Os processos de gestão do Sistema Único de Saúde (SUS) são apoiados por um conjunto de sistemas de informação de abrangência nacional, com funcionalidades para as áreas epidemiológicas, ambulatoriais, hospitalares e administrativas. Trabalhos na literatura descrevem pontos fracos nessas aplicações, tais como a falta de integração entre sistemas e bases de dados, fragmentação de informações, baixa cobertura, incertezas quanto à confiabilidade dos dados mantidos e deficiências no apoio ao gestor para planejamento e tomada de decisões. Nesse contexto, foi identificada uma lacuna para pesquisar e discutir qualidade e avaliação dessas aplicações. Este trabalho propõe um modelo para avaliação de características de qualidade de sistemas de informação em saúde que possa ser aplicado aos sistemas do SUS. É descrito o processo de pesquisa, análise e classificação dos indicadores de avaliação para o modelo. Os indicadores foram obtidos por meio de pesquisa em bases bibliográficas e classificados segundo os atributos de qualidade da norma ISO/IEC 25010, adotada como modelo de qualidade no estudo. Como resultado, 57 indicadores foram identificados e mapeados, abrangendo todas as características de qualidade do modelo. A avaliação dos indicadores foi instrumentalizada por meio do desenvolvimento de questionários e procedimentos de inspeção de software, orientados aos diversos stakeholders envolvidos: profissionais de saúde, gestores de saúde, profissionais de tecnologia da informação e usuários do sistema de saúde. A aplicabilidade do modelo proposto foi avaliada para o Sistema de Informações sobre Mortalidade (SIM). A factibilidade dos procedimentos de inspeção foram analisados pelos mantenedores da aplicação e o SIM foi avaliado em um processo que envolveu profissionais de saúde de 18 municípios paulistas e 10 gestores de saúde que atuam nos níveis locais, regionais e estadual. Este trabalho poderá contribuir como mais uma referência para estudos que envolvam processos de avaliação da qualidade de softwares em saúde e auxiliar na normatização de planos de avaliação e monitoramento de qualidade de sistemas e dados em saúde pública no Brasil e em projetos de melhoria de software. / The management processes of the Unified Health System (SUS) are supported by a set of information systems with national scope, having features for the epidemiological, ambulatory, hospital, and administrative areas. Papers in the literature describe weaknesses in these applications, such as the lack of integration between systems and databases, fragmentation of information, low coverage, uncertainties regarding the reliability of data held and weaknesses in supporting managers in planning and decision making. In this context, we identified a gap for quality research and discuss and review these applications.This work proposes a model for evaluating health information systems that may be applied to the systems of SUS. It describes the research, analysis, and classification process of evaluation indicators for the model. The indicators were obtained by search in bibliographic databases and they were classified according to the quality attributes of the standard ISO/IEC 25010, adopted as quality model in the study. As a result, 57 indicators were identified and mapped, covering all quality features of the model. The evaluation of the indicators was instrumentalized by developing questionnaires and inspection procedures of software, oriented to the various stakeholders involved: health professionals, health managers, information technology professionals and users of the health system. The applicability of the proposed model was evaluated for the Information System on Mortality (SIM). The feasibility of the inspection procedures were analyzed by the maintainers of the application and the SIM has been reported in a case involving health professionals from 18 cities and 10 health managers working in local, regional and state levels. This work will be able to contribute as a further reference for studies involving quality assessment processes for softwares in health and to assist in the standardization of plans for assessing and monitoring the quality of systems and data on public health in Brazil and in projects for improving softwares

Abstract The topic of this work is the transformation of real-world human activity into virtual environments. More specifically, the topic is the process of identifying various aspects of visible human activity with sensor networks and studying the different ways how the identified activity can be visualized in a virtual environment. The transformation of human activities into virtual environments is a rather new research area. While there is existing research on sensing and visualizing human activity in virtual environments, the focus of the research is carried out usually within a specific type of human activity, such as basic actions and locomotion. However, different types of sensors can provide very different human activity data, as well as lend itself to very different use-cases. This work is among the first to study the transformation of human activities on a larger scale, comparing various types of transformations from multiple theoretical viewpoints. This work utilizes constructs built for use-cases that require the transformation of human activity for various purposes. Each construct is a mixed reality application that utilizes a different type of source data and visualizes human activity in a different way. The constructs are evaluated from practical as well as theoretical viewpoints. The results imply that different types of activity transformations have significantly different characteristics. The most distinct theoretical finding is that there is a relationship between the level of detail of the transformed activity, specificity of the sensors involved and the extent of world knowledge required to transform the activity. The results also provide novel insights into using human activity transformations for various practical purposes. Transformations are evaluated as control devices for virtual environments, as well as in the context of visualization and simulation tools in elderly home care and urban studies. / Tiivistelmä Tämän väitöskirjatyön aiheena on ihmistoiminnan muuntaminen todellisesta maailmasta virtuaalitodellisuuteen. Työssä käsitellään kuinka näkyvästä ihmistoiminnasta tunnistetaan sensoriverkkojen avulla erilaisia ominaisuuksia ja kuinka nämä ominaisuudet voidaan esittää eri tavoin virtuaaliympäristöissä. Ihmistoiminnan muuntaminen virtuaaliympäristöihin on kohtalaisen uusi tutkimusalue. Olemassa oleva tutkimus keskittyy yleensä kerrallaan vain tietyntyyppisen ihmistoiminnan, kuten perustoimintojen tai liikkumisen, tunnistamiseen ja visualisointiin. Erilaiset anturit ja muut datalähteet pystyvät kuitenkin tuottamaan hyvin erityyppistä dataa ja siten soveltuvat hyvin erilaisiin käyttötapauksiin. Tämä työ tutkii ensimmäisten joukossa ihmistoiminnan tunnistamista ja visualisointia virtuaaliympäristössä laajemmassa mittakaavassa ja useista teoreettisista näkökulmista tarkasteltuna. Työssä hyödynnetään konstrukteja jotka on kehitetty eri käyttötapauksia varten. Konstruktit ovat sekoitetun todellisuuden sovelluksia joissa hyödynnetään erityyppistä lähdedataa ja visualisoidaan ihmistoimintaa eri tavoin. Konstrukteja arvioidaan sekä niiden käytännön sovellusalueen, että erilaisten teoreettisten viitekehysten kannalta. Tulokset viittaavat siihen, että erilaisilla muunnoksilla on selkeästi erityyppiset ominaisuudet. Selkein teoreettinen löydös on, että mitä yksityiskohtaisemmasta toiminnasta on kyse, sitä vähemmän tunnistuksessa voidaan hyödyntää kontekstuaalista tietoa tai tavanomaisia datalähteitä. Tuloksissa tuodaan myös uusia näkökulmia ihmistoiminnan visualisoinnin hyödyntämisestä erilaisissa käytännön sovelluskohteissa. Sovelluskohteina toimivat ihmiskehon käyttäminen ohjauslaitteena sekä ihmistoiminnan visualisointi ja simulointi kotihoidon ja kaupunkisuunnittelun sovellusalueilla.

This thesis was one of the deliverables of StandIN. The purpose of StandIN was to propose a common framework including standards for technical interoperability. The goal of this thesis was to structure and analyze information about the knowledge- and adoption level of the standards among providers of healthcare information systems (HIS's). Moreover, it aimed to evaluate different aspect that might affect the adoption. The target group was providers of HIS's used in Swedish county councils and regions. The information was gathered through a survey and semi-structured interviews, and stored in an Excel database. From the database, Pivot tables and charts were created in order to show the knowledge- as well as adoption level of the different standards. The results were thereafter compared to theory about interoperability and standard adoption. It was clear that the knowledge level varied for the different standards. In addition, the adoption level was very low - except from CCOW and HL7 v2. Least adopted were domain-specific standards. The results also indicated a trend for only adopting parts of standards. Moreover, many providers stated that they performed specific integrations rather than followed common standards. This seemed to be due to the choice of standards being too wide, and the actual adoption not being consistent among the different providers. According to the providers, an introduction of a national framework based on uniform and consistent international standards was an awaited solution to the problem. A future extension of this thesis would be to perform a similar study involving the customers. The database could also be used to do clustered analyses of the adoption state in different county councils and regions. Moreover, it could be used to analyze the development of standard adoption over time. / Den här uppsatsen var ett utav delresultaten i StandIN, ett initiativ till att ta fram ett gemensamt ramverk med standarder för teknisk interoperabilitet. Den här uppsatsen syftade till att strukturera och analysera information om kunskaps- och tillämpningsnivån för de tilltänkta standarderna. Målgruppen var leverantörer av vårdinformationssystem som används i Sveriges landsting och regioner. Informationen samlades in genom en enkät samt semi-strukturerade intervjuer, och lagrades sedan i en Excel-databas. Pivot-tabeller och -diagram skapades för att visualisera kunskaps- och tillämpningsnivån, och resultaten jämfördes sedan med teori om interoperabilitet och standardtillämpning. Det var tydligt att kunskapsnivån skilde sig för de olika standarderna. Tillämpningsnivån var generellt sett väldigt låg, bortsett från CCOW och HL7 v2. Minst tillämpade var domänspecifika standarder. Det var också tydligt att centrala leverantörer inte tillämpade samma standarder, vilket troligtvis påverkar de kompletterande systemen. Många leverantörer gjorde snarare specifika integrationer, än följde gemensamma standarder. Anledningen var att valet av standarder var för brett, och att den faktiska tillämpningen av standarder inte var konsekvent mellan olika leverantörer. Enligt leverantörerna skulle ett nationellt ramverk med enhetliga och internationella standarder vara en efterlängtad lösning på problemet. En fortsättning på denna uppsats är att använda databasen till att göra klusteranalyser för tillämpningsnivån av standarder hos system i olika landsting och regioner. Databasen skulle också kunna användas till att analysera utvecklingen av kunskap och tillämpning över tid. / StandIN

Indiana University-Purdue University Indianapolis (IUPUI) / Retrieving data from a patient in real-time is a challenging operation, especially when requiring information from the network to support the patient’s health. A real-time healthcare system process is conducted with a continual input, processing, and output of data. It needs to have the ability to provide different priorities to different applications, users, or data flows, or to guarantee a certain level of performance to a data flow. The current Internet does not allow applications to request any special treatment. Every packet, including delay-sensitive audio and video packets, is treated equally at the routers. This simplest type service of network is often referred to as best effort, a network service in which the network does not provide any guarantees that data is delivered or that a user is given a guaranteed QoS level or a certain priority. Providing guaranteed services requires routers to manage per-flow states and perform per-flow operations. Such network architecture requires each router to maintain and manage perflow state on the control path, and to perform per-flow classification, scheduling, and buffer management on the data path. This complicated and expensive network architecture is less scalable and robust than today’s modern stateless network architectures such as Random Early Dropping (RED) for congestion control, DiffServ for QoS, and the original IP network. This thesis introduces a new DiffServ-based scheme of IP bandwidth allocation during congestion, called Proportional Allocation of Bandwidth (PAB) which can be used in all networks. In PAB scheme, the bandwidth is allocated in proportion to Subscripted Information Rate (SIR) of the competing flows. PAB implementation uses multiple token buckets to label the packets at the edge of the network and multilevel threshold queue at the IP routers to discard packets during congestion.

Bakgrund: Flera nordiska länder byter ut sina vårdinformationssystem då systemens livscykel är förbrukad. Detta leder till ett generationsskifte bland nordiska vårdinformationssystem. Inom hälso- och sjukvårdsorganisationer finns en förväntan om och ett behov av moderna vårdinformationssystem som passar för hälso- och sjukvårdens arbetsprocesser. Vårdpersonalens delaktighet i utvecklingen av framtidens vårdinformationssystem är avgörande för om förväntningarna kan uppfyllas. Syfte: Studien huvudsyfte är att undersöka vårdpersonalens upplevelser av delaktighet i utvecklingen av vårdinformationssystem utifrån tekniskt, socialt/ mänskligt, organisatoriskt och samhälleligt område. Material och metod: Data insamlades genom ett webbaserat frågeformulär med öppna och slutna frågor. Insamlade data analyserades med kvalitativ innehållsanalys med en deduktiv ansats utifrån områdena i Technology, People, Organizations, and Macroenvironmental factors (TPOM) ramverket. Respondenter i studien var journalförande personal verksamma i en finländsk hälso- och sjukvårdsorganisation. Sammanlagt deltog 101 respondenter i studien. Resultat: Med stöd av TPOM ramverket identifierades 2 områden och 6 underkategorier som påvisar vårdpersonalens upplevelser av utmaningar för delaktighet i utvecklingen av vårdinformationssystem. Vårdpersonalens upplevelser visar att Arbetsbelastning, Engagemang, Attityder och förväntningar, Utbildning och stöd, Kommunikation och Vision påverkar delaktigheten. Slutsats: På ett övergripande plan bidrar studien till att erinra att vårdpersonalens delaktighet spelar en avgörande roll för att utveckla vårdinformationssystem som passar för hälso- och sjukvårdens arbetssätt. Med utgångspunkt i vårdpersonalens upplevelser gällande utmaningar för delaktighet i utvecklingen av vårdinformationssystem belyser studien omständigheter som kan påverka hur framtidens vårdinformationssystem ser ut samt informationssystemens nivå av användbarhet. Förslag till framtida forskning är bland annat att undersöka vilken utbildning som skulle främja vårdpersonalens delaktighet i utveckling av vårdinformationssystem samt om den utbildningen kan införlivas i vårdpersonalens kärnkompetenser. / Background: Several Nordic countries are replacing their healthcare information systems when the life cycle of the systems has been exhausted. This leads to a generational shift among Nordic healthcare information systems. Within healthcare organizations, there is an expectation and a need for modern healthcare information systems that are suitable for healthcare work processes. The participation of healthcare professionals in the development of the healthcare information system of the future is crucial for whether expectations can be met. Aim: The main purpose of the study is to investigate health care professionals' experiences of participation in the development of health care information systems based on technical, social/human, organizational and societal areas. Method: Data was collected through a web-based questionnaire with open and closed questions. The collected data was analyzed with qualitative content analysis with a deductive approach based on the areas of the Technology, People, Organizations, and Macroenvironmental factors (TPOM) framework. Respondents in the study were record-keeping staff working in a Finnish health care organization. A total of 101 respondents participated in the study. Results: With the support of the TPOM framework, 2 areas and 6 subcategories were identified that demonstrate healthcare professionals' experiences of challenges for participation in the development of healthcare information systems. Healthcare professionals' experiences show that Workload, Commitment, Attitudes and expectations, Education and support, Communication and Vision affect participation. Conclusion: On an overall level, the study contributes to recalling that the participation of health care professionals plays a crucial role in developing health care information systems that are suitable for the health care system. Based on healthcare professionals' experiences regarding challenges for participation in the development of healthcare information systems, the study highlights circumstances that may affect how the healthcare information system of the future looks like and the level of usability of the information systems. Suggestions for future research include investigating what education would promote the participation of health care professionals in the development of health care information systems and whether that education can be incorporated into the core competencies of health care professionals.

The U.S. Congress has made health information technology a central component of the national quest to improve health care delivery. The problem addressed in this study was the uncertainty among healthcare providers regarding the benefits of health care information technology adoption relative to healthcare delivery processes and outcomes. The purpose of the study was to understand the effectiveness of information technology as perceived by healthcare providers. The research questions were designed to investigate the relationship between health information technology and organizational effectiveness, exchange of information, organizational process, organizational productivity, and direct personal care. Sociotechnical systems theory and Donabedian's framework for health care quality evaluation were the theoretical bases for this quantitative study. Data were provided through anonymous online survey of 116 healthcare workers, and analyzed using multiple regression and Spearman's correlation coefficient. The results of the study showed a statistically significant positive correlation between organizational effectiveness, organizational exchange of information, organizational process, organizational productivity, and healthcare information technology. No statistically significant correlation existed between personal care and health information technology. These findings suggest that providers' frequent use of healthcare information technology, like telemedicine, makes patients less involved. The implications for social change include enabling healthcare providers to develop an efficient and effective way to engage with patients, in order to achieve effective patient-centered organization.

Informationssäkerhet är ett område som kommit att sättas alltmer i fokus hos organisationer. Tidigare har främst tekniska lösningar för att skydda viktig information fått uppmärksamhet, det är först på senare tid som informationssäkerhet har börjat uppfattas som ett komplext område som innefattar såväl tekniska, som organisatoriska och mänskliga faktorer. För att eftersträva en god informationssäkerhet inom organisationen bör ett grundligt arbete läggas på att utveckla informationssäkerhetspolicys och säkerhetsansvariga måste kontinuerligt utbilda och skapa medvetenhet hos anställda kring vilka hot som finns mot organisationen ifall informationssäkerhetsbestämmelser inte efterlevs. Huvudsyftet i föreliggande studie har varit att undersöka vilka faktorer som styr anställdas efterlevnad av informationssäkerhetspolicys. Ytterligare delsyfte har varit att undersöka hur den faktiska efterlevnaden av informationssäkerhetsbestämmelser avspeglar sig inom två vårdverksamheter i Landstinget i Östergötland. För att uppfylla studiens syfte har fallstudier genomförts där såväl observationer som intervjuer med personal legat till grund för datainsamlingen. Resultatet visar att säkerhetsmedvetandet och efterlevnaden av säkerhetsbestämmelser inom de undersökta organisationerna är tämligen god, men det finns skillnader i graden av efterlevnad. Resultaten visar att anställda i viss mån hoppar över säkerhetsbestämmelser för att effektivisera sitt arbete. Den vanligaste säkerhetsbestämmelsen som visade på bristande efterlevnad var att en del anställda slarvade med att logga ut eller låsa datorn då denna lämnades oövervakad. Faktorer som visat sig vara avgörande för ifall säkerhetsbestämmelser efterlevs eller inte är bland annat ifall den anställde anser att beteendet övervakas, hur väl medveten man är kring konsekvensen av att säkerhetsbestämmelser inte efterlevs, samt hur stor sannolikhet man anser det vara att hotet realiseras. Ytterligare faktorer som visat sig spela roll är ifall den anställde anser att säkerhetsbestämmelsen ligger i konflikt med andra intressen, såsom effektivitet eller bekvämlighet. För att kunna införa effektiva policyåtgärder krävs det därmed att policyutvecklare förstår vad som motiverar anställda till att följa säkerhetsbestämmelser och vilka värderingar som ligger bakom deras beteende. / Information security has grown into a field of study that has gained increasingly attention within organizations. In the early days focus of the field has primerly been on technical solutions in order to protect information. Only recently information security has come to be seen as a complex area including both technical, organizational and human factors. In order to strive for a high degree of information security within the organization, emphasis has to be placed on developing a functional information security policy. Just as important is that security managers continually educate and create awareness amongst employees with regards to existing threats if information security rules are not respected. The main purpose in regards to this study has been to investigate the determinants of employees' compliance with information security policies. A further aim of the study has been to examine how the actual compliance of information security regulations is reflected in two healthcare clinics in the county council of Östergötland. In order to fulfill the purpose of the study, case studies were carried out in the clinics, where both filed studies and interviews with staff members formed the basis for data collection. The results show that security awareness and compliance with safety regulations within the surveyed organizations are fairly good, but there are differences in the level of compliance. The results show that employees to some degree overlook safety rules in order to make their work more efficient. The most common security rule that showed non-compliance was where employees occasionally did not logg off or lock the computer as it was left unattended. Determinants that showed to have an influence on whether or not employees comply with information security policys are among other factors to what extent the employee belives that the behavior is being monitored, awareness about conseqences from not complying with the security rules, as well as to what extent one belives that the actual threat occurs. Additional determinants that were found to have an influence on the actual behavior with regards to compliance is to what extent the employee considers the regulations to be in conflict with other interests, such as efficiency or convenience. In order to introduce effective policy measures knowledge is needed where policy makers understand what motivates employees to comply with safety rules, as well as the values that underlie their behavior.

No description available.

Made available in DSpace on 2011-05-04T12:36:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / A Base de Dados de Identificação Unívoca de Indivíduos voltada para o SUS constitui uma base de informações relacionada ao processo de identificação unívoca dos indivíduos formando, juntamente com as bases de informações de Profissionais de Saúde e Estabelecimentos de Saúde o que podemos chamar de bases de dados estruturantes para os Sistemas de Atenção à Saúde. Estas bases de dados estruturantes contribuíram para aconstrução de um alicerce de informações para o SUS, tornando-se referência para os Sistemas de Atenção à Saúde no Brasil. Sua construção se deu para que fosse possível o desenvolvimento e implantação de uma solução informatizada contratada pelo Ministério da Saúde. O presente trabalho inicia-se com o estudo da história de desenvolvimento desta solução informatizada, denominada de Projeto do Cartão Nacional de Saúde, e seu contexto histórico de construção iniciado em 1999. Por meio de revisões bibliográficas, análise de documentos institucionais produzidos pelo Ministério da Saúde, e as principais escolas formadoras e produtoras de estudos sobre o tema, além da experiência profissional do autor, são discutidas as soluções encontradas para o projeto procurando dar ênfase aos aspectos de desenvolvimento e tecnologias empregadas, dentro do contexto político institucional e organizacional do seu processo histórico de criação. Realiza-se ainda exposição do panorama da situação atual (2008) do projeto e suas bases estruturantes, com destaque para a gestão da Base de Identificação Unívoca de Indivíduos do SUS. Por fim,procura-se contribuir com discussões e conclusões que permitam sua consolidação como uma base de dados de identificação unívoca de indivíduos para o SUS e, desta forma, ser capaz de atender às demandas dos Sistemas de Atenção à Saúde. / The Brazilian HealthCare System (SUS in portuguese) Database of Unique identification of Individuals is a database of information related to the process of unique identification of individuals, together with the Healthcare Individual Provider and Healthcare Provider Information Databases, form what we call the structuring databases for the health care information systems. These databases contributed to building a foundation of information for the SUS, becoming a reference for the Health Care Systems in Brazil. Its construction was done to make possible the development and implementation of a computerized solution contracted by the Ministry of Health. This work begins with the study of the history of development of this computerized solution, called Projeto do Cartão Nacional de Saúde (National Healthcare Card), which began in 1999, and its historical context. Through literature review, analysis of institutional documents produced by the Health Ministry and by the main schools on the subject, beyond the professional experience of the author, this study presents the solutions to the project, seeking to emphasize the development process and the technologies employed, taking into account the institutional and political context of its evolution. It also shows the current situation (2008) of the project and is structuring databases, with emphasis on the management of Database of Unique Identification of Individuals. Finally, we seek to contribute with discussions and conclusions that allow the consolidation of a database of unique identification of individuals for SUS and thus be able to meet the demands of the Brazilian health care information systems.

[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