Este trabalho promove um estudo em informática em saúde no qual se analisam laudos de radiologia torácica através de métodos de processamento estatístico de linguagem natural com o intuito de subsidiar a interoperabilidade entre sistemas de saúde. Foram utilizados 2000 laudos de radiologia do tórax para a extração de conhecimento identificando-se as palavras, n-gramas e frases que os compõem. Foi calculado o índice de Zipf e verificou-se que poucas palavras compõem a maioria dos laudos e que a maioria das palavras não tem representatividade estatística A partir dos termos identificados foi realizada a tradução e a comparação da existência desses em um vocabulário médico padronizado com terminologia internacional, o SNOMEDCT. Os termos que tinham uma relação completa e direta com os termos traduzidos foram incorporados nos termos de referência juntamente com a classe à qual o termo pertence e seu identificador. Foram selecionados outros 200 laudos de radiologia de tórax para realizar o experimento de rotulação dos termos em relação à referência. A eficiência obtida neste estágio, que é o percentual de rotulação dos laudos, foi de 45,55%. A partir de então foram incorporados aos termos de referência, sob a classe de conceito de ligação, artigos, preposições e pronomes. É importante ressaltar que esses termos não adicionam conhecimento de saúde ao texto. A eficiência obtida foi de 73,23%, aumentando significativamente a eficiência obtida anteriormente. Finalizamos o trabalho com algumas formas de aplicação dos laudos rotulados para a interoperabilidade de sistemas, utilizando para isto ontologias, o HL7 CDA (Clinical Documents Architecture) e o modelo de arquétipos da Fundação OpenEHR. / This work promotes a study in health informatics technology which analyses reports of chest X-ray through statistical natural language processing methods for the purpose of supporting the interoperability between health systems. Two thousand radiology reports were used for the extraction of knowledge by identifying the words, n-grams and phrases of reports. Zipfs constant was studied and it was determined that few words make up the majority of the reports and that most of the words do not have statistical significance. The translation and comparison with exisiting standardized medical vocabulary with international terminology, called SNOMED-CT, was done based on the terms identified. The terms that had a complete and direct correlation with the translated terms were incorporated into the reference terms along with its class and the word identifier. Another 200 reports of chest x-rays were selected to perform the terms tagging experiment of with respect to the reference. The efficiency obtained, which is the percentage of labeling of the reports, was 45.55%. Subsequentely, articles, prepositions and pronouns were incorporated into the terms of reference under the linkage concept of class. It is important to note that these terms do not carry health knowledge to the text. Thus, the efficiency ratio was 73.23%, significantly increasing the efficiency obtained previously. The study was concluded with some forms of application of the reports tagged for system interoperability, using different ontologies, the HL7 CDA (Clinical Documents Architecture) and the archetypes at OpenEHR Fondation.

Orientador: Ana Silvia Sartori Barraviera Seabra Ferreira / Resumo: De acordo com a OMS o termo Telemedicina pode ser definido como “a oferta de serviços ligados aos cuidados com a saúde, nos casos em que a distância é um fator crítico”. Ela pode ser utilizada em várias áreas como dermatologia, cardiologia, trauma, emergência, patologia, cirurgia, psiquiatria, radiologia. Já a Telessaúde é um termo mais amplo, envolvendo diferentes profissionais de saúde de áreas como enfermagem, fisioterapia, nutrição, psicologia. Devido à atual crise financeira do país, as características geográficas e dimensões territoriais, contrastes sociais, econômicos e culturais, existência de milhares de pessoas que vivem em locais de difícil acesso e distantes de unidades de saúde especializadas, o uso da tecnologia nas áreas da Telemedicina e Telessaúde mostra-se muito eficaz para a aproximação das populações localizadas em lugares remotos; integração de profissionais e pesquisadores; melhorias na gestão dos serviços de saúde e economia de gastos públicos. Assim, este estudo teve como objetivo descrever, por meio de um ebook, as ações das atividades e serviços de Telemedicina e Telessaúde desenvolvidas no Hospital das Clínicas e na Faculdade de Medicina de Botucatu da UNESP entre os anos de 2017 e 2018. Desta forma, este o estudo foi retrospectivo, caracterizando-se pela investigação e análise de atividades e serviços acontecidos entre os anos de 2017 e 2018, além de abranger reflexões e discussões sobre atividades e planejamentos futuros e desenvolvimento de dossi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: According to WHO the term telemedicine can be defined as "the provision of health care services in cases where distance is a critical factor." It can be used in several areas such as dermatology, cardiology, trauma, emergency, pathology, surgery, psychiatry, radiology. Telehealth is a broader term, involving different health professionals in areas such as nursing, physiotherapy, nutrition, psychology. Due to the country's current financial crisis, geographical characteristics and territorial dimensions, social, economic and cultural contrasts, existence of thousands of people living in difficult to reach places and away from specialized health units, the use of technology in the areas of telemedicine and telehealth are very effective for the approximation of populations located in remote places; integration of professionals and researchers; improvements in the management of health services and savings in public spending. The purpose of this study was to describe, through an ebook, the actions of the telemedicine and telehealth services and activities developed at the Hospital das Clínicas and at the Botucatu Medical School of UNESP between 2017 and 2018. Thus, this study was retrospective and characterized by the investigation and analysis of activities and services that took place between the years 2017 and 2018, as well as reflections and discussions on future activities and planning and development of dossier with the information and data raised during the research . Thus,... (Complete abstract click electronic access below) / Mestre

Testing an integrated information system that relies on data from multiple sources can be a challenge, particularly when the data is confidential. This thesis describes a novel test data extraction approach, called semantic-based test data extraction for integrated systems (iSTDE) that solves many of the problems associated with creating realistic test data for integrated information systems containing confidential data. iSTDE reads a consistent cross-section of data from the production databases, manipulates that data to obscure individual identities while still preserving overall semantic data characteristics that are critical to thorough system testing, and then moves that test data to an external test environment. This thesis also presents a theoretical study that compares test-data extraction with a competing technique, named test-data generation. Specifically, this thesis a) describes a comparison method that includes a comprehensive list of characteristics essential for testing the database applications organized into seven different areas, b) presents an analysis of the relative strengths and weaknesses of the different test-data creation techniques, and c) reports a number of specific conclusions that will help testers make appropriate choices.

Consumers face several challenges using the Internet to fill health-related needs. (1) In many cases, they face a language gap as they look for information that is written in unfamiliar technical language. (2) Medical information in social media is of variable quality and may be appealing even when it is dangerous. (3) Discussion groups provide valuable social support for necessary lifestyle changes, but are variable in their levels of activity. (4) Finding less popular groups is tedious. We present solutions to these challenges. We use a novel adaptation of topic models to address the language gap. Conventional topic models discover a set of unrelated topics that together explain the combinations of words in a collection of documents. We add additional structure that provides relationships between topics corresponding to relationships between consumer and technical medical topics. This allows us to support search for technical information using informal consumer medical questions. We also analyze social media related to eating disorders. A third of these videos promote eating disorders and consumers are twice as engaged by these dangerous videos. We study the interactions of two communities in a photo-sharing site. There, a community that encourages recovery from eating disorders interacts with the pro-eating disorder community in an attempt to persuade them, but we found that this attempt entrenches the pro-eating disorder community more firmly in its position. We study the process by which consumers participate in discussion groups in an online diabetes community. We develop novel event history analysis techniques to identify the characteristics of groups in a diabetes community that are correlated with consumer activity. This analysis reveals that uniformly advertise the popular groups to all consumers impairs the diversity of the groups and limits their value to the community. To help consumers find interesting discussion groups, we develop a system for personalized recommendation for social connections. We extend matrix factorization techniques that are effective for product recommendation so that they become suitable for implicit power-law-distributed social ratings. We identify the best approaches for recommendation of a variety of social connections involving consumers, discussion groups and discussions.

No description available.

The process of patient care relies on clinical data spread across specialized hospital departments. Powerful software is being designed to assimilate this disconnected patient data before treatment can be decided. However, these data are often presented to clinicians on interfaces that do not fit clinical workflows, leading to poor operational efficiency and increased patient safety risks. This project relies on ethnographic design methods to create evidence of clinician preferences pertaining to the presentation and collection of information on user interfaces in patient rooms. Using data gathered in clinical observation, a prototype interface was designed to enable doctors to conduct clinical tasks through a usable patient room interface. The prototype evaluation with doctors identified clinical tasks that are relevant in the patient room and provided insight into the perceived usability of such an interface. The evaluation sessions also elucidated on issues of patient-centeredness in technology design, effortless authentication and interface customizability.

The process of patient care relies on clinical data spread across specialized hospital departments. Powerful software is being designed to assimilate this disconnected patient data before treatment can be decided. However, these data are often presented to clinicians on interfaces that do not fit clinical workflows, leading to poor operational efficiency and increased patient safety risks. This project relies on ethnographic design methods to create evidence of clinician preferences pertaining to the presentation and collection of information on user interfaces in patient rooms. Using data gathered in clinical observation, a prototype interface was designed to enable doctors to conduct clinical tasks through a usable patient room interface. The prototype evaluation with doctors identified clinical tasks that are relevant in the patient room and provided insight into the perceived usability of such an interface. The evaluation sessions also elucidated on issues of patient-centeredness in technology design, effortless authentication and interface customizability.

Referrals to the Halifax Infirmary Neurosurgery Department are submitted with regards to spinal conditions with different degrees of complications. Although there exists a Spinal Condition Consultation Protocol to standardize spinal referrals, the information provided from referring physicians is frequently inadequate to accurately triage the patient's condition, partly due to missing diagnostic therapies. The Neurosurgery Department receives a high volume of referrals each year, which imposes a significant administrative workload on the staff. We propose to develop a protocol-driven decision support system to: 1) Provide primary care physicians with timely access to condition specific consultation treatment protocols; and 2) Automate the referral assessment process to eliminate processing delays and administration burden. To this aim, we transformed the Consultation Protocol into a semantic knowledgebase. The decision support services are integrated within a standardized electronic referral system. We believe this system can significantly improve the referral process at the Neurosurgery Division.

Background: UK primary care accounts for 90% of patient contacts in the NHS, and over 300 million consultations every year. Consequently, when primary is suboptimal it has important impacts on population health. At the same time, virtually all general practices use electronic health records (EHR) to capture patient data. Clinical Decision Support (CDS) systems use it to highlight when individual patients do not receive care consistent with clinical guidelines, though ignore the wider population. Electronic Audit and Feedback (e-A&F) systems address the wider population, but their results are difficult to interpret. EHR data has the richness to suggest ways in which care quality could be improved, though this is currently not exploited. The aim of this thesis was to make progress towards better use of primary care EHR data for the purposes of quality improvement (QI) by focusing on e-A&F as a vehicle. Research Objectives were: 1) Develop a model and recommendations to guide EHR data analysis and its communication to health professionals; 2) Use these models and recommendations to develop a system for UK primary care; 3) Implement and evaluate the system to test the models and recommendations, and derive generalisable knowledge. Methods: The overall approach of this thesis was informed by guidance from the Medical Research Council on the development of complex interventions, and Boyrcki et al.’s evidence-based framework for the development of health information technologies (Chapter 2). Theory was first identified through a critical examination of the empirical and theoretical literature regarding CDS and e-A&F systems (Chapter 3), then built upon in a systematic literature search and metasynthesis of qualitative studies of A&F (and e-A&F) interventions (Chapter 4). This resulted in the development a new theory of A&F (Clinical Performance Feedback Intervention Theory; CP-FIT), which was used to inform the development of an e-A&F system for UK primary care – the Performance Improvement plaN GeneratoR (PINGR; version 1). PINGR was then iteratively optimised through a series of three empirical studies. First, its usability was evaluated by software experts using Heuristic Evaluation and Cognitive Walkthrough methodologies (Chapter 5). GPs then performed structured tasks using the system in a laboratory whilst their on-screen interactions and eye movements were recorded (Chapter 6). Finally, PINGR was implemented in 15 GP practices, and CP-FIT used to guide the mixed methods evaluation including examinations of usage records, and interviews with 38 health professionals. Results: There are both empirical and theoretical arguments for combining features from CDS and e-A&F systems to increase their effectiveness; a key recommendation is that e-A&F systems should suggest clinical actions to health professionals (Chapter 3). This is supported by CP-FIT, which has three core propositions: 1) A&F interventions exert their effects through health professionals taking action; 2) Health care organisations have limited capacity to engage with A&F; and 3) Health care professionals and organisations have a strong set of beliefs and behaviours regarding how they provide patient care (Chapter 4). Based on these findings, the unique feature of PINGR is that it suggests improvement actions to users based on EHR data analysis (‘decision-supported feedback’). Key findings from PINGR’s usability evaluation with software experts translated into a set of design guidelines for e-A&F interfaces regarding: summarising clinical performance, patient lists, patient-level information, and suggested actions (Chapter 5). When tested with GPs, these guidelines were found to impact: user engagement; actionability; and information prioritisation (Chapter 6). Following its implementation in practice, PINGR was used on 227 occasions to facilitate the care of 725 patients. These patients were 1.8 (95% CI 1.6-1.9) times more likely to receive improved care according to at least one clinical guideline. Barriers and facilitators to its success included: the resources available to use it; its perceived relative advantages; how compatible it was with pre-existing beliefs and ways of working; the credibility of its data; the complexity of the clinical problems it highlighted; and the ability to act on its recommendations (Chapter 7). Conclusion: It is both feasible and acceptable to health professionals to make better use of EHR data for QI by enabling e-A&F systems to suggest actions for them to take. When designing e-A&F interfaces, attention should be paid to how they summarise clinical performance, and present patient lists and detailed patient-level information. Implementation of e-A&F interventions is influenced by availability of resources, compatibility with existing workflows, and ability to take action based on their feedback results. Unresolved tensions exist regarding how they may deal with patient complexity. Policymakers should consider the relevance of these findings for National Clinical Audits and pay-for-performance initiatives.

The internet has radically changed the way people obtain and interact with information about diseases, treatments, and conditions. Yet, our understanding of how people access and use health information to make decisions- in other words, their health literacy- has not progressed. The overall aim of this thesis is to assess the extent to which health literacy is a valid and useful construct for policy and practice related to online health resources. A mixed-methods research programme of five studies was undertaken, influenced by realist evaluation methodology. First, to ascertain engagement with user-generated online health content (UGC) in the UK, analysis of a large European survey was undertaken. Then, the uncertainty regarding the relationship between health literacy and outcomes was addressed by a systematic review and qualitative analysis of health literacy measures. Results of these two studies informed interviews carried out with 13 'key informants': policymakers and primary care clinicians in the UK with a particular interest in health literacy and/or online information. A systematic review, incorporating a traditional narrative review and a realist review, evaluated existing trials addressing how effects of online resources vary by health literacy level. Finally, data were analysed from a feasibility randomized controlled trial, comparing usage and outcomes of accessing a 'personal experiences'-based asthma website (representing curated user-generated content) versus a 'facts and figures'-based website. Participant health literacy was assessed using an index identified from the systematic review of measures, and website usage was tracked. Approximately 25% of UK internet users engage with UGC at least monthly. The most frequent users were younger, more likely to be male, and to be carers for someone with a long-term illness. Three themes were identified from health literacy measurement: 'appropriate health decisions', 'ability to obtain healthcare services', and 'confidence'. Key informants noted the lack of clarity about how health literacy influences outcomes, and suggested that personal preferences and digital access and skills may be more relevant than health literacy for policy and practice. Existing trials of online resources in which participant health literacy was measured were mostly at high risk of bias; some possible explanations of how these interventions should work in people with low health literacy were that they may experience higher data entry burden related to chronic diseases, and that they may prefer simulated face-to-face communication. Finally, there were no differences between health literacy groups in the feasibility trial regarding usage or outcomes related to either the 'facts and figures' or 'personal experiences' websites. Taken together, these results question the validity and appropriateness of health literacy as a key objective or consideration in the development or use of online resources. While health literacy has value as a general idea, this thesis demonstrates that it may no longer be the right construct to guide intervention development and implementation to improve health outcomes.