Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records.

BACKGROUND: We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria. METHODS: We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content. RESULTS: All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified. CONCLUSION: If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.

Development, implementation, and evaluation of a structured reporting web tool for abdominal aortic aneurysms

BACKGROUND The majority of radiological reports are lacking a standard structure. Even within a specialized area of radiology, each report has its individual structure with regards to details and order, often containing too much of non-relevant information the referring physician is not interested in. For gathering relevant clinical key parameters in an efficient way or to support long-term therapy monitoring, structured reporting might be advantageous. OBJECTIVE Despite of new technologies in medical information systems, medical reporting is still not dynamic. To improve the quality of communication in radiology reports, a new structured reporting system was developed for abdominal aortic aneurysms (AAA), intended to enhance professional communication by providing the pertinent clinical information in a predefined standard. METHODS Actual state analysis was performed within the departments of radiology and vascular surgery by developing a Technology Acceptance Model. The SWOT (strengths, weaknesses, opportunities, and threats) analysis focused on optimization of the radiology reporting of patients with AAA. Definition of clinical parameters was achieved by interviewing experienced clinicians in radiology and vascular surgery. For evaluation, a focus group (4 radiologists) looked at the reports of 16 patients. The usability and reliability of the method was validated in a real-world test environment in the field of radiology. RESULTS A Web-based application for radiological "structured reporting" (SR) was successfully standardized for AAA. Its organization comprises three main categories: characteristics of pathology and adjacent anatomy, measurements, and additional findings. Using different graphical widgets (eg, drop-down menus) in each category facilitate predefined data entries. Measurement parameters shown in a diagram can be defined for clinical monitoring and be adducted for quick adjudications. Figures for optional use to guide and standardize the reporting are embedded. Analysis of variance shows decreased average time required with SR to obtain a radiological report compared to free-text reporting (P=.0001). Questionnaire responses confirm a high acceptance rate by the user. CONCLUSIONS The new SR system may support efficient radiological reporting for initial diagnosis and follow-up for AAA. Perceived advantages of our SR platform are ease of use, which may lead to more accurate decision support. The new system is open to communicate not only with clinical partners but also with Radiology Information and Hospital Information Systems.

Guidelines for WB3 Part III: Stakeholder workshop 2: Selection and decision on prevention and mitigation strategies to be implemented

These guidelines were developed in the context of working block 3 of the DESIRE project. They address the facilitators in the 18 DESIRE study sites and support them in conducting stakeholder workshops aiming at the selection and decision on mitigation strategies to be implemented in the study site context. The decision-making process is supported by a multi-objective decision support system (MODSS) Software called 'Facilitator'.

Roadmap for implementing the Chronic Care Model for weight management: Healthcare Institution's Response to Obesity (HIRO)

Background. Excess weight and obesity are at epidemic proportions in the United States and place individuals at increased risk for a variety of chronic conditions. Rates of diabetes, high blood pressure, coronary artery disease, stroke, cancer, and arthritis are all influenced by the presence of obesity. Small reductions in excess weight can produce significant positive clinical outcomes. Healthcare organizations have a vital role to play in the identification and management of obesity. Currently, healthcare providers do not adequately diagnose and manage excess weight in patients. Lack of skill, time, and knowledge are commonly cited as reasons for non-adherence to recommended standards of care. The Chronic Care Model offers an approach to healthcare organizations for chronic disease management. The model consists of six elements that work together to empower both providers and patients to have more productive interactions: the community, the health system itself, self-management support, delivery system design, decision support, and clinical information systems. The model and its elements may offer a framework through which healthcare organizations can adapt to support, educate, and empower providers and patients in the management of excess weight and obesity. Successful management of excess weight will reduce morbidity and mortality of many chronic conditions. Purpose. The purpose of this review is to synthesize existing research on the effectiveness of the Chronic Care Model and its elements as they relate to weight management and behaviors associated with maintaining a healthy weight. Methods: A narrative review of the literature between November 1998 and November 2008 was conducted. The review focused on clinical trials, systematic reviews, and reports related to the chronic care model or its elements and weight management, physical activity, nutrition, or diabetes. Fifty-nine articles are included in the review. Results. This review highlights the use of the Chronic Care Model and its elements that can result in improved quality of care and clinical outcomes related to weight management, physical activity, nutrition, and diabetes. Conclusions. Healthcare organizations can use the Chronic Care Model framework to implement changes within their systems to successfully address overweight and obesity in their patient populations. Specific recommendations for operationalizing the Chronic Care Model elements for weight management are presented.^

Posttraumatic stress disorder among veterans of the Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) wars: Psychological comorbidities, postdeployment social support and unit support

Much attention has been given to treating Operation Iraqi Freedom/Operation Enduring (OIF/OEF) Veterans with posttraumatic stress disorder (PTSD). However, little attention is given to those Veterans who do not meet diagnostic criteria for PTSD but who may still benefit from intervention. Research is needed to investigate the impact of how different racial/ethnic backgrounds, different levels of social support and comorbid mental health disorders impact OIF/OEF Veterans with varying levels of PTSD. The purpose of this dissertation is to examine the association of comorbid Axis I disorders, race/ethnicity, different levels of postdeployment social support and unit support on OIF/OEF Veterans with varying levels of PTSD. Data for this dissertation were from postdeployment screenings of OIF/OEF Veterans from a large Veterans Affairs hospital in southeast Texas. To examine the study hypotheses, we conducted multinomial logistic regressions of the clinician reported data. ^ The first article examined the prevalence of subthreshold and full levels of PTSD and compared Axis I and alcohol use comorbidity rates among 1,362 OIF/OEF Veterans with varying levels of PTSD. Results suggest that OIF/OEF Veterans with subthreshold PTSD experience similar levels of psychological distress as those with full PTSD and highlight the need to provide timely and appropriate mental health services to individuals who may not meet the diagnostic criteria for full PTSD. ^ These results suggest that OIF/OEF Veterans of all race/ethnicities can benefit from strong social support systems. Postdeployment social support was found to be a protective factor against the development of PTSD among White, Black and Hispanic veterans while deployment unit support was a protective factor only among Black Veterans. The second article investigated the association between postdeployment social support and unit support with varying levels of PTSD by race/ethnicity among 1,115 OIF/OEF Veterans. ^ The results of this study can help to formulate treatment and interventions for OIF/OEF Veterans with varying levels of PTSD and social support systems.^

Detecting Traffic Problems with ILP

Expert systems for decision support have recently been successfully introduced in road transport management. In this paper, we apply three state-of-the art ILP systems to learn how to detect traffic problems.

Simulating improved combinations tillage-rotation under dryland conditions.

The adequate combination of reduced tillage and crop rotation could increase the viability of dry land agriculture in Mediterrenean zones. Crop simulation models can support to examine various tillage-rotation combinations and explore management scenarios. The decision support system for agrotechnology transfer (DSSAT) (Hoogenboom et al., 2010) provides a suite of crop models suitable for this task. The objective of this work was to simulate the effects of two tillage systems, conventional tillage (ConvT) and no tillage (NoT), and three crop rotations, continuous cereal (CC), fallow-cereal (FallowC) and legume-cereal (LegumeC), under dry conditions, on the cereal yield, soil organic carbon (SOC) and nitrogen (SON) in a 15-year experiment, comparing these simulations with field observations.

On a meaningful integration of web services in data-intensive biomedical environments: The DICODE approach

This paper reports on an innovative approach that aims to reduce information management costs in data-intensive and cognitively-complex biomedical environments. Recognizing the importance of prominent high-performance computing paradigms and large data processing technologies as well as collaboration support systems to remedy data-intensive issues, it adopts a hybrid approach by building on the synergy of these technologies. The proposed approach provides innovative Web-based workbenches that integrate and orchestrate a set of interoperable services that reduce the data-intensiveness and complexity overload at critical decision points to a manageable level, thus permitting stakeholders to be more productive and concentrate on creative activities.

MOIRA-PLUS use in decision making on the long-term management of contaminated freshwater bodies and catchments

In the mid-long-term after a nuclear accident, the contamination of drinking water sources, fish and other aquatic foodstuffs, irrigation supplies and people?s exposure during recreational activities may create considerable public concern, even though dose assessment may in certain situations indicate lesser importance than for other sources, as clearly experienced in the aftermath of past accidents. In such circumstances there are a number of available countermeasure options, ranging from specific chemical treatment of lakes to bans on fish ingestion or on the use of water for crop irrigation. The potential actions can be broadly grouped into four main categories, chemical, biological, physical and social. In some cases a combination of actions may be the optimal strategy and a decision support system (DSS) like MOIRA-PLUS can be of great help to optimise a decision. A further option is of course not to take any remedial actions, although this may also have significant socio-economic repercussions which should be adequately evaluated. MOIRA-PLUS is designed to allow for a reliable assessment of the long-term evolution of the radiological situation and of feasible alternative rehabilitation strategies, including an objective evaluation of their social, economic and ecological impacts in a rational and comprehensive manner. MOIRA-PLUS also features a decision analysis methodology, making use of multi-attribute analysis, which can take into account the preferences and needs of different types of stakeholders. The main functions and elements of the system are described summarily. Also the conclusions from end-user?s experiences with the system are discussed, including exercises involving the organizations responsible for emergency management and the affected services, as well as different local and regional stakeholders. MOIRAPLUS has proven to be a mature system, user friendly and relatively easy to set up. It can help to better decisionmaking by enabling a realistic evaluation of the complete impacts of possible recovery strategies. Also, the interaction with stakeholders has allowed identifying improvements of the system that have been recently implemented.

Implementación de una arquitectura de componentes para un sistema de apoyo a la toma de decisiones en Atención Primaria

Este Proyecto Fin de Grado tiene como objetivo fundamental el perfeccionamiento y puesta en explotación de un sistema de ayuda a la decisión que evalúa el desarrollo del lenguaje en niños de 0 a 6 años de edad. Este sistema está formado fundamentalmente por una aplicación diseñada y construida mediante una arquitectura de componentes de software modular y reutilizable. La aplicación será usada por los pediatras para realizar evaluaciones del desarrollo del lenguaje infantil y además por los neuropediatras, logopedas y miembros de equipos de Atención Temprana para consultar las evaluaciones y validar las decisiones propuestas por el sistema. El sistema es accesible vía web y almacena toda la información que maneja en una base de datos. Asimismo, el sistema se apoya en un modelo conceptual u ontología desarrollado previamente para inferir las decisiones adecuadas para las evaluaciones del lenguaje. El sistema incorpora las funciones de gestión de los usuarios del mismo. ABSTRACT This Grade End Project has as fundamental objective the improvement and deployment of a decision support system for evaluating children language development from 0 to 6 years of age. This system is mainly formed by an application designed and built using a modular and reusable software component architecture. The application will be used by pediatricians for evaluating children´s speech development and also by neuro-pediatricians, speech therapists and early childhood intervention team members, for consulting previous evaluations and for validating system´s proposed decision. The system is web based and stores its information in a database. Likewise, the system is supported by a conceptual model or ontology previously developed to infer the appropriate decision for language evaluation. The system also includes user management functions.

A Web-based Support System for Providing Effective Monitoring, Feedback and Evaluation in Project Management Education

This work introduces a web-based learning environment to facilitate learning in Project Management. The proposed web-based support system integrates methodological procedures and information systems, allowing to promote learning among geographically-dispersed students. Thus, students who are enrolled in different universities at different locations and attend their own project management courses, share a virtual experience in executing and managing projects. Specific support systems were used or developed to automatically collect information about student activities, making it possible to monitor the progress made on learning and assess learning performance as established in the defined rubric.

Simulating improved combinations tillage-rotation under dryland conditions.

Crop simulation models allow analyzing various tillage-rotation combinations and exploring management scenarios. This study was conducted to test the DSSAT (Decision Support System for Agrotechnology Transfer) modelling system in rainfed semiarid central Spain. The focus is on the combined effect of tillage system and winter cereal-based rotations (cereal/legume/fallow) on the crop yield and soil quality. The observed data come from a 16-year field experiment. The CERES and CROPGRO models, included in DSSAT v4.5, were used to simulate crop growth and yield, and DSSAT- CENTURY was used in the soil organic carbon (SOC) and soil nitrogen (SN) simulations. Genetic coefficients were calibrated using part of the observed data. Field observations showed that barley grain yield was lower for continuous cereal (BB) than for vetch (VB) and fallow (FB) rotations for both tillage systems. The CERES-Barley model also reflected this trend. The model predicted higher yield in the conventional tillage (CT) than in the no tillage (NT) probably due to the higher nitrogen availability in the CT, shown in the simulations. The SOC and SN in the top layer only, were higher in NT than in CT, and decreased with depth in both simulated and observed values. These results suggest that CT-VB and CT-FB were the best combinations for the dry land conditions studied. However, CT presented lower SN and SOC content than NT. This study shows how models can be a useful tool for assessing and predicting crop growth and yield, under different management systems and under specific edapho-climatic conditions. Additional key words: CENTURY model; CERES-Barley; crop simulation models; DSSAT; sequential simula- tion; soil organic carbon.

Integration of a data acquisition system based on FlexRIO technology with EPICS

EPICS (Experimental Physics and Industrial Control System) lies in a set of software tools and applications which provide a software infrastructure for building distributed data acquisition and control systems. Currently there is an increase in use of such systems in large Physics experiments like ITER, ESS, and FREIA. In these experiments, advanced data acquisition systems using FPGA-based technology like FlexRIO are more frequently been used. The particular case of ITER (International Thermonuclear Experimental Reactor), the instrumentation and control system is supported by CCS (CODAC Core System), based on RHEL (Red Hat Enterprise Linux) operating system, and by the plant design specifications in which every CCS element is defined either hardware, firmware or software. In this degree final project the methodology proposed in Implementation of Intelligent Data Acquisition Systems for Fusion Experiments using EPICS and FlexRIO Technology Sanz et al. [1] is used. The final objective is to provide a document describing the fulfilled process and the source code of the data acquisition system accomplished. The use of the proposed methodology leads to have two diferent stages. The first one consists of the hardware modelling with graphic design tools like LabVIEWFPGA which later will be implemented in the FlexRIO device. In the next stage the design cycle is completed creating an EPICS controller that manages the device using a generic device support layer named NDS (Nominal Device Support). This layer integrates the data acquisition system developed into CCS (Control, data access and communication Core System) as an EPICS interface to the system. The use of FlexRIO technology drives the use of LabVIEW and LabVIEW FPGA respectively. RESUMEN. EPICS (Experimental Physics and Industrial Control System) es un conjunto de herramientas software utilizadas para el desarrollo e implementación de sistemas de adquisición de datos y control distribuidos. Cada vez es más utilizado para entornos de experimentación física a gran escala como ITER, ESS y FREIA entre otros. En estos experimentos se están empezando a utilizar sistemas de adquisición de datos avanzados que usan tecnología basada en FPGA como FlexRIO. En el caso particular de ITER, el sistema de instrumentación y control adoptado se basa en el uso de la herramienta CCS (CODAC Core System) basado en el sistema operativo RHEL (Red Hat) y en las especificaciones del diseño del sistema de planta, en la cual define todos los elementos integrantes del CCS, tanto software como firmware y hardware. En este proyecto utiliza la metodología propuesta para la implementación de sistemas de adquisición de datos inteligente basada en EPICS y FlexRIO. Se desea generar una serie de ejemplos que cubran dicho ciclo de diseño completo y que serían propuestos como casos de uso de dichas tecnologías. Se proporcionará un documento en el que se describa el trabajo realizado así como el código fuente del sistema de adquisición. La metodología adoptada consta de dos etapas diferenciadas. En la primera de ellas se modela el hardware y se sintetiza en el dispositivo FlexRIO utilizando LabVIEW FPGA. Posteriormente se completa el ciclo de diseño creando un controlador EPICS que maneja cada dispositivo creado utilizando una capa software genérica de manejo de dispositivos que se denomina NDS (Nominal Device Support). Esta capa integra la solución en CCS realizando la interfaz con la capa EPICS del sistema. El uso de la tecnología FlexRIO conlleva el uso del lenguaje de programación y descripción hardware LabVIEW y LabVIEW FPGA respectivamente.

Simulating potential growth and yield of oil palm (Elaeis guineensis) with PALMSIM: Model description, evaluation and application.

Reducing the gap between water-limited potential yield and actual yield in oil palm production systems through intensification is seen as an important option for sustainably increasing palm oil production. Simulation models can play an important role in quantifying water-limited potential yield, and therefore the scope for intensification, but no oil palm model exists that is both simple enough and at the same time incorporates sufficient plant physiological knowledge to be generally applicable across sites with different growing conditions. The objectives of this study therefore were to develop a model (PALMSIM) that simulates, on a monthly time step, the potential growth of oil palm as determined by solar radiation and to evaluate model performance against measured oil palm yields under optimal water and nutrient management for a range of sites across Indonesia and Malaysia. The maximum observed yield in the field matches the corresponding simulated yield for dry bunch weight with a RMSE of 1.7 Mg ha?1 year?1 against an observed yield of 18.8 Mg ha?1. Sensitivity analysis showed that PALMSIM is robust: simulated changes in yield caused by modifying the parameters by 10% are comparable to other tree crop model evaluations. While we acknowledge that, depending on the soils and climatic environment, yields may be often water limited, we suggest a relatively simple physiological approach to simulate potential yield, which can be usefully applied to high rainfall environments and is considered as a first step in developing an oil palm model that also simulates water-limited potential yield. To illustrate the application possibil- ities of the model, PALMSIM was used to create a potential yield map for Indonesia and Malaysia by sim- ulating the growth and yield at a resolution of 0.1?. This map of potential yield is considered as a first step towards a decision support tool that can identify potentially productive, but at the moment degraded sites in Indonesia and Malaysia. ?

Modelización e integración de sistemas de adquisición de datos inteligentes en sistemas de instrumentación para dispositivos de fusión

La obtención de energía a partir de la fusión nuclear por confinamiento magnético del plasma, es uno de los principales objetivos dentro de la comunidad científica dedicada a la energía nuclear. Desde la construcción del primer dispositivo de fusión, hasta la actualidad, se han llevado a cabo multitud de experimentos, que hoy en día, gran parte de ellos dan soporte al proyecto International Thermonuclear Experimental Reactor (ITER). El principal problema al que se enfrenta ITER, se basa en la monitorización y el control del plasma. Gracias a las nuevas tecnologías, los sistemas de instrumentación y control permiten acercarse más a la solución del problema, pero a su vez, es más complicado estandarizar los sistemas de adquisición de datos que se usan, no solo en ITER, sino en otros proyectos de igual complejidad. Desarrollar nuevas implementaciones hardware y software bajo los requisitos de los diagnósticos definidos por los científicos, supone una gran inversión de tiempo, retrasando la ejecución de nuevos experimentos. Por ello, la solución que plantea esta tesis, consiste en la definición de una metodología de diseño que permite implementar sistemas de adquisición de datos inteligentes y su fácil integración en entornos de fusión para la implementación de diagnósticos. Esta metodología requiere del uso de los dispositivos Reconfigurable Input/Output (RIO) y Flexible RIO (FlexRIO), que son sistemas embebidos basados en tecnología Field-Programmable Gate Array (FPGA). Para completar la metodología de diseño, estos dispositivos van a ser soportados por un software basado en EPICS Device Support utilizando la tecnología EPICS software asynDriver. Esta metodología se ha evaluado implementando prototipos para los controladores rápidos de planta de ITER, tanto para casos prácticos de ámbito general como adquisición de datos e imágenes, como para casos concretos como el diagnóstico del fission chamber, implementando pre-procesado en tiempo real. Además de casos prácticos, esta metodología se ha utilizado para implementar casos reales, como el Ion Source Hydrogen Positive (ISHP), desarrollada por el European Spallation Source (ESS Bilbao) y la Universidad del País Vasco. Finalmente, atendiendo a las necesidades que los experimentos en los entornos de fusión requieren, se ha diseñado un mecanismo mediante el cual los sistemas de adquisición de datos, que pueden ser implementados mediante la metodología de diseño propuesta, pueden integrar un reloj hardware capaz de sincronizarse con el protocolo IEEE1588-V2, permitiendo a estos, obtener los TimeStamps de las muestras adquiridas con una exactitud y precisión de decenas de nanosegundos y realizar streaming de datos con TimeStamps. ABSTRACT Fusion energy reaching by means of nuclear fusion plasma confinement is one of the main goals inside nuclear energy scientific community. Since the first fusion device was built, many experiments have been carried out and now, most of them give support to the International Thermonuclear Experimental Reactor (ITER) project. The main difficulty that ITER has to overcome is the plasma monitoring and control. Due to new technologies, the instrumentation and control systems allow an approaching to the solution, but in turn, the standardization of the used data acquisition systems, not only in ITER but also in other similar projects, is more complex. To develop new hardware and software implementations under scientific diagnostics requirements, entail time costs, delaying new experiments execution. Thus, this thesis presents a solution that consists in a design methodology definition, that permits the implementation of intelligent data acquisition systems and their easy integration into fusion environments for diagnostic purposes. This methodology requires the use of Reconfigurable Input/Output (RIO) and Flexible RIO (FlexRIO) devices, based on Field-Programmable Gate Array (FPGA) embedded technology. In order to complete the design methodology, these devices are going to be supported by an EPICS Device Support software, using asynDriver technology. This methodology has been evaluated implementing ITER PXIe fast controllers prototypes, as well as data and image acquisition, so as for concrete solutions like the fission chamber diagnostic use case, using real time preprocessing. Besides of these prototypes solutions, this methodology has been applied for the implementation of real experiments like the Ion Source Hydrogen Positive (ISHP), developed by the European Spallation Source and the Basque country University. Finally, a hardware mechanism has been designed to integrate a hardware clock into RIO/FlexRIO devices, to get synchronization with the IEEE1588-V2 precision time protocol. This implementation permits to data acquisition systems implemented under the defined methodology, to timestamp all data acquired with nanoseconds accuracy, permitting high throughput timestamped data streaming.