Task analysis and interoperable application services for service event management.

In addition to the information specifications for electronic health records, functional and behavioral capabilities need to be agreed to achieve interoperability. In this paper, we present results from task analysis and specification of software services to support the management of service events. The work has been performed to support the management of the nationally shared EPR in Finland. The results support the specification of information sharing and composition in relation to healthcare workflows and activities. The specification of a functional reference model and software services for the management of service events and encounters promotes the integration of shared EHR and systems adaptability for migration towards interoperable electronic health records in healthcare networks.

Task analysis and application services for cross-organizational scheduling and citizen eBooking.

In this paper, we present generalized results from the task analysis and definition of software services to support healthcare appointment and services scheduling, based on national coordination project for citizen e-services in Finland which involves several regional initiatives. The results are part of guidelines for regional-level and national-level scheduling solutions in Finland, and can be used in similar efforts. The specification of a functional reference model and software services for appointment scheduling promotes interoperability and systems adaptability for the transformation of health services and citizen empowerment.

Approaching harmonised medication information management through process and information modelling.

Medication information should be available in a correct content and format and where and when needed in medical care. In this paper process and information models are presented in order to identify the items, their relations, contents, sources and use contexts of medication information. The motivation for this study has been to develop a harmonized information model for medication information to overcome current problems and pitfalls in medication information management and information accessibility.

Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial.

STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To assess the effectiveness of decompressive surgery as compared with nonoperative measures in the treatment of patients with lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: No previous randomized trial has assessed the effectiveness of surgery in comparison with conservative treatment for spinal stenosis. METHODS: Four university hospitals agreed on the classification of the disease, inclusion and exclusion criteria, radiographic routines, surgical principles, nonoperative treatment options, and follow-up protocols. A total of 94 patients were randomized into a surgical or nonoperative treatment group: 50 and 44 patients, respectively. Surgery comprised undercutting laminectomy of the stenotic segments in 10 patients augmented with transpedicular fusion. The primary outcome was based on assessment of functional disability using the Oswestry Disability Index (scale, 0-100). Data on the intensity of leg and back pain (scales, 0-10), as well as self-reported and measured walking ability were compiled at randomization and at follow-up examinations at 6, 12, and 24 months. RESULTS: Both treatment groups showed improvement during follow-up. At 1 year, the mean difference in favor of surgery was 11.3 in disability (95% confidence interval [CI], 4.3-18.4), 1.7 in leg pain (95% CI, 0.4-3.0), and 2.3(95% CI, 1.1-3.6) in back pain. At the 2-year follow-up, the mean differences were slightly less: 7.8 in disability (95% CI, 0.8-14.9) 1.5 in leg pain (95% CI, 0.3-2.8), and 2.1 in back pain (95% CI, 1.0-3.3). Walking ability, either reported or measured, did not differ between the two treatment groups. CONCLUSIONS: Although patients improved over the 2-year follow-up regardless of initial treatment, those undergoing decompressive surgery reported greater improvement regarding leg pain, back pain, and overall disability. The relative benefit of initial surgical treatment diminished over time, but outcomes of surgery remained favorable at 2 years. Longer follow-up is needed to determine if these differences persist.