Studies in health technology and informatics (Stud Health Tech Informat)

Publications in this journal

• Article: Design and implementation of synoptic operative report template using interoperable standards.

  Wilfred Bonney, Sean Christie, Grace Paterson, Ginette Thibault-Halman, Areej Alsulaiman
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  ABSTRACT: The increasing use of synoptic operative reports in clinical settings represents a major milestone in the advancement of health information technology. Synoptic operative report templates enable clinicians to capture and display succinct clinical information in a standardized and logical manner. Synoptic operative report templates also provide the optimum goal of enriching personalized health information of a given patient at the point of care so as to support the exchange of clinical information across the continuum of multiple healthcare providers. However, most of the available synoptic operative report templates in many clinical settings do not incorporate interoperable standards in their design and implementation. This paper proposes a novice template (i.e., eSOR-SCI) that uses interoperable standards for its design and implementation.
  Studies in health technology and informatics 01/2013; 183:195-200.
• Article: Architecture of an automated coaching system for elderly population.

  Stěpán Obdržálek, Gregorij Kurillo, Edmund Seto, Růžena Bajcsy
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  ABSTRACT: We present an automated coaching system for elderly population living in assisted homes. The system guides its users through a sequence of exercises and tests. Each exercise is demonstrated by a pre-recorded video of a coach, checked for correct execution and qualitatively evaluated. Automatic coaching advices are generated in order to improve the execution. Performance measurements are shown as an immediate feedback to the user, and stored and evaluated over time. The system is designed to allow for a remote interaction with a coach, and, to bolster social aspect of the exercise, for concurrent exercise of two (or eventually multiple) remote users.
  Studies in health technology and informatics 01/2013; 184:309-11.
• Article: Nuclear morphology measurements with angle-resolved low coherence interferometry for application to cell biology and early cancer detection.

  Adam Wax, Kevin J Chalut
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  ABSTRACT: The study of intact, living cells using non-invasive optical spectroscopic methods offers the opportunity to assess cellular structure and organization in a way that is not possible with commonly used cell biology imaging techniques. We have developed a novel spectroscopic technique for diagnosing disease at the cellular level based on using low-coherence interferometry (LCI) to detect the angular distribution of scattered light. Angle-resolved LCI (a/LCI) combines the ability of LCI to isolate scattering from sub-surface tissue layers with the ability of light scattering spectroscopy to obtain structural information on sub-wavelength scales. In application to examining cellular structure, a/LCI enables quantitative measurements of changes in the size and texture of cell nuclei. These quantitative measurements are characteristic of different pathological states. The capabilities of a/LCI were demonstrated using a clinical system that can be applied in endoscopic surveillance of esophageal tissue, producing high sensitivity and specificity for detecting dysplastic tissues in vivo. Experiments with in vitro cell samples also show the utility of a/LCI in observing structural changes due to environmental stimuli as well as detecting apoptosis due to chemotherapeutic agents.
  Studies in health technology and informatics 01/2013; 185:129-51.
• Article: Project I-COP - Architecture of Software Tool for Decision Support in Oncology.

  Milan Blaha, Dalibor Janča, Petr Klika, Jan Mužík, Ladislav Dušek
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  ABSTRACT: This article briefly describes the development of the I-COP tool, which is designed to promote education and decision making of clinical oncologists. It is based on real data from medical facilities, which are processed, stored in database, analyzed and finally displayed in an interactive software application. Used data sources are shortly described in individual sections together with the functionality of developed tools. The final goal of this project is to provide support for work and education within each involved partner center. Clinical oncologists are therefore supposed to be the authors and users at the same time.
  Studies in health technology and informatics 01/2013; 186:130-4.
• Article: Impedance measurements in the biomedical sciences.

  Frederick D Coffman, Stanley Cohen
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  ABSTRACT: Biological organisms and their component organs, tissues and cells have unique electrical impedance properties. Impedance properties often change with changes in structure, composition, and metabolism, and can be indicative of the onset and progression of disease states. Over the past 100 years, instruments and analytical methods have been developed to measure the impedance properties of biological specimens and to utilize these measurements in both clinical and basic science settings. This chapter will review the applications of impedance measurements in the biomedical sciences, from whole body analysis to impedance measurements of single cells and cell monolayers, and how cellular impedance measuring instruments can now be used in high throughput screening applications.
  Studies in health technology and informatics 01/2013; 185:185-205.
• Article: Prognostic Decision Support Using Symbolic Dynamics in CTG Monitoring.

  Mario Cesarelli, Maria Romano, Paolo Bifulco, Giovanni Improta, Giovanni D'Addio
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  ABSTRACT: Foetal heart rate variability is one of the most important parameters to monitor foetal wellbeing. Linear parameters, widely employed to study foetal heart variability, have shown some limitations in highlight dynamics potentially relevant. During the last decades, therefore, nonlinear analysis methods have gained a growing interest to analyze the chaotic nature of cardiac activity. Parameters derived by techniques investigating nonlinear can be included in computerised systems of cardiotocographic monitoring. In this work, we described an application of symbolic dynamics to analyze foetal heart rate variability in healthy foetuses and a concise index, introduced for its classification in antepartum CTG monitoring. The introduced index demonstrated to be capable to highlight differences in heart rate variability and resulted correlated with the Apgar score at birth, in particular, higher variability indexes values are associated to early greater vitality at birth. These preliminary results confirm that SD can be a helpful tool in CTG monitoring, supporting medical decisions in order to assure the maximum well-being of newborns.
  Studies in health technology and informatics 01/2013; 186:140-4.
• Article: Simultaneously authoring and modeling clinical practice guidelines: a case study in the therapeutic management of type 2 diabetes in france.

  Jacques Bouaud, Hector Falcoff, Brigitte Séroussi
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  ABSTRACT: By providing patient-specific advice, clinical decision support systems (CDSSs) are expected to promote the implementation of clinical practice guidelines (CPGs) to improve the quality of care. However, produced as texts, often incomplete and ambiguous, CPGs are difficult to translate into the formal knowledge bases (KBs) of CDSSs. The French National Authority for Health (HAS) decided to update CPGs on the management of type 2 diabetes. This work illustrates the simultaneous development of the text and its formal counterpart in a CDSS named RecosDiab. CPGs were elaborated by a working group according to the guideline development methodology. Textual recommendations were graded, either as evidence-based when evidence existed or as consensus-based when acknowledge by the working group. Knowledge modeling was performed following the steps of de-abstraction, disambiguation, and verification of completeness. This last step generated clinical situations not explicitly mentioned in the text and were graded as expert-based. The resulting KB provides therapeutic advice for 805 clinical situations, among which 2 are graded as evidence-based, 37 are consensus-based, and 766 are expert-based. However, because of the amount of expert-based propositions, the HAS did not endorse the system.
  Studies in health technology and informatics 01/2013; 186:108-12.
• Article: Automatic system testing of a decision support system for insulin dosing using google android.

  Stephan Spat, Bernhard Höll, Georg Petritsch, Lukas Schaupp, Peter Beck, Thomas R Pieber
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  ABSTRACT: Hyperglycaemia in hospitalized patients is a common and costly health care problem. The GlucoTab system is a mobile workflow and decision support system, aiming to facilitate efficient and safe glycemic control of non-critically ill patients. Being a medical device, the GlucoTab requires extensive and reproducible testing. A framework for high-volume, reproducible and automated system testing of the GlucoTab system was set up applying several Open Source tools for test automation and system time handling. The REACTION insulin titration protocol was investigated in a paper-based clinical trial (PBCT). In order to validate the GlucoTab system, data from this trial was used for simulation and system tests. In total, 1190 decision support action points were identified and simulated. Four data points (0.3%) resulted in a GlucoTab system error caused by a defective implementation. In 144 data points (12.1%), calculation errors of physicians and nurses in the PBCT were detected. The test framework was able to verify manual calculation of insulin doses and detect relatively many user errors and workflow anomalies in the PBCT data. This shows the high potential of the electronic decision support application to improve safety of implementation of an insulin titration protocol and workflow management system in clinical wards.
  Studies in health technology and informatics 01/2013; 186:187-91.
• Article: Rule-based healthcare-associated bloodstream infection classification and surveillance system.

  Yi-Ju Tseng, Jung-Hsuan Wu, Hui-Chi Lin, Hsiang-Ju Chiu, Bo-Chiang Huang, Rung-Ji Shang, Ming-Yuan Chen, Wei-Hsin Chen, Huai-Te Chen, Feipei Lai, Yee-Chun Chen
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  ABSTRACT: Healthcare-associated infections (HAIs) are a major patient safety issue. These adverse events add to the burden of resource use, promote resistance to antibiotics, and contribute to patient deaths and disability. A rule-based HAI classification and surveillance system was developed for automatic integration, analysis, and interpretation of HAIs and related pathogens. Rule-based classification system was design and implement to facilitate healthcare-associated bloodstream infection (HABSI) surveillance. Electronic medical records from a 2200-bed teaching hospital in Taiwan were classified according to predefined criteria of HABSI. The detailed information in each HABSI was presented systematically to support infection control personnel decision. The accuracy of HABSI classification was 0.94, and the square of the sample correlation coefficient was 0.99.
  Studies in health technology and informatics 01/2013; 186:145-9.
• Article: Commercial versus In-Situ Usability Testing of Healthcare Information Systems: Towards "Public" Usability Testing in Healthcare Organizations.

  Andre W Kushniruk, Elizabeth M Borycki, Joseph Kannry
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  ABSTRACT: The need for improved usability in healthcare IT has been widely recognized. In addition, methods from usability engineering, including usability testing and usability inspection have received greater attention. Many vendors of healthcare software are now employing usability testing methods in the design and development of their products. However, despite this, the usability of healthcare IT is still considered to be problematic and many healthcare organizations that have purchased systems that have been tested at vendor testing sites are still reporting a range of usability and safety issues. In this paper we explore the distinction between commercial usability testing (conducted at centralized vendor usability laboratories and limited beta test sites) and usability testing that is carried out locally within healthcare organizations that have purchased vendor systems and products (i.e. public "in-situ" usability testing). In this paper it will be argued that both types of testing (i.e. commercial vendor-based testing) and in-situ testing are needed to ensure system usability and safety.
  Studies in health technology and informatics 01/2013; 183:157-61.
• Article: Computerisation in General Practice: Lessons for Canada from the UK and Australia.

  Nicola T Shaw, Mike Bainbridge
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  ABSTRACT: In 2000 Shaw and Kidd published an article on the lessons that could be learned from the UK in general practice computerization. Over a decade later many of these lessons remain yet to be learned. Hence Shaw & Bainbridge felt that it was time to revisit these issues and review progress made against each in both the UK and Australia in an effort to help Canada learn the lessons as it follows behind both countries. Nine lessons are identified, reviewed and discussed in the hope that Canada will choose to take note and leapfrog these jurisdictions by learning from history, rather than being doomed to repeat it.
  Studies in health technology and informatics 01/2013; 183:28-36.
• Article: The evolution of anatomic pathology: new strategies and emerging trends.

  Stanley Cohen
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  ABSTRACT: Science advances both by conceptual leaps and by improved observational and analytic tools. Mechanism and function in biological systems can best be understood in the context of the complex microenvironments in which they occur, and for this purpose morphologic analysis can be critical. The technological advances in cell and tissue imaging described in this book are currently finding application in a wide variety of basic, translational, and clinical biomedical studies. We have chosen some specific approaches that illustrate the various categories of imaging methodologies available. Many other ways of applying modern morphology-based interrogation of cells and tissues have already been described and are continuously evolving. This chapter provides examples of some of these. On the clinical front, radiologists have embraced new imaging technique to a greater extent than have pathologists. This chapter discusses some of the factors responsible for this, and suggests that pathology and radiology are converging towards a more holistic approach to diagnostic imaging.
  Studies in health technology and informatics 01/2013; 185:325-37.
• Article: How Turing and Wolf Influenced my Decision Support Systems.

  Bernard Richards
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  ABSTRACT: Decision Support Systems (DSS) have a vital role to play in today's scenario for Patient Care. They can embody a vast knowledge not normally found in one individual where diagnosis and treatment are involved. This paper highlights the training in minute details and precise mathematics needed in a successful DSS and indicates how such attention-to-detail was instilled into the writer as a result of working with Alan Turing and Emil Wolf who have both since achieved world-wide recognition in their own fields as a result of international publicity by the current writer. The article discusses four Decision Support Systems written by the present writer all of which have been shown to improve patient treatment and care, and which are of such complexity that, without their use, patient care would fall short of optimum. The Systems considered are those for Intensive Care Units, Cardiovascular Surgery, a Programmed Investigation Unit, and Diagnosis of Congenital Abnormalities. All these Systems have performed better than the human alternatives and have shown their value in the improvement of patient care.
  Studies in health technology and informatics 01/2013; 186:31-5.
• Article: mHealth Application for Upper Extremity Range of Motion and Reachable Workspace.

  Posu Yan, Gregorij Kurillo, Ruzena Bajcsy, R Ted Abresch, Alina Nicorici, Linda Johnson, Jay J Han
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  ABSTRACT: We present mobile health (mHealth) applications utilizing embedded phone sensors as an angle-measuring device for upper-limb range of motion (ROM) and estimation of reachable workspace to assist in evaluation of upper limb functional capacity. Our results show that the phone can record accurate measurements, as well as provide additional functionalities for clinicians.
  Studies in health technology and informatics 01/2013; 184:478-80.
• Article: A conceptual framework for automating the operational and strategic decision-making process in the health care delivery system.

  Toni Ruohonen, Mohammed Ennejmy
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  ABSTRACT: Making reliable and justified operational and strategic decisions is a really challenging task in the health care domain. So far, the decisions have been made based on the experience of managers and staff, or they are evaluated with traditional methods, using inadequate data. As a result of this kind of decision-making process, attempts to improve operations usually have failed or led to only local improvements. Health care organizations have a lot of operational data, in addition to clinical data, which is the key element for making reliable and justified decisions. However, it is progressively problematic to access it and make usage of it. In this paper we discuss about the possibilities how to exploit operational data in the most efficient way in the decision-making process. We'll share our future visions and propose a conceptual framework for automating the decision-making process.
  Studies in health technology and informatics 01/2013; 186:115-9.
• Article: Knowledge representation and management enabling intelligent interoperability - principles and standards.

  Bernd Blobel
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  ABSTRACT: Based on the paradigm changes for health, health services and underlying technologies as well as the need for at best comprehensive and increasingly automated interoperability, the paper addresses the challenge of knowledge representation and management for medical decision support. After introducing related definitions, a system-theoretical, architecture-centric approach to decision support systems (DSSs) and appropriate ways for representing them using systems of ontologies is given. Finally, existing and emerging knowledge representation and management standards are presented. The paper focuses on the knowledge representation and management part of DSSs, excluding the reasoning part from consideration.
  Studies in health technology and informatics 01/2013; 186:3-21.
• Article: A novel way of integrating rule-based knowledge into a web ontology language framework.

  Dragan Gamberger, Goran Krstaçić, Alan Jović
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  ABSTRACT: Web ontology language (OWL), used in combination with the Protégé visual interface, is a modern standard for development and maintenance of ontologies and a powerful tool for knowledge presentation. In this work, we describe a novel possibility to use OWL also for the conceptualization of knowledge presented by a set of rules. In this approach, rules are represented as a hierarchy of actionable classes with necessary and sufficient conditions defined by the description logic formalism. The advantages are that: the set of the rules is not an unordered set anymore, the concepts defined in descriptive ontologies can be used directly in the bodies of rules, and Protégé presents an intuitive tool for editing the set of rules. Standard ontology reasoning processes are not applicable in this framework, but experiments conducted on the rule sets have demonstrated that the reasoning problems can be successfully solved.
  Studies in health technology and informatics 01/2013; 186:51-5.