Discussion of "Representation of People's Decisions in Health Information Systems: A Complementary Approach for Understanding Health Care Systems and Population Health".

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Representation of People's Decisions in Health Information Systems: A Complementary Approach for Understanding Health Care Systems and Population Health" written by Fernan Gonzalez Bernaldo de Quiros, Adriana Ruth Dawidowski, and Silvana Figar. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of de Quiros, Dawidowski, and Figar. In subsequent issues the discussion can continue through letters to the editor.

Assessing the prognoses on Health care in the information society 2013--thirteen years after.

Health care and information technology in health care is advancing at tremendous speed. We analysed whether the prognoses by Haux et al. - first presented in 2000 and published in 2002 - have been fulfilled in 2013 and which might be the reasons for match or mismatch. Twenty international experts in biomedical and health informatics met in May 2013 in a workshop to discuss match or mismatch of each of the 71 prognoses. After this meeting a web-based survey among workshop participants took place. Thirty-three prognoses were assessed matching; they reflect e.g. that there is good progress in storing patient data electronically in health care institutions. Twenty-three prognoses were assessed mismatching; they reflect e.g. that telemedicine and home monitoring as well as electronic exchange of patient data between institutions is not established as widespread as expected. Fifteen prognoses were assessed neither matching nor mismatching. ICT tools have considerably influenced health care in the last decade, but in many cases not as far as it was expected by Haux et al. in 2002. In most cases this is not a matter of the availability of technical solutions but of organizational and ethical issues. We need innovative and modern information system architectures which support multiple use of data for patient care as well as for research and reporting and which are able to integrate data from home monitoring into a patient centered health record. Since innovative technology is available the efficient and wide-spread use in health care has to be enabled by systematic information management.

Past and next 10 years of medical informatics.

More than 10 years ago Haux et al. tried to answer the question how health care provision will look like in the year 2013. A follow-up workshop was held in Braunschweig, Germany, for 2 days in May, 2013, with 20 invited international experts in biomedical and health informatics. Among other things it had the objectives to discuss the suggested goals and measures of 2002 and how priorities on MI research in this context should be set from the viewpoint of today. The goals from 2002 are now as up-to-date as they were then. The experts stated that the three goals: "patient-centred recording and use of medical data for cooperative care"; "process-integrated decision support through current medical knowledge" and "comprehensive use of patient data for research and health care reporting" have not been reached yet and are still relevant. A new goal for ICT in health care should be the support of patient centred personalized (individual) medicine. MI as an academic discipline carries out research concerning tools that support health care professionals in their work. This research should be carried out without the pressure that it should lead to systems that are immediately and directly accepted in practice.

Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?

E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients' self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed.

Evaluation methodology for automatic radiology reporting transcription systems.

This article describes a usability evaluation methodology for automatic transcription system used for radiology reporting. In order to assess this class of system's limitations and strengths, a review of the concepts involved in this kind of system is done in a critical way. Specific requirements, for this category of application, that are forgotten when a product is launched in the market, are listed and a methodology for their evaluation is presented.

Software engineering principles applied to large healthcare information systems--a case report.

São Paulo is the largest city in Brazil and one of the largest cities in the world. In 2004, São Paulo City Department of Health decided to implement a Healthcare Information System to support managing healthcare services and provide an ambulatory health record. The resulting information system is one of the largest public healthcare information systems ever built, with more than 2 million lines of code. Although statistics shows that most software projects fail, and the risks for the São Paulo initiative were enormous, the information system was completed on-time and on-budget. In this paper, we discuss the software engineering principles adopted that allowed to accomplish that project's goals, hoping that sharing the experience of this project will help other healthcare information systems initiatives to succeed.

São Paulo city health information system--a case report.

São Paulo is the largest city in Brazil and one of the largest in the world. In 2004, São Paulo City Department of Health decided to implement a Healthcare Information System that would support managing healthcare services and provide an ambulatory health record. The system was designed to build on from national standards that identify healthcare workers, organizations and the relationships among them and reuse as much as possible existing concepts and software. At the same time, the system should reduce fragmentation, not only by integrating existing redundant or competing systems but also by providing a framework in which new modules would be naturally integrated to each other. Today, the web-based system, known as SIGA Saúde, runs in more than 370 healthcare units, processes some 8 thousand appointment scheduling daily and more than 10 thousand high-cost procedure authorizations monthly. This paper profiles the São Paulo City and its needs and describes the project, obstacles and results so far.

Knowledge sharing and information integration in healthcare using ontologies and deductive databases.

This paper describes a method for using Semantic Web technologies for sharing knowledge in healthcare. It combines deductive databases and ontologies, so that it is possible to extract knowledge that has not been explicitly declared within the database. A representation of the UMLS (Unified Medical Language System) Semantic Network and Metathesaurus was created using the RDF standard, in order to represent the basic medical ontology. The inference over the knowledge base is done by the TRI-DEDALO System, a deductive data-base created to query and update RDF based knowledge sources as well as conventional relational databases. Finally, an ontology was created for the Brazilian National Health Card data interchange format, a standard to capture and transmit health encounter information throughout the country. This paper demonstrates how this approach can be used to integrate heterogeneous information and to answer complex queries in a real world environment.

Sistema para teste de inclinaçäo ortostática: análise nos domínios do tempo e da frequência / System to orthostatic inclination test: analysis in time and frequency domain

Este trabalho descreve um sistema baseado em microcomputador que automatiza o registro durante o teste de inclinação, armazenando os valores de pressão arterial e frequência cardíaca batimento a batimento de uma maneira digital e automatizando a emissão de laudos. Além disso, o sistema possibilita a análise da Variabilidade da Frequência Cardíaca no domínio da frequência (análise espectral), visando que há comprovadas alterações na atuação do sistema nervoso em pacientes dados como positivos durante o teste.

Identificaçäo única de pacientes: porque é necessária / Unique patient identifier: why is necessary

A partir da revisão do atual fluxo informatizado de atendimento de pacientes do HCFMUSP, constata-se a necessidade imediata de maior integração dos sistemas de informações em Saúde. Este artigo subsidia a Identificação Única de Pacientes como um mecanismo viável e efetivo na busca dessa integração.

Avaliaçäo do pré-processamento das projeçöes em ESPECT com phantom físico / Evaluation of projections pre-processing in SPECT with physical phantom

Neste trabalho, apresenta-se uma solução alternativa para a reconstrução de imagens tomográficas em Medicina Nuclear que usa o modelo de ruído de Poisson. O algoritmo proposto foi aplicado a um phantom físico e comparada com a metodologia usual de reconstrução em rotina clínica. A análise dos resultados mostrou que a aplicação do método melhora a qualidade das imagens reconstruídas.

We present an altemative solution for the reconstruction of SPECT images using a Poisson Noise Model. The proposed algorithm was applied on a real phantom and compared to the standard clinica! procedure. Results have shown that the proposed method improves the quality ofthe SPECT images.

Quantificaçäo do movimento 3D do miocárdio em Gated SPECT / Quantifies 3D motion of myocardial in Gated SPECT

Os métodos convencionais para análise do movimento do ventrículo esquerdo (VE) são baseados em imagens planas e considerações geométricas que, em geral, são inválidas em ventrículos anormais. Propõe-se, neste trabalho, a quantificação do movimento 3D do VE em imagens de Medicina Nuclear (gated-SPECT), através da técnica de Fluxo Óptico estendida para o espaço voxel. O movimento das paredes do VE é representado por uma série de campos de vetores de velocidade 3D, os quais são calculados automaticamente para cada voxel na seqüência de volumes cardíacos.

The conventional methods for analysis of L V wall motion abnormalities are based on planar images and geometrical analysis with many hardly fulfilled assumptions. This work describes a method which quantifies 3D L V motion by means of the optical flow technique extended to the voxel space. The LV wall motion is represented by a series of 3D velocity vector field which is computed automatically by the proposed method for each voxel on the sequence of cardiac volumes.

Determinaçäo automática das regiöes de interesse em estudos de ventriculografia radioisotópica / Automatic determination of regions of interest in radioisotopic ventriculography studies

Apresentamos um método para a determinação automática das regiões de interesse em estudos de ventriculografia radioisotópica (VR). O método utiliza informações a priori sobre a localização do ventrículo esquerdo (VE), além de uma versão modificada do operador Lapraciano da Guassiana conjugado com operações de morfologia matemática. O algoritmo apresenta boa correlação com o procedimento manual, além de ser rápido e robusto.

We present a method for the automatic determination of regions of interest in gated blood pool studies. The method uses a priori information about left ventricle location, and a modified version of the Laplacian of Gaussian operator is applied with some mathematical morphology operations, yielding the final regions. The algorithm showed to be highly correlated to the manual procedure, besides being to be fast and robust.