[ES] La explotación de datos de salud ha demostrado ser de creciente interés en la comunidad científica, especialmente para la creación y uso de sistemas de ayuda a la decisión clínica (SADC). Para abordar este problema, tradicionalmente se ha investigado por separado en materia de modelos de información, modelos de dominio y SADC. En lo que se refiere a modelos de información, las propuestas presentan limitaciones semánticas y no tienen en cuenta la interacción con los modelos de dominio, que pretenden proporcionar una comprensión formal y compartida del conocimiento clínico, ni con los SADC, cuya finalidad es proporcionar apoyo a la toma de decisión clínica a partir de la historia clínica electrónica (HCE). La finalidad de esta tesis se enmarca dentro del objetivo general de enriquecer sistemas de HCE con resultados de SADC y modelos de dominio representados mediante datos enlazados abiertos. Para ello, se investiga la combinación y explotación conjunta de las tecnologías más avanzadas para modelos de información, modelos de dominio y SADC. La principal contribución de esta tesis es el desarrollo de metodologías y herramientas para enriquecer la HCE con resultados de SADC y datos enlazados abiertos. Las contribuciones específicas son las siguientes: * Definición conceptual y metodológica de la HCE aumentada con información potencialmente relevante de la web semántica. * Definición conceptual y metodológica del informe radiológico estructurado (IRE), enriquecido con resultados de SADC basados en reglas, visión por computación y modelos de aprendizaje automático. * Caso de uso de HCE aumentada, consistente en enriquecer la HCE resumida del Sistema Nacional de Salud de España con datos enlazados abiertos sobre interacciones farmacológicas y tratamientos recomendados para los episodios activos del paciente. * Sistema de IRE enriquecido con resultados de SADC. Incluye el desarrollo de plantillas de IRE y mecanismos para el enriquecimiento de las mismas con resultados de SADC basados en reglas, cuantificación de imagen médica y redes neuronales. Nuestro objetivo es mejorar el grado de interoperabilidad en las integraciones de sistemas de HCE con SADC y datos enlazados abiertos, mediante estrategias basadas en los tres pilares de la interoperabilidad semántica: modelos de información, de arquetipos y de dominio. Esto tiene el potencial de repercutir positivamente sobre la salud y el cuidado del paciente, especialmente en el paradigma de la medicina personalizada. / [CA] L'explotació de dades de salut ha demostrat ser de creixent interés en la comunitat científica, especialment per a la creació i ús de sistemes d'ajuda a la decisió clínica (SADC). Per a abordar aquest problema, tradicionalment s'ha investigat per separat en matèria de models d'informació, models de domini i SADC. Pel que fa a models d'informació, les propostes presenten limitacions semàntiques i no tenen en compte la interacció amb els models de domini, que pretenen proporcionar una comprensió formal i compartida del coneixement clínic, ni amb els SADC, la finalitat dels quals és proporcionar suport a la presa de decisió clínica partint de la història clínica electrònica (HCE). La finalitat d'aquesta tesi s'emmarca dins de l'objectiu general d'enriquir sistemes de HCE amb resultats de SADC i models de domini representats mitjançant dades enllaçades obertes. Per a això, s'investiga la combinació i explotació conjunta de les tecnologies més avançades per a models d'informació, models de domini i SADC. La principal contribució d'aquesta tesi és el desenvolupament de metodologies i eines per a enriquir la HCE amb resultats de SADC i dades enllaçades obertes. Les contribucions específiques són les següents: * Definició conceptual i metodològica de la HCE augmentada amb informació potencialment rellevant de la web semàntica. * Definició conceptual i metodològica de l'informe radiològic estructurat (IRE), enriquit amb resultats de SADC basats en regles, visió per computació i models d'aprenentatge automàtic. * Cas d'ús de HCE augmentada, consistent a enriquir la HCE resumida del Sistema Nacional de Salut d'Espanya amb dades enllaçades obertes sobre interaccions farmacològiques i tractaments recomanats per als episodis actius del pacient. * Sistema de IRE enriquit amb resultats de SADC. Inclou el desenvolupament de plantilles de IRE i mecanismes per a l'enriquiment de les mateixes amb resultats de SADC basats en regles, quantificació d'imatge mèdica i xarxes neuronals. El nostre objectiu és millorar el grau d'interoperabilitat en les integracions de sistemes de HCE amb SADC i dades enllaçades obertes, mitjançant estratègies basades en els tres pilars de la interoperabilitat semàntica: models d'informació, d'arquetips i de domini. Això té el potencial de repercutir positivament sobre la salut i la cura del pacient, especialment en el paradigma de la medicina personalitzada. / [EN] The exploitation of health data has proven to be of increasing interest in the scientific community, especially for the creation and use of clinical decision support systems (CDSS). To address this problem, separate research has traditionally been done on information models, domain models and CDSS. Regarding information models, the proposals present semantic limitations and do not consider the interaction with domain models, which aim to provide a formal and shared understanding of clinical knowledge, nor with CDSS, whose purpose is to provide clinical decision support from the electronic health record (EHR). The aim of this thesis is framed within the general goal of enriching EHR systems with SADC results and domain models represented by open linked data. For this purpose, the combination and joint exploitation of state-of-the-art technologies for information models, domain models and SADC is investigated. The main contribution of this thesis is the development of methodologies and tools to enrich EHR with SADC results and open linked data. Specific contributions are: * Conceptual and methodological definition of EHR augmented with potentially relevant information from the semantic web. * Conceptual and methodological definition of the structured radiology report (SRR), enriched with CDSS results based on logical rules, computer vision and machine learning models. * Augmented EHR use case, consisting of enriching the summarized EHR of the Spanish National Health System with linked open data on pharmacological interactions and recommended treatments for active patient episodes. * SRR system enriched with CDSS results. Includes the development of SRR templates and mechanisms for enriching them with SADC results based on logical rules, medical image quantification and neural networks. Our goal is to improve the degree of interoperability in EHR system integrations with CDSS results and linked open data, through strategies based on the three pillars of semantic interoperability: information, archetype and domain models. This has the potential to positively impact health and patient care, especially in the personalized medicine paradigm. / Mañas García, A. (2022). Enriquecimiento de la historia clínica electrónica con información de sistemas de ayuda a la decisión clínica y datos enlazados abiertos [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/187730

The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health / Information Science / D. Litt. et Phil. (Information Science)

<p>This thesis examines the problems related to IT in the Swedish healthcare system, specifically the drug searching part of the electronic healthcare systems used in Sweden. The question formulation is divided into two questions: What parameters and functions are of greatest importance when performing a search on drugs, and how should these be presented in a graphical user interface? Thus the purpose is to answer these questions through developing a design concept, in the form of a prototype, which describes how a drug search can be carried out.</p><p>The entry point is a central quality checked drug database that is managed and owned by Swedish county councils and regions. The problem is attacked through user-centered methods where interviews of physicians and developers, in conjunction with observations, are used to give an overview of the problem area as well as to specify a requirements specification for the prototype that this thesis aims to develop. The thesis result is a requirements specification in combination with a prototype that exemplifies how drug searching can be performed, the prototype is based the requirements gathered from the interviews with the user group of physicians.</p> / <p>Den här uppsatsen behandlar problematiken kring IT i vården och mer specifikt läkemedelssökningar i vårddokumentationssystem. Frågeställningen är uppdelad i två frågor: Vilka parametrar och funktioner är av störst vikt vid en sökning på läkemedel samt, hur bör dessa presenteras i det grafiska gränssnittet? Syftet är därav att besvara dessa frågor genom ett designkoncept, i form av en prototyp, som beskriver hur en läkemedelssökning kan gå till.</p><p>Ingångspunkten är en centralt kvalitetssäkrad läkemedelsdatabas som förvaltas av en organisation som ägs av Sveriges landsting och regioner. Problemet angrips med hjälp av användarcentrerade metoder där intervjuer av läkare och utvecklare används, tillsammans med observationer, för att ge en bild av problemområdet samt för att ställa upp krav på den prototyp som denna uppsats ämnar framta. Uppsatsens resultat är en kravspecifikation i kombination med en prototyp för hur läkemedelssökning kan gå till baserat på krav extraherade ur intervjuer med en användargrupp bestående av läkare.</p>

En esta tesis doctoral se presenta una propuesta de representación ontológica de la arquitectura de modelo dual de la Historia Clínica Electrónica. La representación de arquetipos con el lenguaje OWL ha permitido: 1) la definición e implementación de un método de evaluación de la calidad de arquetipos basado en técnicas de razonamiento, 2) la definición de una metodología y un marco de trabajo para la interoperabilidad de modelos de contenido clínico, y 3) la aplicación de técnicas y herramientas de desarrollo de software dirigido por modelos para la generación automática de sistemas de información sanitarios a partir de arquetipos. / In this doctoral thesis an ontology-based approach for representing the dual model architecture of Electronic Health Record is presented. The representation of archetypes in OWL allows: 1) the definition and implementation of a quality evaluation method for archetypes based on reasoning techniques, 2) the definition of a methodology and a framework for the interoperability of clinical content models, and 3) applying model driven software development techniques and tools for the automatic generation of health information systems from archetypes.

The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health / Information Science / D. Litt. et Phil. (Information Science)

This thesis examines the problems related to IT in the Swedish healthcare system, specifically the drug searching part of the electronic healthcare systems used in Sweden. The question formulation is divided into two questions: What parameters and functions are of greatest importance when performing a search on drugs, and how should these be presented in a graphical user interface? Thus the purpose is to answer these questions through developing a design concept, in the form of a prototype, which describes how a drug search can be carried out. The entry point is a central quality checked drug database that is managed and owned by Swedish county councils and regions. The problem is attacked through user-centered methods where interviews of physicians and developers, in conjunction with observations, are used to give an overview of the problem area as well as to specify a requirements specification for the prototype that this thesis aims to develop. The thesis result is a requirements specification in combination with a prototype that exemplifies how drug searching can be performed, the prototype is based the requirements gathered from the interviews with the user group of physicians. / Den här uppsatsen behandlar problematiken kring IT i vården och mer specifikt läkemedelssökningar i vårddokumentationssystem. Frågeställningen är uppdelad i två frågor: Vilka parametrar och funktioner är av störst vikt vid en sökning på läkemedel samt, hur bör dessa presenteras i det grafiska gränssnittet? Syftet är därav att besvara dessa frågor genom ett designkoncept, i form av en prototyp, som beskriver hur en läkemedelssökning kan gå till. Ingångspunkten är en centralt kvalitetssäkrad läkemedelsdatabas som förvaltas av en organisation som ägs av Sveriges landsting och regioner. Problemet angrips med hjälp av användarcentrerade metoder där intervjuer av läkare och utvecklare används, tillsammans med observationer, för att ge en bild av problemområdet samt för att ställa upp krav på den prototyp som denna uppsats ämnar framta. Uppsatsens resultat är en kravspecifikation i kombination med en prototyp för hur läkemedelssökning kan gå till baserat på krav extraherade ur intervjuer med en användargrupp bestående av läkare.

Sepsis is the leading cause of death among critically ill patients and the 10th most common cause of death overall in the United States. The mortality rates increase with severity of the disease, ranging from 15% for sepsis to 60% for septic shock. Patient with sepsis can present varied clinical symptoms depending on the personal predisposition, causal microorganism, organ system involved, and disease severity. To facilitate sepsis diagnosis, the first sepsis consensus definitions was published in 1991 and then updated in 2001. Early recognition of a sepsis patient followed with timely and appropriate treatment and management strategies have been shown to significantly reduce sepsis-related mortality, and allows care to be provided at lower costs. Despite the rapid progress in the knowledge of pathophysiological mechanisms of sepsis and its treatment in the last two decades, identifying patient with sepsis and therapeutic approaches to sepsis and its complications remains challenging to critical care clinicians. Hence, the objectives of this thesis were to 1) evaluate the test characteristics of the two sepsis consensus definitions and delineate the differences in patient profile among patients meeting or not meeting sepsis definitions; 2) determine the relationship between the changes in several physiological parameters before sepsis onset and sepsis, and to determine whether these parameters could be used to identify sepsis in critically ill adults; 3) evaluate the effect of corticosteroids therapy on patient mortality. Data used in this thesis were prospectively collected from an electronic medical record system for all the adult patients admitted into the seven critical care units (ICUs) in a tertiary medical center. Besides analyzing data at the ICU stay level, we investigated patient information in various time frames, including 24-hour, 12-hour, and 6-hour time windows. In the first study of this thesis, the 1991 sepsis definition was found to have a high sensitivity of 94.6%, but a low specificity of 61.0%. The 2001 sepsis definition had a slightly increased sensitivity but a decreased specificity, which was 96.9% and 58.3%, respectively. The areas under the ROC curve for the two consensus definitions were similar, but less than optimal. The sensitivity and area under the ROC curve of both definitions were lower at the 24-hour time window level than those of the unit stay level, though the specificity increased slightly. At the time window level, the 1991 definitions performed slightly better than the 2001 definition. In the second study, minimum systolic blood pressure performed the best, followed by maximum respiratory rate in discriminating sepsis patients from SIRS patients. Maximum heart rate and maximum respiratory rate can differentiate sepsis patients from non-SIRS patients fairly well. The area under ROC of the combination of five physiological parameters was 0.74 and 0.90 for comparing sepsis to non-infectious SIRS patients and comparing sepsis to non-SIRS patients, respectively. Parameters typically performed better in 24-hour windows compared to 6-hour or 12-hour windows. In the third study, significantly increased hospital mortality and ICU mortality were observed in the group treated with low-dose corticosteroids than the control group based on the propensity score matched comparisons, and multivariate logistic regression analyses after adjustment for propensity score alone, covariates, or propensity score (in deciles) and covariates. This thesis advances the existing knowledge by systemically evaluating the test characteristics for the 1991 and 2001 sepsis consensus definitions, delineating physiological signs and symptoms of deterioration in the preceding 24 hours prior to sepsis onset, assessing the prediction performances of single or combined physiological parameters, and examining the use of corticosteroids treatment and survival among septic shock patients. In addition, this thesis sets an innovative example on how to use data from electronic medical records as these surveillance systems are becoming increasingly popular. The results of these studies suggest that a more parsimonious set of definitional criteria for sepsis diagnosis are needed to improve sepsis case identification. In addition, continuously monitored physiological parameters could help to identify patients who show signs of deterioration prior to developing sepsis. Last but not least, caution should be used when considering a recommendation on the use of low dose corticosteroids in clinical practice guidelines for the management of sepsis.

This thesis introduces the reader into RespiHeart, which is a product under development. RespiHeart is an complement/alternative to the regular Pulse Oximeter and is intended to be used within the health care sector for combined measurements and communication on open inexpensive platforms. This thesis evaluates interaction between RespiHeart and a Raspberry Pi 3 Model B to evaluate if the computer is capable of handling the data from RespiHeart and make signal processing. Python is used throughout the whole project and is a suitable language for interaction and signal processing in real time. / Detta examensarbete introducerar läsaren till RespiHeart, en ny trådlös produkt som är under utveckling. RespiHeart är ett komplement/alternativ till den nuvarande Pulsoximetern och är tänkt att användas inom sjukvården för analys, kommuniakation och kombinerade mätningar på öppna billiga plattformar. Detta project utvärderar interaktionen mellan RespiHeart och en Raspberry Pi 3 Model B för att undersöka om datorn är kapabel till att hantera datan från RespiHeart samt göra signal processing i real tid. Programmeringsspråket Python användes under hela projektet och är ett lämpligt språk att använda för interation och signal processing i real tid.

Healthcare is a complex system under great pressure for meeting the patients’ needs. Implementing technology at inpatient wards might possibly support healthcare professionals and improve quality of care. However, these technologies might come with issues and the system might not be used as intended. This master thesis project investigates how healthcare professionals communicate at an inpatient ward and how this might be affected by implementing a Mobile Healthcare Solution (MHS). Further, it sought to question why healthcare professions might, or might not, use the MHS as a support of their daily work and what some reasons for this might be. Research methods were of qualitative approach. Field studies were performed at an inpatient ward and further, two healthcare professionals were interviewed. Grounded Theory (GT) was chosen as a method to process the data and obtain understanding for communication at the inpatient ward. The results showed that healthcare professionals communicate verbally, written and by reading, using different tools. The most prominent ways of communication were verbally, where it was common to report or discuss about a patient. The means for communication did not get drastically affected by implementing the MHS and reasons for this were of social, technical and organizational types. Some reasons for not using the MHS were habits and due to healthcare professionals perceiving the MHS as more time consuming than manual handling. However, a specific investigation of whether this might affect the usage of the MHS is yet needed

Colorectal cancer (CRC) is a health challenge worldwide and early detection of the disease is crucial to improve patient prognosis. It is common for the first contact with care to occur in primary care centers where general practitioners often face the challenge of distinguishing CRC from other diseases with similar symptoms. In this master thesis, patient records from primary care were used to create, optimize, and evaluate a machine learning model that classifies patients with CRC for early detection of the disease. The data used in the project included parts of electronic health records (EHRs) from both public (SLSO) and privately run (Capio and Praktikertjänst) primary care centers in the Stockholm region. The available dataset was cleaned and pre- processed, and then tested on four separate models. After selecting and optimizing the most promising model, LightGBM, a detailed evaluation of the model was performed. To simulate realistic clinical conditions, data from the three months prior to diagnosis were excluded from two of the datasets. The results were then compared with a baseline machine learning model that utilized ICD codes extracted from EHRs in primary care for early detection of CRC.The results showed that the final developed model had a generally good performance with an AUROC score of a maximum of 85.8%, which indicates very good ability to distinguish between the classes. The performance dropped when using the datasets with 3 months of data removed, but the ROC curves still showed a better ability than random classification to distinguish between the classes with a AUROC score of maximum 60,8%. The results also showed that the model developed in this master thesis outperforms the baseline model, which was based on ICD codes, from a performance perspective. For future development and before a possible clinical implementation, a larger data set should be used for training and testing. / Tjock- och ändtarmscancer, kolorektal cancer (KRC) är en hälsoutmaning över hela världen och tidig upptäckt av sjukdomen är avgörande för att förbättra patientens prognos. Det är vanligt att den första kontakten med vården inträffar på vårdcentraler där allmänläkare ofta står inför utmaningen att skilja KRC från andra sjukdomar med liknande symtom. I denna masteruppsats kommer patientjournaler från primärvården att användas för att skapa, optimera och utvärdera en maskininlärningsmodell som klassificerar patienter med KRC för tidig upptäckt av sjukdomen.De data som använts i projektet omfattade delar av elektroniska patientjournaler (EHR) från både offentliga (SLSO) och privatägda (Capio och Praktikertjänst) primärvårdscentraler i Stockholmsregionen. Den tillgängliga datamängden städades och förbehandlades, och testades sedan på fyra separata modeller. Efter att ha valt ut och optimerat den mest lovande modellen, LightGBM, utfördes en detaljerad utvärdering av modellen. För att simulera realistiska kliniska tillstånd utvärderades modellen på två datamängder där data från tre månader före diagnos uteslöts. Resultaten jämfördes sedan med en baslinjemodell som använde ICD-koder som hämtats från journalsystem inom primärvården för tidig upptäckt av CRC.Resultaten visade att den slutliga utvecklade modellen hade en generellt bra prestanda med en AUROC-poäng på högst 85,8%, vilket indikerar mycket god förmåga att skilja mellan klasserna. Prestandan sjönk vid användning av datasatserna med 3 månaders data borttagen, men ROC-kurvorna visade fortfarande en bättre förmåga än slumpmässig klassificering att skilja mellan klasserna med en AUROC-poäng på högst 60,8%. Resultaten visade också att den modell som utvecklats i denna masteruppsats överträffar baslinjemodellen, som baserades på ICD-koder, ur ett prestationsperspektiv. För framtida utveckling och före en eventuell klinisk implementation bör en större datamängd användas för träning och testning av modellen.