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  • 1.
    Aspevall, Olle
    et al.
    Karolinska Inst Stockholm.
    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.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Preiminary report: Concepts and terms used to describe urinary tract infection in primary health care and in the clinical microbiology laboratory1999In: Medical Informatics Europe99,1999, Amsterdam: IOS Press , 1999, p. 899-Conference paper (Refereed)
  • 2.
    Aspevall, Olle
    et al.
    Karolinska institutet Stockholm.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    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.
    Building a concept system to structure the contents of a decision support system - a grounded theory study of concepts in the knowledge domain of urinary tract infection2001In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 26, no 2, p. 115-129Article in journal (Refereed)
  • 3.
    Barlow, Lotti
    et al.
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Gerdin, Ulla
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Almborg, Ann-Helene
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Kron, Bengt
    Regionkansliet Hälso- och sjukvårdsavdelningen, Västra Götalandsregionen.
    Lindberg, Christina
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Bränd Persson, Kristina
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Ahlzén, Karin
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Ericsson, Erika
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Adelöf, Anna
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Wolff Foster, Lisa
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Widigson, Lena
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Bratt, Maria
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Testi, Stefano
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Staerner Steen, Anna
    Fackspråk och informatik, Regler och tillstånd, Socialstyrelsen.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nationellt fackspråk för vård och omsorg: Slutrapport2011Report (Other (popular science, discussion, etc.))
    Abstract [sv]

    Sammanfattning

    Ett tillgängligt och använt nationellt fackspråk ska bidra till en god och säker vård och omsorg. Det ska även medverka till att kvaliteten och resultaten på området ska kunna följas upp och jämföras på ett mer effektivt sätt. Slutrapporten presenterar resultatet av projektet Nationellt fackspråk för vård och omsorg samt förslag till förvaltning och utveckling.

    Resultatet

    Resultatet innefattar bland annat att det internationella begreppssystemet Snomed CT är översatt till svenska och att det är förberett för förvaltning och distribution. Socialstyrelsen har även tagit fram och testat metoder för förvaltning och utveckling av det nationella fackspråket i sin helhet. Därtill har representanter för målgrupperna informerats och fått kunskap.

    Rapporten innehåller en utförlig beskrivning av det nationella fackspråkets sammantagna innehåll: Socialstyrelsens termbank, klassifikationer och kodverk, den svenska versionen av Snomed CT, metoder för utveckling och förvaltning samt regler för användning.

    Förvaltning, införande och resursbehov

    I rapporten finns förslag till hur hela det nationella fackspråket kan tas omhand av Socialstyrelsen och hur det kan införas i vården och omsorgen. Projektets övergång till en långsiktigt hållbar organisation kräver resurser. Därför redogör rapporten för det förväntade resursbehovet för förvaltning och utveckling. Bland annat föreslås en treårig utbildningsinsats samt stimulansbidrag för införande.

    Krav på styrning, samordning och förtydligat ansvar

    Rapporten betonar behovet av en samlad och medveten styrning av utvecklingen inom området. Socialstyrelsen vill ha en samordnande roll i utvecklingen och förvaltningen av det nationella fackspråket. Myndigheten föreslås få det initiala ansvaret för att utbilda användare och att driva frågor om det nationella fackspråket.

    Vidare vill Socialstyrelsen få ett uttalat mandat att samordna de nationella aktiviteter som drivs med koppling till Snomed CT. Rapporten pekar ut några särskilt prioriterade områden som myndigheten borde få i uppdrag att arbeta vidare inom.

    Kunskapsstyrning och normgivning

    En viktig slutsats i rapporten är att användningen av det nationella fackspråket behöver regleras för att målet om ökad säkerhet för klienter och patienter ska kunna uppnås. I dagsläget bedöms föreskrifter vara den metod som bäst kan garantera ett brett genomförande.

    Målgrupper för slutrapporten

    Slutrapporten riktar sig till beslutsfattare i kommuner och landsting, vård- och omsorgspersonal med särskilt intresse eller ansvar för dokumentationsfrågor och professionella organisationer. Den riktar sig också till terminologiansvariga i kommuner och landsting, IT-direktörer, IT-leverantörer samt aktörer inom den nationella strategin för eHälsa.

  • 4.
    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.

  • 5.
    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.

  • 6.
    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.

  • 7.
    Cornet, Ronald
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology. University of Amsterdam, The Netherlands.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    User-Directed Coordination in SNOMED CT2013In: MedInfo 2013: Proceedings of the 14th World Congress on Medical and Health Informatics / [ed] Lehmann, C.U., Ammenwerth, E., Nøhr, C., Amsterdam: IOS Press, 2013, p. 72-76Conference paper (Refereed)
    Abstract [en]

    The possibility of post-coordination of SNOMED CT concepts, especially by clinical users, is both an asset and a challenge for SNOMED CT implementation. To get insight in the applicability of post-coordination, we analyzed scenarios for user-directed coordination that are described in the documentation of SNOMED CT. The analyses were based on experiences from previous and ongoing research and implementation work, including national mapping projects, and investigations on collection of data for multiple uses. These scenarios show various usability and representation problems: high number of relationships for refinement and qualification, improper options for refinement, incorrect formal definitions, and lack of support for applying editorial rules. Improved user-directed coordination in SNOMED CT in real practice requires advanced sanctioning, increased consistency of definitions of concepts in SNOMED CT, and real-time analysis of the post-coordinate expression.

  • 8.
    Forsum, Urban
    et al.
    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.
    Hallander, Hans O.
    Swedish Institute for Infectious Disease Control Stockholm.
    Kallner, Anders
    Dept of Clinical Chemistry Karolinska Univesity Hospital.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    The impact of qualitative analysis in laboratory medicine2005In: TrAC. Trends in analytical chemistry, ISSN 0165-9936, E-ISSN 1879-3142, Vol. 24, no 6, p. 546-555Article in journal (Refereed)
    Abstract [en]

    Laboratory medicine is a challenge for the metrologically and terminologically inclined scientist. One main reason is the need for a sound theory that can be applied in a systematic way to cover all aspects of examinations, i.e., those procedures whose results are reported on an ordinal scale and those reported on more primitive scales (e.g., classifications and narratives). Validation of procedures for examinations involving properties on a nominal scale is especially difficult to achieve because it is hard to find gold standards, in the conventional sense, against which to validate and which combine performance characteristics and clinically relevant specificity and sensitivity. We present a systematic, unambiguously defined terminology (the C-NPU coding scheme) for metrologically derived terms for expressing properties, and present some examples of how to attain diagnostic goals. If the analytic process in the laboratory can be subsumed into medical contexts in a systematic way, many pitfalls in reporting results can be avoided. © 2005 Elsevier Ltd. All rights reserved.

  • 9.
    Forsum, Urban
    et al.
    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.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Begrepp och termer inom hälso- och sjukvård1999In: Socialmedicinsk tidskrift, ISSN 0037-833X, no 6, p. 540-547Article in journal (Refereed)
  • 10.
    Forsum, Urban
    et al.
    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.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Terminology, categories and representation of examinations in laboratory medicine [2]2005In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 43, no 3, p. 344-345Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 11.
    Freire, Sergio Miranda
    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.
    Lambrix, Patrick
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Performance of XML Databases for Epidemiological Queries in Archetype-Based EHRs2012In: Proceedings Scandinavian Conference on Health Informatics 2012, Linköping: Linköping University Electronic Press, 2012, p. 51-57Conference paper (Refereed)
    Abstract [en]

    There are very few published studies regarding the performance of persistence mechanisms for systems that use the openEHR multi level modelling approach. This paper addresses the performance and size of XML databases that store openEHR compliant documents. Database size and response times to epidemiological queries are described. An anonymized relational epidemiology database and associated epidemiological queries were used to generate openEHR XML documents that were stored and queried in four opensource XML databases. The XML databases were considerably slower and required much more space than the relational database. For population-wide epidemiological queries the response times scaled in order of magnitude at the same rate as the number of records (total database size) but were orders of magnitude slower than the original relational database. For individual focused clinical queries where patient ID was specified the response times were acceptable. This study suggests that the tested XML database configurations without further optimizations are not suitable as persistence mechanisms for openEHR-based systems in production if population-wide ad hoc querying is needed.

  • 12.
    Freire, Sergio Miranda
    et al.
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Departamento de Tecnologia da Informação e Educação em Saúde, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
    Teodoro, Douglas
    Departamento de Tecnologia da Informação e Educação em Saúde, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil .
    Wei-Kleiner, Fang
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. Region Östergötland.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Lambrix, Patrick
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Comparing the Performance of NoSQL Approaches for Managing Archetype-Based Electronic Health Record Data2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, article id e0150069Article in journal (Refereed)
    Abstract [en]

    This study provides an experimental performance evaluation on population-based queries of NoSQL databases storing archetype-based Electronic Health Record (EHR) data. There are few published studies regarding the performance of persistence mechanisms for systems that use multilevel modelling approaches, especially when the focus is on population-based queries. A healthcare dataset with 4.2 million records stored in a relational database (MySQL) was used to generate XML and JSON documents based on the openEHR reference model. Six datasets with different sizes were created from these documents and imported into three single machine XML databases (BaseX, eXistdb and Berkeley DB XML) and into a distributed NoSQL database system based on the MapReduce approach, Couchbase, deployed in different cluster configurations of 1, 2, 4, 8 and 12 machines. Population-based queries were submitted to those databases and to the original relational database. Database size and query response times are presented. The XML databases were considerably slower and required much more space than Couchbase. Overall, Couchbase had better response times than MySQL, especially for larger datasets. However, Couchbase requires indexing for each differently formulated query and the indexing time increases with the size of the datasets. The performances of the clusters with 2, 4, 8 and 12 nodes were not better than the single node cluster in relation to the query response time, but the indexing time was reduced proportionally to the number of nodes. The tested XML databases had acceptable performance for openEHR-based data in some querying use cases and small datasets, but were generally much slower than Couchbase. Couchbase also outperformed the response times of the relational database, but required more disk space and had a much longer indexing time. Systems like Couchbase are thus interesting research targets for scalable storage and querying of archetype-based EHR data when population-based use cases are of interest.

  • 13.
    Holm, Tua
    et al.
    Östergötland County Council, Linköping, Sweden.
    Norr, Anders
    Östergötland County Council, Linköping, Sweden.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Lessons learned from starting to implement SNOMED CT2014Conference paper (Other academic)
    Abstract [en]

    National eHealth – the strategy for accessible and secure information in health and social care – is a Swedish initiative aiming at improving information management within the healthcare and social services sector. SNOMED CT is one tool in this strategy. To gain experience from SNOMED CT implementation, the National Board of Health and Welfare (host of the National Release Center of SNOMED CT) funded a number of pilot projects during 2013. Our project was one of these, focusing on facilitation of information sharing by using SNOMED CT in two application areas as described below. Furthermore, the project initiated a dialog with the EHR vendor concerning future SNOMED CT implementation.

    One area was transfer of discharge summaries from hospital care at Östergötland County Council to municipal home care. A discharge summary consists of a template with encoded headings, associated free text fields, and instructions about intended content. These headings were mapped to SNOMED CT.

    The other area was transfer of information from the EHR system at hospitals in three counties to the Swedish Stroke Register, a national quality register. The specification of information requested by the register was analyzed. Then, an EHR template was outlined, taking into account the clinical stroke process requirements, quality register requirements, and the information model of the EHR system. The draft template was based on mappings to SNOMED CT to facilitate a mutually agreed template. That means a template common for the three county councils, as well as information transfer to the register, and at the same time reduce the need for double documentation, information searching and other manual routines.

    Lessons learned include that mapping EHR template components and other EHR objects to SNOMED CT concepts holds potential benefits, regardless of whether one’s EHR system can handle mappings. Mapping activities may aid review and management of existing and development of new templates. Furthermore, mappings may be used as a common point of reference when information is shared. Mapping ambiguous template headings to SNOMED CT concepts was found to be time consuming and uncertain and mapping seems to be most useful when EHR contents are structured. These mapping source prerequisites imply that existing documentation practice needs to be revised and that organizations must support end users in that process. The project also concluded that mappings would be even more advantageous if EHR systems can handle mappings of different objects types. Organizations also need to allocate adequate resources for managing its own mappings as well as contributing to the development of SNOMED CT as such.

    Finally, the project found that training of mapping personnel benefits from integrating theoretical instruction and practical use of SNOMED CT, and that finding the correct concept in SNOMED CT calls for clinical expertise in order to be successful.

  • 14.
    Hägglund, Maria
    et al.
    Karolinska Institutet, Solna, Sverige.
    Karlsson, M. G. Daniel
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Klein, Gunnar
    Örebro Universitet, Örebro, Sverige.
    Koch, Sabine
    Karolinska Institutet, Solna, Sverige.
    Lindgren, Helena
    Umeå Universitet, Umeå, Sverige.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Scandurra, Isabella
    Örebro Universitet, Örebro, Sverige.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Världsbäst på eHälsa kräver internationellt samarbete2017In: Svenska dagbladet, ISSN 1101-2412Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Det är glädjande att myndigheter nu äntligen tittar mer på internationellt delade detaljerade dokumentationsmodeller för innehåll i journaler. Vi hoppas att de ger tillräckligt kraftfulla och tydliga budskap så att de upphandlande vårdgivarna också ser vikten av detta. Om vi ska bli världsbäst på eHälsa krävs internationellt samarbete, skriver flera forskare i medicinsk informatik.

  • 15.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    A design and prototype for a decision-support system in the field of urinary tract infections: application of openGALEN techniques for indexing medical information2001In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 84, no 1, p. 479-483Article in journal (Refereed)
    Abstract [en]

    Differences in expert and end-user contexts may be detrimental to the use of decision-support systems. A way to attend to this problem is to triangulate decision-support methods and information sources such as in the case of the expertext system model. To organize the information contained in the system, a common domain model is suggested as a instrument for annotating information. In this paper, a design and a prototype for a decision-support system in the field of urinary tract infections using techniques and methods developed in the GALEN projects is presented.

  • 16.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, The Institute of Technology.
    Aspects of the use of medical decision-support systems: the role of context in decision support2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is a great need today for distribution of medical information. The amount of information is growing quickly, and information that could potentially influence clinical practice fails to reach health care professionals. The supply of information to health care has from the start been the main goal of medical informatics. However, with very few exceptions, the systems developed to support the formalization and distribution of medical knowledge, i.e. decision-support or expert systems, have not attained clinical use. Thus, since there is an unsatisfied need for information and the methods developed so far have been successful to only a limited extent, it is important to gain insight into both how decision-support systems are used and which of their properties may influence the usability.

    This thesis describes aspects of the use of medical decision-support systems by looking at two prototype implementations of such systems. The prototypes concerned bacterial endocarditis and urinary tract infections respectively. The first prototype system was evaluated and a theory of the use of the system was developed, thereby leading to further theorization and the development of a new system design. The goal of the system designs was to facilitate the interpretation and assessment of generated advice. This kind of support was realized by applying an expertext system model, a model that supports triangulation of decision-support methods and information sources. To organize the information in an expertext environment, a common terminological domain model was used in the second system design. In the theorization, a special focus was on contextual aspects of system use. Differences between knowledge provider and end-user contexts concerning the use of decision-support systems were analyzed. The importance of support for multi-perspective interpretation of system output such as is present in our system designs was confirmed.

    List of papers
    1. Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique
    Open this publication in new window or tab >>Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique
    Show others...
    1997 (English)In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 36, no 2, p. 108-114Article in journal (Refereed) Published
    Abstract [en]

    There is an obvious need for geographic distribution of expert knowledge among several health care units without increasing the cost of on-site expertise in locations where health care is provided. This paper describes the design of a knowledge-based decision-support system for extended consultation in clinical medicine. The system is based on Arden Syntax for Medical Logic Modules and hypertext using World Wide Web technology. It provides advice and explanations regarding the given advice. The explanations are presented in a hypertext format allowing the user to browse related information and to verify the relevance of the given advice. The system is intended to be used in a closed local network. With special precautions regarding issues of safety and patient security, the system can be used over wider areas such as in rural medicine. A prototype has been developed in the field of clinical microbiology and infectious diseases regarding infective endocarditis.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13333 (URN)9242006 (PubMedID)
    Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2017-12-13
    2. A study of the usage of a decision-support system for infective endocarditis
    Open this publication in new window or tab >>A study of the usage of a decision-support system for infective endocarditis
    2000 (English)In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 25, no 1, p. 1-18Article in journal (Refereed) Published
    Abstract [en]

    The objective of this study was to examine a design for a World Wide Web-based decision-support system in use by clinically active physicians. A prototype implementation of the design concerned management of infective endocarditis patient cases. The design was based on an integration of hypertext and rule-based knowledge. In the study sessions, physicians in the field of internal medicine worked on managing authentic patient cases in a laboratory setting. Data was collected from interviews with the physicians using video recordings and stimulated recall technique. The qualitative data was analysed according to the constant comparative method in order to develop a model of the physicians' usage of the system. The resulting model describes perceived contributions and criteria for usefulness of the system. The ways the physicians used the system showed that it was able to provide patient-specific support for confirming clinical decisions, for higher-level patient management, and for preparing for and initiating expert consultations. Users also stated that new medical knowledge could be gained as a side effect of using the system.

    Keywords
    Decision-support System, Endocarditis, Qualitative Methodology, Evaluation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13334 (URN)10.1080/146392300298229 (DOI)
    Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2017-12-13
    3. A study of the concept of urinary tract infections in different domains of medicine using the MEDLINE® database
    Open this publication in new window or tab >>A study of the concept of urinary tract infections in different domains of medicine using the MEDLINE® database
    (English)Manuscript (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.

    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-88955 (URN)
    Available from: 2013-02-19 Created: 2013-02-19 Last updated: 2013-02-19
    4. Medical decision-support systems and the concept of context
    Open this publication in new window or tab >>Medical decision-support systems and the concept of context
    2004 (English)In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 29, no 2, p. 109-118Article in journal (Refereed) Published
    Abstract [en]

    Medical decision-support systems are of necessity multi-contextual in nature. There are always at least two contexts involved in the use of such systems: the expert knowledge-provider context and the end-user context. To show this, we present examples of context-dependent aspects significant to the use of decision-support systems. The existence of discrepancies between the contexts threatens to disrupt the rationale for using decision-support systems: for the system to transfer knowledge from the expert to the end-user. Both theoretical and empirical studies show that such discrepancies exist and that they may be detrimental to the use of decision-support systems. Systems must thus give support in interpreting the output produced by the system in the context of the end-user. © 2004 Taylor and Francis Ltd.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-28810 (URN)10.1080/14639230410001684404 (DOI)13998 (Local ID)13998 (Archive number)13998 (OAI)
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
    5. A design and prototype for a decision-support system in the field of urinary tract infections: application of openGALEN techniques for indexing medical information
    Open this publication in new window or tab >>A design and prototype for a decision-support system in the field of urinary tract infections: application of openGALEN techniques for indexing medical information
    2001 (English)In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 84, no 1, p. 479-483Article in journal (Refereed) Published
    Abstract [en]

    Differences in expert and end-user contexts may be detrimental to the use of decision-support systems. A way to attend to this problem is to triangulate decision-support methods and information sources such as in the case of the expertext system model. To organize the information contained in the system, a common domain model is suggested as a instrument for annotating information. In this paper, a design and a prototype for a decision-support system in the field of urinary tract infections using techniques and methods developed in the GALEN projects is presented.

    Place, publisher, year, edition, pages
    Amsterdam: IOS Press, 2001
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-29003 (URN)10.3233/978-1-60750-928-8-479 (DOI)14236 (Local ID)14236 (Archive number)14236 (OAI)
    Conference
    MEDINFO 2001, 10th World Congress on Medical Informatics, London, United Kingdom
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
  • 17.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Design and evaluation of a clinical decision and information support system1997Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is an obvious need today for distribution of medical information and expert knowledge among health-care providers. The ever-expanding volume of the biomedical knowledge base and the reduced funding in health-care organisations make the task of keeping up-to-date with developments in clinical medicine difficult. Nevertheless, this new knowledge must continually be shared among health-care providers. There is consequently a need for decision and information support in clinical practice.

    This thesis describes attempts at using information techniques to meet this information need. In the work addressed in this thesis, a decision and information-support system with the aim of providing geographically distributed expert knowledge has been designed, implemented and assessed with respect to user satisfaction. The system design is based on the integration of rule-based and hypertext knowledge representations to provide efficient access to clinically relevant information and extended explanations to given advice.

  • 18.
    Karlsson, Daniel
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Aspevall, Olle
    Karolinska Inst, Stockholm .
    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.
    A desision support system for urinary tract infections1999In: AMIA99,1999, Philadelphia: Hanley & Belfuse Inc , 1999, p. 1094-Conference paper (Refereed)
  • 19.
    Karlsson, Daniel
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Aspevall, Olle
    KI, Huddinge .
    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.
    Concepts, contexts and expert systemms1999In: Medical Informatics Europe99,1999, Amsterdam: IOS Press , 1999, p. 713-Conference paper (Refereed)
  • 20.
    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.

  • 21.
    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.

  • 22.
    Karlsson, Daniel
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Carlsson, Mats
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    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.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    A design for a World Wide Web decision-support system using a controlled medical terminology1996In: AMIA1996,1996, Washington: Hanley & Belfus , 1996, p. 189-Conference paper (Refereed)
  • 23.
    Karlsson, Daniel
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Ekdahl, Christer
    Linköping University, Department of Molecular and Clinical Medicine.
    Shahsavar, Nosrat
    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.
    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.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    A WWW-based decision-support system using medical logic modules and hypertext1996In: Medical Informatics Europe 96,1996, Amsterdam: IOS Press , 1996, p. 93-Conference paper (Refereed)
  • 24.
    Karlsson, Daniel
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Ekdahl, Christer
    Linköping University, Department of Molecular and Clinical Medicine.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    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.
    A qualitative study of clinicians ways of using a decision-support system1997In: AMIA97,1997, Philadelpia: Hanley & Belfuse Inc , 1997, p. 268-Conference paper (Refereed)
  • 25.
    Karlsson, Daniel
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Ekdahl, Christer
    Linköping University, Department of Molecular and Clinical Medicine.
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    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.
    Design and evaluation of a clinical decision and information support system1998In: MEDINFO 98,1998, Australia: IOS Press , 1998, p. 574-Conference paper (Refereed)
  • 26.
    Karlsson, Daniel
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Ekdahl, Christer
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Wigertz, Ove
    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.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Forsum, Urban
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique1997In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 36, no 2, p. 108-114Article in journal (Refereed)
    Abstract [en]

    There is an obvious need for geographic distribution of expert knowledge among several health care units without increasing the cost of on-site expertise in locations where health care is provided. This paper describes the design of a knowledge-based decision-support system for extended consultation in clinical medicine. The system is based on Arden Syntax for Medical Logic Modules and hypertext using World Wide Web technology. It provides advice and explanations regarding the given advice. The explanations are presented in a hypertext format allowing the user to browse related information and to verify the relevance of the given advice. The system is intended to be used in a closed local network. With special precautions regarding issues of safety and patient security, the system can be used over wider areas such as in rural medicine. A prototype has been developed in the field of clinical microbiology and infectious diseases regarding infective endocarditis.

  • 27.
    Karlsson, Daniel
    et al.
    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.
    Medical decision-support systems and the concept of context2004In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 29, no 2, p. 109-118Article in journal (Refereed)
    Abstract [en]

    Medical decision-support systems are of necessity multi-contextual in nature. There are always at least two contexts involved in the use of such systems: the expert knowledge-provider context and the end-user context. To show this, we present examples of context-dependent aspects significant to the use of decision-support systems. The existence of discrepancies between the contexts threatens to disrupt the rationale for using decision-support systems: for the system to transfer knowledge from the expert to the end-user. Both theoretical and empirical studies show that such discrepancies exist and that they may be detrimental to the use of decision-support systems. Systems must thus give support in interpreting the output produced by the system in the context of the end-user. © 2004 Taylor and Francis Ltd.

  • 28.
    Karlsson, Daniel
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Gøeg, Kirstine Rosenbeck
    Department of Health Science and Technology, Aalborg University.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Højen, Anne Randorff
    Department of Health Science and Technology, Aalborg University.
    Semantic Krippendorff’s α for measuring inter-rater agreement in SNOMED CT coding studies2014In: e-Health – For Continuity of Care / [ed] Christian Lovis, et al., Amsterdam, 2014, p. 151-155Conference paper (Refereed)
    Abstract [en]

    Semantic interoperability requires consistency in use of terminologies such as SNOMED CT. Inter-rater agreement measurement can be used to quantify this consistency among terminology users. Increasingly, studies of SNOMED CT include inter-rater agreement measures. However, published studies do not consider distance between concepts when calculating the inter-rater agreement measures. In this paper we propose a semantic inter-rater agreement measure for use with SNOMED CT encoded data. A semantic Krippendorff's α measure is implemented using a path-length based difference function. The measure is tested using three different datasets. Results show that the proposed semantic measure is sensitive to seriousness of coding differences whereas a nominal measure is not. The proposed measure reflects the intuition that distance matters when comparing uses of SNOMED CT.

  • 29.
    Karlsson, Daniel
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. SICS East Swedish ICT, Linköping, Sweden.
    Archetype Representation of PROMs2015In: Digital Healthcare Empowering Europeans: Proceedings of MIE2015 / [ed] R. Cornet et al., Amsterdam: IOS Press, 2015, Vol. 210, p. 980-980Conference paper (Other academic)
  • 30.
    Karlsson, Daniel
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Kron, Bengt
    Region Västra Götaland.
    An integrated Expression Repository EHR system2012Conference paper (Other academic)
    Abstract [en]

    Introduction: The aim of this work is to develop and test a system for storing and querying pre- and post-coordinated SNOMED CT expressions in an Electronic Health Record (EHR) system. SNOMED CT is here used as a reference terminology and to allow abstraction of EHR data for transfer to quality databases.

    Background: Enumerating all combinations of SNOMED CT concepts is not possible due to combinatorial explosion. E.g. pain may be qualified by severity (7 severities), pain character (152), body site (25888 sites), course (31) etc. giving a total of some 800 million possible, although not always sensible, different ways to express pain.

    For SNOMED CT to be useful, terminology services need to be integrated with the other parts of the information infrastructure, e.g. EHRs. As the boundary between terminology and information model representation may vary among use cases, care should be taken in implementing such integrations.

    Results: A system is developed to support the management of post-coordinated SNOMED CT expressions. This expression repository allows subsumption testing of pre- and post-coordinated expressions using a full view, i.e. historical views are possible. A transitive closure of the Is a-relation is updated continuously with new post-coordinated expressions stored in the repository. The repository is also integrated with an openEHR-based EHR system including archetype querying possibilities. The integrated system allows querying of terminology-bound archetype instances using pre- and post-coordinated SNOMED CT expressions.

  • 31.
    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)
  • 32.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. SICS East Swedish ICT, Linköping, Sweden.
    Carlgren, Gunnar
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Mudra, Jacqueline
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Synnergren, Henrik
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Hilding, Niclas
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Karlsson, daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Persson, Hans Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Preliminary results of a telemonitoring study: COPD and heart failure patients exhibit great difference in their need of health care2015In: European Respiratory Journal: Official Scientific Journal of ERS / [ed] Marc Humbert, European Respiratory Society , 2015, Vol. 46/suppl 59, p. PA2790-PA2790Conference paper (Other academic)
    Abstract [en]

    Background: Growing populations of elderly patients with advanced stages of COPD or heart failure (HF) urge the need for specialized health care in the patients' home. A telemonitoring study has been initiated including patients using digital pens. Health care was provided by the specialized home care unit at a university hospital. Through an IT system the staff checked all daily patient reports. We hypothesized that the two groups of patients, advanced COPD or HF, would exhibit differences regarding exacerbations and the need of health care.

    Objective: To study exacerbations of COPD or HF, and patient health care consumption.

    Methods: A tele-monitoring system, the Health diary, which is based on digital pen technology, was employed. Exacerbations were identified using information provided through the telemonitoring system. Consumed health care was assessed as the number of patient contacts (home visits or telephone consultations).

    Results: Presently, 33 patients with advanced disease are enrolled (13 COPD and 20 HF patients) of which 11 patients (6 COPD and 5 HF patients) have completed the 1-yr study period or have died during the study period (2 COPD and 4 HF patients). Exacerbations were 2.8 and 0.8 and patient contacts were 96 and 42 per COPD and HF patient, respectively. While HF patients were significantly older than COPD patients, the two groups demonstrated no difference regarding gender distribution and comorbidity.

    Conclusions: COPD patients exhibit exacerbations more frequently and demand much more home health care than patients with HF do. It seems that this difference of health care consumption is mainly due to disease characteristics.

  • 33.
    Lind, Leili
    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.
    A system for symptom assessment in advanced palliative home healthcare using digital pens.2004In: Medical informatics and the Internet in medicine, ISSN 1463-9238, Vol. 29, no 3-4, p. 199-210Article in journal (Refereed)
    Abstract [en]

    Symptom control is one of the most important components of delivering effective palliative care, and adequate symptom assessment is a prerequisite for good symptom control. Patients receiving treatment in palliative home healthcare is geographically separated from the caregivers making symptom control a challenge, a challenge that could be met by the use of information and communication technology. Technologies of today offer different ways for patients to assess their symptoms at home and send the assessments to the healthcare provider. Examples are the use of a PC, a touch-tone telephone, and a digital pen, which require different kinds of infrastructure in the patient's home, and which differ in strengths and weaknesses. As part of an ongoing quality assurance work within the hospital-based home care clinic at Linköping University Hospital, the project has designed, developed and implemented an IT-support system for pain assessments for patients at home using digital pen and mobile Internet technology. A questionnaire study indicated that pain assessment using digital pens was accepted by patients and that problems mainly arose from the use of the visual-analogue scale.

  • 34.
    Lind, Leili
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Digital pen technology in palliative home healthcare2004In: 11th World Congress on Medical Informatics MEDINFO04,2004, San Francisco: IOS Press , 2004, p. 1723-Conference paper (Refereed)
  • 35.
    Lind, Leili
    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.
    Digital pen-based telemonitoring of elderly heart failure patients2013In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 192, p. 1062-1062Article in journal (Refereed)
    Abstract [en]

    Considering that a majority of elderlies are non-users of computers and Internet we developed a telemonitoring system for elderly heart failure (HF) home care patients based on digital pen technology - a technology never used before by this patient group. We implemented the system in clinical use in a 13 months long study. Fourteen patients (mean/median age 84 years) with severe HF participated. They accepted the technology and performed daily reports of their health state using the digital pen and a Health Diary form. Via the system the clinicians detected all HF-related deteriorations at an early stage and thereby prevented hospital re-admissions for all patients during the study, implying improved symptom control and large cost savings.

  • 36.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology. Santa Anna IT Research Institute, Linköping, Sweden.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Electronic patient-reported symptom assessment in palliative end-of-life home care2013In: Health Systems, ISSN 2047-6965, E-ISSN 2047-6973, Vol. 2, no 3, p. 171-180Article in journal (Refereed)
    Abstract [en]

    Good symptom control in palliative end-of-life home care requires adequateaccess to patients’ symptom assessments. The aim of the study was to investigatethe feasibility of an electronic symptom assessment reporting system tosupport symptom control. A randomised controlled study was performedduring April 2008–December 2009. The intervention consisted of a networkeddigital-pen-based information system. The primary outcome measure chosenwas the time span from the patient’s reporting of a symptom to the careproviders’ noticing this assessment. Patients with at least moderately severesymptoms were invited to participate in the study. Eighteen (11 intervention,seven control) patients from four home care centres participated, submittinga total of 330 symptom assessments. There was a significantly shorter mediantime span from reporting to noticing for assessments in the intervention group.The system used allowed both frequent and regular symptom reporting frompatients that can contribute to more correct and prompt medical decisions inpalliative end-of-life home care. Trial registration number: ISRCTN09750271.Health Systems (2013) 2, 171–180. doi:10.1057/hs.2013.4;published online 17 May 2013; corrected online 4 June 2013

  • 37.
    Lind, Leili
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Home healthcare patients using digital pens for pain assessment: in Telemedicine journal and e-health(ISSN 1530-5627) vol 11, issue 22005Conference paper (Refereed)
  • 38.
    Lind, Leili
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Symptom assessment in home healthcare using digital pens2003In: AMIA05,2003, 2003, p. 914-Conference paper (Refereed)
  • 39.
    Lind, Leili
    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.
    Symptom assessment in palliative advanced home healthcare using digital pensManuscript (preprint) (Other academic)
    Abstract [en]

    Symptom control is one of the most important components of delivering effective palliative care, and adequate symptom assessment is a prerequisite for good symptom control. Patient receiving treatment in palliative home healthcare is geographically separated from the caregivers making symptom control a challenge, a challenge that could be met by the use of information and communication technology.

    This paper describes experiences from a project focused on symptom assessment using digital pen technology in advanced palliative home healthcare. As part of an ongoing quality assurance work within the hospital-based home care clinic at Linköping University Hospital, the project has designed, developed and implemented an IT-support system for pain assessments for patients at home using digital pen technology. The system uses mobile Internet technology together with digital pen technology from Anoto™ AB. From December 2002 to August 2003 the system was in use at the hospital-based home care clinic. Alternative techniques, for example the use of a PC or a touch-tone telephone for symptom assessment, are discussed.

  • 40.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. SICS East Swedish ICT, Linköping, Sweden.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Telehealth for “the Digital Illiterate”: Elderly Heart Failure Patients’ Experiences2014In: eHealth – For Continuity of Care: Proceedings of MIE2014 / [ed] Lovis, C., Séroussi, B., Hasman, A., Pape-Haugaard, L., Saka, O., Andersen, S.K., Amsterdam, Netherlands: IOS Press, 2014, Vol. 205, p. 353-357Conference paper (Refereed)
    Abstract [en]

    Telehealth solutions should be available also for elderly patients with nointerest in using, or capacity to use, computers and smartphones. Fourteen elderly,severely ill heart failure patients in home care participated in a telehealth study andused digital pens for daily reporting of their health state—a technology never usedbefore by this patient group. After the study seven patients and two spouses wereinterviewed face-to-face. A qualitative content analysis of the interview materialwas performed. The informants had no experience of computers or the Internet andno interest in learning. Still, patients found the digital pen and the health diaryform easy to use, thus effortlessly adopting to changes in care provision. Theyexperienced an improved contact with the caregivers and had a sense of increasedsecurity despite a multimorbid state. Our study shows that, given that technologiesare tailored to specific patient groups, even “the digital illiterate” may use theInternet.

  • 41.
    Lind, Leili
    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.
    Fridlund, Bengt
    School of Health Sciences & Social Work, Växjö University, Sweden.
    Digital pens and pain diaries in palliative home healthcare: Professional caregivers’ experiences.2007In: Medical Informatics and the Internet in Medicine, ISSN 1753-8157, Vol. 32, no 4, p. 287-296Article in journal (Refereed)
    Abstract [en]

    Frequent pain assessment by the use of pain diaries for the follow-up of pain treatment can facilitate the caregivers' work with pain control in home health care. The aim was to explore and describe professional caregivers' experiences of palliative home health-care patients' use of pain diaries and digital pen technology for frequent pain assessment. A system for the follow-up of pain treatment was implemented in routine care and evaluated by means of a qualitative content analysis. Three nurses, two physicians and one secretary were interviewed. Additional analysis data were collected from patients' medical records, and the system log. The caregivers showed a shifting outlook towards the pain-assessment method, an initial cautious outlook due to low expectations of the patients' abilities to use the pain assessment method. Despite this, the caregivers experienced positive outcomes in terms of an increased awareness of pain, and positive patient influences including increased participation in their care, increased security, and improved changes in pain treatment as a response to reported pain assessments. Pain assessment by the use of pain diaries and digital pen technology has positive influences on palliative home-care patients and supports the caregivers' focus on the pain.

  • 42.
    Lind, Leili
    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.
    Fridlund, Bengt
    Växjö University.
    Patients’ use of digital pens for pain assessment in advanced palliative home healthcare.2008In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 77, no 2, p. 129-136Article in journal (Refereed)
    Abstract [en]

    Background: Appropriate pain assessment is a necessary prerequisite for adequate pain control. A way to follow-up on the pain is to let patients use paper-based or electronic pain diaries.

    Purpose: The aim was to explore and describe palliative home care patients’ experiences of assessing their pain by using a pain diary together with digital pen and mobile Internet technology.

    Methods: A system for the follow-up of pain treatment was developed and evaluated by means of a qualitative cross-case content analysis. From December 2002 until September 2003 12 palliative patients, who initially assessed VAS pain ≥ 35 mm (VAS 0–100 mm), used the system. Patients reported their momentary pain intensity and the number of consumed extra doses of analgesics three times per day. Analysis data were collected from interviews with patients and spouses, questionnaires, medical records, and the system log.

    Results: In spite of severe illness and difficulties in comprehending the technology and system intervention, patients found the pain diary and digital pen easy to use for pain assessment. Patients took a greater part in their own care and experienced an improved contact with their caregivers, which led to a sense of increased security. The medical records showed a quick response to variations in the patients’ health status by means of changes in medical treatment.

    Conclusions: The pain assessment system for palliative patients using pain diaries together with digital pen and wireless Internet technology constitutes an effortless method and has positive influences on the care.

  • 43.
    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.

  • 44.
    Liss, Per-Erik
    et al.
    Linköping University, Department of Department of Health and Society.
    Aspevall, Olle
    Karolinska institutet.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    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.
    Interpreting definitions: The problem of interpreting definitions of medical concepts2004In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 7, p. 137-141Article in journal (Refereed)
  • 45.
    Martinez-Costa, Catalina
    et al.
    Medical University of Graz, Austria.
    Cornet, Ronald
    University of Amsterdam, Netherlands.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Schulz, Stefan
    Medical University of Graz, Austria.
    Kalra, Dipak
    UCL, England.
    Semantic enrichment of clinical models towards semantic interoperability. The heart failure summary use case2015In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 22, no 3, p. 565-576Article in journal (Refereed)
    Abstract [en]

    Objective To improve semantic interoperability of electronic health records (EHRs) by ontology-based mediation across syntactically heterogeneous representations of the same or similar clinical information. Materials and Methods Our approach is based on a semantic layer that consists of: (1) a set of ontologies supported by (2) a set of semantic patterns. The first aspect of the semantic layer helps standardize the clinical information modeling task and the second shields modelers from the complexity of ontology modeling. We applied this approach to heterogeneous representations of an excerpt of a heart failure summary. Results Using a set of finite top-level patterns to derive semantic patterns, we demonstrate that those patterns, or compositions thereof, can be used to represent information from clinical models. Homogeneous querying of the same or similar information, when represented according to heterogeneous clinical models, is feasible. Discussion Our approach focuses on the meaning embedded in EHRs, regardless of their structure. This complex task requires a clear ontological commitment (ie, agreement to consistently use the shared vocabulary within some context), together with formalization rules. These requirements are supported by semantic patterns. Other potential uses of this approach, such as clinical models validation, require further investigation. Conclusion We show how an ontology-based representation of a clinical summary, guided by semantic patterns, allows homogeneous querying of heterogeneous information structures. Whether there are a finite number of top-level patterns is an open question.

  • 46.
    Martínez-Costa, Catalina
    et al.
    Institute for Medical Informatics, Statistics and Documentation, Medical University, Graz, Austria.
    Queiroz de Andrade, André
    Institute for Medical Informatics, Statistics and Documentation, Medical University, Graz, Austria; Information Science Graduate Program, School of information Science, Federal University of Minas Gerais, Belo Horizonte, Brazil.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Kalra, Dipak
    The Centre for Health Informatics and Multiprofessional Education, University College London, United Kingdom.
    Schulz, Stefan
    Institute for Medical Informatics, Statistics and Documentation, Medical University, Graz, Austria; Institute of Medical Biometry and Medical Informatics, University Medical Center, Freiburg, Germany.
    Towards the harmonization of Clinical Information and Terminologies by Formal Representation2012In: European Journal for Biomedical Informatics, ISSN 1801-5603, Vol. 8, no 3, p. 3-10Article in journal (Refereed)
  • 47.
    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)
  • 48.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Shahsavar, Nosrat
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Det krävs en riktad satsning på e-hälsa2016In: Dagens medicin, ISSN 1104-7488, no 18, p. 22-Article in journal (Other (popular science, discussion, etc.))
  • 49.
    Pettersson, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Wihlborg, Jenny
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Lövström, Rikard
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    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.
    Systematizing medical alerts2008In: EHEALTH BEYOND THE HORIZON - GET IT THERE, ISSN 0926-9630, vol 136, 2008, Vol. 136, p. 753-758Conference paper (Refereed)
    Abstract [en]

    The current Swedish regulations for medical alerts in health records were designed for paper records. Suggestions for computerized systems are now being investigated. A proposed model using three alert categories, graphically represented using three directions, probably combined with three severity levels is presented here. Up represents hypersensitivities, left/back represents alerting diagnosis and right/forward represents alerting current and planned treatments. A small qualitative user study of the alert classification model and some graphical representations of it was conducted. One main finding is that most respondents found the use of directions intuitive as a means of presenting categories. Context dependency, information overload, and future possibilities for automated alert-gathering are also discussed in the paper.

  • 50.
    Schulz, Stefan
    et al.
    Medical University of Graz, Austria.
    Martínez-Costa, Catalina
    Medical University of Graz, Austria.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Cornet, Ronald
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. Academic Medical Center, Amsterdam, The Netherlands.
    Brochhausen, Mathias
    University of Arkansas for Medical Sciences, U.S..
    Rector, Alan
    University of Manchester, U.K..
    An Ontological Analysis of Reference in Health Record Statements2014In: Formal Ontology in Information Systems / [ed] Pawel Garbacz, Oliver Kutz, Amsterdam: IOS Press, 2014, Vol. 267, p. 289-302Conference paper (Refereed)
    Abstract [en]

    The relation between an information entity and its referent can be described as a second-order statement, as long as the referent is a type. This is typical for medical discourse such as diagnostic statements in electronic health records (EHRs), which often express hypotheses or probability assertions about the existence of an instance of, e.g. a disease type. This paper presents several approximations using description logics and a query language, the entailments of which are checked against a reference standard. Their pros and cons are discussed in the light of formal ontology and logic.

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