and integration of ontologies across disciplinary borders, and for this, coherent formalization of ontologies is a pre-requisite.

Keywords: Quality Assurance, SNOMED CT, Biomedical ontologies, ontology harmonization

DOI

10.3414/ME9302

The full English version can be found in Methods of Information in Medicine 2010 49 2: 135-140 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12619/show.html.

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 Deutsch

Summary

Objectives: The increasing amount of electronically available documents in bibliographic databases and the clinical documentation requires user-friendly techniques for content retrieval.

Methods: A domain-specific approach on semantic text indexing for document retrieval is presented. It is based on a subword thesaurus and maps the content of texts in different European languages to a common interlingual representation, which supports the search across multilingual document collections.

Results: Three use cases are presented where the semantic retrieval method has been implemented: a bibliographic database, a department EHR system, and a consumer-oriented Web portal. Conclusions: It could be shown that a semantic indexing and retrieval approach, the performance of which had already been empirically assessed in prior studies, proved useful in different prototypical and routine scenarios and was well accepted by several user groups.

Keywords: Consumer Health Informatics, Electronic health record, cross-language information retrieval, Thesauri, semantic information retrieval, document indexing, bibliographic databases

DOI

10.3414/ME9303

The full English version can be found in Methods of Information in Medicine 2010 49 2: 141-147 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12759/show.html.

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 Português

Summary

Objectives: Achieving semantic interoperability requires not only the use of communication standards like HL7 with its underlying models and specifications, but also to constrain those models to instances including permitted attributes, data types, values and code systems. Even the application of both strategies may lead to different modeling approaches and therefore incompatible results, however.

Methods: This paper analyzes the different ways to create a model exemplified at score and assessment systems.

Results: The different approaches have advantages and disadvantages. The presented results allow for transmitting the same basic information facilitating HL7 v2.x and V3 in a way reducing implementation efforts.

Conclusions: Establishing a generic approach to communicate the details of score systems driven by an appropriate set of codes is the best solution for implementers.

Keywords: HL7, Health telematics, semantic interoperability, communication standard, conformance, implementation guides, scores and assessments

DOI

10.3414/ME9304

The full English version can be found in Methods of Information in Medicine 2010 49 2: 148-155 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12618/show.html.

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 Deutsch

Summary

Objectives: A significant portion of care related to cardiorespiratory diseases is provided at home, usually but not exclusively, after the discharge of a patient from hospital. It is the purpose of the present study to present the technical means which we have developed, in order to support the adaptation of the continuity of care of cardiorespiratory diseases at home.

Methods: We have developed an integrated system that includes: first, a prototype laptop-based portable monitoring system that comprises low-cost commercially available components, which enable the periodical or continuous monitoring of vital signs at home; second, software supporting medical decision-making related to tachycardia and ventricular fibrillation, as well as fuzzy-rules-based software supporting home-ventilation optimization; third, a typical continuity of care record (CCR) adapted to support also the creation of a homecare plan; and finally, a prototype ontology, based upon the HL7 clinical document architecture (CDA), serving as basis for the development of semantically annotated web services that allow for the exchange and retrieval of homecare information.

Results: The flexible design and the adaptable data-exchange mechanism of the developed system result in a useful and standard-compliant tool, for cardiorespiratory disease-related homecare.

Conclusions: The ongoing laboratory testing of the system shows that it is able to contribute to an effective and low-cost package solution, supporting patient supervision and treatment. Furthermore, semantic web technologies prove to be the perfect solution for both the conceptualization of a continuity of care data exchange procedure and for the integration of the structured medical data.

Keywords: continuity of care, Homecare, cardiorespiratory diseases, semantically annotated web-services

DOI

10.3414/ME9305

The full English version can be found in Methods of Information in Medicine 2010 49 2: 156-160 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12616/show.html.

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 Greek

Summary

Background: Cardiac output is controlled by the autonomic nervous system by changing the heart rate and/or the contractions of the heart muscle in response to the hemodynamic needs of the whole body. Malfunction of these mechanisms causes the postural orthostatic tachycardia syndrome and/or the chronic fatigue syndrome. Evaluation of functionality and efficiency of the control mechanisms could give valuable diagnostic information in the early stages of dysfunction of the heart control systems and help to monitor the healing process in rehabilitation period after interventions.

Objectives: In this study we demonstrate how P-wave changes evoked by an orthostatic test could be quantitatively evaluated by using the method based on the principal component analysis.

Methods: ECG signals were recorded during an orthostatic test performed according to the typical protocol in three groups of volunteer subjects representing healthy young and older persons, part of which had transient periods of supraventricular arrhythmias. Quantitative evaluation of P-wave morphology changes was performed by means of principal component analysis-based method.

Results: Principal component-based estimates showed certain variety of P-wave shape during orthostatic test, what revealed a possibility to evaluate the properties of parasympathetic heart control.

Conclusions: Quantitative evaluation of ECG P-wave changes evoked by an orthostatic test by using a newly developed method provides a quantitative estimate for functionality and efficiency of the heart rate control mechanisms. The method could be used in eHealth systems.

Keywords: principal component analysis, autonomic heart control, ECG P-wave

DOI

10.3414/ME9306

The full English version can be found in Methods of Information in Medicine 2010 49 2: 161-167 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12758/show.html.

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 Lithuanian

Summary

Objectives: To identify support of structured data entry for an electronic health record application in temporomandibular joint disorders.

Methods: The methods of structuring information in dentistry are described and the interactive DentCross component is introduced. A system of structured voice-supported data entry in electronic health record on several real cases in the field of dentistry is performed. The connection of this component to the MUDRLite electronic health record is described.

Results: The use of DentVoice, an application which consists of the electronic health record MUDRLite and the voice-controlled interactive component DentCross, to collect dental information required by temporomandibular joint disorders is shown.

Conclusions: The DentVoice application with the DentCross component showed the practical ability of the temporomandibular joint disorder treatment support.

Keywords: Structured Data Entry, Dentistry, Electronic health record, temporomandibular joint disorder

DOI

10.3414/ME9301

The full English version can be found in Methods of Information in Medicine 2010 49 2: 168-172 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12310/show.html.

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 Česky

Summary

Objectives: Recent important advances in the human genomics and post-genomic “omics” are now bringing about a new medical care which we call “omics-based medicine”. In this article, we investigated the development and future possibilities of omics-based medicine.

Methods: We divided the development of omics-based medicine into three generations in order to clarify the main clinical goals and characteristics of informatics method of each generation, together with its future possibilities.

Results: The first generation of omics-based medicine started with “genomic medicine” based on the inborn individual differences of genome. It has opened the study of genetic polymorphism of the diseases and promoted the personalized medication based on the pharmacogenetic/pharmacogenomic difference of the drug response. In the second generation of omics-based medicine, owing to the advances in the high-throughput technology, vast amount of the various post-genomic disease omics data containing comprehensive molecular information of diseased somatic cells has become available. It reflects the ongoing state of diseases more closely and enables the predictive medicine such as prognosis prediction of disease by applying the data-driven analysis. Finally, due to the rapidly growing knowledge about the cellular molecular network, system-level understanding of the disease, called systems pathology, becomes possible. It can fully exploit the substantial contents of disease omics and will lead to a comprehensive understanding of disease process by using model-driven analysis.

Conclusion: Omics-based medicine and systems pathology will realize a new personalized and predictive medicine.

Keywords: Genomics, pharmacogenomics, systems pathology, Omics-based medicine, omics

DOI

10.3414/ME9307

The full English version can be found in Methods of Information in Medicine 2010 49 2: 173-185 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12757/show.html.

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 Česky

Summary

Objectives: The data interchange in the Czech healthcare environment is mostly based on national standards. This paper describes a utilization of international standards and nomenclatures for building a pilot semantic interoperability platform (SIP) that would serve to exchange information among electronic health record systems (EHR-Ss) in Czech healthcare. The work was performed by the national research project of the „Information Society" program.

Methods: At the beginning of the project a set of requirements the SIP should meet was formulated. Several communication standards (openEHR, HL7 v3, DICOM) were analyzed and HL7 v3 was selected to exchange health records in our solution. Two systems were included in our pilot environment: WinMedicalc 2000 and ADAMEKj EHR. Results: HL7-based local information models were created to describe the information content of both systems. The concepts from our original information models were mapped to coding systems supported by HL7 (LOINC, SNOMED CT and ICD-10) and the data exchange via HL7 v3 messages was implemented and tested by querying patient administration data. As a gateway between local EHR systems and the HL7 message-based infrastructure, a configurable HL7 Broker was developed.

Conclusions: A nationwide implementation of a full-scale SIP based on HL7 v3 would include adopting and translating appropriate international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our pilot study showed that our approach is feasible but it would demand a huge effort to fully integrate the Czech healthcare system into the European e-health context.

Keywords: information storage and retrieval, Electronic health record, HL7, semantic interoperability, communication standards

DOI

10.3414/ME09-02-0018

The full English version can be found in Methods of Information in Medicine 2010 49 2: 186-195 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12381/show.html.

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 Slovensky

Summary

Objective: Information systems integration is hard, especially when semantic and business process interoperability requirements need to be met. To succeed, a unified methodology, approaching different aspects of systems architecture such as business, information, computational, engineering and technology viewpoints, has to be considered. The paper contributes with an analysis and demonstration on how the HL7 standard set can support health information systems integration.

Methods: Based on the Health Information Systems Development Framework (HIS-DF), common architectural models for HIS integration are analyzed. The framework is a standard-based, consistent, comprehensive, customizable, scalable methodology that supports the design of semantically interoperable health information systems and components.

Results: Three main architectural models for system integration are analyzed: the point to point interface, the messages server and the mediator models. Point to point interface and messages server models are completely supported by traditional HL7 version 2 and version 3 messaging. The HL7 v3 standard specification, combined with service-oriented, model-driven approaches provided by HIS-DF, makes the mediator model possible. The different integration scenarios are illustrated by describing a proof-of-concept implementation of an integrated public health surveillance system based on Enterprise Java Beans technology.

Conclusion: Selecting the appropriate integration architecture is a fundamental issue of any software development project. HIS-DF provides a unique methodological approach guiding the development of healthcare integration projects. The mediator model – offered by the HIS-DF and supported in HL7 v3 artifacts – is the more promising one promoting the development of open, reusable, flexible, semantically interoperable, platform-independent, service-oriented and standard-based health information systems.

Keywords: Systems Integration, HL7, semantic interoperability, system architectures, middleware, J2EE

DOI

10.3414/ME09-02-0012

The full English version can be found in Methods of Information in Medicine 2010 49 2: 196-204 or http://www.schattauer.de/de/magazine/uebersicht/zeitschriften-a-z/methods/issue/special/manuscript/12775/show.html.

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