Having the administrative and clinical information concerning the patient presented in a comprehensible format, language, and terminology is valuable for any healthcare provider. In Europe, this type of information is represented by the Patient Summary Guideline and on the other side of the Atlantic by the Continuity of Care Document (CCD). Trillium Bridge is a project co-funded by the European Commission that “compares specifications of EU and US patient summaries with the aim of developing and testing common and consistent specifications and systems enabling interoperability of electronic health records across the Atlantic.” The objective of this article is to summarize the findings of the comparison between these two Patient Summaries. Both documents are using the same syntax, namely Clinical Document Architecture (CDA), making the comparison easier. The documents were compared from a clinical, syntactic, and terminological point of view focusing on semantic interoperability. A common denominator was found in terms of sections, data elements, and value sets. Comparing the value sets led the project team to assess available official maps such as the SNOMED CT and ICD-10 and determine their applicability. In some cases, such as the National Cancer Institute Thesaurus and the EDQM standard terms, no maps were found and the team proposed associations. The common denominator thus identified allows for significant parts of the data to be exchanged, setting the baseline for the transatlantic exchange of a meaningful set of patient summary data and establishing a springboard for an international patient summary standard.

Introduction: This paper describes principles of a promising method for medical data analysis called recurrence analysis, which is based on the chaos theory that better describes processes in the living organisms. Methods: Phase space reconstruction and recurrence analysis are explained in brief. The main part of the work focuses on recurrence plot, which is a basic tool for recurrence analysis. Conclusion: Possible clinical applications of recurrence analysis in the field of medicine are discussed and a short overview of pilot projects performed by our team on this topic is given.

Care Informatics, by 1st Faculty of Medicine of Charles University in Prague and by The Society of General Practice of Czech Medical Association J. E. Purkyn. The workshop was chaired by me and by prof. Simon de Luisignan from Great Britain.

Cost pressures, new payment models, and demographic trends are creating a global economic crisis as health systems struggle to care for an aging population of sicker patients. Funds available for healthcare are constrained, and they’re being wasted by inefficient, uncoordinated healthcare services. Reflecting the importance of collaboration in caring for patients with chronic conditions, nearly 80 percent of the scoring criteria for the National Committee for Quality Assurance’s (NCQA) Recognition Program for Physician Practice Connections (PPC) Patient-Centered Medical Home (PCMH) relate to information sharing and teamwork. New payment models are forcing delivery networks to share the risks and potential cost savings of caring for these patients. By imposing direct or indirect financial consequences, these models incentivize organizations to emphasize prevention, deliver care in the lowest-cost appropriate setting, and reduce readmissions, Emergency Department (ED) visits, acute-care admissions, and bed days of care. Maccabi’s core belief is that all IT investments are business investments that should support strategic priorities and deliver a sustainable advantage to the organization. Among other clinical benefits of collaborative approach to care coordination in Maccabi implementation of Health IT tools supporting care coordination resulted in 13% increase in the number of diabetic patients who had a regular HbA1c and 8% increase in the number of diabetic patients whose HbA1c results indicated that the disease was stable.

Data and knowledge for medical decision support , Data and knowledge for medical decision support , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

Background and Objectives: The development in the technology have witnessed that there is a revival of interest in drug discovery from medicinal plants for treatment of the most destructive diseases.Our investigation characterizes the usage of digital image processing techniques in Matlab to process and analyze the antimicrobial effects of the selected herbal plants.Methods: The first stage of our investigation involves the extraction of components with methanol from the selected three herbal plants-Solanum xanthocarpum, Solanum nigrum and Helianthus annuus by using soxhlet apparatus.These plant extracts were assayed for antimicrobial activity against 4 different bacterial and fungal species using disk diffusion method.Results: Notable cell growth inhibitions were observed from the selected microbes.Solanum xanthocarpum exhibits better antibacterial properties on comparison to other two extracts.Solanum nigrum and Helianthus annuus exhibit better antifungal properties by being sensitive factor towards fungal medium.The obtained images were processed using color coding techniques to determine the activity of the extract by isolating the region of inhibition area.The region of inhibition was measured using matlab code and tabulation was compiled to compare the manually measured distances to the automated measurements.Conclusions: The results provided evidence that the studied plant extracts might indeed be potential sources of natural antimicrobial agents and the introduction of an evaluation technique using image processing was shown to be suitable for the purpose of accurate measurements of zone of inhibition.

Background: Obesity affects one in four people in the Czech Republic and its incidence is growing worldwide.In this article we focused on evaluation of treatment of obesity in diabetic patients by bariatric surgery and we also tried to evaluate the costs of the surgery and antidiabetics.Methods: The total number of patients was 200 and 30 of them with type 2 diabetes mellitus.In the 1-year followup we evaluated remission or compensation of diabetes in patients after particular bariatric methods.We also calculated the decrease of average costs for pharmacotherapy by antidiabetics after 6 and 12 months and the costs for the bariatric surgery.Results: We found that costs for the treatment by antidiabetics were reduced nearly 3× already in the 6th month after the surgery.Insurance companies currently do not take in consideration different costs for the partial surgery methods and the payment is in one package for approx.60 thousands CZK. Conclusion:The positive effect of the surgery appeared in the 6th month of the follow-up.However, to achieve more accurate results we need to evaluate the data after 3 years of the follow-up.

Background: Australia has been in the process of designing and implementing a national ehealth system for a number of years. A core component of this design has been the selection of HL7's CDA as the basis of the Australian EHR. This incorporates CDA into both the shared Personally Controlled Electronic Health Record and for document exchange point-to-point. Objectives: CDA was chosen partly for its ability to address issues of governance and consistency in a national environment that does not have definitive oversight or a single decision making body. Methods: Developing long and complex implementation guides has been assisted by good design of a 'super-schema' to include the Australian extensions, together with a framework for extensive conformance checking. Australia has created a multi-level conformance framework which currently supports a mainly Level 2 CDA architecture yet provides a transition pathway to future full interoperability. Results: One area of contention around the Australian solution, however, is debate over content presentation and data content using CDA. The Australian implementation has had considerable debate around the technical and governance infrastructure for controlling the rendering of the documents. Other challenges have arisen in the selection of transport standards, sourcing of CDA expertise and in relation to the need for local extensions to CDA. Local extensions to CDA have been modelled using the HL7 development paradigm (based on the HL7 RIM) as permitted by the CDA standard, and submitted for inclusion in HL7 CDA Release 3. Conclusions: This paper illustrates the Australian approach to the development of CDA for the National EHR and ehealth point-to-point communications, and provides an insight for other countries considering similar implementations.

Objectives: The increasing sensitivity of forensic analysis methods allows to investigate less and less amount of biological samples. For samples of low quality or quantity, there are stochastic events that require intensive statistical analysis. Methods: There are several models how to calculate the probability of a given set of alleles. We have described three of them and compared them to verify their accuracy. Results: The two models proposed in [1] extend so far the most widely used model by the possibility of dropout and peak areas of individual alleles. The first one is incorrect, while the second model highly improves the possibility of DNA mixture analysis. Conclusions: We have shown the inaccuracy of one of the recently proposed models. We have added the possibility of determining the dropout probability into the second model, otherwise this model overestimates the probabilities calculated.

Background: IHE integration profiles for managing patient identification, PIX and PDQ, exist in two alternative forms: on the one hand using HL7 2.x, on the other hand based on HL7 Version 3. Objective: Knowing differences between the competing integration profiles shall assist the user to choose the one better suitable for their specific deployment. Methods: Differences in the set of interactions, the information model, the vocabulary and the required behavior of individual interactions were analyzed. Results: A list of specific features and constraints for each of the integration profiles was compiled. Conclusions: Not all of the identified deltas originate in the inherent incompatibility between HL7 2.x and 3.0, they also result from the specific constraints imposed by the IHE profile. Identified disparities include the communication pattern, constraints to identifier schemas and pseudonymization capabilities.