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MEDICAL INFORMATICS '99 |
Abstracts 4th symposium of the Croatian Society for Medical Informatics |
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MEDICAL INFORMATICS '99 |
Abstracts 4th symposium of the Croatian Society for Medical Informatics |
S E C T I O N S
Standards within Slovenian Health Informatics Area Duško Božič
Institute for Health Care of the Republic of Slovenia
Trubarjeva 2, 1000 Ljubljana, Slovenia
e-mail: dusko.bozic@gov.siIn the article some definitions of standards and their significance are presented. There is a list of standardization bodies and specialy the organization of slovenian standardization in the frame of Standards and Metrology Institute. Diferent ways to implement standards are mentioned. The most significant projects in healthcare informatics area with standards as results are at the end.
STANDARDS LIBRARY -
Information and Documentation Centre of the State Office for Standardization and Metrology in the service of Medical InformaticsJasenka Žuti
State Office for Standardization and Metrology
10000 Zagreb, Ulica grada Vukovara 78, Croatia
e-mail: jasenkaz@dznm.hrStandards from the field of medical informatics are especially important being essential for life and health of people. Here the information has to be quick and understandable where the information plays very often decisive role. Therefore, we are pleased to introduce our Standards Library wich is destined to necessities of the standardization in the medical informatics.
Standards Library - Information and Documentation Centre of the State Office for Standardization and Metrology (DZNM), collects, maintenances and saves collections of International (ISO, IEC), Regional (CEN, CENELEC, ETSI), Croatian (DZNM) , Foreign National (BSI, DIN, partly ANSI) , as well as Branch (ASTM, MIL) standards and documents of international organisations such as OIML and Codex Alimentarius Commission. It contains approximately 100,000 standards documents with corresponding catalogues, handbooks, periodicals and databases (CD-ROM PERINORM is the most important of them) .The Standards Library is active within the frame of the Technical Department and is the base of the State Office structures. This Library is an important source of information for the Croatian economy because it deals with standards and regulations being applied in the developped countries of the world. Through the ISO Committee INFCO/ISONET, DZNM is able to get information concerning standards documents of all countries which are members of ISO.
The Standadrs Library gives the possibilities to all our users in DZNM and out of the State Office ( economy, government, scientific institutes, faculties and individual users) to get information on standards. DZNM has drawn contracts with international organizations (ISO, IEC) and national standards bodies (BSI, DIN) on sale of standards.
How to get the real information, i.e. ABC of the standardization is explained by the use of search parameters, i.e. bibliographical data is based on the examples of the standardization in medical informatics area. We also have the trilingual and biggest world's data base on CD-ROM PERINORM. PERINORM - International version contains approximately 570,000 records comprising current, historical, full, and draft standards and technical regulations for the majority of the European countries, American , Australian and Japanese standards and European and international standards published by standards organisation: CEN, CENELEC, ETSI, ISO, IEC, ITU. Research results on Medicine Informatics are combined with different parameters. There is a list of titles of all standards that are valid. This applies to CEN/TC 251 - Medical Informatics. The work of this TC could be the best base to build up the Croatian Standards System. This is the best way, at the same time, to fill up definitions of medicine informatics according to the basic requirements of the Law of Standardization.
Paperless Hospital; Reality, Dream or a Nightmare? Miroslav Mađarić1 (UIM/I5), Vesna Nesek-Mađarić2 (Neurology Department), Huber Leitner1 (UIM/I5), Wolfgang Köle1 (ORL Department)
1Public Hospitals of Styria, Graz, Austria,
2University Hospital Centre, Zagreb, Croatia
e-mail: madjaric@kfunigraz.ac.atPublic Hospitals of Styria (KAGes) are about to implement the new hospital information system (MEDOCS- MEdical and nursing DOcumentation and Communication network of Styria) in its 21 hospitals. One of the outstanding features of this system is the coverage of virtually all communication and documentation functions related to the patient. This should be the way to fulfill the conditions for gradually removing the paper as an information medium in daily hospital pracitce. This approach will be tested in the MEDOCS project at two evaluation sites. In this paper the authors discuss in form of "pros and contras" the chances and risks of this approach, as well as possible strategies during the steps of implementing the "paperless" hospital. Besides of general technological, medical and cultural considerations the paper discuss also the technical and economical aspects of "paperless" hospital implementation and production.
A Module Connecting Thanatos with Data from Croatian Cancer Registry Tomislav Plasaj1, Dalibor Šimunović1, Marija Strnad2, Zvonko Kusić1, Mladen Belicza1
1University Hospita "Sestre milosrdnice", Vinogradska 29, Zagreb, Croatia,
2Croatian Insitut of Public Health, Rockefellerova 2, Zagreb, CroatiaThanatos is an Information System developed in Sybase for Windows/NT environment and implemented in the "Ljudevit Jurak" Department of Clinical Pathology "Sestre Milosrdnice" University Hospital, Zagreb. Contribute information was reached after connecting Thanatos with data about died patients from Croatian Cancer Registry for follow up purposes. Unfortunately, data from Croatian Cancer Registry were in text files and connection was "manual". So, we need a module that can connect automatically. Before we start to project the module, several conversions must be done. First, text file must be converted into dBase III form. Than dBase III object must be imported into MS Access 97. After that we can continue with module project. We want to make a module that will be able to automatically connect patients from Thanatos with their record of death in Croatian Cancer Registry, if it exist, through name or unique number of citizens (JMBG).
International Classification of Primary Care and its Application in Health Statistics and Medical Informatics Hrvoje Tiljak1, Ines Zelić-Havić2, Mirjana Kujundžić Tiljak3
1Health Care Unit Utrina, Home of Health Novi Zagreb, Zagreb, Croatia,
2Private General Medicine Unit Bukovlje, Bukovlje near Slavonski Brod, Croatia,
3Andrija Štampar School of Public Health, Medical School, University of Zagreb, Rockefellerova 4, Zagreb, Croatia
e-mail: htiljak@andrija.snz.hrExisting data collection, processing and analysis in primary health care (PHC) seems to be complicated and not suitable for PHC description. The International Classification of Primary Care (ICPC) is presented as a possible improvement of the data collection and analysis process. Its application could make (1) data collection and analysis in PHC less complicated and more suitable for description of specific aspects of PHC and make (2) data from personal health record comparable. At the same time, ICPC is applicable within existing system of data collection and no changes in the system is needed for its use. Description of basic facts of ICPC is prepared, as well as a few examples of its use together with compared.
Operational Characteristics of Cancer Registries in Europe: Preparations in Croatia to Standardise Malignant Neoplasm Notification Forms Marija Strnad
Croatian Institute of Public Health
Rockefellerova 7, 10000 Zagreb, Croatia
e-mail: marija_strnad@yahoo.comOperational characteristics of Europe’s cancer registries were described. It should assess the feasibility of establishing a standard data set for the Croatian Cancer Register’s revised data sources. In Europe, cancer registries operate mainly within public sector health services and receive documents from multiple sources, including hospital administration systems, medical records departments and pathology laboratories. There are variation in the type of staff responsible for various tasks, particularly the coding of diagnostic information, and also in staffing levels for data collection. Although tumour classification should be the most stanardised activity, this is not so. A standard definition of “initial treatment” is required.
Application of Mortality Data in Research Based on Small Area Analysis Methodology Marijan Erceg, Ankica Smoljanović, Andrea Babić-Erceg
Public Health Institute of the Split-Dalmatian County
Vukovarska 46, Split, Croatia
e-mail: merceg@bsb.mefst.hrA model of information system for epidemiological research based on small area analysis was developed and implemented on personal computer. Use of mortality data for the level of towns and municipalities from National Institute for Statistics in small area analysis were discussed. Model was tested using carcinoma of colon, rectosigmoid and rectum mortality data for towns and municipalities of Split and Dalmatia County in period from 1993 to 1997. Before implementation to the model data had to be standardized and uniformed due to different coding rules for causes of death diagnoses and towns and municipalities codes used in different years. Significant differences in mortality rates were observed which could be explained only by further research.
Information Aspects of the Difference Between Coefficients K1 - K2 that Influence the Human Health Berezina Matoković, Nives Štambuk-Giljanović
Public Health Institute of the Split-Dalmatian County
Vukovarska 46, Split, Croatia
e-mail: bmatokov@public.srce.hrRegarding the relatively limited possibilities of the water supply in the Dalmatian region (Southern Croatia) water resources management authorities and health institutions are particularly interested in studying the characteristics of the waters in Dalmatia and the possibility of preserving their quality so that growing attention is paid to this research in Dalmatia. Ecological need to sum up the work on water quality investigations and to estimate future water quality trends resulted in environmental monitoring. As it is necessary, from the informatical aspect, to organize mass ecological health data into databases, the relational database for the research of chemical analyses (the differences between coefficients K1 - K2) as the methodological foundation for the study of the ecological factors that influence the human health, is defined in this paper. Results used for the prototype implementation subsystem of the chemical water analysis control are based on the investigations of the Water Examination Department of the Public Health Institute of the Split-Dalmatian County (Croatia). Over 2,000 data are comprised what is the sufficient examination sample. Used SW is related to Win95, MO’97 (Word , Excel, Access) ; whilst used HW is related to Pentium II 200 MHz, floppy, 64 MB RAM, HDD 2,1 GB, CD x24, HP LJet 6L .
The Role and Position of Clearing House in General Model of the Flow of Basic Medical Documents Miljenko Martinis
High Court of the Republic of Croatia
Trg Nikole Šubića Zrinskog 3, 10000 Zagreb, Croatia
e-mail: martinis@open.hrIn deciding and interchange of health data and basic medical documents, Croatian Institute for Health Insurance has monopolistic position related to other health insurance institutions that might exist by provisions of the Health Insurance Law. In generalized health care model natural persons may be insured by various health insurances, and get medical services at those health care institutions having contractual business relations with health insurance. As to provide equal position to all health care participants it is required that current monopolistic system be replaced with general, normalized and standard system of medical data, information and document interchange among all participants that provide health care. In this article one such model is suggested, being based on independent, self-ruled, non-government clearing house that would allow all health care participants to provide, file and interchange medical information and documents, providing protection of medical records and security of medical and business secrets, privacy, as well as private data protection, human rights and freedom of people.
DATA SECURITY, DECISION SUPPORTED SYSTEM
Some Implication of EU Directive 95/46/EU on the area of Data Protection – Slovenian expiriences Mladen Markota
Institute for Health Care of the Republic of Slovenia
Trubarjeva 2, 1000 Ljubljana, Slovenia
Mladen.Markota@gov.siThe EU Directive”on the protection of individuals with regard to the processing of Personal Data and the free movement of such data” is presented from the point of the requirements imposed on new data protection Law in Slovenia and on the requirements imposed on the area of Health Information System. Asimetric cryptography and digital signitures are currrently thought to be the most important request of Directive.
Fuzzy Logic Based Expert System for Searching for Predictors for Survival of New-born Lukačić Zoran1, Josipa Kern2, Marija Težak-Benčić2
1Centre for Rehabilitation of cardiac patients, Kidričeva 6, Radenci, Slovenia
2Andrija Štampar School of Public Health, Medical School, University of Zagreb, Rockefellerova 4, Zagreb, Croatia
e-mail: zoran.lukacic@siol.netFuzzy logic based expert system was tested on a problem of survival of new-born in the first 15 days after birth. The outcome was classified as "alive" and "died". The sample consisted of 566 new-born, every new-born was described with 113 attributes. 70% of the sample was taken as the teaching set and 30% as the test set. The system found 5 attributes as the best predictors for survival (asphyxia, apnoea, birth weight, reanimation, and gestation age). Although the all combinations of attributes showed the high absolute accuracy (more than 87%), and the high accuracy for group "alive" (more than 86%), the most interesting was the result for group "died". The five attributes selected by the system as "the best" ones showed average accuracy of 86.4% . All the attributes gave average accuracy of 45.5%. The first attribute achieved accuracy of 70.4%. Other attributes (except of the five the best) achieved the worst accuracy (14.4%).
WWW-based radiological PACS Miroslav Končar1, Sven Lončarić2
1Ericsson Nikola Tesla, Krapinska 45, 10000 Zagreb, Croatia
2Faculty of Electrical Engineering and Computing, University of Zagreb, Unska 3, 10000 Zagreb, Croatia
e-mail: mkoncar@zesoi.fer.hr, sven.loncaric@fer.hrThe main characteristics of the developed experimental picture archiving and communication system (PACS) are presented in the paper. The goal was to develop a functional DICOM image archive and a platform independent and user-friendly interface for manipulating the data stored in PACS databases and enable visualisation of the medical images that were taken using different medical imaging modalities. The system allows user access to information stored in the image databases. User accesses the system using a WWW-based interface that enables search and retrieval of images from the database. The WWW-based approach provides platform independent mechanism for client-server communication with medical image archives. The software is implemented in PHP scripting language, which is embedded in HTML. Image archive server is based on CTN implementation of DICOM standard.
Telemedicine in Croatia – Reality, Near or Wide Future? Ratko Magjarević, Stanko Tonković, Dubravko Kovačić, Igor Lacković
Faculty of Electrical Engineering and Computing, University of Zagreb
Unska 3, 10000 Zagreb, Croatia
e-mail:ratko.magjarevic@fer.hrTelemedicine comprises a wide range of information and communication technologies and many clinical applications. Despite the expansion of telemedicine, only a limited number of patients receive medical services through these technologies. In this paper, we tried to discuss technological, scientific, economic and social factors of its application. We pointed out some of the advantages of telemedicine and some restrictions raising out of insufficient infrastructure, lack of consistent investments and planing. The application of telemedicine in Croatia is in an early stage, which may be a comparative advantage if the authorities accept the experience and knowledge of the built and implemented telemedicine systems in planing. Acceptance of international standards for medical informatics and electromedical equipment is one of the first steps for planing and quality assurance of telemedicine systems.
Fractal geometry and medical images Vesna Ilakovac
Medical School, Josip Juraj Strossmayer University of Osijek
Huttlerova 4, 31000 Osijek, Croatia
e-mail: vilakov@vukovar.mefos.hrMedical images consist of complex and irregular geometrical structures. Therefore their description with traditional methods is often insufficient. Application of fractal geometry presents a new approach to classification of shape and texture in digitized images. This paper presents a short review of basic terms in fractal geometry and uses of fractal geometry in analysis of medical images.
Teaching Medical Informatics: Basics on Medical Coding and Classification Systems Mladen Petrovečki
Chair for Informatics, Medical School, University of Rijeka
Ulica braće Branchetta 20, 51000 Rijeka, Croatia
e-mail: mladenp@medri.hrBasic informatical concept of medical classification systems and coding systems is briefly reviewed in this paper. Medical properties and usage of systems as such are experienced during the graduate study of medicine, but conceptual properties should be the part of medical informatics curriculum to explain at least fundamental properties of complex medical language considered as a communication system.
Evaluation of Medical Informatics Curriculum at the University of Rijeka School of Medicine Lidija Bilić-Zulle1,2, Mladen Petrovečki1
1Chair for Informatics, Medical School, University of Rijeka, Ulica braće Branchetta 20, 51000 Rijeka, Croatia
2Institute for Laboratory Diagnostics, Clinical Hospital Centre Rijeka, Cambierieva 17, 51000 Rijeka, Croatia
e-mail: lbilicz@medri.hrThis paper presents some basic data from pilot study on evaluation of Medical Informatics curriculum at the University of Rijeka School of Medicine. Evaluation process is based on the written anonymous survey filled by the students after they pass the exam. Questionnaire consists of question considering basic data (age, gender, study year, etc.), as well as students' opinions and marks on informatics, computers usage and teaching skills during the lessons. In total 286 students from three generations (96/97, 97/98, and 98/99) were evaluated. From one generation to another more students get their own computer, more of them are searching the Internet, and they are more satisfied with the organisation of classes. Average exam mark is lower in the generation 98/99 compared to the others, mainly because of the test (written exam) which became a part of final exam at that school year.
Medical Informatics on Biomedical Faculties in Bosnia and Herzegovina Izet Mašić
Medical Faculty, University of Sarajevo
Sarajevo, Bosnia and HerzegovinaMedical informatics has been the first science that connects all traditional medical disciplines, thanking to common information needs and requirements of these disciplines. Its goal is incorporating of information technology into medical praxis, getting medical professionals in touch with capabilities of computer technology and preparing the professionals for the future that belongs to more and more powerful computer technologies. Information as a "crucial" component of medicine is in the focus of each investigation. There are many problems that have to be solved through fundamental investigation: knowledge structuring problems; joining the different kinds of knowledge; knowledge and representation of decision making process; medical concepts; integration and information and knowledge exchange; education of medical staff; structure and organisation. What kinds of management are the best for application in the fied of medical informatics? What are the changes in organisation and structure when computer are used? How to connect education processes in clinical centres, libraries, clinical functions and investigations? In this article author discuss about the theoretical and practical part of the education process on biomedical faculties in Bosnia and Herzegovina, according to neww curriculum. Curriculum of colloquium on medical informatics is identical at all biomedical faculties. There is a difference, only, within number of theoretical and practical hours of medical informatics on these faculties. Key words: biomedical faculties, medical informatics, curriculum.
A General Pediatrician and Internet Denis Mladinić-Vulić
Mertojak Pediatrician Unit
Doverska 2a, 21000 Split, Croatia
e-mail: Denis.Vulic@public.srce.hrA general pediatrician in primary pediatric settings collects information in a more difficult way than hospital-based pediatricians. Reasons are workday hours, economic situation and broader knowledge needed. The office is opened from 7am to 10pm from Monday to Sunday. That means pediatricians do not have enough time to be out from office. They may attend 1 to 2 meetings or courses per year. Continuing Medical Education (CME) by subscription to journals is too expensive for Croatian pediatricians, because subscription rates for these journals are around a month salary of Croatian pediatrician. The aim of this article is to inform that Internet provides everything mentioned above in a less expensive and as less time consuming manner. A child with thalassemia and a child with hemihypertrophy are presented here like a resolving puzzle. It is important to receive immunization news continuously and to know possible toxic vaccine compounds, such as thymerosal. The Center for Disease Control (CDC) web site gives you all information about vaccines like as BCG local complications. Live communications are possible through e-mails to known colleagues or online meetings.
Computer Aided Alcohological Studies of Literary Works Duško Wölfl
Public Health Institute of the County Primorsko-goranska
Krešimirova 52a, 51000 Rijeka, Croatia
e-mail: dwolfl@mamed.medri.hrWith many writers, alcohol related problems take a significant role in producing literary pieces. Such literary works present an important potential in prevention and treatment of problems caused by alcohol. Study and analysis of the texts have proved to be far easier when using a computer. The text which, for example, consists of about ten or even hundred thousands words, can be checked on a specific word in just several seconds. It can be found out very quickly if there are some interesting alcoholic notions in a text by using software for producing concordances. You can also determine location and frequency of these notions in a text. In such a way especially big quantities of texts be checked by computer in order to make a more detailed alcoholic analysis.
Analysis of statements given by care-givers of schizophrenic patients Željko Majdančić1, Mira Hercigonja-Szekeres2, Vera Folnegović-Šmalc1
1Psychiatric Hospital Vrapče, Vrapčanska 32, 10000 Zagreb, Croatia,
2Polimedika , S.R. Njemačke 4, 10020 Zagreb, Croatia
e-mail: zmajdan@mef.hrClinical practice has shown that the prognosis of schizophrenia depends largely on the support of the patient’s family. Here the so-called key member of the family, i.e. the person who has taken over the greatest part of care for the patient, plays an especially important role for the patient. However, this person’s knowledge, views and relation to the patient are not always correct, which he / she is not always aware of. Therefore it is important to find out which are the problems a caregiver meets in his work with the patient, but gratification in his life with a schizophrenic person as well. The information about the caregivers' difficulties and satisfactions were obtained through an interview carried out by the phone. The answers were analysed by the computer program for the analysis of free text SPAD.T. The following analyses were done: lexicometric analysis, analysis of repeated segments, correspondence analysis and classification techniques. The results reveal very poor presentation of the problems, with a great number of negative words, the fact pointing at a hidden (conscious and / or unconscious) dissatisfaction on the part of the caregivers, which they most often negate when talking with a doctor.
Cancer registry data in view of multistage theory of carcinogenesis Jadranka Božikov1, Marija Strnad2
1Andrija Štampar School of Public Health, Medical School, University of Zagreb, Rockefellerova 4, 10000 Zagreb, Croatia
2Croatian Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia
e-mail: jbozikov@snz.hr, marija_strnad@yahoo.comA way of graphical presentation of age-specific cancer incidence rates is presented which enables observation and monitoring of cancer incidence changes among different age-cohorts in population. It is pointed to a value of cancer registries' data as well as to a need for continuing monitoring and comparison of incidence data through different time periods in order to notice stability or instability of cancer incidence. In view of multistage theory of carcinogenesis such data presentation enables estimation of number of changes necessary for malignant transformation of cell which results as cancer appearance; it enables also the presumptions about a dynamic of cancer risk factors in population by showing how different cohorts are exposed to different levels of risk.
Experience of EDMUS (European Database for Multiple Sclerosis) Software Implementation Dražen Stojanović, Juraj Sepčić
Public Health institute of the County Primorsko-goranska, Krešimirova 42a, 51000 Rijeka, Croatia
Clinical Hospital Centre Rijeka, Medical School, University of Rijeka, Krešimirova 52a, 51000 Rijeka, Croatia
e-mail: drazen.stojanovic@ri.tel.hrAim: To present basic features of EDMUS (European Database for Multiple Sclerosis) version 2.5 software, and to expres a critical overwiev of its usability as a part of an integral informatical system of Croatian Multiple Sclerosis Registry, based on personal experience.
Material and methods: We used the software to analyse clinical and paraclinical data from 120 died patients with multiple sclerosis, treated in Department of neurology in Clinical hospital centre Rijeka. We implementated the softwar within Croatian multiple sclerosis register at the Department of Neurology, Medical school of Rijeka, with cooperation of Multiple sclerosis society of Croatia.
Results: Purposes of EDMUS software were clinical and epidemiological researches. It was not featured as we expected, and improvements were announced by manufacturer. Built-in algorithm of diagnosis' weryfication based on Poser's criteria clasified diagnosis as "Clinicaly definite", even in cases of pathlogicaly non veryfied multiple sclerosis patients, or patient with clinical course non-specific of multiple sclerosis. EDMUS was created by database managment system Omnis version 7, makes its maintenance only at the site of manufacturer.
Conclusions: EDMUS is good compromise, simple enough to be used by informatically less educated physicians. Diagnostic algorithms inconsistencies are results of clinical biases. System of managment and maintenance is adapted with its primary purporse of creation of world pooled data about patients with multiple sclerosis. It is not suitable as basis for local register. It would be more suitable a popular aplication (i.e. MS Access) for that purpose.
Page maintained by Asst. Prof. Jadranka Božikov, Ph.D., e-mail: jbozikov@snz.hr
