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  • 1.
    Arkad, Kristina
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Xiao-Ming, Gao
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Query-handling in MLM-based decision support systems1996In: Medical Informatics & the Internet in Medicine, Vol. 20, no 3, p. 229-240Article in journal (Refereed)
  • 2.
    Ask, Per
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Hägglund, Sture
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, ASLAB - Application Systems Laboratory.
    Olsson, J.
    Pettersson, N-E
    Sjöqvist, Bengt Arne
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    3G-satsning och 'pensionärsdatorer' kan lösa hälso- och sjukvårdens problem2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 1257-1258Article in journal (Other academic)
  • 3.
    Ask, Per
    et al.
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Hägglund, Sture
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Olsson, Jan
    Linköping University, Department of Management and Engineering. Linköping University, Faculty of Arts and Sciences.
    Pettersson, Nils-Erik
    Sjöqvist, Bengt-Arne
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    36-nätet och "pensionärsdatorer" kan bidra till att lösa sjukvårdens problem2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, no 14, p. 1257-1258Article in journal (Refereed)
  • 4.
    Babic, Ankica
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Bodemar, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Mathiesen, Ulrik
    Oskarshamns sjukhus .
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Franzén, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Machine learning to support diagnostics in the domain of asymptomatic liver disease1995In: MEDINFO95,1995, Edmonton: HC & CC , 1995, p. 809-Conference paper (Refereed)
  • 5.
    Babic, Ankica
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Bodemar, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Mathiesen, Ulrik
    Oskarshamn Hospital .
    Artificial neural networks in clustering and classification of data on unspecified liver diseases1993In: Nordic Meeting on Medical and Biomeidical engineering,1993, 1993, p. 136-Conference paper (Refereed)
  • 6.
    Carlsson, Mats
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Wigertz, Ove
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Design and application of a terminology management system1998In: Studies in Health Technology and Informatics, Volume 52: MEDINFO '98 / [ed] Cesnik, B., McCray, A.T., Scherrer, J.R., Australia: IOS Press , 1998, p. 207-211Conference paper (Refereed)
    Abstract [en]

    A Swedish data model for handling terminology, Spriterm, is presented in this paper. A prototype terminology management system, using the Spriterm data model in also described. This prototype is implemented is Microsoft ACCESS. Furthermore, two other applications using this prototype as a base are introduced. One World Wide Web based application, and a data dictionary.

  • 7.
    Carlsson, Mats
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Löfström, Lars
    Linköping University, Faculty of Health Sciences.
    Rogers, Jeremy
    Medical Informatics Group, Department of Computer Science, University of Manchester, UK.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Modelling and reclassification of surgical procedures: experiences from the use of GALEN methods in the domain of thoracic surgery2000In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 25, no 2, p. 109-122Article in journal (Refereed)
    Abstract [en]

    This paper reports on experiences fromthe evaluation of GALEN methods for mapping of follow-up categories in the domain of thoracic surgery to an existing classification of surgical procedures. The mapping of the aggregated levels or groups of thoracic procedures presents a genuine problem in relation to strict hierarchical classifications, since the follow-up categories do not necessarily fit in the pre-set structure of the classification. Experiences from modelling of the traditional classification and of the follow-up categories are reported, and an analysis of the results is presented along with a discussion of opportunities and potential problems and pitfalls when applying GALEN models and tools.

  • 8.
    Carlsson, Mats
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Löfström, Lars
    Linköping University, Faculty of Health Sciences.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Classification of procedures in the domain of thoracic surgery: a study of relibility in coding2001In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 25, no 1, p. 47-61Article in journal (Refereed)
    Abstract [en]

    This paper relates a study of reliability of coding of surgical procedures in the domain of thoracic surgery. The reliability measured is inter-coder variability in form of agreement. Four classifications were used by four physicians on 100 patient cases. The classifications, having differing granularity and structure, were analyzed using a statistical method (kappa). These results are discussed and related to the differences between the classifications. One of the topics for discussion is how the granularity affects the degree of agreement, coupled to the usefulness of the classification. Also the concept of using formal methods for representing classifications is discussed, how this will affect how classifications are designed and used.

  • 9.
    Carlsson, Mats
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Rogers, Jeremy
    University of Manchester, UK .
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Aggregation and reclassification - Assessment of GALEN methods in the domain of thoracic surgery1999In: AIA99,1999, Philadelphia: Hanley & Belfus Inc , 1999, p. 32-Conference paper (Refereed)
  • 10.
    Carlsson, Mats
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Thurin, Anders
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Knowledge module authoring with terminolgy support1995In: AMIA Symposium on Coputer Applications in Medical Care,1995, Hanley & belfus , 1995, p. 969-Conference paper (Refereed)
  • 11.
    Carlsson, Mats
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Thurin, Anders
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Wigertz, Ove
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Terminology support for development of sharable knowledge modules1996In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 21, no 3, p. 207-214Article in journal (Refereed)
    Abstract [en]

    Lack of an agreed infrastructure for terminology is identified as one of the major barriers to interchange of knowledge modules and integration of knowledge bases with other clinical information systems. The goal of the GALEN project is to bridge this gap between different terminology systems through the construction of a terminology server, which is based on a rich conceptual model with mapping facilities to natural language expressions and coding schemas. The long term goal is to support communication between medical information systems. Arden Syntax is a standard format for the creation of knowledge modules, with sharability as one of the main objectives. Since Arden Syntax is based on a data-driven approach, the data items used need to be adapted to locally available terminology. The GALEN approach appears to be complementary to Arden Syntax and to the development of sharable knowledge modules. The major theme of this paper is utilization of the GALEN terminology server for knowledge module authoring. Two systems are presented, a knowledge base manager and a client to the terminology server, allowing the user to navigate in the semantic network and to import concept definitions and terms into the knowledge modules. The benefit of the terminology services is discussed.

  • 12.
    Chen, Rong
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Garde, Sebastian
    Ocean Informatics UK, London, UK.
    Beale, Thomas
    Ocean Informatics UK, London, UK.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Klein, Gunnar O.
    Karolinska Institutet, Sweden.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    An Archetype-based Testing Framework2008In: EHEALTH BEYOND THE HORIZON: GET IT THERE / [ed] Andersen, SK; Klein, GO; Schulz, S; Aarts, J; Mazzoleni, MC, Amsterdam: IOS Press, 2008, Vol. 136, p. 401-406Conference paper (Refereed)
    Abstract [en]

    With the introduction of EHR two-level modelling and archetype methodologies pioneered by openEHR and standardized by CEN/ISO, we are one step closer to semantic interoperability and future-proof adaptive healthcare information systems. Along with the opportunities, there are also challenges. Archetypes provide the full semantics of EHR data explicitly to surrounding systems in a platform-independent way, yet it is up to the receiving system to interpret the semantics and process the data accordingly. In this paper we propose a design of an archetype-based platform-independent testing framework for validating implementations of the openEHR archetype formalism as a means of improving quality and interoperability of EHRs.

  • 13.
    Chen, Rong
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Georgii-Hemming, Patrik
    Department of Oncology, Uppsala University, Sweden.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Representing a chemotherapy guideline using openEHR and rules2009In: Medical Informatics in a United and Healthy Europe / [ed] Klaus-Peter Adlassnig, Bernd Blobel, John Mantas, Izet Masic, IOS Press, 2009, Vol. 150, p. 653-657Conference paper (Refereed)
    Abstract [en]

    Computerized guidelines can provide decision support and facilitate the use of clinical guidelines. Several computerized guideline representation models (GRMs) exist but the poor interoperability between the guideline systems and the Electronic Health Record (EHR) systems limits their clinical usefulness. In this study we analyzed the clinical use of a published lymphoma chemotherapy guideline. We found that existing GRMs have limitations that can make it difficult to meet the clinical requirements. We hypothesized that guidelines could be represented as data and logic using openEHR archetypes, templates and rules. The design was tested by implementing the lymphoma guideline. We conclude that using the openEHR models and rules to represent chemotherapy guidelines is feasible and confers several advantages both from a clinical and from an informatics perspective.

  • 14.
    Chen, Rong
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Klein, Gunnar O
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solna, Sweden.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Archetype-based conversion of EHR content models: pilot experience with a regional EHR system2009In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 9, no 33Article in journal (Refereed)
    Abstract [en]

    Background: Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format. Methods: The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bidirectional conversion between openEHR archetypes and COSMIC templates. Results: Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats. Conclusion: The openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.

  • 15.
    Gill, Hans
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Arkad, Kristina
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Computer communication based on PABX-technique1990In: IMIA Conference on Telematics in Medicine 1990,1990, Elsevier Science Publ , 1990Conference paper (Refereed)
  • 16.
    Johansson, Bo
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Shahsavar, Nosrat
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Database and knowledge base integration - A data mapping method for Arden Syntax knowledge modules1996In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 35, p. 302-309Article in journal (Refereed)
  • 17.
    Johansson, Bo
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Shahsavar, Nosrat
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Database and knowledge base integration in decision support systems1996In: AMIA 1996,1996, Washington: Hanley & belfus , 1996, p. 249-Conference paper (Refereed)
  • 18.
    Karlsson, Daniel
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Aspevall, Olle
    Department of Immunology, Microbiology, pathology and Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Forsum, Urban
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    A study of the concept of urinary tract infections in different domains of medicine using the MEDLINE® databaseManuscript (preprint) (Other academic)
    Abstract [en]

    In the construction of decision-support systems, differences between expert and end-user domains may pose a problem. As a way of studying differences between medical domains regarding management of urinary tract infections, we investigated the MEDLINE® for differences in indexing patterns. Further, our intention was to assess the MEDLINE® database as a source for studying medical domains. We examined the use of main headings, subheadings and the level of main headings in six medical domains that manage urinary tract infections. Many intuitive but also some counterintuitive results were found. We conclude that it is difficult to use the MEDLINE® database for studying medical domains mainJy due to unclear semantics both in the headings and the indexing process, which results in variability in indexing. This variability probably hides significant results. We also conclude that the differences found indicate that in addition to differences between domains, there are also large variations within domains.

  • 19.
    Karlsson, Daniel
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Aspvall, Olle
    KI.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering.
    Forsum, Urban
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Using the MEDLINE® database to study the concept of urinary tract infections in different domains of medicine2004In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 109, no 2, p. 141-157Article in journal (Refereed)
    Abstract [en]

    As a way of exploring differences between medical domains regarding management of urinary tract infections, we investigated the MEDLINE® database for differences in indexing patterns. Further, our intention was to assess the MEDLINE® database as a source for studying medical domains. We examined the use of main headings, subheadings and the level of main headings in six medical domains that manage urinary tract infections. Many intuitive but also some counterintuitive results were found indicating that the MEDLINE® database is difficult to use for studying medical domains mainly due to unclear semantics both in the headings and the indexing process, which results in variability in indexing. This variability probably hides sig-nificant results. We also conclude that the differences found indicate that in addition to differences between domains, there are also large variations within domains.

  • 20.
    Karlsson, Daniel
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    A comment on the Help-system: A program for medical decision making from the early 1970s1999In: Yearbook of Medical Inforamtics 1999, Stuttgart: Schattauer , 1999, p. 103-105Chapter in book (Other academic)
  • 21.
    Kohli, Sunil
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Moidu, Khalid
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Farrier, J
    MEDSIG Sysop Canada.
    Chowdhury, Shamsul
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    A study of e-mail use on a health care bulletin board1992In: World Congress On Medical Informatics MEDINFO92,1992, Amsterdam: ElsivierScience Publ , 1992, p. 124-Conference paper (Refereed)
  • 22.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Shahsavar, Nosrat
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Requirements and prototyping of a home health care application based on emerging JAVA technology.2002In: International Journal of Medical Informatics, ISSN 1386-5056, Vol. 68, no 1-3, p. 129-139Article in journal (Refereed)
    Abstract [en]

    IT support for home health care is an expanding area within health care IT development. Home health care differs from other in- or outpatient care delivery forms in a number of ways, and thus, the introduction of home health care applications must be based on a rigorous analysis of necessary requirements to secure safe and reliable health care. This article reports early experiences from the development of a home health care application based on emerging technologies. A prototype application for the follow-up of diabetes patients is presented and discussed in relation to a list of general requirements on home health care applications.

  • 23.
    Lind, Leili
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Sundvall, Erik
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Experiences from development of home health care applications based on emerging Java technology2001In: MEDINFO 2001,2001, Amsterdam: IOS Press , 2001, p. 830-Conference paper (Refereed)
  • 24.
    Magyar, Gabor
    et al.
    IMT LiU.
    Arkad, Kristina
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Xiao-Ming, Gao
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Gill, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strategies for efficient implementation of the Arden Syntax for medical decision support1991In: MIE91,1991, Berlin: Springer Verlag , 1991, p. 222-Conference paper (Refereed)
  • 25.
    Nilsson, Gunnar H.
    et al.
    Karolinska Institutetet, Sweden.
    Månsson, Jörgen
    Primary Health Care Centre Husläkarna i Kungsbacka, Sweden.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Gunnarsson, Ronny
    Göteborg University, Sweden.
    Strender, Lars-Erik
    Karolinska Institutetet, Sweden.
    Patients, general practitioners, diseases and health problems in urban general practice: a cross-sectional study on electronic patient records2008In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 9, no 2, p. 119-125Article in journal (Refereed)
    Abstract [en]

    Background Statistics from primary health care in Sweden, as well as from other Nordic countries, have been sparse. The electronic patient records (EPR) will be an increasingly important source of clinical information. The aim of this study was to investigate types of encounters, managed diseases and health problems, and characteristics of patients and general practitioners (GPs) in everyday general practice using EPR.

    Methods A multi-centre, cross-sectional database study of EPR in primary health care in Stockholm, Sweden. Twenty-six randomly selected GPs with 20 randomly selected encounters each. Main outcome measures were the number and distribution of diseases and health problems, age and gender of patients and GPs, and type of encounter.

    Results The mean age of the patients was 51.2 years, 30.2% were aged 75 years or older, and 57.5% were women. The mean number of managed problems per encounter was 1.4. The most common specific diagnoses were essential hypertension (9.3% of the encounters) and acute upper respiratory infections (8.8%). Older patients had more health problems in each encounter (P = 0.000001). GPs differed regarding the characteristics of their patients, including sex, age and number of health problems managed at each encounter. The patients of different GPs differed regarding sex, age and number of health problems managed. Female and male patients had different diagnostic panoramas and they had a tendency to encounter a GP of the same sex (odds ratio 1.5, P = 0.053).

    Conclusions We found that two diagnoses (essential hypertension and acute upper respiratory infections), four diagnostic groups, women and the elderly are predominant. Female and male patients have different diagnostic panoramas and they have a tendency to encounter a GP of the same sex. GPs differ regarding the characteristics of their patients, including sex, age and number of health problems managed at each encounter.

  • 26.
    Nilsson, Gunnar
    et al.
    Family Medicine Stockholm, Karolinska Institute, Sweden.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, Lars-Erik
    Family Medicine Stockholm, Karolinska Institute, Sweden.
    Evaluation of three Swedish ICD-10 primary care versions: reliability and ease of use in diagnostic coding2000In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 39, no 4-5, p. 325-331Article in journal (Refereed)
    Abstract [en]

    If computer-stored information is to be useful for purposes other than patient care, reliability of the data is of utmost importance. In primary healthcare settings, however, it has been found to be poor. This paper presents a study on the influence of coding tools on reliability and user acceptance. Six general practitioners coded 152 medical problems each by means of three versions of ICD-10, one with a compositional structure. At code level the reliability was poor and was almost identical when the three versions were compared. At aggregated level the reliability was good and somewhat better in the compositional structure. Ideas for improved user acceptance arose, and the study explored the need for several different tools to retrieve diagnostic codes.

  • 27.
    Nilsson, Gunnar
    et al.
    Karolinska Inst Stockholm.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, Lars-Erik
    Karolinska Inst Stockholm.
    Reliability in diagnostic coding: Evaluation of three Swedish ICD-10 primary care versions1999In: AMIA99,1999, Philadelphia: Harley & Belfus Inc , 1999, p. 1128-Conference paper (Refereed)
  • 28.
    Nilsson, Gunnar
    et al.
    Allmänmedicin Karolinska Institutet.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, L-E
    Allmänmedicin Karolinska Institutet.
    Evaluation of three Swedish ICD-10 primary care versions: reliability and ease of use in diagnostic codig2002In: Yearbook of Medical Informatics, p. 377-383Article in journal (Other academic)
  • 29.
    Nilsson, Gunnar
    et al.
    Allmänmedicin Karolinska Institutet.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, L-E
    Allmänmedicin Karolinska Institutet.
    Computerisation, coding, data retrieval and related attitudes among Swedish general practitioners - A survey of necessary conditions for a database of diseases and health problems2002In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 65, no 2, p. 135-143Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate necessary conditions for the establishment of a database of diseases and health problems for research and health care planning, based on electronic patient records in everyday clinical use among general practitioners (GPs). Design: Postal questionnaire study. Setting: Primary health care in Sweden. Subjects: Three hundred randomly selected GPs. Main outcome measures: Degree of computerisation of patient records. User frequency and characteristics of diagnosis classification systems and coding tools. Frequency of coding activities and retrieval of codes, and related attitudes. Opinions on a primary health care version of ICD-10. Results: A total of 184 GPs (61% of the 300 GPs) were included in the study. About 92% used an electronic record system, some type of diagnostic classification was used by 93%, and ICD based classifications by 88%. The classification in use was computerised for 74%. Mainly simple tools were used to retrieve diagnostic codes. About 76% of GPs reported classifying at least one symptom or disease per encounter. The codes were retrieved 'once a month' or more by 19%. Classification of diseases was considered important for follow-up by 83%, and for the care of the patient by 75% of the GPs. The primary health care version of ICD-10 with a total of 972 codes was considered too limited in size by 31%. Conclusion: Electronic patient records in everyday clinical use in Swedish general practice provide several fundamentals for a database of diagnostic data. However, there are several barriers to the establishment of such a database that is both valid and reliable. ⌐ 2002 Elsevier Science Ireland Ltd. All rights reserved.

  • 30.
    Nilsson, Gunnar
    et al.
    Allmänmedicin Karolinska Institutet.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, L-E
    Allmänmedicin Karolinska Institutet.
    Textual content, health problems and diagnostic codes in electronic patient records in general practice2003In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 1, p. 33-36Article in journal (Refereed)
    Abstract [en]

    Objective - To investigate textual content, health problems and diagnostic codes in everyday electronic patient records. Design - Retrospective and observational database study. Setting - Primary health care in Stockholm. Subjects - Twenty randomly selected general practitioners with 20 records each. Main outcome measures - The frequency of use of problem-oriented medical records. The number of words, problems and diagnostic codes. The completeness and correctness of the diagnostic codes. Results - About 14.5% of 400 studied records were problem-oriented. The mean number of words per record was 99.4, and the mean number of problems managed per record was 1.2. On average, there were 1.1 diagnostic codes per record and this differed widely among GPs and also among the electronic patient record systems. The mean number of codes per problem was 0.9, and the proportion of correct codes was 97.4%. Conclusions - The electronic patient records in general practice in Stockholm have an extensive textual content. A vast majority of the problems are coded and the completeness and correctness of diagnostic codes are high. It seems that problem-oriented electronic patient record systems enforce coding activities. It is feasible to establish a database of diagnostic data for research and health care planning based on electronic patient records.

  • 31.
    Nilsson, Göran
    et al.
    Dept Cadriology Västerås sjukhus.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Ahrén, Tom
    Dept Cardiology Västerås Hospital.
    Jonasson, Tommy
    Dept Cardiology Västerås Hospital.
    Distribution patterns of ventricular premature complexes in long-term electrocardographic recordings and their usefulness in disclosing modulated parasystole1991In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 68, p. 1045-1048Article in journal (Refereed)
  • 32.
    Nyström, Mikael
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Merkel, Magnus
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory.
    Ahrenberg, Lars
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory.
    Zweigenbaum, Pierre
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Creating a medical English-Swedish dictionary using interactive word alignment2006In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 6, no 35Article in journal (Refereed)
    Abstract [en]

    Background: This paper reports on a parallel collection of rubrics from the medical terminology systems ICD-10, ICF, MeSH, NCSP and KSH97-P and its use for semi-automatic creation of an English-Swedish dictionary of medical terminology. The methods presented are relevant for many other West European language pairs than English-Swedish. Methods: The medical terminology systems were collected in electronic format in both English and Swedish and the rubrics were extracted in parallel language pairs. Initially, interactive word alignment was used to create training data from a sample. Then the training data were utilised in automatic word alignment in order to generate candidate term pairs. The last step was manual verification of the term pair candidates. Results: A dictionary of 31,000 verified entries has been created in less than three man weeks, thus with considerably less time and effort needed compared to a manual approach, and without compromising quality. As a side effect of our work we found 40 different translation problems in the terminology systems and these results indicate the power of the method for finding inconsistencies in terminology translations. We also report on some factors that may contribute to making the process of dictionary creation with similar tools even more expedient. Finally, the contribution is discussed in relation to other ongoing efforts in constructing medical lexicons for non-English languages. Conclusion: In three man weeks we were able to produce a medical English-Swedish dictionary consisting of 31,000 entries and also found hidden translation errors in the utilized medical terminology systems. © 2006 Nyström et al, licensee BioMed Central Ltd.

  • 33.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Merkel, Magnus
    Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory. Linköping University, The Institute of Technology.
    Ahrenberg, Lars
    Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory. Linköping University, The Institute of Technology.
    Zweigenbaum, Pierre
    Assistance Publique-Hôpitaux de Paris, Inserm U729, Inalco CRIM.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Creating a medical English-Swedish dictionary using interactive word alignment2009In: Lexicography: The Changing Landscape / [ed] Salonee Priya, Hyderabad, India: The Icfai University Press , 2009, 1, p. 131-157Chapter in book (Other academic)
    Abstract [sv]

    Lexicography is a realm of growing academic specialization. Dictionaries map meaning onto use. We have innumerable dictionaries on different subjects and for different purposes which we keep referring to, time and again. Despite the frequency with which dictionaries are unquestioningly consulted, many have little idea of what actually goes into making them or how meanings are definitively ascertained. We have become so accustomed to using dictionaries that we fail to take notice of the effort and time spent in their making. Understanding the finer nuances of the art of dictionary-making will be of interest to everyone. With changing times and the penetration of technology, the bulkier forms of dictionaries have given way to softer forms. This book updates the reader to the changing notions of the lexicon and dictionary-making in the new realm of modern technology and newer electronic tools. The book introduces us to lexicography and leads us to dictionaries for general and specific purposes. It examines dictionary compilation and research and enables compilers, users, educators and publishers to look anew at the art of lexicography. It duly takes into account the fact that dictionaries are meant to fulfill the needs of specific user groups and reflects the same in the chapters devoted to various professional dictionaries, which have recently achieved widespread recognition in the lexicographical literature. A good read for students of linguistics, teachers and translators apart from general readers interested in knowing the intricate art of making a dictionary.

  • 34.
    Nyström, Mikael
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Merkel, Magnus
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Creating a medical dictionary using word alignment: The influence of sources and resources2007In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 7, no 37Article in journal (Refereed)
    Abstract [en]

    Background. Automatic word alignment of parallel texts with the same content in different languages is among other things used to generate dictionaries for new translations. The quality of the generated word alignment depends on the quality of the input resources. In this paper we report on automatic word alignment of the English and Swedish versions of the medical terminology systems ICD-10, ICF, NCSP, KSH97-P and parts of MeSH and how the terminology systems and type of resources influence the quality. Methods. We automatically word aligned the terminology systems using static resources, like dictionaries, statistical resources, like statistically derived dictionaries, and training resources, which were generated from manual word alignment. We varied which part of the terminology systems that we used to generate the resources, which parts that we word aligned and which types of resources we used in the alignment process to explore the influence the different terminology systems and resources have on the recall and precision. After the analysis, we used the best configuration of the automatic word alignment for generation of candidate term pairs. We then manually verified the candidate term pairs and included the correct pairs in an English-Swedish dictionary. Results. The results indicate that more resources and resource types give better results but the size of the parts used to generate the resources only partly affects the quality. The most generally useful resources were generated from ICD-10 and resources generated from MeSH were not as general as other resources. Systematic inter-language differences in the structure of the terminology system rubrics make the rubrics harder to align. Manually created training resources give nearly as good results as a union of static resources, statistical resources and training resources and noticeably better results than a union of static resources and statistical resources. The verified English-Swedish dictionary contains 24,000 term pairs in base forms. Conclusion. More resources give better results in the automatic word alignment, but some resources only give small improvements. The most important type of resource is training and the most general resources were generated from ICD-10. © 2007 Nyström et al, licensee BioMed Central Ltd.

  • 35.
    Nyström, Mikael
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Merkel, Magnus
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Evaluating Bilingual Medical Terminologies with Word Alignment Methods2007In: Medinfo 2007: Proceedings of the 12th World Congress on Health (Medical) Informatics: Building Sustainable Health Systems / [ed] Kuhn, Klaus A; Warren, James R; Leong, Tze-Yun, Amsterdam: IOS Press, 2007, p. 244-Conference paper (Refereed)
  • 36.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Eneling, Martin
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Introduction to openEHR basic principles2008Conference paper (Refereed)
  • 37.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Örman, Håkan
    Åhlfeldt, Hans
    Data Needs for Patient Overviews: A Literature ReviewCompared with SNOMED CT and openEHRManuscript (preprint) (Other academic)
    Abstract [en]

    Patient overviews automatically generated fromelectronic healthcare data have different data needsdepending on their complexity. A literature reviewbased on a broad MEDLINE search found 16 suchoverviews for which the data needs were analyzedand compared with features provided bySNOMED CT and openEHR. Five systems used onlyinformation type, while five systems also presentedparticular values from its information entities. Sixsystems also aggregated or filtered the information.In addition to that, two systems provided referenceranges and three systems provided more advanceddecision support. The simple data needs can be metusing information entity markups based onSNOMED CT and SNOMED CT relationships. Morecomplex data needs can be satisfied using theopenEHR reference model and archetypes tostructure data and the archetype query language toretrieve individual data values. The most advancedoverviews also need additional methods foraggregation, filtering and connection to knowledgerepresentation.

  • 38.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Vikström, Anna
    Karolinska Institutet.
    Nilsson, Gunnar H
    Karolinska Institutet.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Enriching a primary health care version of ICD-10 using SNOMED CT mapping2010In: Journal of Biomedical Semantics, ISSN 2041-1480, Vol. 1, no 7Article in journal (Refereed)
    Abstract [en]

    Background: In order to satisfy different needs, medical terminology systems musthave richer structures. This study examines whether a Swedish primary health careversion of the mono-hierarchical ICD-10 (KSH97-P) may obtain a richer structureusing category and chapter mappings from KSH97-P to SNOMED CT and SNOMEDCT’s structure. Manually-built mappings from KSH97-P’s categories and chapters toSNOMED CT’s concepts are used as a starting point

    Results: The mappings are manually evaluated using computer-producedinformation and a small number of mappings are updated. A new and polyhierarchicalchapter division of KSH97-P’s categories has been created using thecategory and chapter mappings and SNOMED CT’s generic structure. In the newchapter division, most categories are included in their original chapters. Aconsiderable number of concepts are included in other chapters than their originalchapters. Most of these inclusions can be explained by ICD-10’s design. KSH97-P’scategories are also extended with attributes using the category mappings andSNOMED CT’s defining attribute relationships. About three-fourths of all conceptsreceive an attribute of type Finding site and about half of all concepts receive anattribute of type Associated morphology. Other types of attributes are less common.

    Conclusions: It is possible to use mappings from KSH97-P to SNOMED CT andSNOMED CT’s structure to enrich KSH97-P’s mono-hierarchical structure with a polyhierarchicalchapter division and attributes of type Finding site and Associatedmorphology. The final mappings are available as additional files for this paper.

  • 39.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Vikström, Anna
    Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet.
    Nilsson, Gunnar H
    Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Visualization of disease distribution with SNOMED CT and ICD-102010In: MEDINFO 2010 - Proceedings of the 13th World Congress on Medical Informatics / [ed] Safran, Charles; Reti, Shane; Marin, Heimar, Amsterdam: IOS Press, 2010, Vol. 160, p. 1100-1103Conference paper (Refereed)
    Abstract [en]

    Methods for presentation of disease and health problem distribution in a health care environment rely among other things on the inherent structure of the controlled terminology used for coding. In the present study, this aspect is explored with a focus on ICD-10 and SNOMED CT. The distribution of 2,5 million diagnostic codes from primary health care in the Stockholm region is presented and analyzed through the “lenses” of ICD-10 and SNOMED CT. The patient encounters, originally coded with a reduced set of ICD-10 codes used in primary health care in Sweden, were mapped to SNOMED CT concepts through a mapping table. The method used for utilizing the richer structure of SNOMED CT as compared to ICD-10 is presented, together with examples of produced disease distributions. Implications of the proposed method for enriching a traditional classification such as ICD-10 through mappings to SNOMED CT are discussed.

  • 40.
    Nyström, Mikael
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Berg, Lars
    Socialstyrelsen Stockholm.
    Datorbaserat stödsystem vid användning av ICF2002In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 79, no 6, p. 546-549Article in journal (Other (popular science, discussion, etc.))
  • 41.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Klein, Gunnar
    Karolinska Institutet, Solna.
    Nilsson, Gunnar
    Karolinska Institutet.
    Chen, Rong
    Karolinska Institutet, Solna.
    Ahrenberg, Lars
    Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory. Linköping University, The Institute of Technology.
    Merkel, Magnus
    Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory. Linköping University, The Institute of Technology.
    Halvautomatisk översättning av SNOMED CT till svenska2003In: IT i vården - terminologi, 2003Conference paper (Other academic)
  • 42.
    Petersson, Håkan
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    A variance-based measure of inter-rater agreement in medical databases2002In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 35, no 5-6, p. 331-342Article in journal (Refereed)
    Abstract [en]

    The increasing use of encoded medical data requires flexible tools for data quality assessment. Existing methods are not always adequate, and this paper proposes a new metric for inter-rater agreement of aggregated diagnostic data. The metric, which is applicable in prospective as well as retrospective coding studies, quantifies the variability in the coding scheme, and the variation can be differentiated in categories and in coders. Five alternative definitions were compared in a set of simulated coding situations and in the context of mortality statistics. Two of them were more effective, and the choice between them must be made according to the situation. The metric is more powerful for larger numbers of coded cases, and Type I errors are frequent when coding situations include different numbers of cases. We also show that it is difficult to interpret the meaning of variation when the structures of the compared coding schemes differ.

  • 43.
    Petersson, Håkan
    et al.
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Improving inter-rater reliability by coding scheme reorganization: managing signs and symptomsManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this paper is to study the potential for improving inter-rater reliability in general practice registries through the use of a semantic terminology model that enables diagnostic labels to be separated into symptoms and diseases, i.e. into different levels of diagnostic precision. Cases coded as symptoms according to the ICD-based coding system currently in use in Swedish general practice were reclassified with the help of the model, and inter-rater variability was measured through divergences of observed coding distributions from expected distributions. 40 percent of the symptom cases were candidates for reclassification; half of these could actually be reclassified. This decreased inter-rater variability, but the difference was not statistically significant. Diagnostic categories with large variation in utilization rates were foWld, which calls for careful selection of topics for medical audit. Although reclassification of symptoms may improve reliability, no straightforward association was found between a chapter's diagnostic precision and its contribution to overall variability. Nor could differences in diagnostic precision explain all variation within a chapter. Further research on other dimensions of the coding system is needed before symptom reclassification can be recommended as a general reliability-improving tool.

  • 44.
    Petersson, Håkan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Gill, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Improving Inter-Rater Reliability through Coding Scheme Reorganization: Managing Signs and Symptoms2008In: The First Conference on Text and Data Mining of Clinical Documents Louhi08,2008, Turku: TUCS General Publications , 2008, p. 54-Conference paper (Refereed)
  • 45.
    Petersson, Håkan
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Gunnar
    Family Medicine Stockholm, Karolinska institutet, Stockholm.
    Stender, Lars-Erik
    Family Medicine Stockholm, Karolinska institutet, Stockholm.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    The connection between terms used in medical records and coding system: a study on Swedish primary health care data2001In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 26, no 2, p. 87-99Article in journal (Refereed)
    Abstract [en]

    Implementation of problem lists and their relation to standardized coding systems have been approached and analysed in different ways. Most evaluations concern quantitative aspects such as content coverage in a specific domain. In order to reveal the qualitative aspects of diagnostic coding, medical record texts from primary health care encounters were compared with terms from a coding system that was used for describing them statistically. The records were coded by six general practitioners, and in some cases, an applied diagnostic term was found within the text, while other record text-coding system relationships were categorized as synonyms, alternative terms, and interpretations. Thus, the categories roughly corresponded to a measure of semantic distance between the terms in the record text and the rubrics of the coding system, and there was a correlation between semantic distance and inter-rater agreement. The subcategories of this scheme corresponded fairly well to recently published desiderata for clinical terminology servers, including functionality such as word normalization and spelling correction. However, not all problems could have been automatically coded by means of lexical methods, which can be partly explained by the fact that diagnostic coding also relies on clinical knowledge. In addition, proper automation relies on context representation within the records.

  • 46.
    Petersson, Håkan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Nilsson, Gunnar
    Stockholm County Council .
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Malmberg, Britt-Gerd
    Stockholm County Council .
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Design and implementation of a world wide web accessible database for the Swedish ICD-10 primary care version using a concept system approach1997In: AMIA,1997, Philadelphia: Hanley & Belfus Inc , 1997, p. 885-Conference paper (Refereed)
  • 47.
    Petersson, Håkan
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Gunnar
    Centre of Medical Informatics in General Practice, Stockholm County Council, Sweden.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Malmberg, Britt-Gerd
    Centre of Medical Informatics in General Practice, Stockholm County Council, Sweden.
    Wigertz, Ove
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Semantic modeling of a traditional classification: results and implications1998In: Medinfo ‘98: Proceedings of the Ninth World Congress on Medical Informatics / [ed] Cesnik, B., McCray, A.T., Scherrer, J.-R., Australia: IOS Press , 1998, p. 613-617Conference paper (Refereed)
    Abstract [en]

    A primary health care version of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), together with a three-dimensional model for classification of diseases according to locations, origin, and type has been semantically represented. The resulting computer-based version is made available via the World Wide Web.

  • 48.
    Petersson, Håkan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Terminology support for diagnostic coding in primary health care.2000In: AMIA,2000, Linköping: Department of Biomedical Engineering, Division of Medical Informatics, Linköpings universitet , 2000Conference paper (Refereed)
  • 49.
    Razavi, Amir R
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Shahsavar, Nosrat
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Non-compliance with a postmastectomy radiotherapy guideline: Decision tree and cause analysis2008In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 8, no 41Article in journal (Refereed)
    Abstract [en]

    Background: The guideline for postmastectomy radiotherapy (PMRT), which is prescribed to reduce recurrence of breast cancer in the chest wall and improve overall survival, is not always followed. Identifying and extracting important patterns of non-compliance are crucial in maintaining the quality of care in Oncology.

    Methods: Analysis of 759 patients with malignant breast cancer using decision tree induction (DTI) found patterns of non-compliance with the guideline. The PMRT guideline was used to separate cases according to the recommendation to receive or not receive PMRT. The two groups of patients were analyzed separately. Resulting patterns were transformed into rules that were then compared with the reasons that were extracted by manual inspection of records for the non-compliant cases.

    Results: Analyzing patients in the group who should receive PMRT according to the guideline did not result in a robust decision tree. However, classification of the other group, patients who should not receive PMRT treatment according to the guideline, resulted in a tree with nine leaves and three of them were representing non-compliance with the guideline. In a comparison between rules resulting from these three non-compliant patterns and manual inspection of patient records, the following was found:

    In the decision tree, presence of perigland growth is the most important variable followed by number of malignantly invaded lymph nodes and level of Progesterone receptor. DNA index, age, size of the tumor and level of Estrogen receptor are also involved but with less importance. From manual inspection of the cases, the most frequent pattern for non-compliance is age above the threshold followed by near cut-off values for risk factors and unknown reasons.

    Conclusion: Comparison of patterns of non-compliance acquired from data mining and manual inspection of patient records demonstrates that not all of the non-compliances are repetitive or important. There are some overlaps between important variables acquired from manual inspection of patient records and data mining but they are not identical. Data mining can highlight non-compliance patterns valuable for guideline authors and for medical audit. Improving guidelines by using feedback from data mining can improve the quality of care in oncology.

  • 50.
    Razavi, Amir Reza
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences.
    Sundquist, Marie
    Department of Surgery, County Hospital, Kalmar, Sweden.
    Thorstenson, Sten
    Department of Pathology, County Hospital, Kalmar, Sweden.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Shahsavar, Nosrat
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    The South-East Swedish Breast Cancer Study Group,
    Exploring cancer register data to find risk factors for recurrence of breast cancer: Application of Canonical Correlation Analysis2005In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, Vol. 5, no 29, p. 29-35Article in journal (Refereed)
    Abstract [en]

    Background

    A common approach in exploring register data is to find relationships between outcomes and predictors by using multiple regression analysis (MRA). If there is more than one outcome variable, the analysis must then be repeated, and the results combined in some arbitrary fashion. In contrast, Canonical Correlation Analysis (CCA) has the ability to analyze multiple outcomes at the same time.

    One essential outcome after breast cancer treatment is recurrence of the disease. It is important to understand the relationship between different predictors and recurrence, including the time interval until recurrence. This study describes the application of CCA to find important predictors for two different outcomes for breast cancer patients, loco-regional recurrence and occurrence of distant metastasis and to decrease the number of variables in the sets of predictors and outcomes without decreasing the predictive strength of the model.

    Methods

    Data for 637 malignant breast cancer patients admitted in the south-east region of Sweden were analyzed. By using CCA and looking at the structure coefficients (loadings), relationships between tumor specifications and the two outcomes during different time intervals were analyzed and a correlation model was built.

    Results

    The analysis successfully detected known predictors for breast cancer recurrence during the first two years and distant metastasis 2–4 years after diagnosis. Nottingham Histologic Grading (NHG) was the most important predictor, while age of the patient at the time of diagnosis was not an important predictor.

    Conclusion

    In cancer registers with high dimensionality, CCA can be used for identifying the importance of risk factors for breast cancer recurrence. This technique can result in a model ready for further processing by data mining methods through reducing the number of variables to important ones.

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