The CDIO framework is an integrated and important part of the new quality assurance system within the Faculty of Science and Engineering at Linköping University. Both the CDIO Syllabus and the CDIO Standards are used extensively in the system. First, the paper presents the development and use of the second generation of course matrices (previously denoted ITU-matrices) and program matrices, which build upon an adapted and extended version of the CDIO Syllabus. The extension is made to also include bachelor’s and master’s program in subjects outside the engineering field. Second, the paper presents how the CDIO Standards are used in the quality reports, which are vital parts of the quality assurance systems. As a result, the CDIO framework is used for the design, management, and quality assurance of all education programs ( approximately 60 programs) within the Faculty of Science and Engineering at Linköping University.

Approaches such as ISO 13606 and openEHR aim to address data reusability by defining clinical data structures called archetypes and templates, based on a reference model. A problem with these approaches is that parts of them currently are rather difficult to learn. It can be hard to imagine what an archetype-based clinical system combined with modern terminology systems will look like and what consequences different modeling choices have, without seeing and experimenting with an operational system. This paper reports findings from a survey among openEHR learners and educators combined with observations of related openEHR mailing list discussions. The paper ends with an opinion piece, where we discuss potentially fruitful ways to learn, explore, and extend archetype-based EHR systems using visualization and examples.The findings highlight potential stumble blocks and solutions and should be of interest for both educators and self-learners.

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.

Background

The openEHR project and the closely related ISO 13606 standard have defined structures supporting the content of Electronic Health Records (EHRs). However, there is not yet any finalized openEHR specification of a service interface to aid application developers in creating, accessing, and storing the EHR content.

The aim of this paper is to explore how the Representational State Transfer (REST) architectural style can be used as a basis for a platform-independent, HTTP-based openEHR service interface. Associated benefits and tradeoffs of such a design are also explored.

Results

The main contribution is the formalization of the openEHR storage, retrieval, and version-handling semantics and related services into an implementable HTTP-based service interface. The modular design makes it possible to prototype, test, replicate, distribute, cache, and load-balance the system using ordinary web technology. Other contributions are approaches to query and retrieval of the EHR content that takes caching, logging, and distribution into account. Triggering on EHR change events is also explored.

A final contribution is an open source openEHR implementation using the above-mentioned approaches to create LiU EEE, an educational EHR environment intended to help newcomers and developers experiment with and learn about the archetype-based EHR approach and enable rapid prototyping.

Conclusions

Using REST addressed many architectural concerns in a successful way, but an additional messaging component was needed to address some architectural aspects. Many of our approaches are likely of value to other archetype-based EHR implementations and may contribute to associated service model specifications.

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.

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.

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.

Background

The Archetype formalism and the associated Archetype Definition Language have been proposed as an ISO standard for specifying models of components of electronic healthcare records as a means of achieving interoperability between clinical systems. This paper presents an archetype editor with support for manual or semi-automatic creation of bindings between archetypes and terminology systems.

Methods

Lexical and semantic methods are applied in order to obtain automatic mapping suggestions. Information visualisation methods are also used to assist the user in exploration and selection of mappings.

Results

An integrated tool for archetype authoring, semi-automatic SNOMED CT terminology binding assistance and terminology visualization was created and released as open source.

Conclusion

Finding the right terms to bind is a difficult task but the effort to achieve terminology bindings may be reduced with the help of the described approach. The methods and tools presented are general, but here only bindings between SNOMED CT and archetypes based on the openEHR reference model are presented in detail.

Background

The Archetype formalism and the associated Archetype Definition Language have been proposed as an ISO standard for specifying models of components of electronic healthcare records as a means of achieving interoperability between clinical systems. This paper presents an archetype editor with support for manual or semi-automatic creation of bindings between archetypes and terminology systems.

Methods

Lexical and semantic methods are applied in order to obtain automatic mapping suggestions. Information visualisation methods are also used to assist the user in exploration and selection of mappings.

Results

An integrated tool for archetype authoring, semi-automatic SNOMED CT terminology binding assistance and terminology visualization was created and released as open source.

Conclusion

Finding the right terms to bind is a difficult task but the effort to achieve terminology bindings may be reduced with the help of the described approach. The methods and tools presented are general, but here only bindings between SNOMED CT and archetypes based on the openEHR reference model are presented in detail.