Studies in Health Technology and Informatics pptx

Das A Discussion About the Importance of Laws and Policies for Data Sharing for Public Health in the People’s Xiue Fan and Ping Yu Bradley Malin and Edoardo Airoldi Design of a Decentral

MEDINFO 2007

Studies in Health Technology and Informatics

This book series was started in 1990 to promote research conducted under the auspices of the EC programmes’ Advanced Informatics in Medicine (AIM) and Biomedical and Health Research (BHR) bioengineering branch

A driving aspect of international health informatics is that telecommunication technology, rehabilitative technology, intelligent home technology and many other components are moving together and form one integrated world of information and communication media The complete series has been accepted in Medline Volumes from 2005 onwards are available online

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Dr J.P Christensen, Prof G de Moor, Prof A Famili, Prof A Hasman, Prof L Hunter,

Dr I Iakovidis, Dr Z Kolitsi, Mr O Le Dour, Dr A Lymberis, Prof P.F Niederer,

Prof A Pedotti, Prof O Rienhoff, Prof F.H Roger France, Dr N Rossing, Prof N Saranummi, Dr E.R Siegel, Dr P Wilson, Prof E.J.S Hovenga,

Prof M.A Musen and Prof J Mantas

Volume 129 Recently published in this series Vol 128 P.J Murray, H.-A Park, W.S Erdley and J Kim (Eds.), Nursing Informatics 2020: Towards Defining Our

Own Future – Proceedings of NI2006 Post Congress Conference

Vol 127 L Bos and B Blobel (Eds.), Medical and Care Compunetics 4

Vol 126 N Jacq, H Müller, I Blanquer, Y Legré, V Breton, D Hausser, V Hernández, T Solomonides and

M Hofmann-Apitius (Eds.), From Genes to Personalized HealthCare: Grid Solutions for the Life Sciences – Proceedings of HealthGrid 2007

Vol 125 J.D Westwood, R.S Haluck, H.M Hoffman, G.T Mogel, R Phillips, R.A Robb and K.G Vosburgh

(Eds.), Medicine Meets Virtual Reality 15 – in vivo, in vitro, in silico: Designing the Next in Medicine Vol 124 A Hasman, R Haux, J van der Lei, E De Clercq and F.H Roger France (Eds.), Ubiquity: Technologies for

Better Health in Aging Societies – Proceedings of MIE2006

Vol 123 D Uyttendaele and P.H Dangerfield (Eds.), Research into Spinal Deformities 5

Vol 122 H.-A Park, P Murray and C Delaney (Eds.), Consumer-Centered Computer-Supported Care for Healthy

People – Proceedings of NI2006 – The 9th International Congress on Nursing Informatics

Vol 121 L Bos, L Roa, K Yogesan, B O’Connell, A Marsh and B Blobel (Eds.), Medical and Care Compunetics 3 Vol 120 V Hernández, I Blanquer, T Solomonides, V Breton and Y Legré (Eds.), Challenges and Opportunities of

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Vol 119 J.D Westwood, R.S Haluck, H.M Hoffman, G.T Mogel, R Phillips, R.A Robb and K.G Vosburgh

(Eds.), Medicine Meets Virtual Reality 14 – Accelerating Change in Healthcare: Next Medical Toolkit Vol 118 R.G Bushko (Ed.), Future of Intelligent and Extelligent Health Environment

Vol 117 C.D Nugent, P.J McCullagh, E.T McAdams and A Lymberis (Eds.), Personalised Health Management

Systems – The Integration of Innovative Sensing, Textile, Information and Communication Technologies Vol 116 R Engelbrecht, A Geissbuhler, C Lovis and G Mihalas (Eds.), Connecting Medical Informatics and Bio-

Informatics – Proceedings of MIE2005

Vol 115 N Saranummi, D Piggott, D.G Katehakis, M Tsiknakis and K Bernstein (Eds.), Regional Health

Economies and ICT Services

ISSN 0926-9630

MEDINFO 2007 Proceedings of the 12th World Congress on Health (Medical) Informatics

Building Sustainable Health Systems

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Table of Contents

In Memory of Dr Branko Cesnik

Part 1

eHealth Solutions to the Continuity of Care

Linkcare – Enabling Continuity of Care for the Chronically Ill across Levels and Profession 3Marius Mikalsen, Ståle Walderhaug, Per Håkon Meland and Ole Martin Winnem

Sustainable Ubiquitous Home Health Care – Architectural Considerations and First Practical Experiences 8Michael Marschollek, Klaus-H Wolf, Oliver-J Bott, Mirko Geisler, Maik Plischke, Wolfram Ludwig,

Andreas Hornberger and Reinhold Haux

Do Physicians Take Action on High Risk Family History Information Provided by Patients Outside of a Clinic

Lynn A Volk, Maria Staroselsky, Lisa P Newmark, Hannah Pham, Alexis Tumolo, Deborah H Williams,

Ruslana Tsurikova, Jeffrey Schnipper, Jonathan Wald and David W Bates

Sharing Electronic Laboratory Results in a Patient Portal – A Feasibility Pilot 18Jonathan S Wald, Karen Burk, Kate Gardner, Raisa Feygin, Elizabeth Nelson, Marianna Epstein,

Eric G Poon and Blackford Middleton

eHealth Systems Modeling

Jon Warwick and Gary Bell

Model-Centric Approaches for the Development of Health Information Systems 28Mika Tuomainen, Juha Mykkänen, Heli Luostarinen, Assi Pöyhölä and Esa Paakkanen

Software Engineering Principles Applied to Large Healthcare Information Systems – A Case Report 33Fabiane Bizinella Nardon and Lincoln de A Moura Jr

Towards Modeling and Simulation of Integrated Social and Health Care Services for Elderly 38Alexander Horsch and Daryoush Khoshsima

Healthcare Delivery Systems: Designing Quality into Health Information Systems 43Phil Joyce, Rosamund Green and Graham Winch

Jacqueline Moss, Eta S Berner and Kathy Savell

Towards Sustainable e-Health Networks: Does Modeling Support Efficient Management and Operation? 53Martin Staemmler

Rong Chen and Gunnar Klein

A Conceptual Model of Computerised Hospital Information System (CHIS) use in South Africa 63Lyn A Hanmer, Sedick Isaacs and J Dewald Roode

Are Problem-Oriented Medial Records (POMR) Suitable for Use in GPs’ Daily Practice? 68Etienne De Clercq, Viviane Van Casteren, Pascale Jonckheer, Peter Burggraeve, Marie France Lafontaine,

Karen Degroote and Francis Roger France

Can an EPR Support the Concept of Family-Centred, Individualized Developmental Care of Premature

Christian D Kohl, Claus Schott, Doris Verveur, Otwin Linderkamp and Petra Knaup-Gregori

Multiple Detection Modalities and Disease Natural History of Breast Cancer 78Tony Hsiu-Hsi Chen, Amy Ming-Fang Yen, Grace Hui-Min Wu, Li-Sheng Chen and Yueh-Hsia Chiu

Care at a Distance

Challenges in Telemedicine and eHealth: Lessons Learned from 20 Years with Telemedicine in Tromsø 82Gunnar Hartvigsen, Monika A Johansen, Per Hasvold, Johan Gustav Bellika, Eirik Arsand, Eli Arild,

Deede Gammon, Sture Pettersen and Steinar Pedersen

A Satellite Infrastructure for Health Early Warning in Post-Disaster Health Management 87C.E Chronaki, A Berthier, M.M Lleo, L Esterle, A Lenglet, F Simon, L Josseran, M Lafaye, Y Matsakis,

A Tabasco and L Braak

Remote Support for Stroke Rehabilitation: MyHeart’s “Neurological Rehabilitation” Concept 92Toni Giorgino, Paolo Tormene, Barbara Cattani, Caterina Pistarini and Silvana Quaglini

Effects of a Computerized Cardiac Teletriage Decision Support System on Nurse Performance: Results

Kirsten Carroll Somoza, Kathryn Momtahan and Gitte Lindgaard

Mobile Care

Farhaan Mirza and Tony Norris

Applying Mobile and Pervasive Computer Technology to Enhance Coordination of Work in a Surgical Ward 107 Thomas Riisgaard Hansen and Jakob E Bardram

Feasibility and Usability of a Home Monitoring Concept based on Mobile Phones and Near Field

Jürgen Morak, Alexander Kollmann and Günter Schreier

Using Personal Digital Assistants and Patient Care Algorithms to Improve Access to Cardiac Care Best

Kathryn L Momtahan, Catherine M Burns, Heather Sherrard, Thierry Mesana and Marino Labinaz

Interoperability Issues in eHealth Information Systems

Improving Systems Interoperability with Model-Driven Software Development for HealthCare 122 Ståle Walderhaug, Marius Mikalsen, Gunnar Hartvigsen, Erlend Stav and Jan Aagedal

Conformance Testing of Interoperability in Health Information Systems in Finland 127 Tanja Toroi, Anne Eerola and Juha Mykkänen

Connecting Public Health and Clinical Information Systems by Using a Standardized Methodology 132 Diego M Lopez and Bernd G.M.E Blobel

Clinical and Translational Science Sustainability: Overcoming Integration Issues Between Electronic

Health Records (EHR) and Clinical Research Data Management Systems “Separate but Equal” 137 Robert P DiLaura

Searching for Answers

The FA4CT Algorithm: A New Model and Tool for Consumers to Assess and Filter Health Information

Gunther Eysenbach and Maria Thomson

WRAPIN: A Tool for Patient Empowerment Within EHR 147 Michel Joubert, Arnaud Gaudinat, Célia Boyer, Antoine Geissbuhler, Marius Fieschi,

HON Foundation Council members

How do Clinicians Search For and Access Biomedical Literature to Answer Clinical Questions? 152 Annie Y.S Lau and Enrico Coiera

Emerging Technologies

Blogs, Wikis, and Discussion Forums: Attributes and Implications for Clinical Information Systems 157 Jacob B Weiss and Thomas R Campion Jr

From Intermediation to Disintermediation and Apomediation: New Models for Consumers to Access and

Gunther Eysenbach

A Mobile Phone Based Remote Patient Monitoring System For Chronic Disease Management 167 Mathieu Trudel, Joseph A Cafazzo, Melinda Hamill, Walter Igharas, Kevin Tallevi, Peter Picton, Jack Lam,

Peter G Rossos, Anthony C Easty and Alexander Logan

Consumer Health Technologies

Bernd G.M.E Blobel, Peter Pharow and Thomas Norgall

Rod Ward, Katherine Pollard, Margaret Glogowska and Pam Moule

Development of Patient Centric Virtual Organizations (PCVOs) in Clinical Environment for Patient

Mohyuddin, W.A Gray, Hazel Bailey, Wendy Jones and David Morrey

SPIRS: A Framework for Content-Based Image Retrieval from Large Biomedical Databases 188 William Hsu, L Rodney Long and Sameer Antani

The Impact of Clinical Information Systems

The Quality of Reporting of Health Informatics Evaluation Studies: A Pilot Study 193 Jan Talmon, Elske Ammenwerth and Thom Geven

Exploring the Unintended Consequences of Computerized Physician Order Entry 198 Joan S Ash, Dean F Sittig, Richard Dykstra, Emily Campbell and Kenneth Guappone

Impact of Health Care Information Technology on Hospital Productivity Growth: A Survey in 17 Acute

Rodolphe Meyer, Patrice Degoulet and Louis Omnes

Risk Management and Measuring Productivity with POAS – Point of Act System 208 Masanori Akiyama and Tatsuya Kondo

eHealth at-Large

Connecting the Dots: Creation of an Electronic Regional Infection Control Network 213 Abel N Kho, Paul Dexter, Larry Lemmon, Dauna Carey, Heather Woodward-Hagg, Steve Hare and

Brad Doebbeling

Dealing with Ecological Fallacy in Preparations for Influenza Pandemics: Use of a Flexible Environment

Toomas Timpka, Magus Morin, Johan Jenvald, Elin Gursky and Henrik Eriksson

Effectiveness of a Chronic Disease Surveillance Systems for Blood Pressure Monitoring 223 Damian Borbolla, Diego Giunta, Silvana Figar, Mercedes Soriano, Adriana Dawidowski and

Fernan Gonzalez Bernaldo de Quiros

Nurses and Computers An International Perspective on Nurses’ Requirements 228 Carol S Bond

Issues in Clinical Care and Research

The Need for Global Certification in the Field of Health Informatics: Some Ethical Issues 233

Eike-Henner W Kluge

Ellen Balka, Christine Reidl and Ina Wagner

Gunnar René Øie, Herbjørn Andresen and Inger Anne Tøndel

A Day in the Life of a Clinical Research Coordinator: Observations from Community Practice Settings 247

Sharib A Khan, Rita Kukafka, Philip R.O Payne, J Thomas Bigger and Stephen B Johnson

eHealth System Adoption

A Survey of U.S.A Acute Care Hospitals’ Computer-Based Provider Order Entry System Infusion Levels 252

Dean F Sittig, Ken Guappone, Emily M Campbell, Richard H Dykstra and Joan S Ash

E-Healthcare in India: Critical Success Factors for Sustainable Health Systems 257

Udita Taneja, Sushil

Maryati Mohd Yusof, Lampros Stergioulas and Jasmina Zugic

Ivan V Emelin and Radik A Eltchiyan

eHealth and Risk Management

The Development of an Information System and Installation of an Internet Web Database for the Purposes

I Mavrikakis, J Mantas and M Diomidous

Stergiani Spyrou, Panagiotis Bamidis, Vassilis Kilintzis, Irini Lekka, Nicos Maglaveras and Costas Pappas

From the Description of Activities to the Identification of Risks for Clinical Management: A Proposal of

Building, Merging and Sharing Knowledge Representations of Care Processes 280

Pascal Staccini, Michel Joubert, Rémy Collomp, Jean-François Quaranta and Marius Fieschi

Near-Miss and Hazard Reporting: Promoting Mindfulness in Patient Safety Education 285

Leanne M Currie, Karen S Desjardins, Patricia W Stone, Tsai-ya Lai, Eric Schwartz, Rebecca Schnall and

Suzanne Bakken

Wide Electronic Health Records

A Territory-Wide Electronic Health Record – From Concept to Practicality: The Hong Kong Experience 293

Antonio C.H Sek, N.T Cheung, K.M Choy, W.N Wong, Anna Y.H Tong, Vicky H Fung, Michael Fung

and Eric Ho

Northern Territory HealthConnect: Shared Electronic Health Record Service Implementation Experiences

Stephen Moo and John Fletcher

A Simulation-Based Performance Analysis of a National Electronic Health Record System 302

Leonidas Orfanidis, Panagiotis D Bamidis and Barry Eaglestone

Principles-Based Medical Informatics for Success – How Hong Kong Built One of the World’s Largest

Ngai-Tseung Cheung, Vicky Fung, Wing Nam Wong, Anna Tong, Antonio Sek, Andre Greyling, Nancy Tse

and Hong Fung

Healthcare and Research Data Repositories

Knowledge-Level Querying of Temporal Patterns in Clinical Research Systems 311 Martin J O’Connor, Ravi D Shankar, David B Parrish and Amar K Das

A Discussion About the Importance of Laws and Policies for Data Sharing for Public Health in the People’s

Xiue Fan and Ping Yu

Bradley Malin and Edoardo Airoldi

Design of a Decentralized Reusable Research Database Architecture to Support Data Acquisition in Large

Jimison Iavindrasana, Adrien Depeursinge, Patrick Ruch, Stéphane Spahni, Antoine Geissbuhler and

Henning Müller

Registers and Research

The Cancer Biomedical Informatics Grid (caBIG™): Infrastructure and Applications for a Worldwide

The caBIG Strategic Planning Workspace

The Integration of Grid Resources into a Portal for Research Collaboratories 335 Yassene Mohammed, Sabine Rey, Fabian Rakebrandt and Ulrich Sax

Biomedical Data Mining in Clinical Routine: Expanding the Impact of Hospital Information Systems 340 Marcel Müller, Kornel Markó, Philipp Daumke, Jan Paetzold, Arnold Roesner and Rüdiger Klar

Bengt Astrand, Bo Hovstadius, Karolina Antonov and Göran Petersson

Patient Record Documentation

The Use of Existing Low-Cost Technologies to Enhance the Medical Record Documentation Using a

S Bart and T Hannan

Uros Rajkovic, Olga Sustersic, Vladislav Rajkovic and Vesna Prijatelj

A Survey of the Effects of the full Computerized Nursing Records System on Sharing Nursing Records

Yukio Kurihara, Naho Asai, Eri Ishimoto, Shigeyuki Kawamata and Satsuki Nakamura

New Method of Realization of Nursing Diagnosis Based on 3N in an Electronic Medical Record System 364 Young ah Kim, Mijung An, Jungyoen Park, Hyensun Jung, Yongoock Kim and Byungchul Chang

Integrated Health Records

Integration of Longitudinal Electronic Records in a Large Healthcare Enterprise: The U.S Veterans

Arthur C Curtis, Joseph Gillon and Dale C Malmrose

The AMPATH Medical Record System: Creating, Implementing, and Sustaining an Electronic Medical

William M Tierney, Joseph K Rotich, Terry J Hannan, Abraham M Siika, Paul G Biondich, Burke W Mamlin, Winstone M Nyandiko, Sylvester Kimaiyo, Kara Wools-Kaloustian, John E Sidle, Chrispinus Simiyu,

Erika Kigotho, Beverly Musick, Joseph J Mamlin and Robert M Einterz

Cláudio G.A Costa, Beatriz F Leão and Lincoln A Moura Jr

Experience in Implementing the OpenMRS Medical Record System to Support HIV Treatment in Rwanda 382 Christian Allen, Darius Jazayeri, Justin Miranda, Paul G Biondich, Burke W Mamlin, Ben A Wolfe,

Chris Seebregts, Neal Lesh, William M Tierney and Hamish S.F Fraser

Evaluation of a Simple Method for the Automatic Assignment of MeSH Descriptors to Health Resources

Aurélie Névéol, Suzanne Pereira, Gaetan Kerdelhué, Badisse Dahamna, Michel Joubert and Stéfan J Darmoni

Template-based Data Entry for General Description in Medical Records and Data Transfer to Data

Yasushi Matsumura, Shigeki Kuwata, Yuichiro Yamamoto, Kazunori Izumi, Yasushi Okada, Michihiro Hazumi, Sachiko Yoshimoto, Takahiro Mineno, Munetoshi Nagahama, Ayumi Fujii and Hiroshi Takeda

Frédéric Ehrler, Patrick Ruch, Antoine Geissbuhler and Christian Lovis

Robert Moskovitch, Roee Sa'adon, Eytan Behiri, Susana Martins, Aviram Weiss and Yuval Shahar

Data: Standards and Sharing

StructConsult: Structured Real-Time Wet Read Consultation Infrastructure to Support Patient Care 429 Craig Morioka, John David N Dionisio, Alex Bui, Suzie El-Saden and Hooshang Kangarloo

Refining DICOM for Pathology – Progress from the IHE and DICOM Pathology Working Groups 434 Christel Le Bozec, Dominique Henin, Bettina Fabiani, Thomas Schrader, Marcial Garcia-Rojo and Bruce Beckwith

A Generic, Web-Based Clinical Information System Architecture Using HL7 CDA: Successful Implementation

Thilo Schuler, Martin Boeker, Rüdiger Klar and Marcel Müller

Alejandro E Flores and Khin Than Win

An XML Model of an Enhanced Data Dictionary to Facilitate the Exchange of Pre-Existing Clinical Research

Stephany N Duda, Clint Cushman and Daniel R Masys

Jose A Maldonado, David Moner, Diego Tomás, Carlos Ángulo, Montserrat Robles and Jesualdo T Fernández

Helen Christensen and Kathleen Griffiths

A Discrete Time-Space Geography for Epidemiology: From Mixing Groups to Pockets of Local Order in

Einar Holm and Toomas Timpka

Data: Transfer and Technical Standards

A National Study of eHealth Standardization in Finland – Goals and Recommendations 469 Juha Mykkänen, Maritta Korhonen, Jari Porrasmaa, Tuula Tuomainen and Antero Ensio

Building a Womb-to-Tomb Health Record in Hong Kong – An Application of Information Architecture 474

Vicky Fung, N.T Cheung, Eric Ho, Clara Cheung, Hudson Chan, Kitty Tsang, Joycelyne Cheung, William Ho,

Maggie Lau, Veronica Hung, Austen Wong, Anna Tong, W.N Wong and Antonio Sek

Another HISA – The New Standard: Health Informatics – Service Architecture 478

Gunnar O Klein, Pier Angelo Sottile and Frederik Endsleff

Sharing Data

Protecting Privacy While Sharing Medical Data Between Regional Healthcare Entities 483

Tyrone Grandison, Srivatsava Ranjit Ganta, Uri Braun and James Kaufman

Pulling Back the Covers: Technical Lessons of a Real-World Health Information Exchange 488

Atif Zafar and Brian E Dixon

Geographically Distributed Complementary Content-Based Image Retrieval Systems for Biomedical Image

Sameer K Antani, Thomas M Deserno, L Rodney Long and George R Thoma

Utilizing SELinux to Mandate Ultra-Secure Access Control of Medical Records 498

Peter R Croll, Matt Henricksen, Bill Caelli and Vicky Liu

Secure Data Transmission

Proposal of a French Health Identification Number Interoperable at the European Level 503

Catherine Quantin, François-André Allaert, Paul Avillach, Benoît Riandeye Marius Fieschi, Maniane Fassa

and Olivier Cohen

Clearinghouse: A Teleradiology Platform Emphasizing Security of Data and Communication 508

Michael Spitzer, Lars Brinkmann and Frank Ueckert

K-Box: Automatic Structuring and Exchange of Medical Documents Based on the Clinical Documentation

Minh H Doan, Paul-Ludwig Lott, Marek Václavík and Frank Ueckert

Understanding Natural Language

Jung-Wei Fan, Hua Xu and Carol Friedman

A Reappraisal of Sentence and Token Splitting for Life Sciences Documents 524

Katrin Tomanek, Joachim Wermter and Udo Hahn

Roosewelt L Andrade, Edson Pacheco, Pindaro S Cancian, Percy Nohama and Stefan Schulz

Defining Medical Words: Transposing Morphosemantic Analysis from French to English 535

Louise Deléger, Fiammetta Namer and Pierre Zweigenbaum

Finding Malignant Findings from Radiological Reports Using Medical Attributes and Syntactic Information 540

Takeshi Imai, Eiji Aramaki, Masayuki Kajino, Kengo Miyo, Yuzo Onogi and Kazuhiko Ohe

A Normalized Lexical Lookup Approach to Identifying UMLS Concepts in Free Text 545

Vijayaraghavan Bashyam, Guy Divita, David B Bennett, Allen C Browne and Ricky K Taira

Extracting Subject Demographic Information from Abstracts of Randomized Clinical Trial Reports 550

Rong Xu, Yael Garten, Kaustubh S Supekar, Amar K Das, Russ B Altman and Alan M Garber

Coupling Ontology Driven Semantic Representation with Multilingual Natural Language Generation for

Anne-Marie Rassinoux, Robert H Baud, Jean-Marie Rodrigues, Christian Lovis and Antoine Geissbühler

Discovering New Biomedical Knowledge: Machine Learning and Data Mining

Biomedical Knowledge Discovery with Topological Constraints Modeling in Bayesian Networks:

Guoliang Li and Tze-Yun Leong

Ove Granberg, Johan Gustav Bellika, Eirik Årsand and Gunnar Hartvigsen

Seung Hee Ho, Hyun Young Park, Yang Soo Jang and Sun Ha Jee

Results from Data Mining in a Radiology Department: The Relevance of Data Quality 576 Martin Lang, Nanda Kirpekar, Thomas Bürkle, Susanne Laumann and Hans-Ulrich Prokosch

Evaluating Learning Models with Transitions of Human Interests Based on Objective Rule Evaluation Indices 581 Hidenao Abe, Hideto Yokoi, Shusaku Tsumoto, Miho Ohsaki and Takahira Yamaguchi

Josef Ingenerf and Siegfried J Pöppl

Brian E Dixon, Atif Zafar and Julie J McGowan

A Practical Approach to Advanced Terminology Services in Health Information Systems 621 Maria Laura Gambarte, Alejandro Lopez Osornio, Marcela Martinez, Guillermo Reynoso, Daniel Luna and

Fernan Gonzalez Bernaldo de Quiros

Rachel Richesson, Asif Syed, Heather Guillette, Mark S Tuttle and Jeffrey Krischer

Using SNOMED CT® as a Reference Terminology to Cross Map Two Highly Pre-Coordinated Classification

Steven H Brown, Casey S Husser, Dietlind Wahner-Roedler, Sandra Bailey, Linda Nugent, Karla Porter,

Brent A Bauer and Peter L Elkin

Senthil K Nachimuthu and Lee Min Lau

Issues in Terminology Management

Eiji Aramaki, Takeshi Imai, Masayuki Kajino, Kengo Miyo and Kazuhiko Ohe

Creation and Evaluation of a Terminology Server for the Interactive Coding of Discharge Summaries 650 Hernán Navas, Alejandro Lopez Osornio, Analía Baum, Adrian Gomez, Daniel Luna and

Fernan Gonzalez Bernaldo de Quiros

Jeferson L Bitencourt, Píndaro S Cancian, Edson J Pacheco, Percy Nohama and Stefan Schulz

Harmonizing Clinical Terminologies: Driving Interoperability in Healthcare 660 Russell A Hamm, Sarah E Knoop, Peter Schwarz, Aaron D Block and Warren L Davis IV

Semantic Issues in Healthdata Classification

Rema Padman, Xue Bai and Edoardo M Airoldi

Hirofumi Fujii, Hiromasa Yamagishi, Yutaka Ando, Nobuhiro Tsukamoto, Osamu Kawaguchi,

Tomotaka Kasamatsu, Kaoru Kurosaki, Masakazu Osada, Hiroshi Kaneko and Atsushi Kubo

Semantic Issues in Integrating Data from Different Models to Achieve Data Interoperability 674 Rahil Qamar and Alan Rector

Medication Reconciliation Using Natural Language Processing and Controlled Terminologies 679 James J Cimino, Tiffani J Bright and Jianhua Li

Biomedical Text Mining and Standard Terminology

Comparing Medical Code Usage with the Compression-Based Dissimilarity Measure 684 Thomas Brox Røst, Ole Edsberg, Anders Grimsmo and Øystein Nytrø

Chintan O Patel and James J Cimino

Assigning Categorical Information to Japanese Medical Terms Using MeSH and MEDLINE 694 Yuzo Onogi

PharmARTS: Terminology Web Services for Drug Safety Data Coding and Retrieval 699 Iulian Alecu, Cédric Bousquet, Patrice Degoulet and Marie-Christine Jaulent

Machine Learning Approach for Automatic Quality Criteria Detection of Health Web Pages 705 Arnaud Gaudinat, Natalia Grabar and Célia Boyer

Patrick Ruch, Antoine Geissbühler, Julien Gobeill, Frederic Lisacek, Imad Tbahriti, Anne-Lise Veuthey and

Alan R Aronson

A Comparison of Impact Factor, Clinical Query Filters, and Pattern Recognition Query Filters in Terms

Lawrence D Fu, Lily Wang, Yindalon Aphinyanagphongs and Constantin F Aliferis

A Method for Defining a Journal Subset for a Clinical Discipline Using the Bibliographies of Systematic

Nancy L Wilczynski, Amit X Garg, R Brian Haynes, for the Nephrology Hedges Team

Ontologies

Peter L Elkin, David Froehling, Brent A Bauer, Dietlind Wahner-Roedler, S Trent Rosenbloom, Kent Bailey

and Steven H Brown

What’s in a code? Towards a Formal Account of the Relation of Ontologies and Coding Systems 730 Alan L Rector

A Road from Health Care Classifications and Coding Systems to Biomedical Ontology: The CEN Categorial

J.M Rodrigues, C Rosse, M Fogelberg, A Kumar and B Trombert Paviot

The Nodes Focusing Tool for Clinical Course Data of Hypergraph Structure in the Ontological Framework

Yasuyuki Hirose, Ryuichi Yamamoto and Shinichiro Ueda

Ontology Based Modeling

Integrating Descriptive, Functional and Cooperative Aspects in a Domain Ontology to Computerize Home

N Bricon-Souf, S Ngom and S Hamek

The ICNP-BaT – A Multilingual Web-Based Tool to Support the Collaborative Translation of the

Ulrich Schrader, Peter Tackenberg, Rudolf Widmer, Lucien Portenier and Peter König

Henrik Eriksson, Magnus Morin, Johan Jenvald, Elin Gursky, Einar Holm and Toomas Timpka

Thomas Beale and Sam Heard

Terminologies

Alejandro Lopez Osornio, Daniel Luna, Maria Laura Gambarte, Adrian Gomez, Guillermo Reynoso and

Fernán González Bernaldo de Quirós

A Feasibility Study on Clinical Templates for the National Health Service in Scotland 770 Derek Hoy, Nicholas R Hardiker, Ian T McNicoll and Phil Westwell

Keeping Up with Changing Source System Terms in a Local Health Information Infrastructure: Running

Daniel J Vreeman

The Role of Local Terminologies in Electronic Health Records The HEGP Experience 780 Christel Daniel-Le Bozec, Olivier Steichen, Thierry Dart and Marie-Christine Jaulent

Representing Biomedical Knowledge: Ontologies

Xia Jing, Stephen Kay, Nicholas Hardiker and Tom Marley

Julie Chabalier, Jean Mosser and Anita Burgun

Robert H Baud, Werner Ceusters, Patrick Ruch, Anne-Marie Rassinoux, Christian Lovis and Antoine Geissbühler SNOMED CT’s Problem List: Ontologists’ and Logicians’ Therapy Suggestions 802 Stefan Schulz, Boontawee Suntisrivaraporn and Franz Baader

Paolo Terenziani, Luca Anselma, Alessio Bottrighi, Laura Giordano and Stefania Montani

Knowledge Zone: A Public Repository of Peer-Reviewed Biomedical Ontologies 812 Kaustubh Supekar, Daniel Rubin, Natasha Noy and Mark Musen

PICO Linguist and BabelMeSH: Development and Partial Evaluation of Evidence-Based Multilanguage

Paul Fontelo, Fang Liu, Sergio Leon, Abrahamane Anne and Michael Ackerman

Lessons Learned from Cross-Validating Alignments Between Large Anatomical Ontologies 822 Songmao Zhang and Olivier Bodenreider

Part 2

Decision Support at the Point of Care: Clinical Guidelines

How Updating Textual Clinical Practice Guidelines Impacts Clinical Decision Support Systems: A Case

Jacques Bouaud, Brigitte Séroussi, Ambre Brizon, Thibault Culty, France Mentré and Vincent Ravery

Improving Compliance to Guidelines Through Workflow Technology: Implementation and Results in a

Silvia Panzarasa, Silvana Quaglini, Giuseppe Micieli, Simona Marcheselli, Mauro Pessina, Corrado Pernice,

Anna Cavallini and Mario Stefanelli

Towards a Decision Support System for Optimising Clinical Pathways of Elderly Patients in an Emergency

Marc Cuggia, Delphine Rossille, Aude Arnault, Jacques Bouget and Pierre Le Beux

Ontology-Based Modeling of Clinical Practice Guidelines: A Clinical Decision Support System for Breast

Samina R Abidi, Syed S.R Abidi, Sajjad Hussain and Mike Shepherd

Subramani Mani, Constantin Aliferis, Shanthi Krishnaswami and Theodore Kotchen

Supporting Therapy Selection in Computerized Clinical Guidelines by Means of Decision Theory 855

Stefania Montani, Paolo Terenziani and Alessio Bottrighi

Development, Deployment and Usability of a Point-of-Care Decision Support System for Chronic Disease

Management Using the Recently-Approved HL7 Decision Support Service Standard 861

David F Lobach, Kensaku Kawamoto, Kevin J Anstrom, Michael L Russell, Peter Woods and Dwight Smith

The TAR Model: Use of Therapeutic State Transitions for Quality Assurance Reporting in Chronic Disease

R Gaikwad, J Warren and T Kenealy

Decision Support in Health Information Systems

Development of Case-Based Medication Alerting and Recommender System: A New Approach to

Kengo Miyo, Yuki S Nittami, Yoichiro Kitagawa and Kazuhiko Ohe

Ben W.I Sissons, W Alex Gray, Tony Bater and Dave Morrey

Comparing Decision Support Methodologies for Identifying Asthma Exacerbations 880

Judith W Dexheimer, Laura E Brown, Jeffrey Leegon and Dominik Aronsky

Decision Support at the Point of Care: Enhancing Patient Safety

Analysis and Redesign of a Knowledge Database for a Drug-Drug Interactions Alert System 885

Daniel Luna, Victoria Otero, Daniela Canosa, Sergio Montenegro, Paula Otero and

Fernan Gonzalez Bernaldo de Quirós

Closing the Loop: Bringing Decision Support Clinical Data at the Clinician Desktop 890

Claudine Bréant, Francois Borst, René Nkoulou, Olivier Irion and Antoine Geissbuhler

Are Clinicians’ Information Needs and Decision Support Affected by Different Models of Care?

Vitali Sintchenko, Tim Usherwood and Enrico Coiera

Frédéric Mille, Patrice Degoulet and Marie-Christine Jaulent

Activity Modeling

A Systems Development Life Cycle Approach to Patient Journey Modeling Projects 905

Joanne M Curry, Carolyn McGregor and Sally Tracy

Gregory L Alexander

System Analysis and Improvement in the Process of Transplant Patient Care 915

Catherine J Staes, R Scott Evans, Scott P Narus, Stanley M Huff and John B Sorensen

St Elsewhere’s or St Everywhere’s: Improving Patient Throughput in the Private Hospital Sector 920

Jennifer A Laffey and Moran Wasson

Clinical Guidelines and Protocols

A Meta Schema for Evidence Information in Clinical Practice Guidelines as a Basis for Decision-Making 925

Katharina Kaiser, Patrick Martini, Silvia Miksch and Alime Öztürk

Creating Interoperable Guidelines: Requirements of Vocabulary Standards in Immunization Decision Support 930

Karen M Hrabak, James R Campbell, Samson W Tu, Robert McClure and Robert (Tony) Weida

Automatic Treatment of Temporal Issues in Clinical Guidelines in the GLARE System 935

Luca Anselma, Paolo Terenziani, Stefania Montani and Alessio Bottrighi

Optimal Order Entry

Information and Communication Processes in the Microbiology Laboratory – Implications for Computerised

Andrew Georgiou, Joanne Callen, Johanna Westbrook, Mirela Prgomet and George Toouli

Using an Accident Model to Design Safe Electronic Medication Management Systems 948

Farah Magrabi, Geoff McDonnell, Johanna I Westbrook and Enrico Coiera

Securing Chemotherapies: Fabrication, Prescription, Administration and Complete Traceability 953

Stéphane Spahni, Christian Lovis, Monique Ackermann, Nicolas Mach, Pascal Bonnabry and Antoine Geissbuhler

Sarah Collins, Leanne Currie, Vimla Patel, Suzanne Bakken and James J Cimino

Supporting the Care of Patients with Cancer

Christian Nøhr, Stig Kjær Andersen, Knut Bernstein, Morten Bruun-Rasmussen and Søren Vingtoft

Text Categorization Models for Identifying Unproven Cancer Treatments on the Web 968

Yin Aphinyanaphongs and Constantin Aliferis

Funda Meric-Bernstam, Muhammad Walji, Smitha Sagaram, Deepak Sagaram and Elmer Bernstam

Children’s Contributions to Designing a Communication Tool for Children with Cancer 977

Cornelia M Ruland, Laura Slaughter, Justin Starren, Torun M Vatne and Elisabeth Y Moe

Extending Care

“It’s Your Game”: An Innovative Multimedia Virtual World to Prevent HIV/STI and Pregnancy in Middle

Ross Shegog, Christine Markham, Melissa Peskin, Monica Dancel, Charlie Coton and Susan Tortolero

HeartCareII: Home Care Support for Patients with Chronic Cardiac Disease 988

Patricia Flatley Brennan, Gail Casper, Susan Kossman and Laura Burke

A Web-Based Communities of Practice Support System for Caregivers 993 Shirley L Fenton, H Dominic Covvey, Douglas W Mulholland, Donald D Cowan, Judith Shamian and

Bonnie Schroeder

Roberto A Rocha, Alfred N Romeo and Chuck Norlin

Improving Quality

Empowering Patients to Improve the Quality of Their Care: Design and Implementation of a Shared Health

Eric G Poon, Jonathan Wald, Jeffrey L Schnipper, Richard Grant, Tejal K Gandhi, Lynn A Volk, Amy Bloom, Deborah H Williams, Kate Gardner, Marianna Epstein, Lisa Nelson, Alex Businger, Qi Li, David W Bates and

Blackford Middleton

Yang Gong, Min Zhu, Jun Li, James P Turley and Jiajie Zhang

u-SHARE: Web-Based Decision Support / Risk Communication Tool for Healthcare Consumers with

N Aoki, M Sakai, T Nakayama, S Fukuhara, S Ohta, N Kikuchi, M Oishi, T Kiuchi, K Nozaki and

N Hashimoto

Health On the Net Foundation: Assessing the Quality of Health Web Pages All Over the World 1017 Célia Boyer, Arnaud Gaudinat, Vincent Baujard and Antoine Geissbühler

Accurate Drug Prescribing

The Use of Electronic Medication Reconciliation to Establish the Predictors of Validity of Computerized

Alexander Turchin, Tejal K Gandhi, Christopher M Coley, Maria Shubina and Carol Broverman

Evaluation of an Electronic Medication Reconciliation System in Inpatient Setting in an Acute Care Hospital 1027 Abha Agrawal, Winfred Wub and Israel Khachewatsky

Computerized Management of Chronic Anticoagulation: Three Years of Experience 1032 Beatriz H Rocha, Laura H Langford and Steven Towner

Physicians’ Response to Guided Geriatric Dosing: Initial Results from a Randomized Trial 1037 Josh F Peterson, Benjamin P Rosenbaum, Lemuel R Waitman, Ralf Habermann, James Powers, Debbie Harrell and Randolph A Miller

Optimising User Interfaces

Graphical Overview and Navigation of Electronic Health Records in a Prototyping Environment Using

Erik Sundvall, Mikael Nyström, Mattias Forss, Rong Chen, Håkan Petersson and Hans Åhlfeldt

Anders Barlach and Jesper Simonsen

User Driven, Evidence Based Experimental Design: A New Method for Interface Design Used to Develop

Niels Boye, Frey Eberholst, Richard Farlie, Lene B Sørensen and Karen Marie Lyng

Kai Zheng, Rema Padman and Michael P Johnson

Multi-Channel Physiological Sensing of Human Emotion: Insights into Emotion-Aware Computing Using

Panagiotis D Bamidis, Andrej Luneski, Ana Vivas, Christos Papadelis, Nicos Maglaveras and Costas Pappas

Holly B Jimison, Misha Pavel, Payton Bissell and James McKanna

Magnus Bang, Toomas Timpka, Henrik Eriksson, Einar Holm and Conny Nordin

User Perception and Acceptance

Methods for Measuring the Impact of Health Information Technologies on Clinicians’ Patterns of Work

Johanna I Westbrook, Amanda Ampt, Margaret Williamson, Ken Nguyen and Leanne Kearney

Enhancing User Acceptance of Mandated Mobile Health Information Systems: The ePOC

Lois Burgess and Jason Sargent

When Usage and User Satisfaction Differ: The Case of an Electronic Discharge Summary 1093 Thomas Bürkle and Philip A Engel

Mapping Clinicians’ Perceptions About Computerized Protocol Use to an IT Implementation Framework 1098 Shobha Phansalkar, Katherine A Sward, Charlene R Weir and Alan H Morris

Usability

Sharon Levy, Anne Casey and Alison Wallis

M Cristina Mazzoleni, Raffaella Butera, Franco Corbella, Vittoria Balcet and Enrico Masenga

Investigating Internet Use by Mental Health Service Users: Interview Study 1112 John Powell and Aileen Clarke

Text Characteristics of Clinical Reports and Their Implications for the Readability of Personal Health

Qing Zeng-Treitler, Hyeoneui Kim, Sergey Goryachev, Alla Keselman, Laura Slaughter and

Catherine Arnott Smith

Advances in User Interface

Generic Screen Representations for Future Proof Systems – Is It Possible? Two-Model Approach to a

Helma van der Linden, Thilo Schuler, Rong Chen and Jan Talmon

Speech Recognition in Dental Software Systems: Features and Functionality 1127 Jeannie Yuhaniak Irwin, Shawn Fernando, Titus Schleyer and Heiko Spallek

Assessing the Impact of Recording Quality Target Data on the GP Consultation Using Multi-Channel Video 1132 Maigaelle V Moulene, Simon de Lusignan, George Freeman, Jeremy van Vlymen, Ian Sheeler,

Andrew Singleton and Pushpa Kumarapeli

Sustainability: Government Policy and Initiatives

Prajesh N Chhanabhai, Alec Holt and George Benwell

Locating Nursing Classification Schemes Within Health Information Strategies for New Zealand 1144 Shona K Wilson and Jan Duke

SHARE, from Vision to Road Map: Technical Steps 1149 Mark Olive, Hanene Rahmouni, Tony Solomonides, Vincent Breton, Yannick Legré, Ignacio Blanquer

and Vicente Hernandez

Penetration and Adoption of Health Information Technology (IT) in Thailand’ s Community Health

Boonchai Kijsanayotin, Supasit Pannarunothai and Stuart Speedie

Sustainability: Disaster Planning and Public Health

The Health Informatics Center of Acadiana – Informing Health Policymaking in Post-Katrina/Rita Louisiana 1159

L Philip Caillouet

Elizabeth E Weiner and Patricia A Trangenstein

Robert A Logan and Tony Tse

Sustainable Health Systems

Naoki Nakashima, Kunihisa Kobayashi, Toyoshi Inoguchi, Daisuke Nishida, Naomi Tanaka,

Hiromi Nakazono, Akihiko Hoshino, Hidehisa Soejima, Ryoichi Takayanagi and Hajime Nawata

Towards Sustainability of Health Information Systems: How Can We Define, Measure and Achieve It? 1179 Sebastian Garde, Carola M Hullin, Rong Chen, Thilo Schuler, Jana Gränz, Petra Knaup and Evelyn J.S Hovenga Bermuda Triangle or Three to Tango: Generation Y, e-Health and Knowledge Management 1184 Kwang Chien Yee

Health Service Organisations and Professionals: An Information Systems Model for Transforming the Nexus

Jo-Anne Kelder

Quynh Lê

Sustainable Systems: Design Success

Sheila Bullas and John Bryant

Finn Kensing, Hrönn Sigurdardottir and Arjen Stoop

Karen Day and Tony Norris

A Sustainability View on the EPR System of N.N Burdenko Neurosurgical Institute 1214 Michael A Shifrin, Elena E Kalinina and Eugene D Kalinin

Representing Biomedical Knowledge: Ontologies and Genomic Data Repositories

Predicting Coronary Artery Disease with Medical Profile and Gene Polymorphisms Data 1219 Qiongyu Chen, Guoliang Li, Tze-Yun Leong and Chew-Kiat Heng

Holger Stenzhorn, Elena Beißwanger and Stefan Schulz

Marienne Hibbert, Peter Gibbs, Terence O’Brien, Peter Colman, Robert Merriel, Naomi Rafael and

Michael Georgeff

Cancer Genomics Object Model: An Object Model for Multiple Functional Genomics Data for Cancer

Yu Rang Park, Hye Won Lee, Sung Bum Cho and Ju Han Kim

Algorithms for Genomic and Genetic Data Analysis

Automatic Pedigree Reconstruction for Genetic Studies in Isolated Populations 1240

C Larizza, I Buetti, G Milani, A Nuzzo, C Sala, D Toniolo and R Bellazzi

Enhancing the Quality of Phylogenetic Analysis Using Fuzzy Hidden Markov Model Alignments 1245

Chrysa Collyda, Sotiris Diplaris, Pericles Mitkas, Nicos Maglaveras and Costas Pappas

Determining Transcription Factor Activity from Microarray Data Using Bayesian Markov Chain Monte

Andrew V Kossenkov, Aidan J Peterson and Michael F Ochs

Ensemble Stump Classifiers and Gene Expression Signatures in Lung Cancer 1255

Lewis Frey, Mary Edgerton, Douglas Fisher and Shawn Levy

Algorithms and Research Frameworks for Genomics

From “Glycosyltransferase” to “Congenital Muscular Dystrophy”: Integrating Knowledge from NCBI

Satya S Sahoo, Kelly Zeng, Olivier Bodenreider and Amit Sheth

Building a Research Model for Human Genetic Variation Knowledge Management 1265

Yulong Gu and James Warren

ECTracker – An Efficient Algorithm for Haplotype Analysis and Classification 1270

Li Lin, Limsoon Wong, Tze-Yun Leong and Pohsan Lai

A Dynamic Query System for Supporting Phenotype Mining in Genetic Studies 1275

Angelo Nuzzo, Daniele Segagni, Giuseppe Milani, Carla Rognoni and Riccardo Bellazzi

Biomedical Signal Interpretation

Identifying QT Prolongation from ECG Impressions Using Natural Language Processing and Negation

Joshua C Denny and Josh F Peterson

A Comparison of Supervised Classification Methods for Auditory Brainstem Response Determination 1289

Paul McCullagh, Haiying Wang, Huiru Zheng, Gaye Lightbody and Gerry McAllister

Ioanna Chouvarda, Christos Papadelis, Chrysoula Kourtidou-Papadeli, Panagiotis D Bamidis,

Dimitris Koufogiannis, Evaggelos Bekiaris and Nikos Maglaveras

Identification and Genotype Related Classification of Children with Long QT-Syndrome Using 24h

Matthias Bauch, Annamaria Siegler, Markus Khalil, Jörg Zehelein, Herbert E Ulmer and Hartmut Dickhaus

Information Visualisation and Imaging Informatics

Temporal Abstraction and Data Mining with Visualization of Laboratory Data 1304

Katsuhiko Takabayashi, Tu Bao Ho, Hideto Yokoi, Trong Dung Nguyen, Saori Kawasaki, Si Quang Le,

Takahiro Suzuki and Osamu Yokosuka

Automated Interpretation of Optic Nerve Images: A Data Mining Framework for Glaucoma Diagnostic

Syed S.R Abidi, Paul H Artes, Sanjan Yun and Jin Yu

Intelligent Querying and Exploration of Multiple Time-Oriented Medical Records 1314

Denis Klimov and Yuval Shahar

Analyzing Web Log Files of the Health On the Net HONmedia Search Engine to Define Typical Image

Henning Müller, Célia Boyer, Arnaud Gaudinat, William Hersh and Antoine Geissbuhler

Biomedical Image Processing

Improving Computer Aided Disease Detection Using Knowledge of Disease Appearance 1324

Tatjana Zrimec and James S Wong

MR Atlas for Articular Cartilage Morphology: Potential to Detect Shape Differences 1329

Hussain Z Tameem and Usha S Sinha

Automatic Image Modality Based Classification and Annotation to Improve Medical Image Retrieval 1334

Jayashree Kalpathy-Cramer and William Hersh

Hartmut Dickhaus, Markus Erbacher and Helmut Kücherer

Health Informatics Education and Training

Enabling the Safe and Effective Implementation of Health Informatics Systems – Validating and Rolling

Michael J Rigby, Carol Hulm, Don Detmer and Luca Buccoliero

A Multi-Method Approach to Assessing Health Information Systems End Users’ Training Needs 1352

Yiyu Qiu, Ping Yu and Peter Hyland

Making Health Informatics Competencies Useful: An Applied Health Informatics Competency

H.D Covvey, S Fenton, D Mulholland and K Young

eLearning and Distance Education

E-learning for Students in Their First Year: A French Experimentation at the Medical School of Grenoble 1362

Jean-Marie Renard, Daniel Pagonis, Jean-Philippe Vuillez, Jean-Paul Romanet and Bernard Sele

E-learning at Porto Faculty of Medicine A Case Study for the Subject ‘Introduction to Medicine’ 1366

Cristina Costa-Santos, Ana Coutinho, Ricardo Cruz-Correia, Ana Ferreira and Altamiro Costa-Pereira

Designing m-Learning for Junior Registrars – Activation of a Theoretical Model of Clinical Knowledge 1372

Anne Marie Kanstrup, Niels Boye and Christian Nøhr

Evaluation and Assessment of the Online Postgraduate Critical Care Nursing Course 1377

Reena Patel

Professional Education – Nursing Informatics

Development and Evaluation of a PDA-Based Decision Support System for Pediatric Depression Screening 1382

Ritamarie John, Penélope Buschman, Mosely Chaszar, Judy Honig, Eneida Mendonca and Suzanne Bakken

Data Mining Results from an Electronic Clinical Log for Nurse Practitioner Students 1387

Patricia Trangenstein, Elizabeth Weiner, Jeffry Gordon and Ryan McNew

Phase I Implementation of an Academic Medical Record for Integrating Information Management

Carole A Gassert and Katherine A Sward

William T.F Goossen, Anneke T.M Goossen-Baremans, Laura Hofte and Bert de Krey

Professional Education – Research

Multiple Measures of Provider Participation in Internet Delivered Interventions 1401

Thomas K Houston, Ellen Funkhouser, Jeroan J Allison, Deborah A Levine, O Dale Williams and

Catarina I Kiefe

Medical Students’ Knowledge and Perceptions of e-Health: Results of a Study in Sri Lanka 1406

Sisira Edirippulige, Rohana B Marasinghe, Anthony C Smith, Yoshikazu Fujisawa, Walisundara B Herath,

M.T.M Jiffry and Richard Wootton

Importance of Public Health Informatics: A Survey of Public Health Schools and Graduate Programs

Janise Richards

Educating Medical Students as Competent Users of Health Information Technologies: The MSOP Data 1414

Julie J McGowan, Morgan Passiment and Helene M Hoffman

Professional Education – Case Reports and Methods Studies

Establishing a National Resource: A Health Informatics Collection To Maintain the Legacy of Health

Beverley Ellis, Jean Roberts and Helen Cooper

The EIPEN Project: Promoting Interprofessional Education in Health Professions 1424

Joseph Liaskos, Antonis Frigas, Kostantinos Antypas, Dimitrios Zikos, Marianna Diomidous and John Mantas

Building ICT Capabilities for Clinical Work in a Sustainable Healthcare System: Approaches to Bridging

Kathleen Gray and Jenny Sim

The Development of an Online Clinical Log for Advanced Practice Nursing Students: A Case Study 1432

Jeffry S Gordon, Ryan McNew and Patricia Trangenstein

Computer-Assisted Medical Education

John Chuo, Pavel Sherman, Claire Drain and Casimir Kulikowski

Conceptual Model of Health Information Ethics as a Basis for Computer-Based Instructions for Electronic

Mihoko Okada, Kazuko Yamamoto and Kayo Watanabe

PDA-Based Informatics Strategies for Tobacco Use Screening and Smoking Cessation Management:

Needs Assessment for the Computer-Interpretable Hypertension Guideline at Public Health Centers in Korea 1455

EunJung Lee, SoYoung Kim, InSook Cho, JiHyun Kim, JaeHo Lee and Yoon Kim

Education

Akihiro Takeuchi, Katsura Kobayashi, Noritaka Mamorita and Noriaki Ikeda

Emerging Technologies

Implementing and Evaluating a Laboratory Information System to Optimize the Treatment of Tuberculosis

Joaquin A Blaya, Sonya S Shin, Martin J.A Yagui, Luis Asencios, Javier Vargas, Carmen Suares, Gloria Yale

and Hamish S.F Fraser

Health Information Systems

Risk Analysis – A Tool for IT Development and Patient Safety A Comparative Study of Weaknesses Before

and After Implementation of a Health Care System in the County Council of Ostergotland, Sweden 1458 Annica Öhrn and Gunilla Eriksson

Stephan Spat, Bruno Cadonna, Ivo Rakovac, Christian Gütl, Hubert Leitner, Günther Stark and Peter Beck

What Health Influences Are Caused by EMR Working? – In Case of Japanese Nursing Situation 1462 Yukie Majima and Yasuko Maekawa

Using PDA to Transform the Long MDS-HC Evaluation Form into a Favored System 1463 Chiao-Ling Hsu, Yu-Yin Kuo and Polun Chang

A Sustainable, Multi-Organizational Model for Decision Support During Public Health Emergencies 1465 Julie J McGowan, Margaret W Richwine and J Marc Overhage

Seung-Jin Jang, Jip-Min Jung, Sung-Oh Hwang and Young-Ro Yoon

J Massaut, P Reper, L Hooghe and P Gottignies

Ana M Ferreira, Ricardo Cruz-Correia and Altamiro Costa-Pereira

Application of Wireless and Mobile Computing Technologies to Improve the Efficiency of Patient Care

and Education: The Role of Medical Engineering and Information Technology 1471 Lin Guo

Knowledge Management

Comparing Messages in an Online Communication Forum for Cancer Patients with Patients’ Messages

Annette Jeneson, Trine Andersen and Cornelia Ruland

Ján Stanek and Michelle Joy Davy

Efficiency and Safety of New Radiofrequency Identification System in Japanese Hospital 1478 Yuichiro Saito, Takashi Hasegawa and Tetsuo Sakamaki

Development of Hypertension Management Ontology for Guideline-Based Clinical Decision Support System 1479 JiHyun Kim, InSook Cho, EunJung Lee, JaeHo Lee and Yoon Kim

Secure Remote Access for Web Based Clinical Information System Using Policy Control of PCs and

Katsuya Tanaka, Mayumi Yoshida and Ryuichi Yamamoto

Lily Gutnik, Sarah Collins, Leanne M Currie, James J Cimino and Vimla L Patel

Organisations

The Application of a Clinical Data Warehouse to the Assessment of Drug-Warfarin Interactions 1482 Qiyan Zhang, Yasushi Matusmura and Hiroshi Takeda

Standards

Allen Huang, Jacques Lemieux, Jean-Claude Bouchard, Michel Bourque and Robyn Tamblyn

OpenECG: Promoting Interoperability Through the Consistent Implementation of the SCP-ECG Standard

Catherine Chronaki, Franco Chiarugi and Ronald Fischer

Playing an active role in the 12th World Congress on Medical Informatics has been an honour and a privilege for the Editorial Committee We closely cooperated with our colleagues and friends of the Scientific Program Committee (SPC) and the Organizing Committee (OC)

Out of 638 submissions, 292 high quality papers were selected for publication in these proceedings by the SPC Out of 218 poster submissions, 21 posters were nominated for a best poster award; they are included as 1 page contributions in these proceedings While high quality contributions have been selected by the SPC, the Editorial Committee has focussed on providing proceedings with a high quality of format and presentation which made additional editing necessary The proceedings are also appearing on CD-ROM All accepted poster contributions are published on an additional CD-ROM The MEDINFO 2007 Proceedings present an excellent overview of a dynamic and quickly growing field, demonstrating methodical and practical progress from around the world Information science and, specifically, (Bio-) Medical Informatics have become core pillars of foundational and clinical research, of medical care, and of prevention MEDINFO 2007 in Brisbane will be the leading conference of the year, bringing a worldwide community together

We have organized the proceedings into twelve chapters, covering topics such as eHealth, Decision Support, Improving Quality, Usability, Sustainability, Genomics, Biomedical Image and Signal Processing, and Education and Training Within each chapter, the articles are organized according to the conference sessions; the session titles are shown in the table of contents

The assistance of HISA has been invaluable in all editorial steps, including communication with authors, language editing, and formatting of manuscripts We owe specific thanks to Joan Edgecumbe, Dale Proposch and Tom Morgan

The Editorial Committee

Klaus A Kuhn, Germany

James R Warren, New Zealand

Tze Yun Leong, Singapore

While the Medinfo 2007 Editorial Committee has made every effort to ensure that all accepted contributions are published in these two volumes of the MEDINFO 2007 Proceedings, it reserves the right to:

o Edit/alter one or more parts of an original contribution, including its title, author and affiliation listings, as it sees fit in order to comply with publications requirements

o Withhold the publication of a contribution due to one or more of the following circumstances:

• failure to meet the final deadline for submission of all original/revised contributions;

• failure to revise the original contribution in accordance with the instructions of the Scientific Programme Committee, including the advice of the Editorial Committee

The Editorial Committee is not responsible for the alteration and/or omission of part or parts of an original contribution in cases where a contribution has not fully complied with the submission guidelines and has to be partially or fully re-written and/or reformatted for the final publication 

Preface from the Scientific Program Co-Chairs

The theme of Medinfo2007 is “Building Sustainable Health Systems” Particular foci are health challenges for the developing and developed world, the social and political context of health care, the knowledge that is needed for safe and effective health care, and the difficult task of building and maintaining complex health information systems Sustainable health information systems are those that can meet today’s needs without compromising the needs of future generations It is a challenge and an opportunity to develop and implement systems that can be improved – not replaced To achieve this and to build a global knowledge society, we need to seek increased scientific and technological co- operation, and we need to facilitate access to and use of high-quality knowledge and information

We are pleased to report that more than 900 submissions were made to Medinfo2007 This includes full papers, panels, posters, and workshops Submissions were made from every region of the world and from many countries, including, among others, Argentina, Australia, Belgium, Brazil, Canada, China, Finland, France, Germany, Great Britain, India, Israel, Italy, Japan, New Zealand, Portugal, Russia, Singapore, Switzerland, and the United States, making this a truly international conference The majority of submissions (638) were made in the full paper category Papers were refereed by members of the biomedical informatics community and final decisions were made by the SPC members at a three day meeting in Chamonix, France in late January 2007 Of the 638 papers submitted, 292 were accepted for presentation and publication (a 46% acceptance rate) 260 were not accepted for publication, but their authors were offered the possibility of presenting their work in the Medinfo2007 poster session, and they were also given the opportunity to create a set of slides that is planned to be part of a continuous slide show throughout the meeting 86 paper submissions were rejected (13%)

The contributions to Medinfo2007 reflect the breadth and depth of the field of biomedical and health informatics Papers cover topics in health information systems, knowledge and data management, education, standards, consumer health and human factors, emerging technologies, sustainability, organizational and economic issues, genomics, and image and signal processing

To recognize the truly outstanding contributions to the conference, there will be “Best Paper” and

“Best Poster” awards at the meeting A student paper competition will also be held All decisions will

be made by an international jury at the meeting itself, and the winners will be announced during the closing session of the Congress

On behalf of the members of the Medinfo2007 program committee (listed below), we wish to thank all those who contributed to Medinfo2007 by sending in their paper, poster, panel, and workshop contributions We give special thanks to all those who carefully reviewed the many excellent submissions We expect that the papers included in this volume will be of great interest to anyone engaged in biomedical and health informatics research and application

Alexa T McCray, PhD Heimar Marin, RN, PhD

Harvard Medical School Federal University of São Paulo

Boston, Massachusetts, USA São Paulo, Brazil

Medinfo 2007 Scientific Program Committee SPC Chairs

Alexa McCray (Co-Chair, US)

Heimar Marin (Co-Chair, Brazil)

SPC Members

Europe

Elske Ammenwerth (Austria)

Ricardo Bellazi (Italy)

Jan van Bemmel (Netherlands)

Patrice Degoulet (France)

Nicos Maglaveras (Greece)

George Mihalas (Romania)

Americas

Dominik Aronsky (US)

Marion Ball (US)

Alex Jadad (Canada)

Alvaro Margolis (Uruguay)

Charles Safran (US)

Asia-Pacific

John Bennett (Tutorial chair, Australia)

HM Goh (Malaysia)

Kazuhiko Ohe (Japan)

Hyeoun-Ae Park (Korea)

Africa

Ben Bondo Monga (Congo)

Middle East

Yuval Shahar (Israel)

Ahmed Al Barrak (Saudi Arabia)

In memory of

Dr Branko Cesnik Australia

It is with sadness that as we complete this foreword we acknowledge the passing of Branko Cesnik Melbourne on Sunday, 10, June, 2007 after a courageous battle with cancer

Branko was one of the founders of the Health Informatics Society of Australia, the Asia Pacific Association of Medical Informatics and the Australian College of Health Informatics

Branko was also a member of the Board of the International Medical Informatics Association (IMIA)

as the Vice-President of Membership from 1999 to 2003 He was the lead editor of the Medinfo '98: 9thWorld Congress Medical Informatics Proceedings (Korea) In addition he served IMIA through a variety of other responsibilities, such as being a member of a Medinfo Scientific Program Committee Those who knew him as a colleague will remember his knowledge, level-headedness, spirit of cooperation and sharing, and above all getting things done—no matter what was required or the amount of time required Those who knew him as a friend will remember his panache, his spirit and his zest for living life on the edge and to the fullest That zest and spirit accompanied him throughout all of the latter days of his struggle

His great leadership and vision were instrumental in laying the foundation for health informatics developments “Down Under” that has this year occasioned MEDINFO 2007 to come to Australia

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Chapter 1 eHealth

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MEDINFO 2007

K Kuhn et al (Eds)

IOS Press, 2007

© 2007 The authors All rights reserved.

Linkcare – Enabling Continuity of Care for the Chronically Ill across

Levels and Profession

aSINTEF ICT, Norway

bMedical Informatics and Telemedicine group, Dept for Computer Science, University of Tromsø, Tromsø, Norway

Abstract

Chronic diseases are increasing rapidly and this

phenome-non is becoming a major burden to the health delivery

system around the world A new health care paradigm with

focus on chronic treatment and care will actualize the need

for interoperable standards based services due to the

com-plexity of care where different health levels and

professions are involved Given the complexity of the

domain, we argue the need for a systematic and formal

approach to the development of interoperable information

systems if there shall be any real support of the

cooperat-ing actors We describe our work on technical

interoperability done in the Linkcare project addressing

new models of care and technology to support them in the

domain of the chronically ill using concrete results from an

architecture built using the MAFIIA architecture

frame-work and the UML 2.0 profile for software services, and

argue that building formal architectural descriptions on

the basis of shared interface descriptions and profiles are

an important part of achieving continuity of care based on

sustainable health systems

Keywords:

medical informatics, information systems, systems

integration, continuity of patient care

Introduction

The number of patients suffering from chronic diseases

has increased rapidly over the recent decades The disease

burden is changing from acute to chronic care, 35.000.000

people died from chronic diseases in 2005, and 60% of all

deaths are due to chronic diseases [1]

The new conditions require that we rethink traditional

models of care One prominent aspect of new care models

used for chronic conditions is the cooperation of several

different stakeholders in the care process [2] Stakeholders

include the patient himself, his relatives, and

caregiv-ers

Additionally, patients are no longer passive consumers of

health services, but are instead demanding more control

over their own treatment, together with increased

respon-siveness and improved quality of care services provided by

the involved healthcare institutions Today, healthcare

sys-tems are expected to maintain the continuity of care,shared care, and the empowerment of patients in the man-agement process [3]

The new models of care, including increasingly ing stakeholders and empowered users, would benefitfrom interoperable technology to support continuity ofcare, e.g., shared access to electronic patient records(EPRs) The situation today is that most stakeholders in thecare model have their own proprietary systems, with no orlimited possibilities for exchanging information with theoutside world in a standardized fashion Development ofinteroperable healthcare services would make for moreefficient work processes and constitute considerable sav-ings Walker et.al [4] argue that the value of health careinformation exchange and interoperability (HIEI) in theUnited States alone can yield a net value of $77.8 billionper year once fully implemented

cooperat-There are obstacles to interoperability though Iakovidislists reasons such as organizational and cultural matters,technological gap between healthcare professionals andinformation science experts, and legal requirements as towhy integrating services in healthcare is a challenge [5].This article presents Linkcare1, a European Union project,addressing new models of care for the chronically ill andthe technology to support them Three standalone systems

in three different countries (Norway, Cyprus and Spain)supporting different aspects of care of the chronically illprovided the outset for the Linkcare project This is a rele-vant scenario as cooperation between differentstakeholders using different systems is what characterizescare for the chronically ill

There is a need for a new way of designing information services in healthcare to ensure an interoperability level that supports coordinated management of care.

In this paper we describe our approach to achieve erability between the above mentioned systems We define

interop-interoperability as [9]: “A system’s ability to exchange

information with other systems and to mutually use the exchanged information” This ability is fundamental in

order to allow stakeholders in the continuity of care ess to provide high quality care to the chronically ill We

proc-1 Linkcare project (eTen, Grant Agreement Number C517435)

M Mikalsen et al / Linkcare – Enabling Continuity of Care for the Chronically Ill across Levels and Profession

will show how we applied the MAFIIA architecture

frame-work [9] together with the UML 2.0 profile for software

services [13] to build an architecture enabling sustainable

interoperability between systems in this domain

This article is organized as follows First, in the Methods

section, we describe the methods used to build the

archi-tecture, namely the MAFIIA architecture framework, the

UML 2.0 profile for software services and the Linkcare

process Second, the Results section presents the results

from applying the methodology as a set of MAFIIA

view-points In the Discussion section we present the

experiences gathered in our work, before making our

con-cluding remarks

Methods

This section details the background information relevant to

the research presented in this paper We cover the MAFIIA

architecture framework, and the IBM UML 2.0 Profile for

Software Services, and explain how these were applied by

describing the Linkcare process

MAFIIA

The service architecture that is presented in this document

is created using MAFIIA/H (Modelbased Architecture

description Framework for Information Integration

Abstraction/Healthcare) [9] MAFIIA is an architectural

description framework for software intensive systems with

special a focus on Information Integration Systems (IIS)

An architectural description created using MAFIIA

con-sists of a set of views Viewpoints are used to create a

view The view consists of one or more models that

describe and present different aspects related to structure

and behaviour for a target system Five different

view-points are defined in MAFIIA They are; i) The Context

Viewpoint which describes all aspects of the Target

Sys-tem’s environment, which is of importance to be able to

document all the interfaces between the Target System and

its environment, and what the Target System is intended to

do in its environment ii) The Requirements Viewpoint,

which document all specific requirements related to the

Target System iii) The Component Viewpoint which

iden-tifies and documents specific physical or logical

components iv) The Distribution Viewpoint which

describe the logical distribution of software and hardware

components The distribution view shows if some

compo-nents cannot be separated and if any must be separated v)

The Realisation Viewpoint which describes any

con-straints on how the target system’s components should be

implemented and deployed into its environment

In addition to the viewpoints, a MAFIIA description

includes description of concerns, system assets and

refer-ence architectures Concerns are related to the

documenta-tion of the funcdocumenta-tional aspects of the target system and its

environment A concern is visible and treated in relation to

any view Concerns are related to functionality System

assets are sources of information that can be used when

developing the architecture descriptions The reference

architecture is a high-level, generic architecture which isused as the basis for development of concrete systemarchitectures, and to compare architectures of existing sys-tems to each other

UML 2.0 Profile for software services

The UML2.0 Profile for Software services is a profile forUML 2.0 which allows for the modeling of services andservice oriented architecture solutions A UML profileextends the expressiveness of UML with domain specificknowledge, in this case software service specification Theuse of a service oriented architecture approach in Linkcarefollowed from the fact that the original system platformsalready were build for the web and web services

We present a subset of the profile, intended to explain theresults and discussion sections The complete profile isexplained by Johnston [13], and the following are relevant

excerpts A Service Partition represents some logical or

physical boundary of the system Service partitions areused to represent the web, business, and date tiers of a tra-ditional n-tier application Any owned parts of a partition

shall be a Service Provider A Service Provider is a

soft-ware element that provides one or more services A serviceprovider has a property that captures information about itslocation, but the meaning of this is implementation inde-

pendent A Service Gateway is only available for use on

partitions and not directly on service providers Gateways

are used on partitions to expose services A Service is the

model element that provides the end-point for service

interaction (in web-service terminology) A Service sumer is any component (includes services) that consumes services A Service Channel represents the communica-

Con-tion path between two services InteracCon-tion may occur over

a channel, but the channel does not represent any particularinteraction In web services, each service denotes the bind-ings associated with it, and in the modeling profile, youdenote binding either on the communication between ser-vices or between a service and a consumer

The Linkcare process

The guiding principles of the Linkcare architectural cess was the following First, it was essential to preservethe heritage application, that is the original systems thatthe Linkcare services were built on, and minimal changeshould be introduced upon these systems Second, based

pro-on a market survey performed in the project, the servicescreated should meet concrete needs in the market Third, itshould be easy to compose new services compliant to thearchitecture

We applied the MAFIIA workflow, starting with definition

of system concerns and assets, before specifying the fivearchitectural views First, we used the Linkcare heritagesystems as the foundation for capturing the core businessprocesses (functionality) that must be described in thearchitecture and identified all relevant stakeholders in rela-tion to the Linkcare services (described in the contextviewpoint) Second, from the use cases, architecturalrequirements were defined (requirements model) Third, inthe component viewpoint, the resulting system informa-

M Mikalsen et al / Linkcare – Enabling Continuity of Care for the Chronically Ill across Levels and Profession

tion model was described, together with models that show

how the Linkcare services are composed, the collaboration

of services, and the interfaces of the services Fourth, in

the distribution viewpoint the logical distribution of

Link-care components were modelled, and in the realisation

viewpoint we investigated the platforms on which the

Linkcare systems were running to identity constraints

influencing the realisation of the architecture (such as

technical platforms and development processes)

To enable information sharing and version management in

the process a CSCW tool named eRoom was used The

modelling was done using Rational Software Architect,

and the complete architecture was written in Microsoft

Word Three project meetings, and one two day workshop

were used to cooperate and decide on the architecture

Results – viewpoints of the architecture

In the following we introduce core results from the

MAFIIA viewpoints modeled using the UML 2.0 profile

for software services

Concerns

One of the main concerns was identified to be

interopera-bility as defined by MAFIIA Another important concern

was security, but it is outside the scope of this paper to

address this

System assets

Relevant standards, a project dictionary, and software

pro-files and patterns were identified as important assets We

applied Chari et al’s [8] framework for weighing the scope

and usability of a set of selected standards, and found that

CEN ENV 13940 (Health Informatics System of Concepts

to support continuity of Care) was the most appropriate

standard The dictionary, an agreed upon reference list of

concepts, was created based upon scenario descriptions

and story boards from the three heritage systems, and, as

far as possible, mapped to the terminology of the chosen

standard The profile chosen was the UML 2.0 profile for

software services, and web service patterns such as the

publish-subscriber, asynchronous query, command façade,

and message bus pattern were used to guide the design

Reference architecture

The MAFIIA reference architecture divides the target

sys-tem (in our case, the Linkcare services) into a set of logical

tiers, and defines how the system interfaces with the

envi-ronment A tier is a logical partitioning of a system where

each tier has a unique responsibility Each tier is loosely

coupled to the tiers directly above and below All

compo-nents in the Linkcare architecture were linked to the

reference architecture in the component viewpoint

Context viewpoint

The context viewpoint consists of the business aspects

model, the environment systems model, and the business

to system mapping model

The business aspect models documents any business

related concern that increases the understanding of what

problems the target system solves, or what functionality itimplements (e.g stakeholders) Incorporating the results

of the Linkcare process (market analysis and studying theLinkcare systems), we identified 17 core stakeholdersmodeled in a UML use case model/actor hierarchy accom-panied by text outlining each stakeholder

The Environment Systems model documents other cal systems (environment systems) that are involved in theimplementation of the business models, or influences theoperation of the target system We identified seven ser-vices that constituted the Linkcare services (the targetsystem) These services are modeled as a Service Partitionand made available for other services (Service Consumers)through Service Gateways This was done in order use thegateway construct to control the access to services as thepartition in Norway differs from the Spanish partition asdifferent services are provided

techni-Figure 1 - The Linkcare service partition

Applying the service profile in this way implies that allLinkcare services can be accessed through well-definedinterfaces (the gateways) We designed a Linkcare ServiceRegistry that controls the location and availability of theLinkcare services (using the concept of location in the Ser-vice provider) This structure enables new Linkcareservices to be added, existing services to be modified andrelocated without notifying its clients and communication(Service Channels) between Linkcare service partitionscan be managed through the gateways

We used UML component diagrams to stereotype ment systems either as Service Providers or ServiceConsumers according to the software services profile.UML Sequence diagrams were used to detail the interac-tion between the Linkcare services and the environmentsystems

environ-Requirements viewpoint

Having a clear understanding of what were to be solvedfollowing the context viewpoint, we gathered require-ments for the target system We organized the requirementsinto generic requirements for all the services, requirementsfor each service, and generic interoperability requirements

class LinkCare Serv ice Partition

«ServiceProvider» LinkCare Professional Mobile Access Service

«ServiceProvider» LinkCare Educational Information Access Service

Publish Service

Depends on consists of

0 1

1 0 1

M Mikalsen et al / Linkcare – Enabling Continuity of Care for the Chronically Ill across Levels and Profession

Component viewpoint

The component viewpoint consists of the system

informa-tion model, the system decomposiinforma-tion model, the system

collaboration model and the component and interface

specification model

The system information model describes the most

impor-tant information elements in the Linkcare system As in the

dictionary, the elements in this model were mapped to the

CEN standard as far as possible The model was built

using a UML class diagram and the elements were

addi-tionally explained using text

The system decomposition model describes how the target

system is divided into different subsystems and

compo-nents The Linkcare services were modeled as being part

of a Service Partition consisting of one to many Service

Providers (the services) The Service Partition publishes

services to the Linkcare Service Registry Interaction with

the service registry was detailed in a UML sequence

dia-gram A UML component diagram was used to stereotype

the components to the MAFIIA reference architecture

Figure 2 - Mapping to MAFIIA Reference architecture

A UML composite structure diagram were used to model

the Service Gateways on a partition, and a UML

collabora-tion diagram were used to model the Service Channels on

the gateways

In the system collaboration model we defined the main

interactions between the components in the architecture

using a component diagram showing use relations This

was elaborated with text explaining the collaborations, and

detailed using UML communication diagrams showing the

intra-service communication

In the component and interface specification model each

interface has a specification that shows which methods are

available and the input/output parameters of these

meth-ods

Distribution viewpoint

In the distribution viewpoint we modeled the logical

distri-bution of services focusing on what functionality could be

distributed together and what should be kept separate (e.g

for business or security reasons) We used a UML

deploy-ment diagram and identified four nodes (a node is

something that can host software)

The original Linkcare system instances are kept on rate application servers This is because these are separatesystems, maintained by separate organizations in separatecountries The services will cooperate through the Link-care services, which will help to keep the core businessfunctionality separated, and avoiding building monolithicsystems

sepa-Some services, such as the Linkcare patient mobile accessservice and the Linkcare patient mobile access service areservices that typically require rich clients and introducespecial requirements on services Examples of which areextended session logic to handle session interruptions (e.g.when transferring measurement data) and extended secu-rity mechanisms

The Linkcare EHR service is also kept separated This isbecause sensitive data typically is transferred using thisservice, and extra security mechanisms (such as firewalls,log on mechanisms etc) is needed

The Linkcare service registry service will receive a higheramount of service requests (service lookup) than other ser-vices In order for this not to influence other services, thisservice is also kept separate

tech-on the different platforms We were focusing tech-on, servicedescription, service implementation, service publishing,discovery and binding, and service invocation and execu-tion

Discussion

The reason we chose to use MAFIIA in this domain isbecause it is a proven and documented framework for cre-ating information integration architecture descriptions Anoverview of other projects in which MAFIIA is used isprovided by Walderhaug et al [9] In Linkcare we useMAFIIA to ensure that the architectural description cre-ated for Linkcare is inline with requirements toarchitectural descriptions for interoperable systems, andcontains the necessary viewpoints Using the viewpointsand the guidelines that MAFIIA provides, allows us to

“think right” when designing the system and ensures thatall relevant information, such as important stakeholder,what standards are applied, decomposition of the systemand the systems environment and how the system relates tothe environment, is sufficiently documented We believethat the lack of such documentation can considerably ham-per the development of interoperable and sustainablesystems for continuity of care

In addition to enforce the presence of essential tion, the use of architecture frameworks also ensure thatthe architecture is described on a sufficient level ofabstraction, making it more resilient to change in the

documenta-M Mikalsen et al / Linkcare – Enabling Continuity of Care for the Chronically Ill across Levels and Profession

domain it is addressing It is important to note that abstract

does not imply informal On the contrary, MAFIIA

sug-gests using UML as the formalism when describing

models We are inline with Fowler 10], in that there are

three ways of using UML; as sketch, as blueprint and as

programming languages We have used UML as blueprints

to describe interfaces, and let the implementation of

com-ponents be hidden in the architecture This is inline with

other current standardisation initiatives see e.g the

Health-care Service Specification Project [11], a joint effort

between the OMG and HL7

We have used design patterns and the UML 2.0 profile for

software services when modelling the architecture

Pat-terns describe a well proven solution to a recurring design

problem By applying agreed upon patterns (such as the

publish-subscriber pattern) we are one step closer to

hav-ing interoperable systems A UML profile can be used to

further specialize the architecture design The UML profile

defines stereotypes, tagged values and constraints that can

be assigned to modelling elements in the design process

[13] We have designed our architecture using the UML

2.0 profile for software services, modelling our services as

service partitions with stereotypes like service gateways,

communication over service channels, and the notion of

service providers and consumers We experienced several

benefits of using this approach First, since the MAFIIA

framework was already assuming the use of UML,

apply-ing a UML profile in the framework was straightforward

Second, the profile incorporated software service design

terms, allowing us to unambiguously represent the system

artefacts in a formal language Third, the UML Profile

assists in communicating concepts in the project A

Ser-vice Provider for instance, is a well defined concept and

elements stereotyping this concept are bound by the

con-straints as defined in the profile We used the profile in the

tool it was created for, which is Rational Software

archi-tect, so a potential drawback of the profile is that it is not

automatically applicable in other tools

Conclusion and future work

In this paper we have argued for a systematic and formal

approach to the development of interoperable information

systems using architecture frameworks such as MAFIIA

that en-able formal software interface descriptions We

have shown how we applied a UML profile providing us

support in design-ing our architecture inline with best

practice Healthcare enter-prises could impose vendors to

apply the same design patterns in their system design, thus

preparing the ground for interoper-able healthcare

enter-prises Consequently, we are currently continuing ourwork on profiles by creating domains specific healthcareprofiles that incorporate information from standards (such

as CEN) in support of developing interoperable care systems (see e.g., [12])

health-References

[1] Beaglehole R (ed.) Preventing chronic diseases:

a vital investment: WHO global report World Health Organisation, ISBN: 92 4 156300 1 2005

[2] Winnem OM, Walderhaug S Distributed, role based, guideline based decision support, Proceedings of E-he@lth

in Common Europe, Springer pp 101-109, ISBN 915141-2-9 2002.

83-[3] Tattersall R The expert patient: a new approach to chronic disease management for the twenty-first century Clin Med 2002; 2(3): 227-229

[4] Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B The value of health care information exchange and interoperability Health Affairs Web Exclusive 2005 (Jan.19): W5-10 W5-18.

[5] Iakovidis I Towards a Health Telematics Infrastructure in the European Union, In Information technology strategies from US and the European union: transferring research to practice for healthcare improvement, Amsterdam, IOS Press, 2000.

[6] Patient Mobility in the European Union - Learning from experience: World Health Organization 2006, 2006 [7] MDA Guide Version 1.0.1 http://www.omg.org/cgi-bin/ doc?omg/03-06-01

[8] Chari K, Seshadri S Demystifying Integration

Communications of the ACM, vol 47, pp 58-63, 2004 [9] Walderhaug S, Stav, E, Tomassen SL, Røstad L, Moe NB MAFIIA - an Architectural Description Framework: Experience from the Health Care Domain In: Konstantas D, Bourrières JP, Léonard M, Boudjlida N (eds.):

Interoperability of Enterprise Software and Applications Springer, 2005; 43-54

[10] Fowler M UML Distilled, 3 ed: Addison Wesley, 2004 [11] The Healthcare Service Specification Project, http:// hssp.wikispaces.com/

[12] Walderhaug S, Mikalsen M, Hartvigsen G, Aagedal J Improving Systems Interoperability with Model-driven Software Development for Healthcare

In Proceedings of Medinfo 2007.

[13] Johnston S UML 2.0 Profile for Software Services http://www-128.ibm.com/developerworks/rational/library/ 05/419_soa/

Address for correspondence

Marius Mikalsen, SINTEF ICT, NO-7465 Trondheim, Norway

marius.mikalsen@sintef.no

MEDINFO 2007

K Kuhn et al (Eds)

IOS Press, 2007

© 2007 The authors All rights reserved.

Sustainable Ubiquitous Home Health Care – Architectural Considerations and

First Practical Experiences Michael Marschollek, Klaus-H Wolf, Oliver-J Bott, Mirko Geisler, Maik Plischke, Wolfram

Ludwig, Andreas Hornberger, Reinhold Haux

Institute for Medical Informatics, Technical University Carolo-Wilhelmina of Braunschweig, Germany

Abstract

Despite the abundance of past home care projects and the

maturity of the technologies used, there is no widespread

dissemination as yet The absence of accepted standards

and thus interoperability and the inadequate integration

into transinstitutional health information systems (tHIS)

are perceived as key factors Based on the respective

liter-ature and previous experiences in home care projects we

propose an architectural model for home care as part of a

transinstitutional health information system using the HL7

clinical document architecture (CDA) as well as the HL7

Arden Syntax for Medical Logic Systems In two short case

studies we describe the practical realization of the

archi-tecture as well as first experiences Our work can be

regarded as a first step towards an interoperable – and in

our view sustainable – home care architecture based on a

prominent document standard from the health information

Telemedicine in general and telemedical systems for home

care have been a key interest in medicine and medical

informatics in the last two decades Many research projects

and funding programs have been conducted and some of

the solutions developed have been successfully introduced

in medical care and are commercially available On the

one hand there is a considerable advancement and maturity

of the underlying technologies and methods, e.g computer

systems, ubiquitous computing, sensor systems, signal

analysis, networks and health information systems, and on

the other hand there is first proof that specific patient

groups stand to benefit from tele home care [1] Despite

this there is no widespread use of these technologies as yet

The reasons for this lack of sustainability are manifold and

it is often argued that, apart from technological barriers,

evidence for cost benefit is sparse for tele home care

sys-tems [2], that profound changes in the work processes of

care providers are required and that physicians lack the

resources to interpret huge amounts of sensor data

recorded in home settings [3] In particular, the lack of

uti-lization of standards such as the HL7 Clinical DocumentArchitecture (CDA) [4] or prEN 13606 [5] and the inade-quate integration into regional health information systeminfrastructures, if existent, are regarded as key factors [6,7] Only few examples of the use of standards in home carecan be found in literature Van der Linden et al presentPropeR, a re-usable, modular EHR system based on opensource components such as the openEHR standard, andreport on its use for multidisciplinary care of strokepatients [8, 9], but make no statement on the representation

of sensor data In [10] the processes in home care aredescribed in detail and a framework for home care cooper-ation is proposed The authors use the XML standard formessaging between different health information systems Concentrating on the use of standards from the healthinformation system domain, we aim:

• to elucidate the requirements for sustainability in home care systems (aim 1),

• to propose a functional, adaptive and modular (and in our view sustainable) architectural model (aim 2), and

• to report on two current projects of the authors and their status of implementation (aim 3)

The research questions addressed are the following:Q1: What are the basic requirements for sustainable homecare architectures with respect to the usage of standards?Q1.1: What are the categories of data processed in homecare, what are the basic paths of information flow, and whoare the participants?

Q1.2: What are suitable forms of medical data tion for further use in transinstitutional health informationsystems?

representa-Q2: What is an architectural model suitable to meet theserequirements and how can it be implemented?

Materials and methods

Based on our previous experiences in building home caresystems and with regard to the respective literature wesummarize the basic architectural requirements for a sus-tainable, standards-based home care system (first section

in Results) We then propose an architectural model along

M Marschollek et al / Sustainable Ubiquitous Home Health Care – Architectural Considerations and First Practical Experiences

with the strategy for its practical realization in the

follow-ing section, employfollow-ing the Three-layer Graph-based meta

model (3LGM 2 )-methodology for statical modeling of

health information systems [11, 12] In the final two

sec-tions in Results we report on two case studies using our

architectural model and present their current status of

implementation In the Discussion we balance advantages

and disadvantages of our architecture and finally conclude

with an outlook on our future work

Results

Requirements for sustainable home care architectures

In home care, mostly two different categories of data are

gathered Firstly, there are sensor data that are inherently a

very heterogenous group, with sensors that measure just

one parameter once a day, e.g a sphygomanometer for

blood pressure measurements, to multi-sensor devices that

continuously record multiple channels and transfer a data

stream to a computer system, e.g a 12-lead ECG Different

persons with individually different diseases or functional

disabilities will need customized sensor device

compila-tions that fit their situation best Therefore there is an

urgent need for device interoperability standards that allow

to build self-configurating ‘plug-and-play’ sensor sets with

known features [13] The ISO/IEEE 11073 medical device

standard is a candidate [14], though at present hardly used

outside intensive care units Apart from medical sensors,

context sensors that provide valuable information for the

interpretation of the medical data also should be

consid-ered, e.g accelerometers for the classification of activities

of daily life (ADL) [15]

A second category of data are data actively provided by the

persons themselves, from relatives and care givers These

may either be structured, e.g in a standardized

question-naire for well-being, and therefore can be represented with

reference to code systems such as SNOMED CT [16], or

unstructured such as e.g in free text in emails or spoken

comments The semantic integration of the latter into

exist-ing health information systems remains a largely unsolved

problem The addressees of home care not only are a

source but also a target of information, because feedback is

a necessary precondition for promoting self-management

and patient empowerment

When multiple sensors are used in home care, huge

amounts of data will be recorded every day There is an

irrevocable need for intelligent processing of these data,

which may be done already within the sensor device, on an

additional mobile device worn by the patient, or on a

com-puter at the patient’s home, probably all three in form of

cascading preprocessing procedure Data fusion is

neces-sary both on technical and content level, and conclusions

should be drawn considering all available data from a

patient, including those stored in her or his electronic

health record (EHR) As there are different groups of

recipients of information – the patients, their care givers

and their physicians – with different informational needs

and levels of ‘health literacy’, there should also be

differ-ent, configurable forms of data aggregation andpresentation to fit user needs

In order to achieve semantic interoperability the nous data gathered from multiple sources have to berepresented in a consistent form, so that they can be used

heteroge-in transheteroge-institutional health heteroge-information systems A nent standard for clinical documents is the HL7 CDA,which is designed primarily for clinical documents such asdischarge letters or diagnostic findings, and not for hugeamounts of sensor readings

promi-An architectural model for standards-based home care

We propose an architectural model for a sensor-basedhome care system that makes use of the HL7 CDA (ver-sion 2), for data representation and includes a decisionsupport infrastructure based on the HL7 Arden Syntax forMedical Logic Systems and its Medical Logic Modules(MLMs) [17]

Figure 1 shows the general component model of our tecture The patient or respectively the person is theprimary source of data in the home care environment, butrelatives and care givers may also provide valuable data onher or him, e.g in the form of questionnaires or observa-tions Thus these are also part of the architecture All datagathered are transformed into CDA documents and thentransferred to a home server with a personal electronichealth record (pEHR) system Attached to this system is adecision support system that automatically retrieves storedCDA documents, analyzes them and in turn produces syn-opses or reports in CDA format or as messages, e.g emailalarms to a health care provider The processing of the datatakes place in two stages: firstly, the huge amounts of sen-sor data are preprocessed by employing temporalabstraction methods, intelligent filters and machine-learned classifiers to aggregated data units in CDA format.Secondly, the data are analyzed along with other CDAdocuments on the patient from ‘external EHR’ systems,i.e other components of the transinstitutional health infor-mation system (cmp Figure 1), with predefined MLMs.The MLMs contain medical knowledge coded in ArdenSyntax to extract medically relevant information that inturn can be used e.g to trigger alarms The model architec-ture also contains two loops of feedback (cmp Figure 1,dotted arrow) to the patient: an inner loop with machine-generated reports made available via an interface, e.g thehome TV set, and an outer loop, where the feedback isposted by a health professional, e.g a General Practitioner,

archi-on her or his institutiarchi-onal system and then transmitted viathe transinstitutional communication infrastructure to thepersonal EHR at home and then sent to the interface.Figure 2 shows the 3LGM2 model of the architecturedescribed, with all entities, functions and relationshipssubdivided into three distinct architectural layers: thedomain layer and the logical and physical tool layer

M Marschollek et al / Sustainable Ubiquitous Home Health Care – Architectural Considerations and First Practical Experiences

Figure 1 - Component model of the proposed architecture based on the HL7 clinical document architecture standard (CDA)

pEHR = personal electronic health record; MLM = Medical Logic Module

Figure 2 - Three-layer graph-based meta model (3LGM 2 ) of the proposed home care information system pEHR = personal

electronic health record; CDA = clinical document architecture; MLM = Medical Logic Module