G. De Moor

Electronic health records: new opportunities for clinical research

Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources.

Grain size trends associated with net sediment transport patterns: an example from the Belgian continental shelf

Grain size trends in relation to net sediment transport pathways are examined, using some commonly-used grain size parameters. The results of the trend analysis (for 15 types of the trends) are compared with a known net sediment transport pathways established on the basis of the sandbank hydro- and sediment-dynamics (i.e. general water and sediment movement patterns and bedform asymmetry). It is shown that: (1) the results for grain size trends associated with “a worsening in sorting along the transport pathways” have little similarity to transport pathways; (2) the results for grain size trends associated with “an improvement in sorting along the transport pathways” have relatively high degree of similarity to the identified pathways; and (3) the residual pattern, derived on the basis of a combined grain size trend used elsewhere (Gao and Collins, 1992), appears to be most similar and suitable for defining transport pathways.

The water-table aquifer in the eastern coastal area of Belgium

Abstract A resistivity survey in Wenner arrangement has been conducted in the water-table aquifer in the eastern part of the Coastal Area of Belgium. Bore holes have been drilled to test the geoelectrical data and also to collect water samples. The chemical characteristics and the distribution of different water types explain the hydrochemistry of the water-table aquifer. The fresh-/brackish-water boundary as determined by the resistivity survey has been expressed in terms of total dissolved-solids content.

The European Institute for Innovation through Health Data

The European Institute for Innovation through Health Data (i~HD, www.i‐hd.eu) has been formed as one of the key sustainable entities arising from the Electronic Health Records for Clinical Research (IMI‐JU‐115189) and SemanticHealthNet (FP7‐288408) projects, in collaboration with several other European projects and initiatives supported by the European Commission. i~HD is a European not‐for‐profit body, registered in Belgium through Royal Assent. i~HD has been established to tackle areas of challenge in the successful scaling up of innovations that critically rely on high‐quality and interoperable health data. It will specifically address obstacles and opportunities to using health data by collating, developing, and promoting best practices in information governance and in semantic interoperability. It will help to sustain and propagate the results of health information and communication technology (ICT) research that enables better use of health data, assessing and optimizing their novel value wherever possible. i~HD has been formed after wide consultation and engagement of many stakeholders to develop methods, solutions, and services that can help to maximize the value obtained by all stakeholders from health data. It will support innovations in health maintenance, health care delivery, and knowledge discovery while ensuring compliance with all legal prerequisites, especially regarding the insurance of patients privacy protection. It is bringing multiple stakeholder groups together so as to ensure that future solutions serve their collective needs and can be readily adopted affordably and at scale.

From syntactic-semantic tagging to knowledge discovery in medical texts

In the GALEN project, the syntactic-semantic tagger MultiTALE is upgraded to extract knowledge from natural language surgical procedure expressions. In this paper, we describe the methodology applied and show that out of a randomly selected sample of such expressions coming from the procedure axis of Snomed International, 81% could be analysed correctly. The problems encountered fall in three different categories: unusual grammatical configurations within the Snomed terms, insufficient domain knowledge and different categorisation of concepts and semantic links in the domain and linguistic models used. It is concluded that the Multi-TALE system can be used to attach meaning to words that not have been encountered previously, but that an interface ontology mediating between domain models and linguistic models is needed to arrive at a higher level of independence from both particular languages and from particular domains.

External quality assessment (EQA) of Belgian clinical laboratories. The telematics paradigm

Technology that enables communication between information systems has recently become cheaper and more powerful. It is therefore timely to consider the effects of the introduction of such techniques in external quality assessment (EQA) schemes on both users and organizers. Traditionally, results are returned to EQA organizers as hand-written numbers on structured forms. These data are then manually entered into a computer. The process is time-consuming, slow (as it depends on the postal service), prone to error at every transcription stage, and expensive, as clerical staff must be employed to input the data. Computer-to-computer communication allows this process to be improved. A telematics system for electronic data interchange has been developed for the Belgian EQA programme and it offers several advantages, such as the use of standardized semantics, expression of results in laboratory familiar units, possible interface with the Laboratory Information System, faster data analysis, shorter report time and long-term performance evaluation.

International Coordinated Development of Educational Software

The Department of Medical Informatics and Statistics of the University of Limburg has developed several program packages in the area of medical decision making and adapted some programs that were initially developed at the Free University in Amsterdam to the educational situation in Limburg [1,2,3,4]. The programs are written in Turbo-Pascal and implemented on PC’s. The programs are presented to medical and health sciences students in a problem-oriented educational environment. After each confrontation with the programs the students evaluate them and their evaluation has always been positive.

Preparation of semi-detailed lithologic and hydrogeologic maps for land management by means of a geo-electrical survey

SummaryIn gathering information about the physical aspects of the environment, standard methods, such as drilling and excavation, can be advantageously replaced by resistivity sounding. With the sounding data a geo-electrical map is made from which other maps can be derived. The method has been applied in the northern part of Belgium. The investigation of a test area of 625 km2 has led to the drawing of a geo-electrical map, on the basis of which a semi-detailed map of the lithology of the top layers and a map of the thickness of these layers have been worked out.RésuméDans la recherche des données sur les aspects physiques de l’environnement les méthodes classiques, telles que le forage et l’excavation, peuvent être avantageusement remplacées par la méthode géoélectrique des sondages de résistivité. Les données de sondage permettent de dresser une carte géoélectrique, de laquelle on peut déduire d’autres cartes thématiques. La méthode a été appliquée dans la partie septentrionale de la Belgique. Une carte géoélectrique a été établie pour une région d’essai de 625 km2. A base de celle-ci une carte semi-détaillée de la lithologie des couches supérieures et une carte de l’épaisseur de ces formation ont été construites.

Electronic medical file exchange between on-duty care providers and the attending paediatrician: a Belgian paediatric pilot project

Abstract The authors propose the introduction of a pilot project: “paediatric core file exchange in emergencies” (PCF-EXEM) which enables the exchange of medical data between the attending paediatrician (AP), holder of the medical record, and on-duty medical units (i.e. general practitioners, paediatricians, surgeons, emergency physicians,...). This project is based on two pillars: a protected server (PCF-server) containing paediatric core files (PCF), with important clinical data that should be available for the physician in order to quickly get a clear insight into the relevant clinical medical history of the child, and secondly, the possibility to provide feedback to the attending physician about the findings recorded during the on-call duty. The permanent availability of health data on the PCF-server and the possibility to provide feedback represent together the PCF-EXEM-project. This project meets the demand of the care providers to have relevant medical information permanently available in order to guarantee high quality care in emergency situations. The frail balance between the right to informative privacy and professional confidentiality on the one hand and the right to quality health care on the other hand has been taken into account. The technical and practical feasibility of this project is described. The objectives and vision of the PCF-EXEM project are conform to Belgian legislation concerning the processing of medical data and are in line with the still under consideration European projects which are focusing on interoperability and the development of a common access control to databanks containing health data for care providers. PCF-EXEM could therefore be a model for other EU countries as well.