Title: Voice controlled electronic health record in dentistry Author: MUDr. Radek Hippmann Department: Department of paediatric stomatology, Faculty hospital Motol Supervisor: Prof. MUDr. Taťjana Dostalová, DrSc., MBA Supervisor's e-mail: Tatjana.Dostalova@fnmotol.cz This PhD thesis is concerning with development of the complex electronic health record (EHR) for the field of dentistry. This system is also enhanced with voice control based on the Automatic speech recognition (ASR) system and module for speech synthesis Text-to- speech (TTS). In the first part of the thesis is described the whole issue and are defined particular areas, whose combination is essential for EHR system creation in this field. It is mainly basic delimiting of terms and areas in the dentistry. In the next step we are engaged in temporomandibular joint (TMJ) problematic, which is often ignored and trends in EHR and voice technologies are also described. In the methodological part are described delineated technologies used during the EHR system creation, voice recognition and TMJ disease classification. Following part incorporates results description, which are corresponding with the knowledge base in dentistry and TMJ. From this knowledge base originates the graphic user interface DentCross, which is serving for dental data...

The information in the medical records serve many purposes: they can be used for diagnosis and therapy, medical documentation contains information that can be the basis for financial authorities for treatment or for pumping reimbursement from health insurance. The data can be used in statistics and other scientific purposes. The aim of study is to verify the simplicity of data process implementation and time of data storing for modification of classical paper WHO dental card, lifetime dental EHR controlled by keyboard and lifetime dental EHR controlled by voice. All three methods were applied on 126 patients. At first the patients were inspected by a standard technique (communication between dentist and nurse) and the data recorded into the paper WHO dental card. The same person recorded all data to lifetime dental EHR using keyboard and using voice. Then we compared the time, which was needed for recording the data using these three methods. Using Friedman test we found very significant differences in time of recording among three methods (p<0.001). We can see that the paper WHO dental card was recorded quickly, but its rise due to missing electronic form is difficult. Times for recording data using keyboard or voice in lifetime dental EHR were not significantly different. The clinical practice...

Objectif : Notre objectif était d’évaluer la qualité des données de la base de données haute résolution (BDHR) implantée dans l’unité de soins intensifs pédiatriques (USIP) de l’Hôpital Sainte-Justine (HSJ). Type d’étude : Un rapport descriptif et une analyse d’une étude prospective de validation d’une BDHR. Environnement : Une USIP de 32 lits, adaptée aux soins médicaux, chirurgicaux et cardiaques dans un centre tertiaire mère-enfant du Canada. Population : Tous les patients admis à l’USIP et ayant un monitorage d’au moins 1 signe vital par un moniteur cardio-respiratoire. Mesures et résultats principaux : Entre juin 2017 et août 2018, les données de 295 jours de patients ont été enregistrées à partir des appareils médicaux et 4465 données ont été filmées et comparées aux données correspondantes dans la BDHR de l’USIP de l’HSJ. Les analyses statistiques ont démontré en général une bonne corrélation, une excellente fiabilité et un bon agrément. Les graphiques de Bland-Altman ont aussi démontré l’exactitude et la précision entre les données récoltées et les données filmées selon les limites d’agrément cliniquement significatives préalablement définies. Conclusions : Cette étude de validation exécutée sur un échantillon représentatif a démontré que la qualité des données était globalement excellente. / Objective: Our objective was to evaluate the data quality of our high-resolution electronic database (HRDB) implemented in the pediatric intensive care unit (PICU) of HSJ. Design: A descriptive report and analysis of a prospective validation of a HRDB. Setting: A 32 beds pediatric medical, surgical and cardiac PICU in a tertiary care free-standing maternal-child health center in Canada. Population: All patients admitted to the PICU with at least one vital sign recorded using a cardiorespiratory monitor connected to the central monitoring station. Measurements and Main Results: Between June 2017 and August 2018, data from 295 patient days were recorded from medical devices and 4,645 data points were video recorded and compared to the corresponding data collected in the HSJ-PICU HRDB. Statistical analysis showed excellent overall correlation, agreement and reliability. Bland-Altman analysis showed excellent accuracy and precision between recorded and collected data within clinically significant pre-defined limits of agreement. Conclusions: This prospective validation study performed on a representative sample showed excellent overall data quality.

The objective of the dissertation thesis has been the information-lexical analysis of Czech medical reports and the usability of international classification systems in the Czech healthcare environment. The analysis of medical reports has been based on the attributes of the Minimal Data Model for Cardiology (MDMC). Narrative medical reports and structured medical reports from the ADAMEK software application have been used. For the thesis SNOMED CT and ICD-10 classification systems have been used. There has been compared how well attributes of MDMC are recorded in narrative and structured medical reports. The language analysis of the Czech narrative medical reports has been made. A new application for measuring diversity in medical reports written in any language is proposed. The application is based on the general concepts of diversities derived from f-diversity, relative f- diversity, self f-diversity and marginal f-diversity. The thesis has come to the conclusion that using a free text in medical reports is not consistent and not standardized. The standardized terminology would bring benefits to physicians, patients, administrators, software developers and payers and it would help healthcare providers as it could provide complete and easily accessible information that belongs to the process of...

Title: Voice controlled electronic health record in dentistry Author: MUDr. Radek Hippmann Department: Department of paediatric stomatology, Faculty hospital Motol Supervisor: Prof. MUDr. Taťjana Dostalová, DrSc., MBA Supervisor's e-mail: Tatjana.Dostalova@fnmotol.cz This PhD thesis is concerning with development of the complex electronic health record (EHR) for the field of dentistry. This system is also enhanced with voice control based on the Automatic speech recognition (ASR) system and module for speech synthesis Text-to- speech (TTS). In the first part of the thesis is described the whole issue and are defined particular areas, whose combination is essential for EHR system creation in this field. It is mainly basic delimiting of terms and areas in the dentistry. In the next step we are engaged in temporomandibular joint (TMJ) problematic, which is often ignored and trends in EHR and voice technologies are also described. In the methodological part are described delineated technologies used during the EHR system creation, voice recognition and TMJ disease classification. Following part incorporates results description, which are corresponding with the knowledge base in dentistry and TMJ. From this knowledge base originates the graphic user interface DentCross, which is serving for dental data...

The information in the medical records serve many purposes: they can be used for diagnosis and therapy, medical documentation contains information that can be the basis for financial authorities for treatment or for pumping reimbursement from health insurance. The data can be used in statistics and other scientific purposes. The aim of study is to verify the simplicity of data process implementation and time of data storing for modification of classical paper WHO dental card, lifetime dental EHR controlled by keyboard and lifetime dental EHR controlled by voice. All three methods were applied on 126 patients. At first the patients were inspected by a standard technique (communication between dentist and nurse) and the data recorded into the paper WHO dental card. The same person recorded all data to lifetime dental EHR using keyboard and using voice. Then we compared the time, which was needed for recording the data using these three methods. Using Friedman test we found very significant differences in time of recording among three methods (p<0.001). We can see that the paper WHO dental card was recorded quickly, but its rise due to missing electronic form is difficult. Times for recording data using keyboard or voice in lifetime dental EHR were not significantly different. The clinical practice...

The objective of the dissertation thesis has been the information-lexical analysis of Czech medical reports and the usability of international classification systems in the Czech healthcare environment. The analysis of medical reports has been based on the attributes of the Minimal Data Model for Cardiology (MDMC). Narrative medical reports and structured medical reports from the ADAMEK software application have been used. For the thesis SNOMED CT and ICD-10 classification systems have been used. There has been compared how well attributes of MDMC are recorded in narrative and structured medical reports. The language analysis of the Czech narrative medical reports has been made. A new application for measuring diversity in medical reports written in any language is proposed. The application is based on the general concepts of diversities derived from f-diversity, relative f- diversity, self f-diversity and marginal f-diversity. The thesis has come to the conclusion that using a free text in medical reports is not consistent and not standardized. The standardized terminology would bring benefits to physicians, patients, administrators, software developers and payers and it would help healthcare providers as it could provide complete and easily accessible information that belongs to the process of...

La France connaît un vieillissement de sa population sans précédent. La part des séniors s’accroît et notre société se doit de repenser son organisation pour tenir compte de ce changement et mieux connaître cette population.De nombreuses cohortes de personnes âgées existent déjà à travers le monde dont quatre en France et, bien que la part de cette population vivant dans des structures d’hébergement collectif (EHPAD, cliniques de soins de suite) augmente, la connaissance de ces seniors reste lacunaire.Aujourd’hui les groupes privés de maisons de retraite et d’établissements sanitaires comme Korian ou Orpéa s’équipent de grandes bases de données relationnelles permettant d’avoir de l’information en temps réel sur leurs patients/résidents. Depuis 2010 les dossiers de tous les résidents Korian sont dématérialisés et accessibles par requêtes. Ils comprennent à la fois des données médico-sociales structurées décrivant les résidents et leurs traitements et pathologies, mais aussi des données textuelles explicitant leur prise en charge au quotidien et saisies par le personnel soignant.Au fil du temps et alors que le dossier résident informatisé (DRI) avait surtout été conçu comme une application de gestion de base de données, il est apparu comme une nécessité d’exploiter cette mine d’informations et de construire un outil d’aide à la décision destiné à améliorer l’efficacité des soins. L’Institut du Bien Vieillir IBV devenu entretemps la Fondation Korian pour le Bien Vieillir a alors choisi, dans le cadre d’un partenariat Public/Privé de financer un travail de recherche destiné à mieux comprendre le potentiel informatif de ces données, d’évaluer leur fiabilité et leur capacité à apporter des réponses en santé publique. Ce travail de recherche et plus particulièrement cette thèse a alors été pensée en plusieurs étapes.- D’abord l’analyse de contenu du data warehouse DRI, l’objectif étant de construire une base de données recherche, avec un versant social et un autre de santé. Ce fut le sujet du premier article.- Ensuite, par extraction directe des informations socio-démographiques des résidents dès leur entrée, de leurs hospitalisations et décès puis, par un processus itératif d’extractions d’informations textuelles de la table des transmissions et l’utilisation de la méthode Delphi, nous avons généré vingt-quatre syndromes, ajouté les hospitalisations et les décès et construit une base de données syndromique, la Base du Bien Vieillir (BBV) . Ce système d’informations d’un nouveau type a permis la constitution d’une cohorte de santé publique à partir de la population des résidents de la BBV et l’organisation d’un suivi longitudinal syndromique de celle-ci. La BBV a également été évaluée scientifiquement dans un cadre de surveillance et de recherche en santé publique au travers d’une analyse de l’existant : contenu, périodicité, qualité des données. La cohorte construite a ainsi permis la constitution d’un outil de surveillance. Cet échantillon de population a été suivi en temps réel au moyen des fréquences quotidiennes d’apparitions des 26 syndromes des résidents. La méthodologie d’évaluation était celle des systèmes de surveillance sanitaire proposée par le CDC d’Atlanta et a été utilisée pour les syndromes grippaux et les gastro entérites aiguës. Ce fut l’objet du second article.- Enfin la construction d’un nouvel outil de santé publique : la distribution de chacun des syndromes dans le temps (dates de transmissions) et l’espace (les EHPAD de transmissions) a ouvert le champ de la recherche à de nouvelles méthodes d’exploration des données et permis d’étudier plusieurs problématiques liées à la personne âgée : chutes répétées, cancer, vaccinations et fin de vie. / French population is rapidly aging. Senior citizens ratio is increasing and our society needs to rethink its organization, taking into account this change, better knowing this fast growing population group.Even if numerous cohorts of elderly people already exist worldly with four in France and, even as they live in growing numbers in nursing homes and out-patient treatment clinics, knowledge of this population segment is still missing.Today several health and medico-social structures groups as Korian and Orpéa invest in big relational data bases enabling them to get real-time information about their patients/residents. Since 2010 all Korian residents’ files are dematerialized and accessible by requests. They contain at the same time, structured medico-social data describing the residents as well as their treatments and pathologies, but also free-textual data detailing their daily care by the medical staff.Through time and as the computerized resident file (DRI) was mainly conceived as a data base management application, it appeared essential to mine these data and build a decision-making tool intended to improve the care efficiency. The Ageing Well Institute becoming meanwhile the Korian Ageing Well Foundation chose then, working in a private/public partnership, to finance a research work intented to better understand these datas’ informative potential, to assess their reliability and response to public health threats. This research work and this thesis were then designed in several steps:- First, a content analysis of the data warehouse DRI, the objective being to build a research data base, with a social side and a health side. This was the first paper subject.- Then, by direct extraction of the residents’ socio-demographic information at nursing home (NH) entry, adding hospitalizations and deaths, and finally, by an iterative textual extraction process of the transmissions data and by using the Delphi method, we created twenty-four syndromes, added hospitalizations and deaths and built a syndromic data base, the Ageing Well data base. This information system of a new kind, allowed the constitution of a public health cohort for elderly people from the BBV residents’population and its syndromic longitudinal follow-up. The BBV was also scientifically assessed for surveillance and public health research through present situation analysis: content, periodicity and data quality. This cohort then gave us the opportunity to build a surveillance tool and follow the residents’ population in real-time by watching their 26 daily frequency syndromic distributions. The methodology for that assessment, Atlanta CDCs’ health surveillance systems method, was used for flu and acute gastro enteritis syndroms and was the second paper subject.- Finally, the building of a new public health tool: each syndrom’s distribution through time (transmissions dates) and space (transmissions NH ids) opened the research field to new data exploration methods. I used these to study different health problems afflicting senior citizens: frequent falls, cancer, vaccinations and the end of life.

Bakgrund: Malnutrition hos geriatriska patienter är vanligt och ger negativa hälsoeffekter som genererar ökade vårdbehov. Sjuksköterskor har en nyckelfunktion i behandlingen. Syfte: Syftet var att kartlägga omvårdnadsdokumentationen kring nutrition hos geriatriska patienter på ett länssjukhus. Metod: En retrospektiv, kvantitativ tvärsnittsstudie genomfördes där 37 journaler inkluderades och granskades. Urvalet var konsekutivt. Resultat: Samtliga journaler innehöll någon form av grundläggande information i status. Strukturerade riskbedömningar och generella vårdplaner vid bedömd risk fanns i majoriteten av journalerna. Alla vårdplaner innehöll åtgärder men många saknade kompletterande information om huruvida åtgärden sedan genomförts eller ej. Åtgärderna i den generella vårdplanen var allmänt uttryckta och det var oklart vad patienten i praktiken fått för åtgärd. I 35 % av vårdplanerna fanns en diskrepans mellan dokumenterad måluppfyllelse och övrig dokumentation. Epikrisen innehöll i 51% av journalerna brister som innebär att den inte motsvarar en sammanfattning av given vård och/eller fortsatt behov av åtgärder. Konklusion: Resultatet tyder på att det finns en medvetenhet kring nutrition som omvårdnadsområde med riskbedömning och behov av åtgärder vid risk för malnutrition. Kvaliteten på dokumentationen minskar dock för varje led i omvårdnadsprocessen och behov av förbättringar föreligger både på IT-systemnivå och individ/vårdenhetsnivå hos sjuksköterskorna. / Background: Malnutrition in geriatric patients is common and causes negative health effects that increases further need of care. Nurses have a crucial part of its treatment. Purpose: The purpose was to survey the nutritional documentation of geriatric patients in a county hospital. Method: A retrospective, quantitative cross-sectional study was performed where 37 records where included and reviewed. A consecutive sampling method was used. Results: All records contained some sort of basic nutritional information.  Structured risk assessment and general care plans at assessed risk, was to be found within the majority of the records. All care plans contained planned treatments, but many lacked supplementary information on whether the endeavor was fulfilled or not. The treatments in the care plans were generally expressed and therefore lacks the ability to tell what kind of treatment the patient had received. A discrepancy was found in 35% of the care plans between the reported achievements and other recordings.  Of the epicrisis, 51% did not correspond to delivered care and/or further need of intervention. Conclusion: The result indicates an awareness of the nutritional role in the field of nursing and the importance of risk assessments as well as the need of treatment in patients at risk of malnutrition. The quality of the documentation is successively decreasing in every step of the nursing process. There is a need of improvement in the IT systems as well as the performance of nurses and care settings routines.

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