Ebook: Medical Informatics Europe '99

The MIE'99 (Medical Informatics Europe) conference is the 15^th in the series of conferences organised by European Federation of Medical Informatics and is organised in alternation with the MEDINFO (World Congress on Medical Informatics) organised by IMIA (International Medical Informatics Association). For the last conference in this millennium Ljubljana, the capital of Slovenia has been selected by the EFMI board. The motto of this year’s conference “Bridges of Knowledge” reflects this historical event - bridges between millenniums, and bridges between various countries and various disciplines.

The response to the call for papers was overwhelming, 263 contributions from 28 different countries were received and 208 high quality papers were accepted for oral or poster presentations. Each paper has been reviewed by at least two reviewers coming from 35 countries. The quality, clarity and originality were the main criteria for accepting or rejecting a paper.

All accepted presentations presented in this proceedings are divided into following topics:

- Information systems in health care and medicine

- Telemedicine and telematics

- Security

- Biomedical processing, data analysis and image processing

- Data warehousing, data mining and knowledge discovery

- Training and education

- Internet/Intranet

- Resources management

- Intelligent medical systems

- Health guidelines and protocols

- Electronic patient encounter, card technology, electronic data interchange

- Terminology

- Nursing informatics.

The presented papers not only reflect the "state of the art", but present many new exciting ideas that will guide the progress of medical informatics in the new millenium. The editors of the proceedings would like to thank all that in some or another way contributed in the production of the proceedings. Specially acknowledge goes to:

• All authors for presenting their valuable ideas

• Reviewers and programming committee for selecting the papers and improving their quality

• The staff of Laboratory of System Design (University of Maribor, Slovenia) for managing the contributions from early draft to final camera ready copy

• Organising committee for their support in all stages of the proceeding’s production process and

• IOS Press for being so kind to publish it.

Peter Kokol

Blaž Zupan

Janez Stare

Marjan Premik

Rolf Engelbrecht

The aim of this project is to expand DIOGENE with a centralized and integrated patient clinical database system providing a standardized framework for the building of future clinical databases and for the integration of existing heterogeneous ones. The combined ‘across time view’ and ‘across departments view’ generated from the integrated clinical data will enable an evolutionary view of the patient state both across time and across medical specialties. For this purpose and to permit the communication and exchange of data, a new controlled vocabulary for representing clinical data has been created. The construction of this vocabulary is based on the international ICD classification, already being used in DIOGENE for encoding patient diagnosis and procedures. A new extension of the ICD is proposed for medical information that goes beyond diagnosis and procedures encoding. The building of a common clinical finding dictionary recording the definition of findings is based on this newly developed clinical vocabulary. This process is incremental, manual, and significant.

Computer supported drug design is based on the biochemical information for the prediction of alternative bio-chemical pathways. Molecular information on genes, proteins, biochemical reactions, mutations, inborn errors and metabolic diseases are available via internet. Based on this information we developed an information retrieval and processing concept combining knowledge about metabolic diseases and biochemical effects.

In the frame of an European telemedicine project, we have designed and implemented an Andrology server that provides the user (e.g. physicians, students) with a set of anonymized andrology cases. Within this context we faced the problem of re-structuring existing clinical information sources and gained some experience on how much of the problem might be solved by the software engineer. This paper presents a method that partially automates the maintenance of the andrology case collection. Moreover, the potential benefit of XML for information representation will be discussed.

Today, most large hospital information systems (HIS) comprise many heterogeneous application systems, loosely coupled via interfaces. Integration could offer many advantages, like the support of interdepartmental workflows or a consistent patient record. This cannot be achieved, however, by simply interfacing originally unrelated component systems. In this paper, we present relevant concepts of integration, the autonomy/consistency tradeoff, and technical alternatives in some detail. Based on our recent experiences in analyzing an existing HIS and selecting adequate vendors for the needs of our 1250-bed hospital, we then discuss strategies and tradeoffs on the way to a HIS that utilizes state-of-the-art technology to fill the users’ needs.

Cooperation between Health Care Professionals is essential for the quality of care. Workflow systems could improve the transfer of informations and responsibilities within Health Care Actors. We have proposed a conversation-based Workflow in order to modelize the therapeutics plan in the ICU. In such a complex field, the flexibility of the workflow system is essential for the system to be usable. We have introduced some dynamicity by adding roles in the model. With the use of roles, the dynamicity of the workflow is assumed by the routing process. We need to use simulation to be able to study the impact of routing algorythms on the efficiency of the coordination.

A research-action program was established in 1996 between the Loos- Lez-Lille prison psychiatric unit and the Department of Medical Informatics of the University Hospital of Lille (France) : - (1) to investigate the health status and the general characteristics of the prison population - (2) to develop an Information System for improving the prison health care and to facilitate social rehabilitation of convicts. Starting off 1988, all new prisoners are interviewed on their arrival using a standard questionnaire. The transfer of all the information recorded in this questionnaire into a computer base was initiated in 1996, when the research action program began. A statistical analysis was performed on 15200 records (1989-1995) to identify the most informative parameters : 50% of inmates were less than 24 years old; 57% were unemployed; 60% had no professional qualification. 31% of inmates had a psychiatric history and 16% had made a previous suicide attempt. The rate of drug abuse has increased from 24% in 89 to 53% in 95. To analyze the time trends of these parameters, a prototype of Information System was then developed. The system uses the database to product standard reports in real time.

A communication system for the automation of the follow up of AIDS patients set up by DIST at the Molecular Virology Unit in the Advanced Biotechnology Centre of Genova and at the Department of Internal Medicine of the Medical School of Genova is presented. This system includes a distributed database to store both clinical and virological data and a set of procedures to transfer patient data with a complete respect of requirements about completeness and privacy.

Aim of the project is to define and to implement an information system able to help people, who produce chemotherapic antineoplastic drugs, and health care operators, who manipulate such drugs, to prevent short and long term adverse effects connected to the above mentioned activities. The system is able to give a detailed and updated information about these problems, and to give an up-to date, from a professional point of view, to the users of the system. Also an information system prototype was implemented, which consists of an object-oriented database, a decision support system, able to manage and to plan a periodic control of workers, to verify the adverse effects of the antineoplastic chemotherapic drugs, a management system for the network communications.

Data warehouse implementation is assumed to be a very knowledge- demanding, expensive and long-lasting process. As such it requires senior management sponsorship, involvement of experts, a big budget and probably years of development time. Presented Outpatient Health Care Statistics Data Warehouse implementation research provides ample evidence against the infallibility of the above statements. New, inexpensive, but powerful technology, which provides outstanding platform for On-Line Analytical Processing (OLAP), has emerged recently. Presumably, it will be the basis for the estimated future growth of data warehouse market, both in the medical and in other business fields. Methods and tools for building, maintaining and exploiting data warehouses are also briefly discussed in the paper.

This article describes our experiences in implementation of the European standard for the architecture of healthcare information systems. The standard was a great help, but this article focuses more on some problems we have encountered.

The aim of ELCANO, an EU - funded project, is to build a virtual multilingual multimedia library of unusual clinical cases related to gastroenterology. Based on a standardisation of the format to report and the representation of clinical information on WWW, the multilingual multimedia case has been developed and till now 350 cases have been included. User satisfaction and user acceptance of ELCANO are under evaluation.

Medical Information Systems (MIS) are seen as a way of optimizing the use of existing health-care infrastructure, without resorting to new and costly hospital (re)construction. The qualitative (re)design of such an environment requires a basic understanding of patient and doctors related characteristics and capabilities. Patient care, patient education, medical education, and clinical research need to be considered to meet the basic requirements on the level of services desirable, determined on the basis of the patient's length of stay; i.e., used for modeling the significant entities of such a world. The aim is to extract conclusions for the level of services provided to the users. One’s concept will capture, as well as will integrate, the basic design principles under which MIS may be set.

Data and information are nowadays keys of success. We experienced the building of an hospital Information System (IS) selecting data from those already routinely produced and sharing them with health care units and general management. IS should be shaped to accomplish mission, vision and strategic direction of the hospital and in this direction our efforts are oriented.

A formalized “top to bottom” design approach was described in [1] for distributed applications built on databases, which were considered as a medium between virtual and real user environments for a specific medical application.

Merging different components within a unified distributed application posits new essential problems for software. Particularly protection tools, which are sufficient separately, become deficient during the integration due to specific additional links and relationships not considered formerly. E.g., it is impossible to protect a shared object in the virtual operating room using only DBMS protection tools, if the object is stored as a record in DB tables. The solution of the problem should be found only within the more general application framework. Appropriate tools are absent or unavailable.

The present paper suggests a detailed outline of a design and testing toolset for access differentiation systems (ADS) in distributed medical applications which use databases. The appropriate formal model as well as tools for its mapping to a DMBS are suggested. Remote users connected via global networks are considered too.

Among the characteristics of the present time, we meet the ranking of information among the key resources of effective management of business systems. Up to date, integral and accurate information have gained precedence over conventional economic resources. This applies particularly in the case of large and complex business systems, including the national health care and health insurance systems. High quality and unified databases form the foundation for rational and quality procedures ranging from the operative level to the national strategy level.

The goal of this paper is to demonstrate, on the example of Slovene experience, the importance of keeping quality databases for the purposes of health care and health insurance system management. The paper reviews the achieved level and the plans of further development of unified databases in this sector in Slovenia. The key emphasis in the development of an integrated system has been laid upon establishing uniform primary databases and providing appropriate integration in the area of data interchange among the actors of the health care and health insurance systems and other national systems.

The compulsory health insurance databases represent fundamental infrastructure to the implementation of the Health Insurance Institute of Slovenia (HIIS) operations, i.e. for its effective performance in all the fields of its business. This paper presents the legal bases of the database management, the logocal database structure, the supply of data from various data sources, and the role of databases as the primary source of supply for the data collections kept by other institutions in Slovenia.

Laparoscopy is a wonderful tool for performing gynecologic surgery. Whether or not laparoscopic surgery is advisable to diagnose or treat a particular gynecologic problem requires a careful consultation with an experienced gynecologist, who can help the patient weight the pros and cons of laparoscopy versus other options. For the management of this kind of surgical intervention we realise a computer based patient record.

The present paper deals with an experience of blackout of the hospital information system at our Medical Centre, trying to evaluate the impact on internal users (physicians, nurses, clerks) and patients population. Limited inconveniences have occurred to out-patients in terms of delay in collecting medical reports after diagnostic test execution. As regards direct users, impact was evaluated through a structured interview. Administrative personnel, that have been using computer-based system for at least ten years, have not declared particular inconveniences, accepting the overtime or the extra-work as simply unavoidable. On the contrary, health-care personnel reported a heavy negative impact of the system failure on their activity. After a great effort to achieve the system acceptance and direct physicians usage, the blackout of the system has pointed out that the situation has changed since a few years ago: now the HIS, and particularly its clinical core, is considered mission critical.

Motivated by economic and quality management issues, many hospitals strive for the introduction of information systems into the clinical environment. To introduce the most suitable software product, a systematic selection procedure is required involving all affected staff. The paper describes a methodology that guides the clinical users to an objective motivated decision. This semi-formal methodology is necessary in view of missing standard models for the description of hospital in- formation systems and leads to high acceptance in practical use. The methodology consists of structured product demonstrations with a quantitative assessment, benefit-value-analyses based on step weights for the functions needed, and test installations. Prerequisite of this procedure was the definition of objectives and priorities in a standard catalog that was used as reference in the whole project. Selecting a software product following this systematic procedure establishes a sound basis for a successful application in the clinical environment.