Archetype-based electronic health records: a literature review and evaluation of their applicability to health data interoperability and access.

Health Information Managers (HIMs) are responsible for overseeing health information. The change management necessary during the transition to electronic health records (EHR) is substantial, and ongoing. Archetype-based EHRs are a core health information system component which solve many of the problems that arise during this period of change. Archetypes are models of clinical content, and they have many beneficial properties. They are interoperable, both between settings and through time. They are more amenable to change than conventional paradigms, and their design is congruent with clinical practice. This paper is an overview of the current archetype literature relevant to Health Information Managers. The literature was sourced in the English language sections of ScienceDirect, IEEE Explore, Pubmed, Google Scholar, ACM Digital library and other databases on the usage of archetypes for electronic health record storage, looking at the current areas of archetype research, appropriate usage, and future research. We also used reference lists from the cited papers, papers referenced by the openEHR website, and the recommendations from experts in the area. Criteria for inclusion were (a) if studies covered archetype research and (b) were either studies of archetype use, archetype system design, or archetype effectiveness. The 47 papers included show a wide and increasing worldwide archetype usage, in a variety of medical domains. Most of the papers noted that archetypes are an appropriate solution for future-proof and interoperable medical data storage. We conclude that archetypes are a suitable solution for the complex problem of electronic health record storage and interoperability.

The FARMING approach: main results and perspectives of the French FARMING groups.

The Chernobyl accident led to a long-term crisis that affected agriculture, food and living conditions in complex ways, and that modified the usual economical, political and social relations between public and private stakeholders at local, national and international level. The EC FARMING project aims to create a European stakeholder network to consider possible rehabilitation strategies for rural areas contaminated after a nuclear accident. The Institute of Patrimonial Strategies of the National Institute on Agronomy had responsibility for setting up the French stakeholder group. The objective was to develop favourable conditions and ways whereby stakeholders could deal with such a complex situation as a nuclear emergency and develop rehabilitation strategies. The results from the 3-year work programme on both strategic and technical aspects, showed an increasing commitment from the stakeholders that led to the building up of a common understanding of what a nuclear accident could be and how it could be dealt with.

Variation in stakeholder opinion on countermeasures across Europe.

A compendium of agricultural countermeasures and rural waste disposal options has been compiled as part of the EC STRATEGY (Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems) project. The compendium was discussed by the FARMING (Food and Agriculture Restoration Management Involving Networked Groups) network of stakeholders during meetings of national panels in the UK, Finland, Belgium, Greece and France in 2002. Their preliminary feedback has been summarised in terms of whether an option is generally acceptable, unacceptable or only acceptable under specific circumstances. A considerable divergence of opinion between national panels was apparent for many of the options considered. This could be attributed to differences in geomorphology, climate, land management, infrastructure, consumer confidence, sociopolitical context and culture. Where consensus was reached between stakeholders it was generally for those countermeasures that provide public reassurance, sustain farming practices and minimise environmental impact. Furthermore, whilst there was general agreement that contaminated food should not enter the food chain, many of the options proposed for its subsequent management were not generally acceptable to stakeholders.

Achievements, difficulties and future challenges for the FARMING network.

The EC FARMING network (Food and Agriculture Restoration Management Involving Networked Groups) was set up to bring together the many and diverse stakeholders who would be involved in intervention following wide scale radioactive contamination of the food chain, so that acceptable strategies can be developed for maintaining agricultural production and safe food supply. The network comprises stakeholder panels in the UK, Finland, Belgium, France and Greece that have met regularly since 2001 to debate, discuss and exchange opinion on the acceptability, constraints and impact of various countermeasure options and strategies. The objectives of this paper are to consolidate the main achievements of the FARMING project over the period 2000-2004, to highlight the various difficulties that were encountered and to discuss the challenges for engaging stakeholders in off-site emergency management and long-term rehabilitation in the future.

Attitude of a group of Belgian stakeholders towards proposed agricultural countermeasures after a radioactive contamination: synthesis of the discussions within the Belgian EC-FARMING group.

In the case of radioactive contamination of the environment with an impact on the food chain, the remediation strategy will not only be based on scientific knowledge and technical experience, but will also be dictated by peculiarities of the country. These characteristics include the agro-industrial structure, the local and international economical contexts and the political configuration including the distribution of responsibilities and competencies. This paper identifies and illustrates the most relevant characteristics of the Belgian agricultural system and political environment; it also describes the past experience with food chain contamination, which is expected to influence the attitude of Belgian stakeholders, who would be involved in the setting up of countermeasure strategies for maintaining agricultural production and food safety. The picture drawn explains why several countermeasures aiming to reduce the contamination in food products, although scientifically sound and technically feasible, are hardly acceptable or even not acceptable at all, to the stakeholders.

Stakeholder involvement in nuclear crisis management in Greece.

The setting up of the Greek Stakeholders Group in the framework of the EC Food and Agriculture Restoration Management Involving Networked Groups (FARMING) project is described. The Group included members from more than 20 governmental and non-governmental organisations, having interest and/or responsibilities in the management of a crisis following a nuclear accident. The stakeholders, during their meetings in 2002, discussed the agricultural countermeasures and rural waste disposal options which have been compiled by the EC Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems (STRATEGY) project. All stakeholders agreed that the most preferable were those options that ensure public acceptance, minimise environmental impact and maintain farming practices and acceptable living and working conditions. Their views are synoptically presented along with the major conclusions from the stakeholders meetings regarding nuclear crisis management.

The STRATEGY project: decision tools to aid sustainable restoration and long-term management of contaminated agricultural ecosystems.

The STRATEGY project (Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems) aimed to provide a holistic decision framework for the selection of optimal restoration strategies for the long-term sustainable management of contaminated areas in Western Europe. A critical evaluation was carried out of countermeasures and waste disposal options, from which compendia of state-of-the-art restoration methods were compiled. A decision support system capable of optimising spatially varying restoration strategies, that considered the level of averted dose, costs (including those of waste disposal) and environmental side effects was developed. Appropriate methods of estimating indirect costs associated with side effects and of communicating with stakeholders were identified. The importance of stakeholder consultation at a local level and of ensuring that any response is site and scenario specific were emphasised. A value matrix approach was suggested as a method of addressing social and ethical issues within the decision-making process, and was designed to be compatible with both the countermeasure compendia and the decision support system. The applicability and usefulness of STRATEGY outputs for food production systems in the medium to long term is assessed.

The long-term management of nuclear emergencies: the principles.

The long-term impact of the Chernobyl accident on the most affected populations in Belarus, Ukraine and the Russian Federation is still evident in terms of a continuing elevated level of thyroid cancer, prominent psychosocial effects, a depressed economy and a low level of well being. Some of these impacts are directly and primarily attributable to exposure to ionising radiation, while others have more complex origins and have evolved over the period since the accident. It is argued that although these latter impacts were largely unpredictable at the time of the accident, they could have been minimised had an appropriate management plan been in force. The principles underlying such a management plan for use in future accidents are enumerated. An essential component in further developing such a plan would be a thorough review of the experience of the Chernobyl accident in order to 'learn the lessons' that accident holds.

Ongoing efforts to improve the international nuclear and radiological emergency response.

It is recognised that states, through the development of a consistent, coherent and sustainable joint programme for improved and more efficient international responses to nuclear and radiological emergencies, could achieve a better and more cost-effective response capability. Enhanced efforts by IAEA member states and the IAEA secretariat to improve the implementation of the Convention on Early Notification of a Nuclear Accident and the Convention on Assistance in Case of a Nuclear Accident or Radiological Emergency have been initiated, establishing a national competent authority coordination group (NCACG) and a long-term action plan for the work.

Maintaining competence in radiological protection in emergency situations: a challenge for the 21st century.

State-of-the-art radiological protection in emergency situations requires specific technical resources, qualified personnel and competence in a variety of scientific and technical areas. In many developed countries a high technical standard is available currently in these areas. There are, however, strong indicators that future expertise is at risk. The indicators are declining university enrolment, dilution of university course content and high retirement expectations of staff members, with little or no replacement planned. This paper describes the underlying problem and makes recommendations for an action plan that includes both short-term actions and a long-term strategy to minimise the emerging risks. A strategic approach will be required to stop the decline and to avoid a drop in competence to an unacceptable level.

Enhancing malaria control using a computerised management system in southern Africa.

BACKGROUND: Malaria control programmes utilising indoor residual spraying are only effective if a high coverage of targeted structures is achieved and an insecticide that is effective against the specific mosquito vector is correctly applied. Ongoing monitoring of spraying operations is essential to assure optimal programme performance and early corrective action, where indicated. METHODS: Successful development and application of a computerised spraying operations management system in Mpumalanga Province, South Africa during 1998 resulted in its adaptation and introduction in neighbouring Maputo Province, southern Mozambique during 2000. The structure and components of this computerised management system are described, and its' operational benefit in southern Mozambique, where community-based spray operators apply intradomiciliary insecticide, are reviewed. CONCLUSIONS: The computerised management system allowed malaria programme management and field supervisors to monitor spraying coverage, insecticide consumption and application rates on an ongoing basis. The system supported a successful transition to community-based spraying, while assuring correct insecticide application and spraying completion according to schedule.

Medical diagnostic decision support systems--past, present, and future: a threaded bibliography and brief commentary.

Articles about medical diagnostic decision support (MDDS) systems often begin with a disclaimer such as, "despite many years of research and millions of dollars of expenditures on medical diagnostic systems, none is in widespread use at the present time." While this statement remains true in the sense that no single diagnostic system is in widespread use, it is misleading with regard to the state of the art of these systems. Diagnostic systems, many simple and some complex, are now ubiquitous, and research on MDDS systems is growing. The nature of MDDS systems has diversified over time. The prospects for adoption of large-scale diagnostic systems are better now than ever before, due to enthusiasm for implementation of the electronic medical record in academic, commercial, and primary care settings. Diagnostic decision support systems have become an established component of medical technology. This paper provides a review and a threaded bibliography for some of the important work on MDDS systems over the years from 1954 to 1993.

Continuous improvement of strategic information systems: concepts and issues.

Health care organizations that want to position themselves for the future must develop and continuously improve strategic information systems (SIS). The authors consider several problem areas on the current frontier of SIS development and propose solutions that for the most part are expedient and pragmatic.