Voice-controlled data entry in dental electronic health record.

The EuroMISE Center focuses on new approaches in the field of electronic health record (EHR). Among others, the structured health documentation in dentistry in the form of an EHR is being systematically studied. This paper describes the evolution of the EHR developed at the EuroMISE Center named MUDRLite and its graphical component for dentists called DentCross. The summary of features of the DentCross component is followed by a brief description of automatic speech recognition and an ASR module. The problems with data insertion into EHR during examination of a dental patient lead to further research in the area of the automatic speech recognition in medical practice. Cooperation of engineers, informaticians and dental physicians resulted in an application called DentVoice which is a successful application of the ASR module and the DentCross component of the MUDRLite EHR. The junction of voice control and graphical representation of dental arch makes hand-busy activities in dental praxis easier, quicker and more comfortable. This will result in a better quality of the data stored in a structured form in dental EHR, thus enabling better decision making and use of decision support systems.

Information technology in clinical research in rheumatology domain.

The development of a functional clinical database of rheumatic diseases represents an essential step in the process of acquiring the necessary epidemiological and other information on disorders under study. In 1999-2005 the Institute of Rheumatology in cooperation with the EuroMISE Center has developed the Clinical database/National Register of selected systemic inflammatory rheumatic diseases inclusive of a bank of sera and DNA. Aims of this phase of the pilot research were gathering clinical, laboratory, genetic, pharmaco-and socio-economic data in a representative sample of patients with systemic lupus erythematosus, systemic sclerosis, polymyositis/dermatomyositis, mixed connective tissue disease; rheumatoid arthritis, juvenile chronic arthritis, ankylosing spondylitis, psoriatic arthritis and reactive arthritis. In 2002 the preset number of over 2000 registered patients had been achieved with collaboration of 34 territorial and 20 institutional rheumatologists in the whole covering the majority of the Czech Republic. Based on experiences gathered, the systems for other related studies are being developed and implemented using modern information technologies.

Some principles of the development of a clinical database/national register of selected inflammatory rheumatic diseases in the Czech Republic.

According to the World Health Organisation, rheumatic diseases are likely to go on occupying a prominent place worldwide. As to US statistics, rheumatic diseases are currently the most frequent chronic disorders and leading cause of disability. The development of functional clinical database or rheumatic diseases represents an essential condition how to acquire necessary epidemiological and other information on disorders under study. In 1999-2003, Institute of Rheumatology in cooperation with EuroMISE have developed clinical database/national register of selected systemic inflammatory rheumatic diseases inclusive of bank of sera and DNA. Aims of this phase of the pilot research have been formulated into following relevant and time borders: to gather clinical, laboratory, genetic but also pharmaco- and socio-economic data in a representative sample of patients with systemic lupus erythematosus, systemic sclerosis, polymyositis/dermatomyositis, mixed connective tissue disease; rheumatoid arthritis, juvenile chronic arthritis, ankylosing spondylitis, psoriatic arthritis and reactive arthritis. The data about patients entering the register are differentiated according to the disease of the patient. However, many diseases have several data in common. Therefore, a simple common data structure for examination of all monitored diseases was chosen. In 2002, the preset number of over 2000 registered patients had been achieved with collaboration of 34 territorial and 20 institutional rheumatologists in the whole covering the majority of the Czech Republic. Some first acquired information inclusive comparison with German database is demonstrated.

Flexible information storage in MUDR(II) EHR.

An important research task of the EuroMISE Centre is the applied research in the field of electronic health record (EHR) design including electronic medical guidelines and intelligent systems for data mining and decision support. The research in this field was inspired by several European projects. We have proposed a mathematical meta-description of a flexible information storage model based on the experience gathered in cooperation in those projects. In this model, we use two basic structures called a knowledge base and data files. We describe those two structures using the graph theory concepts. Furthermore, we use logical formulas to express conditions that should be valid. Additionally, we present a description of a global system architecture of a 3-tier EHR application with interfaces based on the latest technologies; predominately on Web Services, SOAP, XML, HTTP, CORBA, etc. According to our experience and test results gained from the MUDR EHR usage, we describe an open universal solution, which can be applied as the EHR kernel of hospital information systems. To realize this approach in a daily practice for health professionals we have started a co-operative project with clinical information systems developers. Within that project we are developing a new system for continual shared health care.

User interface of MUDR electronic health record.

Development of the electronic health record architecture at the EuroMISE Center was inspired by existing European standards and several European projects. The developed EHR named MUDR implements a 3-layer architecture, using XML for communication between application layer and clients. A decision support module implementing the "1999 WHO/ISH Guidelines for the Management of Hypertension" is part of an application layer. Universal graph structure is used both to represent the set of medical concepts in the EHR and to represent the collected data. Advanced methods of interaction between EHR and its user are studied, software prototypes of client applications are developed and their effectiveness evaluated.

Universal electronic health record MUDR.

One of the important research tasks of the European Centre for Medical Informatics, Statistics and Epidemiology - Cardio (EuroMISE Centre - Cardio) is the applied research in the field of electronic health record design including electronic medical guidelines and intelligent systems for data mining and decision support. The research in the field of data storage and data acquisition was inspired by several European projects and standards, mostly by the I4C and TripleC projects. Based on experience gathered during cooperation in the TripleC project we have proposed a description of a flexible information storage model. The motivation for this effort was the large variability of the set of collected features in different departments - including temporal variability. Therefore, a dynamically extensible and modifiable structure of items is needed. In our model we use two basic structures called the knowledge base and data files. The main function of the knowledge base is to express the hierarchy of collectable features - medical concepts, their characteristics and relations among them. The data files structure is used to store the patient's data itself. These two structures can be described using graph theory expressions. Based on this model, a three-layer system architecture named "Multimedia Distributed Record" (MUDR) has been proposed and implemented. During the implementation, modern technologies such as Web Services, SOAP and XML were used. For the practical usage of EHR MUDR, an intelligent application called MUDRc (MUDR Client) was created. It enables physicians to use EHR MUDR in a flexible way. During the development process, maximum emphasis was placed on user-friendliness and comfortable usage of this application. Several methods of data entry can be used: pre-defined forms, direct entry into the tree data structure of the EHR MUDR, or automatic unstructured free-text report parsing and data retrieval. The system enables fast and simple importing and exporting of data as well. The system integrates modern multimedia formats (X-ray photos, sonography and other pictures, video-sequences, audio records) as well as progressive methods of decision support systems realized by medical guidelines and other modules.

MUDRLite - health record tailored to your particular needs.

Nowadays most hospitals use electronic health records as part of their hospital information systems. However, these systems are more suitable for hospital management than for physicians. The health record is not sufficiently structured; it includes a lot of free-text information, and the set of collected attributes is fixed and practically impossible to extend. Physicians, gathering information for the purpose of medical studies, often use varied proprietary solutions based on MS Access databases or MS Excel Sheets. The EuroMISE Centre - Cardio is developing an electronic health record (EHR) application called MUDRLite, which could easily fill the gap between existing EHRs. MUDRLite is the result of applied research in the field of EHR design, which is based on experience gathered during cooperation in the TripleC project. MUDRLite development is an extra branch in the MUDR (MUltimedia Distributed Record) development; it simplifies both the MUDR architecture and the MUDR data storage principles.MUDRLite itself is an empty body, which has to be filled in with an XML configuration file. This file completely describes the visual aspects and the behavior of the EHR application. It includes simple 4GL-like constructs written in the MUDRLite Language (MLL). This enables - using the event-oriented programming principles - to program various handling procedures for a range of actions, e.g. clicking a button fills a form with the result of an SQL statement. MUDRLite can be tailored to particular needs of any healthcare provider. This makes the MUDRLite application easy to use in specific environments. In the first instance, we are testing it at the Neurovascular Department of the Central Military Hospital in Prague.

Development of electronic form of the 1999 WHO/ISH hypertension guidelines.

An electronic form of 1999 ISH/WHO Guidelines for Management of Hypertension was developed. It concentrates on two main problems--assessment of a patient's cardiovascular risk and selecting drug treatment. Moreover, it can remind the risk of unfilled items both for a cardiovascular risk calculation and drug contraindications. It can be stored for comparison with other records from follow-up both in an electronic and paper form.

Development of universal electronic health record in cardiology.

In the paper we discuss the vision and experiences in development of electronic health record based on universal structure of collectable data, multimedia objects, all equipped by supporting systems for data verification and medical guidelines connection. This development is based on existing European and international standards in the field of medical informatics.

Enhanced care of hypertensive patients using the Internet.

BACKGROUND: Medical guidelines provide recommendations that ought to help physicians in medical decision-making under different circumstances. To develop electronic medical guidelines and to make them available for physicians using the Internet can further enhance the quality and efficiency of health care, especially with the simultaneous use of electronic health records. OBJECTIVES: This study aims to outline the needs for web-based systems that support the use of medical guidelines in practice; and to focus on the development of web-based electronic medical guidelines for treatment of arterial hypertension. METHODS: The importance of electronic health record in cardiology for data acquisition, data storage and data mining is considered. The anonymized database of approximately 1800 hypertensive patients has been created to compare medical practice with guidelines and discover features of diseases that can help with their management. Using this database we evaluated several web-based electronic guidelines systems. RESULTS: The 1999 WHO/ISH Guidelines for the Management of Hypertension were formalized and interpreted using the Guide-X methodology, using the Apollo system and web-based electronic guidelines. The web-based electronic guidelines were tested on the smaller anonymous recent data set of 840 hypertensive patients. CONCLUSIONS: An easy transfer of knowledge from medical guidelines to structured electronic guidelines opens new possibilities for easy reusability of medical knowledge by general practitioners and clinicians.