Health information systems. What are the underlying links to enhanced health care delivery?

OBJECTIVES: Summarize excellent current research in the field of Health Information Systems. METHOD: Synopsis of the articles selected for the IMIA Yearbook 2012. RESULTS: Three papers from international peer reviewed journals have been selected for the section on health information systems. CONCLUSIONS: The selected articles illustrate current research regarding health IT impacts and evaluation and the latest developments in health information exchange.

Health information systems is our focus correct?

OBJECTIVES: Summarize excellent current research in the field of Health Information Systems. METHOD: Synopsis of the articles selected for the IMIA Yearbook 2011. RESULTS: Five papers from international peer reviewed journals have been selected for the section on health information systems. CONCLUSIONS: The selected articles illustrate that strategic, organizational and human aspects require specific attention in order to increase HIS adoption, and to demonstrate value in supporting the needs of clinicians and their patients.

Health Information Systems. Understanding Health Care IT Alignment.

OBJECTIVES: Summarize excellent current research in the field of Health Information Systems. METHOD: Synopsis of the articles selected for the IMIA Yearbook 2010. RESULTS: Five papers from international peer reviewed journals have been selected for the section on health information systems. CONCLUSIONS: The elected articles illustrate how health care IT alignment, assessment and benchmarking have become a challenge and a key aspect to the strengthening of health information systems in order to maintain and expand the objectives and strategies of organizations.

Health information systems - new shifts and emerging trends in health IT infrastructures.

OBJECTIVES: Summarize excellent current research in the field of Health Information Systems. METHOD: Synopsis of the articles selected for the IMIA Yearbook 2009. RESULTS: Five papers from international peer reviewed journals have been selected for the section on health information systems. They concentrate on topics such as personal health records, the comparison of IT infrastructures in hospitals from different countries, hospital to hospital IT outsourcing partnership, and the wireless monitoring of patients. CONCLUSIONS: The elected articles highlight the new shifts in health information management and challenges faced by hospitals regarding IT infrastructures.

Health information systems: current challenges and developments. Findings from the Yearbook 2008 Section on Health Information Systems.

OBJECTIVES: To summarize excellent current research in the field of Health Information Systems. METHOD: Synopsis of the articles selected for the IMIA Yearbook 2008. RESULTS: HIS is a broad field that includes many fruitful areas of research and development. Some current topics were selected for this IMIA yearbook. CONCLUSIONS: The best paper selection of articles on health information systems shows examples of original developments in the area of: medical record systems to meet specific requirements in a developing country, methodologies to identify strengths and weaknesses of hospital information systems, networking of hospital information systems towards an integrated regional health platform, and development of an open source picture archiving and communication systems to facilitate the integration of advanced new imaging functionalities.

Plasticity of endothelial cells during arterial-venous differentiation in the avian embryo.

Remodeling of the primary vascular system of the embryo into arteries and veins has long been thought to depend largely on the influence of hemodynamic forces. This view was recently challenged by the discovery of several molecules specifically expressed by arterial or venous endothelial cells. We here analysed the expression of neuropilin-1 and TIE2, two transmembrane receptors known to play a role in vascular development. In birds, neuropilin-1 was expressed by arterial endothelium and wall cells, but absent from veins. TIE2 was strongly expressed in embryonic veins, but only weakly transcribed in most arteries. To examine whether endothelial cells are committed to an arterial or venous fate once they express these specific receptors, we constructed quail-chick chimeras. The dorsal aorta, carotid artery and the cardinal and jugular veins were isolated together with the vessel wall from quail embryos between embryonic day 2 to 15 and grafted into the coelom of chick hosts. Until embryonic day 7, all grafts yielded endothelial cells that colonized both host arteries and veins. After embryonic day 7, endothelial plasticity was progressively lost and from embryonic day 11 grafts of arteries yielded endothelial cells that colonized only chick arteries and rarely reached the host veins, while grafts of jugular veins colonized mainly host veins. When isolated from the vessel wall, quail aortic endothelial cells from embryonic day 11 embryos were able to colonize both host arteries and veins. Our results show that despite the expression of arterial or venous markers the endothelium remains plastic with regard to arterial-venous differentiation until late in embryonic development and point to a role for the vessel wall in endothelial plasticity and vessel identity.

Selective expression of angiopoietin 1 and 2 in mesenchymal cells surrounding veins and arteries of the avian embryo.

The expression of angiopoietin1 and 2 (ang1 and 2) and their receptor tie-2 was studied in avian embryos using in situ hybridization. Ang1 was transcribed in the mesenchymal cells surrounding venous endothelium expressing tie-2. By contrast, ang2 was transcribed around arteries in which the endothelium down-regulated tie-2 mRNA. The aorta and large arteries of the heart outflow tract were never surrounded by ang2 positive cells and maintained tie-2 expression.

Expanding DIOGENE with a clinical information system based on a new hospital-wide clinical findings dictionary.

The DIOGENE hospital information system has been expanded with a centralized and integrated patient clinical database recording structured patient data. The objective is to provide a standardized framework for the building of future clinical databases and for the integration of existing heterogeneous ones. The combined 'across time view' and 'across departments view' generated from the integrated clinical data will enable an evolutionary view of the patient state, both across time and across medical specialties. For this purpose and to permit the communication and exchange of data, a new controlled vocabulary for representing clinical data has been created. The construction of this vocabulary is based on the international ICD classification, already being used in DIOGENE for encoding patient diagnosis and procedures. A new extension of the ICD is proposed for medical information that goes beyond diagnosis and procedures encoding. The building of a common clinical findings dictionary, recording the definition of clinical entities, is based on this newly developed clinical vocabulary. This process is incremental, manual and substantial.

ARCHIMED: a Network of Integrated Information Systems.

ARCHIMED is a Network of Integrated Information Systems (NIIS). This novel concept of hospital information system has a major advantage over the currently used distributed systems. The normalized representation structure of its databases enable its Navigators to reach simultaneously not only the data coming from different hospital departments, laboratories, and other hospital facilities, but also the data from different hospitals associated in the network.

Developmental expression of pim kinases suggests functions also outside of the hematopoietic system.

We have cloned a novel quail cDNA with strong homology to the pim family of proto-oncogenes. The deduced amino acid (aa) sequence of the cDNA, named qpim, is more closely related to Xenopus Pim and to the recently identified rat Pim-3 than to human or rodent Pim-1 or Pim-2. The protein encoded by the qpim cDNA can autophosphorylate itself and share substrates with murine Pim-1, suggesting functional redundancy to other Pim family serine/threonine kinases. We have compared the expression of qpim in avian embryos to mouse pim-1, -2 and -3 by in situ hybridization. qpim shows a highly dynamic expression pattern, particularly at early developmental stages. Surprisingly, its expression pattern is not identical to any of the murine pim genes, which show complementary and/or partially overlapping expression sites both in- and outside of the hematopoietic system. Altogether, our results suggest novel functions for Pim family kinases during embryonic development, in particular in epithelia and in the central nervous system.

Issues in designing a controlled vocabulary and a patient data representation model for a hospital-wide EPR system.

Careful attention must be paid when designing the following components of a hospital-wide electronic patient record (EPR) system: the common medical controlled terminology, the semantic data model for a standardized representation of patient data and the normalized database. Requirements are detailed. Problems encountered when coordinating the development of a medical terminology with the modeling of patient medical data are analyzed. Solutions implemented in the hospital-wide DOCLIN EPR system at the University Hospital of Geneva (HUG) are presented.

Finding similar cases within a hospital information system.

Most of the theoretical medical knowledge comes from literature. The knowledge obtained from the vast majority of patients is then lost. The vast majority of patients do not participate in the elaboration of medical knowledge, apart from the lucky few entering a clinical trial or a published case study. Moreover, locally treated patients do not always correspond to the same time, space or age context as literature patients. How can the knowledge of one patient be used for treating other patients? How can we save the knowledge of our own patients? Hospital information systems contain a lot of detailed and precise information about many patients over several years. Databases containing detailed information can provide solutions based on case analysis (Case-based reasoning or "similar case approach"). An example of a Geneva's decision system called Archimed is shown here.

A hospital-wide clinical findings dictionary based on an extension of the International Classification of Diseases (ICD).

The use of a controlled vocabulary set in a hospital-wide clinical information system is of crucial importance for many departmental database systems to communicate and exchange information. In the absence of an internationally recognized clinical controlled vocabulary set, a new extension of the International statistical Classification of Diseases (ICD) is proposed. It expands the scope of the standard ICD beyond diagnosis and procedures to clinical terminology. In addition, the common Clinical Findings Dictionary (CFD) further records the definition of clinical entities. The construction of the vocabulary set and the CFD is incremental and manual. Tools have been implemented to facilitate the tasks of defining/maintaining/publishing dictionary versions. The design of database applications in the integrated clinical information system is driven by the CFD which is part of the Medical Questionnaire Designer tool. Several integrated clinical database applications in the field of diabetes and neuro-surgery have been developed at the HUG.

The bridge between administrative and clinical information system.

On one side, physicians are asked to record administrative information, such as activity measurement, case-mix of their specialty, billing, for statistical, legal or reimbursement purposes; and on the other side, they need to gather detailed information about their own patients in terms of clinical evolution, for the day-to-day care of the patients or for clinical research purposes. Many other actors are also involved with these processes, both on the administrative side, such as registration officers, administrators and on the clinical side, nurses and other care providers. Applications have been developed within hospital information systems for capturing and disseminating information according to these specific actors and dedicated purposes. But more and more appears the need to integrate these data for insuring the coherence of information and avoiding redundancy of data capture. How to conciliate these objectives? We describe the Geneva's approach for integrating the administrative and the clinical systems.

Expanding DIOGENE with a clinical information system based on a new hospital-wide clinical finding dictionary.

The aim of this project is to expand DIOGENE with a centralized and integrated patient clinical database system providing a standardized framework for the building of future clinical databases and for the integration of existing heterogeneous ones. The combined 'across time view' and 'across departments view' generated from the integrated clinical data will enable an evolutionary view of the patient state both across time and across medical specialties. For this purpose and to permit the communication and exchange of data, a new controlled vocabulary for representing clinical data has been created. The construction of this vocabulary is based on the international ICD classification, already being used in DIOGENE for encoding patient diagnosis and procedures. A new extension of the ICD is proposed for medical information that goes beyond diagnosis and procedures encoding. The building of a common clinical finding dictionary recording the definition of findings is based on this newly developed clinical vocabulary. This process is incremental, manual, and significant.

Avian VEGF-C: cloning, embryonic expression pattern and stimulation of the differentiation of VEGFR2-expressing endothelial cell precursors.

VEGF-C is a recently discovered secreted polypeptide related to the angiogenic mitogen VEGF. We have isolated the quail VEGF-C cDNA and shown that its protein product is secreted from transfected cells and interacts with the avian VEGFR3 and VEGFR2. In situ hybridization shows that quail VEGF-C mRNA is strongly expressed in regions destined to be rich in lymphatic vessels, particularly the mesenteries, mesocardium and myotome, in the region surrounding the jugular veins, and in the kidney. These expression sites are similar to those observed in the mouse embryo (E. Kukk, A. Lymboussaki, S. Taira, A. Kaipainen, M. Jeltsch, V. Joukov and K. Alitalo, 1996, Development 122, 3829-3837). We have observed VEGFR3-positive endothelial cells in proximity to most of the VEGF-C-expressing sites, suggesting functional relationships between this receptor-ligand couple. The comparison of the VEGF and VEGFR2 knockout phenotypes had suggested the existence of another ligand for VEGFR2. We therefore investigated the effect of VEGF-C on VEGFR2-positive cells isolated from the posterior mesoderm of gastrulating embryos. We have recently shown that VEGF binding triggers endothelial differentiation of these cells, whereas hemopoietic differentiation appears to be mediated by binding of a so far unidentified VEGFR2 ligand. We show here that VEGF-C also triggers endothelial differentiation of these cells, presumably via VEGFR2. These results indicate that VEGF and VEGF-C can act in a redundant manner via VEGFR2. In conclusion, VEGF-C appears to act during two different developmental phases, one early in posterior mesodermal VEGFR2-positive endothelial cell precursors which are negative for VEGFR3 and one later in regions rich in lymphatic vessels at a time when endothelial cells express both VEGFR2 and VEGFR3.

Ligand-dependent development of the endothelial and hemopoietic lineages from embryonic mesodermal cells expressing vascular endothelial growth factor receptor 2.

The existence of a common precursor for endothelial and hemopoietic cells, termed the hemangioblast, has been postulated since the beginning of the century. Recently, deletion of the endothelial-specific vascular endothelial growth factor receptor 2 (VEGFR2) by gene targeting has shown that both endothelial and hemopoietic cells are absent in homozygous null mice. This observation suggested that VEGFR2 could be expressed by the hemangioblast and essential for its further differentiation along both lineages. However, it was not possible to exclude the hypothesis that hemopoietic failure was a secondary effect resulting from the absence of an endothelial cell microenvironment. To distinguish between these two hypotheses, we have produced a mAb directed against the extracellular domain of avian VEGFR2 and isolated VEGFR2+ cells from the mesoderm of chicken embryos at the gastrulation stage. We have found that in clonal cultures, a VEGFR2+ cell gives rise to either a hemopoietic or an endothelial cell colony. The developmental decision appears to be regulated by the binding of two different VEGFR2 ligands. Thus, endothelial differentiation requires VEGF, whereas hemopoietic differentiation occurs in the absence of VEGF and is significantly reduced by soluble VEGFR2, showing that this process could be mediated by a second, yet unidentified, VEGFR2 ligand. These observations thus suggest strongly that in the absence of the VEGFR2 gene product, the precursors of both hemopoietic and vascular endothelial lineages cannot survive. These cells therefore might be the initial targets of the VEGFR2 null mutation.

Molecular cloning of Quek 1 and 2, two quail vascular endothelial growth factor (VEGF) receptor-like molecules.

We have previously reported the cloning of two partial cDNAs corresponding to two quail (Coturnix coturnix japonica) receptor tyrosine kinases (RTKs), named Quek 1 and Quek 2, and their expression in endothelial cells of the early avian embryo. We here report the cloning of the full-size cDNAs for both molecules. Sequence comparison shows that Quek 1 and 2 share an overall amino acid (aa) identity of 49%. They both comprise seven extracellular immunoglobulin-like (Ig-like) domains, a single transmembrane domain, and an intracellular kinase domain split into two by a 70 aa insertion. These structural characteristics are shared by the members of the recently discovered VEGF receptor (VEGFR) family. We have compared the sequences of Quek 1 and 2 to the other VEGFRs. At the aa level, Quek 1 is most closely related to KDR/flk-1 (VEGFR 2) (aa identity of 69% and 71%, respectively). Quek 2 shows a similar degree of aa identity to fit-4 (VEGFR 3). Quek 1 and 2 display a lower homology to fit-1 (VEGFR 1) (about 45% aa identity). These data suggest that Quek 1 and 2 are the avian homologues of VEGFRs 2 and 3, respectively.