Yes / Interoperability within different healthcare systems (clinics/hospitals/pharmacies) remains an issue of further research due to a barrier in sharing of the patient’s Electronic Health Record (EHR) information. To solve this problem, cross healthcare system collaboration is required. This paper proposes an interoperability framework that enables a pharmacist to access an electronic version of the patient’s prescription from the doctor using a RESTFul API with ease. Semantic technology standards like Web Ontology Language (OWL), RDF (Resource Description Framework) and SPARQL (SPARQL Protocol and RDF Query Language) were used to implement the framework using JENA semantic framework tool to demonstrate how interoperability is achieved between a pharmacy and a clinic JENA was used to generate the ontology models for the pharmacy called pharmacy.rdf and clinic called clinic.rdf. The two models contain all the information from the two isolated systems. The JENA reasoner was used to merge the two ontology models into a single model.rdf file for easy querying with SPARQL. The model.rdf file was uploaded into a triple store database created using FUSEKI server. SPARQL Endpoint generated from FUSEKI was used to query the triple store database using a RESTFul API. The system was able to query the triple store database and output the results containing the prescription name and its details in JSON and XML formats which can be read by both machines and humans. / Supported by a Institutional Links grant, ID 261865161, under the Newton-Ristekdikti Fund partnership. The grant is funded by the UK Department for Business, Energy and Industrial Strategy and Indonesia Ministry of Research, Technology and Higher Education and delivered by the British Council.

Yes / Purpose: To identify a minimum list of metrics of international relevance to public health, research and service development which can be extracted from practice management systems and electronic patient records in primary optometric practice. Methods: A two stage modified Delphi technique was used. Stage 1 categorised metrics that may be recorded as being part of a primary eye examination by their importance to research using the results from a previous survey of 40 vision science and public health academics. Delphi stage 2 then gauged the opinion of a panel of 7 vision science academics and achieved consensus on contentious metrics and methods of grading/classification. Results: A consensus regarding inclusion and response categories was achieved for nearly all metrics. A recommendation was made of 53 metrics which would be appropriate in a minimum data set. Conclusions: This minimum data set should be easily integrated into clinical practice yet allow vital data to be collected internationally from primary care optometry. It should not be mistaken for a clinical guideline and should not add workload to the optometrist. A pilot study incorporating an additional Delphi stage prior to implementation is advisable to refine some response categories. / This work was supported by the College of Optometrists.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13600号 / 論医博第2310号 / 新制||医||1072(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 村井 俊哉, 教授 佐藤 俊哉, 教授 永井 洋士 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Yes / frailty is an especially problematic expression of population ageing. International guidelines recommend routine identification of frailty to provide evidence-based treatment, but currently available tools require additional resource. Objectives: to develop and validate an electronic frailty index (eFI) using routinely available primary care electronic health record data. Study design and setting: retrospective cohort study. Development and internal validation cohorts were established using a randomly split sample of the ResearchOne primary care database. External validation cohort established using THIN database. Participants: patients aged 65–95, registered with a ResearchOne or THIN practice on 14 October 2008. Predictors: we constructed the eFI using the cumulative deficit frailty model as our theoretical framework. The eFI score is calculated by the presence or absence of individual deficits as a proportion of the total possible. Categories of fit, mild, moderate and severe frailty were defined using population quartiles. Outcomes: outcomes were 1-, 3- and 5-year mortality, hospitalisation and nursing home admission. Statistical analysis: hazard ratios (HRs) were estimated using bivariate and multivariate Cox regression analyses. Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was assessed using pseudo-R2 estimates. Results: we include data from a total of 931,541 patients. The eFI incorporates 36 deficits constructed using 2,171 CTV3 codes. One-year adjusted HR for mortality was 1.92 (95% CI 1.81–2.04) for mild frailty, 3.10 (95% CI 2.91–3.31) for moderate frailty and 4.52 (95% CI 4.16–4.91) for severe frailty. Corresponding estimates for hospitalisation were 1.93 (95% CI 1.86– 2.01), 3.04 (95% CI 2.90–3.19) and 4.73 (95% CI 4.43–5.06) and for nursing home admission were 1.89 (95% CI 1.63–2.15), 3.19 (95% CI 2.73–3.73) and 4.76 (95% CI 3.92–5.77), with good to moderate discrimination but low calibration estimates. Conclusions: the eFI uses routine data to identify older people with mild, moderate and severe frailty, with robust predictive validity for outcomes of mortality, hospitalisation and nursing home admission. Routine implementation of the eFI could enable delivery of evidence-based interventions to improve outcomes for this vulnerable group.

The aim of this project was to investigate what information is critical to convey to nurses when performing digital triage. In addition, the project aimed to investigate how such information could be visualized. This was done through a combined user research and machine learning approach, which enabled for a more nuanced and thorough investigation compared to only making use of one of the two fields. There is sparse research investigating how digital triaging can be improved and made more efficient. Therefore, this study has contributed with new and relevant insights. Three machine learning algorithms were implemented to predict the right level of care for a patient. Out of these three, the random forest classifier proved to have the best performance with an accuracy of 69.46%, also having the shortest execution time. Evaluating the random forest classifier, the most important features were stated to be the duration and progress of the symptoms, allergies to medicine, chronic diseases and the patient's own estimation of his/her health. These factors could all be confirmed by the user research approach, indicating that the results from the approaches were aligned. The results from the user research approach also showed that the patients' own description of their symptoms was of great importance. These findings served as a basis for a number of visualization decisions, aiming to make the triage process as accurate and efficient as possible.

This thesis portrays a research study undertaken to explore the unknown concept of electronic interprofessional documentation. Academic literature largely centers on multidisciplinary electronic documentation yet clinicians provide care using an integrated interprofessional model. Current design of electronic health records (EHRs) continue to propagate a deluge of data resulting from disparate siloed documentation. End users report challenges with finding data. Additionally, care planning and decision making are delayed. To bridge the gap between electronic design and interprofessional delivery of care, more understanding of shared documentation is required. The provenance of the design of this study is based on the concept of common ground and the framework for complex diverse data. Common ground is a shared communication space within a team with a shared purpose (Cioffi, Wilkes, Cummings, Warne, & Harrison, 2010). The framework for complex diverse data posits that data must be linked to other interconnected data; linked data enables connection of diverse pieces and insight-sharing within a team. A descriptive qualitative study was designed to answer the research question: What are the common data elements between disciplines? A case scenario of a patient with a fractured hip was created; participants generated clinical notes based on the video and patient record. The clinical notes were coded and results indicated numerous diverse common data elements. These were analyzed and major findings such as categories appropriate for use by all disciplines on admission and design implications for care planning throughout an acute care stay were identified. Further, as disciplines and care team members do have different documentation patterns, it is suggested attendance to differences in the entry of data yet maintaining a common ground in the display of patient information is vital. Finally suggestions such as duplicate checking for documentation through a common care plan that tracks assessments and completed interventions alongside planned interventions are made. Creation of a standardized interprofessional terminology is key in building the road leading to interprofessional electronic documentation. / Graduate

The problem exists that there are no education initiatives focused on teaching and taking into practice the skills of effective interprofessional discourse in this online, asynchronous, professional environment. The purpose of this study was to examine whether it is possible for students in the health professions to learn to practice effective interprofesssional online discourse in an electronic health record. This was a mixed methods study that included both quantitative ad qualitative inquiry underpinned by post positivism and used a method triangulation research design model. Both quantitative and qualitative data were collected and analyzed from an educational intervention and simulated electronic health record exercise. The students' perceptions of their practice in an electronic health record did not necessarily match their knowledge and skills in this group of students. Emergent themes from the study pointed in the possible direction of perceived value of the exercise, prior experience in an electronic health record, and logistical barriers to the activity. Perceived time constraints was a particularly strong concern of the students. The emergent themes might be valuable considerations for other interprofessional programs looking to implement similar activities concerning the electronic health record.

Pacientes críticos tratados em uma UTI comumente apresentam quadros severos de hiperglicemia. Estudos mostram que o controle da glicemia a níveis restritos leva à melhoria no prognóstico de tais pacientes. O controle glicêmico é feito através da medição freqüente da glicemia através de um exame de \"ponta de dedo\", aliada à infusão de insulina, numa atividade bastante trabalhosa para a equipe de enfermagem. Nos últimos anos, surgiram os primeiros sistemas comerciais de monitoramento contínuo de glicose para uso ambulatorial. Entretanto, há uma série de limitações que dificultam seu uso em uma UTI. No presente trabalho, foi desenvolvido um sistema de monitoramento contínuo de glicose para pacientes críticos hiperglicêmicos, batizado de vMonGluco. Esse sistema utiliza um monitor contínuo de glicose, disponível comercialmente, conectado a um palmtop, de forma a obter leituras de glicose em tempo real. Os dados coletados são enviados a um servidor seguindo a norma Health Level Seven (HL7). O servidor redireciona os dados a um monitor de beira de leito, disponibilizando as leituras de maneira prática. As informações também são armazenadas em um sistema de Prontuário Eletrônico do Paciente. Testes realizados em pacientes comprovaram a validade das leituras obtidas. Assim, com o presente trabalho, espera-se trazer uma contribuição prática e significativa no tratamento de pacientes críticos hiperglicêmicos. / Critical patients in an ICU usually experience severe hyperglycemia. Studies show that the control of glycemia to restricted levels can increase the prognosis of these patients. This control is usually done through the frequent reading of glycemia using a fingerstick test, together with the infusion of insulin, in a troublesome activity for the nursery team. In the last few years, the first commercial glucose monitoring systems for ambulatory use have been created. However, several difficulties limit its use in an ICU. In the present work, a continuous glucose monitoring system, named as vMonGluco, was developed. The system uses a commercially available continuous glucose monitor connected to a palmtop, in order to get glucose readings in real time. The collected data are sent to a server using the Health Level Seven (HL7) standard. The server redirects the data to a bedside monitor, so the readings can be accessed in practical way. The information is also stored in an Electronic Health Record system. Tests applied to patients showed the validity of the obtained readings. This way, with the present work, it is expected to bring a practical and significant contribution to the treatment of critical hyperglycemic patients.

Esta tese apresenta um modelo de representação de conhecimento fundamentado em arquétipos para o mapeamento da base de conhecimento que separa a informação e o conhecimento. De um lado, a informação representada por uma estrutura de dados comum com o mínimo de semânticas e, do outro, o conhecimento especificado por arquétipos que representam os conceitos formais hierarquizados em matrizes. Os arquétipos permitem a integração de dados existentes e de sistemas não estruturados do ponto de vista da base de conhecimento. A pesquisa da tese objetivou a apresentação do modelo para o Mapeamento da Base de Conhecimento Fundamentado em Arquétipos, extraído de literatura formal e experiência na área de aplicabilidade, e a verificação de sua aderência em ambientes reais com a proposição do modelo através de um protótipo. Em se tratando de campo de aplicabilidade, o modelo concebido pode fazer frente aos problemas da área de informática em saúde, principalmente visualizando contribuições na construção de artefatos computacionais como as aplicações de Telessaúde. Assim, o modelo traz benefícios para a combinação do conhecimento técnico computacional dos profissionais de informática em saúde, com o conhecimento disciplinar em saúde, esse último consolidado na mente dos profissionais da área, ou mesmo de maneira explícita, em vários formatos: documentado em manuscritos, rotinas, processos, livros, e até mesmo em vídeos, voz, imagens médicas, resultados gráficos e numéricos de exames, entre outros. Desse modo, o modelo auxiliará no mapeamento do conhecimento disciplinar, como é a gestão do Registro Eletrônico de Saúde com suas operações de criação, identificação, coleta, armazenamento e acesso, de maneira mais natural aos profissionais de saúde. A estratégia de usabilidade considerada visa a que a gestão proceda de maneira mais natural, ou seja, sem necessidade de qualificação técnica especializada em sistema de informação. Além disso, o modelo permitiu a proposição de um método de conversão de Mapeamento da Base de Conhecimento, particularmente a partir de mapas mentais, para Arquétipos. / The thesis presents a model of knowledge representation based on archetypes for mapping the knowledge base which identifies information and knowledge. On the one hand, the information is represented by a common data structure with minimal semantic, and on the other hand, the knowledge is described by archetypes that represent concepts in formal hierarchical matrices. Archetypes are able to integrate existing data and unstructured systems from the knowledge base standpoint. The thesis research was aimed at presenting the model for mapping the knowledge base focused on archetypes, derived from formal literature and from expertise in the applicability area, and the verification of its adherence to real environments with the model proposition by means of a prototype. In terms of field applicability, the designed model can tackle the problems in the Health Informatics area, particularly visualizing contributions in building computational devices and Telehealth applications. Then, the model allows for the combination of computer professionals technical knowledge in health informatics with disciplinary knowledge in health, the latter consolidated in the health professionals minds, and even explicitly, in various formats: documented in manuscripts, routines, processes, books, and even videos, voice, medical images, graphics and tests numerical results, among others. Thus, the model will help in disciplinary knowledge mapping, according to the Electronic Health Record management operations, namely, creation, identification, collection, storage, and access in a way that is natural for the health professionals. The usability strategy considered in this thesis proposes that the management process acts in a more natural way, without the need for specialized technical skills in information system. In addition, the model allowed the conversion method of mapping knowledge base, particularly from mind maps to archetypes.

Esta tese apresenta um modelo de representação de conhecimento fundamentado em arquétipos para o mapeamento da base de conhecimento que separa a informação e o conhecimento. De um lado, a informação representada por uma estrutura de dados comum com o mínimo de semânticas e, do outro, o conhecimento especificado por arquétipos que representam os conceitos formais hierarquizados em matrizes. Os arquétipos permitem a integração de dados existentes e de sistemas não estruturados do ponto de vista da base de conhecimento. A pesquisa da tese objetivou a apresentação do modelo para o Mapeamento da Base de Conhecimento Fundamentado em Arquétipos, extraído de literatura formal e experiência na área de aplicabilidade, e a verificação de sua aderência em ambientes reais com a proposição do modelo através de um protótipo. Em se tratando de campo de aplicabilidade, o modelo concebido pode fazer frente aos problemas da área de informática em saúde, principalmente visualizando contribuições na construção de artefatos computacionais como as aplicações de Telessaúde. Assim, o modelo traz benefícios para a combinação do conhecimento técnico computacional dos profissionais de informática em saúde, com o conhecimento disciplinar em saúde, esse último consolidado na mente dos profissionais da área, ou mesmo de maneira explícita, em vários formatos: documentado em manuscritos, rotinas, processos, livros, e até mesmo em vídeos, voz, imagens médicas, resultados gráficos e numéricos de exames, entre outros. Desse modo, o modelo auxiliará no mapeamento do conhecimento disciplinar, como é a gestão do Registro Eletrônico de Saúde com suas operações de criação, identificação, coleta, armazenamento e acesso, de maneira mais natural aos profissionais de saúde. A estratégia de usabilidade considerada visa a que a gestão proceda de maneira mais natural, ou seja, sem necessidade de qualificação técnica especializada em sistema de informação. Além disso, o modelo permitiu a proposição de um método de conversão de Mapeamento da Base de Conhecimento, particularmente a partir de mapas mentais, para Arquétipos. / The thesis presents a model of knowledge representation based on archetypes for mapping the knowledge base which identifies information and knowledge. On the one hand, the information is represented by a common data structure with minimal semantic, and on the other hand, the knowledge is described by archetypes that represent concepts in formal hierarchical matrices. Archetypes are able to integrate existing data and unstructured systems from the knowledge base standpoint. The thesis research was aimed at presenting the model for mapping the knowledge base focused on archetypes, derived from formal literature and from expertise in the applicability area, and the verification of its adherence to real environments with the model proposition by means of a prototype. In terms of field applicability, the designed model can tackle the problems in the Health Informatics area, particularly visualizing contributions in building computational devices and Telehealth applications. Then, the model allows for the combination of computer professionals technical knowledge in health informatics with disciplinary knowledge in health, the latter consolidated in the health professionals minds, and even explicitly, in various formats: documented in manuscripts, routines, processes, books, and even videos, voice, medical images, graphics and tests numerical results, among others. Thus, the model will help in disciplinary knowledge mapping, according to the Electronic Health Record management operations, namely, creation, identification, collection, storage, and access in a way that is natural for the health professionals. The usability strategy considered in this thesis proposes that the management process acts in a more natural way, without the need for specialized technical skills in information system. In addition, the model allowed the conversion method of mapping knowledge base, particularly from mind maps to archetypes.