| 1. |
- Dentler, Kathrin, et al.
(författare)
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Formalization and computation of quality measures based on electronic medical records
- 2014
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Ingår i: JAMIA Journal of the American Medical Informatics Association. - : BMJ Publishing Group / Elsevier. - 1067-5027 .- 1527-974X. ; 21:2, s. 285-291
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Tidskriftsartikel (refereegranskat)abstract
- Objective Ambiguous definitions of quality measures in natural language impede their automated computability and also the reproducibility, validity, timeliness, traceability, comparability, and interpretability of computed results. Therefore, quality measures should be formalized before their release. We have previously developed and successfully applied a method for clinical indicator formalization (CLIF). The objective of our present study is to test whether CLIF is generalizablethat is, applicable to a large set of heterogeneous measures of different types and from various domains. Materials and methods We formalized the entire set of 159 Dutch quality measures for general practice, which contains structure, process, and outcome measures and covers seven domains. We relied on a web-based tool to facilitate the application of our method. Subsequently, we computed the measures on the basis of a large database of real patient data. Results Our CLIF method enabled us to fully formalize 100% of the measures. Owing to missing functionality, the accompanying tool could support full formalization of only 86% of the quality measures into Structured Query Language (SQL) queries. The remaining 14% of the measures required manual application of our CLIF method by directly translating the respective criteria into SQL. The results obtained by computing the measures show a strong correlation with results computed independently by two other parties. Conclusions The CLIF method covers all quality measures after having been extended by an additional step. Our web tool requires further refinement for CLIF to be applied completely automatically. We therefore conclude that CLIF is sufficiently generalizable to be able to formalize the entire set of Dutch quality measures for general practice.
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| 2. |
- Hägglund, Maria, et al.
(författare)
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Modeling shared care plans using CONTsys and openEHR to support shared homecare of the elderly.
- 2011
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Ingår i: JAMIA Journal of the American Medical Informatics Association. - : Oxford University Press (OUP). - 1067-5027 .- 1527-974X. ; 18:1, s. 66-9
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Tidskriftsartikel (refereegranskat)abstract
- This case report describes how two complementary standards, CONTsys (European Standard EN 13940-1 for continuity of care) and the reference model of openEHR, were applied in modeling a shared care plan for shared homecare based on requirements from the OLD@HOME project. Our study shows that these requirements are matched by CONTsys on a general level. However, certain attributes are not explicit in CONTsys, for example agents responsible for performing planned interventions, and support for monitoring outcome of interventions. We further studied how the care plan conceptual model can be implemented using the openEHR reference model. The study demonstrates the feasibility of developing shared care plans combining a standard concept model, for example CONTsys with an electronic health records (EHR) interoperability specification, that is the openEHR, while highlighting areas that need further exploration. It also explores the reusability of existing clinical archetypes as building blocks of care plans and the modeling of new shared care plan archetypes.
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| 3. |
- Lee, Dennis, et al.
(författare)
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Literature review of SNOMED CT use
- 2014
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Ingår i: JAMIA Journal of the American Medical Informatics Association. - : BMJ Group. - 1067-5027 .- 1527-974X. ; 21:E1, s. E11-E19
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: The aim of this paper is to report on the use of the systematised nomenclature of medicine clinical terms (SNOMED CT) by providing an overview of published papers.METHODS: Published papers on SNOMED CT between 2001 and 2012 were identified using PubMed and Embase databases using the keywords 'systematised nomenclature of medicine' and 'SNOMED CT'. For each paper the following characteristics were retrieved: SNOMED CT focus category (ie, indeterminate, theoretical, pre-development/design, implementation and evaluation/commodity), usage category (eg, prospective content coverage, used to classify or code in a study), medical domain and country.RESULTS: Our search strategy identified 488 papers. A comparison between the papers published between 2001-6 and 2007-12 showed an increase in every SNOMED CT focus category. The number of papers classified as 'theoretical' increased from 46 to 78, 'pre-development/design' increased from 61 to 173 and 'implementation' increased from 10 to 34. Papers classified as 'evaluation/commodity' only started to appear from 2010.CONCLUSIONS: The majority of studies focused on 'theoretical' and 'pre-development/design'. This is still encouraging as SNOMED CT is being harmonized with other standardized terminologies and is being evaluated to determine the content coverage of local terms, which is usually one of the first steps towards adoption. Most implementations are not published in the scientific literature, requiring a look beyond the scientific literature to gain insights into SNOMED CT implementations.
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| 4. |
- Ludvigsson, Jonas F., et al.
(författare)
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Use of computerized algorithm to identify individuals in need of testing for celiac disease
- 2013
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Ingår i: JAMIA Journal of the American Medical Informatics Association. - : Oxford University Press (OUP). - 1067-5027 .- 1527-974X. ; 20:E2, s. E306-E310
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Tidskriftsartikel (refereegranskat)abstract
- Background and aim Celiac disease (CD) is a lifelong immune-mediated disease with excess mortality. Early diagnosis is important to minimize disease symptoms, complications, and consumption of healthcare resources. Most patients remain undiagnosed. We developed two electronic medical record (EMR)-based algorithms to identify patients at high risk of CD and in need of CD screening. Methods (I) Using natural language processing (NLP), we searched EMRs for 16 free text (and related) terms in 216 CD patients and 280 controls. (II) EMRs were also searched for ICD9 (International Classification of Disease) codes suggesting an increased risk of CD in 202 patients with CD and 524 controls. For each approach, we determined the optimal number of hits to be assigned as CD cases. To assess performance of these algorithms, sensitivity and specificity were calculated. Results Using two hits as the cut-off, the NLP algorithm identified 72.9% of all celiac patients (sensitivity), and ruled out CD in 89.9% of the controls (specificity). In a representative US population of individuals without a prior celiac diagnosis (assuming that 0.6% had undiagnosed CD), this NLP algorithm could identify a group of individuals where 4.2% would have CD (positive predictive value). ICD9 code search using three hits as the cut-off had a sensitivity of 17.1% and a specificity of 88.5% (positive predictive value was 0.9%). Discussion and conclusions This study shows that computerized EMR-based algorithms can help identify patients at high risk of CD. NLP-based techniques demonstrate higher sensitivity and positive predictive values than algorithms based on ICD9 code searches.
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| 5. |
- Terner, Annika, et al.
(författare)
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Predefined headings in a multiprofessional electronic health record system
- 2012
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Ingår i: JAMIA Journal of the American Medical Informatics Association. - Linköping : Oxford University Press (OUP). - 1067-5027 .- 1527-974X. ; 19:6, s. 1032-1038, s. 61-61
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundApplying multiprofessional electronic health records (EHRs) is expected to improve the quality of patient care and patient safety. Both EHR systems and system users depend on semantic interoperability to function efficiently. A shared clinical terminology comprising unambiguous terms is required for semantic interoperability. Empirical studies of clinical terminology, such as predefined headings, in EHR systems are scarce and limited to one profession or one clinical specialty.ObjectiveTo study predefined headings applied by users in a Swedish multiprofessional EHR system.Materials and methodsThis was a descriptive study of predefined headings (n=3596) applied by 5509 users in a Swedish multiprofessional EHR system. The predefined headings were classified into four term and word categories.ResultsLess than half of the predefined headings were shared by two or more professional groups. All eight professionals groups shared 1.7% of the predefined headings. The distribution of predefined headings across categories yielded two-thirds "terms for special purposes" and "specialist terms" and one-third "common words" and "unclassified headings".DiscussionThe indicated presence of profession-specific predefined headings and the conflict between ambiguity and comprehension of terms and words used as headings are discussed.ConclusionsThe predefined headings in the multiprofessional EHR system studied did not constitute a joint language for specific purposes. The improvement of the quality and usability of multiprofessional EHR systems requires attention.
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