H.J. Spruijt

A multicentre PDA project to support the clinical decision process

In the Netherlands, the departments of cardiology of all academic hospitals work together under the auspices of the Interuniversity Cardiology Institute of the Netherlands (ICIN). In many of these ICIN centers, PDAs are used to support the cardiologist in his daily practice. In these centers PDA versions are being developed of relevant clinical guidelines. Also, medical PDA applications are evaluated and distributed locally. To give a boost to these local efforts, representatives of 5 ICIN centers have started a PDA collaboration project, with the purpose to jointly develop or find PDA applications to support the clinical decision process. Relevant cardiology guidelines, such as the European (ESC) and national guidelines have been made available for the PDA. In addition, we have selected PDA applications that will be used in all centers, such as risk-prediction software, medical calculators and drug reference software. All PDA clinical guidelines and medical applications have been made available for download on a special Website.

Uniform pacemaker and ICD information system in the Netherlands

In the Netherlands the Central Pacemaker Patient Registry (CPPR) collects information of pacemaker and ICD (implantable cardio defibrillator) patients from all 109 Dutch hospitals. Many pacemaker clinics use a computer to store their implant and follow-up data in a database. Because the devices are getting more and more complex more clinical data is needed for optimal use of the device. Since 1989 databases have been developed by several pacemaker industries and some clinics use databases developed themselves. When using these databases you depend on individual persons for support and update of the database. In order to improve the accuracy of received data and to ensure continuity a uniform pacemaker and ICD information system is developed where data is checked, after which it is sent to the central registry by e-mail and where support is guaranteed by the NPRF.

Unravelling gene interactions to find the cause of artherosclerosis, a multigenic disease, using an artificial neural network

To understand the etiology of multigenic diseases like atherosclerosis, a polymerase chain reaction (PCR) based gene array containing 65 single nucleotide polymorphisms (SNPs) was analyzed. To asses the possibilities of pattern recognition techniques in detecting unfavorable genetic combinations, two approaches were analysed. A selection of these 65 SNPs formed the input both to binary logistic regression models and to self-learning artificial neural networks (ANNs). Repeated analyses showed that both methods performed equally well. Further research to improve the differentiating power of both methods should focus first on decreasing the number of otherwise indeterminable polymorphisms.

A diagnostic component for the EPD-Car project

This paper describes a diagnostic module which is a part of the EPD-CAR (Electronic Patient Dossier for Cardiology) project of the Interuniversity Cardiology Institute of the Netherlands. It consists of 13 coding trees, each containing between 3 and 20 subitems. The scheme evolved from daily practice where standard coding schemes proved insufficient. It consists of one main diagnosis and up to 10 optional subdiagnoses. Back-end integration is achieved through conversion tables to ICD-9 and ICD-10. The current system is in use now,for over 1.5 years and contains diagnoses of over 11000 patients. The system is written in Visual Foxpro 6.0 and is an ActiveX-component.

The choice of a commercial broadband communication system for ABC4CarE

In order to inquire the hard- and software possibilities for broadband communication applications, an inventory was made of specific solutions for the three main goals of the ABC4CarE project: teleconsulting, teleguiding and teleteaching. As the project plans for ABC4CarE are maturing, three of these telecommunication applications have been chosen, and a thorough survey was made on the usefulness of the application in each specific situation. For the Groningen-Leeuwarden X-ray cathlab teleconsulting connection the Philips VISU solution will be used because of the low cost. For the Amsterdam-Alkmaar X-ray cathlab teleconsulting and teleguiding connection, the Lucent MediaBuilder solution was chosen because of the broad spectrum of possibilities. The Rotterdam-Rotterdam echocardiographic teleguiding connection uses a home built application using a toolkit from Berkeley University.

An enhanced DTC component for the EPD-CAR project

This paper describes a module which is a part of the EPD-CAR (Electronic Patient Dossier for Cardiology) project of the Interuniversity Cardiology Institute of the Netherlands. It uses general guidelines to advise on the functional tests that have to be performed depending on the diagnoses. The model differentiates between the diverse conditions under which the patient enters the medical circuit. The model converts the detailed information into a crude code the is becoming the basis of financial compensation for medical treatment, starting January 1st 2003. The system is written in Visual Foxpro 7.0 and is an ActiveX-component.

Data standards in echocardiography: a Dutch experience

The current echocardiographic data sets from five of the eight Dutch University Hospitals have been analyzed and compared. The resulting data set formed the starting point for the determination of the minimal or basic core data set, consensus data set and maximal data set. These data sets include measurements, calculations, interpretations, descriptive terms, normal values for the result data and indications (referral reasons) for an echocardiographic study. The relationship between referral reasons, measurements and the resulting echocardiographic report was one of the main purposes of this study. The resulting data sets have been related to the proposed recommendations and guidelines of The American Society of Echocardiography and The German Cardiology Society.

A generic secure Internet-based facility to support multiple registries using modern encryption technology and client certificates

For the management of their disease chronic patients are alternately dependent on the care of the general practitioner, (specialized) nurses or the specialist. For optimally coordinated communication there is a strong need for one single patient record containing all necessary medical information in order to get a complete overview of the condition of the patient for all healthcare providers. In this feasibility study we demonstrated that using current methods for data security and encryption over the Internet an electronic patient record could be employed to be used by only those care providers that have legitimate access to the data. The data security and encryption technology can also be used to employ various other registries not necessary requiring the same level of security.