Christoph Rinner

Extraction of standardized archetyped data from Electronic Health Record systems based on the Entity-Attribute-Value Model.

OBJECTIVE The ISO/EN 13606 Electronic Health Record architecture standard permits semantically interoperable exchange of Electronic Health Record data by using archetypes to define the structure and semantics of Electronic Health Record contents. Practical implementations of the ISO/EN 13606 standard have been scarcely reported on, and none of the publications describes in detail an efficient technique of archetype-compliant data extraction from an Electronic Health Record system. We address this research issue in the present report, and focus on a specific class of largely research-oriented Electronic Health Record systems which are internally based on the Entity-Attribute-Value Model. METHOD We propose an approach for extracting data described by archetypes from an Entity-Attribute-Value based Electronic Health Record system in an ISO/EN 13606-conformant manner. The approach is based on mapping from the structure of exported source documents to the archetype. It is implemented via standard XML technologies. RESULTS We tested our approach on an Electronic Health Record system employed for clinical research at the Medical University of Vienna. Using test data defined by three different archetypes, source documents were successfully extracted as archetype-conformant ISO/EN 13606 Electronic Health Record extracts. CONCLUSIONS Electronic Health Record data may be effectively extracted from Entity-Attribute-Value based Electronic Health Record systems using the suggested approach. As a prerequisite for applying our approach, the internal data model of the Electronic Health Record system and the archetype must overlap in a way that a semantic mapping between them is possible. The system must further provide an XML interface which permits the export of the source documents in conventional format. The export must include data and metadata that are mandatorily postulated by the archetype and the ISO/EN 13606 Reference Model.

The EHR-ARCHE project: Satisfying clinical information needs in a Shared Electronic Health Record System based on IHE XDS and Archetypes

Highlights • Content-based search avoids information overload in IHE XDS Shared EHR systems.• Content-based search enables retrieval of fine-grained information items.• Content-based search implemented by integrating Archetypes in IHE XDS.

On analyzing process compliance in skin cancer treatment: an experience report from the evidence-based medical compliance cluster (EBMC 2 )

Process mining has proven itself as a promising analysis technique for processes in the health care domain. The goal of the EBMC2 project is to analyze skin cancer treatment processes regarding their compliance with relevant guidelines. For this, first of all, the actual treatment processes have to be discovered from the available data sources. In general, the L* life cycle model has been suggested as structured methodology for process mining projects. In this experience paper, we describe the challenges and lessons learned when realizing the L* life cycle model in the EBMC2 context. Specifically, we provide and discuss different approaches to empower data of low maturity levels, i.e., data that is not already available in temporally ordered event logs, including a prototype for structured data acquisition. Further, first results on how process mining techniques can be utilized for data screening are presented.

Towards plug-and-play integration of archetypes into legacy electronic health record systems: the ArchiMed experience

BackgroundThe dual model approach represents a promising solution for achieving semantically interoperable standardized electronic health record (EHR) exchange. Its acceptance, however, will depend on the effort required for integrating archetypes into legacy EHR systems.MethodsWe propose a corresponding approach that: (a) automatically generates entry forms in legacy EHR systems from archetypes; and (b) allows the immediate export of EHR documents that are recorded via the generated forms and stored in the EHR systems’ internal format as standardized and archetype-compliant EHR extracts. As a prerequisite for applying our approach, we define a set of basic requirements for the EHR systems.ResultsWe tested our approach with an EHR system called ArchiMed and were able to successfully integrate 15 archetypes from a test set of 27. For 12 archetypes, the form generation failed owing to a particular type of complex structure (multiple repeating subnodes), which was prescribed by the archetypes but not supported by ArchiMed’s data model.ConclusionsOur experiences show that archetypes should be customized based on the planned application scenario before their integration. This would allow problematic structures to be dissolved and irrelevant optional archetype nodes to be removed. For customization of archetypes, openEHR templates or specialized archetypes may be employed. Gaps in the data types or terminological features supported by an EHR system will often not preclude integration of the relevant archetypes. More work needs to be done on the usability of the generated forms.

Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin

Background Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. Objective To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. Methods We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close‐up images taken with and without dermatoscopy to 95 examiners with different levels of experience. Results The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P < .001). Among 51 possible diagnoses, the correct diagnosis was selected in 33.1% of cases with and 26.4% of cases without dermatoscopy (P < .001). For experts, the frequencies of correct specific diagnoses of a malignant lesion improved from 40.2% without to 51.3% with dermatoscopy. For all malignant neoplasms combined, the frequencies of appropriate management strategies increased from 78.1% without to 82.5% with dermatoscopy. Limitations The study deviated from a real‐life clinical setting and was potentially affected by verification and selection bias. Conclusions Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.

Effects of Shared Electronic Health Record Systems on Drug-Drug Interaction and Duplication Warning Detection

Shared electronic health records (EHRs) systems can offer a complete medication overview of the prescriptions of different health care providers. We use health claims data of more than 1 million Austrians in 2006 and 2007 with 27 million prescriptions to estimate the effect of shared EHR systems on drug-drug interaction (DDI) and duplication warnings detection and prevention. The Austria Codex and the ATC/DDD information were used as a knowledge base to detect possible DDIs. DDIs are categorized as severe, moderate, and minor interactions. In comparison to the current situation where only DDIs between drugs issued by a single health care provider can be checked, the number of warnings increases significantly if all drugs of a patient are checked: severe DDI warnings would be detected for 20% more persons, and the number of severe DDI warnings and duplication warnings would increase by 17%. We show that not only do shared EHR systems help to detect more patients with warnings but DDIs are also detected more frequently. Patient safety can be increased using shared EHR systems.

JADE: a tool for medical researchers to explore adverse drug events using health claims data.

OBJECTIVE The objective of our project was to create a tool for physicians to explore health claims data with regard to adverse drug reactions. The Java Adverse Drug Event (JADE) tool should enable the analysis of prescribed drugs in connection with diagnoses from hospital stays. METHODS We calculated the number of days drugs were taken by using the defined daily doses and estimated possible interactions between dispensed drugs using the Austria Codex, a database including drug-drug interactions. The JADE tool was implemented using Java, R and a PostgreSQL database. RESULTS Beside an overview of the study cohort which includes selection of gender and age groups, selected statistical methods like association rule learning, logistic regression model and the number needed to harm have been implemented. CONCLUSION The JADE tool can support physicians during their planning of clinical trials by showing the occurrences of adverse drug events with population based information.

Long-term evaluation of the efficacy of digital dermatoscopy monitoring at a tertiary referral center

We examined the value of monitoring patients with multiple nevi using sequential digital dermatoscopy imaging at a tertiary referral center.

Use of beta-blocker is associated with lower mortality in patients with coronary artery disease with or without COPD

Beta‐blockers are indicated for secondary prevention of coronary artery disease (CAD). However, in patients with co‐morbidity of chronic obstructive pulmonary disease (COPD) an underuse of beta‐blocker has been reported.

Langzeitauswertung des Nutzens der digitalen Dermatoskopie an einem Referenzzentrum

Wir untersuchten den Nutzen der sequentiellen digitalen Dermatoskopie für die Kontrolle von Patienten mit multiplen Nävi in einem spezialisierten Zentrum.