Open source challenges for hospital information system (HIS) in developing countries: a pilot project in Mali.

BACKGROUND: We are currently witnessing a significant increase in use of Open Source tools in the field of health. Our study aims to research the potential of these software packages for developing countries. Our experiment was conducted at the Centre Hospitalier Mere Enfant in Mali. METHODS: After reviewing several Open Source tools in the field of hospital information systems, Mediboard software was chosen for our study. To ensure the completeness of Mediboard in relation to the functionality required for a hospital information system, its features were compared to those of a well-defined comprehensive record management tool set up at the University Hospital "La Timone" of Marseilles in France. It was then installed on two Linux servers: a first server for testing and validation of different modules, and a second one for the deployed full implementation. After several months of use, we have evaluated the usability aspects of the system including feedback from end-users through a questionnaire. RESULTS: Initial results showed the potential of Open Source in the field of health IT for developing countries like Mali.Five main modules have been fully implemented: patient administrative and medical records management of hospital activities, tracking of practitioners' activities, infrastructure management and the billing system. This last component of the system has been fully developed by the local Mali team.The evaluation showed that the system is broadly accepted by all the users who participated in the study. 77% of the participants found the system useful; 85% found it easy; 100% of them believe the system increases the reliability of data. The same proportion encourages the continuation of the experiment and its expansion throughout the hospital. CONCLUSIONS: In light of the results, we can conclude that the objective of our study was reached. However, it is important to take into account the recommendations and the challenges discussed here to avoid several potential pitfalls specific to the context of Africa.Our future work will target the full integration of the billing module in Mediboard and an expanded implementation throughout the hospital.

An open repositories network development for medical teaching resources.

The lack of interoperability between repositories of heterogeneous and geographically widespread data is an obstacle to the diffusion, sharing and reutilization of those data. We present the development of an open repositories network taking into account both the syntactic and semantic interoperability of the different repositories and based on international standards in this field. The network is used by the medical community in France for the diffusion and sharing of digital teaching resources. The syntactic interoperability of the repositories is managed using the OAI-PMH protocol for the exchange of metadata describing the resources. Semantic interoperability is based, on one hand, on the LOM standard for the description of resources and on MESH for the indexing of the latter and, on the other hand, on semantic interoperability management designed to optimize compliance with standards and the quality of the metadata.

Design and evaluation of a semantic approach for the homogeneous identification of events in eight patient databases: a contribution to the European EU-ADR project.

The overall objective of the EU-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four different terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.

A semantic approach for the homogeneous identification of events in eight patient databases: a contribution to the European eu-ADR project.

The overall objective of the eu-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four different terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.

Using knowledge for indexing health web resources in a quality-controlled gateway.

OBJECTIVES: The aim of this study is to provide to indexers MeSH terms to be considered as major ones in a list of terms automatically extracted from a document. MATERIAL AND METHODS: We propose a method combining symbolic knowledge - the UMLS Metathesaurus and Semantic Network - and statistical knowledge drawn from co-occurrences of terms in the CISMeF database (a French-language quality-controlled health gateway) using data mining measures. The method was tested on CISMeF corpus of 293 resources. RESULTS: There was a proportion of 0.37+/-0.26 major terms in the processed records. The method produced lists of terms with a proportion of terms initially pointed out as major of 0.54+/-0.31. DISCUSSION: The method we propose reduces the number of terms, which seem not useful for content description of resources, such as "check tags", but retains the most descriptive ones. Discarding these terms is accounted for by: 1) the removal by using semantic knowledge of associations of concepts bearing no real medical significance, 2) the removal by using statistical knowledge of nonstatistically significant associations of terms. CONCLUSION: This method can assist effectively indexers in their daily work and will be soon applied in the CISMeF system.

Collaborative and workflow-oriented digital portfolio: Creating a web-based tool to support a nationwide program of practices evaluation in the blood transfusion area.

PURPOSE: The French National Blood Transfusion Institute received approval from the French National Health Authority to organize a nationwide program for the evaluation of professional practices in the area of blood transfusion. Major issues of the project were: (1) managing numerous physicians spread nationwide; (2) tracking and storing the physician's entire process (from his/her enrollment to his/her lifelong follow-up); (3) creating a collaborative technique for processing an evaluation program; (4) enhancing exchanges between participants; (5) proposing effective implementation of the assessment. METHODS: As faculty members with experience in distance learning, we considered the digital/electronic portfolio to be one of the most suitable techniques to support such a project. Due to the lack of methods and tools to meet users' expectations, the decision was made to prototype a new and innovative assessment environment. A team was formed to complete the design phase within 6 months (information content, roles and functions). Implementation of the prototype, which includes tests, was also planned over a 6-month period. The methodology involves two approaches: one concerns business process modelling; the other is related to object-oriented methods for design and implementation. RESULTS: This primary work was aimed at describing a specific object, the evaluation program, which can be shared between players within a web-based collaborative platform. Four types of players were identified: (1) physicians enrolled into the assessment program; (2) tutors assigned to follow physicians' assessment process; (3) program directors who manage the content of the assessment program and the application of follow-up rules; (4) supervisors who administrate the global system. The evaluation program is composed of a set of actions, which has to be performed by the physicians. These actions are directly related to the activities of the business processes to which the candidate belongs. For each action, elements of proof have to be uploaded by the physician, according to a predefined schedule. The status of this object and its changes are followed and managed by a workflow engine. Implementation of the system required an object-oriented content management system (Zope/Plone). CONCLUSION: The object-oriented approach helped us to focus on the topic of interest, the assessment program, without being concerned by the whole environment. The assessment model we designed attempts to make a link with the business process performed in daily routine. This article explores the way business process modelling can contribute to the modelling of a professional practices assessment system. Apart from the modelling and technical aspects, this nationwide project contains major challenges: to enroll all physicians on an individualized basis and to create appropriate conditions for the extension of the evaluation program and device to other specialties.

WRAPIN: a tool for patient empowerment within EHR.

Legal and technologic trends are making medical records progressively more patient-accessible. In the near future, information technology may make it even easier to provide patients a chance to review their records. One may wonder, however, about the practical use of this technology by patients. Understanding his/her own health record will certainly be one of the main concerns of patients. WRAPIN has been designed to provide patients and citizens with trusted health information. It will help to determine the reliability of documents by checking the ideas contained against established benchmarks, and enable users to determine the relevance of a given document from a page of search results. First, we present what is, in our opinion, the most original and important patient-centred WRAPIN characteristics and functionalities. Then, we compare these characteristics with those of representatives of two main trends in information retrieval: systems based on the popularity of web sites, and on the clustering of web sites. This comparison shows that, even though patients are tempted to use popular search engines, these are not sufficiently specialized in the medical domain to help them understand their own HER.. Finally, we discuss the complexity of medical readings over the Internet and the efforts that are still required in this domain.

From the description of activities to the identification of risks for clinical management: a proposal of building, merging and sharing knowledge representations of care processes.

Management of clinical processes and hospital activities takes advantage of business process reengineering methodology. It is now recognized that care process modeling must integrate the definition of goals and the assessment of risk. Two kinds of issues have been outlined: 1) the lack of an integrated model to identify and describe processes and their components according to a functional point of view; and 2) an increasing amount of documents that hospital staff members have to create, collect, index and maintain. As initial models focused only on a structural view of activities, we reviewed different sources of standards and norms to extract and classify a set of metadata aimed at describing any activity and its outcomes. The model includes links to structured terminologies to name attributes or value them. An object-oriented information model has been created and implemented to test the relevance and the feasibility of the modeling approach. Conceptually speaking, this model gives opportunity to bridge tacit and explicit knowledge. Practically speaking, limits to generalization remain partly due to the lack of a template processes database.

Proposal of a French health identification number interoperable at the European level.

The French ministry of Health is setting up the Personal Medical Record (PMR). This innovative tool has long been expected by French Health Authorities, Associations of Patients, other Health's associations, those defending Individual Liberties and the French National Data Protection Authority. The PMR will lead to improvements in many areas such as Diagnosis (Research and monitoring) Healthcare (Management of emergencies, urgent situations, Temporal health monitoring and evaluation), Therapy (Cohorts of patients for Clinical trials and epidemiological studies). The PMR will foster safe healthcare management, clinical research and epidemiological studies. Nevertheless, it raises many important questions regarding duplicates and the quality, precision and coherence of the linkage with other health data coming from different sources. The currently planned identifying process raises many questions with regard to its ability to deal with potential duplicates and to perform data linkage with other health data sources. Through this article, using the electronic health records, we develop and propose an identification process to improve the French PMR. Our proposed unique patient identifier will guarantee the security, confidentiality and privacy of the personal data, and will prove to be particularly useful for health planning, health policies and research as well as clinical and epidemiological studies. Finally, it will certainly be interoperable with other European health information systems. We propose here an alternative identification procedure that would allow France to broaden the scope of its PMR project by making it possible to contribute to public health research and policy while increasing interoperability with European health information systems and preserving the confidentiality of the data.

Health search engine with e-document analysis for reliable search results.

OBJECTIVE: After a review of the existing practical solution available to the citizen to retrieve eHealth document, the paper describes an original specialized search engine WRAPIN. METHOD: WRAPIN uses advanced cross lingual information retrieval technologies to check information quality by synthesizing medical concepts, conclusions and references contained in the health literature, to identify accurate, relevant sources. Thanks to MeSH terminology [1] (Medical Subject Headings from the U.S. National Library of Medicine) and advanced approaches such as conclusion extraction from structured document, reformulation of the query, WRAPIN offers to the user a privileged access to navigate through multilingual documents without language or medical prerequisites. RESULTS: The results of an evaluation conducted on the WRAPIN prototype show that results of the WRAPIN search engine are perceived as informative 65% (59% for a general-purpose search engine), reliable and trustworthy 72% (41% for the other engine) by users. But it leaves room for improvement such as the increase of database coverage, the explanation of the original functionalities and an audience adaptability. CONCLUSION: Thanks to evaluation outcomes, WRAPIN is now in exploitation on the HON web site (http://www.healthonnet.org), free of charge. Intended to the citizen it is a good alternative to general-purpose search engines when the user looks up trustworthy health and medical information or wants to check automatically a doubtful content of a Web page.