Professional Documents
Culture Documents
... with a few years of experience, weve observed that Google Health is not having the broad impact that we hoped it would.
...the single most influential postwar innovation in medical financing: Medicare's prospective payment system (PPS). Inexorably rising
medical inflation and deep economic deterioration forced policymakers in the late 1970s to pursue radical reform of Medicare to keep the
program from insolvency. Congress and the Reagan administration eventually turned to the one alternative reimbursement system that analysts
and academics had studied more than any other and had even tested with apparent success in New Jersey: prospective payment with
diagnosis-related groups (DRGs). Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new
model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare
and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary.
For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new
prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care
(hospitals and physicians) and those who paid for it - power that providers had successfully accumulated for more than half a century."
CMS DRG version 25 revision
As of October 1, 2007, with version 25, the CMS DRG system resequenced the groups, so that for instance
"Ungroupable" is no longer 470 but is now 999.
[citation needed]
To differentiate it, the newly resequenced DRG are
now known as MS-DRG.
[citation needed]
Before the introduction of version 25, many CMS DRG classifications were "paired" to reflect the presence of
complications or comorbidities (CCs). A significant refinement of version 25 was to replace this pairing, in many
instances, with a trifurcated design that created a tiered system of the absence of CCs, the presence of CCs, and a
higher level of presence of Major CCs. As a result of this change, the historical list of diagnoses that qualified for
membership on the CC list was substantially redefined and replaced with a new standard CC list and a new Major
CC list.
[citation needed]
Another planning refinement was not to number the DRGs in strict numerical sequence as compared with the prior
versions. In the past, newly created DRG classifications would be added to the end of the list. In version 25, there are
gaps within the numbering system that will allow modifications over time, and also allow for new MS-DRGs in the
same body system to be located more closely together in the numerical sequence.
[citation needed]
MS-DRG version 26 revision
MS-DRG Grouper version 26 took effect as of October 1, 2008 with one main change: implementation of Hospital
Acquired Conditions (HAC). Certain conditions are no longer considered complications if they were not present on
admission (POA), which will cause reduced reimbursement from Medicare for conditions apparently caused by the
hospital.
[citation needed]
MS-DRG version 27 revision
MS-DRG Grouper version 27 took effect as of October 1, 2009. Changes involved are mainly related to Influenza A
virus subtype H1N1.
[citation needed]
Diagnosis-related group
509
References
[1] Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD (1980) Case mix definition by diagnosis related groups. Medical Care 18(2):153
[2] Fetter RB, Freeman JL (1986) Diagnosis related groups: product linemanagement within hospitals. Academy of Management Review
11(1):4154
[3] Baker JJ (2002) Medicare payment system for hospital inpatients: diagnosis related groups. Journal of Health Care Finance 28(3):113
[4] Lessons of the New Jersey DRG Payment System (http:/ / content. healthaffairs. org/ cgi/ reprint/ 5/ 2/ 32. pdf)
[5] [5] Eastaugh SR (1999) Managing risk in a risky world. Journal of Health Care Finance 25(3):10
[6] [6] Kuntz L, Scholtes S, Vera A (2008) DRG Cost Weight Volatility and Hospital Performance. OR Spectrum 30(2): 331-354
External links
Official CMS website (http:/ / cms. hhs. gov)
DRG codes for FY2005, also referred to as version 23 (http:/ / www. cms. hhs. gov/
MedicareFeeforSvcPartsAB/ Downloads/ DRGDesc05. pdf)
DRG codes for FY2010, also referred to as version 27 (http:/ / www. cms. hhs. gov/ AcuteInpatientPPS/
downloads/ FY_2010_FR_Table_5. zip)
Agency for Healthcare Research and Quality (AHRQ) (http:/ / www. ahrq. gov).
DRG definition (http:/ / www. ahrq. gov/ data/ hcup/ 94drga. htm).
Most Frequent Diagnoses and Procedures for DRGs (http:/ / www. hcup-us. ahrq. gov/ reports/ natstats. jsp).
DRG and ICD (http:/ / www. umanitoba. ca/ centres/ mchp/ concept/ dict/ drg/ DRG_overview. html) (Canada)
from the MCHP research unit of the University of Manitoba's Faculty of Medicine.
Diagnosis Related Groups (DRGs) and the Medicare Program (http:/ / govinfo. library. unt. edu/ ota/ Ota_4/
DATA/ 1983/ 8306. PDF) - Implications for Medical Technology (PDF format). A 1983 document found in the
"CyberCemetery: OTA Legacy" section of University of North Texas Libraries Government Documents
department.
Mayes, Rick, "The Origins, Development, and Passage of Medicare's Revolutionary Prospective Payment
System" (http:/ / muse. jhu. edu/ login?uri=/ journals/ journal_of_the_history_of_medicine_and_allied_sciences/
v062/ 62. 1mayes. html) Journal of the History of Medicine and Allied Sciences Volume 62, Number 1, January
2007, pp. 21-55
Digital Imaging and Communications in Medicine
510
Digital Imaging and Communications in
Medicine
Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and
transmitting information in medical imaging. It includes a file format definition and a network communications
protocol. The communication protocol is an application protocol that uses TCP/IP to communicate between systems.
DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM
format. The National Electrical Manufacturers Association (NEMA) holds the copyright to this standard.
[1]
It was
developed by the DICOM Standards Committee, whose members
[2]
are also partly members of NEMA.
[3]
DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple
manufacturers into a picture archiving and communication system (PACS). The different devices come with DICOM
conformance statements which clearly state which DICOM classes they support. DICOM has been widely adopted
by hospitals and is making inroads in smaller applications like dentists' and doctors' offices.
DICOM is known as NEMA standard PS3, and as ISO standard 12052:2006 "Health informatics -- Digital imaging
and communication in medicine (DICOM) including workflow and data management".
Parts of the standard
The DICOM standard is divided into related but independent parts:
The links below are to the 2011 version. Additions to the standard (Supplements and Change Proposals) since that
publication are available through the DICOM Web site
[4]
.
PS 3.1: Introduction and Overview
[5]
PDF(241KB)
PS 3.2: Conformance
[6]
PDF(6.46MB)
PS 3.3: Information Object Definitions
[7]
PDF(6.96MB)
PS 3.4: Service Class Specifications
[8]
PDF(1.07MB)
PS 3.5: Data Structure and Encoding
[9]
PDF(588KB)
PS 3.6: Data Dictionary
[10]
PDF(7.32MB)
PS 3.7: Message Exchange
[11]
PDF(1.97MB)
PS 3.8: Network Communication Support for Message Exchange
[12]
PDF(901KB)
PS 3.9: Retired (formerly Point-to-Point Communication Support for Message Exchange)
PS 3.10: Media Storage and File Format for Media Interchange
[13]
PDF(406KB)
PS 3.11: Media Storage Application Profiles
[14]
PDF(398KB)
PS 3.12: Media Formats and Physical Media for Media Interchange
[15]
PDF(302KB)
PS 3.13: Retired (formerly Print Management Point-to-Point Communication Support)
PS 3.14: Grayscale Standard Display Function
[16]
PDF(478KB)
PS 3.15: Security and System Management Profiles
[17]
PDF(753KB)
PS 3.16: Content Mapping Resource
[18]
PDF(5.03MB)
PS 3.17: Explanatory Information
[19]
PDF(11.40MB)
PS 3.18: Web Access to DICOM Persistent Objects (WADO)
[20]
PDF(203KB)
PS 3.19: Application Hosting
[21]
PDF(1.22MB)
PS 3.20: Transformation of DICOM to and from HL7 Standards
[22]
PDF(570KB)
Digital Imaging and Communications in Medicine
511
History
Front page of ACR/NEMA 300, version 1.0,
which was released in 1985
DICOM is the First version of a standard developed by American
College of Radiology (ACR) and National Electrical Manufacturers
Association (NEMA).
In the beginning of the 1980s, it was very difficult for anyone other
than manufacturers of computed tomography or magnetic resonance
imaging devices to decode the images that the machines generated.
Radiologists and medical physicists wanted to use the images for
dose-planning for radiation therapy. ACR and NEMA joined forces
and formed a standard committee in 1983. Their first standard,
ACR/NEMA 300, was released in 1985. Very soon after its release, it
became clear that improvements were needed. The text was vague and
had internal contradictions.
In 1988 the second version was released. This version gained more
acceptance among vendors. The image transmission was specified as
over a dedicated 2 pair cable (EIA-485). The first demonstration of
ACR/NEMA V2.0 interconnectivity technology was held at
Georgetown University, May 2123, 1990. Six companies participated in this event, DeJarnette Research Systems,
General Electric Medical Systems, Merge Technologies, Siemens Medical Systems, Vortech (acquired by Kodak
that same year) and 3M. Commercial equipment supporting ACR/NEMA 2.0 was presented at the annual meeting of
the Radiological Society of North America (RSNA) in 1990 by these same vendors. Many soon realized that the
second version also needed improvement. Several extensions to ACR/NEMA 2.0 were created, like Papyrus
(developed by the University Hospital of Geneva, Switzerland) and SPI (Standard Product Interconnect), driven by
Siemens Medical Systems and Philips Medical Systems.
The first large-scale deployment of ACR/NEMA technology was made in 1992 by the US Army and Air Force, as
part of the MDIS (Medical Diagnostic Imaging Support)
[23]
program run out of Ft. Detrick, Maryland. Loral
Aerospace and Siemens Medical Systems led a consortium of companies in deploying the first US military PACS
(Picture Archiving and Communications System) at all major Army and Air Force medical treatment facilities and
teleradiology nodes at a large number of US military clinics. DeJarnette Research Systems and Merge Technologies
provided the modality gateway interfaces from third party imaging modalities to the Siemens SPI network. The
Veterans Administration and the Navy also purchased systems off this contract.
In 1993 the third version of the standard was released. Its name was then changed to "DICOM" so as to improve the
possibility of international acceptance as a standard. New service classes were defined, network support added and
the Conformance Statement was introduced. Officially, the latest version of the standard is still 3.0. However, it has
been constantly updated and extended since 1993. Instead of using the version number, the standard is often
version-numbered using the release year, like "the 2007 version of DICOM".
While the DICOM standard has achieved a near universal level of acceptance amongst medical imaging equipment
vendors and healthcare IT organizations, the standard has its limitations. DICOM is a standard directed at addressing
technical interoperability issues in medical imaging. It is not a framework or architecture for achieving a useful
clinical workflow. RSNA's Integrating the Healthcare Enterprise (IHE) initiative layered on top of DICOM (and
HL-7) provides this final piece of the medical imaging interoperability puzzle.
Digital Imaging and Communications in Medicine
512
Derivations
There are some derivations from the DICOM standard into other application areas. These include:
DICONDE - Digital Imaging and Communication in Nondestructive Evaluation, was established in 2004 as a
way for nondestructive testing manufacturers and users to share image data.
[24]
DICOS - Digital Imaging and Communication in Security was established in 2009 to be used for image sharing in
airport security.
[25]
Data format
DICOM differs from some, but not all, data formats in that it groups information into data sets. That means that a file
of a chest x-ray image, for example, actually contains the patient ID within the file, so that the image can never be
separated from this information by mistake. This is similar to the way that image formats such as JPEG can also have
embedded tags to identify and otherwise describe the image.
A DICOM data object consists of a number of attributes, including items such as name, ID, etc., and also one special
attribute containing the image pixel data (i.e. logically, the main object has no "header" as such: merely a list of
attributes, including the pixel data). A single DICOM object can have only one attribute containing pixel data. For
many modalities, this corresponds to a single image. But note that the attribute may contain multiple "frames",
allowing storage of cine loops or other multi-frame data. Another example is NM data, where an NM image, by
definition, is a multi-dimensional multi-frame image. In these cases, three- or four-dimensional data can be
encapsulated in a single DICOM object. Pixel data can be compressed using a variety of standards, including JPEG,
JPEG Lossless, JPEG 2000, and Run-length encoding (RLE). LZW (zip) compression can be used for the whole data
set (not just the pixel data), but this has rarely been implemented.
DICOM uses three different Data Element encoding schemes. With Explicit Value Representation (VR) Data
Elements, for VRs that are not OB, OW, OF, SQ, UT, or UN, the format for each Data Element is: GROUP (2 bytes)
ELEMENT (2 bytes) VR (2 bytes) LengthInByte (2 bytes) Data (variable length). For the other Explicit Data
Elements or Implicit Data Elements, see section 7.1 of Part 5 of the DICOM Standard.
The same basic format is used for all applications, including network and file usage, but when written to a file,
usually a true "header" (containing copies of a few key attributes and details of the application which wrote it) is
added.
Image display
To promote identical grayscale image display on different monitors and consistent hard-copy images from various
printers, the DICOM committee developed a lookup table to display digitally assigned pixel values. To use the
DICOM grayscale standard display function (GSDF),
[26]
images must be viewed (or printed) on devices that have
this lookup curve or on devices that have been calibrated to the GSDF curve.6
[27]
Value representations
Extracted from Chapter 6.2 of
PS 3.5: Data Structure and Encoding
[28]
PDF(1.43MiB)
Digital Imaging and Communications in Medicine
513
Value Representation Description
AE Application Entity
AS Age String
AT Attribute Tag
CS Code String
DA Date
DS Decimal String
DT Date/Time
FL Floating Point Single (4 bytes)
FD Floating Point Double (8 bytes)
IS Integer String
LO Long String
LT Long Text
OB Other Byte
OF Other Float
OW Other Word
PN Person Name
SH Short String
SL Signed Long
SQ Sequence of Items
SS Signed Short
ST Short Text
TM Time
UI Unique Identifier
UL Unsigned Long
UN Unknown
US Unsigned Short
UT Unlimited Text
In addition to a Value Representation, each attribute also has a Value Multiplicity to indicate the number of data
elements contained in the attribute. For character string value representations, if more than one data element is being
encoded, the successive data elements are separated by the backslash character "\".
Digital Imaging and Communications in Medicine
514
Services
DICOM consists of many different services, most of which involve transmission of data over a network, and the file
format below is a later and relatively minor addition to the standard.
Store
The DICOM Store service is used to send images or other persistent objects (structured reports, etc.) to a picture
archiving and communication system (PACS) or workstation.
Storage commitment
The DICOM storage commitment service is used to confirm that an image has been permanently stored by a device
(either on redundant disks or on backup media, e.g. burnt to a CD). The Service Class User (SCU: similar to a
client), a modality or workstation, etc., uses the confirmation from the Service Class Provider (SCP: similar to a
server), an archive station for instance, to make sure that it is safe to delete the images locally.
Query/Retrieve
This enables a workstation to find lists of images or other such objects and then retrieve them from a picture
archiving and communication system.
Modality worklist
This enables a piece of imaging equipment (a modality) to obtain details of patients and scheduled examinations
electronically, avoiding the need to type such information multiple times (and the mistakes caused by retyping).
Modality performed procedure step
A complementary service to Modality Worklist, this enables the modality to send a report about a performed
examination including data about the images acquired, beginning time, end time, and duration of a study, dose
delivered, etc. It helps give the radiology department a more precise handle on resource (acquisition station) use.
Also known as MPPS, this service allows a modality to better coordinate with image storage servers by giving the
server a list of objects to send before or while actually sending such objects.
Printing
The DICOM Printing service is used to send images to a DICOM Printer, normally to print an "X-Ray" film. There
is a standard calibration (defined in DICOM Part 14) to help ensure consistency between various display devices,
including hard copy printout.
Off-line media (files)
The off-line media files correspond to Part 10 of the DICOM standard. It describes how to store medical imaging
information on removable media. Except for the data set containing, for example, an image and demography, it's also
mandatory to include the File Meta Information.
DICOM restricts the filenames on DICOM media to 8 characters (some systems wrongly use 8.3, but this does not
conform to the standard). No information must be extracted from these names (PS3.10 Section 6.2.3.2). This is a
common source of problems with media created by developers who did not read the specifications carefully. This is
a historical requirement to maintain compatibility with older existing systems. It also mandates the presence of a
media directory, the DICOMDIR file, which provides index and summary information for all the DICOM files on
the media. The DICOMDIR information provides substantially greater information about each file than any filename
could, so there is less need for meaningful file names.
Digital Imaging and Communications in Medicine
515
DICOM files typically have a .dcm file extension if they are not part of a DICOM media (which requires them to be
without extension).
The MIME type for DICOM files is defined by RFC 3240 as application/dicom.
The Uniform Type Identifier type for DICOM files is org.nema.dicom.
There is also an ongoing media exchange test and "connectathon" process for CD media and network operation that
is organized by the IHE organization. MicroDicom is free Windows software for reading DICOM data.
Application areas
Modality Description
AS Modality of type Angioscopy - Retired
BI Modality of type Biomagnetic Imaging
CD Modality of type Color Flow Doppler - Retired 2008
CF Modality of type Cinefluorography - Retired
CP Modality of type Colposcopy - Retired
CR Modality of type Computed Radiography
CS Modality of type Cystoscopy - Retired
CT Modality of type Computed Tomography
DD Modality of type Duplex Doppler - Retired 2008
DG Modality of type Diaphanography
DM Modality of type Digital Microscopy - Retired
DS Modality of type Digital Subtraction Angiography - Retired
DX Modality of type Digital Radiography
EC Modality of type Echocardiography - Retired
ECG Modality of type Electrocardiograms
EM Modality of type Electron Microscope
ES Modality of type Endoscopy
FA Modality of type Fluorescein Angiography - Retired
FS Modality of type Fundoscopy - Retired
GM Modality of type General Microscopy
HC Modality of type Hard Copy
LP Modality of type Laparoscopy - Retired
LS Modality of type Laser Surface Scan
MA Modality of type Magnetic Resonance Angiography (retired)
MG Modality of type Mammography
MR Modality of type Magnetic Resonance
MS Modality of type Magnetic Resonance Spectroscopy - Retired
NM Modality of type Nuclear Medicine
OP Modality of type Ophthalmic Photography
OPM Modality of type Ophthalmic Mapping
Digital Imaging and Communications in Medicine
516
OPR Modality of type Ophthalmic Refraction
OPV Modality of type Ophthalmic Visual Field
OT Modality of type Other
PT Modality of type Positron Emission Tomography (PET)
PX Modality of type Panoramic X-Ray
RD Modality of type Radiotherapy Dose (a.k.a. RTDOSE)
RF Modality of type Radio Fluoroscopy
RG Modality of type Radiographic Imaging (conventional film screen)
RTIMAG Modality of type Radiotherapy Image
RP Modality of type Radiotherapy Plan (a.k.a. RTPLAN)
RS Modality of type Radiotherapy Structure Set (a.k.a. RTSTRUCT)
RT Modality of type Radiation Therapy
SC Modality of type Secondary Capture
SM Modality of type Slide Microscopy
SR Modality of type Structured Reporting
ST Modality of type Single-Photon Emission Computed Tomography (retired 2008)
TG Modality of type Thermography
US Modality of type Ultrasound
VF Modality of type Videofluorography - Retired
VL Modality of type Visible Light
XA Modality of type X-Ray Angiography
XC Modality of type External Camera (Photography)
Port numbers over IP
DICOM have reserved the following TCP and UDP port numbers by the Internet Assigned Numbers Authority
(IANA):
104 well-known port for DICOM over Transmission Control Protocol (TCP) or User Datagram Protocol (UDP).
Since 104 is in the reserved subset, many operating systems require special privileges to use it.
2761 registered port for DICOM using Integrated Secure Communication Layer (ISCL) over TCP or UDP
2762 registered port for DICOM using Transport Layer Security (TLS) over TCP or UDP
11112 registered port for DICOM using standard, open communication over TCP or UDP
The standard recommends but does not require the use of these port numbers.
Digital Imaging and Communications in Medicine
517
Disadvantages
According to a paper presented at an international symposium in 2008, the DICOM standard has problems related to
data entry. "A major disadvantage of the DICOM Standard is the possibility for entering probably too many optional
fields. This disadvantage is mostly showing in inconsistency of filling all the fields with the data . Some image
objects are often incomplete because some fields are left blank and some are filled with incorrect data."
HL7
DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. The
communication protocol is an application protocol that uses TCP/IP to communicate between systems. DICOM files
can be exchanged between two entities that are capable of receiving image and patient data in DICOM format. The
National Electrical Manufacturers Association (NEMA) holds the copyright to this standard. It was developed by the
DICOM Standards Committee, whose members are also partly members of NEMA.
[29]
Health Level Seven (HL7), is a non-profit organization involved in the development of international healthcare
informatics interoperability standards.[1] "HL7" also refers to some of the specific standards created by the
organization (e.g., HL7 v2.x, v3.0, HL7 RIM). The HL7 Strategic Initiatives document is a business plan for our
products and services and was designed specifically to meet the business needs of our members and stakeholders.
Derived from collaborative efforts with our members, government and non-government agencies and other standards
development organizations, the Strategic Initiatives are five high-level organizational strategies that are supported by
a detailed tactical plan with clearly defined objectives, milestones, and metrics for success.
[30]
Both of the standards are focused on the data exchange and the data compatibility. Among many standards for the
syntax, HL7 and DICOM are most successful. However, everything could not be handled by HL7 solely. DICOM is
good for radiology images, but, other clinical images are already handled by other lighter data formats like JPEG,
TIFF. So, it is not realistic to use only one standard for every area of clinical information.
Opening the HL7 and DICOM standards in order to foster the integrated use of persistent health information objects
is proposed as a step towards the creation of the health information infrastructure.
IHE
Integrating the Healthcare Enterprise (IHE) was founded in 1997 by members of the Radiological Society of North
America (RSNA) and the Healthcare Information and Management Systems Society for the purpose of improving
interoperability between information systems. The IHE initiative was charged with the task of using existing
standards of health care data communication such as DICOM and HL7 to improve exchange of medical information
beyond the radiology department at the hospital level or health systems level. Just as radiologists were confronted in
the past with imaging connectivity incompatibilities, entire health systems are continually faced with the task of
connecting multiple disparate information systems in which the only reliable communications pathway is the paper
printout.
The IHE working group is a panel made up of industry representatives from medical informatics and imaging
vendors as well as medical professionals. Their primary focus is to develop a common information model of medical
information exchange. The devised IHE technical framework consists of a common lexicon that defines specific
medical information transactions using the existing standards of medical information exchange (DICOM and HL7).
The specifics of these transactions have been worked out in great detail so that vendors have been free to
independently develop solutions to meet the goals of the technical framework. In the year 2001 to 2002, 30
companies took part in the testing and implementation of the IHE demonstrations.
[31]
Digital Imaging and Communications in Medicine
518
References
[1] DICOM brochure (http:/ / medical. nema. org/ dicom/ geninfo/ Brochure. pdf), nema.org.
[2] MEMBERS of the DICOM STANDARDS COMMITTEE (http:/ / medical. nema. org/ members. pdf)
[3] http:/ / www. nema. org/ About/ Pages/ Members.aspx
[4] http:/ / dicom.nema. org
[5] http:/ / medical. nema. org/ Dicom/ 2011/ 11_01pu.pdf
[6] http:/ / medical. nema. org/ Dicom/ 2011/ 11_02pu.pdf
[7] http:/ / medical. nema. org/ Dicom/ 2011/ 11_03pu.pdf
[8] http:/ / medical. nema. org/ Dicom/ 2011/ 11_04pu.pdf
[9] http:/ / medical. nema. org/ Dicom/ 2011/ 11_05pu.pdf
[10] http:/ / medical. nema. org/ Dicom/ 2011/ 11_06pu. pdf
[11] http:/ / medical. nema. org/ Dicom/ 2011/ 11_07pu. pdf
[12] http:/ / medical. nema. org/ Dicom/ 2011/ 11_08pu. pdf
[13] http:/ / medical. nema. org/ Dicom/ 2011/ 11_10pu. pdf
[14] http:/ / medical. nema. org/ Dicom/ 2011/ 11_11pu. pdf
[15] http:/ / medical. nema. org/ Dicom/ 2011/ 11_12pu. pdf
[16] http:/ / medical. nema. org/ Dicom/ 2011/ 11_14pu. pdf
[17] http:/ / medical. nema. org/ Dicom/ 2011/ 11_15pu. pdf
[18] http:/ / medical. nema. org/ Dicom/ 2011/ 11_16pu. pdf
[19] http:/ / medical. nema. org/ Dicom/ 2011/ 11_17pu. pdf
[20] http:/ / medical. nema. org/ Dicom/ 2011/ 11_18pu. pdf
[21] http:/ / medical. nema. org/ Dicom/ 2011/ 11_19pu. pdf
[22] http:/ / medical. nema. org/ Dicom/ 2011/ 11_20pu. pdf
[23] http:/ / www.ncbi. nlm.nih. gov/ pubmed/ 7612705?dopt=Abstract
[24] http:/ / www.astm. org: If a Picture Is Worth 1,000 Words, then Pervasive, Ubiquitous Imaging Is Priceless (http:/ / www. astm. org/
SNEWS/ OCTOBER_2003/ voelker_oct03. html)
[25] http:/ / www.nema. org: Industrial Imaging and Communications Section (http:/ / www. nema. org/ prod/ security/ indust-Img. cfm)
[26] http:/ / medical. nema. org/ Dicom/ 2011/ 11_14pu. pdf
[27] Shiroma, J. T. (2006). An introduction to DICOM. Veterinary Medicine, , 19-20. Retrieved from http:/ / 0-search. proquest. com. alpha2.
latrobe. edu. au/ docview/ 195482647?accountid=12001
[28] http:/ / medical. nema. org/ dicom/ 2007/ 07_05pu.pdf
[29] http:/ / www.dicombuzz. blogspot. in/ p/ dicom.html
[30] http:/ / www.hl7. org/ about/ index.cfm
[31] Flanders, A.E., Carrino, J.A., 2003. Understanding DICOM and IHE. Seminars in Roentgenology 38, 270281.
External links
DICOM standard (http:/ / dabsoft. ch/ dicom/ index. html), Dabsoft.ch.
The latest DICOM specification (http:/ / medical. nema. org/ standard. html)
DICOM Standard Status (approved and proposed changes) (http:/ / www. dclunie. com/ dicom-status/ status.
html)
Brief introduction to DICOM (http:/ / www. cabiatl. com/ mricro/ dicom/ index. html)
Introduction to DICOM using OsiriX (http:/ / www. saravanansubramanian. com/ Saravanan/
Articles_On_Software/ Entries/ 2010/ 2/ 10_Introduction_to_the_DICOM_Standard. html)
Introduction to DICOM using RZDCX (http:/ / dicomiseasy. blogspot. co. il/ p/ introduction-to-dicom. html)
Medical Image FAQ part 2 (http:/ / www. dclunie. com/ medical-image-faq/ html/ part2. html) - Standard formats
including DICOM.
Medical Image FAQ part 8 (http:/ / www. dclunie. com/ medical-image-faq/ html/ part8. html) - Contains a long
list DICOM software.
Collection of DICOM images (clinical images and technical testpatterns) (http:/ / www. aycan. de/ main/ lp/
sample_dicom_images. html)
Example of an applet based DICOM Viewer (http:/ / legeneraliste. perso. sfr. fr/ ?p=dicom_eng)
DICOM is a standard (http:/ / www. dicombuzz. blogspot. in/ p/ dicom. html) - For Medical Images handling,
storing, printing, and transmitting information
Digital Imaging and Communications in Medicine
519
(http:/ / 0-search. proquest. com. alpha2. latrobe. edu. au/ docview/ 195482647)
DOCLE
DOCLE (Doctor Command Language), is a non-numeric health coding and medical classification system. The
Docle system is used in Health Communication Network's electronic medical record and patient management
software package, Medical Director. Medical Director is the most widely used electronic medical record system by
Australian primary health care providers.
DOCLE has been modelled on the Linnaean biological classification system since 1995. Docle generates clinical
codes from ubiquitous health language using an algorithm, hence it is a human readable clinical coding system.
The design principles of Docle, as enumerated by the author in the www.docle.com
[1]
website include:
Docle codes being meaningful and intentional
Docle codes are derived from ubiquitous health language
Docle codes grew with evolving order and speciation of large scale structures in a linnean manner.
Docle codes are designed to strap together and form clinical structures using joiner codes
The author of Docle, Dr. Y Kuang Oon, has likened clinical codes to "neuron's" and joiner codes as the "glia"
References
"Docle coding and classification system browser"
[2]
(HTML). Retrieved 2008-03-29.
"Medical Director - Product Details"
[3]
(HTML). Health Communication Network. Retrieved 2008-04-04.
"Docle Systems"
[4]
(HTML). Retrieved 2008-07-02.
External links
Docle Systems Web Site
[4]
References
[1] http:/ / www. docle.com
[2] http:/ / www. docle.com. au/ publ/ Hic99.htm
[3] http:/ / www. hcn. net. au/ products/ md/ md.asp
[4] http:/ / www. docle.com. au/
Electronic Common Technical Document
520
Electronic Common Technical Document
The electronic Common Technical Document (eCTD) is an interface for the pharmaceutical industry to agency
transfer of regulatory information. The content is based on the Common Technical Document (CTD) format.
It was developed by the International Conference on Harmonisation (ICH) Multidisciplinary Group 2 Expert
Working Group (ICH M2 EWG). As of January 1, 2008, the U.S. Food and Drug Administration announced that the
eCTD is the preferred format for electronic submissions. To date, over 98,000 eCTD sequences have been submitted
to the FDA. Although the agency has not released an expected target date, the FDA revealed during the 2009 DIA
Annual Meeting that it is looking at draft legislation to require eCTD.
Pharmaceutical point of view
The eCTD has five modules:
1. 1. Administrative Information and
Prescribing Information
2. 2. Common Technical Document
Summaries
3. 3. Quality
4. 4. Nonclinical Study Reports
5. 5. Clinical Study Reports
A full table of contents
[1]
could be
quite large.
There are two categories of modules:
Regional module: 1 (different for
each region; i.e., country)
Common modules: 2-5 (common to
all the regions)
The CTD defines the content only of the common modules. The contents of the Regional Module 1 are defined by
each of the ICH regions (USA, Europe and Japan).
IT point of view
eCTD (data structure)
The eCTD is a message specification for the transfer of files and metadata from a submitter to a receiver. The
primary technical components are:
A high level folder structure (required)
An XML "backbone" file which provides metadata about content files and lifecycle instructions for the receiving
system
An optional lower level folder structure (recommended folder names are provided in Appendix 4 of the eCTD
specification)
Associated Document Type Definitions (DTDs) and stylesheets.
Each submission message constitutes one "sequence". A cumulative eCTD consists of one or more sequences. While
a single sequence may be viewed with web browser and the ICH stylesheet provided, viewing a cumulative eCTD
requires specialized eCTD viewers.
The top part of the directory structure is as follows:
Electronic Common Technical Document
521
ctd-123456/0000/index.xml
ctd-123456/0000/index-md5.txt
ctd-123456/0000/m1
ctd-123456/0000/m2
ctd-123456/0000/m3
ctd-123456/0000/m4
ctd-123456/0000/m5
ctd-123456/0000/util
The string ctd-123456/0000 is just an example.
Backbone (header)
This is the file index.xml in the submission sequence number folder. For example:
ctd-123456/0000/index.xml
The purpose of this file is twofold:
Manage meta-data for the entire submission
Constitute a comprehensive table of contents and provide corresponding navigation aid.
Stylesheets
Stylesheets that support the presentation and navigation should be included. They must be placed in the directory:
ctd-123456/0000/util/style
See entry 377 in Appendix 4.
DTDs
DTDs must be placed in the directory:
ctd-123456/0000/util/dtd
See entry 371 to 376 in Appendix 4. They must follow a naming convention.
The DTD of the backbone is in Appendix 8. It must be placed in the above directory.
Business process (protocol)
The business process to be supported can be described as follows:
Industry <-----> Message <-----> Agency
The lifecycle management is composed at least of:
Initial submission: should be self-contained.
Incremental updates: with its sequence number.
Electronic Common Technical Document
522
References
[1] http:/ / www. fda. gov/ downloads/ Drugs/ DevelopmentApprovalProcess/ FormsSubmissionRequirements/ ElectronicSubmissions/
UCM163175. pdf
External links
AquilaSolutions.us - eCTD Support and Freeware eCTD Viewer (http:/ / www. AquilaSolutions. us/ )
eCTDBlog.com (http:/ / www. ectdblog. com/ )
eCTDOffice.com (http:/ / www. ectdoffice. com/ )
Electronic Common Technical Document (eCTD) (http:/ / www. fda. gov/ Drugs/ DevelopmentApprovalProcess/
FormsSubmissionRequirements/ ElectronicSubmissions/ ucm153574. htm) (FDA)
EUDRALEX Volume 2 - Pharmaceutical Legislation : Notice to Applicants (http:/ / ec. europa. eu/ enterprise/
pharmaceuticals/ eudralex/ homev2. htm) (EU legislation, contains section on eCTD)
Exalon eCTD News - free and strictly neutral eCTD related news from regulators (http:/ / www. exalon. com/
ectd-news. html)
EXTEDO.com - free eCTD validator EURSvalidator used by EMA and many other regulatory authorities (http:/ /
www. extedo. com/ )
ICH eCTD Specification V 3.2.2 (http:/ / estri. ich. org/ eCTD/ eCTD_Specification_v3_2_2. pdf) (The
specification)
ICH M2 ESTRI Main (http:/ / estri. ich. org)
IT Pharma Validation Europe (Organization: CSV Validation Network) (http:/ / www. it-validation. eu)
Liquent.com (http:/ / www. Liquent. com/ )
LORENZ.cc (http:/ / www. Lorenz. cc/ )
nPeopleSoftware.com - eCTD Software & Service Provider (http:/ / www. npeoplesoftware. com/ )
EUDRANET
523
EUDRANET
EUDRANET, the European Telecommunication Network in Pharmaceuticals (European Union Drug
Regulating Authorities Network), is an IT platform to facilitate the exchange of information between regulatory
partners and industry during submission and evaluation of applications. The aim of EUDRANET is to provide
appropriate secure services for inter-Administration data interchange and for exchanges between Administrations
and industry. EUDRANET is based on the TESTA backbone infrastructure provided by the IDA Programme.
The processes which EUDRANET supports include:
The submission and evaluation of marketing authorisation applications by pharmaceutical companies;
The pharmacovigilance of products on the market to ensure the maintenance of high standards of quality as well
as adhering to European national and regional regulations;
The dissemination of relevant information to industry, scientific experts and regulators.
External links
EUDRANET
[1]
Projects of Common Interest for Administrations
[2]
(European Union)
e-Health
[3]
(European Union)
References
[1] http:/ / ec.europa.eu/ idabc/ en/ document/ 2291
[2] http:/ / ec.europa.eu/ idabc/ en/ chapter/ 565
[3] http:/ / ec.europa.eu/ information_society/ eeurope/ 2005/ all_about/ ehealth/ index_en. htm
General Data Format for Biomedical Signals
The General Data Format for Biomedical Signals is a scientific and medical data file format. The aim of GDF is
to combine and integrate the best features of all biosignal file formats
[1]
into a single file format. GDF v1 uses a
binary header, and uses an event table. GDF v2
[2]
added fields for additional subject-specific information (gender,
age, etc.), and utilizes several standard codes (for storing physical units and other properties).
GDF is used mostly in braincomputer interface research; however, GDF provides a superset of features from many
different file formats, it could be also used for many other domains.
The free and open source software library BioSig
[3]
provides implementations for reading and writing of GDF in
Octave/Matlab and C/C++. A lightweight C++ library called libGDF
[4]
is also available and implements version 2 of
the GDF format.
The binary nature of the meta-information might not be suitable for all applications. Therefore, a new format called
XDF
[5]
was developed with the aim to provide a flexible and extensible format for all kinds of data streams, but in
particular for biosignals.
General Data Format for Biomedical Signals
524
External links
BioSig
[3]
libGDF
[4]
GDF v2.0
[2]
XDF
[5]
References
[1] http:/ / pub. ist.ac. at/ ~schloegl/ matlab/ eeg/
[2] http:/ / arxiv.org/ abs/ cs. DB/ 0608052
[3] http:/ / biosig. sf. net/
[4] http:/ / sourceforge. net/ projects/ libgdf/
[5] http:/ / code. google. com/ p/ xdf/
Health Level 7
Health Level Seven (HL7), is a non-profit organization involved in the development of international healthcare
informatics interoperability standards. "HL7" also refers to some of the specific standards created by the organization
(e.g., HL7 v2.x, v3.0, HL7 RIM).
HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and
retrieval of electronic health information. The 2.x versions of the standards, which support clinical practice and the
management, delivery, and evaluation of health services, are the most commonly used in the world.
Organization
HL7 is an international community of healthcare subject matter experts and information scientists collaborating to
create standards for the exchange, management and integration of electronic healthcare information.
HL7 promotes the use of such informatics standards within and among healthcare organizations to increase the
effectiveness and efficiency of healthcare information delivery for the benefit of all.
[citation needed]
The HL7 community is organized in the form of a global organization (Health Level Seven, Inc.) and
country-specific affiliate organizations:
Health Level Seven, Inc. (HL7, Inc. ) is headquartered in Ann Arbor, Michigan.
HL7 affiliate organizations, not-for-profit organizations incorporated in local jurisdictions, exist in over 40
countries. The first affiliate organization was created in Germany in 1993.
[citation needed]
The organizational structure of HL7 Inc. is as follows:
[citation needed]
The organization is managed by a Board of Directors, which comprises 10 elected positions and three appointed
positions.
The Chief Executive Officer (currently Charles Jaffe, MD, PhD) serves as an ex officio member of and reports to
the Board of Directors. The Chief Technology Officer (currently John Quinn); and the Chief Operations Officer
(currently Mark McDougall) report to the CEO and also serve as ex officio members on the Board of Directors.
Members of HL7 are known collectively as "The Working Group". The Working Group is responsible for
defining the HL7 standard protocol and is composed of Standing Administrative Committees and Working
Groups.
Standing Administrative committees focus on organizational or promotional activities, such as Education,
Implementation, Marketing, Outreach Committee for Clinical Research, Publishing and Process Improvement
and Tooling.
Health Level 7
525
Working groups are directly responsible for the content of the Standards, framing the actual language of the
specifications.
Origin
HL7 was founded in 1987 to produce a standard for hospital information systems. HL7, Inc. is a standards
organization that was accredited in 1994 by the American National Standards Institute (ANSI).
[1]
HL7 is one of several American National Standards Institute accredited Standards Developing Organizations (SDOs)
operating in the healthcare arena. Most of these SDOs produce standards (sometimes called specifications or
protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims
processing) transactions. Health Level Sevens domain is clinical and administrative data.
Today, HL7 has been adopted by several national SDOs outside the United States. Those SDOs are consequently not
accredited by ANSI. However, HL7 is now adopted by ISO as a centre of gravity in international standardization and
accredited as a partnering organization for mutual issuing of standards. The first mutually published standard is
ISO/HL7 21731:2006 Health informaticsHL7 version 3Reference information modelRelease 1.
The name "Health Level-7"
The name "Health Level-7" is a reference to the seventh layer of the ISO OSI Reference model also known as the
application layer. The name indicates that HL7 focuses on application layer protocols for the health care domain,
independent of lower layers. HL7 effectively considers all lower layers merely as tools.
Collaboration
HL7 collaborates with other standards development organizations and national and international sanctioning bodies
(e.g. ANSI and ISO), in both the healthcare and information infrastructure domains to promote the use of supportive
and compatible standards. HL7 collaborates with healthcare information technology users to ensure that HL7
standards meet real-world requirements, and that appropriate standards development efforts are initiated by HL7 to
meet emergent requirements.
[citation needed]
About 45% of the global membership (of either HL7 Inc. or an HL7 affiliate) is located in Europe, 35% in North
America, 15% in Asia-Oceania and 5% elsewhere.
HL7 standards
HL7 encompasses the complete life cycle of a standards specification including the development, adoption, market
recognition, utilization, and adherence.
[citation needed]
Prior to April 2013, HL7 International asserted that business use of the HL7 standards required a paid organizational
membership in HL7, Inc. HL7 Members could access standards for free, and non-members could buy the standards
from HL7, ANSI, or for some standards, ISO.
Most HL7 standards can now be deemed Open Standards, as since April 2013 they are available for free download.
On Sept 4, 2012, the HL7 Board of Directors had announced its intention to relax the HL7 IP policy and allow free
access and implementation to promote adoption and interoperability, as described in their press release.
The revenue model and business plan of HL7 is discussed in HL7's Strategic Initiatives and Implementation
Proposal. However, since the earlier policy as described in the Bylaws of October 2002 placed the HL7 protocol
specifications in the Public Domain, and under 17 USC 102 there is no copyright protection for an "idea,
procedure, process, system, method of operation, concept, principle, or discovery", this revised policy may not be
enforceable.
Hospitals and other healthcare provider organizations typically have many different computer systems used for
everything from billing records to patient tracking. All of these systems should communicate with each other (or
Health Level 7
526
"interface") when they receive new information but not all do so. HL7 specifies a number of flexible standards,
guidelines, and methodologies by which various healthcare systems can communicate with each other. Such
guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and
consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical
information. Theoretically, this ability to exchange information should help to minimize the tendency for medical
care to be geographically isolated and highly variable.
[citation needed]
HL7 develops conceptual standards (e.g., HL7 RIM), document standards (e.g., HL7 CDA), application standards
(e.g., HL7 CCOW), and messaging standards (e.g., HL7 v2.x and v3.0). Messaging standards are particularly
important because they define how information is packaged and communicated from one party to another. Such
standards set the language, structure and data types required for seamless integration from one system to another.
The Reference Information Model (RIM) and the HL7 Development Framework (HDF) are the basis of the HL7
Version 3 standards development process. RIM is the representation of the HL7 clinical data (domains) and the life
cycle of messages or groups of messages. HDF is a project to specify the processes and methodology used by all the
HL7 committees for project initiation, requirements analysis, standard design, implementation, standard approval
process, etc.
HL7 standards:
Version 2.x Messaging Standard an interoperability specification for health and medical transactions
Version 3 Messaging Standard an interoperability specification for health and medical transactions, based on
RIM
Version 3 Rules/GELLO a standard expression language used for clinical decision support
Arden Syntax a grammar for representing medical conditions and recommendations as a Medical Logic Module
(MLM)
Clinical Context Object Workgroup (CCOW) an interoperability specification for the visual integration of user
applications
Claims Attachments a Standard Healthcare Attachment to augment another healthcare transaction
Clinical Document Architecture (CDA) an exchange model for clinical documents, based on HL7 Version 3
Electronic Health Record (EHR) / Personal Health Record (PHR) in support of these records, a standardized
description of health and medical functions sought for or available
Structured Product Labeling (SPL) the published information that accompanies a medicine, based on HL7
Version 3
HL7 version 2.x
The HL7 version 2 standard (also known as Pipehat) has the aim to support hospital workflows. It was originally
created in 1989.
V2.x Messaging
HL7 version 2 defines a series of electronic messages to support administrative, logistical, financial as well as
clinical processes. Since 1987 the standard has been updated regularly, resulting in versions 2.1, 2.2, 2.3, 2.3.1, 2.4,
2.5, 2.5.1 and 2.6. The v2.x standards are backward compatible (e.g., a message based on version 2.3 will be
understood by an application that supports version 2.6).
HL7 v2.x messages use a human-readable (ASCII), non-XML encoding syntax based on segments (lines) and
one-character delimiters. Segments have composites (fields) separated by the composite delimiter. A composite can
have sub-composites (subcomponents) separated by the sub-composite delimiter, and sub-composites can have
sub-sub-composites (subcomponents) separated by the sub-sub-composite delimiter. The default delimiters are
vertical bar or pipe (|) for the field separator, caret (^) for the component separator, and ampersand (&) for the
subcomponent separator. The tilde (~) is the default repetition separator. The first field (composite) in each segment
contains the 3-character segment name. Each segment of the message contains one specific category of information.
Health Level 7
527
Every message has MSH as its first segment, which includes a field that identifies the message type. The message
type determines the expected segment names in the message. The segment names for a particular message type are
specified by the segment grammar notation used in the HL7 standards.
The following is an example of an admission record. MSH is the header record, PID the Patient Identity, etc. The 5th
field for the PID record is the patient's name.
MSH|^~\&|MegaReg|XYZHospC|SuperOE|XYZImgCtr|20060529090131-0500||ADT^A01^ADT_A01|01052901|P|2.5
EVN||200605290901||||200605290900
PID|||56782445^^^UAReg^PI||KLEINSAMPLE^BARRY^Q^JR||19620910|M||2028-9^^HL70005^RA99113^^XYZ|260
GOODWIN CREST DRIVE^^BIRMINGHAM^AL^35 209^^M~NICKELLS PICKLES^10000 W 100TH
AVE^BIRMINGHAM^AL^35200^^O |||||||0105I30001^^^99DEF^AN
PV1||I|W^389^1^UABH^^^^3||||12345^MORGAN^REX^J^^^MD^0010^UAMC^L||678
90^GRAINGER^LUCY^X^^^MD^0010^UAMC^L|MED|||||A0||13579^POTTER^SHER
MAN^T^^^MD^0010^UAMC^L|||||||||||||||||||||||||||200605290900
OBX|1|NM|^Body Height||1.80|m^Meter^ISO+|||||F
OBX|2|NM|^Body Weight||79|kg^Kilogram^ISO+|||||F
AL1|1||^ASPIRIN
DG1|1||786.50^CHEST PAIN, UNSPECIFIED^I9|||A
HL7 v2.x has allowed for the interoperability between electronic Patient Administration Systems (PAS), Electronic
Practice Management (EPM) systems, Laboratory Information Systems (LIS), Dietary, Pharmacy and Billing
systems as well as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems. Currently, HL7s
v2.x messaging standard is supported by every major medical information systems vendor in the United States.
HL7 version 3
The HL7 version 3 standard has the aim to support all healthcare workflows. Development of version 3 started
around 1995, resulting in an initial standard publication in 2005. The v3 standard, as opposed to version 2, is based
on a formal methodology (the HDF) and object-oriented principles.
RIM - ISO/HL7 21731
The Reference Information Model (RIM) is the cornerstone of the HL7 Version 3 development process and an
essential part of the HL7 V3 development methodology. RIM expresses the data content needed in a specific clinical
or administrative context and provides an explicit representation of the semantic and lexical connections that exist
between the information carried in the fields of HL7 messages. The RIM is essential to increase precision and reduce
implementation costs. Models are available.
HL7 Development Framework - ISO/HL7 27931
The HL7 Version 3 Development Framework (HDF) is a continuously evolving process that seeks to develop
specifications that facilitate interoperability between healthcare systems. The HL7 RIM, vocabulary specifications,
and model-driven process of analysis and design combine to make HL7 Version 3 one methodology for development
of consensus-based standards for healthcare information system interoperability. The HDF is the most current edition
of the HL7 V3 development methodology.
The HDF not only documents messaging, but also the processes, tools, actors, rules, and artifacts relevant to
development of all HL7 standard specifications. Eventually, the HDF will encompass all of the HL7 standard
specifications, including any new standards resulting from analysis of electronic health record architectures and
requirements.
HL7 specifications draw upon codes and vocabularies from a variety of sources. The V3 vocabulary work ensures
that the systems implementing HL7 specifications have an unambiguous understanding of the code sources and code
value domains they are using.
Health Level 7
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V3 Messaging
The HL7 version 3 messaging standard defines a series of electronic messages (called interactions) to support all
healthcare workflows. HL7 v3 messages are based on an XML encoding syntax.
'COMMENT: Please insert sample HL7 version 3 Data Markup Example Here:
'
Clinical Document Architecture - ISO/HL7 27932
The HL7 Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the
encoding, structure and semantics of clinical documents for exchange.
Methods applied by HL7
Services Aware Interoperability Framework
The HL7 Services-Aware Enterprise Architecture Framework (SAIF) provides consistency between all HL7
artifacts, and enables a standardized approach to Enterprise Architecture (EA) development and implementation, and
a way to measure the consistency.
SAIF is a way of thinking about producing specifications that explicitly describe the governance, conformance,
compliance, and behavioral semantics that are needed to achieve computable semantic working interoperability. The
intended information transmission technology might use a messaging, document exchange, or services approach.
SAIF is the framework that is required to rationalize interoperability of other standards. SAIF is an architecture for
achieving interoperability, but it is not a whole-solution design for enterprise architecture management.
Arden syntax
The Arden syntax is a language for encoding medical knowledge. HL7 adopted and oversees the standard beginning
with Arden syntax 2.0. These Medical Logic Modules (MLMs) are used in the clinical setting as they can contain
sufficient knowledge to make single medical decisions.
[citation needed]
They can produce alerts, diagnoses, and
interpretations along with quality assurance function and administrative support. An MLM must run on a computer
that meets the minimum system requirements and has the correct program installed. Then, the MLM can give advice
for when and where it is needed.
MLLP
A large portion of HL7 messaging is transported by Minimal Lower Layer Protocol (MLLP), also known as Lower
Layer Protocol (LLP). For transmitting via TCP/IP, header and trailer characters are added to the message to identify
the beginning and ending of the message because TCP/IP is a continuous stream of bytes. Hybrid Lower Layer
Protocol (HLLP) is a variation of MLLP that includes a checksum to help verify message integrity. Amongst other
software vendors, MLLP is supported by Microsoft and Oracle.
Health Level 7
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CCOW
CCOW, or "Clinical Context Object Workgroup," is a standard protocol designed to enable disparate applications to
share user context and patient context in real-time, and at the user-interface level. CCOW implementations typically
require a CCOW vault system to manage user security between applications.
Functional EHR and PHR specifications
Functional specifications for an electronic health record.
Country specific aspects
Australia
HL7 Australia was established in 1998.
Australia was an early adopter of the HL7 V2.x standards, which are now used ubiquitously in Australian public and
private healthcare organisations.
The localisation of the HL7 standards is undertaken in cooperation with the national standards body, Standards
Australia.
HL7 Australia closely cooperates with the National E-Health Transition Authority (NEHTA).
HL7 Australia
Standards Australia (IT-014 "Health Informatics")
National E-Health Transition Authority (NEHTA)
Australia has been selected to host the International HL7 Interoperability Conference in 2013. This will be a two day
event in Sydney from 28 30 October 2013.
Proposed themes for the event include:
HL7/FHIR (Fast Healthcare Interoperability Resources),
CDA implementation and innovation,
Leveraging HL7v2.x investment, and
Emerging developments: CIMI, clinical terminology & semantic web
Canada
HL7 within Canada is supported by the HL7 Canadian Constituency, which is hosted by the Canadian Health
Infoway Standards Collaborative.
Among its support for domestic and international activities are:
Liaising with HL7 International;
Supporting communication and correspondence domestically and international for specific HL7 items;
Responding to inquiries from HL7 International;
Planning and execution of HL7 Canada Constituency roles and responsibilities;
Supporting domestic and international HL7 Canada meetings;
Providing support to domestic input on international HL7 ballot and comment items; and
Administering the HL7 Canada Constituency forum to facilitate member collaboration.
Notable HL7 implementations currently include Prince Edward Island's drug information system (DIS).
Health Level 7
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Czech republic
Czech republic has a national HL7 organization since 2001. In addition to HL7 standards, EHR systems in the Czech
republic use a national interface (called DASTA) endorsed by the Ministry of Health (Czech Republic)
Finland
National Health Archive http:/ / www. kanta. fi/ en
The Social Insurance Institution of Finland, together with other health and welfare bodies in Finland have been
rolling out a national health care database based on HL7 CDA R2 and V3 messages. The system is known by the
acronym KanTa which is an abbreviation of KANsallinen TerveysArkisto (National Health Archive). The word
KANTA in Finnish means "base", "stem" or "heel".
Currently (as at February 2013) the system holds details of all electronic prescriptions and all pharmacies in Finland
are connected to the database. The system enables prescriptions to be written by any medically qualified doctor into
the system and enables the patient to collect prescriptions from any pharmacy nationwide. Citizens can log into the
system via the internet using an authentication service and see their own record. There is a choice of using a
government controlled authorization system or using the same authentication service used for on-line banking. These
services use one-time (i.e. non repeating log in identifiers) which minimizes the risk of phishing or other intercepts.
By logging into the system, the patient can see what medicines have been prescribed, which doctor prescribed them
and when, what prescriptions have been collected from which pharmacy and on which date, and what the price paid
was. The latter is useful for patients taking expensive medications because there is a national ceiling on patient
medical costs so that the government will 100% of costs over the ceiling under the social insurance program. The
record also shows what the dose should be, the name of the doctor who prescribed the medication, and what
quantities of prescribed medications are still available for collection, subject to controls around the amount of
medication is allowed to store at home. The system alerts doctors and pharmacies to prevent simultaneous use of
incompatible medicines. For regular prescriptions, when the last prescription is fulfilled, the pharmacist can ask the
patient if he would like the doctor to be asked to repeat issue the prescription. If yes, the pharmacy issues the request
electronically and the doctor must either renew, modify, or terminate the prescription within 8 days. The patient can
choose to receive a text message to his/her mobile phone advising of the outcome.
Still being rolled out is the second phase of the project which is to enable the national database to be used to store
other patient medical records. This is subject to the patient consenting for the transfer of data from his home health
service station into the national archive. Patients thus have control over their own records, though most are expected
to see the benefits of having their records in a permanently available national register.
Version 2 HL7 messaging is widely deployed in most hospitals and healthcare centers. CDA R1 is used in sharing
patient records on a regional level.
HL7 Finland national affiliate
Germany
The German chapter of HL7 was founded in 1993. This is an entity for benefit to the public and registered as an
association as HL7 e. V.
Due to federal structure of operational administration in German healthcare, the standardization aspect is much
behind the possibilities of the public economy and due to competitive interests in industry of low normative impact
to healthcare information systems development. Currently HL7 in Germany operates as an informal cluster and
collaborates with the national standardization body.
The voluntary membership in HL7 relies on personal interest and engagement of clinical users and mainly on
industrial interest: Clinical memberships are in minority. There is low membership of governmental administration
and thus low contribution to ongoing discussion e.g. on patient data records (EPA = elektronische Patientenakte)
Health Level 7
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balancing data availability vs. data security. Impact on productivity for hospital information systems (called KIS =
Krankenhaus-Informationssysteme in German) is of no importance yet, as the variability of HIS systems has not
been challenged by HL7.
Governmental funding for a broader adoption of HL7 does yet not exist in Germany, neither on federal level nor in
most of the regional governments.
India
HL7 India is active in conducting e-learning courses for HL7 and HL7 certification examinations.
HL7 India
Italy
HL7 Italia was established in 2003 and it is responsible for the localization of this standard in the Italian context. The
aim is to stimulate and direct the regional and national contributions towards the standard development and to
promote the modernization of Italian health IT.
HL7 Italia members are suppliers of health IT market. Some Italian regions, regional In-Houses, Governative
Agencies, Public Research Institutes, local Hospital departments and individual IT professionals are HL7 Italia
members.
HL7 Italia
The Netherlands
AORTA - National Healthcare ICT infrastructure
AORTA is the Dutch national infrastructure for the exchange of data between healthcare providers. AORTA uses
HL7 version 3 messages and documents as its core mechanism for information exchange. The initial specifications
were created in 2003. The Dutch Ministry of Health is working on a virtual national Electronic Patient Records
(EPR) which will enable healthcare providers to share patient data. This development takes place in close
collaboration with Nictiz, the National Information and Communication Technology Institute for Healthcare. Nictiz
coordinates its efforts with regard to the usage of HL7 version 3 with the volunteers of HL7 the Netherlands.
Almost all hospitals use HL7 version 2 to support hospital-internal workflows. EDIfact is being used to support
workflows involving general practitioners (GPs/PCPs). EDIfact will be gradually replaced by HL7 version 3.
HL7 the Netherlands
National Information and Communication Technology Institute for Healthcare (Nictiz)
AORTA whitepaper
Pakistan
HLH - Health Life Horizon
HLH (a national project) is being carried out at School of Electrical Engineering and Computer Sciences of National
University of Sciences and Technology and is supported by Government of Pakistan with funds provided by
National ICT R&D Fund. HLH basic theme is to target health care information exchange and interoperability using
HL7 version 3. Though the penetration and use of HL7 in Pakistan is lower than the countries like US and that of
Europe. But its getting popularity among the stakeholders in Pakistan. HLH Team members have been participating
in HL7 International Working Group meetings and conferences for last two years. On Oct 1, 2010 HL7 International
formally announced the Pakistan Chapter at the 24th Plenary and WGM in Cambridge, MA, USA. Pakistan is now
the 37th affiliate of HL7 International around the world. HL7 Pakistan is now officially authorized to give
memberships to local organizations along with other privileges like certification, training, etc.
Health Level 7
532
Health Life Horizon (HLH)
HL7 Pakistan
USA
Laika
The Certification Commission for Healthcare Information Technology (CCHIT) has developed an open-source
program called Laika to test EHR software for compliance with CCHIT interoperability standards.
HIPAA
HL7s initial involvement in the Health Insurance Portability and Accountability Act (HIPAA) legislation began in
1996 with the formation of the Attachments special interest group to standardize the supplemental information
needed to support health care insurance, and other e-commerce transactions. The initial deliverable of this group was
a set of six recommended Claims Attachments for the Notice of Proposed Rule Making (NPRM) process. Future
attachment projects include, but are not limited to, Home Health, Skilled Nursing Facility, durable medical
equipment (DME), end stage renal disease (ESRD), and Pre-Authorization and Referrals. The Attachment special
interest group is responsible for implementing the Administrative Simplification provisions of HIPAA mandates,
providing on-going support, and representing HL7 in the Designated Standards Maintenance Organization (DSMO)
efforts. Its purpose is to encourage the use of HL7 for uniform implementation of this supplemental information.
This SIG coordinates industry input to produce and maintain guides for HL7 messages that can stand alone or be
embedded within ANSI X12 transactions.
ARRA and HITECH
The American Recovery and Reinvestment Act of 2009 (ARRA) and Health Information Technology for Economic
and Clinical Health Act (HITECH) legislation specified HL7 versions 2.3.1 and 2.5.1, and the HL7 Continuity of
Care Document (CCD), as the healthcare standards to meet certain certification requirements.
References
[1] http:/ / www. ansi.org/ ANSI
External links
HL7 Standards (http:/ / hl7messaging. com/ hl7-standards)
HL7.org site (http:/ / www. HL7. org/ )
Introduction to HL7 (http:/ / www. HL7. com. au/ FAQ. htm)
How does HL7 work? (Video Introduction) (http:/ / blog. interfaceware. com/ hl7/ how-does-hl7-work/ )
HL7.org EHR Page (http:/ / www. HL7. org/ EHR)
Fast Healthcare Interoperability Resources (FHIR) (http:/ / www. HL7. org/ FHIR)
What does HL7 enablement means? (http:/ / www. ehrmarket. com/ blog/ 2009/ 10/
what-does-hl7-enablement-means/ )
HL7 is a member of the Joint Initiative on SDO Global Health Informatics Standardization (http:/ / www.
global-ehealth-standards. com/ )
HL7 Tools Page (http:/ / www. HL7. com. au/ HL7-Tools. htm)
Australian Healthcare Messaging Laboratory (AHML) - Online HL7 Message Testing and Certification (http:/ /
www. AHML. au. org/ )
Comprehensive Implementation of HL7 v3 Specifications in Java (http:/ / aurora. regenstrief. org/ javasig)
HL7 Programming Tutorial using Java (http:/ / www. saravanansubramanian. com/ Saravanan/
Articles_On_Software/ Entries/ 2009/ 2/ 21_HL7_Programming_using_Java_A_Short_Tutorial. html)
HL7 101: A Beginners Guide (http:/ / www. fortherecordmag. com/ archives/ ftr_01082007p22. shtml)
Health Level 7
533
International HL7 Experts Consortium (http:/ / www. HL7Experts. com/ )
The Healthcare IT Interoperability Blog (http:/ / www. ehrguy. com/ )
NIST HL7 Conformance Testing Framework (http:/ / www. cs. duke. edu/ ~jgm/ files/ nist. 2006. ppt)
ICH-HL7 Regulated Product Submissions (http:/ / globalsubmit. com/ home/ LearningCenter/
HL7RegulatedProductSubmissions/ tabid/ 252/ Default. aspx)
Critical reviews
HL7 RIM: An Incoherent Standard (http:/ / ontology. buffalo. edu/ hl7/ doublestandards. pdf) and The HL7 RIM
Under Scrutiny - rebuttal (http:/ / amisha. pragmaticdata. com/ ~schadow/ Schadow-MIE06-r3. pdf)
HL7 Watch Blog; critical review of HL7 (http:/ / hl7-watch. blogspot. com/ ). See also the posted comments for
attempted rebuttals to some of the earlier posts.
Open source tools
There are a number of FOSS based tools that can foster worldwide adoption of the HL7 standards
The HL7 Tools Directory lists many FOSS tools and resources (http:/ / www. HL7. com. au/ HL7-Tools. htm)
Mirth Connect, an Open Source HL7 Integration Engine for HL7 V2/V3, DICOM, NCPDP and X12. Freely
available under MPL 1.1 license (http:/ / www. mirthcorp. com/ community/ overview)
The open health tools consortium (http:/ / www. openhealthtools. org)
The HL7 Java Special Interest Group's implementation of HL7 v3 (http:/ / aurora. regenstrief. org/ javasig)
The Eclipse OHF project - v2 and v3 implementations (IDE type tools and run-time libraries) (http:/ / www.
eclipse. org/ ohf)
HAPI, An open-source, object-oriented HL7 2.x parser for Java (http:/ / hl7api. sourceforge. net/ )
The Perl HL7 Toolkit, an Open-Source HL7 Perl module (http:/ / hl7toolkit. sourceforge. net/ )
Pear (PHP) HL7 messaging API module (http:/ / pear. php. net/ package/ Net_HL7)
The eXcessively Simple HL7 v2 Processing Platform using XML and XSLT (http:/ / aurora. regenstrief. org/
xhl7)
The Ruby HL7 Library (http:/ / rubyforge. org/ projects/ ruby-hl7)
HL7 Java binding (http:/ / xmlbeans. googlepages. com/ )
nule.org HL7 Utilities (http:/ / nule. org/ wp/ ?page_id=55)
nHAPI open-source library for .NET (http:/ / nhapi. sourceforge. net/ home. php)
HL7v3 Messaging Framework for .NET (http:/ / everest. marc-hi. ca/ )
HL7 Analyst for .NET (http:/ / hl7analyst. codeplex. com)
HL7Kit Free Sender, HL7 Message Editor and Sender (http:/ / www. hl7kit. com/ hl7senderOpenSource. html)
Healthcare Common Procedure Coding System
534
Healthcare Common Procedure Coding System
The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks")
is a set of health care procedure codes based on the American Medical Association's Current Procedural
Terminology (CPT).
History
The acronym HCPCS originally stood for HCFA Common Procedure Coding System, as the Centers for Medicare
and Medicaid (CMS) was previously (before 2001) known as the Health Care Financing Administration (HCFA).
The Healthcare Common Procedure Coding System (HCPCS) was established in 1978 to provide a standardized
coding system for describing the specific items and services provided in the delivery of health care. Such coding is
necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed
in an orderly and consistent manner. Initially, use of the codes was voluntary, but with the implementation of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for transactions involving
health care information became mandatory.
[1]
Levels of codes
HCPCS includes three levels of codes:
Level I consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric.
Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and
prosthetic devices,
[2]
and represent items and supplies and non-physician services, not covered by CPT-4 codes
(Level I).
Level III codes, also called local codes, were developed by state Medicaid agencies, Medicare contractors, and
private insurers for use in specific programs and jurisdictions. The use of Level III codes was discontinued on
December 31, 2003, in order to adhere to consistent coding standards.
[3]
References
[1] at page 1 cms.hhs.gov (http:/ / www.cms. hhs. gov/ MedHCPCSGenInfo/ Downloads/ HCPCSReform. pdf)
[2] HCPCS Level II Codes (http:/ / www.asha.org/ about/ publications/ leader-online/ b-line/ bl040608/ )
[3] HCPCS Background Information (http:/ / www. cms.hhs. gov/ MedHCPCSGenInfo/ )
External links
Official site (http:/ / www. cms. hhs. gov/ MedHCPCSGenInfo/ )
HCPCS Level II alphanumeric procedure and modifier codes (http:/ / www. cms. hhs. gov/
HCPCSReleaseCodeSets/ 01_Overview. asp#TopOfPage)
NDC-HCPCS crosswalk data files (http:/ / www. cms. hhs. gov/ McrPartBDrugAvgSalesPrice/ 01a_2008aspfiles.
asp)
Free online HCPCS Level 2 Codes Search Engine from drchrono (https:/ / drchrono. com/ billing/ medical_codes/
?code_type=hcpcs_level_2& search_text=Enter+ search+ here.& Submit=Search)
Searchable HCPCS codes and NDC numbers (http:/ / www. commondatahub. com/ hcpcs_source. jsp)
Healthcare Information Technology Standards Panel
535
Healthcare Information Technology Standards
Panel
The American National Standards Institute (ANSI) Healthcare Information Technology Standards Panel
(HITSP) was created in 2005 as part of efforts by the Office of the National Coordinator for Health Information
Technology (ONC, part of the United States Department of Health and Human Services) to promote interoperability
in health care by harmonizing health information technology standards. HITSP is chaired by John Halamka, MD,
CIO of Harvard Medical School.
Membership
Membership is by organization and there is currently no cost to join. Volunteers commit time to working on
standards harmonization efforts as prioritized by the American Health Information Community (AHIC).
Goals
According to their website, HITSP's mission is to "serve as a cooperative partnership between the public and private
sectors for the purpose of achieving a widely accepted and useful set of standards specifically to enable and support
widespread interoperability among healthcare software applications, as they will interact in a local, regional and
national health information network for the United States."
HITSP is generally organized around Use Cases, which are profiles of specific interoperability needs that have been
identified by AHIC as being important national priorities. The initial 2006 Use Cases were:
Consumer Empowerment
Registration Summary
Medication History
Electronic Health Records (EHRs)
Laboratory Result Reporting
Biosurveillance
Visit
Utilization
Clinical Data
Lab and Radiology
The 2007 Use Cases are:
Consumer Access to Clinical Information
Access to Clinical Data
Provider Permissions
Personal Health Record (PHR) Transfer
Emergency Responder EHR
On-site Care
Emergency Care
Definitive Care
Provider Authentication and Authorization
Medication Management
Medication Reconciliation
Ambulatory Prescriptions
Healthcare Information Technology Standards Panel
536
Contraindications
Quality
Hospital Measurement and Reporting
Clinician Measurement and Reporting
Feedback to Clinicians
External links
Healthcare Information Technology Standards Panel website
[1]
References
[1] http:/ / www. hitsp. org
Health Informatics Service Architecture
The European Committee for Standardization (CEN) Standard Architecture for Healthcare Information Systems
(ENV 12967), Health Informatics Service Architecture or HISA is a standard that provides guidance on the
development of modular open information technology (IT) systems in the healthcare sector. Broadly, architecture
standards outline frameworks which can be used in the development of consistent, coherent applications, databases
and workstations. This is done through the definition of hardware and software construction requirements and
outlining of protocols for communications.
[1]
The HISA standard provides a formal standard for a Service Oriented
Architecture (SOA), specific for the requirements of health services, based on the principles of Open Distributed
Processing.
[2]
The HISA standard evolved from previous work on healthcare information systems architecture
commenced by Reseau dInformation et de Communication Hospitalier Europeen (RICHE) in 1989, and
subsequently built upon by a number of organizations across Europe.
[3]
Development of Health Informatics Service Architecture EN/ISO 12967
The HISA standard was developed by CEN Technical Committee (TC) 251, the technical committee for Health
Informatics within the federation of European national standards bodies (CEN).
[4]
The CEN/TC 251 was made up of
four working groups, covering: information models; systems of concepts and terminology; security; and technologies
for interoperable communication.
[5]
Working Group I were responsible for information models and completed the
specifications that became the HISA standard. Working Group I worked with experts from across Europe, plus
contributors from Australia and the United States in the development and finalization of ENV 12967.
The CEN HISA standard was adopted by the International Organization for Standardization (ISO) in 2009, with the
stated aim of ISO 12967 being to provide guidance on:
the description, planning and development of new electronic health systems; and
the integration of existing electronic health systems, both intra- and inter-organizationally, through architecture
that integrates common data and business logic into middleware, which is then made available throughout whole
information systems.
Health Informatics Service Architecture
537
The Standard
EN/ISO 12967 is broken down into three parts: Enterprise Viewpoint; Information Viewpoint; and Computational
Viewpoint, all of which deal with different aspects of ensuring service architecture supports openness and
vendor-independence.
[6]
Part One: Enterprise Viewpoint
The Enterprise Viewpoint component of EN/ISO 12967 provides health services with guidance in describing,
planning and developing new IT systems, utilizing an open distributed processing approach. In addition to this it
provides direction for the integration of existing information systems, within the one enterprise and across different
healthcare organizations. Part one of the standard sets forth the common enterprise-level requirements (e.g.
workflows, authorizations) that must be supported through the HISA, which integrates the common data and
business logic into a specific architectural layer (i.e. the middleware), accessible throughout the whole information
system of the health service.
[7]
Part Two: Information Viewpoint
The Information Viewpoint component of EN/ISO 12967 sets forth the fundamental characteristics of the
information model to be implemented by the middleware to provide comprehensive, integrated storage of the
common enterprise data and to support the fundamental business processes of the healthcare organisation, as defined
in ISO 12967 Part One. The specifications were designed to be universally relevant, whilst being sufficiently specific
to allow implementers to derive an efficient design of the system for their organisation. This specification does not
aim to provide a fixed, complete specification of all possible data that may be necessary for any given health service.
It specifies only a set of characteristics, in terms of overall organisation and individual information objects, identified
as fundamental and common to all healthcare organizations.
[8]
Part Three: Computational Viewpoint
The Computational Viewpoint component of EN/ISO 12967 provides details on the fundamental characteristics of
the computational model to be implemented by the middleware, to provide a comprehensive and integrated interface
to the common, fundamental business processes of the health service. The computational model, like the information
model is designed to be universally relevant, whilst still being sufficiently specific to allow implementers to derive
an efficient design of the system for their organisation, irrespective of the specifics of the pre-existing information
technology environment in which it will be implemented.
[9]
Use of common services
The implementation of a modular, open architecture in healthcare IT systems (as specified by the HISA) relies upon
disparate heterogeneous applications interacting and communicating through a middleware layer, made up of
common services. In the case of the HISA, these common services are divided into Healthcare-related Common
Services and Generic Common Services.
[10]
Healthcare-related Common Services (HCS)
Healthcare-related Common Services are those middleware components responsible for supporting the
functionalities and information relevant to the healthcare business domain, including subject of care, activities,
resources, authorization, health characteristics and concepts.
[11]
Generic Common Services (GCS)
Generic Common Services are those middleware components are those middleware components responsible for
supporting the generic functionality and information requirements that are non-specific to the healthcare domain, and
may be broadly relevant to any information system in the business domain.
[12]
Health Informatics Service Architecture
538
References
[1] Engel, Kjeld. Blobel, Bernd. Pharow, Peter. (2006) Standards for Enabling Health Informatics Interoperability, Ubiquity: Technologies for
Better Health in Aging Societies IOS Press
[2] [2] Klein, Gunnar. Sottile, Pier Angelo. Endsleff, Frederik. (2007) Another HISA - The new standard: Health Informatics - Service
Architecture,Studies in Health Technology and Informatics,129(Pt 1):478-82
[3] [3] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
[4] [4] Klein, Gunnar. Sottile, Pier Angelo. Endsleff, Frederik. (2007) Another HISA - The new standard: Health Informatics - Service
Architecture,Studies in Health Technology and Informatics,129(Pt 1):478-82
[5] [5] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
[6] [6] Klein, Gunnar. Sottile, Pier Angelo. Endsleff, Frederik. (2007) Another HISA - The new standard: Health Informatics - Service
Architecture,Studies in Health Technology and Informatics,129(Pt 1):478-82
[7] European Committee for Standardization: http:/ / www. cen. eu/ cen/ Pages/ default. aspx
[8] European Committee for Standardization: http:/ / www. cen. eu/ cen/ Pages/ default. aspx
[9] European Committee for Standardization: http:/ / www. cen. eu/ cen/ Pages/ default. aspx
[10] [10] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
[11] [11] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
[12] [12] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
Healthcare Services Specification Project
The Healthcare Services Specification Project (HSSP) is a standards development effort to create health industry
service oriented architecture (SOA) standards supportive of the health care market sector. HSSP is a jointly
sponsored activity operating within the Health Level Seven (HL7) and the Object Management Group (OMG)
standards group. Formally beginning as a collaboration between the HL7 Service-oriented Architecture Special
Interest Group and the OMG Healthcare Domain Task Force, HSSP is developing healthcare middleware standards
addressing interoperability challenges.
The activity is an effort to create common service interface specifications that ultimately can be tractable within a
Health IT context. The stated objective of the HSSP project is to create useful, usable healthcare standards that
define the functions, semantics, and technology bindings supportive of system-level interoperability. To the extent
possible, HSSP specifications complement existing work and standards.
A key tenet to the HSSP approach is to focus on practical needs, capitalizing on open industry participation and
maximizing contributions from industry talent interested in engaging.
Context
By design, HSSP specifications are applicable for use in multiple use contexts, including inter-enterprise,
intra-enterprise, intra-product, and intra-implementation. In other words, nothing inherent in the standard work
deliberately precludes their use in any targeted system setting.
Mission
The following is the stated Mission and Charter of the HSSP project, used with permission.
[citation needed]
Recognizing the need for specifications for services to support healthcare IT as part of national infrastructures
(such as US NHII, Australias HealthConnect and Finland's Terveyshanke), Health Level Seven and the Object
Management Group have forged this agreement to collaborate to the advantage of the health domain sector.
Healthcare Services Specification Project
539
This charter outlines high-level distribution of responsibilities and separation of concerns specifically related
to this services effort. Note that this joint effort between HL7 and OMG is not exclusive. Either organization
may engage in independent efforts or similar joint efforts with others. This project is a collaborative effort
between HL7 and OMG to identify and document service specifications, functionality, and conformance
supportive and relevant to healthcare IT stakeholders and resulting in real-world implementations.
As part of this collaborative effort:
HL7 and OMG shall jointly identify the service candidates for specification and prioritize and select
candidate services for specification and implementation, and jointly allocate functions to services. OMG
members shall provide expertise in distributed architecture and implementation to HL7 activities to
positively impact the selection of services and allocation of functions. HL7 members shall engage in the
OMG RFP process to ensure consistency with the functional requirements.
HL7 shall elaborate the business functional needs, allocate functions to services, and develop
conformance criteria for the services specified. HL7 shall also have responsibility for providing the
information modeling and content in support of these services. All of the computationally independent
work shall occur within HL7, as well as the functional conformance criteria assuring that service
implementations meet their specified capability. In general, information models and content will be
managed by other HL7 domain committees, and HSSP will work with those committees to define any
additions or changes.
OMG shall refine the HL7 developed computationally independent specifications [functional, semantics,
information model, terminology, etc.] resulting in computationally dependent standards and user,
vendor, and reference implementations. OMG shall provide technical expertise such as Unified
Modeling Language (UML) and Model-driven architecture (MDA), as well as leveraging multi-industry
solutions. OMG shall leverage the strength of its adoption process to promote rapid standards
development and marketplace product support given that submitters are required to produce
implementations of the standards they specify.
As a project and through its presence in other organizations, the HSSP will provide an umbrella
structure under which various subgroups will be chartered to carry out specific tasks in conjunction and
under the auspices of these organizations, such as definition of methodology, architecture and specific
services. The HSSP additionally will facilitate between organizations to provide the tools, knowledge,
methodologies, or viewpoints deemed necessary for them to fulfill their purpose. The responsibilities of
the main HSSP will be to manage the subgroups and verify their charters, as well as provide cohesive
vision and any appropriate administrative tasks.
Philosophy
HSSP specification work is divided into two foundational components: functional specifications (manifested as
Service Functional Models) and technical specifications (resulting in technology adoptions). The functional
specification work is being originated within health industry standards communities, such as HL7 and CEN. The
functional models enumerate what capabilities are to be supported but not how they are supported. The technical
specification work details exactly how those functions are manifested and ultimately realized in a technology
platform.
The intention behind splitting the standard into two work products is to facilitate and improve involvement from
different communities, leveraging each to their strengths. To date, HL7 has been leading in identifying
standardization priorities, elaborating the functions desired into Service Functional Models, and in defining
conformance criteria that would be used to assess compliance. The OMG has been leading the technical specification
process as part of their Technology Adoption Process.
Healthcare Services Specification Project
540
The OMG process requires participants to make commitments to implement standards as working software, ensuring
that the technical specifications are used and available. During implementation of these technical specifications,
errors and shortcomings of adopted Service Functional Models are captured, logged, and ultimately incorporated into
subsequent versions of the Service Functional Models as part of a continuous process improvement approach.
History
Prior to establishing HSSP as a moniker, the activity began informally as an informal group to discuss issues
pertaining to SOA and interoperability in a health context. Meeting concurrently with regularly scheduled HL7
Working Group meetings, HSSP operated in this form for several years until June 2005. In June a meeting was
hosted in Salt Lake City by the U.S. Veterans Health Administration to establish a formal direction for the group and
to initiate steps to formalize its activities.
In January 2006, Health Level Seven accepted the charter of the Service-oriented Architecture Special Interest Group
(SOA SIG), which was to become the hosting body for HSSP within the HL7 organization. The OMG Healthcare
Domain Task Force had already agreed to sponsor the activity. The HSSP project was formally chartered in January,
2006, operating under a board-level agreement forged between Health Level Seven and the Object Management
Group.
References
HSSP Wiki
[1]
Clinical Research Filtered Query Service
[2]
Common Terminology Service II
[3]
Decision Support Service
[4]
Human Services Directory
[5]
Privacy Access Security Services
[6]
External links
Introduction to the HL7 Standards
[1]
Healthcare Services Specification Project (HSSP)
[1]
References
[1] http:/ / hssp. healthinterop. org
[2] http:/ / hssp-cohort. wikispaces. com/
[3] http:/ / hssp. wikispaces.com/ cts2
[4] http:/ / hssp-dss. wikispaces.com/
[5] http:/ / hssp-provider-services-directory.wikispaces. com/
[6] http:/ / hssp-security. wikispaces.com/
International Statistical Classification of Diseases and Related Health Problems
541
International Statistical Classification of Diseases
and Related Health Problems
The International Classification of Diseases (also known by the abbreviation ICD) is the United Nations-sponsored
World Health Organizations "standard diagnostic tool for epidemiology, health management and clinical
purposes."
[1]
The ICD is designed as a health care classification system, providing a system of diagnostic codes for
classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings,
complaints, social circumstances, and external causes of injury or disease. This system is designed to map health
conditions to corresponding generic categories together with specific variations, assigning for these a designated
code, up to six characters long. Thus, major categories are designed to include a set of similar diseases.
The International Classification of Diseases is published by the World Health Organization (WHO) and used
worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in health
care. This system is designed to promote international comparability in the collection, processing, classification, and
presentation of these statistics. As in the case of the analogous (but limited to mental and behavioral disorders)
Diagnostic and Statistical Manual of Mental Disorders (DSM, currently in version 5), the ICD is a major project to
statistically classify health disorders, and provide diagnostic assistance. The ICD is a core statistically-based
classificatory diagnostic system for health care related issues of the WHO Family of International Classifications
(WHO-FIC).
[2]
The ICD is revised periodically and is currently in its tenth revision. The ICD-10, as it is therefore known, was
developed in 1992 to track health statistics. ICD-11
[3]
is planned for 2015 and will be revised using Web 2.0
principles. Annual minor updates and triennial major updates are published by the WHO.
[4]
The ICD is part of a
"family" of guides that can be used to complement each other, including also the International Classification of
Functioning, Disability and Health which focuses on the domains of functioning (disability) associated with health
conditions, from both medical and social perspectives.
Historical synopsis
In 1893, a French physician, Jacques Bertillon, introduced the Bertillon Classification of Causes of Death at a
congress of the International Statistical Institute in Chicago.
[5]
A number of countries and cities adopted Dr.
Bertillons system, which was based on the principle of distinguishing between general diseases and those localized
to a particular organ or anatomical site, as used by the City of Paris for classifying deaths. Subsequent revisions
represented a synthesis of English, German and Swiss classifications, expanding from the original 44 titles to 161
titles. In 1898, the American Public Health Association (APHA) recommended that the registrars of Canada,
Mexico, and the United States also adopt it. The APHA also recommended revising the system every ten-years to
ensure the system remained current with medical practice advances. As a result, the first international conference to
revise the International Classification of Causes of Death took place in 1900; with revisions occurring every
ten-years thereafter. At that time the classification system was contained in one book, which included an Alphabetic
Index as well as a Tabular List. The book was small compared with current coding texts.
The revisions that followed contained minor changes, until the sixth revision of the classification system. With the
sixth revision, the classification system expanded to two volumes. The sixth revision included morbidity and
mortality conditions, and its title was modified to reflect the changes: International Statistical Classification of
Diseases, Injuries and Causes of Death (ICD). Prior to the sixth revision, responsibility for ICD revisions fell to the
Mixed Commission, a group composed of representatives from the International Statistical Institute and the Health
Organization of the League of Nations. In 1948, the World Health Organization (WHO) assumed responsibility for
preparing and publishing the revisions to the ICD every ten-years. WHO sponsored the seventh and eighth revisions
in 1957 and 1968, respectively. It later become clear that the established ten-year interval between revisions was too
International Statistical Classification of Diseases and Related Health Problems
542
short.
The ICD is currently the most widely used statistical classification system for diseases in the world. International
health statistics using this system are available at the Global Health Observatory (GHO)
[6]
(
[7]
)
In addition, some countriesincluding Australia, Canada and the United Stateshave developed their own
adaptations of ICD, with more procedure codes for classification of operative or diagnostic procedures.
Versions of ICD
ICD-6
The ICD-6, published in 1949, was the first to be shaped to become suitable for morbidity reporting. Accordingly the
name changed from International List of Causes of Death to International Statistical Classification of Diseases. The
combined code section for injuries and their associated accidents was split into two, a chapter for injuries, and a
chapter for their external causes. With use for morbidity there was a need for coding mental conditions, and for the
first time a section on mental disorders was added.
[8]
ICD-7
The International Conference for the Seventh Revision of the International Classification of Diseases was held in
Paris under the auspices of WHO in February 1955. In accordance with a recommendation of the WHO Expert
Committee on Health Statistics, this revision was limited to essential changes and amendments of errors and
inconsistencies.
ICD-8
The Eighth Revision Conference convened by WHO met in Geneva, from 6 to 12 July 1965. This revision was more
radical than the Seventh but left unchanged the basic structure of the Classification and the general philosophy of
classifying diseases, whenever possible, according to their etiology rather than a particular manifestation. During the
years that the Seventh and Eighth Revisions of the ICD were in force, the use of the ICD for indexing hospital
medical records increased rapidly and some countries prepared national adaptations which provided the additional
detail needed for this application of the ICD. In the USA, a group of consultants was asked to study the 8th revision
of ICD (ICD-8) for its applicability to various users in the United States. This group recommended that further detail
be provided for coding hospital and morbidity data. The American Hospital Associations Advisory Committee to
the Central Office on ICDA developed the needed adaptation proposals, resulting in the publication of the
International Classification of Diseases, Adapted (ICDA). In 1968, the United States Public Health Service published
the International Classification of Diseases, Adapted, 8th Revision for use in the United States (ICDA-8). Beginning
in 1968, ICDA-8 served as the basis for coding diagnostic data for both official morbidity [and mortality] statistics in
the United States.
[9]
International Statistical Classification of Diseases and Related Health Problems
543
ICD-9
The International Conference for the Ninth Revision of the International Classification of Diseases, convened by
WHO, met in Geneva from 30 September to 6 October 1975. In the discussions leading up to the conference, it had
originally been intended that there should be little change other than updating of the classification. This was mainly
because of the expense of adapting data processing systems each time the classification was revised.
There had been an enormous growth of interest in the ICD and ways had to be found of responding to this, partly by
modifying the classification itself and partly by introducing special coding provisions. A number of representations
was made by specialist bodies which had become interested in using the ICD for their own statistics. Some subject
areas in the classification were regarded as inappropriately arranged and there was considerable pressure for more
detail and for adaptation of the classification to make it more relevant for the evaluation of medical care, by
classifying conditions to the chapters concerned with the part of the body affected rather than to those dealing with
the underlying generalized disease.
At the other end of the scale, there were representations from countries and areas where a detailed and sophisticated
classification was irrelevant, but which nevertheless needed a classification based on the ICD in order to assess their
progress in health care and in the control of disease. A field test with a bi-axial classification approach - one axis for
anatomy, another for etiology - showed the impracticability of such approach for routine use.
The final proposals presented to and accepted by the Conference retained the basic structure of the ICD, although
with much additional detail at the level of the four digit subcategories, and some optional five digit subdivisions. For
the benefit of users not requiring such detail, care was taken to ensure that the categories at the three digit level were
appropriate.
For the benefit of users wishing to produce statistics and indexes oriented towards medical care, the Ninth Revision
included an optional alternative method of classifying diagnostic statements, including information about both an
underlying general disease and a manifestation in a particular organ or site. This system became known as the dagger
and asterisk system and is retained in the Tenth Revision. A number of other technical innovations were included in
the Ninth Revision, aimed at increasing its flexibility for use in a variety of situations. It was eventually replaced by
ICD-10, the version currently in use by the WHO and most countries. Given the widespread expansion in the tenth
revision, it is not possible to convert ICD-9 data sets directly into ICD-10 data sets, although some tools are available
to help guide users.
[10]
Publication of ICD-9 without IP restrictions in a world with evolving electronic data systems
led to a range of products based on ICD-9, such as MeDRA or the Read directory.
ICPM
When ICD-9 was published by the World Health Organization (WHO), the International Classification of Procedures
in Medicine (ICPM) was also developed (1975) and published (1978). The ICPM surgical procedures fascicle was
originally created by the United States, based on its adaptations of ICD (called ICDA), which had contained a
procedure classification since 1962. ICPM is published separately from the ICD disease classification as a series of
supplementary documents called fascicles (bundles or groups of items). Each fascicle contains a classification of
modes of laboratory, radiology, surgery, therapy, and other diagnostic procedures. Many countries have adapted and
translated the ICPM in parts or as a whole and are using it with amendments since then.
International Statistical Classification of Diseases and Related Health Problems
544
ICD-9-CM
International Classification of Diseases, Clinical Modification (ICD-9-CM) is an adaption created by the U.S.
National Center for Health Statistics (NCHS) and used in assigning diagnostic and procedure codes associated with
inpatient, outpatient, and physician office utilization in the United States. The ICD-9-CM is based on the ICD-9 but
provides for additional morbidity detail. It is updated annually on October 1.
[11][12]
It consists of two or three volumes:
Volumes 1 and 2 contain diagnosis codes. (Volume 1 is a tabular listing, and volume 2 is an index.) Extended for
ICD-9-CM
Volume 3 contains procedure codes. ICD-9-CM only
The NCHS and the Centers for Medicare and Medicaid Services are the U.S. governmental agencies responsible for
overseeing all changes and modifications to the ICD-9-CM.
ICD-10
Work on ICD-10 began in 1983, and the new revision was endorsed by the Forty-third World Health Assembly in
May 1990. The latest version came into use in WHO Member States starting in 1994.
[13]
The classification system
allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures, a significant
expansion on the 17,000 codes available in ICD-9. Adoption was relatively swift in most of the world. Several
materials are made available online by WHO to facilitate its use, including a manual, training guidelines, a browser,
and files for download. Some countries have adapted the international standard, such as the "ICD-10-AM" published
in Australia in 1998 (also used in New Zealand),
[14]
and the "ICD-10-CA" introduced in Canada in 2000.
[15]
ICD-10-CM
Adoption of ICD-10 has been slow in the United States. Since 1979,
[16]
the USA had required ICD-9-CM codes for
Medicare and Medicaid claims, and most of the rest of the American medical industry followed suit. On 1 January
1999 the ICD-10 (without clinical extensions) was adopted for reporting mortality, but ICD-9-CM was still used for
morbidity. Meanwhile, NCHS received permission from the WHO to create a clinical modification of the ICD-10,
and has production of all these systems:
ICD-10-CM, for diagnosis codes, is intended to replace volumes 1 and 2. Annual updates are provided.
ICD-10-PCS, for procedure codes, is intended to replace volume 3. Annual updates are provided.
On August 21, 2008, the US Department of Health and Human Services (HHS) proposed new code sets to be used
for reporting diagnoses and procedures on health care transactions. Under the proposal, the ICD-9-CM code sets
would be replaced with the ICD-10-CM code sets, effective October 1, 2013. On April 17, 2012 the Department of
Health and Human Services (HHS) published a proposed rule that would delay, from October 1, 2013 to October 1,
2014,the compliance date for the ICD-10-CM and PCS.
ICD-10-CA
ICD-10-CA is a clinical modification of ICD-10 developed by the Canadian Institute for Health Information for
morbidity classification in Canada. ICD-10-CA applies beyond acute hospital care, and includes conditions and
situations that are not diseases but represent risk factors to health, such as occupational and environmental factors,
lifestyle and psycho-social circumstances.
ICD-11
The World Health Organization is currently revising the International Classification of Diseases (ICD) towards the
ICD-11. The development is taking place on an internet-based workspace, called iCAT (Collaborative Authoring
Tool) Platform, somewhat similar to Wikipedia yet it requires more structure and peer review process. The WHO
collaborates through this platform with all interested parties.
International Statistical Classification of Diseases and Related Health Problems
545
The final draft of the ICD-11 system is expected to be submitted to WHO's World Health Assembly (WHA) for
official endorsement by 2015. The beta draft
[17]
was made available online in May 2012 for initial consultation and
commenting.
[18]
In ICD-11 each disease entity will have definitions that give key descriptions and guidance on what the meaning of
the entity/category is in human readable terms - to guide users. This is an advancement over ICD-10, which had only
title headings. The Definitions have a standard structure according to a template with standard definition templates
and further features exemplified in a Content Model. The Content Model is a structured framework that captures
the knowledge that underpins the definition of an ICD entity. The Content Model therefore allows computerization
(with links to ontologies and SNOMED CT). Each ICD entity can be seen from different dimensions or parameters.
For example, there are currently 13 defined main parameters in the Content Model (see below) to describe a category
in ICD.
1. ICD Entity Title - Fully Specified Name
2. Classification Properties - disease, disorder, injury, etc.
3. Textual Definitions - short standard description
4. Terms - synonyms, other inclusion and exclusions
5. Body System/Structure Description - anatomy and physiology
6. Temporal Properties - acute, chronic or other
7. Severity of Subtypes Properties - mild, moderate, severe, or other scales
8. Manifestation Properties - signs, symptoms
9. Causal Properties - etiology: infectious, external cause, etc.
10. Functioning Properties - impact on daily life: activities and participation
11. Specific Condition Properties - relates to pregnancy etc.
12. Treatment Properties - specific treatment considerations: e.g. resistance
13. Diagnostic Criteria - operational definitions for assessment
ICD exists in 41 Languages in electronic versions and its expression in multiple languages will be systematically
pursued in ICD11.
Usage and current topics
History and usage in the United States
In the United States, the U.S. Public Health Service published The International Classification of Diseases, Adapted
for Indexing of Hospital Records and Operation Classification (ICDA), completed in 1962 and expanding the ICD-7
in a number of areas to more completely meet the indexing needs of hospitals. The U.S. Public Health Service later
published the Eighth Revision, International Classification of Diseases, Adapted for Use in the United States,
commonly referred to as ICDA-8, for official national morbidity and mortality statistics. This was followed by the
ICD, 9th Revision, Clinical Modification, known as ICD-9-CM, published by the U.S. Department of Health and
Human Services and used by hospitals and other healthcare facilities to better describe the clinical picture of the
patient. The diagnosis component of ICD-9-CM is completely consistent with ICD-9 codes, and remains the data
standard for reporting morbidity. National adaptations of the ICD-10 progressed to incorporate both clinical code
(ICD-10-CM) and procedure code (ICD-10-PCS) with the revisions completed in 2003. In 2009, the U.S. Centers for
Medicare and Medicaid Services announced that it would begin using ICD-10 on April 1, 2010, with full compliance
by all involved parties by 2013.
The years for which causes of death in the United States have been classified by each revision as follows:
International Statistical Classification of Diseases and Related Health Problems
546
ICD-1 1900
ICD-2 1910
ICD-3 1921
ICD-4 1930
ICD-5 1939
ICD-6 1949
ICD-7 1958
ICD-8A 1968
ICD-9 1979
ICD-10 1999
Mental and behavioral disorders
The ICD includes a section classifying mental and behavioral disorders (Chapter V). This has developed alongside
the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the two
manuals seek to use the same codes. There are significant differences, however, such as the ICD including
personality disorders in the same way as other mental disorders, while the DSM-IV-TR lists them on a separate
'axis'. The WHO is revising their classifications in these sections as part the development of the ICD-11 (scheduled
for 2015), and an "International Advisory Group" has been established to guide this.
[19]
An international survey of
psychiatrists in 66 countries comparing use of the ICD-10 and DSM-IV found that the former was more often used
for clinical diagnosis while the latter was more valued for research. The ICD is actually the official system for the
US, although many mental health professionals do not realize this due to the dominance of the DSM. The US is due
to adopt a modified version of the ICD-10 in 2013. Psychologists note that, "Serious problems with the clinical
utility of both the ICD and the DSM are widely acknowledged."
References
[1] http:/ / www. who. int/ classifications/ icd/ en/ access:26 June 2012
[2] World Health Organization. Family of International Classifications. (http:/ / www. who. int/ classifications/ en/ ) Accessed 12 July 2011.
[3] ICD11 Alpha is already available online, at http:/ / apps. who. int/ classifications/ icd11/ browse/ f/ en#/ http%3A%2F%2Fwho.
int%2Ficd%232772_712a6f06_71f2_48d0_919c_2b3cb8b7172d (retrieved Apr 15 - 11:02 UTC)
[4] WHO. List of Official ICD-10 Updates. (http:/ / www.who. int/ classifications/ icd/ icd10updates/ en)
[5] WHO. History of the development of the ICD. (http:/ / www. who. int/ entity/ classifications/ icd/ en/ HistoryOfICD. pdf)
[6] http:/ / www. who. int/ gho/ en/
[7] WHOSIS. WHO Statistical Information System. (http:/ / www. who. int/ whosis/ en/ )
[8] [8] ICD-10 Volume 2, online at www.who.int/classifications
[9] Scientific Data Documentation, International Classification of Diseases-9-CM (http:/ / wonder. cdc. gov/ wonder/ sci_data/ codes/ icd9/
type_txt/ icd9cm.asp)
[10] World Health Organization. FAQ on ICD. (http:/ / www. who. int/ classifications/ help/ icdfaq/ en/ ) Accessed 12 July 2011.
[11] National Center for Health Statistics, CDC. ICD-9-CM Guidelines, Conversion Table, and Addenda (http:/ / www. cdc. gov/ nchs/ icd/
icd9cm_addenda_guidelines.htm). Classification of Diseases, Functioning, and Disability. Retrieved 2010-01-24.
[12] InstaCode Institute. ICD-10 Demystified. (http:/ / www. instacode. com/ news-icd10-demystified. htm)
[13] WHO. International Classification of Diseases (ICD). (http:/ / www. who. int/ classifications/ icd/ en/ )
[14] New Zealand Health Information Service. ICD-10-AM. (http:/ / www. nzhis. govt. nz/ moh. nsf/ pagesns/ 534) Accessed 12 July 2011.
[15] Canadian Institute for Health Information. ICD-10-CA. (http:/ / www. cihi. ca/ cihi-ext-portal/ internet/ en/ document/ standards+ and+
data+ submission/ standards/ classification+ and+ coding/ codingclass_icd10) Accessed 12 July 2011.
[16] http:/ / wonder.cdc. gov/ wonder/ sci_data/ codes/ icd9/ type_txt/ icd9cm. asp
[17] http:/ / apps. who.int/ classifications/ icd11/ browse/ f/ en#
[18] World Health Organization. "The International Classification of Diseases 11th Revision is due by 2015." (http:/ / www. who. int/
classifications/ icd/ revision/ en/ ) Accessed 21 June 2012.
[19] http:/ / www.who. int/ mental_health/ evidence/ en/
International Statistical Classification of Diseases and Related Health Problems
547
External links
Official website (http:/ / www. who. int/ classifications/ icd/ en/ ) at World Health Organization (WHO)
ICD-10 online browser (http:/ / apps. who. int/ classifications/ icd10) (WHO)
ICD-10 online training direct access (http:/ / apps. who. int/ classifications/ apps/ icd/ ICD10Training) (WHO)
ICD-10 online training support (http:/ / sites. google. com/ site/ icd10onlinetraining) (WHO)
ICD-10-CM (http:/ / www. cdc. gov/ nchs/ icd/ icd10cm. htm) (USA modification) at Centers for Disease
Control and Prevention
ICD-11 Revision (http:/ / sites. google. com/ site/ icd11revision/ home) (WHO)
Code Browser for ICD-9-CM, ICD-10-CM, ICD-10-PCS, HCPCS, DRGs (http:/ / www. findacode. com/ tools/
browse-a-code. php)
ICD-9-CM to ICD-10-CM code conversions (http:/ / www. ecodingnow. com/ OnlineCodes/ OnlineCodes/
i9toi10. html)
ICD-9-CM and DRG on-line coding engine (http:/ / www. icd9coding. com)
Free ICD-9-CM Code search (https:/ / drchrono. com/ public_billing_code_search/ )
ICD-10 and ICD-10 PCS (http:/ / www. med-code. info/ ?country=us& locale=us)
ICD-9 and ICD-10 code lookup (http:/ / icdx. org)
Free ICD-9 and ICD-10 online browser in english and spanish (http:/ / www. itserver. es)
ICD-10
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems
(ICD), a medical classification list by the World Health Organization (WHO). It codes for diseases, signs and
symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. The codes
can be expanded to over 16,000 codes by using optional sub-classifications. The detail reported by ICD can be
further increased, with a simplified multi-axial approach, by using codes meant to be reported in a separate data
field.
The WHO provides detailed information about ICD online, and makes available a set of materials online, such as an
ICD-10 online browser,
[1]
ICD-10 Training, ICD-10 online training,
[2]
ICD-10 online training support,
[3]
and study
guide materials for download.
The International version of ICD should not be confused with national Clinical Modifications of ICD that frequently
include much more detail, and sometimes have separate sections for procedures. The US ICD-10 CM, for instance,
has some 68,000 codes. The US also has ICD-10 PCS, a procedure code system not used by other countries that
contains 76,000 codes.
Work on ICD-10 began in 1983 and was completed in 1992.
ICD-10
548
List
The following is a List of ICD-10 codes.
International Statistical Classification of Diseases and Related Health Problems 10th
Revision
Chapter Blocks Title
I A00B99 Certain infectious and parasitic diseases
II C00D48 Neoplasms
III D50D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
IV E00E90 Endocrine, nutritional and metabolic diseases
V F00F99 Mental and behavioural disorders
VI G00G99 Diseases of the nervous system
VII H00H59 Diseases of the eye and adnexa
VIII H60H95 Diseases of the ear and mastoid process
IX I00I99 Diseases of the circulatory system
X J00J99 Diseases of the respiratory system
XI K00K93 Diseases of the digestive system
XII L00L99 Diseases of the skin and subcutaneous tissue
XIII M00M99 Diseases of the musculoskeletal system and connective tissue
XIV N00N99 Diseases of the genitourinary system
XV O00O99 Pregnancy, childbirth and the puerperium
XVI P00P96 Certain conditions originating in the perinatal period
XVII Q00Q99 Congenital malformations, deformations and chromosomal abnormalities
XVIII R00R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
XIX S00T98 Injury, poisoning and certain other consequences of external causes
XX V01Y98 External causes of morbidity and mortality
XXI Z00Z99 Factors influencing health status and contact with health services
XXII U00U99 Codes for special purposes
National adoption for clinical use
Some 25 countries use ICD-10 for reimbursement and resource allocation in their health system. A few of them
made modifications to ICD to better accommodate this use of ICD-10. The article below makes reference to some of
these modifications. The unchanged international version of ICD-10 is used in about 110 countries for cause of death
reporting and statistics.
Australia
1 July 1998 Victoria, New South Wales, Australian Capital Territory and Northern Territory implemented
ICD-10-AM.
1 July 1999 Queensland, South Australia, Tasmania and Western Australia implemented ICD-10-AM.
[4]
ICD-10
549
Canada
Canada introduced ICD-10-CA in 2000.
[5]
China
China now using ICD-10 as diagnosis reference and ICD-9 as procedure reference.
[citation needed]
France
France introduced a clinical addendum to ICD-10 in 2005. See also website of the ATIH.
Germany
Germany: ICD-10-GM (German Modification)
Korea
A Korean modification has existed since 2008.
Netherlands
The Dutch translation of ICD-10 is ICD10-nl, which was created by the WHO-FIC Netwerk in 1994.
[6]
There is an
online dictionary
[7]
.
South Africa
1 January 2005 Pretoria, Johannesburg, Cape town
Sweden
The current Swedish translation of ICD-10 was created in 1997. A clinical modification has added more detail and
omits codes of the international version in the context of clinical use of ICD:
The codes F64.1 (Dual-role transvestism), F64.2 (Gender identity disorder of childhood), F65.0 (Fetishism), F65.1
(Fetishistic transvestism), F65.5 (Sadomasochism), F65.6 (Multiple disorders of sexual preference) are not used in
Sweden since 1 January 2009 according to a decision by the present Director General of The National Board of
Health and Welfare, Sweden. The code O60.0 (Preterm labor without delivery) is not used in Sweden; instead, since
1 January 2009, the Swedish extension codes to O47 (False labor) are recommended for use.
Thailand
A Thai modifications exists since 2007.
Now Ministry of Public Health have **ICD 10 TM**
United States
The deadline for the United States to begin using Clinical Modification ICD-10-CM for diagnosis coding and
Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding is currently October 1, 2014.
[8]
The
deadline was previously October 1, 2013.
[9][10]
All HIPAA "covered entities" must make the change; a pre-requisite
to ICD-10 is the adoption of EDI Version 5010 by January 1, 2012.
[11]
Enforcement of 5010 transition by the
Centers for Medicare & Medicaid Services (CMS), however, was postponed by CMS until March 31, 2012, with the
federal agency citing numerous factors, including slow software upgrades.
[12]
The implementation of ICD-10 has
been subject to previous delays. In January 2009, the date was pushed back by two years, to October 1, 2013 rather
than a prior proposal of October 1, 2011.
[13]
ICD-10
550
Even though the deadline for ICD-10 has been pushed back repeatedly, CMS recommends that medical practices
take several years to prepare for implementation of the new code set.
[14]
The basic structure of the ICD-10 code is
the following: Characters 1-3 (the category of disease); 4 (etiology of disease); 5 (body part affected), 6 (severity of
illness) and 7 (placeholder for extension of the code to increase specificity) .
[15]
Not only must new software be
installed and tested, but medical practices must provide training for physicians, staff members, and administrators.
They will also need to develop new practice policies and guidelines, and update paperwork and forms. Practices
should also create crosswalks that will convert their most frequently used ICD-9 codes to the ICD-10 equivalents.
Although the undertaking can seem overwhelming, especially to small practices,
[16]
technology can be a big help.
Practices should check with their EHR vendors to make sure they understand the data storage requirements for the
new code set; seek online training available through association websites and software-based instruction; and invest
in additional technology, such as patient kiosks, to boost productivity.
[17]
U.A.E (Dubai)
Dubai Health Authority (DHA) introduced ICD-10 in 2012.
Language versions
Language versions should not be confused with clinical versions. ICD has been translated into 42 languages.
References
[1] ICD-10 online browser (http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en)
[2] ICD-10 training tool (http:/ / apps.who.int/ classifications/ apps/ icd/ icd10training/ )
[3] ICD 10 Online Support (http:/ / sites. google. com/ site/ icd10onlinetraining)
[4] DRG and ICD information in Queensland (http:/ / www. health. qld. gov. au/ qcc/ documents/ resources/ icd_drg_qld11. pdf)
[5] "ICD10-CA" (http:/ / www.cihi. ca/ cihi-ext-portal/ internet/ en/ document/ standards+ and+ data+ submission/ standards/ classification+
and+ coding/ codingclass_icd10)
[6] WHO - FIC Homepage (http:/ / www. rivm.nl/ who-fic/ ICD. htm)
[7] http:/ / class.who-fic.nl/ browser. aspx?scheme=ICD10-nl. cla
[8] [8] . of . of .
[9] "International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)" (http:/ / www. cdc. gov/ nchs/ icd/ icd10cm.
htm). National Center for Health Statistics. Centers for Disease Control and Prevention (CDC). December 20, 2010.
[10] "Overview ICD-10" (http:/ / www.cms. gov/ ICD10/ ). Centers for Medicare and Medicaid Services.
[11] Noblis ICD-10 F.A.Q. (http:/ / www. noblis. org/ MissionAreas/ HI/ Solutions/ Pages/ ICD-10FAQ. aspx)
[12] "Physicians Get Grace Period from CMS on HIPAA 5010 Enforcement" (http:/ / www. physicianspractice. com/ blog/ content/ article/
1462168/ 1994128).Physicians Practice.November 18, 2011
[13] "Feds Delay ICD-10 for Two Years" (http:/ / blogs.wsj. com/ health/ 2009/ 01/ 15/ feds-delay-icd-10-for-two-years/ ). The Wall Street
Journal. January 15, 2009.
[14] "CMS.gov/ICD-10/Provider Resources" (http:/ / www. cms. gov/ Medicare/ Coding/ ICD10/ ProviderResources. html) accessed Aug 1,
2012.
[15] "AHIMA ICD-10 CM Primer" (http:/ / www.jiteshchawla. org/ 1_11_ICD-10. html).
[16] "Managing ICD-10 Conversions for Smaller Healthcare Providers" (http:/ / www. insidepatientfinance. com/ revenue-cycle-news/
managing-icd-10-conversions-for-smaller-healthcare-providers/ ) insidePatientFinance.com, Nov. 13, 2012.
[17] "How Your Medical Practice Can Avoid ICD-10 Pitfalls" (http:/ / www. physicianspractice. com/ icd-10/ content/ article/ 1462168/
2075228) Marisa Torrieri, Physicians Practice, June 2012.
ICD-10 Procedure Coding System
551
ICD-10 Procedure Coding System
The ICD-10 Procedure Coding System (ICD-10-PCS) is an American system of medical classification used for
procedural coding. The Centers for Medicare and Medicaid Services, the agency responsible for maintaining the
inpatient procedure code set in the U.S., contracted with 3M Health Information Systems in 1993 to design and then
develop a procedure classification system to replace Volume 3 of ICD-9-CM. ICD-9-CM contains a procedure
classification; ICD-10-CM does not. ICD-10-PCS is the result. ICD-10-PCS was initially released in 1998. It has
been updated annually since that time.
Section structure
Each code consists of seven alphanumeric characters. The second through seventh characters mean the same thing
within each section, but may mean different things in other sections. Each character can be any of 34 possible values
the ten digits 0-9 and the 24 letters A-H,J-N and P-Z may be used in each character. The letters O and I excluded to
avoid confusion with the numbers 0 and 1. There are no decimals in ICD-10-PCS
Of the 72,081 codes in ICD-10-PCS, 62,022 are in the first section, "Medical and surgical".
[1]
Character 1 Character 2 Character 3 Character 4 Character 5 Character
6
Character
7
0
[2]
Medical
and Surgical
Body System
00
[3]
0 Central nervous system; 01
[4]
Peripheral nervous system; 02
[5]
Heart and Great vessels; 03
[6]
Upper
arteries; 04
[7]
4 Lower arteries; 05
[8]
Upper veins; 06
[9]
Lower veins;
07
[10]
Lymphatic and Hemic
system; 08
[11]
Eye; 09
[12]
Ear,
Nose, Sinus; 0B
[13]
Respiratory
System; 0C
[14]
Mouth and Throat;
0D
[15]
Gastrointestinal system; 0F
[16]
Hepatobiliary System and
Pancreas; 0G
[17]
Endocrine system;
0H
[18]
Skin and Breast; 0J
[19]
Subcutaneous tissue; 0K
[20]
Muscles; 0L
[21]
Tendons; 0M
[22]
Bursae and Ligaments; 0N
[23]
Head
and Facial bones; 0P
[24]
Upper
bones; 0Q
[25]
Lower bones; 0R
[26]
Upper joints; 0S
[27]
Lower joints;
0T
[28]
Urinary system; 0U
[29]
female reproductive system; 0V
[30]
Male reproductive system; 0W
[31]
Anatomical regions, General; 0X
[32]
Anatomical regions, Upper
extremities; 0Y
[33]
Anatomical
regions, Lower extremities
Root Operation
see below
Body Part Approach
0 Open; 3
Percutaneous; 4
Percutaneous
Endoscopic; 7 Via
Natural or
Artificial Opening;
8 Via Natural or
Artificial Opening
Endoscopic; F Via
Natural or
Artificial Opening
Endoscopic with
Percutaneous
Endoscopic
Assistance; X
External
Device Qualifier
ICD-10 Procedure Coding System
552
1
[34]
Obstetrics
10
[35]
Pregnancy
102 Change; 109
Drainage; 10A Abortion;
10D Extraction; 10E
Delivery; 10H Insertion;
10J Inspection; 10P
Removal; 10Q Repair;
10S Reposition; 10T
Resection; 10Y
Transplantation
Body Part Approach Device Qualifier
2
[36]
Placement
2W
[37]
Anatomical Regions; 2Y
[38]
Anatomical Orifices
Root Operation
2?0 Change; 2?1
Compression; 2?2
Dressing; 2?3
Immobilization; 2?4
Packing; 2?5 Removal;
2?6 Traction
Body
Region/Orifice
Approach Device Qualifier
3
[39]
Administration
30
[40]
Circulatory; 3C
[41]
Indwelling Device; 3E
[42]
Physiological Systems and
Anatomical Regions
Root Operation Body
System/Region
Approach Substance Qualifier
4
[43]
Measurement
and Monitoring
4A
[44]
Physiological Systems; 4B
[45]
Physiological Devices
Root Operation Body System Approach Function Qualifier
5
[46]
Extracorporeal
Assistance and
Performance
5A
[47]
Physiological Systems
Root Operation Body System Duration Function Qualifier
6
[48]
Extracorporeal
Therapies
6A
[49]
Physiological Systems Root Operation
6A0
[50]
Atmospheric
control; 6A1
[51]
Decompression; 6A2
[52]
Electromagnetic therapy;
6A3
[53]
Hyperthermia;
6A4
[54]
Hypothermia;
6A5
[55]
Pheresis; 6A6
[56]
Phototherapy; 6A7
[57]
Ultrasound therapy;
6A8
[58]
Ultraviolet light
therapy; 6A9
[59]
Shock
wave therapy
Body System Duration Qualifier Qualifier
7
[60]
Osteopathic
7W
[61]
7W0
[62]
Body Region Approach Method Qualifier
8
[63]
Other
Procedures
8C
[64]
Indwelling Device; 8E
[65]
Physiological Systems and
Anatomical Regions
Root Operation Body Region Approach Method Qualifier
9
[66]
Chiropractic
9W
[67]
9WB
[68]
Body Region Approach Method Qualifier
ICD-10 Procedure Coding System
553
B
[69]
Imaging
Body System
0 Central Nervous System; 2 Heart; 3
Upper Arteries; 4 Lower Arteries; 5
Veins; 7 Lymphatic System; 8 Eye; 9
Ear, Nose, Mouth and Throat; B
Respiratory System; D
Gastrointestinal System; F
Hepatobiliary System and Pancreas;
G Endocrine System; H Skin,
Subcutaneous Tissue and Breast; L
Connective Tissue; N Skull and
Facial Bones; P Non-Axial Upper
Bones; Q Non-Axial Lower Bones; R
Axial Skeleton, Except Skull and
Facial Bones; T Urinary System; U
Female Reproductive System; V
Male Reproductive System; W
Anatomical Regions; Y Fetus and
Obstetrical
Root Type Body Part Contrast
0=high osmolar
contrast; 1=low
osmolar contrast;
z=other contrast
Qualifier Qualifier
C
[70]
Nuclear
medicine
Body System
0 Central Nervous System; 2 Heart; 5
Veins; 7 Lymphatic and Hematologic
System; 8 Eye; 9 Ear, Nose, Mouth
and Throat; B Respiratory System; D
Gastrointestinal System; F
Hepatobiliary System and Pancreas;
G Endocrine System; H Skin,
Subcutaneous Tissue and Breast; P
Musculoskeletal System; T Urinary
System; V Male Reproductive
System; W Anatomical Regions
Root Type Body Part Radionuclide Qualifier Qualifier
D
[71]
Radiation
oncology
Body System
0 Central and Peripheral Nervous
System; 7 Lymphatic and
Hematologic System; 8 Eye; 9 Ear,
Nose, Mouth and Throat; B
Respiratory System; D
Gastrointestinal System; F
Hepatobiliary System and Pancreas;
G Endocrine System; H Skin; M
Breast; P Musculoskeletal System; T
Urinary System; U Female
Reproductive System; V Male
Reproductive System; W Anatomical
Regions
Root Type Body Part Modality Qualifier Isotope Qualifier
F
[72]
Physical
rehabilitation
and Diagnostic
Audiology
F0
[73]
Rehabilitation; F1
[74]
Diagnostic Audiology
Root Type Body System
& Region
Type Qualifier Equipment Qualifier
ICD-10 Procedure Coding System
554
G
[75]
Mental
health
GZ
[76]
None Root Type
GZ1
[77]
Psychological
tests; GZ2
[78]
Crisis
intervention; GZ3
[79]
Medication management;
GZ5
[80]
Individual
psychotherapy; GZ6
[81]
Counseling; GZ7
[82]
Family psychotherapy;
GZB
[83]
Electroconvulsive
therapy; GZC
[84]
Biofeedback; GZF
[85]
Hypnosis; GZG
[86]
Narcosynthesis; GZH
[87]
Group
psychotherapy; GZJ
[88]
Light therapy
Type Qualifier Qualifier Qualifier Qualifier
H
[89]
Substance
abuse
Treatment
HZ
[90]
None
Root Type Type Qualifier Qualifier Qualifier Qualifier
Root operations
For medical/surgical, these are the root operation codes:
00 alteration; 01 bypass; 02 change; 03 control; 04 creation; 05 destruction; 06 detachment; 07 dilation; 08 division;
09 drainage; 0B excision; 0C extirpation; 0D extraction; 0F fragmentation; 0G fusion; 0H insertion; 0J inspection;
0K map; 0L occlusion; 0M reattachment; 0N release; 0P removal; 0Q repair; 0R replacement; 0S reposition; 0T
resection; 0U supplement ; 0V restriction; 0X transfer; 0Y transplantation
They can be grouped into several categories:
take out or eliminate all or a portion of a body part: excision (sigmoid polypectomy), resection (total
nephrectomy), extraction (toenail extraction), destruction (rectal polyp fulguration), detachment (below knee
amputation). For biopsies, "extraction" is used when force is required (as with endometrial biopsy), and
"excision" is used when minimal force is involved (as with liver biopsy). See also ectomy.
involve putting in or on, putting back, or moving living body part: transplantation (heart transplant), reattachment
(finger reattachment), reposition (reposition undescended testicle), transfer (tendon transfer)
take out or eliminate solid matter, fluids, or gases from a body part: drainage (incision and drainage), extirpation
(thrombectomy), fragmentation (lithotripsy of gallstones)
only involve examination of body parts and regions: inspection (diagnostic arthroscopy), map (cardiac mapping)
involve putting in or on, putting back, or moving living body part: bypass (gastrojejunal bypass), dilation
(coronary artery dilation), occlusion (fallopian tube ligation), restriction (cervical cerclage)
always involve devices: insertion (pacemaker insertion), replacement (total hip replacement), supplement
(herniorrhaphy using mesh), removal (cardiac pacemaker removal), change (drainage tube change), revision (hip
prosthesis adjustment)
involve cutting and separation only: division (osteotomy), release (peritoneal adhesiolysis)
involving other repair: control (control of postprostatectomy bleeding), repair (suture of laceration)
with other objectives: alteration (face lift), creation (artificial vagina creation), fusion (spinal fusion)
ICD-10 Procedure Coding System
555
Regions
Regions: 0 Head; 1 Cervical, 2 Thoracic, 3 Lumbar, 4 Sacrum, 5 Pelvis, 6 Lower extremities, 7 Upper extremities, 8
Rib cage, 9 Abdomen
References
[1] https:/ / www. cms.gov/ ICD10/ Downloads/ pcs_final_report2011. pdf
[2] http:/ / www. icd10data. com/ ICD10PCS/ Codes/ 0
[3] http:/ / www. icd10data. com/ ICD10PCS/ Codes/ 0/ 0
[4] http:/ / www. icd10data. com/ ICD10PCS/ Codes/ 0/ 1
[5] http:/ / www. icd10data. com/ ICD10PCS/ Codes/ 0/ 2
[6] http:/ / www. icd10data. com/ ICD10PCS/ Codes/ 0/ 3
[7] http:/ / www. icd10data. com/ ICD10PCS/ Codes/ 0/ 4
[8] http:/ / www. icd10data. com/ ICD10PCS/ Codes/ 0/ 5
[9] http:/ / www. icd10data. com/ ICD10PCS/ Codes/ 0/ 6
[10] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ 7
[11] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ 8
[12] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ 9
[13] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ B
[14] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ C
[15] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ D
[16] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ F
[17] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ G
[18] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ H
[19] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ J
[20] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ K
[21] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ L
[22] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ M
[23] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ N
[24] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ P
[25] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ Q
[26] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ R
[27] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ S
[28] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ T
[29] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ U
[30] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ V
[31] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ W
[32] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ X
[33] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 0/ Y
[34] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 1
[35] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 1/ 0
[36] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 2
[37] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 2/ W
[38] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 2/ Y
[39] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 3
[40] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 3/ 0
[41] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 3/ C
[42] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 3/ E
[43] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 4
[44] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 4/ A
[45] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 4/ B
[46] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 5
[47] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 5/ A
[48] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6
[49] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A
[50] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 0
[51] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 1
[52] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 2
ICD-10 Procedure Coding System
556
[53] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 3
[54] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 4
[55] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 5
[56] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 6
[57] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 7
[58] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 8
[59] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 6/ A/ 9
[60] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 7
[61] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 7/ W
[62] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 7/ W/ 0
[63] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 8
[64] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 8/ C
[65] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 8/ E
[66] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 9
[67] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 9/ W
[68] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ 9/ W/ B
[69] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ B
[70] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ C
[71] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ D
[72] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ F
[73] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ F/ 0
[74] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ F/ 1
[75] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G
[76] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z
[77] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ 1
[78] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ 2
[79] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ 3
[80] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ 5
[81] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ 6
[82] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ 7
[83] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ B
[84] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ C
[85] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ F
[86] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ G
[87] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ H
[88] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ G/ Z/ J
[89] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ H
[90] http:/ / www.icd10data. com/ ICD10PCS/ Codes/ H/ Z
External links
2011 ICD-10-PCS and GEMs (http:/ / www. cms. gov/ ICD10/ 11b_2011_ICD10PCS. asp)
ICD-10-PCS Code Browser (http:/ / www. findacode. com/ tools/ browse-a-code. php?set=ICD10PCS)
Browser (http:/ / www. icd10data. com/ ICD10PCS/ Codes)
Search Engine for ICD-10 PCS and ICD-10 WHO 2010 (http:/ / med-code. info/ ?country=us& locale=us)
International Classification of Diseases for Oncology
557
International Classification of Diseases for
Oncology
The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the
International Statistical Classification of Diseases and Related Health Problems for tumor diseases. This
classification is widely used by cancer registries.
It is currently in its third revision (ICD-O-3). ICD-10 includes a list of morphology codes. They stem from ICD-O
second edition (ICD-O-2) that was valid at the time of publication.
Axes
The classification has two axes: topography and morphology
Morphology
The morphology axis is for the morphology of the tumor.
This axis has particular importance because the Systematized Nomenclature of Medicine ("SNOMED") has adopted
the ICD-O classification of morphology. SNOMED has been changing continuously, and several different versions
of SNOMED are in use. Accordingly, mapping of ICD-O codes to SNOMED requires careful assessment of whether
entities are indeed true matches.
Examples of codes (ICD-O-3)
(80008009) Not otherwise specified
(80008004) Neoplasms, NOS
(M8000/0
[1]
) Neoplasm, benign
(M8000/1
[2]
) Neoplasm, uncertain whether benign or malignant
(M8000/3
[3]
) Neoplasm, malignant
(M8000/6
[4]
) Neoplasm, metastatic
(M8000/9
[5]
) Neoplasm, malignant, uncertain whether primary or metastatic
(80108790) Epithelial
(80108040) Epithelial neoplasms, NOS
(80508080) Squamous cell neoplasms
(M8070/3
[6]
) Squamous cell carcinoma, NOS
(80908110) Basal cell neoplasms
(M8090/3
[7]
) Basal cell carcinoma, NOS
(81208130) Transitional cell Papillomas And Carcinomas
(81408380) Adenomas And Adenocarcinomas (glands)
(M8140/0
[8]
) Adenoma, NOS
(M8140/3
[9]
) Adenocarcinoma, NOS
(M8142/3
[10]
) Linitis plastica
(M8151/0
[11]
) Insulinoma, NOS
(M8152/0
[12]
) Glucagonoma, NOS
(M8153/1
[13]
) Gastrinoma, NOS
(M8155/3
[14]
) Vipoma
International Classification of Diseases for Oncology
558
(M8160/3
[15]
) Cholangiocarcinoma
(M8170/3
[16]
) Hepatocellular carcinoma, NOS
(M8200/3
[17]
) Adenoid cystic carcinoma
(M8240/1
[18]
) Carcinoid tumor, NOS, of appendix
(M8271/0
[19]
) Prolactinoma
(M8290/0
[20]
) Oncocytoma
(M8290/0
[20]
) Hurthle cell adenoma
(M8312/3
[21]
) Renal cell carcinoma
(M8312/3
[21]
) Grawitz tumor
(M8360/1
[22]
) Multiple endocrine adenomas
(M8380/0
[23]
) Endometrioid adenoma, NOS
(83908420) Adnexal And Skin appendage Neoplasms
(84308439) Mucoepidermoid Neoplasms
(84408490) Cystic, Mucinous And Serous Neoplasms
(M8440/0
[24]
) Cystadenoma, NOS
(M8480/6
[25]
) Pseudomyxoma peritonei
(85008540) Ductal, Lobular And Medullary Neoplasms
(85508559) Acinar cell neoplasms
(85608580) Complex epithelial neoplasms
(M8561/0
[26]
) Warthin's tumor
(M8580/0
[27]
) Thymoma, NOS
(85908670) Specialized gonadal neoplasms
(M8590/1
[28]
) Sex cord-stromal tumor
(M8600/0
[29]
) Thecoma, NOS
(M8620/1
[30]
) Granulosa cell tumor, NOS
(M8630/1
[31]
) Arrhenoblastoma, NOS
(M8631/0
[32]
) Sertoli-Leydig cell tumor
(86808710) Paragangliomas And Glomus tumors
(M8680/1
[33]
) Paraganglioma, NOS
(M8700/0
[34]
) Pheochromocytoma, NOS
(M8711/0
[35]
) Glomus tumor
(87208790) Nevi And Melanomas
(M8720/0
[36]
) Melanocytic nevus
(M8720/3
[37]
) Malignant melanoma, NOS
(M8720/3
[37]
) Melanoma, NOS
(M8721/3
[38]
) Nodular melanoma
(M8727/0
[39]
) Dysplastic nevus
(M8742/3
[40]
) Lentigo maligna melanoma
(M8743/3
[41]
) Superficial spreading melanoma
(M8744/3
[42]
) Acral lentiginous melanoma, malignant
(M8745/3
[43]
) Melanoma, desmoplastic, amelanotic
International Classification of Diseases for Oncology
559
(88009370) Connective tissue
(88008809) Soft tissue Tumors And Sarcomas, Nos
(M8800/3
[44]
) Sarcoma, NOS
(M8800/3
[44]
) Soft tissue sarcoma
(M8806/3
[45]
) Desmoplastic small round cell tumor
(88108830) Fibromatous neoplasms
(M8810/0
[46]
) Fibroma, NOS
(M8810/3
[47]
) Fibrosarcoma, NOS
(88408849) Myxomatous neoplasms
(M8840/0
[48]
) Myxoma, NOS
(88508880) Lipomatous neoplasms
(M8850/0
[49]
) Lipoma, NOS
(M8850/3
[50]
) Liposarcoma, NOS
(88908920) Myomatous neoplasms
(M8890/0
[51]
) Leiomyoma, NOS
(M8890/3
[52]
) Leiomyosarcoma, NOS
(M8895/0
[53]
) Myoma
(M8895/3
[54]
) Myosarcoma
(M8900/0
[55]
) Rhabdomyoma, NOS
(M8900/3
[56]
) Rhabdomyosarcoma, NOS
(89308990) Complex Mixed And Stromal Neoplasms
(M8940/0
[57]
) Pleomorphic adenoma
(M8960/3
[58]
) Nephroblastoma, NOS (Wilms's tumor)
(90009030) Fibroepithelial Neoplasms
(M9000/0
[59]
) Brenner tumor, NOS
(90409049) Synovial-Like Neoplasms
(M9040/3
[60]
) Synovial sarcoma, NOS
(90509059) Mesothelial Neoplasms
(M9050/0
[61]
) Mesothelioma, benign
(M9050/3
[62]
) Mesothelioma, NOS
(90609090) Germ cell Neoplasms
(M9060/3
[63]
) Dysgerminoma
(M9064/3
[64]
) Germ cell tumor, NOS
(M9070/3
[65]
) Embryonal carcinoma, NOS
(M9071/3
[66]
) Yolk sac tumor
(M9080/0
[67]
) Teratoma, benign
(M9080/3
[68]
) Teratoma, malignant, NOS
(M9084/0
[69]
) Dermoid cyst, NOS
(91009109) Trophoblastic neoplasms
(M9100/3
[70]
) Choriocarcinoma, NOS
(91109119) Mesonephromas
(91209160) Blood vessel tumors
(M9120/0
[71]
) Hemangioma, NOS
(M9120/0
[71]
) Angioma, NOS
(M9120/3
[72]
) Hemangiosarcoma
International Classification of Diseases for Oncology
560
(M9120/3
[72]
) Angiosarcoma
(M9130/0
[73]
) Hemangioendothelioma, benign
(M9130/1
[74]
) Hemangioendothelioma, NOS
(M9140/3
[75]
) Kaposi's sarcoma
(M9150/0
[76]
) Hemangiopericytoma, benign
(M9150/1
[77]
) Hemangiopericytoma, NOS
(91709179) Lymphatic vessel tumors
(M9170/0
[78]
) Lymphangioma, NOS
(M9173/0
[79]
) Cystic lymphangioma
(91809240) Osseous And Chondromatous neoplasms
(M9180/0
[80]
) Osteoma, NOS
(M9180/3
[81]
) Osteosarcoma, NOS
(M9210/0
[82]
) Osteochondroma
(M9210/0
[82]
) Cartilaginous exostosis
(M9220/0
[83]
) Chondroma, NOS
(M9220/3
[84]
) Chondrosarcoma, NOS
(92509259) Giant cell tumors
(92609269) Miscellaneous bone tumors
(M9260/3
[85]
) Ewing's sarcoma
(92709340) Odontogenic tumors
(M9273/0
[86]
) Cementoblastoma, benign
(M9310/0
[87]
) Ameloblastoma, NOS
(93509370) Miscellaneous tumors
(M9350/1
[88]
) Craniopharyngioma
(93809589) Nervous system
(93809480) Gliomas
(M9382/3
[89]
) Mixed oligoastrocytoma
(M9391/3
[90]
) Ependymoma, NOS
(M9400/3
[91]
) Astrocytoma, NOS
(9421/3) Pilocytic astrocytoma
(9440/3) Glioblastoma multiforme
(M9450/3
[92]
) Oligodendroglioma, NOS
(94909520) Neuroepitheliomatous neoplasms
(M9500/3
[93]
) Neuroblastoma, NOS
(M9510/3
[94]
) Retinoblastoma
(95309539) Meningiomas
(95409570) Nerve sheath tumors
(M9540/0
[95]
) Neurofibroma, NOS
(M9540/1
[96]
) Neurofibromatosis, NOS
(M9560/0
[97]
) Schwannoma, NOS
(M9560/0
[97]
) Neurinoma
(M9560/0
[97]
) Acoustic neuroma
(M9570/0
[98]
) Neuroma, NOS
(95809589) Granular cell tumors and Alveolar soft part sarcoma
International Classification of Diseases for Oncology
561
(95909999) Hematologic (Leukemias, Lymphomas and related disorders)
(95909599) Malignant lymphoma, NOS, Or diffuse
(M9590/3
[99]
) Lymphoma, NOS
(M9591/3
[100]
) Non-Hodgkin's lymphoma, NOS
(M9592/3
[101]
) Lymphosarcoma, NOS
(96509660) Hodgkin's disease
(M9650/3
[102]
) Hodgkin's disease, NOS
(M9651/3
[103]
) Lymphocyte-rich classical Hodgkin lymphoma
(M9652/3
[104]
) Mixed cellularity classical Hodgkin lymphoma
(M9653/3
[105]
) Lymphocyte-depleted classical Hodgkin lymphoma
(M9659/3
[106]
) Nodular lymphocyte predominant Hodgkin lymphoma
(M9663/3
[107]
) Nodular sclerosis classical Hodgkin lymphoma
(96709680) Malignant lymphoma Specified Type, Diffuse Or Nos
(M9670/3
[108]
) Small lymphocytic lymphoma
(M9671/3
[109]
) Lymphoplasmacytic lymphoma
(M9673/3
[110]
) Mantle cell lymphoma
(M9678/3
[111]
) Primary effusion lymphoma
(M9679/3
[112]
) Mediastinal (thymic) large cell lymphoma
(M9680/3
[113]
) Diffuse large B-cell lymphoma or Intravascular large B-cell lymphoma
(M9687/3
[114]
) Burkitt lymphoma
(M9689/3
[115]
) Splenic marginal zone lymphoma
(96909699) Malignant lymphoma, Follicular Or Nodular, With Or Without diffuse areas
(M9690/3
[116]
) Follicular lymphoma
(M9698/3
[117]
) Follicular lymphoma
(M9699/3
[118]
) Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
(MALT-lymphoma)
(M9699/3
[118]
) Nodal marginal zone B-cell lymphoma
(97009709) Specified Cutaneous And Peripheral T-Cell Lymphomas
(M9700/3
[119]
) Mycosis fungoides
(M9701/3
[120]
) Sezary syndrome
(M9702/3
[121]
) Peripheral T-cell lymphoma, unspecified
(M9705/3
[122]
) Angioimmunoblastic T-cell lymphoma
(M9708/3
[123]
) Subcutaneous panniculitis-like T-cell lymphoma
(97109719) Other Specified Non-Hodgkin's lymphomas
(M9714/3
[124]
) Anaplastic large cell lymphoma
(M9716/3
[125]
) Hepatosplenic T-cell lymphoma
(M9717/3
[126]
) Enteropathy type T-cell lymphoma
(M9718/1
[127]
) Lymphomatoid papulosis
(M9718/3
[128]
) Primary cutaneous anaplastic large cell lymphoma
(M9719/3
[129]
) Extranodal NK/T cell lymphoma, nasal type
(97209729) Other Lymphoreticular neoplasms
(M9727/3
[130]
) Blastic NK cell lymphoma
(M9728/3
[131]
) Lymphoma
(M9729/3
[132]
) Lymphoma
(97309739) Plasma cell tumors
International Classification of Diseases for Oncology
562
(M9731/3
[133]
) Plasmacytoma, NOS or Extramedullary plasmacytoma or Solitary plasmacytoma of bone
(M9732/3
[134]
) Multiple myeloma or Plasma cell myeloma
(M9734/3
[135]
) Extraosseous plasmacytoma
(97409749) Mast cell Tumors
(M9740/1
[136]
) Mastocytoma, NOS or Extracutaneous mastocytoma
(M9740/3
[137]
) Mast cell sarcoma
(M9741/1
[138]
) Malignant mastocytosis or Indolent systemic mastocytosis
(M9741/3
[139]
) Aggressive systemic mastocytosis or Systemic mastocytosis with associated clonal,
hematological non-mast cell lineage disease
(M9742/3
[140]
) Mast cell leukemia
(M9751/1
[141]
) Langerhans cell histiocytosis
(M9755/3
[142]
) Histiocytic sarcoma
(M9756/3
[143]
) Langerhans cell sarcoma
(M9757/3
[144]
) Dendritic cell sarcoma, NOS or Interdigitating dendritic cell sarcoma/tumor
(M9758/3
[145]
) Follicular dendritic cell sarcoma/tumor
(97609769) Immunoproliferative diseases
(M9761/3
[146]
) Waldenstrom macroglobulinemia
(M9766/1
[147]
) Lymphomatoid granulomatosis
-- Lymphoid leukemias, and related conditions
(98009809) Leukemias, NOS
(M9800/3
[148]
) Leukemia, NOS
(M9805/3
[149]
) Acute leukemia of ambiguous lineage
(M9801/3
[150]
) Acute leukemia, NOS
(98209829) Lymphoid leukemias
(M9820/3
[151]
) Lymphocytic leukemia, NOS
(M9820/3
[151]
) Lymphatic leukemia, NOS
(M9821/3
[152]
) Acute lymphoblastic leukemia, NOS
(M9821/3
[152]
) Acute lymphocytic leukemia
(M9823/3
[153]
) Chronic lymphocytic leukemia
(M9826/3
[154]
) Leukemia
(M9827/3
[155]
) Adult T-cell leukemia/lymphoma
(98309839) Plasma cell leukemia
(M9831/3
[156]
) T-cell large granular lymphocytic leukemia
(M9833/3
[157]
) B-cell prolymphocytic leukemia
(M9834/3
[158]
) T-cell prolymphocytic leukemia
(M9835/3
[159]
) Precursor cell lymphoblastic leukemia, NOS
(M9836/3
[160]
) Precursor B lymphoblastic leukemia
(M9837/3
[161]
) Precursor T lymphoblastic leukemia
International Classification of Diseases for Oncology
563
-- Myeloid leukemias, and related conditions
(98409849) Erythroleukemias (FAB-M6)
(M9840/3
[162]
) Acute erythroid leukemia
(98509859) Lymphosarcoma cell leukemia
(98609869) Myeloid (Granulocytic) Leukemias
(M9860/3
[163]
) Myeloid leukemia, NOS
(M9860/3
[163]
) Myelogenous leukemia, NOS
(M9861/3
[164]
) Acute myelogenous leukemia (FAB-M1,M2)
(M9863/3
[165]
) Chronic myelogenous leukemia
(M9866/3
[166]
) Acute promyelocytic leukemia (FAB-M3)
(M9866/3
[166]
) Acute promyelocytic leukemia (AML with t(15;17)(q22;q12), PML-RARa and variants)
(M9867/3
[167]
) Acute myelomonocytic leukemia (FAB-M4)
(98709889) Basophilic leukemia and Eosinophilic leukemia
(M9870/3
[168]
) Basophilic leukemia or Acute basophilic leukemia
(M9871/3
[169]
) AML with inv(16)(p13q22) or t(16;16)(p13;q22), CBFb/MYH11 (FAB M4Eo)
(M9872/3
[170]
) Acute myeloid leukemia, minimally differentiated (FAB type M0)
(M9873/3
[171]
) Acute myeloid leukemia, without maturation (FAB type M1)
(M9874/3
[172]
) Acute myeloid leukemia, with maturation (FAB M2)
(M9875/3
[173]
) Chronic myelogenous leukemia
(M9876/3
[174]
) Atypical chronic myelogenous leukemia
(M9880/3
[175]
) Eosinophilic leukemia
(98909899) Monocytic leukemias
(M9890/3
[176]
) Monocytic leukemia, NOS (FAB-M5)
(M9891/3
[177]
) Acute monoblastic and monocytic leukemia (FAB M5)
(M9895/3
[178]
) Acute myeloid leukemia multilineage dysplasia
(M9896/3
[179]
) AML with t(8;21)(q22;q22), AML1/ETO
(M9897/3
[180]
) AML with 11q23 (MLL) abnormalities
(99009948) Other Leukemias
(M9910/3
[181]
) Acute megakaryoblastic leukemia (FAB-M7)
(M9920/3
[182]
) Acute myeloid leukemia and myelodysplastic syndrome, therapy related
(M9930/3
[183]
) Chloroma or Myeloid sarcoma
(M9931/3
[184]
) Acute panmyelosis with myelofibrosis
(M9940/3
[185]
) Hairy cell leukemia
(M9946/3
[186]
) Juvenile myelomonocytic leukemia
(M9948/3
[187]
) Aggressive NK cell leukemia
-- Other
(99509970) Miscellaneous Myeloproliferative And Lymphoproliferative disorders
(M9950/3
[188]
) Polycythemia vera
(M9960/1
[189]
) Myeloproliferative disease, NOS
(M9961/3
[190]
) Chronic idiopathic myelofibrosis
(M9962/3
[191]
) Essential thrombocytemia
(M9963/3
[192]
) Chronic neutrophilic leukemia
(M9964/3
[193]
) Chronic eosinophilic leukemia / hypereosinophilic syndrome
(M9970/1
[194]
) Post-transplant lymphoproliferative disorder, pleomorphic
(M9975/3
[195]
) Chronic Myeloproliferative disease, unclassifiable
International Classification of Diseases for Oncology
564
(M9975/3
[195]
) Myelodysplastic / myeloproliferative diseases, unclassifiable
(99809989) Myelodysplastic syndrome
(M9980/3
[196]
) Chronic myelomonocytic leukemia or Refractory anemia
(M9982/3
[197]
) Refractory anemia with ringed sideroblasts
(M9983/3
[198]
) Refractory anemia with excess blasts
(M9985/3
[199]
) Refractory cytopenia with multilineage dysplasia
(M9986/3
[200]
) Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality
(M9989/3
[201]
) Myelodysplastic syndrome, NOS
Topography
The topography axis is for the topographical codes of the tumor's site. It is standardized with the C section of ICD-10
There were no changes in the topography axis between ICD-O-2 and ICD-O-3.
See List of ICD-10 codes#(C00C97) Malignant Neoplasms for examples.
External links
Official page
[202]
at World Health Organization
Tutorial
[203]
at National Cancer Institute
Overview
[204]
at DIMDI
Overview of multiple primaries
[205]
at healthyarkansas.com (PPT)
History of versions
[206]
at National Cancer Institute
Morphology
Cancer.gov overview
[207]
, includes link to Excel spreadsheet with codes
[208]
at National Cancer Institute
Overview
[209]
at National Cancer Institute
Word document malignancies only
[210]
at National Cancer Institute
Overview
[211]
at University hospital Gieen und Marburg
Download table German version
[212]
at DIMDI
Codes
[213]
at IARC
1st, 2nd, and 3rd editions
[214]
at wolfbane.com
List
[215]
at The National Cancer Registry Ireland
List
[216]
at London School of Hygiene & Tropical Medicine
References
[1] http:/ / www. progenetix. net/ progenetix/ I80000/
[2] http:/ / www. progenetix. net/ progenetix/ I80001/
[3] http:/ / www. progenetix. net/ progenetix/ I80003/
[4] http:/ / www. progenetix. net/ progenetix/ I80006/
[5] http:/ / www. progenetix. net/ progenetix/ I80009/
[6] http:/ / www. progenetix. net/ progenetix/ I80703/
[7] http:/ / www. progenetix. net/ progenetix/ I80903/
[8] http:/ / www. progenetix. net/ progenetix/ I81400/
[9] http:/ / www. progenetix. net/ progenetix/ I81403/
[10] http:/ / www.progenetix. net/ progenetix/ I81423/
[11] http:/ / www.progenetix. net/ progenetix/ I81510/
[12] http:/ / www.progenetix. net/ progenetix/ I81520/
[13] http:/ / www.progenetix. net/ progenetix/ I81531/
[14] http:/ / www.progenetix. net/ progenetix/ I81553/
[15] http:/ / www.progenetix. net/ progenetix/ I81603/
International Classification of Diseases for Oncology
565
[16] http:/ / www.progenetix. net/ progenetix/ I81703/
[17] http:/ / www.progenetix. net/ progenetix/ I82003/
[18] http:/ / www.progenetix. net/ progenetix/ I82401/
[19] http:/ / www.progenetix. net/ progenetix/ I82710/
[20] http:/ / www.progenetix. net/ progenetix/ I82900/
[21] http:/ / www.progenetix. net/ progenetix/ I83123/
[22] http:/ / www.progenetix. net/ progenetix/ I83601/
[23] http:/ / www.progenetix. net/ progenetix/ I83800/
[24] http:/ / www.progenetix. net/ progenetix/ I84400/
[25] http:/ / www.progenetix. net/ progenetix/ I84806/
[26] http:/ / www.progenetix. net/ progenetix/ I85610/
[27] http:/ / www.progenetix. net/ progenetix/ I85800/
[28] http:/ / www.progenetix. net/ progenetix/ I85901/
[29] http:/ / www.progenetix. net/ progenetix/ I86000/
[30] http:/ / www.progenetix. net/ progenetix/ I86201/
[31] http:/ / www.progenetix. net/ progenetix/ I86301/
[32] http:/ / www.progenetix. net/ progenetix/ I86310/
[33] http:/ / www.progenetix. net/ progenetix/ I86801/
[34] http:/ / www.progenetix. net/ progenetix/ I87000/
[35] http:/ / www.progenetix. net/ progenetix/ I87110/
[36] http:/ / www.progenetix. net/ progenetix/ I87200/
[37] http:/ / www.progenetix. net/ progenetix/ I87203/
[38] http:/ / www.progenetix. net/ progenetix/ I87213/
[39] http:/ / www.progenetix. net/ progenetix/ I87270/
[40] http:/ / www.progenetix. net/ progenetix/ I87423/
[41] http:/ / www.progenetix. net/ progenetix/ I87433/
[42] http:/ / www.progenetix. net/ progenetix/ I87443/
[43] http:/ / www.progenetix. net/ progenetix/ I87453/
[44] http:/ / www.progenetix. net/ progenetix/ I88003/
[45] http:/ / www.progenetix. net/ progenetix/ I88063/
[46] http:/ / www.progenetix. net/ progenetix/ I88100/
[47] http:/ / www.progenetix. net/ progenetix/ I88103/
[48] http:/ / www.progenetix. net/ progenetix/ I88400/
[49] http:/ / www.progenetix. net/ progenetix/ I88500/
[50] http:/ / www.progenetix. net/ progenetix/ I88503/
[51] http:/ / www.progenetix. net/ progenetix/ I88900/
[52] http:/ / www.progenetix. net/ progenetix/ I88903/
[53] http:/ / www.progenetix. net/ progenetix/ I88950/
[54] http:/ / www.progenetix. net/ progenetix/ I88953/
[55] http:/ / www.progenetix. net/ progenetix/ I89000/
[56] http:/ / www.progenetix. net/ progenetix/ I89003/
[57] http:/ / www.progenetix. net/ progenetix/ I89400/
[58] http:/ / www.progenetix. net/ progenetix/ I89603/
[59] http:/ / www.progenetix. net/ progenetix/ I90000/
[60] http:/ / www.progenetix. net/ progenetix/ I90403/
[61] http:/ / www.progenetix. net/ progenetix/ I90500/
[62] http:/ / www.progenetix. net/ progenetix/ I90503/
[63] http:/ / www.progenetix. net/ progenetix/ I90603/
[64] http:/ / www.progenetix. net/ progenetix/ I90643/
[65] http:/ / www.progenetix. net/ progenetix/ I90703/
[66] http:/ / www.progenetix. net/ progenetix/ I90713/
[67] http:/ / www.progenetix. net/ progenetix/ I90800/
[68] http:/ / www.progenetix. net/ progenetix/ I90803/
[69] http:/ / www.progenetix. net/ progenetix/ I90840/
[70] http:/ / www.progenetix. net/ progenetix/ I91003/
[71] http:/ / www.progenetix. net/ progenetix/ I91200/
[72] http:/ / www.progenetix. net/ progenetix/ I91203/
[73] http:/ / www.progenetix. net/ progenetix/ I91300/
[74] http:/ / www.progenetix. net/ progenetix/ I91301/
International Classification of Diseases for Oncology
566
[75] http:/ / www.progenetix. net/ progenetix/ I91403/
[76] http:/ / www.progenetix. net/ progenetix/ I91500/
[77] http:/ / www.progenetix. net/ progenetix/ I91501/
[78] http:/ / www.progenetix. net/ progenetix/ I91700/
[79] http:/ / www.progenetix. net/ progenetix/ I91730/
[80] http:/ / www.progenetix. net/ progenetix/ I91800/
[81] http:/ / www.progenetix. net/ progenetix/ I91803/
[82] http:/ / www.progenetix. net/ progenetix/ I92100/
[83] http:/ / www.progenetix. net/ progenetix/ I92200/
[84] http:/ / www.progenetix. net/ progenetix/ I92203/
[85] http:/ / www.progenetix. net/ progenetix/ I92603/
[86] http:/ / www.progenetix. net/ progenetix/ I92730/
[87] http:/ / www.progenetix. net/ progenetix/ I93100/
[88] http:/ / www.progenetix. net/ progenetix/ I93501/
[89] http:/ / www.progenetix. net/ progenetix/ I93823/
[90] http:/ / www.progenetix. net/ progenetix/ I93913/
[91] http:/ / www.progenetix. net/ progenetix/ I94003/
[92] http:/ / www.progenetix. net/ progenetix/ I94503/
[93] http:/ / www.progenetix. net/ progenetix/ I95003/
[94] http:/ / www.progenetix. net/ progenetix/ I95103/
[95] http:/ / www.progenetix. net/ progenetix/ I95400/
[96] http:/ / www.progenetix. net/ progenetix/ I95401/
[97] http:/ / www.progenetix. net/ progenetix/ I95600/
[98] http:/ / www.progenetix. net/ progenetix/ I95700/
[99] http:/ / www.progenetix. net/ progenetix/ I95903/
[100] http:/ / www.progenetix. net/ progenetix/ I95913/
[101] http:/ / www.progenetix. net/ progenetix/ I95923/
[102] http:/ / www.progenetix. net/ progenetix/ I96503/
[103] http:/ / www.progenetix. net/ progenetix/ I96513/
[104] http:/ / www.progenetix. net/ progenetix/ I96523/
[105] http:/ / www.progenetix. net/ progenetix/ I96533/
[106] http:/ / www.progenetix. net/ progenetix/ I96593/
[107] http:/ / www.progenetix. net/ progenetix/ I96633/
[108] http:/ / www.progenetix. net/ progenetix/ I96703/
[109] http:/ / www.progenetix. net/ progenetix/ I96713/
[110] http:/ / www.progenetix. net/ progenetix/ I96733/
[111] http:/ / www.progenetix. net/ progenetix/ I96783/
[112] http:/ / www.progenetix. net/ progenetix/ I96793/
[113] http:/ / www.progenetix. net/ progenetix/ I96803/
[114] http:/ / www.progenetix. net/ progenetix/ I96873/
[115] http:/ / www.progenetix. net/ progenetix/ I96893/
[116] http:/ / www.progenetix. net/ progenetix/ I96903/
[117] http:/ / www.progenetix. net/ progenetix/ I96983/
[118] http:/ / www.progenetix. net/ progenetix/ I96993/
[119] http:/ / www.progenetix. net/ progenetix/ I97003/
[120] http:/ / www.progenetix. net/ progenetix/ I97013/
[121] http:/ / www.progenetix. net/ progenetix/ I97023/
[122] http:/ / www.progenetix. net/ progenetix/ I97053/
[123] http:/ / www.progenetix. net/ progenetix/ I97083/
[124] http:/ / www.progenetix. net/ progenetix/ I97143/
[125] http:/ / www.progenetix. net/ progenetix/ I97163/
[126] http:/ / www.progenetix. net/ progenetix/ I97173/
[127] http:/ / www.progenetix. net/ progenetix/ I97181/
[128] http:/ / www.progenetix. net/ progenetix/ I97183/
[129] http:/ / www.progenetix. net/ progenetix/ I97193/
[130] http:/ / www.progenetix. net/ progenetix/ I97273/
[131] http:/ / www.progenetix. net/ progenetix/ I97283/
[132] http:/ / www.progenetix. net/ progenetix/ I97293/
[133] http:/ / www.progenetix. net/ progenetix/ I97313/
International Classification of Diseases for Oncology
567
[134] http:/ / www.progenetix. net/ progenetix/ I97323/
[135] http:/ / www.progenetix. net/ progenetix/ I97343/
[136] http:/ / www.progenetix. net/ progenetix/ I97401/
[137] http:/ / www.progenetix. net/ progenetix/ I97403/
[138] http:/ / www.progenetix. net/ progenetix/ I97411/
[139] http:/ / www.progenetix. net/ progenetix/ I97413/
[140] http:/ / www.progenetix. net/ progenetix/ I97423/
[141] http:/ / www.progenetix. net/ progenetix/ I97511/
[142] http:/ / www.progenetix. net/ progenetix/ I97553/
[143] http:/ / www.progenetix. net/ progenetix/ I97563/
[144] http:/ / www.progenetix. net/ progenetix/ I97573/
[145] http:/ / www.progenetix. net/ progenetix/ I97583/
[146] http:/ / www.progenetix. net/ progenetix/ I97613/
[147] http:/ / www.progenetix. net/ progenetix/ I97661/
[148] http:/ / www.progenetix. net/ progenetix/ I98003/
[149] http:/ / www.progenetix. net/ progenetix/ I98053/
[150] http:/ / www.progenetix. net/ progenetix/ I98013/
[151] http:/ / www.progenetix. net/ progenetix/ I98203/
[152] http:/ / www.progenetix. net/ progenetix/ I98213/
[153] http:/ / www.progenetix. net/ progenetix/ I98233/
[154] http:/ / www.progenetix. net/ progenetix/ I98263/
[155] http:/ / www.progenetix. net/ progenetix/ I98273/
[156] http:/ / www.progenetix. net/ progenetix/ I98313/
[157] http:/ / www.progenetix. net/ progenetix/ I98333/
[158] http:/ / www.progenetix. net/ progenetix/ I98343/
[159] http:/ / www.progenetix. net/ progenetix/ I98353/
[160] http:/ / www.progenetix. net/ progenetix/ I98363/
[161] http:/ / www.progenetix. net/ progenetix/ I98373/
[162] http:/ / www.progenetix. net/ progenetix/ I98403/
[163] http:/ / www.progenetix. net/ progenetix/ I98603/
[164] http:/ / www.progenetix. net/ progenetix/ I98613/
[165] http:/ / www.progenetix. net/ progenetix/ I98633/
[166] http:/ / www.progenetix. net/ progenetix/ I98663/
[167] http:/ / www.progenetix. net/ progenetix/ I98673/
[168] http:/ / www.progenetix. net/ progenetix/ I98703/
[169] http:/ / www.progenetix. net/ progenetix/ I98713/
[170] http:/ / www.progenetix. net/ progenetix/ I98723/
[171] http:/ / www.progenetix. net/ progenetix/ I98733/
[172] http:/ / www.progenetix. net/ progenetix/ I98743/
[173] http:/ / www.progenetix. net/ progenetix/ I98753/
[174] http:/ / www.progenetix. net/ progenetix/ I98763/
[175] http:/ / www.progenetix. net/ progenetix/ I98803/
[176] http:/ / www.progenetix. net/ progenetix/ I98903/
[177] http:/ / www.progenetix. net/ progenetix/ I98913/
[178] http:/ / www.progenetix. net/ progenetix/ I98953/
[179] http:/ / www.progenetix. net/ progenetix/ I98963/
[180] http:/ / www.progenetix. net/ progenetix/ I98973/
[181] http:/ / www.progenetix. net/ progenetix/ I99103/
[182] http:/ / www.progenetix. net/ progenetix/ I99203/
[183] http:/ / www.progenetix. net/ progenetix/ I99303/
[184] http:/ / www.progenetix. net/ progenetix/ I99313/
[185] http:/ / www.progenetix. net/ progenetix/ I99403/
[186] http:/ / www.progenetix. net/ progenetix/ I99463/
[187] http:/ / www.progenetix. net/ progenetix/ I99483/
[188] http:/ / www.progenetix. net/ progenetix/ I99503/
[189] http:/ / www.progenetix. net/ progenetix/ I99601/
[190] http:/ / www.progenetix. net/ progenetix/ I99613/
[191] http:/ / www.progenetix. net/ progenetix/ I99623/
[192] http:/ / www.progenetix. net/ progenetix/ I99633/
International Classification of Diseases for Oncology
568
[193] http:/ / www.progenetix. net/ progenetix/ I99643/
[194] http:/ / www.progenetix. net/ progenetix/ I99701/
[195] http:/ / www.progenetix. net/ progenetix/ I99753/
[196] http:/ / www.progenetix. net/ progenetix/ I99803/
[197] http:/ / www.progenetix. net/ progenetix/ I99823/
[198] http:/ / www.progenetix. net/ progenetix/ I99833/
[199] http:/ / www.progenetix. net/ progenetix/ I99853/
[200] http:/ / www.progenetix. net/ progenetix/ I99863/
[201] http:/ / www.progenetix. net/ progenetix/ I99893/
[202] http:/ / www.who.int/ classifications/ icd/ adaptations/ oncology/ en/
[203] http:/ / training. seer.cancer. gov/ index.html
[204] http:/ / www.dimdi. de/ static/ en/ klassi/ diagnosen/ icdo3/ basisicdo3. htm
[205] http:/ / www.healthyarkansas. com/ arkcancer/ publications/ Multiple%20Primaries. ppt
[206] http:/ / training. seer.cancer. gov/ module_coding_primary/ unit01_hist_bkgrnd01. html
[207] http:/ / seer. cancer. gov/ icd-o-3/
[208] http:/ / seer. cancer. gov/ icd-o-3/ sitetype.icd03.d20090401. xls
[209] http:/ / training. seer.cancer. gov/ module_coding_primary/ table_who_class_hemo_1. html
[210] http:/ / training. seer.cancer. gov/ module_icdo3/ downloadables/ Supplemental%20ICD-O-3%20List. DOC
[211] http:/ / uniklinikum-giessen. de/ imi/ konvi2t2.html?m=27
[212] http:/ / www.dimdi. de/ static/ en/ klassi/ diagnosen/ icdo3/
[213] http:/ / www-p53. iarc. fr/ Morphology. html
[214] http:/ / www.wolfbane. com/ icd/ index.html
[215] http:/ / www.ncri.ie/ data.cgi/ html/ icdo2morphs.shtml
[216] http:/ / www.celsius.lshtm. ac.uk/ dataDict/ appendices/ MorphologyofNeoplasmsICDO2. html
International Classification of Functioning,
Disability and Health
International Classification of Functioning, Disability and Health, also known as ICF, is a classification of the
health components of functioning and disability.
Disability
Disability portal
Category: Disability
Category: Disability
lists
After nine years of international revision efforts coordinated by the World Health Organization (WHO), the World
Health Assembly on May 22, 2001, approved the International Classification of Functioning, Disability and Health
and its abbreviation of "ICF." This classification was first created in 1980 and then called the International
Classification of Impairments, Disabilities, and Handicaps, or ICIDH
[1]
by WHO to provide a unifying
framework for classifying the health components of functioning and disability.
The ICF classification complements WHOs International Classification of Diseases-10th Revision (ICD), which
contains information on diagnosis and health condition, but not on functional status. The ICD and ICF constitute the
core classifications in the WHO Family of International Classifications (WHO-FIC).
International Classification of Functioning, Disability and Health
569
Overview
The ICF is structured around the following broad components:
Body functions and structure
Activities (related to tasks and actions by an individual) and participation (involvement in a life situation)
Additional information on severity and environmental factors
Functioning and disability are viewed as a complex interaction between the health condition of the individual and the
contextual factors of the environment as well as personal factors. The picture produced by this combination of
factors and dimensions is of "the person in his or her world". The classification treats these dimensions as interactive
and dynamic rather than linear or static. It allows for an assessment of the degree of disability, although it is not a
measurement instrument. It is applicable to all people, whatever their health condition. The language of the ICF is
neutral as to etiology, placing the emphasis on function rather than condition or disease. It also is carefully designed
to be relevant across cultures as well as age groups and genders, making it highly appropriate for heterogeneous
populations.
Benefits of ICF
There are benefits of using the ICF for both the client and the health professional. A major advantage for the client is
the integration of the medical and social aspects of his or her health condition. All aspects of a persons life
(development, participation, and environment) are incorporated into the ICF instead of solely focusing on his or her
diagnosis. A diagnosis reveals little about ones functional abilities. Diagnoses are important for defining the cause
and prognosis, but identifying the limitations of function is often the information used to plan and implement
interventions
[2]
Once a rehabilitation team is aware of the daily activities a client is required to participate in, the
problem solving sequence set up by the ICF can be utilized. An occupational therapist, for example, would observe a
client performing his or her daily activities and note the clients functional abilities. This information would then be
used to determine the extent to which the individuals abilities can be improved through therapy and to what extent
the environment can be changed to facilitate the individuals performance.
[3]
Intervention at one level (current
abilities) has the potential to prevent or modify events at a succeeding level (participation). For example, teaching a
deaf child manual signs will foster effective interaction and increase ones participation with his or her family.
Rehabilitation therapists will be empowered with the ICF not only in their daily work with their patients, but also
when working with other medical disciplines; hospitals and other health care administrations; health authorities and
policy makers.
[4]
All items are operationally defined with clear descriptions that can be applied to real life
evaluations with clarity and ease.
[5]
The language used in the ICF helps facilitate better communication between
these groups of people.
Clinical relevance
Knowing how a disease affects ones functioning enables better planning of services, treatment, and rehabilitation for
persons with long-term disabilities or chronic conditions. The current ICF creates a more integrative understanding
of health forming a comprehensive profile of an individual instead of focusing on ones health condition.
[6]
The
implications of using the ICF include emphasizing the strengths of individuals, assisting individuals in participating
more extensively in society by the use of interventions aimed at enhancing their abilities, and taking into
consideration the environmental and personal factors that might hamper ones participation. Qualifiers: The ICF
qualifiers may be best translated clinically as the levels of functioning seen in a standardized or clinic setting and in
everyday environments.
[7]
Qualifiers support standardization and the understanding of functioning in a
multidisciplinary assessment. They enable all team members to quantify the extent of problems, even in areas of
functioning where one is not a specialist.
[8]
Without qualifiers codes have no inherent meaning. An impairment,
limitation or restriction, is qualified from 0 (No problem; 0-4%), 1 (Mild problem: 5-24%, 2 (Moderate problem:
International Classification of Functioning, Disability and Health
570
25-49%), 3 (Severe problem: 50-95%) to 4 (Complete problem: 96-100%). Environmental factors are quantified
with a negative and positive scale denoting the extent to which the environment acts as a barrier or facilitator.
[9]
For
insurance purposes, the qualifiers can describe the effectiveness of treatment. One can interpret the decreasing of a
qualifier score to be an increase in the functional ability of a patient.
ICF Core Sets
An ICF Core Set can serve as a reference framework and a practical tool to classify and describe patient functioning
in a more time efficient way. ICF Core Sets can be used along the continuum of care and over the course of a health
condition. The ICF classification includes more than 1,400 categories limiting its use in clinical practice.
[10]
It is
time consuming for a clinician to utilize the main volume of the ICF with his or her patients. Only a fraction of the
categories is needed. As a general rule, 20% of the codes will explain 80% of the variance observed in practice.
[11]
ICF Core Sets contain as few as possible, but as many ICF categories as necessary, to describe a patients level of
functioning. It is hypothesized that using an ICF Core Set will increase the inter-rater reliability when coding clinical
cases as only the relevant categories for a particular patient will be utilized. Since all of the relevant categories are
listed in an ICF Core Set, its use in multidisciplinary assessments protects health professionals from missing
important aspects of functioning.
Children and Youth Version (ICF-CY)
As clinicians and researchers used the ICF, they became more aware of its limitations. The ICF lacks the ability to
classify the functional characteristics of a developing child. Different ICF codes are needed across the first years of a
childs life to capture the growth and development of a disability even when the childs diagnosis does not change.
[12]
The coding system can provide essential information about the severity of a health condition in terms of its impact
on functioning. This can serve a significant role for providers caring for children with spectrum disorders such as
autism or cerebral palsy.
[13]
Children with these conditions may have the same diagnosis, but their abilities and
levels of functioning widely vary across and within individuals over time. The first draft of the ICF-CY was
completed in 2003 and published in 2007. The ICF-CY was developed to be structurally consistent with the ICF for
adults. A major difference between the ICF-CY and ICF is that the generic qualifiers from the adult ICF now include
developmental aspects for children and youth in the ICF-CY. Descriptions of codes in the ICF-CY were revised and
expanded and new content was added to previously unused codes. Codes were added to document characteristics as
adaptability, responsivity, predictability, persistence, and approachability. Sensing and exploration of objects
codes were expanded as well as the importance of learning. Since a childs main occupation is playing, it is also
important to include more codes in this area. Different levels of play have separate codes in the ICF-CY (solitary,
onlooker, parallel). This contrasts with the adult ICF as only one code existed in regards to leisure or recreation.
Changes in ICF-CY codes over time reflect developmental effects attributable to the childs interaction with the
environment. Environmental factors influence functioning and development and can be documented as barriers or
facilitators using the ICF-CY. The key environments of children and adolescents include their homes, day care
centers, schools and recreation settings of playground, parks, and ball fields.
[14]
Children will transition between
different environments many times as they grow. For example, a child will transition into elementary or high school
or from one service setting or agency to another. Attention to these transitions of children with disabilities has been
identified as an important role for health care providers. A transition requires preparation and planning to find an
appropriate and accommodating setting for a childs needs. With a coding system such as the ICF-CY, the transition
will be smoother and interventions can start where the previous health provider left off.
International Classification of Functioning, Disability and Health
571
External links
International Classification of Functioning, Disability and Health (ICF)
[15]
- WHO
International Classification of Functioning, Disability and Health (ICF)
[16]
- CDC
International Classification of Functioning, Disability and Health (ICF)
[17]
in the NCBO BioPortal
[18]
ICF case studies: Implementation of ICF in rehabilitation management
[19]
Age based "developmental" code sets derived from the ICF CY can be found at *http:/ / www.
icf-cydevelopmentalcodesets. com/
The Italian Portal of Classifications
[20]
is the ICF and ICF-CY browsing tool of the Italian Collaborating Centre
of the World Health Organization for the Family of International Classifications
References
[1] http:/ / www. cdc.gov/ nchs/ about/ otheract/ icd9/ icfhome. htm
[2] Lollar, D.J., & Simeonsson, R.J. (2005). Diagnosis to function: classification for children and youths. Developmental and Behavioral
Pediatrics, 26, 323-330.
[3] Bornman, J. (2004). The World Health Organizations terminology and classification: application to severe disability. Disability and
Rehabiliation, 26, 182-188.
[4] Stucki, G., Ewert, T., & Cieza, A. (2002). Value and application of the ICF in rehabilitation medicine. Disability and Rehabilitation, 24,
932-938.
[5] stn, T. B., Chatterji, S., Bickenbach, J., Kostanjsek, N., & Schneider, M. (2003). The International Classification of Functioning, Disability
and Health: A new tool for understanding disability and health. Disability and Rehabilitation, 25, 565571.
[6] Hemmingsson, H., & Jonsson, H. (2005). An occupational perspective on the concept of participation in the international classification of
functioning, disability and health some critical remarks. The American Journal of Occupational Therapy, 59, 569-576.
[7] Reed, G., Lux, J., Bufka, L., Peterson, D., Threats, T., Trask, C., Stark, S., Jacobson, J., & Hawley, J. (2005). Operationalizing the
International Classification of Functioning, Disability, and Health: A model to guide clinical thinking, practice and research in the field of
cerebral palsy. Seminars in Pediatric Neurology, 11, 5-10.
[8] Rauch, A., Cieza, A., & Stucki, G. (2008). How to apply the International Classification of Functioning Disability and Health (ICF) for
rehabilitation management in clinical practice. European Journal of Physical and Rehabilitation Medicine, 44, 329-342.
[9] [9] World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: Author.
[10] Arlinger, M., Stamm, T.A., Pisetsky, D.S., Yarboro, C.H., Cieza, A., Smolen, J.S., & Stucki, G. (2006). ICF core sets: how to specify
impairment and function in systemic lupus erythematosus. Lupus, 15, 248-253.
[11] Ustun, B., Chatterji, S., & Kostanjsek, N. (2004). Comments from WHO for the Journal of Rehabilitation Medicine special supplement on
ICF core sets. Journal of Rehabiliation Medicine, (Suppl. 44), 7-8.
[12] Simeonsson, R.J., Scarborough, A.A., & Hebbeler, K.M. (2006). ICF and ICD codes provide a standard language of disability in young
children. Journal of Clinical Epidemiology, 59, 365-373.
[13] Ogonowski, J., Kronk, R., Rice, C., & Feldman, H. (2004). Inter-rater reliability in assigning ICF codes to children with disabilities.
Disability and Rehabilitation, 26, 353-361.
[14] Simeonsson, R.J., Lollar, D., Hollowell, J., & Adams, M. (2000). Revision of the international classification of impairments, disabilities, and
handicaps developmental issues. Journal of Clinical Epidemiology, 53, 113-124.
[15] http:/ / www.who. int/ classifications/ icf/ en/
[16] http:/ / www.cdc. gov/ nchs/ icd/ icf.htm
[17] http:/ / purl. bioontology. org/ ontology/ ICF
[18] http:/ / bioportal. bioontology.org/
[19] http:/ / www.icf-casestudies. org
[20] http:/ / www.reteclassificazioni. it
International Classification of Health Interventions
572
International Classification of Health
Interventions
The International Classification of Health Interventions (ICHI) is a system of classifying procedure codes being
developed by the World Health Organization. It is currently only available as a beta release.
It is designed to replace the "International Classification of Procedures in Medicine" (ICPM), a system that was
developed in the 1970s but which never received the same international acceptance as ICD-9. As a result, most
nations developed their own incompatible standards for coding procedures and interventions.
It is largely derived from the "Australian Classification of Health Interventions" (ACHI), a portion of the Australian
standard ICD-10-AM, which in turn was largely derived from ICD-10 and the United States extension ICD-9-CM.
External links
WHO site
[1]
(International framework for coding, evolution of ICHI paused)
Australian site
[2]
(Australian version for coding)
References
[1] http:/ / www. who. int/ classifications/ ichi/ en/
[2] http:/ / meteor. aihw.gov. au/ content/ index.phtml/ itemId/ 391343
International Classification of Primary Care
573
International Classification of Primary Care
International Classification of Primary
Care
Author WONCA International Classification Committee
Country United Kingdom
Language English
Subject Medicine
Publisher Oxford University Press
Publication date 1987 (1st edition); 1998 (2 ed.)
ISBN 0-19-262802-X
The International Classification of Primary Care (ICPC) is a classification method for primary care encounters. It
allows for the classification of the patients reason for encounter (RFE), the problems/diagnosis managed, primary or
general health care interventions, and the ordering of the data of the primary care session in an episode of care
structure. It was developed by the WONCA International Classification Committee (WICC), and was first published
in 1987 by Oxford University Press (OUP). A revision and inclusion of criteria and definitions was published in
1998. The second revision was accepted within the World Health Organization's (WHO) Family of International
Classifications.
[1]
The classification was developed in a context of increasing demand for quality information on primary care as part
of growing worldwide attention to global primary health care objectives, including the WHO's target of "health for
all".
[2]
History
The first version of ICPC, which was published in 1987, is referred to as ICPC-1. A subsequent revision which was
published in the 1993 publication The International Classification of Primary Care in the European Community:
With a Multi-Language Layer is known as ICPC-E.
The 1998 publication, of version 2, is referred to as ICPC-2. The acronym ICPC-2-E, refers to a revised electronic
version, which was released in 2000. Subsequent revisions of ICPC-2 are also labelled with a release date.
Structure
Chapters
The ICPC contains 17 chapters:
A General and unspecified
B Blood, blood forming organs, lymphatics, spleen
D Digestive
F Eye
H Ear
K Circulatory
L Musculoskeletal
N Neurological
P Psychological
International Classification of Primary Care
574
R Respiratory
S Skin
T Endocrine, metabolic and nutritional
U Urology
W Pregnancy, childbirth, family planning
X Female genital system and breast
Y Male genital system
Z Social problems
Components
The ICPC classification, within each chapter, is based on 3 components coming from 3 different classifications:
Reason for Encounter Classification (1981)
International Classification of Process in Primary Care (IC-Process-PC) (1985)
International Classification of Health Problem in Primary Care (ICHPPC-2-d) (1976, 1983)
References
[1] World Health Organization. International Classification of Primary Care, Second edition (ICPC-2). (http:/ / www. who. int/ classifications/
icd/ adaptations/ icpc2/ en/ ) Geneva. Accessed 24 June 2011.
[2] Bentsen BG. "International classification of primary care." Scand J Prim Health Care. 1986 Feb;4(1):43-50.
Bibliography
Bentzen N (ed). WONCA international glossary for general/family practice. Fam Pract. 1995; 12:267. (http:/ /
www. ulb. ac. be/ esp/ wicc/ letter_a. htm)
External links
WICC at WONCA (http:/ / www. globalfamilydoctor. com/ groups/ WorkingParties/ wicc. aspx)
Primary Healthcare Classification Consortium (Classification Committee) (http:/ / www. ph3c. org)
ICPC-2e (http:/ / www. kith. no/ templates/ kith_WebPage____1062. aspx) (by the Norwegian Centre for
Informatics in Health and Social Care)
University of Sydney Family Medicine Research Centre (http:/ / sydney. edu. au/ medicine/ fmrc/ icpc-2/ )
ICPC publication bibliography (http:/ / sydney. edu. au/ medicine/ fmrc/ icpc-2/ publications/ )
International Primary Care Association (IPCA) (http:/ / www. ipcauk. org)
International Healthcare Terminology Standards Development Organisation
575
International Healthcare Terminology Standards
Development Organisation
The International Health Terminology Standards Development Organisation (IHTSDO
[1]
) is an international
non-profit standards development organisation. Its mission is to develop, maintain, promote and deliver medical
terminology products in order to improve the health in a global scale through the development and application of
appropriately standardized clinical terminologies in general. In particular, the IHTSDO promotes SNOMED CT to
ensure safe, precise and effective exchange of clinical and health related information. By pooling human and
financial resources synergies are used in order to ensure a sustainable, high-quality terminology development. The
resulting terminology products help accomplish the vision of a comprehensive, accurate, semantically interoperable
and machine processable computer-based health record.
Governance
The IHTSDO is based in Denmark and constituted as an association under Danish Law. The founding of the
organisation was carried out by nine charter countries in 2007. Currently (April 2012) 19 countries are IHTSDO
Members
[2]
(Australia, Cyprus, Denmark, Estonia, Canada, Iceland, Israel, Lithuania, Malta, New Zealand, Poland,
Singapore, Slovakia, Slovenia, Spain, Sweden, The Netherlands, the United Kingdom, and the United States). The
countries largely finance the institution; they constitute the General Assembly, which nominates the Management
Board. Member countries commit themselves to the dissemination of terminologies at a national level, including the
creation of local translations, extensions, and mappings as well as contributing to the body of knowledge around its
use and application. Members of IHTSDO can be either an agency of a national government or other bodies (such as
corporations or regional government agencies) endorsed by an appropriate national government authority within the
country it represents. The IHTSDO welcomes new members.
The IHTSDO General Assembly (GA) is the highest authority of the Association and composed of representatives
from all member countries with equal representation. The GA is collectively charged with assuring that the purpose,
objects and principles of the Association are pursued and that the interests of the IHTSDO are safeguarded.
Arrangements for Governance of the IHTSDO and SNOMED CT are set out in the IHTSDO Articles of Association.
The GA appoints the Management Board (MB), who has overall responsibility for the management and direction of
the IHTSDO and a duty to act in a manner so the best interests of the IHTSDO is ensured. The management of
IHTSDO as well as the professional lead in content development and maintenance, technical issues, quality
assurance and implementation is currently in the hands of a Chief Executive Officer (CEO), a Chief Terminologist, a
Chief Technical Architect, a Chief Quality Officer, and a Chief Implementation and Innovation Officer. Four
Standing Committees provide advice for the Management Board: Content Committee, Technical Committee, Quality
Assurance Committee and Implementation & Innovation Committee. Furthermore there are topic-specific project
groups (PGs) and special interest groups (SIGs) which report to the standing committees. All interested persons are
invited to bring in their expertise into these groups. IHTSDO PGs and SIGs include:
International Healthcare Terminology Standards Development Organisation
576
IHTSDO Governance and Advisory
IHTSDO special interest groups (SIGs) IHTSDO project groups
Anesthesia Anatomy Model
Concept Model Collaborative Editing Roadmap
Education Content Product Development Planning
IHTSDO Workbench Developers Event, Condition and Episode Model
Implementation Family/General Practice Refset and ICPC Mapping
International Pathology & Laboratory Medicine IHTSDO Translation Tooling
Mapping Machine & Human Readable Concept Model
Nursing Mapping SNOMED CT to ICD-10
Pharmacy Migration
Translation Observable and Investigation Model
Organism & Infectious Disease Model
Request Submission
Substance Hierarchy Redesign
Translation Quality Assessment
IHTSDOs work is documented on their Website
[1]
. The internal communication is supported by a Collaborative
content management system.
Strategic Directions
The broad vision for IHTSDO is set out in the [Articles of Association http:/ / www. ihtsdo. org/ index. php?id=508
Articles of Association] . In 2008 the General Assembly and the Management Board agreed that the organisations
focus for the next 3-5 years should be to broaden the use of SNOMED CT, within and across health information
systems, countries and professions. Strategic Directions to 2015
[3]
describes IHTSDOs plans for 2015. To ensure
the implementation of the strategic directions, each Standing Committee develops a yearly action plan in their areas
of responsibility. The IHTSDO aims at achieving interoperability and harmonisation between its terminology
products and standards produced by other international standards development organisations. To this end,
harmonization bodies consisting of IHTSDO representatives and representatives of other SDOs have been
International Healthcare Terminology Standards Development Organisation
577
established. Examples are HL7, ICN, IEEE, LOINC & NPU
[4]
, openEHR, WHO, and WONCA. For each
harmonisation body, the IHTSDO aims at signing an agreement, setting out an agenda and the objectives of the
harmonisation process.
Meetings
The IHTSDO organizes periodic conferences open to an international audience. Generally within these conferences
time is allocated to committees meetings, project groups and SIGs, to enable them to meet face to face and address
their direction and priorities for the following year. Furthermore there are meetings of the Member Forum and the
Affiliate Forum. Committees, PGs and SIGs communicate regularly via conference calls and manage messages and
documents in its own content management system (CMS).
Documentation
To support implementation of SNOMED CT a number of publications are produced by the IHTSDO. These range
from user guides to technical implementation guides as well as some educational materials and videos. The
documents are available through the public website but some items such as the videos can be found through
YouTube. Member countries also contribute into the public domain and documents, which can often be found on
individual member country web sites; a link to these is provided on the IHTSDO web pages.
Office
The IHTSDO head office is located at Gammeltorv 4, 1. Sal, 1457 Copenhagen K, Denmark. A current overview of
IHTSDO staff can be found on the IHTSDO website
[1]
. The IHTSDO office can be contacted by E-Mail:
info(at)ihtsdo.org, phone +45 36 44 87 36 and fax +45 44 44 87 36.
External links
IHTSDO Homepage
[5]
References
[1] http:/ / www. ihtsdo. org
[2] http:/ / www. ihtsdo. org/ members
[3] http:/ / www. ihtsdo. org/ fileadmin/ user_upload/ Docs_01/ Publications/ Inside_IHTSDO/ IHTSDO_s_Strategic_Directions_to_2015.
pdfIHTSDOs
[4] http:/ / www. iupac.org/ web/ ins/ 2006-048-2-700
[5] http:/ / www. ihtsdo. org/
ICPC-2 PLUS
578
ICPC-2 PLUS
ICPC-2 PLUS is an extended terminology classified to ICPC-2 International Classification of Primary Care, which
aids data entry, retrieval and analysis. ICPC-2 PLUS takes into account the frequency distribution of problems seen
in primary health care. It allows for the classification of the patients reason for encounter (RFE), the
problems/diagnosis managed, primary care interventions, and the ordering of the data of the primary care session in
an episode of care structure.
ICPC-2 PLUS provides a list of possible terms matching a keyword (or start of a keyword) entered by the user. The
user then selects the most appropriate term. Each term is already classified to ICPC-2 rubrics and a system of
additional groupers that may include terms from multiple ICPC-2 rubrics.
Each term has one or more keywords linked to it which may include abbreviations, synonyms, generics or specifics.
The keyword searching is thus much broader, faster and better controlled than text mining of free text and labels.
Instead of guessing what the physician meant by a term (in free text) prior to classification, the physician is actually
prompted with a small list of terms to select from which are already classified.
The product also includes a 'natural language' label for each term which can be used for reports and letters.
Note: The PLUS extension mentioned here is not part of the ICPC-2 standard. The World Organization of Family
Doctors (WONCA) and the WONCA International Classification Committee (WICC) have no control over it
although they do have control over the ICPC classification which the PLUS extension makes use of. Its similar to
the difference between a car and fuel.
History
ICPC-2 PLUS was the successor to 'ICPC PLUS' and were both designed by the Family Medicine Research
Centre([1] FMRC]) for use in Australia. The FMRC continues to update and support ICPC-2 PLUS.
ICPC is being developed by the WONCA International Classification Committee (WICC), and the first version was
published as ICPC-1 in 1987 by Oxford University Press (OUP), and a revision and inclusion of criteria and
definitions, was published in 1998 as ICPC-2.
External links
ICPC-2 PLUS Introduction
[1]
(FMRC)
ICPC story
[2]
(WICC)
ICPC-2 Introduction
[3]
(ULB) (out-of-date, please use other links)
References
[1] http:/ / sydney.edu.au/ medicine/ fmrc/ icpc-2-plus/
[2] http:/ / www. globalfamilydoctor. com/ wicc/ icpcstory. html
[3] http:/ / www. ulb. ac.be/ esp/ wicc/ icpc2.html
ISO 27799
579
ISO 27799
ISO 27799 is an information security standard developed by the International Organization for Standardization
(ISO). Its title is Health informatics -- Information security management in health using ISO/IEC 27002
The purpose of ISO 27799 is to provide guidance to health organizations and other holders of personal health
information on how to protect such information via implementation of ISO/IEC 27002.
The content sections
[1]
are:
1: Scope
2: References
3: Terminology
4: Symbols
5: Health information security
6: Practical Action Plan for Implementing ISO 17799/27002
7: Healthcare Implications if ISO 17799/27002
8: Annex A: Threats
9: Annex B: Tasks and documentation of the ISMS
10: Annex C: Potential benefits and tool attributes
11: Annex D: Related standards
References
[1] An Introduction to ISO 27799 (http:/ / www. 27000. org/ iso-27799. htm)
External links
Current status of the ISO 27799 standard (http:/ / www. iso. org/ iso/ iso_catalogue/ catalogue_tc/
catalogue_detail. htm?csnumber=41298)
ISO/IEEE 11073
580
ISO/IEEE 11073
CEN ISO/IEEE 11073 Health informatics - Medical / health device communication standards enable
communication between medical, health care and wellness devices and with external computer systems. They
provide automatic and detailed electronic data capture of client-related and vital signs information, and of device
operational data.
Background
Goals
1. 1. Real-time plug-and-play interoperability for citizen-related medical, healthcare and wellness devices;
2. Efficient exchange of care device data, acquired at the point-of-care, in all care environments.
Real-time means that data from multiple devices can be retrieved, time correlated, and displayed or
processed in fractions of a second.
Plug-and-play means that all a user has to do is make the connection the systems automatically detect,
configure, and communicate without any other human interaction
Efficient exchange of care device data means that information that is captured at the point-of-care (e.g.,
personal vital signs data) can be archived, retrieved, and processed by many different types of applications
without extensive software and equipment support, and without needless loss of information.
The standards are targeted at personal health and fitness devices (such as glucose monitors, pulse oximeters,
weighing scales, medication dispensers and activity monitors) and at continuing and acute care devices (such as
pulse oximeters, ventilators and infusion pumps). They comprise a family of standards that can be layered together to
provide connectivity optimized for the specific devices being interfaced. There are four main partitions to the
standards:
Device data, including a nomenclature, or terminology, optimized for vital signs information representation
based on an object-oriented data model, and device specialisations;
General application services (e.g., polled vs. event driven services);
Internetworking and gateway standards (e.g., an observation reporting interface from CEN ISO/IEEE
11073-based messaging and data representation to HL7 or DICOM);
Transports (e.g., cable connected or wireless).
Problems
In the absence of standards for these devices, (a) data is captured either manually or at considerable expense
(using specialized equipment), or (b) it is not captured at all, which is most often the case.
Manually captured data is labour intensive, recorded infrequently (e.g., written down hourly by a nurse clinician),
and prone to human error.
Use of expensive custom connectivity equipment (a) drives up the cost of care delivery; (b) is only used for
patients with the highest acuity; and (c) tends to lock care providers into single companies or partnerships that
provide complete information system solutions, making it difficult to choose best-of-breed technologies to meet
client needs, or the most cost effective systems.
Development and deployment of advanced care delivery systems are hindered. For example, systems that collect
real-time data from multiple devices and use the information to detect safety problems (e.g., adverse drug events),
or to quickly determine a client's condition and automatically, or with minimal carer involvement, optimally
adjust a devices operation (e.g., for insulin delivery based on glucose level information) cannot operate without
these standards.
ISO/IEEE 11073
581
With no standardisation in this area, even when similar devices do provide communications, there is no
consistency in the information and services that are provided, thus inhibiting the development of advanced care
delivery systems or even consistent health records.
In short: appropriate use of 11073 device communication standards can help deliver better health, fitness and care,
more quickly, safely, and at a lower cost.
Motivation
These are the only standards addressing this area of connectivity.
They provide a complete solution for medical device connectivity, starting at the physical cable or wireless
connection up through the abstract representation of information and the services used for its management and
exchange.
They can enable full disclosure of device-mediated information. So measurement modalities be declared in detail
and the associated metrics & alerts communicated, together with any user-made changes to settings. In addition,
the device can communicate its manufacturer, model, serial number, configuration, operating status and network
location all in real time if required.
The IEEE 11073 standards have been developed with a high level of international participation. They have been,
and continue to be, adopted as International Standards Organisation (ISO) standards through ISO TC215 Health
Informatics and as European standards through the Committee for European Normalisation (CEN) TC251 Health
Informatics, specifically as the CEN ISO/IEEE 11073 series. The end result is a single set of internationally
harmonized standards that have been developed and adopted by ISO and CEN member countries.
These CEN ISO/IEEE 11073 standards have been developed in close coordination with other standards
development organisations, including IEEE 802, IHTSDO, IrDA, HL7, DICOM, and CLSI.
Memoranda of Understanding with IHE, IHTSDO, and HL7; and (through ISO) close liaison with Continua
Health Alliance assist still wider integration.
The CEN ISO/IEEE 11073 nomenclature is now being used to populate, and to establish equivalence, within
SNOMED CT - the most widely used clinical terminology.
A liaison between the IEEE 11073 standards group and the USA Food and Drug Administration (FDA) Center for
Devices and Radiological Health (CDRH) in the USA helps ensure that patient safety and efficacy concerns are
fully addressed in the standards.
The Continua Health Alliance and the English NHS National Programme for Information Technology (NPfIT)
both specify use of the standards for device communication.
The standards have been included in the USA National Committee on Vital and Health Statistics
recommendations to the Department of Health and Human Services related to patient medical record information
message formats supporting Health Insurance Portability and Accountability Act (HIPAA) compliant
implementations.
The cost of integrating innovative technologies into established product lines is reduced and a barrier to new
companies is lowered.
ISO/IEEE 11073
582
Availability
11073 standards are available freely to those actively involved in their development, others may purchase them. For
published and draft standards search for '11073' at: IEEE,
[1]
ISO
[2]
or CEN.
[3]
Standards may be purchased from
your national standards organisation or bookstore (e.g. AFNOR, BSI, DIN, JIS, UNI, etc.). Meeting agendas and
minutes are linked from the official joint working group website.
[4]
Overview
The ISO/IEEE 11073 Medical / Health Device Communication Standards are a family of ISO, IEEE, and CEN joint
standards addressing the interoperability of medical devices. The ISO/IEEE 11073 standard family defines parts of a
system, with which it is possible, to exchange and evaluate vital signs data between different medical devices, as
well as remote control these devices.
Point-of-care medical device
11073-00101 Health informatics - PoC medical device communication - Part 00101: GuideGuidelines for the use of RF wireless
technology
11073-10101:2004(E) Health informatics - Point-of-care medical device communication - Part 10101: Nomenclature
11073-10103:2012(E) Health informatics - Point-of-care medical device communication Part 10103: Nomenclature - Implantable device, cardiac
11073-10201:2004(E) Health informatics - Point-of-care medical device communication - Part 10201: Domain information model
11073-20101:2004(E) Health informatics - Point-of-care medical device communication - Part 20101: Application profile - Base standard
11073-30200a:2011
(E)
Health informatics - Point-of-care medical device communication - Part 30200: Transport profile - Cable connected
(amended)
11073-30300:2004(E) Health informatics - Point-of-care medical device communication - Part 30300: Transport profile - Infrared wireless
11073-30400:2012(E) Health informatics - Point-of-care medical device communication - Part 30400: Transport profile - Cabled Ethernet
The 'core' standards are: 11073-10101, 11073-10201, 11073-20101 and 11073-30200
Personal health device
ISO/IEEE 11073 personal health device (PHD) standards are a group of standards addressing the interoperability of
personal health devices (PHDs) such as weighing scales, blood pressure monitors, blood glucose monitors and the
like. The standards draw upon earlier IEEE11073 standards work, but differ from this earlier work due to an
emphasis on devices for personal use (rather than hospital use) and a simpler communications model.
These are described in more detail at ISO/IEEE 11073 Personal Health Data (PHD) Standards
ISO/IEEE 11073
583
Core standard
Nomenclature
Within this standard nomenclature codes are defined, these give the possibility to clearly identify objects and
attributes in relation to the so-called OID-Code ([5]). The nomenclature is divided in partitions, to demarcate codes
with regards to content and functional. Programmatically these codes are defined as constants, those can be used by a
pseudonym.
example in C++:
#define MDC_PART_OBJ 1
/* Definition fr die Partition Object Infrastructure */
#define MDC_MOC_VMS_MDS_SIMP 37
/* Definiert das Objekt Simple Medical Device System */
Domain information model
This standard is the "heart" of VITAL. Within this, objects and their arrangement in a Domain Information Model
for vital signs data transmission are defined. Beyond this the standard defines a service model for the standardized
communication.
Base standard
The common background for assembly and transmission of objects and their attributes are defined in this standard.
It's subdivided in a communication model and an information model. The communication model describes the layers
5 to 7 of the OSI 7-layer model. The information model defines the modeling, formatting and the syntax for
transmission coding of the objects.
Agent/manager principle
Agents and managers in ISO/IEEE 11073
All defined parts of this standard
family are designed to allow
communication according to this
principle. The arrangement of two or
more medical devices as a system, so
that the components are possible to
understand and to interact, are the
basic idea of this principle.
The agent is the part of the principle
that is connected to the medical
devices. It provides the data. The manager keeps a copy of the agent data, reacts on update events from them, and
triggers events on the Agent. In most use cases the manager is only use to remotely monitor and display agent data,
but in some cases it may also remotely control the agents. Agents and manager are built in the same structure. This
enables an agent to act as a manager and reverse. Besides the plain agent-manager application, hybrid systeme over
multiple stages are possible.
ISO/IEEE 11073
584
Agent application process(es)
This module is the interface between a proprietary (eventually native) protocol and the ISO/IEEE (VITAL) object
world. It is not defined within the standard and as a result it can be implemented free.
Medical data information base
MMOs (Managed Medical Objects) are stored hierarchically within a tree structure in a form named Domain
Information Model (DIM). This MMOs and their arrangement in the DIM are defined within this standard. The
implementation of the MDIB (Medical Device Information Base) and their functionallity is out of the scope of the
standard.
Association service control element
This module is subject to the standards ISO/IEC 15953 and ISO/IEC 15954. It has services available, that controlling
the association assembly and disassembly. A possible association and their condition is negotiated here, no MMOs
are transmitted over this module.
Common medical device information service element
Services for the data exchange of MMOs (Managed Medical Objects) between Agent-Manager systems, are defined
in this module. This data exchange is highly dynamic. Objects are created, changed or deleted by services named
CREATE, UPDATE, DELETE. Through reports, which can be defined detailed down to the single object attribute, it
is possible to trigger complex operations in Agent or Manager, through this services.
Presentation layer
This layer contains the encoding of object data. Objects, groups of objects attributes or single attributes are encoded
by ASN.1 representations, respectively the spezialization MDER (Medical Device encoding Rules).
Session layer
That layer controls connection at the session level.
Domain information model
The central core of the standard is the so-called Domain Information Model. Objects containing vital-sign data
representations and their relationships are defined in this model. Objects for additional services around vital signs
data objects, are defined also here.
ISO/IEEE 11073
585
For content sensitive classification of the objects, they are divided into packages.
Medical package
The package that defines objects, to map medical vital signs data. There are different objects to store vital signs data
in different ways. As an example the RealTimeSampleArray object for the management of e.g. ECG data be
mentioned.
Alert package
This small package is related within the medical package. It is used for setting and administrating alerts respectively
alert parameters to objects from the medical package.
System package
A representation of a medical device can be achieved with objects of this package. It contains concrete derivations of
the abstract MDS (MedicalDevice System) object. One of these koncrte derivations are ever the root object of an
DIM tree. The Battery object and the Clock object are further objects in this package. The last one can be used for
time synchronization of medical device data.
Control package
Inside the control package, objects for the remote control of a medical device are defined. There are objects used for
influenceing the modality of measuring (for example the SetRangeOperation object) and objects for direct remote
control of medical devices (for example the ActivateOperation object).
Extended services package
Other than the name supposes, in this package essential and ever used objects are defined. This package is built on
so-called scanner objects in different derivations. Scanning data in other objects and generation of event reports, who
can be sendend, are the sense of this objects. The scanner objects have a wide range of different attributes (e.g. scan
interval, scan lists, scan period etc.), for a wide range of applications the DIM. As an example the
FastPeriCfgScanner object (Fast Periodic Configurable Scanner), that is specially constructed for the requirements of
real-time data exchange in conjunction with the RealTimeSampleArray object, to transmit live data from egc
devices.
ISO/IEEE 11073
586
Communication package
The objects in these package containing information, which are responsible for basic communication profiles. These
package are developed very open, so that different communication profiles and interfaces to proprietary device
interfaces can be built. Annotation by the author: From a historic view, the standard was developed for the first time
in the early 90s, this package has to be reconstructed.
Archival package
Storing Patient related data in online or offline archives is the idea for objects in the archival package. For Example,
the Patient Archive object can store vital signs data, demographic data and treatment data in one object.
Patient package
The patient package contains only one object, the Patient Demographics object. This object contains patient related
data and can be set in relationship to an MDS object or one of the objects from the archive package, to give
anonymous data the reference to patient data.
Communication model
The complete communication sequence can be very complex. This article should provide basic information, that can
be more detailed at a later time in a separate article.
Finite state machine
The finite state machine regulates the synchronization of an Agent Manager system over different conditions. A
complete session roundtrip starts up with the disconnected state, is transferred by multiple stages to the initialized
state, in what the actual data transfer shall be done and ends with the disconnected state.
Initializing MDIB
During the association phase, the configuring state will be reached. In this condition Agent and Manager are to
exchange object data for the first time. In the process a MDSCreateEvent in the form of a report would be triggered.
This report creates a copy of the MDS root object from the Agent MDIB in the Manager MDIB. Afterward a
Contextscanner object is created in the Agents MDIB. This scanner object scans the complete MDIB and generates a
report containing the complete Agent's MDIB representation, expect the MDS root object. The Manager evaluates
this report and creates the objects defined here in his own MDIB copy. At this point the manager has an exact copy
of the Agent's MDIB. Both are now at configured state.
Data exchange through services
The Common Medical Device Information Service Element (CMDISE) provides a GET service, to deliver data
requested by the Manager. The Agents GET service retrieves a list of attribute ids. These ids identifying explicit
values within Agents MDIB. Now the Agent creates a report, containing the requested values. This report is sent
back to the Manager.
Data exchange through scanner objects
In an MDIB, additional objects shall be createed thtough the CREATE service of CMDISE. The Manager requests
the Agent through this service to create a scanner object himself, and to fix the scanner object on one or more values.
Optional for example the scan intervall for the data delivery can be set. The Agent creates the scanner object in his
own MDIB and sends the Manager a response message. Now the Manager creates a copy of the scanner object in his
MDIB. The data update form Agent to Manager now occurs automatically through the scanner object. Through
ISO/IEEE 11073
587
CMDISEes DELETE service, the scanner object can be deleted, like all other MDIBs objects.
References
[1] http:/ / shop. ieee. org/ ieeestore
[2] http:/ / www. iso.org/ iso/ search.htm?qt=11073& searchSubmit=Search& sort=rel& type=simple& published=true
[3] http:/ / www. cen.eu/ esearch/ extendedsearch. aspx
[4] http:/ / www. 11073.org
[5] http:/ / www. oid-info.com
Android 4.0 implements support for IEEE 11073 via the BluetoothHealth class (http:/ / developer. android. com/
reference/ android/ bluetooth/ BluetoothHealth. html)
NIST Standard Conformance Tools (http:/ / www. nist. gov/ medicaldevices/ )
ISO/TC 215
The ISO/TC 215 is the International Organization for Standardization's (ISO) Technical Committee (TC) on health
informatics. TC 215 works on the standardization of Health Information and Communications Technology (ICT), to
allow for compatibility and interoperability between independent systems.
Working Groups
ISO TC 215 consists of several Working Groups (WG), each dealing with an aspect of Electronic Health Records
(EHR).
CAG 1: Executive council, harmonization and operations
WG 1: Data structure
WG 2: Messaging and communications
WG 3: Health Concept Representation
WG 4: Privacy and Security
WG 5: Health Cards >>Transitioned to a Task Force on Health Cards.
WG 6: Pharmacy and medicines business
WG 7: Devices
WG 8: Business requirements for Electronic Health Records
WG 9: SDO Harmonization
Task Forces: --e-Business for Healthcare TransactionsMultidisciplinary for Healthcare CliniciansHarmonized
Joint Work Group for DevicesTraditional Medicine (Currently restricted to Far Eastern Traditional Medicine)
--Health CardsPatient Safety and Quality
Standards
July 2009 Current list of completed standards and other deliverables from TC 215:
ISO/HL7 27931:2009 Data Exchange StandardsHealth Level Seven Version 2.5 -- An application protocol for
electronic data exchange in healthcare environments Health Level 7
ISO/TR 27809:2007 Health informaticsMeasures for ensuring patient safety of health software
ISO 27799:2008 Health informaticsInformation security management in health using ISO/IEC 27002
ISO/TS 25238:2007 Health informaticsClassification of safety risks from health software
ISO/TS 25237:2008 Health informaticsPseudonymization
ISO/TC 215
588
ISO 22857:2004 Health informaticsGuidelines on data protection to facilitate trans-border flows of personal health
information
ISO/TR 22790:2007 Health informaticsFunctional characteristics of prescriber support systems
ISO/TS 22600-2:2006 Health informaticsPrivilege management and access controlPart 2: Formal models
ISO/TS 22600-1:2006 Health informaticsPrivilege management and access controlPart 1: Overview and policy
management
ISO/TR 22221:2006 Health informatics - Good principles and practices for a clinical data warehouse
ISO/TS 22220:2009 Health InformaticsIdentification of subjects of health care
ISO/HL7 21731:2006 Health informaticsHL7 version 3 -- Reference information modelRelease 1
ISO/TR 21730:2007 Health informaticsUse of mobile wireless communication and computing technology in
healthcare facilitiesRecommendations for electromagnetic compatibility (management of unintentional
electromagnetic interference) with medical devices
ISO/TS 21667:2004 Health informaticsHealth indicators conceptual framework
ISO 21549-7:2007 Health informaticsPatient healthcard dataPart 7: Medication data
ISO 21549-6:2008 Health informaticsPatient healthcard dataPart 6: Administrative data
ISO 21549-5:2008 Health informaticsPatient healthcard dataPart 5: Identification data
ISO 21549-4:2006 Health informaticsPatient healthcard dataPart 4: Extended clinical data
ISO 21549-3:2004 Health informaticsPatient healthcard dataPart 3: Limited clinical data
ISO 21549-2:2004 Health informaticsPatient healthcard dataPart 2: Common objects
ISO 21549-1:2004 Health informaticsPatient healthcard dataPart 1: General structure
ISO/TS 21298:2008 Health informaticsFunctional and structural roles
ISO/TS 21091:2005 Health informaticsDirectory services for security, communications and identification of
professionals and patients
ISO/TR 21089:2004 Health informaticsTrusted end-to-end information flows
ISO/TR 20514:2005 Health informaticsElectronic health recordDefinition, scope and context
ISO 20302:2006 Health informaticsHealth cardsNumbering system and registration procedure for issuer
identifiers
ISO 20301:2006 Health informaticsHealth cardsGeneral characteristics
ISO 18812:2003 Health informaticsClinical analyser interfaces to laboratory information systemsUse profiles
ISO/TS 18308:2004 Health informaticsRequirements for an electronic health record architecture
ISO/TR 18307:2001 Health informaticsInteroperability and compatibility in messaging and communication
standardsKey characteristics
ISO 18232:2006 Health InformaticsMessages and communicationFormat of length limited globally unique
string identifiers
ISO 18104:2003 Health informaticsIntegration of a reference terminology model for nursing
ISO 17432:2004 Health informaticsMessages and communicationWeb access to DICOM persistent objects
ISO/TS 17120:2004 Health informaticsCountry identifier standards (Withdrawn 2009-09-22)
ISO/TR 17119:2005 Health informatics - Health informatics profiling framework
ISO/TS 17117:2002 Health informaticsControlled health terminologyStructure and high-level indicators
ISO 17115:2007 Health informaticsVocabulary for terminological systems
ISO/TC 215
589
ISO 17090-3:2008 Health informaticsPublic key infrastructurePart 3: Policy management of certification and
authority
ISO 17090-2:2008 Health informaticsPublic key infrastructurePart 2: Certificate profile
ISO 17090-1:2008 Health informaticsPublic key infrastructurePart 1: Overview of digital certificate services
ISO/TS 16058:2004 Health informaticsInteroperability of telelearning systems
ISO/TR 16056-2:2004 Health informaticsInteroperability of telehealth systems and networksPart 2: Real-time
systems
ISO/TR 16056-1:2004 Health informaticsInteroperability of telehealth systems and networksPart 1:
Introduction and definitions
EN 14463:2007 Health informatics-A syntax to represent the content of medical classification systems - ClaML
ISO 13606-3:2009 Health informaticsElectronic health record communicationPart 3: Reference archetypes and
term lists
ISO 13606-2:2008 Health informaticsElectronic health record communicationPart 2: Archetype interchange
specification
ISO 13606-1:2008 Health informaticsElectronic health record communicationPart 1: Reference model
ISO/TR 12773-2:2009 Business requirements for health summary recordsPart 2: Environmental scan
ISO/TR 12773-1:2009 Business requirements for health summary recordsPart 1: Requirements
ISO 12052:2006 (DICOM) Health informaticsDigital imaging and communication in medicine (DICOM)
including workflow and data management
ISO/TR 11487:2008 Health informaticsClinical stakeholder participation in the work of ISO TC 215
ISO/IEEE 11073:
ISO/TS 11073-92001:2007 Health informaticsMedical waveform formatPart 92001: Encoding rules
ISO 11073-91064:2009 Health informaticsStandard communication protocolPart 91064: Computer-assisted
electrocardiography
ISO 11073-90101:2008 Health informaticsPoint-of-care medical device communicationPart 90101: Analytical
instrumentsPoint-of-care test
ISO/IEEE 11073-30300:2004 Health informaticsPoint-of-care medical device communicationPart 30300:
Transport profileInfrared wireless
ISO/IEEE 11073-30200:2004 Health informaticsPoint-of-care medical device communicationPart 30200:
Transport profileCable connected
ISO/IEEE 11073-20101:2004 Health informaticsPoint-of-care medical device communicationPart 20101:
Application profilesBase standard
ISO/IEEE 11073-10201:2004 Health informaticsPoint-of-care medical device communicationPart 10201:
Domain information model
ISO/IEEE 11073-10101:2004 Health informaticsPoint-of-care medical device communicationPart 10101:
Nomenclature
ISO/TC 215
590
External links
http:/ / www. iso. org/ iso/ standards_development/ technical_committees/ list_of_iso_technical_committees/
iso_technical_committee. htm?commid=54960
ISO/TC 215 is a member of the Joint Initiative on SDO Global Health Informatics Standardization
[1]
http:/ / www. himss. org/ ASP/ topics_ISO. asp
References
[1] http:/ / www. global-ehealth-standards.com/
LOINC
Logical Observation Identifiers Names and Codes (LOINC) is a database and universal standard for identifying
medical laboratory observations. It was developed and is maintained by the Regenstrief Institute, a US non-profit
medical research organization, in 1994. LOINC was created in response to the demand for an electronic database for
clinical care and management and is publicly available at no cost.
It is endorsed by the American Clinical Laboratory Association
[1]
and the College of American Pathologists. Since
its inception, the database has expanded to include not just medical and laboratory code names, but also: nursing
diagnosis, nursing interventions, outcomes classification, and patient care data set.
Function
LOINC applies universal code names and identifiers to medical terminology related to electronic health records. The
purpose is to assist in the electronic exchange and gathering of clinical results (such as laboratory tests, clinical
observations, outcomes management and research). LOINC has two main parts: laboratory LOINC and clinical
LOINC. Clinical LOINC contains a subdomain of Document Ontology which captures types of clinical reports and
documents.
Several standards, such as IHE or HL7, use LOINC to electronically transfer results from different reporting
systems to the appropriate healthcare networks
[citation needed]
. However, the health information enclosed is identified
by a multiplicity of code values that may vary according to the entity producing those results. This has obvious
disadvantages to the healthcare network that may need to adopt different codes to access and manage information
coming from multiple sources. Managed care providers, for example, often have negotiated contracts that reimburse
episodes of care and unique coding to trigger automated claim payment. Mapping each entity-specific code to its
corresponding universal code can represent a significant investment of both human and financial capital.
A universal code system will enable facilities and departments across the world to receive and send results from their
areas for comparison and consultation and may contribute toward a larger public health initiative of improving
clinical outcomes and quality of care
[2]
.
LOINC is one of the standards for use in U.S. Federal Government systems for the electronic exchange of clinical
health information. In 1999, it was identified by the HL7 Standards Development Organization as a preferred code
set for laboratory test names in transactions between health care facilities, laboratories, laboratory testing devices,
and public health authorities.
LOINC
591
Format
A formal, distinct, and unique 6-part name is given to each term for test or observation identity. The database
currently has over 71,000 observation terms that can be accessed and understood universally. Each database record
includes six fields for the unique specification of each identified single test, observation, or measurement:
1. 1. Component- what is measured, evaluated, or observed (example: urea,...)
2. 2. Kind of property- characteristics of what is measured, such as length, mass, volume, time stamp and so on
3. 3. Time aspect- interval of time over which the observation or measurement was made
4. 4. System- context or specimen type within which the observation was made (example: blood, urine,...)
5. 5. Type of scale- the scale of measure. The scale may be quantitative, ordinal, nominal or narrative
6. 6. Type of method- procedure used to make the measurement or observation
A unique code (format: nnnnn-n) is assigned to each entry upon registration. Other database fields include status and
mapping information for database change management, synonyms, related terms, substance information (e.g. molar
mass, CAS registry number), choices of answers for nominal scales, translations.
Uses
Some of the advantages resulting from adopting LOINC may include improved communication in integrated
healthcare delivery networks, improved community wide electronic health records, the automatic transfer to public
health authorities of case reports for reportable diseases (e.g. for disease control or detection of epidemics), improved
transfer of payment information for services rendered and a significant improvement in the overall quality of health
care by reducing errors in the system.
The fact that universal standards are being promoted (if not adopted by national organizations and agencies) is an
indication that the dialogue will continue regarding the development, structure, financing, monitoring, enforcement,
and integration of standards within the broader health care system.
International interest in LOINC continues to grow. A number of efforts have been undertaken to translate the LOINC
documents and terms into various languages, such as Simplified Chinese, German, Spanish. For more information on
LOINC International, see LOINC International
[3]
. As of January, 2009, the software RELMA (Regenstrief LOINC
Mapping Assistant) is available in separate downloads that contain an additional word index in Spanish, Simplified
Chinese, or Korean, which allows searching in these languages in addition to English. Harmonization efforts
between LOINC and SNOMED CT were initiated in 2012.
References
[1] http:/ / www. clinical-labs. org/
[2] http:/ / www. iom. edu/ topic. asid=3718
[3] http:/ / www. regenstrief. org/ medinformatics/ loinc/ international
External links
LOINC pages of Regenstrief Institute, Inc. (http:/ / loinc. org/ )
LOINC International (http:/ / loinc. org/ international)
Web site of the Regenstrief LOINC Mapping Assistant (RELMA) (http:/ / loinc. org/ relma)
Introduction to the HL7 Standards (http:/ / www. HL7. com. au/ FAQ. htm)
U.S. National Library of Medicine (http:/ / www. nlm. nih. gov/ research/ umls/ loinc_main. html)
Chinese LOINC Interface System (http:/ / www. cnehr. org. cn/ documents/ gwyj/ CLISOL/ Search_Keywords.
asp) - a pilot project that aims to show a simplified Chinese version of LOINC terms.
LOINC JSON API (http:/ / aqua. io/ codes/ loinc/ documentation) - an open API for searching and retrieving
LOINC code metadata in JSON
LOINC
592
ITServer-LOINC Browser (http:/ / www. itserver. es) - A free online LOINC browser that shows all the attributes
and the official mapping with SNOMED CT
MEDCIN
MEDCIN, a system of standardized medical terminology, is a proprietary medical vocabulary and was developed by
Medicomp Systems, Inc.
[1]
MEDCIN is a point-of-care terminology, intended for use in Electronic Health Record
(EHR) systems, and it includes over 280,000 clinical data elements encompassing symptoms, history, physical
examination, tests, diagnoses and therapy. This clinical vocabulary contains over 26 years of research and
development as well as the capability to cross map to leading codification systems such as SNOMED CT, CPT,
ICD-9-CM/ICD-10-CM, DSM, LOINC, CDT and the Clinical Care Classification (CCC) System for nursing and
allied health.
[2]
The MEDCIN coding system is touted especially for point-of-care documentation and architecture. Several
Electronic Health Record (EHR) systems embed MEDCIN, which allows them to produce structured and
numerically codified patient charts. Such structuring enables the aggregation, analysis, and mining of clinical and
practice management data related to a disease, a patient or a population.
History
MEDCIN was initially developed by Peter S. Goltra, founder of Medicomp Systems as an intelligent clinical
database for documentation at the time of care." The first few years of the development were spent in designing the
structure of a knowledge engine that would enable the population of relationships between clinical events. Since
1978, the MEDCIN database engine has been continuously refined and expanded to include concepts from clinical
histories, test, physical examination, therapies and diagnoses to enable coding of complete patient encounters with
the collaboration of physicians and teaching institutions such as Cornell, Harvard, and John Hopkins.
Features
Multiple Hierarchical Structure
MEDCIN data elements are organized in multiple clinical hierarchies, where users can easily navigate to a medical
term by following down the tree of clinical propositions. The clinical propositions define unique intellectual clinical
content. An example of such similar propositions include "wheezing which is worse during cold weather" and
"wheezing which is worse with a cold" differ in meaning significantly to clinicians and therefore it enables the
software to present relevant items to clinical users.
[3]
This hierarchy provides an inheritance of clinical properties between data elements, which greatly enhances the
capabilities of EHR systems and as well providing logical presentation structures for the clinical users.
[4]
The linkage
of MEDCIN data elements through the use of describing many diagnoses in the diagnostic index creates multiple
hierarchies. The MEDCIN engine uses Intelligent Prompting and navigation tools to enable clinicians to select
specific clinical terms that they need rather than having to create new terms for rapid documentation.
[5]
Enhances EHRs usability
MEDCIN has been designed to work as an interface terminology to include components to make EHRs more usable
when it is used in conjunction with proprietary physician and nursing documentation tools.
[6]
According to
Rosenbloom et al. (2006), investigators such as Chute et al., McDonald et al., Rose et al. and Campbell et al. have
defined clinical interface terminologies as a systematic collection of health care-related phrases (term) (p.277) that
supports the capturing of patient-related clinical information entered by clinicians into software programs such as
MEDCIN
593
clinical note capture and decision support tools.
For an interface terminology to be clinical usable, it has to be able to describe any clinical presentation with speed,
ease of use, and accuracy for clinicians to accomplish the intended tasks (e.g documenting patient care) when using
the medical terminology. In addition, the terms in medical terminology must have medical relationships. The
MEDCINs presentation engine, accomplish this usability criteria by using the Intelligent Prompting capabilities to
present a relevant list of MEDCIN clinical terms for rapid clinical documentations. Another usability feature that the
MEDCINs presentation engine provides is the medical relationships of clinical terms through multiple clinical
hierarchies for each MEDCIN term.
Support ICD-10-CM coding
In August 2012, Medicomp Systems released the new updated version of the MEDCIN Engine
[7]
embedded with
ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) mappings and
functionality to comply with the transition from ICD-9-CM to ICD-10-CM as mandated by the US Department of
Health and Human Services. This new version is specially designed to make the ICD-10 more usable in the EHR
systems by providing clinicians easier access to bi-directional mappings, accurate data and codes through their EHR
products. The ICD-10 is published by the World Health Organization (WHO) to enable the systematic collection of
morbidity and mortality data from different countries for statistical analysis.
Integration to most EHRs and Legacy systems
MEDCIN terminology engine can be easily integrated into existing EHRs and legacy systems to enable mapping of
existing terminologies and other coding systems such as ICD, DSM, CPT, LOINC, SNOMED CT and the Clinical
Care Classification (CCC) System to generate seamless codified data at point of care. MEDCINs interoperability
features enable easy access and sharing of patient data between health care facilities.
Interface with Electronic Health Record (EHR) systems
MEDCIN has been implemented into several commercial EHR systems as an interface terminology to support
integrated care, clinical documentation, health maintenance monitoring and disease management, and the care
planning functions of physicians, nurses and allied health professionals.
[8]
Such commercial EHR systems include
MedcomSoft Record (developed by MedcomSoft Inc) and the United States Department of Defences (DoD) EHR
system, the Armed Forces Health Longitudinal Technology Application (AHLTA).
MedcomSoft Record
In 2006, MedcomSoft introduced an interoperable EHR system, MedcomSoft Record, that integrates with MEDCIN
engine to produce structure data that is automatically codified and provides cross mapping to other industry standard
reference terminologies such as SNOMED, LOINC and ICD-9. This integration also enables laboratory test results
and drug prescriptions to be automatically codified with MEDCIN numeric codes in the same way as clinical notes.
AHLTA
AHLTA is an EHR system developed for the US Department of Defense. This application uses the Medicomps
MEDCIN terminology engine for clinical documentation purposes. Figure 1, shows an example of the MEDCIN
terminology where the physician can search for the correct terms for input into the patient note.
MEDCIN
594
MEDCIN Nursing Plan of Care
The Nursing Plan of Care (POC) was developed by Medicomp Systems, for the Clinical Care Classification (CCC)
System. The CCC System is a standardized, coded nursing terminology that provides a unique framework and
coding structure for accessing, classifying and documenting patient care by nurses and other allied health
professionals.
[9]
The CCC is directly linked in the MEDCIN nursing POC to medical terminology with the purpose
of creating patient plan of care by extracting a pool of documentation from the EHR history. The CCC nursing
terminology is integrated into the MEDCIN clinical database through a contextual hierarchical tree, providing an
array of terminology standards and concepts with Intelligent Prompting capabilities of the MEDCINE engine.
MEDCIN used a diagnostic index to provide a method to link signs and symptoms and as well clinical diagnoses
to CCC nursing diagnoses, interventions, goals, actions and outcome.
[10]
This method enables the MEDCIN
clinical database to be populated with CCC nursing terminology as illustrated in Figure 2.
Sample Computer Applications Using MEDCIN
Electronic Medical Records
Vitera Intergy EHR
[11]
Origin Healthcare Solutions, EMRge
[12]
Computerized Physician Order Entry (e.g. E-Prescribing or Laboratory Order Entry)
Emergency Room Charting
MedcomSoft Record
[13]
Pulse EMR
[14]
Further reading
Goltra, Peter S. MEDCIN: A New Nomenclature for Clinical Medicine. Ann Arbour, MI 1997:Springer-Verlag
ISBN 0-387-94953-4.
References
[1] http:/ / www. medicomp.com
[2] Whittenberg, L. (n.d.) The CCC system in medicomps point of care knowledge engine (MEDCIN) (pp.52) In Saba, V. (2012) Clinical Care
Classification (CCC) System Version 2.5, 2nd Edition: User's Guide, New York,NY: Springer Publishing.
[3] Zanstra, P.E, van der Haring, E.J, Cornet, R, (2003) Introduction of a Clinical Terminology in the Netherlands: Needs, Constraints,
Opportunities. (http:/ / www. openclinical. org/ docs/ ext/ terminologiesNL2003. pdf) Depts. Medical Informatics, UMC St Radboud
Nijmegen, AMC Amsterdam. pg 61
[4] Zanstra, P.E, van der Haring, E.J, Cornet, R, (2003). Introduction of a Clinical Terminology in the Netherlands: Needs, Constraints,
Opportunities. (http:/ / www. openclinical. org/ docs/ ext/ terminologiesNL2003. pdf) Depts. Medical Informatics, UMC St Radboud
Nijmegen, AMC Amsterdam. pg 62
[5] Zanstra, P.E, van der Haring, E.J, Cornet, R, (2003). Introduction of a Clinical Terminology in the Netherlands: Needs, Constraints,
Opportunities. (http:/ / www. openclinical. org/ docs/ ext/ terminologiesNL2003. pdf) Depts. Medical Informatics, UMC St Radboud
Nijmegen, AMC Amsterdam. pg 60
[6] Rosenbloom, S.T, Miller, R.A., Johnson, K.B., Elkin, P.L., Brown, S.H. (2008). A Model for Evaluating Interface Terminologies. (http:/ /
www.ncbi. nlm. nih. gov/ pubmed/ 17947616) Journal of the American Medical Informatics Association. 15:6576. DOI 10.1197
[7] http:/ / www. medicomp.com/ medicin-engine/
[8] Whittenberg, L. (n.d.) The CCC system in medicomps point of care knowledge engine (MEDCIN) (pp.51-53). In Saba, V. (2012) Clinical
Care Classification (CCC) System Version 2.5, 2nd Edition: User's Guide, New York,NY: Springer Publishing.
[9] Saba, V. K. (2005). Clinical Care Classification (CCC) of Nursing Interventions. Retrieved 25 May 2013, from http:/ / www. sabacare. com/
About/ .
[10] Whittenberg, L. (n.d.) The CCC system in medicomps point of care knowledge engine (MEDCIN) (pp.52) In Saba, V. (2012) Clinical
Care Classification (CCC) System Version 2.5, 2nd Edition: User's Guide, New York,NY: Springer Publishing.
[11] http:/ / www.viterahealthcare. com/
[12] http:/ / www.originhs. com
[13] http:/ / www.medcomsoft. com
MEDCIN
595
[14] http:/ / www.pulseinc. com
External links
Medicomp home page (http:/ / www. medicomp. com/ )
MedDRA
MedDRA or Medical Dictionary for Regulatory Activities is a clinically validated international medical
terminology used by regulatory authorities and the regulated biopharmaceutical industry during the regulatory
process, from pre-marketing to post-marketing activities, and for data entry, retrieval, evaluation, and presentation.
In addition, it is the adverse event classification dictionary endorsed by the International Conference on
Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH).
Originally available in English and Japanese, MedDRA is now also translated into Chinese, Czech, Dutch, French,
German, Hungarian, Italian, Portuguese and Spanish. MedDRA is widely used internationally, including in the
United States, European Union, and Japan. Its use is currently mandated in Europe and Japan for safety reporting.
Organization of the dictionary
The MedDRA dictionary is organized by System Organ Class (SOC), divided into High-Level Group Terms
(HLGT), High-Level Terms (HLT), Preferred Terms (PT) and finally into Lower-Level Terms (LLT). In addition,
the MedDRA dictionary includes Standardized MedDRA Queries (SMQs). SMQs are groupings of terms that relate
to a defined medical condition or area of interest.
Individual cases are usually coded for data entry at the most specific LLT level, and outputs of counts or cases are
usually provided at the PT level. The higher levels (HLT, HLGT and SOC) as well as SMQ are used for searching
and for organisation and subtotalling of outputs.
Maintenance of MedDRA
MedDRA is managed by the MSSO (Maintenance and Support Services Organization). The International Federation
of Pharmaceutical Manufacturers and Associations (IFPMA) is the Trustee of the International Conference on
Harmonisation (ICH) Steering Committee and holds the intellectual property rights (ownership) of MedDRA. The
ICH selected Northrop Grumman and has contracted it to act as the MSSO. MedDRA is free for regulators and
priced according to company revenue for industry. The Japanese counterpart for MSSO is called JMO.
The MSSO updates MedDRA from subscriber change requests to add a new medical concept that is yet to be in
MedDRA or to change an existing concept. The decisions are made by international medical officers on how to map
the terminology within the grouping categories according to a general consensus based on language considerations
internationally.
The MSSO releases updated MedDRA versions twice a year - in March and September. The March release is the
main annual release and contains changes at the HLT level and above along with LLT and PT changes. The
September release typically contains changes only at the LLT and PT level. The March 2013 Version 16.0 release is
the current version.
MedDRA
596
References
External links
MedDRA and the MSSO (http:/ / www. meddramsso. com/ index. asp)
Medical Subject Headings
597
Medical Subject Headings
Medical subject headings
Content
Description Medical subject headings.
Data types captured controlled vocabulary
Contact
Research center United States National Library of Medicine
National Center for Biotechnology Information
Laboratory United States National Library of Medicine
Authors F B Rogers
Primary citation PMID 13982385
Access
Tools
Miscellaneous
Medical Subject Headings (MeSH) is a comprehensive controlled vocabulary for the purpose of indexing journal
articles and books in the life sciences; it can also serve as a thesaurus that facilitates searching. Created and updated
by the United States National Library of Medicine (NLM), it is used by the MEDLINE/PubMed article database and
by NLM's catalog of book holdings.
MeSH was introduced in 1963. The yearly printed version was discontinued in 2007 and MeSH is now available
online only. It can be browsed and downloaded free of charge through PubMed. Originally in English, MeSH has
been translated into numerous other languages and allows retrieval of documents from different languages.
Structure of MeSH
The 2009 version of MeSH contains a total of 25,186 subject headings, also known as descriptors. Most of these are
accompanied by a short description or definition, links to related descriptors, and a list of synonyms or very similar
terms (known as entry terms). Because of these synonym lists, MeSH can also be viewed as a thesaurus.
[1]
Descriptor hierarchy
The descriptors or subject headings are arranged in a hierarchy. A given descriptor may appear at several locations
in the hierarchical tree. The tree locations carry systematic labels known as tree numbers, and consequently one
descriptor can carry several tree numbers. For example, the descriptor "Digestive System Neoplasms" has the tree
numbers C06.301 and C04.588.274; C stands for Diseases, C06 for Digestive System Diseases and C06.301 for
Digestive System Neoplasms; C04 for Neoplasms, C04.588 for Neoplasms By Site, and C04.588.274 also for
Digestive System Neoplasms. The tree numbers of a given descriptor are subject to change as MeSH is updated.
Every descriptor also carries a unique alphanumerical ID that will not change.
Medical Subject Headings
598
Descriptions
Most subject headings come with a short description or definition. See the MeSH description for diabetes type 2
[2]
as an example. The explanatory text is written by the MeSH team based on their standard sources if not otherwise
stated. References are mostly encyclopaedias and standard textbooks of the subject areas. References for specific
statements in the descriptions are not given, instead readers are referred to the bibliography
[3]
.
Qualifiers
In addition to the descriptor hierarchy, MeSH contains a small number of standard qualifiers (also known as
subheadings), which can be added to descriptors to narrow down the topic.
[4]
For example, "Measles" is a descriptor
and "epidemiology" is a qualifier; "Measles/epidemiology" describes the subheading of epidemiological articles
about Measles. The "epidemiology" qualifier can be added to all other disease descriptors. Not all
descriptor/qualifier combinations are allowed since some of them may be meaningless. In all there are 83 different
qualifiers.
Supplements
In addition to the descriptors, MeSH also contains some 139,000 Supplementary Concept Records. These do not
belong to the controlled vocabulary as such; instead they enlarge the thesaurus and contain links to the closest fitting
descriptor to be used in a MEDLINE search. Many of these records describe chemical substances.
Use in Medline/PubMed
In MEDLINE/PubMed, every journal article is indexed with about 1015 subject headings, subheadings and
supplementary concept records, with some of them designated as major and marked with an asterisk, indicating the
article's major topics. When performing a MEDLINE search via PubMed, entry terms are automatically translated
into (i.e. mapped to) the corresponding descriptors with a good degree of reliability; it is recommended to check the
'Details tab' in PubMed to see how a search formulation was translated. By default, a search for a descriptor will
include all the descriptors in the hierarchy below the given one.
Categories
For the full hierarchy, see List of MeSH codes
The top-level categories in the MeSH descriptor hierarchy are:
Anatomy [A]
Organisms [B]
Diseases [C]
Chemicals and Drugs [D]
Analytical, Diagnostic and Therapeutic Techniques and Equipment [E]
Psychiatry and Psychology [F]
Biological Sciences [G]
Physical Sciences [H]
Anthropology, Education, Sociology and Social Phenomena [I]
Technology and Food and Beverages [J]
Humanities [K]
Information Science [L]
Persons [M]
Health Care [N]
Publication Characteristics [V]
Medical Subject Headings
599
Geographic Locations [Z]
References
[1] Introduction to MeSH 2010 (http:/ / www. nlm. nih.gov/ mesh/ introduction. html)
[2] http:/ / www. ncbi. nlm.nih. gov/ sites/ entrez?Db=mesh& Cmd=ShowDetailView& TermToSearch=68003924& ordinalpos=3&
itool=EntrezSystem2.PEntrez.Mesh. Mesh_ResultsPanel. Mesh_RVDocSum
[3] http:/ / www. nlm. nih.gov/ mesh/ intro_biblio2007.html
[4] List of qualifiers MeSH 2009 (http:/ / www.nlm.nih. gov/ mesh/ 2009/ introduction/ topsubscope. html)
External links
Medical Subject Heading Home (http:/ / www. nlm. nih. gov/ mesh/ ) provided by National Library of Medicine,
National Institutes of Health (U.S.)
MeSH database tutorials (http:/ / www. ncbi. nlm. nih. gov/ entrez/ query. fcgi?db=mesh)
Automatic Term Mapping (http:/ / www. nlm. nih. gov/ bsd/ disted/ pubmedtutorial/ 020_040. html)
Browsing MeSH:
Entrez (http:/ / www. ncbi. nlm. nih. gov/ entrez/ query. fcgi?db=mesh)
MeSH Browser (http:/ / www. nlm. nih. gov/ mesh/ MBrowser. html)
Visual MeSH Browser (http:/ / www. curehunter. com/ public/ dictionary. do) mapping drug-disease
relationships in research
Reference.MD (http:/ / www. reference. md/ )
List of qualifiers 2009 (http:/ / www. nlm. nih. gov/ mesh/ 2009/ introduction/ topsubscope. html)
Minimum Data Set
The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all
residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of
each resident's functional capabilities and helps nursing home staff identify health problems.
Resource Utilization Groups (RUG) are part of this process, and provide the foundation upon which a resident's
individual care plan is formulated. MDS assessment forms are completed for all residents in certified nursing homes,
regardless of source of payment for the individual resident. MDS assessments are required for residents on admission
to the nursing facility and then periodically, within specific guidelines and time frames. In most cases, participants in
the assessment process are licensed health care professionals, usually Registered Nurses, employed by the nursing
home. MDS information is transmitted electronically by nursing homes to the MDS database in their respective
states. MDS information from the state databases is captured into the national MDS database at Centers for Medicare
and Medicaid Services (CMS).
Categories of MDS (Minimum Data Set)
1) Cognitive patterns
2) Communication and hearing patterns
3) Vision patterns
4) Physical functioning and structural problems
5) Continence
6) Psychosocial well-being
7) Mood and behavior patterns
8) Activity pursuit patterns
Minimum Data Set
600
9) Disease diagnoses
10) Other health conditions
11) Oral/nutritional status
12) Oral/dental status
13) Skin condition
14) Medication use
15) Treatments and procedures
References
CMS
[1]
References
[1] http:/ / www. cms. hhs.gov/ apps/ mds/
Multiscale Electrophysiology Format
Multiscale Electrophysiology Format (MEF) was developed to handle the large amounts of data produced by
large-scale electrophysiology in human and animal subjects. MEF can store any time series data up to 24 bits in
length, and employs lossless range encoded difference compression. Subject identifying information in the file
header can be encrypted using 128-bit AES encryption in order to comply with HIPAA requirements for patient
privacy when transmitting data across an open network.
Compressed data is stored in independent blocks to allow direct access to the data, facilitate parallel processing and
limit the effects of potential damage to files. Data fidelity is ensured by a 32-bit cyclic redundancy check in each
compressed data block using the Koopman polynomial (0xEB31D82E), which has a Hamming distance of from 4 to
114 kbits.
A formal specification can be found here
[1]
.
[2]
References
[1] http:/ / mayoresearch. mayo. edu/ mayo/ research/ msel/ upload/ mef%20_format. pdf
[2] Source code (http:/ / mayoresearch. mayo.edu/ mayo/ research/ msel/ example_code. cfm)
Sources
Martin, GNN. Range encoding: an algorithm for removing redundancy from a digitised message. Video & Data
Recoding Conference, Southampton, 1979.
Koopman, P. 32-Bit Cyclic Redundancy Codes for Internet Applications. The International Conference on
Dependable Systems and Networks (June 2002). 459.
Brinkmann, BH et al. Large-scale electrophysiology: acquisition, compression, encryption, and storage of big
data. Journal of Neuroscience Methods 180 (2009) 185192.
Multiscale Electrophysiology Format
601
External links
Source code: http:/ / mayoresearch. mayo. edu/ mayo/ research/ msel/ example_code. cfm
NANDA
NANDA-I
Full name NANDA International
Native name North American Nursing Diagnosis Association
Founded 1982
Members 519
Country International
Key people Dr. Jane Brokel, President
Office location Kaukauna, US
Website
Nanda.org
[1]
NANDA International (formerly the North American Nursing Diagnosis Association) is a professional organization
of nurses standardized nursing terminology that was officially founded in 1982 and develops, researches,
disseminates and refines the nomenclature, criteria, and taxonomy of nursing diagnoses. In 2002, NANDA
relaunched as NANDA International in response to the broadening scope of its membership. NANDA International
published Nursing Diagnosis quarterly, which became the International Journal of Nursing Knowledge in 2002.
Other related international associations are ACENDIO (Europe), AENTDE (Spanish language), AFEDI (French
language) and JSND (Japan). The Membership Network Groups foster collaboration among NANDA-I members in
countries (Brazil, Colombia, Ecuador, Mexico and Nigeria-Ghana) and for languages: the German Language Group
(Germany, Austria, Switserland) and the Dutch Language Group (Netherlands and Belgium).
History
In 1973, Kristine Gebbie and Mary Ann Lavin called the First National Conference on the Classification of Nursing
Diagnoses. It was held in St. Louis, Missouri. Attendees produced a beginning classification, an alphabetized list of
nursing diagnoses. The conference also created three structures: A National Clearinghouse for Nursing Diagnoses,
located at Saint Louis University and led by Ann Becker; a Nursing Diagnosis Newsletter, edited by Anne Perry; and
a National Conference Group to standardize nursing terminology and led by Marjory Gordon. In 1982 NANDA was
formed. It included members from the United States and Canada.
NANDA developed a nursing classification to organize nursing diagnoses into different categories. Although the
taxonomy was revised to accommodate new diagnoses, in 1994 it became apparent that an overhaul was needed. In
2002 Taxonomy II, which was a revised version of Gordon's functional health patterns, was released.
In 2002, NANDA became NANDA International in response to requests from its growing base of membership from
outside North America. The acronym of NANDA was retained in the name because of the name recognition, but it is
no longer merely "North American", and in fact boasts members from 32 countries as of 2010.
NANDA
602
Presidents
1982-1988 Dr. Marjory Gordon
1988-1993 Jane Lancour
1993-1997 Dr. Lois Hoskins
1997-2001 Dr. Judith Warren
2001-2005 Dr. Dorothy A. Jones
2005-2006 Kay Avant
2006-2007 Mary Ann Lavin
2007-2008 Martha Craft-Rosenberg
2008-2009 Dr. Heather Herdman
2009-2012 Prof. Dickon Weir-Hughes
2012-2016 Dr. Jane Brokel
Taxonomy II
The current structure of NANDA's nursing diagnoses is referred to as Taxonomy II and has three levels: 13 domains,
47 classes, and 216 diagnoses.
Domain Health
Promotion
Nutrition Elimination/
Exchange
Activity/
Rest
Perception/
Cognition
Self-
Perception
Role
Relationship
Sexuality Coping/Stress
Tolerance
Life
Principles
Safety/
Protection
Comfort Growth/
Development
Class 1 Health
awareness
Ingestion Urinary
system
Sleep/Rest Attention Self-Concept Caregiving
Roles
Sexual
Identity
Post-Trauma
Responses
Values Infection Physical
Comfort
Growth
Class 2 Health
Management
Digestion Gastrointestinal
System
Activity/
Exercise
Orientation Self-Esteem Family
Relationships
Sexual
Function
Coping
Responses
Beliefs Physical
Injury
Environmental
Comfort
Development
Class 3 Absorption Integumentary
System
Energy
Balance
Sensation/
Perception
Body Image Role
Performance
Reproduction Neuro-behavioral
Stress
Value/Belief/
Action
Congruence
Violence Social
Comfort
Class 4 Metabolism Pulmonary
System
Cardio-Pulmonary
Responses
Cognition Environmental
Hazards
Class 5 Hydration Self-Care Communication Defensive
Processes
Class 6 Thermo
Regulation
References
Herdman, TH (Ed.) Nursing Diagnoses: Definitions and classification 2009-2011. Wiley-Blackwell: Singapore.
Gebbie, KM & Lavin, MA (1975). Proceedings of the First National Conference on the Classification of Nursing
Diagnoses. St. Louis: Mosby.
External links
NANDA International's official website
[1]
References
[1] http:/ / www. nanda. org
Nursing Interventions Classification
603
Nursing Interventions Classification
The Nursing Interventions Classification (NIC) is a care classification system which describes the activities that
nurses perform as a part of the planning phase of the nursing process associated with the creation of a nursing care
plan.
The NIC provides a four level hierarchy whose first two levels consists of a list of 433 different interventions, each
with a definition in general terms, and then the ground-level list of a variable number of specific activities a nurse
could perform to complete the intervention. The second two levels form a taxonomy in which each intervention is
grouped into 27 classes, and each class is grouped into 6 domains.
An intent of this structure is to make it easier for a nurse to select an intervention for the situation, and to use a
computer to describe the intervention in terms of standardized labels for classes and domains. Another intent is in
each case to make it easy to use a Nursing Minimum Data Set (NMDS).
The terminology is an American Nurses' Association-recognized terminology, which is included in the UMLS, and is
HL7 registered.
[1][2][3][4]
References
[1] [1] Iowa Intervention Project (1996). Nursing Interventions Classification (NIC) (2nd ed.), St. Louis: Mosby-Year Book
[2] Henry SB, Warren JJ, Lange L, Button P., A review of major nursing vocabularies and the extent to which they have the characteristics
required for implementation in computer-based systems, J Am Med Inform Assoc. 1998 Jul-Aug;5(4):321-8
[3] Henry SB, Mead CN., Nursing classification systems: necessary but not sufficient for representing "what nurses do" for inclusion in
computer-based patient record systems, J Am Med Inform Assoc. 1997 May-Jun;4(3):222-32
[4] Nursing Interventions Classification (http:/ / www. ncvhs. hhs. gov/ 970416w4. htm)
Nursing Minimum Data Set
The Nursing Minimum Data Set (NMDS) is a classification system which allows for the standardized collection of
essential nursing data. The collected data are meant to provide an accurate description of the nursing process used
when providing nursing care. The NMDS allow for the analysis and comparison of nursing data across populations,
settings, geographic areas, and time.
[1][2]
References
[1] H H Werley, E C Devine, C R Zorn, P Ryan and B L Westra, The Nursing Minimum Data Set: abstraction tool for standardized, comparable,
essential data, American Journal of Public Health,1991, Vol. 81, Issue 4 421-426
[2] C A Williams, The Nursing Minimum Data Set: a major priority for public health nursing but not a panacea, Am J Public Health. 1991
April; 81(4): 413414
External links
Nursing Minimum Data Set for School Nursing Practice (http:/ / www. nasn. org/ Default. aspx?tabid=234)
Nursing Outcomes Classification
604
Nursing Outcomes Classification
The Nursing Outcomes Classification (NOC) is a classification system which describes patient outcomes sensitive
to nursing intervention. The NOC is a system to evaluate the effects of nursing care as a part of the nursing process.
The NOC contains 330 outcomes, and each with a label, a definition, and a set of indicators and measures to
determine achievement of the nursing outcome and are included The terminology is an American Nurses'
Association-recognized terminology, is included in the UMLS, and is HL7 registered.
[1]
[2]
References
[1] Donahue, M.P. & Brighton, V., Nursing outcome classification: Development and implementation, Journal of Nursing Care Quality, 1998,
12(5)
[2] S. Moorhead, M. Johnson, M. Maas, E. Swanson, Nursing Outcomes Classification (NOC), Elsevier, Fourth Edition, 936 pages, 2007, ISBN
0-323-05408-0
External links
Nursing Outcomes Classification (http:/ / www. nursing. uiowa. edu/ excellence/ nursing_knowledge/
clinical_effectiveness/ noc. htm) (U. Iowa)
OpenGALEN
OpenGALEN is a not-for-profit organisation that provides an open source medical terminology. This terminology is
written in a formal language called GRAIL (GALEN Representation And Integration Language)
[1]
and also
distributed in OWL.
Background
The GALEN technologies were developed with research funding provided by the European Community Framework
III (GALEN Project) and Framework IV (GALEN-In-Use Project) programmes.
Early phases of the GALEN Programme developed the GRAIL concept modelling language, experimented with
different structures for the GALEN Common Reference Model, and, in parallel, tested the usefulness of the approach
with a series of clinical demonstrator projects.
Later phases of the GALEN Programme, during the late 1990s, have concentrated on robust implementations of
GRAIL and the Terminology Server, development of the GALEN Common Reference Model in both scope and
detail, and development of tools and techniques to enable the further development, scaling-up and maintenance of
the model. An important additional focus has been in developing tools and techniques with which we can map the
information found in existing coding and Medical classification schemes to the GALEN Common Reference Model.
OpenGALEN has been set up as a not-for-profit Dutch Foundation by the universities of Manchester and Nijmegen
to make the results of the GALEN projects available to the world.
OpenGALEN
605
GALEN Common Reference Model
The GALEN Common Reference Model is the model of medical concepts (or clinical terminology) being built in
GRAIL. This model forms the underlying structural foundation for the services provided by a GALEN Terminology
Server.
The GALEN Common Reference Model is written in the formal language GRAIL (see below). The GRAIL
statements in the model are equivalent with sentences like these:
Ulcer is a kind of inflammatory lesion
The process whose outcome is an ulcer is called ulceration
The stomach is a part of the GI tract
It is sensible to talk about ulcers located in the stomach
Ulcers located in the stomach are called Gastric Ulcers
Ulcers located in the stomach are actually located on the mucosa of the wall of the stomach
The GALEN Common Reference Model is available from the OpenGALEN Foundation as open source.
Projects
The GALEN tools and technologies were used in France for the development of the French classification of
procedures Classification Commune des Actes Mdicaux (CCAM).
References
[1] http:/ / www. opengalen. org/ faq/ faq1. html#1.2
Rector, A.; Rogers, J.; Zanstra, P.; Van Der Haring, E. (2003). "OpenGALEN: Open source medical terminology
and tools". AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium: 982. PMC 1480228
(http:/ / www. ncbi. nlm. nih. gov/ pmc/ articles/ PMC1480228). PMID 14728486 (http:/ / www. ncbi. nlm. nih.
gov/ pubmed/ 14728486).
Rector, A.; Solomon, W.; Nowlan, W.; Rush, T.; Zanstra, P.; Claassen, W. (1995). "A Terminology Server for
medical language and medical information systems". Methods of information in medicine 34 (12): 147157.
PMID 9082124 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 9082124).
Rector, A.; Zanstra, P.; Solomon, W.; Rogers, J.; Baud, R.; Ceusters, W.; Claassen, W.; Kirby, J.; Rodrigues, J.;
Rossi Mori, A. R.; Van Der Haring, E. J.; Wagner, J. (1998). "Reconciling users' needs and formal requirements:
Issues in developing a reusable ontology for medicine". IEEE transactions on information technology in
biomedicine : a publication of the IEEE Engineering in Medicine and Biology Society 2 (4): 229242. doi:
10.1109/4233.737578 (http:/ / dx. doi. org/ 10. 1109/ 4233. 737578). PMID 10719533 (http:/ / www. ncbi. nlm.
nih. gov/ pubmed/ 10719533).
Rogers, J.; Roberts, A.; Solomon, D.; Van Der Haring, E.; Wroe, C.; Zanstra, P.; Rector, A. (2001). "GALEN ten
years on: Tasks and supporting tools". Studies in health technology and informatics 84 (Pt 1): 256260. PMID
11604744 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 11604744).
Ten Napel, H.; Rogers, J. (2001). "Assessment of the GALEN methodology on holistic classifications for
professions allied to medicine". Studies in health technology and informatics 84 (Pt 2): 13691373. PMID
11604951 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 11604951).
Rogers, J.; Rector, A. (2000). "GALEN's model of parts and wholes: Experience and comparisons". Proceedings /
AMIA ... Annual Symposium. AMIA Symposium: 714718. PMC 2243933 (http:/ / www. ncbi. nlm. nih. gov/
pmc/ articles/ PMC2243933). PMID 11079977 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 11079977).
Solomon, W.; Roberts, A.; Rogers, J.; Wroe, C.; Rector, A. (2000). "Having our cake and eating it too: How the
GALEN Intermediate Representation reconciles internal complexity with users' requirements for appropriateness
and simplicity". Proceedings / AMIA ... Annual Symposium. AMIA Symposium: 819823. PMC 2244105 (http:/ /
OpenGALEN
606
www. ncbi. nlm. nih. gov/ pmc/ articles/ PMC2244105). PMID 11079998 (http:/ / www. ncbi. nlm. nih. gov/
pubmed/ 11079998).
Rogers, J. (2006). "Quality assurance of medical ontologies". Methods of information in medicine 45 (3):
267274. PMID 16685334 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 16685334).
External links
OpenGALEN (http:/ / www. opengalen. org) Web site
CCAM, Classification Commune des Actes Mdicaux (http:/ / www. ccam. sante. fr/ )
University of Manchester, Bio-Health Informatics Group (http:/ / www. cs. man. ac. uk/ bhig/ )
University of Nijmegen, Medical Informatics (http:/ / www. umcn. nl/ mi/ )
SNOMED
The Systematized Nomenclature of Medicine (SNOMED) is a systematic, computer-processable collection of
medical terms, in human and veterinary medicine, to provide codes, terms, synonyms and definitions which cover
anatomy, diseases, findings, procedures, microorganisms, substances, etc. It allows a consistent way to index, store,
retrieve, and aggregate medical data across specialties and sites of care. Although now international, SNOMED was
started in the U.S. by the College of American Pathologists in 1973 and revised into the 1990s, then in 2002,
SNOMED was merged and expanded with the UK National Health Service (NHS).
Versions of SNOMED released prior to 2001 were based on a multiaxial, hierarchical classification system.
[]
As in
any such system, a disease may be located in a body organ (anatomy), which results in a code in a topography axis
and may lead to morphological alterations represented by a morphology code.
In 2002 the first release of SNOMED CT adopted a completely different structure. A sub-type hierarchy, supported
by defining relationships based on description logic, replaced the axes described in this article. Versions of
SNOMED prior to SNOMED CT are planned to be formally deprecated from 2017.
[1]
Therefore readers interested in
current information about SNOMED are directed to the article on SNOMED CT.
Purpose
SNOMED was designed as a comprehensive nomenclature of clinical medicine for the purpose of accurately storing
and/or retrieving records of clinical care in human and veterinary medicine. The metaphor used by Roger A. Ct,
the first editorial chair, was that SNOMED would become the periodical table of elements of medicine because of its
definitional organization beyond the hierarchical design. Indeed, diseases and procedures were ordered hierarchically
and are further referenced back to more elementary terms (see Reference Ontology and Multi-Axial Design, below).
History
SNOMED was originally conceived by Dr. Roger A. Ct as an extension of the design of the Systematized
Nomenclature of Pathology (SNOP) applicable for all medicine. SNOP was originally designed by Dr. Arnold Pratt
to describe pathological specimen according to their morphology and anatomy (topography). The ambitious
development of SNOMED required many more axises (see multi-axial design, below). SNOMED was jointly
proposed for development to the College of American Pathologists by Drs. Ct and Dr. Arnold Pratt and the former
was appointed as Editorial Chair of the Committee on Nomenclature and Classification of Diseases of the College of
American Pathologists and developed the Systematized Nomenclature of Medicine (SNOMED) from 1973 to 1997.
In 1998, Dr. Kent Spackman was appointed Chair of this Committee and spearheaded the transformation of the
multi-axis systems into a highly computable form (See SNOMED CT): a directed acyclic graph anchored in formal
SNOMED
607
representation logic. In 2007, the newly formed International Health Terminology Standards Development
Organisation (IHTSDO) acquired all the Intellectual Property of SNOMED CT and all antecedent SNOMED
versions.
Brief timeline:
1965 SNOP
1974 SNOMED
1979 SNOMED II
1993 SNOMED International 3.0
1995 SNOMED Microglossary of Signs and Symptoms
1993-98 SNOMED International versions 3.1-3.5
2002 First release of SNOMED CT
2007 All versions of SNOMED acquired by IHTSDO
2017 All SNOMED versions except SNOMED CT will be formally deprecated by IHTSDO
Reference ontology
SNOMED was designed from its inception with complex concepts defined in term of simpler ones. For example, a
disease can be defined in terms of its abnormal anatomy, abnormal functions and morphology. In some cases, the
etiology of the disease is known and can be attributed to an infectious agent, a physical trauma or a chemical or
pharmaceutical agent.
Multi-axial design
The current concept uses eleven (11) axes that comprise terms organised in hierarchical trees. The axes and some
examples are provided below:
T (Topography) Anatomic terms
(T-28000) Lung
(T-32000) Heart
(T-51000) Mouth
(T-D2500) Hip
(T-D9600) Heel
M (Morphology) Changes found in cells, tissues and organs
(M-40000) Inflammation
(M-44000) Granuloma
(M-54700) Infarcted
(M-54701) Microscopic infarct
For the Morphology axis, SNOMED has agreed
[2]
to collaborate and use the same harmonized codes shared with
International Classification of Diseases for Oncology. Additional examples on topology are provided on that page.
SNOMED
608
L (Living organisms) Bacteria and viruses
(L-21801) Mycobacterium tuberculosis
(L-25116) Streptococcus pneumoniae
C (Chemical) Drugs
(C-C137A) Bufferin Analgesic Tablets
(C-C137B) Bufferin Analgesic Caplets
F (Function) Signs and symptoms
(F-03003) Fever
J (Occupation) Terms that describe the occupation
Kindergarten teacher (13420)
Computer programmer (08420)
Doctor (06105)
Professional Nurse (General) (07110)
Beautician (57040)
D (Diagnosis) Diagnostic terms
(D-13510) Pneumococcal pneumonia
(D-14800) Tuberculosis
(D3-15000) Myocardial infarction
S (Social context) Social conditions and important relationships in medicine
(S-10120) Mother
References
[1] Deprecation of Antecedent Versions of SNOMED by IHTSDO General Assembly (http:/ / www. ihtsdo. org/ snomed-ct/ history0/ )
[2] http:/ / www. snomed. org/ clinical/ anatomic. html
External links
Official page at snomed.org (http:/ / www. snomed. org/ ) (now redirects to www.ihtsdo.org (http:/ / www. ihtsdo.
org/ ))
Studies of the formal structure of SNOMED CT at buffalo.edu (http:/ / ontology. buffalo. edu/ medo/
SNOMED_Smith. html)
Browser at vetmed.vt.edu (http:/ / terminology. vetmed. vt. edu/ SCT/ menu. cfm)
Dataline SNOMED Browser: Looks up clinical terms online for free. (http:/ / www. snoflake. co. uk/ )
SNOCat: the SNOMED Categorizer/Browser to automatically encode medical narratives - provided by the
BiTeM group (http:/ / bitem. hesge. ch) ! (http:/ / eagl. unige. ch/ SNOCat/ )
SNOMED CT
609
SNOMED CT
SNOMED CT
[1]
</ref> or SNOMED Clinical Terms
[2]
is a systematically organized computer processable
collection of medical terms providing codes, terms, synonyms and definitions used in clinical documentation and
reporting. SNOMED CT is considered to be the most comprehensive, multilingual clinical healthcare terminology in
the world.Wikipedia:No original research#Primary, secondary and tertiary sources The primary purpose of
SNOMED CT is to encode the meanings that are used in health information and to support the effective clinical
recording of data with the aim of improving patient care. SNOMED CT provides the core general terminology for
electronic health records. SNOMED CT comprehensive coverage includes: clinical findings, symptoms, diagnoses,
procedures, body structures, organisms and other etiologies, substances, pharmaceuticals, devices and specimen.
SNOMED CT provides for consistent information interchange and is fundamental to an interoperable electronic
health record. It allows a consistent way to index, store, retrieve, and aggregate clinical data across specialties and
sites of care. It also helps in organizing the content of electronic health records systems by reducing the variability in
the way data is captured, encoded and used for clinical care of patients and research. SNOMED CT can be used to
record clinical details of individuals in the electronic patient records. It also provides the user with a number of
linkages to clinical care pathways, shared care plans and other knowledge resources, in order to facilitate informed
decision-making and support long term patient care. The availability of free automatic coding tools and services,
which can return a ranked list of SNOMED CT descriptors to encode any clinical report, could help healthcare
professionals to navigate the terminology.
SNOMED CT is a terminology that can cross-map to other international standards and classifications. Specific
language editions are available which augment the international edition and can contain language translations, as
well as additional national terms. For example, SNOMED CT-AU, released in December 2009 in Australia, is based
on the international version of SNOMED CT, but encompasses words and ideas that are clinically and technically
unique to Australia.
History
SNOMED was started in 1965 as a Systematized Nomenclature of Pathology (SNOP) and has further developed into
a logic-based health care terminology. SNOMED CT was created in 1999 by the merger, expansion and restructuring
of two large-scale terminologies: SNOMED Reference Terminology (SNOMED RT), developed by the College of
American Pathologists (CAP); and the Clinical Terms Version 3 (CTV3) (formerly known as the Read codes),
developed by the National Health Service of the United Kingdom (NHS).
[3][4]
The final product was released in
January 2002.
The historical strength of SNOMED was its coverage of medical specialties. SNOMED RT, with over 120,000
concepts, was designed to serve as a common reference terminology for the aggregation and retrieval of health care
data recorded by multiple organizations and individuals. The strength of CTV3 was its terminologies for general
practice. CTV3, with 200,000 interrelated concepts, was used for storing structured information about primary care
encounters in individual, patient-based records. Currently, SNOMED CT contains more than 311,000 active
concepts and provides the core general terminology for the electronic health record (EHR).
In July 2003, the National Library of Medicine (NLM), on behalf of the U.S. Department of Health and Human
Services, entered into an agreement with the College of American Pathologists to make SNOMED CT available to
U.S. users at no cost through the National Library of Medicine's Unified Medical Language Systems UMLS
Metathesaurus . The contract provided NLM with a perpetual license for the core SNOMED CT (in Spanish and
English) and its ongoing updates.
[5][6][7]
In April 2007, SNOMED CT intellectual property rights were transferred from the CAP to the International Health
Terminology Standards Development Organisation IHTSDO in order to promote international adoption and use of
SNOMED CT
610
SNOMED CT. IHTSDO is responsible for "ongoing maintenance, development, quality assurance, and distribution
of SNOMED CT" internationally and consists of a number of the world's leading e-health countries, including:
Australia, Canada, Czech Republic, Denmark, Estonia, Hong Kong, Iceland, Israel, Lithuania, Malaysia, Malta,
Netherlands, New Zealand, Poland, Singapore, Sloval Republic, Slovenia, Spain, Sweden, United Kingdom, United
States and Uruguay.
SNOMED CT is a multinational and multilingual terminology, which can manage different languages and dialects.
SNOMED CT is currently available in American English, British English, Spanish, Danish and Swedish, with other
translations under way or nearly completed in French and Dutch. SNOMED CT cross maps to other terminologies,
such as: ICD-9-CM, ICD-10, ICD-O-3, ICD-10-AM, Laboratory LOINC and OPCS-4. It supports ANSI, DICOM,
HL7, and ISO standards. SNOMED CT is currently used in a joint project with the WHO as the ontological basis of
the upcoming ICD-11.
Structure
SNOMED CT consists of four primary core components:
1. Concept Codes - numerical codes that identify clinical terms, primitive or defined, organized in hierarchies
2. Descriptions - textual descriptions of Concept Codes
3. Relationships - relationships between Concept Codes that have a related meaning
4. Reference Sets - used to group Concepts or Descriptions into sets, including reference sets and cross-maps to
other classifications and standards.
SNOMED CT "Concepts" are representational units that categorize all the things that characterize health care
processes and need to be recorded therein. In 2011, SNOMED CT includes more than 311,000 concepts, which are
uniquely identified by a concept ID, i.e. the concept 22298006 refers to Myocardial infarction. All SNOMED CT
concepts are organized into acyclic taxonomic (is-a) hierarchies; for example, Viral pneumonia IS-A Infectious
pneumonia IS-A Pneumonia IS-A Lung disease. Concepts may have multiple parents, for example Infectious
pneumonia is also a child of Infectious disease. The taxonomic structure allows data to be recorded and later
accessed at different levels of aggregation. SNOMED CT concepts are linked by approximately 1,360,000 links,
called relationships.
[8]
Concepts are further described by various clinical terms or phrases, called Descriptions, which are divided into Fully
Specified Names (FSNs), Preferred Terms (PTs), and Synonyms. Each Concept has exactly one FSN, which is unique
across all of SNOMED CT. It has, in addition, exactly one PT, which has been decided by a group of clinicians to be
the most common way of expressing the meaning of the concept. It may have zero to many Synonyms. Synonyms
are additional terms and phrases used to refer to this concept. They do not have to be unique or unambiguous.
The formal model underlying SNOMED CT
SNOMED CT can be characterized as a multilingual thesaurus with an ontological foundation. Thesaurus-like
features are conceptterm relations such as the synonymous descriptions "Acute coryza", "Acute nasal catarrh",
"Acute rhinitis", "Common cold" (as well as Spanish "resfro comn" and "rinitis infecciosa") for the concept
82272006.
Under ontological scrutiny SNOMED-CT is a class hierarchy (with extensive overlap of classes in contrast to typical
statistical classifications like ICD). This means that the SNOMED CT concept 82272006 defines the class of all the
individual disease instances that match the criteria for "common cold" (e.g., one patient may have "head cold" noted
in their record, and another may have "Acute coryza"; both can be found as instances of "common cold"). The
superclass (Is-A) Relation relates classes in terms of inclusion of their members. That is, all individual
"cold-processes" are also included in all superclasses of the class Common Cold, such as Viral upper respiratory tract
infection (Figure).
SNOMED CT
611
Common cold as a primitive concept in
SNOMED CT
SNOMED CT's relational statements are basically triplets of the form
Concept
1
- Relation
x
- Concept
2
, with Relation
x
being from a small
number of relation types (called linkage concepts), e.g. finding site,
due to, etc. The interpretation of these triplets is (implicitly) based on
the semantics of a simple Description logic (DL). E.g., the triplet
Common Cold - causative agent Virus, corresponds to the first-order
expression
forall x: instance-of (x, Common cold) ->
exists y: instance-of (y, Virus) and
causative-agent (y, x)
or the more intuitive DL expression
Common cold subClassOf causative-agent some Virus
In the Common cold example the concept description is "primitive", which means that necessary criteria are given
that must be met for each instance, without being sufficient for classifying a disorder as an instance of Common Cold
. In contrast, the example Viral upper respiratory tract infection depicts a fully described concept, which is
represented in description logic as follows:
Viral upper respiratory tract infection as a
defined concept in SNOMED CT
Viral upper respiratory tract infection equivalentTo
Upper respiratory infection and Viral respiratory infection and
Causative-agent some Virus and
Finding-site some Upper respiratory tract structure and
Pathological-process some Infectious process
This means that each and every individual disorder for which all definitional criteria are met can be classified as an
instance of Viral upper respiratory tract infection.
Description logics
As of 2011, SNOMED CT content limits itself to a subset of the EL++ formalism, restricting itself to the following
operators:
Top, bottom
Primitive roles and concepts with asserted parent(s) for each
Concept definition and conjunction but NOT disjunction or negation
Role hierarchy but not role composition
Domain and range constraints
Existential but not universal restriction
A restricted form of role inclusion axiom (xRy ^ ySz => xRz)
The logic will be extended in the near future to include General Concept Inclusion Axioms.
SNOMED CT
612
Precoordination and postcoordination
SNOMED CT provides a compositional syntax
[9]
that can be used to create expressions that represent clinical ideas
which are not explicitly represented by SNOMED CT concepts.
For example, there is no explicit concept for a "third degree burn of left index finger caused by hot water". However,
using the compositional syntax it can be represented as
284196006 | burn of skin | :
116676008 | associated morphology | = 80247002 | third degree burn injury |
, 272741003 | laterality | = 7771000 | left |
, 246075003 | causative agent | = 47448006 | hot water |
, 363698007 | finding site | = 83738005 | index finger structure
Such expressions are said to have been 'postcoordinated'. Post-coordination avoids the need to create large numbers
of defined Concepts within SNOMED CT. However, many systems only allow for precoordinated representations.
Reliable analysis and comparison of post-coordinated expressions is possible using appropriate algorithms
machinery to efficiently process the expression taking account of the underlying description logic.
For example, the postcoordinated expression above can be transformed using a set of standard rules to the following
"normal form expression" which enables comparison with similar concepts.
64572001 | disease | :
246075003 | causative agent | = 47448006 | hot water |
, 363698007 | finding site | = ( 83738005 | index finger structure | :
272741003 | laterality | = 7771000 | left | )
, { 116676008 | associated morphology | = 80247002 | third degree burn injury |
, 363698007 | finding site | = 39937001 | skin structure | }
Known deficiencies and mitigation strategies
Earlier SNOMED versions had faceted structure ordered by semantic axes, requiring that more complex situations
required to be coded by a coordination of different codes. This had two major shortcomings. On the one hand, the
necessity of post-coordination was perceived as a user-unfriendly obstacle, which has certainly contributed to the
rather low adoption of early SNOMED versions. On the other hand, uniform coding was difficult to obtain.
E.g.,Acute appendicitis could be post-coordinated in three different ways
[10]
with no means to compute semantic
equivalences. SNOMED RT had addressed this problem by introducing description logic formula. With the addition
of CTV3 a large number of concepts were redefined using formal expressions. However, the fusion with CTV3, as a
historically grown terminology with many close-to user descriptions, introduced some problems which still affect
SNOMED CT. In addition to a confusing taxonomic web of many hierarchical levels with massive multiple
inheritance (e.g. there are 36 taxonomic ancestors for Acute appendicitis), many ambiguous, context-dependent
concepts have found their way into SNOMED CT. Pre-coordination was sometimes pushed to extremes, so there are,
for example, 350 different concepts for burns found on the head.
A further phenomenon which characterizes parts of SNOMED CT is the so called epistemic intrusion.
[11]
In
principle, the task of terminology (and even an ontology) should be limited to providing context-free term or class
meanings. The contextualization of these representational units should be ideally the task of an information
model.
[12]
Human language is misleading here, as we use syntactically similar expression to represent categorically
distinct entities, e.g. Ectopic pregnancy vs. Suspected pregnancy. The first one refers to a real pregnancy, the second
one to a piece of (uncertain) information. In SNOMED CT most (but not all) of these context-dependent concepts are
concentrated in the subhierachy Situation with explicit context. A major reason for why such concepts cannot be
dispensed with is that SNOMED CT takes on, in many cases, the functionality of information models, as the latter do
not exist in a given implementation.
SNOMED CT
613
With the establishment of IHTSDO SNOMED CT became more accessible to a wider audience. Criticism of the
state of the terminology was sparked by numerous substantive weaknesses as well as on the lack of quality assurance
measures.
[13]
From the beginning IHTSDO was open regarding such (also academic) criticism. In the last few years
considerable progress has been made regarding quality assurance and tooling
[14]
.
The need for a more principles ontological foundation was gradually accepted, as well as a better understanding of
description logic semantics. Redesign priorities were formulated regarding observables,
[15]
disorders, findings,
[16]
substances, organisms etc. Translation guidelines
[17]
were elaborated as well as guidelines for content submission
requests and a strategy for the inclusion of pre-coordinated content. There are still known deficiencies regarding the
"ontological commitment" of SNOMED CT,
[18]
e.g., the clarification of which kind of entity is an instance of a
given SNOMED CT concept. The same term can be interpreted as a disorder or a patient with a disorder, for
example Tumour might denote a process or a piece of tissue; Allergy may denote an allergic reaction or just an
allergic disposition. A more recent strategy is the use of rigorously typed upper-level ontologies to disambiguate
SNOMED CT content.
The increased take-up of SNOMED CT into applications in daily use across the world to support patient care is
leading to a larger engaged community. This has led to an increase in the resource allocated to authoring SNOMED
CT terms as well as to an increase in collaboration to take SNOMED CT into a robust industry used standard. This is
leading to an increase in the number of software tools and development of materials that contribute to knowledge
base to support implementation. A number of on-line communities that focus on particular aspects of SNOMED CT
and its implementation are also developing.
In theory, description logic reasoning can be applied to any new candidate post-coordinated expressions in order to
assess whether it is a parent or ancestor of, a child or other descendent of, or semantically equivalent to any existing
concept from the existing pre-coordinated concepts. However, partly as the continuing fall-out from the merger with
CTV3, SNOMED still contains undiscovered semantically duplicate primitive and defined concepts. Additionally,
many concepts remain primitive whilst their semantics can also be legitimately defined in terms of other primitives
and roles concurrently in the system. Because of these omissions and actual or possible redundancies of semantic
content, real-world performance of algorithms to infer subsumption or semantic equivalence will be unpredictably
imperfect.
SNOMED CT and ICD
SNOMED CT is a clinical terminology designed to capture and represent patient data for clinical purposes.
[19]
International Classification of Diseases (ICD) is a statistical classification system used to assign diagnostic and
procedural codes in order to produce coded data for statistical analysis, epidemiology, reimbursement and resource
allocation.
[20]
Both systems use standardized definitions and form a common medical language used within the
electronic health record (EHR) systems.
[21]
SNOMED CT enables information input into EHR during the course of
patient care, while ICD facilitates information retrieval, or output, for secondary data purposes.
[22]
SNOMED CT
614
SNOMED CT ICD
Type Terminology System Classification System
Purpose Information Input Information Output
Function Describes and defines clinical information for primary data
purposes
Aggregates and categorizes clinical information for secondary data
purposes
Use
SNOMED CT is used in a number of different ways, some of which are:
It captures clinical information at the level of detail needed for the provision of healthcare
Through sharing data it can reduce the need to repeat health history at each new encounter with a healthcare
professional
Information can be recorded by different people in different locations and combined into simple information
views within the patient record
Use of a common terminology decreases the potential for differing interpretation of information
Electronic recording in a common way reduces errors and can help to ensure completeness in recording all
relevant data
Standardised information makes analysis easier, supporting quality, cost effective practice, research and future
clinical guideline development
A clinical terminology allows a health care provider to identify patients based on specified coded information,
and more effectively manage screening, treatment and follow up
Use cases
More specifically, the following sample computer applications use SNOMED CT:
Electronic Health Record Systems
Computerized Provider Order Entry CPOE such as E-Prescribing or Laboratory Order Entry
Catalogues of clinical services; e.g., for Diagnostic Imaging procedures
Knowledge databases used in clinical decision support systems (CDSS)
Remote Intensive Care Unit Monitoring
Laboratory Reporting
Emergency Room Charting
Cancer Reporting
Genetic Databases
Access
SNOMED CT is maintained and distributed by the IHTSDO, an international non-profit standards development
organization, located in Copenhagen, Denmark. The use of SNOMED CT in production systems requires a license
[23]
. There are two models. On the one hand SNOMED CT can be achieved by national membership in the IHTSDO
(charged according to the GNP). On the other hand it can be used via a corporate business license (dependent on the
number of end users). LDCs (least developed countries) can use SNOMED CT without charges. For scientific
research in medical informatics, for demonstrations or evaluation purposes SNOMED CT sources can be freely
downloaded and used. The original SNOMED CT sources in tabular form are accessible by registered users of the
Unified Medical Language System (UMLS) who have signed an agreement. Numerous online and offline browsers
[24]
are available . Those wishing to obtain a license for its use and to download SNOMED CT should contact their
National Release Centre, links to which are provided on the IHTSDO
[25]
web site .
SNOMED CT
615
Notes
[1] From Systematized Nomenclature Of Medicine Clinical Terms<ref name="Cornet">
[2] SNOMED CT (http:/ / www.ihtsdo. org/ snomed-ct)
[3] http:/ / www. nlm. nih.gov/ research/ umls/ Snomed/ snomed_announcement. html SNOMED CT Announcement
[4] SNOMED FAQ (http:/ / www. nlm. nih.gov/ research/ umls/ Snomed/ snomed_faq. html)
[5] SNOMED CT Announcement (http:/ / www. nlm. nih.gov/ research/ umls/ Snomed/ snomed_announcement. html)
[6] license (http:/ / www.nlm. nih.gov/ research/ umls/ Snomed/ snomed_license. html)
[7] Unified Medical Language System (http:/ / www.nlm.nih. gov/ research/ umls/ Snomed/ snomed_main. html)
[8] SNOMED CT Documentation is publicly available at http:/ / www. snomed. org/ doc
[9] SNOMED CT Compositional Grammar http:/ / www. snomed. org/ tig?t=rfg_expression_scg
[10] [10] Spackman KA, Campbell KE. Compositional concept representation using SNOMED: towards further convergence of clinical
terminologies. Proc AMIA Symp. 1998:740-744
[11] Ingenerf J, Linder R. Assessing applicability of ontological principles to different types of biomedical vocabularies. Methods of Information
in Medicine 2009;48(5):459-467. Epub 2009 May 15
[12] Rector A. (2008) Barriers, approaches and research priorities for integrating biomedical ontologies. Semantic Health Deliverable 6.1 http:/ /
www.semantichealth. org/ DELIVERABLES/ SemanticHEALTH_D6_1. pdf
[13] [13] Schulz S, Suntisrivaraporn B, Baader F, Boeker M. SNOMED reaching its adolescence: ontologists' and logicians' health check.
International Journal of Medical Informatics. 2009 Apr;78 Suppl 1:S86-94. Epub 2008 Sep 12.
[14] http:/ / www.ihtsdo.org/ develop/ tooling/
[15] SNOMED CT Style Guide: Observable Entities and Evaluation Procedures (Laboratory) Draft IHTSDO Standard v1.0, 2010-06-30, http:/
/ www.ihtsdo.org/ fileadmin/ user_upload/ Docs_01/ Publications/ Drafts_for_review/ SNOMED_CT_Style_Guide_Observables_v1. 0. pdf
[16] Schulz S, Spackman K, James A, Cocos C, Boeker M. Scalable representations of diseases in biomedical ontologies. Journal of Biomedical
Semantics. 2011 May 17;2 Suppl 2:S6.
[17] [17] www.ihtsdo.org/fileadmin/user_upload/Docs_01/About_IHTSDO/Publications/IHTSDO_Translation_Guidelines_v2.00_20100407.pdf
[18] Schulz, S; Cornet, R; Spackman, K Consolidating SNOMED CTs . Applied ontology. 2011; 6: 1-11.
[19] [19] Kostick, K. (2012) SNOMED CT Integral Part of Quality HER Documentation. Journal of AHIMA 83.10 (October 2012): 72-75.
[20] http:/ / www.who. int/ classifications/ icd/ en/
[21] [21] Bowman, S. (2005) Coordinating SNOMED-CT and ICD-10: Getting the Most out of Electronic Health Record Systems. Journal of
AHIMA 76(7):60-61. www.ahima.org/perspectives
[22] [22] Truran, D., Saad, P. Zhang, M., Innes, K. (2010) SNOMED CT and its place in health information management practice. Health Information
Management Journal Vol 39 (2):37-39 ISSN 1833-3583 (Print) 1833-3575 (Online)
[23] http:/ / www.snomed. org/ license
[24] http:/ / www.nlm.nih. gov/ research/ umls/ Snomed/ snomed_browsers. html
[25] http:/ / www.ihtsdo.org/ members/
References
External links
IHTSDO Web Site - Home of the owners of SNOMED (http:/ / www. ihtsdo. org/ )
SNOMED CT Value Proposition (http:/ / www. snomed. org/ benefits. pdf)
SNOMED CT Online Documentation Directory (http:/ / www. snomed. org/ doc)
CAP SNOMED Terminology Solutions - the original creators of SNOMED CT (http:/ / www. capsts. org)
Online SNOMED CT Browser English and German (http:/ / semfinder-snomed. ch/ )
CliniClue SNOMED CT Browser (Windows) - freeware download (http:/ / www. cliniclue. com)
UMLS-SNOMED FAQs (http:/ / www. nlm. nih. gov/ research/ umls/ Snomed/ snomed_faq. html)
NHS Connecting for Health UK (http:/ / www. connectingforhealth. nhs. uk/ terminology/ snomed)
SNOB - Desktop SNOMED Browser (Windows/WINE) - freeware download (http:/ / snob. eggbird. eu)
SNOMED CT Browser with SNOFLAKE view at dataline.co.uk (http:/ / snomed. dataline. co. uk/ )
VMIL terminology browser (http:/ / terminology. vetmed. vt. edu/ SCT/ menu. cfm)
SNOCat: the SNOMED Categorizer/Browser (http:/ / bitem. hesge. ch/ content/ snocat)
Minnow SNOMED CT Browser (Windows/Mac OS X/Linux) - freeware download (http:/ / aehrc. com/ snapper/
minnow/ )
Problems with SNOMED (Papers by Barry Smith) (http:/ / ontology. buffalo. edu/ medo/ SNOMED_Smith. html)
SNOMED CT
616
Snow Owl - Freeware multiplatform SNOMED CT browser and authoring tool integrating Protg. (http:/ / www.
b2international. com/ portal/ snow-owl)
What Is SNOMED Clinical Terms" (http:/ / northern. assist. org. uk/ Documents/ 2007 - 2008/ 0704/ SnomedCT.
pps)
Health Data Management, February 14, 2002: New Clinical Terminology Available from SNOMED, (http:/ /
www. healthdatamanagement. com/ html/ PortalStory. cfm?type=newprod& DID=7841,)
SNOMED CT-AU Information (http:/ / www. nehta. gov. au/ media-centre/ feature-story/
574-nehta-launches-the-first-release-of-snomed-ct-aur/ )
ITServer - Online SNOMED CT Browser English and Spanish (http:/ / www. itserver. es)
Standard for Exchange of Non-clinical Data
SEND, or the Standard for Exchange of Nonclinical Data, is an implementation of the CDISC CDISC Standard Data
Tabulation Model (SDTM) for nonclinical studies, which specifies a way to present nonclinical data in a consistent
format. These types of studies are typically related to animal testing as part of pre-clinical (pre-Phase 1) clinical
trials.
Having a common model to which the industry can conform enables benefits such as the ability for vendors to
develop tools, for intercompany exchange that is consistent in format regardless of the parties involved, and so on.
A SEND package consists of a few parts, but the main focus is on individual endpoint data. Endpoints typically map
to domains (essentially, datasets), with a number of variables (a.k.a., columns or fields). The SEND Implementation
Guide (SENDIG) is a document that provides implementers with specifications for implementing SEND, including
how to model various nonclinical endpoints, rules to doing so, and examples with sample data.
The SEND Implementation Wiki
[1]
is a wiki hosted by phUSE
[2]
designed to assist with the implementation
process, most notably containing:
Fundamentals pages - providing entry-level descriptions of fundamental concepts in SEND, such as SEND itself,
Controlled Terminology (CT), and Define.xml
Getting SEND-ready, to help new implementers get started
FAQ - providing a large, evolving list of commonly asked questions
History
The work on this standard began in July 2002subsequently, a U.S. Food and Drug Administration pilot project
was initiated in July 2003 through a Cooperative Research and Development Agreement (CRADA). Feedback from
this pilot and continuous efforts to more closely align this implementation with the SDTM for human clinical trials
led to development of SEND 2.3, but without widespread adoption.
In 2006, with renewed FDA interest, the industry met to revive SEND and work on a version that, with FDA
backing, would cover regulatory submission as well as operational data transfer needs. By 2007, an FDA pilot was
announced, during which time the SEND team worked on the SENDIG (implementation guide).
SENDIG 3.0 was released to production in July 2011. This was soon followed by the FDA's statement of preference
for SEND datasets.
Standard for Exchange of Non-clinical Data
617
External links
SEND Implementation Wiki
[1]
FDA Data Standards
[3]
CDISC SEND
[4]
References
[1] http:/ / www. phusewiki.org/ wiki/ index.php?title=SEND_Implementation_Wiki
[2] http:/ / www. phuse.eu
[3] http:/ / www. fda. gov/ ForIndustry/ DataStandards/ StudyDataStandards/ ucm155320. htm
[4] http:/ / www. cdisc.org/ send
TC 251
CEN/TC 251 (CEN Technical Committee 251) is a workgroup within the European Union working on
standardization in the field of Health Information and Communications Technology (ICT) in the European Union.
The goal is to achieve compatibility and interoperability between independent systems and to enable modularity in
Electronic Health Record systems.
Workgroups establish requirements for health information structure in order to support clinical and administrative
procedures, technical methods to support interoperable systems. In addition they establish requirements regarding
safety, security and quality.
Workgroups
The seven Working Groups (WGs) in CEN/TC 251 are :
WG1: Healthcare Information Modelling and Medical Records
WG2: Healthcare Terminology, Semantics and Knowledge Bases
WG3: Healthcare Communications and Messages
WG4: Medical Imaging and Multimedia
WG5: Communication with Medical Devices
WG6: Healthcare Security, Privacy, Quality and Safety
WG7: Intermittently Connected Devices (including Cards)
External links
CEN/TC 251
[1]
CEN/TC 251 - Published standards
[2]
CEN/TC 251 is a member of the Global Health Informatics Standardization
[1]
Joint Initiative Council
[3]
References
[1] http:/ / www. centc251. org/
[2] http:/ / www. cen.eu/ CEN/ Sectors/ TechnicalCommitteesWorkshops/ CENTechnicalCommittees/ Pages/ Standards. aspx?param=6232&
title=CEN%2FTC+ 251
[3] http:/ / www. jointinitiativecouncil. org/
WHOART
618
WHOART
The WHO Adverse Reactions Terminology (WHOART) is a dictionary meant to serve as a basis for rational
coding of adverse reaction terms. The system is maintained by the Uppsala Monitoring Centre (UMC), the World
Health Organization Collaborating Centre for International Drug Monitoring.
Structure
32 System-organ classesbody organ groups
180 High level terms for grouping Preferred terms
2085 Preferred terms principal terms for describing adverse reactions
3445 Included terms synonyms to Preferred terms
References
WHO Adverse Reactions Terminology
[1]
References
[1] http:/ / www. umc-products. com/ graphics/ 3149.pdf
619
Healthcare Ontologies
Nosology
Nosology (from Ancient Greek (nosos), meaning "disease", and - (-logia), meaning "study of-") is a
branch of medicine that deals with classification of diseases.
Types of classification
Diseases may be classified by etiology (cause), pathogenesis (mechanism by which the disease is caused), or by
symptom(s). Alternatively, diseases may be classified according to the organ system involved, though this is often
complicated since many diseases affect more than one organ.
A chief difficulty in nosology is that diseases often cannot be defined and classified clearly, especially when etiology
or pathogenesis are unknown. Thus diagnostic terms often only reflect a symptom or set of symptoms (syndrome).
History
The Ayurveda is a collection of early Indian works about medicine. In China the Huangdi Neijing is another ancient
text. In the West, Hippocrates was one of the earliest writers on the subject of disease. The book of Leviticus also
includes an early discussion of the treatment of skin diseases. See Metzora (parsha) In the 10th century the Arabian
psychologist Najab ud-din Unhammad classified a nosology of nine major categories of mental disorders, which
included 30 different mental illnesses in total. Some of the categories he described included obsessive-compulsive
disorders, delusional disorders, degenerative diseases, involutional melancholia, and states of abnormal
excitement.Wikipedia:Verifiability
In the 18th century, the taxonomist Carolus Linnaeus, Francois Boissier de Sauvages, and psychiatrist Philippe Pinel
developed an early classification of physical illnesses. Thomas Sydenham's work in the late 17th century might also
be considered a nosology. In the 19th century, Emil Kraepelin and then Jacques Bertillon developed their own
nosologies. Bertillon's work, classifying causes of death, was a precursor of the modern code system, the
International Classification of Diseases.
The early nosological efforts grouped diseases by their symptoms, whereas modern systems (e.g. SNOMED) focus
on grouping diseases by the anatomy and etiology involved.
Applications
Nosology is used extensively in public health, to allow epidemiological studies of public health issues. Analysis
of death certificates requires nosological coding of causes of death.
Nosological classifications are used in medical administration, such as filing of health insurance claims, and
patient records, among others
References
External links
Gordon L. Snider, Nosology for Our Day Its Application to Chronic Obstructive Pulmonary Disease, American
Journal of Respiratory and Critical Care Medicine Vol 167. pp.678683, (2003). fulltext (http:/ / ajrccm.
Nosology
620
atsjournals. org/ cgi/ content/ full/ 167/ 5/ 678)
C. S. Herrman, The Bipolar Spectrum, SSRN (Social Science Research Network, 5 August 2010), (http:/ / www.
ssrn. com/ author=510356)
Nosology.net (http:/ / www. nosology. net): An online resource for nosologic diagnostic systems. This site also
demonstrates how the proposed system can be used currently in Neurology and Psychiatry
(http:/ / www. who. int/ whosis/ icd10/ ): International Classification of Diseases by the World Health
Organization.
Archetype
In the field of informatics, an archetype is a formal re-usable model of a domain concept. Traditionally, the term
archetype is used in psychology to mean an idealized model of a person, personality or behaviour (see Archetype).
The usage of the term in informatics is derived from this traditional meaning, but applied to domain modelling
instead.
An archetype is defined by the OpenEHR Foundation (for health informatics) as follows:
An archetype is a computable expression of a domain content model in the form of structured constraint
statements, based on some reference model. openEHR archetypes are based on the openEHR reference model.
Archetypes are all expressed in the same formalism. In general, they are defined for wide re-use, however,
they can be specialized to include local particularities. They can accommodate any number of natural
languages and terminologies.
The use of archetypes in health informatics was first documented by Thomas Beale, who stated the concept was
coined by Derek Renouf. According to Beale, Renouf applied archetypes to configuring Smalltalk systems.
[1]
References
[1] [1] (PDF)
OBO Foundry
621
OBO Foundry
The Open Biomedical Ontologies (OBO) Foundry (now The Open Biological and Biomedical Ontologies
(OBO) Foundry) is a collaborative experiment involving developers of science-based ontologies. The foundry is
concerned with establishing a set of principles for ontology development with the goal of creating a suite of
orthogonal interoperable reference ontologies in the biomedical domain.
Introduction
The value of any kind of data is greatly enhanced when it exists in a form that allows it to be integrated with other
data. One approach to integration is through the annotation of multiple bodies of data using common controlled
vocabularies. Ideally, such controlled vocabularies take the form of 'ontologies', which means that they are
constructed in such a way as to support logical reasoning over the data annotated in their terms.
The success of this general approach in helping to tame the explosive proliferation of data in the biomedical domain
has led to the development of principles of good practice in ontology development, which are now being put into
practice within the framework of the Open Biomedical Ontologies consortium through its OBO Foundry initiative.
Existing OBO ontologies, including the Gene Ontology, are undergoing coordinated reform and new ontologies are
being created in a coordinated effort to create a family of ontologies designed to be interoperable and logically well
formed and to incorporate accurate representations of biological reality.
The Open Biological and Biomedical Ontologies
[1]
(formerly The Open Biomedical Ontologies as well as The Open
Biological Ontologies) is an effort to create controlled vocabularies for shared use across different biological and
medical domains. As of 2006, OBO ontologies form part of the resources of the National Center for Biomedical
Ontology, where they form a central component of the NCBO's BioPortal
[2]
.
The OBO Foundry
[3]
is a collaborative experiment, involving a group of OBO ontology developers who have agreed
in advance to the adoption of a growing set of principles specifying best practices in ontology development. The goal
is to develop a set of interoperable humanly validated reference ontologies for all major domains of biomedical
research. The project is summarized in this article
[4]
published in Nature Biotechnology.
Custodians
The custodians of the OBO Foundry are:
Michael Ashburner (Cambridge, UK)
Suzanna Lewis
[5]
(Berkeley)
Chris Mungall
[6]
(Berkeley)
Alan Ruttenberg
[7]
(Cambridge, MA)
Richard Scheuermann
[8]
(JCVI)
Barry Smith
[9]
(Buffalo/Saarbrcken)
OBO Foundry
622
Principles
(Version as of 24 April 2006.)
1. The ontology is open in the sense that it is available to be used by all under the following two constraints (1) its
origin must be acknowledged and (2) it is not to be altered and subsequently redistributed under the original name or
with the same identifiers.
2. The ontology is in, or can be expressed in, a common formal language. (A provisional list of languages supported
by OBO is provided at http:/ / obo. sf. net/ . )
3. The ontology possesses a unique identifier space within OBO.
4. The ontology provider has procedures for identifying distinct successive versions.
5. The ontology has a clearly specified and clearly delineated content.
6. The ontology includes textual definitions for all terms.
7. The ontology uses relations which are unambiguously defined following the pattern of definitions laid down in the
OBO Relation Ontology
[10]
.
8. The ontology is well documented.
9. The ontology has a plurality of independent users.
10. The ontologies in the OBO Foundry will be developed in a collaborative effort.
Members of the OBO Foundry (March 2010)
The goal of the OBO Foundry initiative is to create an evolving group of biological and biomedical ontologies which
will have the potential to cover a wide range of life science phenomena in a modular fashion. To realize this goal, we
have subjected a number of candidate ontologies to a process of review, the first phase of which has now been
completed, and the results are reported here
[11]
. The following six ontologies have satisfied the OBO Foundry
principles and are recommended as preferred targets for community convergence.
CHEBI: Chemical Entities of Biological Interest
GO: Gene Ontology
PATO: Phenotypic Quality Ontology
PRO: Protein Ontology
XAO: Xenopus Anatomy Ontology
ZFA: Zebrafish Anatomy Ontology
Candidate Members of the OBO Foundry
The following groups of ontologies can be informally distinguished among current OBO Foundry candidate
members:
Mature Ontologies undergoing reform
Cell Ontology (CL)
Foundational Model of Anatomy (FMA) Ontology
Plant growth and developmental stage
Plant structure
Sequence Ontology (SO)
Ontologies being built ab initio within the Foundry framework
Common Anatomy Reference Ontology (CARO)
Environment Ontology (EnvO)
Fish Multi-Species Anatomy Ontology (NSF funding received)
OBO Foundry
623
Infectious Disease Ontology (IDO)
Malaria Ontology (IDO-MAL)
Influenza Ontology
Ixodidae and Argasidae (Tick) Anatomy Ontology
Mosquito Anatomy Ontology (MAO)
Ontology for Biomedical Investigations (OBI)
Ontology for General Medical Science
RNA Ontology (RnaO)
Spider Anatomy Ontology (SPD)
Subcellular Anatomy Ontology (SAO)
Vaccine Ontology
Other candidate ontologies
Disease Ontology
Drosophila Development
Drosophila Gross Anatomy
Human Phenotype Ontology
Mammalian Phenotype
Mouse Adult Gross Anatomy
Mouse Gross Anatomy and Development
Mouse Pathology
Systems Biology Ontology
Teleost Anatomy and Development
Teleost Taxonomy
Tick Gross Anatomy
References
[1] http:/ / obo. sourceforge.net/
[2] http:/ / www. bioontology.org/ ncbo/ faces/ pages/ ontology_list. xhtml
[3] http:/ / obofoundry.org
[4] http:/ / www. nature. com/ nbt/ journal/ v25/ n11/ full/ nbt1346. html
[5] http:/ / www. fruitfly.org/
[6] http:/ / www. fruitfly.org/ ~cjm/
[7] http:/ / sciencecommons. org/ about/ whoweare/ ruttenberg/
[8] http:/ / www. jcvi. org/ cms/ research/ platforms/ informatics/ team/
[9] http:/ / ontology.buffalo.edu/ smith
[10] http:/ / genomebiology.com/ 2005/ 6/ 5/ R46
[11] http:/ / www.obofoundry. org/ wiki/ index. php/ Announcement_of_First_Set_of_OBO_Foundry_Ontologies
Ontology for Biomedical Investigations
624
Ontology for Biomedical Investigations
The OBI Consortium logo.
The Ontology for Biomedical Investigations (OBI) is an
open access, integrated ontology for the description of
biological and clinical investigations. OBI provides a model for
the design of an investigation, the protocols and
instrumentation used, the materials used, the data generated
and the type of analysis performed on it. The project is being
developed as part of the OBO Foundry and as such adheres to
all the principles therein such as orthogonal coverage (i.e. clear
delineation from other foundry member ontologies) and the use
of a common formal language. In OBI the common formal
language used is the Web Ontology Language (OWL). As of
March 2008, a pre-release version of the ontology was made
available at the project's SVN repository
[1]
Scope of the Ontology
The Ontology for Biomedical Investigations (OBI) addresses the need for controlled vocabularies to support
integration and joint ("cross-omics") analysis of experimental data, a need originally identified in the transcriptomics
domain by the FGED Society, which developed the MGED Ontology as an annotation resource for microarray
data.
[2]
OBI uses the Basic Formal Ontology
[3]
upper level ontology as a means of describing general entities that do
not belong to a specific problem domain. As such, all OBI classes are a subclass of some BFO class.
The ontology has the scope of modeling all biomedical investigations and as such contains ontology terms for
aspects such as:
biological material - for example blood plasma
instrument (and parts of an instrument therein) - for example DNA microarray, centrifuge
information content - such as an image or a digital information entity such as an electronic medical record
design and execution of an investigation (and individual experiments therein) - for example study design,
electrophoresis material separaition
data transformation (incorporating aspects such as data normalization and data analysis) - for example principal
components analysis dimensionality reduction, mean calculation
Less 'concrete' aspects such as the role a given entity may play in a particular scenario (for example the role of a
chemical compound in an experiment) and the function of an entity (for example the digestive function of the
stomach to nutriate the body) are also covered in the ontology.
OBI Consortium
The MGED Ontology was originally identified in the transcriptomics domain by the FGED Society and was
developed to address the needs of data integration. Following a mutual decision to collaborate, this effort later
became a wider collaboration between groups such as FGED, PSI and MSI in response to the needs of areas such as
transcriptomics, proteomics and metabolomics and the FuGO (Functional Genomics Investigation Ontology)
[4]
was
created. This later became the OBI covering the wider scope of all biomedical investigations.
As an international, cross-domain initiative, the OBI consortium draws upon a pool of experts from a variety of
fields, not limited to biology. The current list of OBI consortium members is available at the OBI consortium
Ontology for Biomedical Investigations
625
website.
[5]
The consortium is made up of a coordinating committee which is a combination of two subgroups, the
Community Representative (those representing a particular biomedical community) and the Core Developers
(ontology developers who may or may not be members of any single community). Separate to the coordinating
committee is the Developers Working Group which consists of developers within the communities collaborating in
the development of OBI at the discretion of current OBI Consortium members.
References
[1] Ontology for Biomedical Investigations (OBI) | Home (http:/ / purl. obofoundry. org/ obo/ obi/ )
[2] Smith et al. (2007) Nature Biotechnology 25, 1251 - 1255 (2007)
[3] Basic Formal Ontology (BFO) | Home (http:/ / www.ifomis. org/ bfo)
[4] Whetzel, PL et al. Development of FuGO: an ontology for functional genomics investigations. OMICS 10, 199204
[5] http:/ / obi-ontology.org/ page/ Consortium
External links
The OBI Consortium project homepage http:/ / obi-ontology. org/
The OBI Consortium SVN Repository homepage http:/ / obi. svn. sourceforge. net/ viewvc/ obi/
The OBI Consortium mailing list homepage http:/ / obi-ontology. org/ page/ Mailing_lists
Open Biomedical Ontologies
Open Biomedical Ontologies (abbreviated OBO; formerly Open Biological Ontologies) is an effort to create
controlled vocabularies for shared use across different biological and medical domains. As of 2006, OBO forms part
of the resources of the U.S. National Center for Biomedical Ontology, where it will form a central element of the
NCBO's BioPortal.
OBO Foundry
The OBO Ontology library forms the basis of the OBO Foundry, a collaborative experiment involving a group of
ontology developers who have agreed in advance to the adoption of a growing set of principles specifying best
practices in ontology development. These principles are designed to foster interoperability of ontologies within the
broader OBO framework, and also to ensure a gradual improvement of quality and formal rigor in ontologies, in
ways designed to meet the increasing needs of data and information integration in the biomedical domain.
Related Projects
Ontology Lookup Service
The Ontology Lookup Service
[1]
is a spin-off of the PRIDE project, which required a centralized query interface for
ontology and controlled vocabulary lookup. While many of the ontologies queriable by the OLS are available online,
each has its own query interface and output format. The OLS provides a web service interface to query multiple
ontologies from a single location with a unified output format.
Gene Ontology Consortium
The goal of the Gene ontology (GO) consortium is to produce a controlled vocabulary that can be applied to all
organisms even as knowledge of gene and protein roles in cells is accumulating and changing. GO provides three
structured networks of defined terms to describe gene product attributes.
Sequence Ontology
Open Biomedical Ontologies
626
The Sequence Ontology
[2]
(SO) is a part of the Gene Ontology project and the aim is to develop an ontology
suitable for describing biological sequences. It is a joint effort by genome annotation centres, including WormBase,
the Berkeley Drosophila Genome Project, FlyBase, the Mouse Genome Informatics group, and the Sanger Institute.
Generic Model Organism Databases
The Generic Model Organism Project (GMOD) is a joint effort by the model organism system databases WormBase,
FlyBase, MGI, SGD, Gramene, Rat Genome Database, EcoCyc, and TAIR to develop reusable components suitable
for creating new community databases of biology.
Standards and Ontologies for Functional Genomics
SOFG
[3]
is both a meeting and a website; it aims to bring together biologists, bioinformaticians, and computer
scientists who are developing and using standards and ontologies with an emphasis on describing high-throughput
functional genomics experiments.
FGED
The Functional Genomics Data (FGED) Society is an international organisation of biologists, computer scientists,
and data analysts that aims to facilitate the sharing of microarray data generated by functional genomics experiments.
Ontology for Biomedical Investigations
The Ontology for Biomedical Investigations (OBI) is an open access, integrated ontology for the description of
biological and clinical investigations. OBI provides a model for the design of an investigation, the protocols and
instrumentation used, the materials used, the data generated and the type of analysis performed on it. The project is
being developed as part of the OBO Foundry and as such adheres to all the principles therein such as orthogonal
coverage (i.e. clear delineation from other foundry member ontologies) and the use of a common formal language. In
OBI the common formal language used is the Web Ontology Language (OWL).
Plant ontology
The Plant Ontology Consortium
[4]
(POC) aims to develop, curate and share structured controlled vocabularies
(ontologies) that describe plant structures and growth/developmental stages. Through this effort, the project aims to
facilitate cross database querying by fostering consistent use of these vocabularies in the annotation of tissue and/or
growth stage specific expression of genes, proteins and phenotypes.
Phenoscape
Phenoscape
[5]
is a project to develop a database of phenotype data for species across the Osteriophysi, a large group
of Teleost fish. The data is captured using annotations that combine terms from an Anatomy Ontology
[6]
, an
accompanying Taxonomic Ontology
[7]
, and quality terms from the PATO ontology of phenotype qualities
[8]
.
Several other OBO ontologies are also used. The anatomy ontology was developed from the zebrafish anatomy
ontology developed by the Zebrafish Information Network
[9]
.
Open Biomedical Ontologies
627
OBO and Semantic Web
OBO & OWL Roundtrip Transformations
As a community effort, a standard common mapping has been created for lossless roundtrip transformations between
Open Biomedical Ontologies (OBO) format and OWL. The research contains methodical examination of each of the
constructs of OBO and a layer cake for OBO, similar to the Semantic Web stack.
References
[1] http:/ / www. ebi. ac. uk/ ontology-lookup/
[2] http:/ / song. sourceforge. net/
[3] http:/ / www. sofg. org/
[4] http:/ / www. plantontology.org/
[5] http:/ / phenoscape. org/
[6] http:/ / bioportal. bioontology.org/ ontologies/ 39892/
[7] http:/ / bioportal. bioontology.org/ ontologies/ 39905/
[8] http:/ / bioportal. bioontology.org/ ontologies/ 39886/
[9] http:/ / www. zfin. org/
External links
Open Biomedical Ontologies (OBO) (http:/ / obofoundry. org)
Ontology browser for most of the Open Biological Ontologies at BRENDA website (http:/ / www.
brenda-enzymes. info/ index. php4?page=ontology/ )
PubOnto: OBO-based literature search tool (http:/ / brainarray. mbni. med. umich. edu/ Brainarray/ prototype/
PubOnto/ )
Project Page (http:/ / www. cs. utexas. edu/ ~hamid/ oboowl. html)
Morphster Project (http:/ / www. morphster. org/ )
ONTO-PERL (https:/ / metacpan. org/ release/ ONTO-PERL)
SimCT (http:/ / tagc. univ-mrs. fr/ SimCT) Web-based tool to display relationships between biological objects
annotated to an ontology in the form of a tree, based on their annotation similarity.
TIME-ITEM
628
TIME-ITEM
TIME-ITEM is an ontology of Topics that describes the content of undergraduate medical education. TIME is an
acronym for "Topics for Indexing Medical Education"; ITEM is an acronym for "Index de thmes pour lducation
mdicale." Version 1.0 of the taxonomy has been released and the web application that allows users to work with it
is still under development. Its developers are seeking more collaborators to expand and validate the taxonomy and to
guide future development of the web application.
History
The development of TIME-ITEM began at the University of Ottawa in 2006. It was initially developed to act as a
content index for a curriculum map being constructed there. After its initial presentation at the 2006 conference of
the Canadian Association for Medical Education
[1]
,
[2]
early collaborators included the University of British
Columbia, McMaster University and Queen's University.
Features
The TIME-ITEM ontology is unique in that it is designed specifically for undergraduate medical education. As such,
it includes fewer strictly biomedical entries than other common medical vocabularies (such as MeSH or SNOMED
CT) but more entries relating to the medico-social concepts of communication, collaboration, professionalism, etc.
Topics within TIME-ITEM are arranged poly-hierarchically, meaning any Topic can have more than one parent.
Relationships are established based on the logic that learning about a Topic contributes to the learning of all its
parent Topics.
In addition to housing the ontology of Topics, the TIME-ITEM web application can house multiple Outcome
frameworks. All Outcomes, whether private Outcomes entered by single institutions or publicly available medical
education Outcomes (such as CanMeds 2005) are hierarchically linked to one or more Topics in the ontology. In this
way, the contribution of each Topic to multiple Outcomes is made explicit.
[3]
The structure of the XML documents exported from TIME-ITEM (which contain the hierarchy of Outcomes and
TIME-ITEM Topics) is being developed alongside the MedBiquitous
[4]
Competency standards.
The taxonomy currently exists in English only but translation to Canadian French is in progress.
Applications
TIME-ITEM is intended to be a general-use ontology for medical education informatics. It has two primary potential
applications:
1. Inclusion in curriculum maps. By mapping learning objects or sessions to TIME-ITEM Topics in a curriculum
map, the map becomes searchable for both granular and broad concepts. If one or more Outcome frameworks are
included with the Topic ontology, then the contribution of each curricular element to one or more Outcomes is
made explicit. This also facilitates curriculum evaluation in terms of one or more outcome frameworks.
2. Indexing learning, assessment and portfolio objects. Metatagging learning objects or assessment objects with a
controlled vocabulary enhances the organization and retrieval of objects from a repository. Metatagging electronic
portfolio entries allows one to show how multiple entries "add up" to a demonstration of competence with respect
to certain educational outcomes.
The possibility of expanding or modifying TIME-ITEM for use in postgraduate/continuing medical education and in
nursing education is currently being explored.
TIME-ITEM
629
References
[1] http:/ / www. came-acem.ca/
[2] Willett T & Clarke M. A Map of Medical Concepts: A General-use Database for Applications in Medical Education. AFMC Resource Group
on Medical Informatics Reception. At the Canadian Association for Medical Education Conference (May 2006) London, Canada
[3] Willett TG, Marshall KC, Broudo M & Clarke M. TIME as a generic index for outcome-based medical education. Medical Teacher 2008;
29(7):655-9.
[4] http:/ / www. medbiq.org
External links
http:/ / www. time-item. org (Registration required, by application only)
630
Associations, Committees and Conferences
American Association for Medical Systems and
Informatics
The American Association for Medical Systems and Informatics was an organization created to encourage
improvements in the state of medical care by encouraging the development of computer systems for that field.
On August 19, 1981, the American Association for Medical Systems and Informatics (AAMSI) was incorporated.
This organization came into existence as a result of the efforts of two predecessor organizations, the Society for
Computer Medicine (SCM), incorporated in November, 1972, and the Society for Advanced Medical Systems
(SAMS), incorporated in November, 1975, to merge into one. Formal dissolution of SCM and SAMS occurred on
April 30, 1982. AAMSI's main purpose was to support patient care, teaching, research, and health administration
through the development and implementation of computer systems. To meet this goal, the association served as a
clearinghouse for information on medical systems and informatics, supported committees which contributed to the
advance of medical informatics and sponsored annual conferences on advances in medical information systems.
[1]
In 1989, AAMSI merged with the Symposium on Computer Applications in Medical Care (SCAMC) and the
American College of Medical Informatics (ACMI) to form the American Medical Informatics Association
(AMIA).
[2]
Notes
[1] This article uses content from the United States National Library of Medicine, located at http:/ / www. nlm. nih. gov/ . For copyright
information, see http:/ / www. nlm.nih. gov/ copyright.html
[2] http:/ / www. amia. org/ college/ Retrieved on 2009-03-03.
External Links
American Association for Medical Systems Informatics Records (1972-1984) (http:/ / oculus. nlm. nih. gov/ cgi/
f/ findaid/ findaid-idx?c=nlmfindaid;cc=nlmfindaid;view=reslist;subview=standard;didno=aamsi) -- National
Library of Medicine finding aid
American College of Medical Informatics
631
American College of Medical Informatics
American College of Medical
Informatics
Abbreviation ACMI
Formation 1984 (29 years ago)
Type NGO
Legalstatus NPO
Purpose/focus Learned society
Headquarters Bethesda, MD
Membership 300
Officiallanguages English
President Joyce A. Mitchell
Key people James J. Cimino, President Elect
Mainorgan Inducted Fellows
Executive Committee
Website [1]
The American College of Medical Informatics,
[2]
is a college of elected fellows from the United States and abroad
who have made significant and sustained contributions to the field of medical informatics. Initially incorporated in
1984, the organization later dissolved its separate corporate status to merge with the American Association for
Medical Systems and Informatics (AAMSI) and the Symposium on Computer Applications in Medical Care
(SCAMC) when the American Medical Informatics Association (AMIA) was formed in 1989. The College now
exists as an elected body of fellows within AMIA, with its own bylaws and regulations that guide the organization,
its activities, and its relationship with the parent organization. The College is fiscally self-sufficient, and its officers
prepare and submit its financial plan annually for approval by the AMIA Board of Directors.
History
The College was initially created using an election process that assured that the founding fellows would be elected
by their peers. Five individuals, Marsden S. Blois, Morris F. Collen, Donald A. B. Lindberg, Thomas E. Piemme,
and Edward H. Shortliffe, prepared a ballot of over 100 names of leaders in the field and sent the ballot to all listed
individuals. Nominees were asked to vote for 50 colleagues to become the founding fellows, and in this way the
initial set of 52 fellows was selected (three individuals were tied for the fiftieth place). The founding fellows then
incorporated, elected officers, and initiated a process through which the existing fellows nominate and elect new
fellows. The number of people and international associates elected through the years has now reached close the 300
inducted Fellows of the ACMI, with approximately fifteen to twenty new fellows and international associates elected
each year. Photographs of people elected through 1993 were published in the inaugural issue of JAMIA, the Journal
of the American Medical Informatics Association, in January 1994, and each year's class of newly elected fellows is
published in JAMIA.
American College of Medical Informatics
632
References
[1] https:/ / www. amia.org/ programs/ acmi-fellowship
[2] Web Portal (https:/ / www.amia.org/ college|ACMI)
External links
ACMI homepage (http:/ / www. amia. org/ college/ )
American Health Information Management
Association
The American Health Information Management Association (AHIMA) is a
professional organization for the field of medical record management. Traditionally
practicing in hospitals and to referring paper files and records, the field presently refers
to all healthcare systems and types of media.
The organization traces its history back to 1928 when the American College of
Surgeons established the Association of Record Librarians of North America
(ARLNA) to "elevate the standards of clinical records in hospitals and other medical
institutions." The organization has had three name changes in its history, all were
justified with an e xplanation that reflected the progression of contemporary medical
record use, practices and perceptions. In 1938 the association became the American
Association of Medical Record Librarians (AAMRL). In 1970, the association became
the American Medical Record Association (AMRA) and in 1991, the title American
Health Information Management Association (AHIMA) was adopted. Incorporation
occurred in 1943 and became effective the next year. AHIMA's stated mission is to be
the professional community that improves healthcare by advancing best practices and
standards for health information management and the trusted source for education,
research, and professional credentialing.
American Health Information Management
Association
Formation 1928
Type professional association
Headquarters Chicago, Illinois
Location United States
Membership 64,000
Official Language English
President Patty Thierry Sheridan
As of 2011, the association has more than 64,000 members in four membership
classifications. Each member subsequently belongs to a relevant state chapter. The
association offers seven credentials pertaining to four areas of practice; HIM, Coding,
Data Analysis and Privacy. Two credentials require formal education, the others are
acquired by a combination of testing and work experience. AHIMA requires members
obtain regular continuing education to maintain their credentials. The Journal of
AHIMA has a circulation of 61,000 and publishes both peer-reviewed and
non-peer-reviewed articles. The association's membership is overwhelmingly female.
AHIMA describes its foundation as a sister organization and states the foundation has a
charitable and educational nature. The foundation's stated mission is to be the
pre-eminent foundation recognized for excellence in health information leadership,
policy and research for the healthcare industry and the public. The foundation
formulates and issues opinions, supports education, conducts research and compiles its
contributions into the Body of Knowledge (BoK).
American Health Information Management Association
633
References
AHIMA entry - TheFreeDictionary (http:/ / medical-dictionary. thefreedictionary. com/ AHIMA)
External links
AHIMA.org is the American Health Information Management Association's official site (http:/ / www. AHIMA.
org)
ArHIMA.org is the Arkansas Health Information Management Association's official site (http:/ / www.
ARHIMA. org)
WHIMA.org is the Wisconsin Health Information Management Association's official site (http:/ / www. WHIMA.
org)
TXHIMA.org is the Texas Health Information Management Association's official site (http:/ / www. TXHIMA.
org)
WSHIMA.org is the Washington State Health Information Management Association's official site (http:/ / www.
WSHIMA. org)
MNHIMA.org is the Minnesota Health Information Management Association's official site (http:/ / www.
MNHIMA. org)
WVHIMA.org is the West Virginia Health Information Management Association's official site (http:/ / www.
WVHIMA. org)
American Telemedicine Association
634
American Telemedicine Association
American Telemedicine
Association
Location 1100 Connecticut Ave, NW
Suite 540, Washington, DC 20036
Website http:/ / www. americantelemed. org
American Telemedicine Association (ATA), established in 1993 as a non-profit organization, ATA goal is to
promote access to medical care for consumers and health professionals via telecommunications technology
(alternatively referred to as telemedicine, telehealth or eHealth). Membership in ATA is open to individuals,
companies and other healthcare and technology organizations.
The American Telemedicine Association is the leading resource and advocate promoting access to medical care for
consumers and health professionals via telecommunications technology. ATA seeks to bring together diverse groups
from traditional medicine, academic medical centers, technology and telecommunications companies, e-health,
medical societies, government and others to overcome barriers to the advancement of telemedicine through the
professional, ethical and equitable improvement in health care delivery. ATA is governed by a Board of Directors
elected by the Association's membership.
The Association implements these objectives by:
Educating government about telemedicine as an essential component in the delivery of modern medical care.
Serving as a clearinghouse for telemedical information and services.
Fostering networking and collaboration among interests in medicine and technology.
Promoting research and education including the sponsorship of scientific educational meetings and
theTelemedicine and e-Health Journal.
Spearheading the development of appropriate clinical and industry policies and standards.
In accordance with the mission of the organization, ATA provides a broad range of services for its members and the
industry as a whole.
ATA Annual Meeting - the world's largest scientific meeting and exposition focusing exclusively on
telemedicine, with hundreds of presentations, posters and workshops.
On-line Member News Updates - direct, exclusive news briefs via email about the latest event and activities
affecting telemedicine professionals.
ATA Website - a widely-used resource for telemedicine news and information.
ATA Online Membership Directory - the single source of who's who in telemedicine.
Telemedicine and e-Health - a peer-reviewed publication encompassing all aspects of clinical telemedicine
practice; technical advances and enabling technologies; continuing medical education; and the impact of
telemedicine on the quality, cost-effectiveness, and access to health care.
Special Interest Groups (SIGs), Regional Chapters and Discussion Groups - allow members to address issues
related to the advancement and application of telemedicine regarding specific areas including home telehealth,
ocular telehealth, technology, teledermatology, telemental health, telenursing, telepathology, and
telerehabilitation.
American Telemedicine Association
635
References
Choi, Candice (March 13, 2006). "Doctors, Patients Back Telemedicine"
[1]
. Bangor Daily News. Retrieved
September 7, 2010.
"Telemedicine growth examined"
[2]
. Fierce Healthcare. March 12, 2006. Retrieved September 7, 2010.
"Tribal Healthcare 2000: Telecommunications and Telemedicine"
[3]
. The Ojibwe News. June 13, 1997. Retrieved
September 7, 2010.
External links
ATA
[4]
homepage
Wiki for telemedicine (ATAwiki)
[5]
References
[1] http:/ / news.google. com/ newspapers?id=_AA1AAAAIBAJ& sjid=DU8KAAAAIBAJ& pg=3045,3220792&
dq=american-telemedicine-association+ -newswire& hl=en
[2] http:/ / www. fiercehealthcare. com/ story/ telemedicine-growth-examined/ 2006-03-13
[3] http:/ / www. highbeam.com/ doc/ 1P1-3985567.html
[4] http:/ / www. americantelemed. org/
[5] http:/ / www. atawiki. org
Belgian Health Telematics Commission
The Belgian Health Telematics Commission (BHTC) is a Belgian government committee working on standards for
exchanging and sharing of health information, between health care participants. The committee provides advice on
eHealth to the Belgian government.
[1][2]
Professor Georges De Moor is head of the committee.
The BHTC consists of several working groups:
Data
Hospitals
Telemedicine
Label: homologation of (para)medical software
Georges De Moor, together with Jos Devlies and Geert Thienpont, authored the 2006 eHealth strategy and
implementation activities in Belgium report.
[3]
References
[1] Belgian Telematics Commission, Recommendations regarding national development of standardized electronic health care messages, Stud
Health Technol Inform. 2004;110:112-7
[2] Belgian Telematics Commission, Digital signature and electronic certificates in health care, Stud Health Technol Inform. 2004;110:87-9
[3] eHealth strategy and implementation activities in Belgium (http:/ / www. ehealth-era. org/ database/ documents/ ERA_Reports/
Belgium_eHealth-ERA_country-report_final_30-06-2007. pdf)
Source
Telematics Commission (https:/ / portal. health. fgov. be/ portal/ page?_pageid=56,4280396& _dad=portal&
_schema=PORTAL)
Rcommendations (https:/ / portal. health. fgov. be/ portal/ page?_pageid=56,4280450& _dad=portal&
_schema=PORTAL)
Belgian Health Telematics Commission
636
Telematics Standards in relation to the Health Sector (https:/ / portal. health. fgov. be/ pls/ portal/ docs/ PAGE/
INTERNET_PG/ HOMEPAGE_MENU/ GEZONDHEIDZORG1_MENU/ AUTOMATISERING1_MENU/
SYMPOSIA1_MENU/ AVIS25_MENU/ AVIS25_DOCS/ A01-UK. PDF) (PDF, advice)
Brazilian Society of Health Informatics
The Sociedade Brasileira de Informtica em Sade (Brazilian Society of Health Informatics in Portuguese,
abbreviated as SBIS is a professional society created in November 1986 in Campinas, during the First Brazilian
Congress on Health Informatics
[1]
It has the mission of promoting the development and the interchange of ideas and
results in the fields devoted to the information technologies applied to the health sciences (Medical informatics,
Telemedicine, Bioinformatics, etc.).
Mission and areas of interest
SBIS is a nonprofit membership organization of individuals and institutions interested in developing and using
information technologies to improve health care in Brazil. To accomplish its goal, SBIS may develop the following
activities:
Stimulate educational activities related to health informatics;
Stimulate scientific research and technical development in Health Informatics;
Organize conferences, symposiums, courses, seminars, and other activities that lead to experience and knowledge
exchange;
Cooperate with sister societies;
Contribute to the definition of healthcare policies;
Promote Health Informatics as a means to reduce costs and improve the quality of healthcare services.
Some of SBIS areas of interest are:
Health information systems
Health information management
Electronic patient record
Telemedicine and telehealth
Medical decision support systems
Biological signal processing
Medical image processing
Internet applications in health
Health information standards
Health informatics education
Distance education in health
Currently it has around 780 associates, thus being the third largest in the Americas, after the American Medical
Informatics Association and the Canada's Health Informatics Association, and the largest in Latin America,
according to the International Medical Informatics Association.
[2]
The Society is affiliated to the International
Medical Informatics Association since 1988.
Brazilian Society of Health Informatics
637
Governance
The current Executive Board (20082010) is led by Dr. Cludio Giulliano Alves da Costa (President). Former
presidents were: Roberto J. Rodrigues, Renato M.E. Sabbatini, Mariza Machado Klck, Beatriz de Faria Leo,
Daniel Sigulem, Umberto Tachinardi, Lincoln de Assis Moura Jr. and Heimar de Ftima Marin. Short histories of
Health Informatics in Brazil have been published elsewhere
[3][4]
by former presidents of the Society.
Conferences and Meetings
SBIS organizes since 1986 a biannual national conference, the Brazilian Congress of Health Informatics and a
biannual specialized conference on Electronic Health Records (PEP); besides other, smaller and less periodical
meetings.
The Brazilian Congress on Health Informatics takes place in different cities every two years and has as its main
subjects the applications of information technology and telematics to medicine, nursing, dentistry and allied health
care sciences, from the point of view of the expert scientific and technical worker in these areas. The first conference
was organized in November 1986, in the city of Campinas by Dr. Renato M.E. Sabbatini. The vice-president was Dr.
Hugo Sabatino, and the editor-in-chief of the Conference's proceedings was Dr. Renato G.G. Terzi, all with the
Medical School at the same university. During this conference, the Brazilian Society of Health Informatics was
launched, as well as the Brazilian Journal of Health Informatics. The conference was then repeated in 1988 (So
Paulo), 1990, 1992, 1994, 1996 (Campos do Jordo), 1998, 2000, 2002, 2004 (Natal), 2006 (Florianpolis) and 2008
(Campos do Jordo). The next conference will be held in November 2010, in Porto de Galinhas, Pernambuco.
Publications
SBIS' flagship periodical is the on-line scientific journal, Journal of Health Informatics (Heimar Marin,
Editor-in-Chief). It also publishes SBIS News, an electronic bulletin hosted by Yahoo! Groups (Renato M.E.
Sabbatini, editor-in-chief), and coordinates the SBIS-L e-mail discussion list.
Electronic Health Record Certification Project
In collaboration with the Brazilian Federal Council of Medicine since 2007, SBIS has developed one of few
programs in the developing world geared towards the software certification in the area of electronic health records.
The standards for access, information security, digital certification, patient confidentiality, storage of records, etc.,
have been discussed together and officially approved by a number of decrees enforced by CFM and are part now of a
Manual, a course for buildup of a task force of specialized consultants. The certification standards cover ambulatory
healthcare, clinical laboratory and other areas, and in the future will be expanded for inpatient health records and
Picture archiving and communication system.
Professional Education
In 2008 the Society approved the creation of a new initiative and a directorship to boost educational activities in
health informatics.
[5][6]
A website and a Learning Management System based on Moodle server were created in 2009
(address [7]). The site is used to support presential courses as well as to offer purely distance courses, seminars,
lectures, and other educational activities. The site has also a digital library
[8]
with on-line references to papers,
reviews, e-books, multimedia files, etc., which are deemed useful for education and learning purposes. In addition,
webconferencing facilities using DimDim have been added and can be used by associated individuals and
institutions.
Brazilian Society of Health Informatics
638
Professional Certificate in Health Informatics
In October 2009 the Society launched a program for certificating health care professionals as specialists, in a manner
similar to medical specialties coordinated by the Brazilian Medical Association and the Federal Council of Medicine
in Brazil. The program entails a minimum list of technical proficiency, a written and oral annual examination, and
the issue of a certificate which is valid for five years. The revalidation of the certificate will be mandatory by means
of continuing education credits. The Society installed also an educational accreditation program in place, for
recognizing courses and curricula in health informatics, for this purpose, with a point-based system of credits. The
entire program is under the responsibility of a new Directorship of Professional Education, coordinated by Prof.
Renato M.E. Sabbatini.
References
[1] Sabbatini, RME: Associaes de Informtica em Sade. Revista Informdica, 2 (10): 13-14, 1994 (In Portuguese) (http:/ / www.
informaticamedica. org. br/ informed/ assoc.htm)
[2] International Medical Informatics Association (http:/ / www. imia. org)
[3] Marin, H.F. Informtica em Sade no Brasil. 2008 Conference of IMIA-LAC, International Medical Informatics Association Federation for
Latin America and the Caribbeam. Published by the Argentinian Association of Medical Informatics, Buenos Aires, Argentina, 2008 (in PDF,
in Portuguese) (http:/ / www. aaim. com. ar/ paneles/ PN20-1. pdf)
[4] Sabbatini, R.M.E. Histria da Informtica em Sade no Brasil. Revista Informtica Mdica, 1(5), Set/Out 1998. (In Portuguese) (http:/ /
www.informaticamedica. org. br/ informaticamedica/ n0105/ sabbatini. htm)
[5] Costa, CGA: Retrospectiva 2009 e Planos para 2010 da SBIS, Published December 29, 2009 (http:/ / www. sbis. org. br/ site/ site. dll/
noticia?pagina=1& item=111)
[6] Sociedade Brasileira de Informtica em Sade. Diretoria de Educao e Capacitao Profissional. So Paulo, 2009. (http:/ / www. sbis.
virtual.org. br/ mod/ resource/ view. php?id=22)
[7] http:/ / www. sbis.virtual. org. br
[8] Biblioteca Virtual em Informtica em Sade, So Paulo, 2009. (http:/ / www. sbis. virtual. org. br/ mod/ resource/ view. php?id=65)
External links
SBIS Home Page (http:/ / www. sbis. org. br/ )
Journal of Health Informatics Home Page (http:/ / www. jhi-sbis. saude. ws/ ojs-jhi/ index. php/ jhi-sbis)
Distance Education Site (http:/ / www. sbis. virtual. org. br/ index. php)
Email Discussion Group (http:/ / www. yahoogrupos. com. br/ group/ sbis_l)
Electronic news bulletin (http:/ / www. yahoogrupos. com. br/ group/ SBIS-News)
Brazilian Congress on Health Informatics
639
Brazilian Congress on Health Informatics
The Sociedade Brasileira de Informtica em Sade (Brazilian Society of Health Informatics in Portuguese,
abbreviated as SBIS is a professional society created in November 1986 in Campinas, during the First Brazilian
Congress on Health Informatics
[1]
It has the mission of promoting the development and the interchange of ideas and
results in the fields devoted to the information technologies applied to the health sciences (Medical informatics,
Telemedicine, Bioinformatics, etc.).
Mission and areas of interest
SBIS is a nonprofit membership organization of individuals and institutions interested in developing and using
information technologies to improve health care in Brazil. To accomplish its goal, SBIS may develop the following
activities:
Stimulate educational activities related to health informatics;
Stimulate scientific research and technical development in Health Informatics;
Organize conferences, symposiums, courses, seminars, and other activities that lead to experience and knowledge
exchange;
Cooperate with sister societies;
Contribute to the definition of healthcare policies;
Promote Health Informatics as a means to reduce costs and improve the quality of healthcare services.
Some of SBIS areas of interest are:
Health information systems
Health information management
Electronic patient record
Telemedicine and telehealth
Medical decision support systems
Biological signal processing
Medical image processing
Internet applications in health
Health information standards
Health informatics education
Distance education in health
Currently it has around 780 associates, thus being the third largest in the Americas, after the American Medical
Informatics Association and the Canada's Health Informatics Association, and the largest in Latin America,
according to the International Medical Informatics Association.
[2]
The Society is affiliated to the International
Medical Informatics Association since 1988.
Brazilian Congress on Health Informatics
640
Governance
The current Executive Board (20082010) is led by Dr. Cludio Giulliano Alves da Costa (President). Former
presidents were: Roberto J. Rodrigues, Renato M.E. Sabbatini, Mariza Machado Klck, Beatriz de Faria Leo,
Daniel Sigulem, Umberto Tachinardi, Lincoln de Assis Moura Jr. and Heimar de Ftima Marin. Short histories of
Health Informatics in Brazil have been published elsewhere
[3][4]
by former presidents of the Society.
Conferences and Meetings
SBIS organizes since 1986 a biannual national conference, the Brazilian Congress of Health Informatics and a
biannual specialized conference on Electronic Health Records (PEP); besides other, smaller and less periodical
meetings.
The Brazilian Congress on Health Informatics takes place in different cities every two years and has as its main
subjects the applications of information technology and telematics to medicine, nursing, dentistry and allied health
care sciences, from the point of view of the expert scientific and technical worker in these areas. The first conference
was organized in November 1986, in the city of Campinas by Dr. Renato M.E. Sabbatini. The vice-president was Dr.
Hugo Sabatino, and the editor-in-chief of the Conference's proceedings was Dr. Renato G.G. Terzi, all with the
Medical School at the same university. During this conference, the Brazilian Society of Health Informatics was
launched, as well as the Brazilian Journal of Health Informatics. The conference was then repeated in 1988 (So
Paulo), 1990, 1992, 1994, 1996 (Campos do Jordo), 1998, 2000, 2002, 2004 (Natal), 2006 (Florianpolis) and 2008
(Campos do Jordo). The next conference will be held in November 2010, in Porto de Galinhas, Pernambuco.
Publications
SBIS' flagship periodical is the on-line scientific journal, Journal of Health Informatics (Heimar Marin,
Editor-in-Chief). It also publishes SBIS News, an electronic bulletin hosted by Yahoo! Groups (Renato M.E.
Sabbatini, editor-in-chief), and coordinates the SBIS-L e-mail discussion list.
Electronic Health Record Certification Project
In collaboration with the Brazilian Federal Council of Medicine since 2007, SBIS has developed one of few
programs in the developing world geared towards the software certification in the area of electronic health records.
The standards for access, information security, digital certification, patient confidentiality, storage of records, etc.,
have been discussed together and officially approved by a number of decrees enforced by CFM and are part now of a
Manual, a course for buildup of a task force of specialized consultants. The certification standards cover ambulatory
healthcare, clinical laboratory and other areas, and in the future will be expanded for inpatient health records and
Picture archiving and communication system.
Professional Education
In 2008 the Society approved the creation of a new initiative and a directorship to boost educational activities in
health informatics.
[5][6]
A website and a Learning Management System based on Moodle server were created in 2009
(address [7]). The site is used to support presential courses as well as to offer purely distance courses, seminars,
lectures, and other educational activities. The site has also a digital library
[7]
with on-line references to papers,
reviews, e-books, multimedia files, etc., which are deemed useful for education and learning purposes. In addition,
webconferencing facilities using DimDim have been added and can be used by associated individuals and
institutions.
Brazilian Congress on Health Informatics
641
Professional Certificate in Health Informatics
In October 2009 the Society launched a program for certificating health care professionals as specialists, in a manner
similar to medical specialties coordinated by the Brazilian Medical Association and the Federal Council of Medicine
in Brazil. The program entails a minimum list of technical proficiency, a written and oral annual examination, and
the issue of a certificate which is valid for five years. The revalidation of the certificate will be mandatory by means
of continuing education credits. The Society installed also an educational accreditation program in place, for
recognizing courses and curricula in health informatics, for this purpose, with a point-based system of credits. The
entire program is under the responsibility of a new Directorship of Professional Education, coordinated by Prof.
Renato M.E. Sabbatini.
References
[1] Sabbatini, RME: Associaes de Informtica em Sade. Revista Informdica, 2 (10): 13-14, 1994 (In Portuguese) (http:/ / www.
informaticamedica. org. br/ informed/ assoc.htm)
[2] International Medical Informatics Association (http:/ / www. imia. org)
[3] Marin, H.F. Informtica em Sade no Brasil. 2008 Conference of IMIA-LAC, International Medical Informatics Association Federation for
Latin America and the Caribbeam. Published by the Argentinian Association of Medical Informatics, Buenos Aires, Argentina, 2008 (in PDF,
in Portuguese) (http:/ / www. aaim. com. ar/ paneles/ PN20-1. pdf)
[4] Sabbatini, R.M.E. Histria da Informtica em Sade no Brasil. Revista Informtica Mdica, 1(5), Set/Out 1998. (In Portuguese) (http:/ /
www.informaticamedica. org. br/ informaticamedica/ n0105/ sabbatini. htm)
[5] Costa, CGA: Retrospectiva 2009 e Planos para 2010 da SBIS, Published December 29, 2009 (http:/ / www. sbis. org. br/ site/ site. dll/
noticia?pagina=1& item=111)
[6] Sociedade Brasileira de Informtica em Sade. Diretoria de Educao e Capacitao Profissional. So Paulo, 2009. (http:/ / www. sbis.
virtual.org. br/ mod/ resource/ view. php?id=22)
[7] Biblioteca Virtual em Informtica em Sade, So Paulo, 2009. (http:/ / www. sbis. virtual. org. br/ mod/ resource/ view. php?id=65)
External links
SBIS Home Page (http:/ / www. sbis. org. br/ )
Journal of Health Informatics Home Page (http:/ / www. jhi-sbis. saude. ws/ ojs-jhi/ index. php/ jhi-sbis)
Distance Education Site (http:/ / www. sbis. virtual. org. br/ index. php)
Email Discussion Group (http:/ / www. yahoogrupos. com. br/ group/ sbis_l)
Electronic news bulletin (http:/ / www. yahoogrupos. com. br/ group/ SBIS-News)
Center for Telehealth and E-Health Law
642
Center for Telehealth and E-Health Law
The Center for Telehealth & E-Health Law (CTeL), established in 1995 by a consortium including the Mayo
Foundation, Cleveland Clinic Foundation, Texas Children's Hospital, and the Mid-West Rural Telemedicine
Consortium, is a non-profit organization committed to overcoming legal and regulatory barriers to the utilization of
telehealth and related e-health services.
[1]
CTeL, based in Washington, D.C., specializes in compiling, analyzing and
disseminating information on legal and regulatory issues information associated with telemedicine. It also handles
underlying issues such as licensure and reimbursement.
CTeL briefs public policymakers, writes reports, and provides testimony in support of telehealth. In its materials,
CTeL argues that expanding the use of telehealth can improve patient safety, reduce medical errors, and increase
patient access to primary and specialty care in both rural and urban settings. CTeL offers a variety of services,
including involvement in public policy. CTeL activities include:
"Telehealth Leadership Conference" - annual conference dedicated solely to telehealth issues and telehealth
advocacy.
Telehealth Policy Clerkship Program - offered for second and third year law students interested in public policy
and legal issues as they apply to advancing communication technologies in the practice of medicine.
Washington Live! Brown Bag Lunches in Washington, D.C. monthly seminars on various topics of interest in
telehealth and e-health.
*The National Telehealth Resource Center (NTRC), one of several telehealth resource centers funded through a
grant from the Office for the Advancement of Telehealth at the Health Resources and Services Administration
(HRSA) in the Department of Health and Human Services.
[2]
In 2004, CTeL worked with HRSAs Office for the Advancement of Telehealth (OAT) and the University of
Colorado Health Sciences Center to perform an analysis of the use of telehealth in skilled nursing facilities for a
report to Congress. This report is titled Multi-State Telehealth Practice and summarizes the current state of
physician and nurse licensure issues.
Also in 2004, CTeL was recognized by the United States Department of Commerce: [The] progress there has
been in resolving such issues can be attributed to a very recent and concentrated effort by such stakeholders as
Center for Telemedicine Law, and the Office for the Advancement of Telehealth (OAT), within the Department
of Health and Human Services (HHS). Innovation, Demand, & Investment in Telehealth, US Commerce
Department, Feb. 2004.
References
[1] Center for Telehealth and e-Health Law (http:/ / www. telehealthlawcenter. org/ content/ ?page=9)
[2] HRSA - Telehealth Grantee Directory (http:/ / www.hrsa. gov/ telehealth/ granteedirectory/ overview. htm)
External links
CTeL (http:/ / www. telehealthlawcenter. org/ )
Office for the Advancement of Telehealth (http:/ / www. hrsa. gov/ telehealth/ / )
European Federation for Medical Informatics
643
European Federation for Medical Informatics
The European Federation for Medical Informatics (EFMI) is a non-profit organization, which was conceived at a
meeting, assisted by the Regional Office for Europe of the World Health Organisation (WHO), in Copenhagen,
(Denmark, Europe), in September 1976.
Objectives
The EFMI wants to:
advance international co-operation and dissemination of information in Medical Informatics in Europe
promote high standards in the application of medical informatics
promote research and development in medical informatics
encourage high standards in education in medical informatics
function as the autonomous European Regional Council of the International Medical Informatics Association
(IMIA)
Organizations
Working Group Medical Informatics (AKMI) of the Austrian Society for Biomedical Engineering GBMT) and
of the Austrian Computer Society (OCG) (Austria)
Belgian Medical Informatics Association (Belgium)
Society for Medical Informatics of Bosnia & Herzegovina (Bosnia-Herzegovina)
Croatian Society for Medical Informatics (Croatia)
The Cyprus Society of Medical Informatics (Cyprus)
Czech Society for Biomedical Engineering and Medical Informatics (Czech Republic)
The Danish Society for Medical Informatics (Denmark)
Finnish Social and Health Informatics Association (FinnSHIA) (Finland)
French Medical Informatics Association (AIM) (France)
German Association for Medical Informatics, Biometry and Epidemiology (Germany)
Greek Health Informatics Association (Greece)
National Institute for Strategic Health Research (Hungary)
Icelandic Society of Information Processing (Iceland)
Healthcare Informatics Society of Ireland (Ireland)
The Israeli Association for Medical Informatics (Israel)
Italian Medical Informatics Society (AIIM) (Italy)
State Medical and Pharmaceutical University "N. Testemitanu" (Moldova, Republic of)
VMBI, Society for Healthcare Informatics (Netherlands)
Norwegian Society for Medical Informatics (Norway)
The Technical University of Lodz (Politechnika dzka) (Poland)
Faculty of Medicine of Oporto University (Portugal)
Romanian Society of Medical Informatics (Romania)
N. N. Burdenko Neurosurgical Institute (Russian Federation)
Association for Medical Informatics of Serbia (Serbia)
Slovenian Medical Informatics Association (SIMIA) (Slovenia)
Spanish Society of Health Informatics (Spain)
Swedish Federation for Medical Informatics (SFMI) (Sweden)
Swiss Society for Medical Informatics (Switzerland)
European Federation for Medical Informatics
644
Turkish Medical Informatics Association (TurkMIA) (Turkey)
The Ukraine Association for "Computer Medicine" (UACM) (Ukraine)
British Computer Society Health Informatics Forum (BCSHIF) (United Kingdom)
External links
European Federation for Medical Informatics
[1]
References
[1] http:/ / www. efmi.org/
European Health Telematics Association
The European Health Telematics Association (EHTEL) is a European non-profit organization, which provides a
platform to all European eHealth stakeholders to exchange information on eHealth. Martin Denz of the Swiss
Society for Telemedicine and eHealth is the current President of EHTEL.
Vision
EHTELs Vision eHealth is a cooperative process intensifying and changing the interactions of all stakeholders in
health and social care for the purpose of improving Continuity of Care and Patient Safety. eHealth is a tool to
ensure information, choice and empowerment, as requested by European consumers and patients eHealth must
comprise multiple communication channels for ensuring both equal access to services and their ubiquity
Mission
EHTEL: The European eHealth Multidisciplinary Stakeholder Platform Through our growing membership of
currently 60 organisations, we enable our members to voice their views throughout the eHealth ecosystem. We also
facilitate the sharing of experience with colleagues and representatives across Europe and beyond. At EHTEL, we
take an holistic view of eHealth.
As such we collaborate closely with European associations representing Hospitals (HOPE and EHMA), health
insurers (AIM), Physicians (CPME, UEMS), Pharmacists (PGEU, EAHP), Nurses (EFN), patient and citizens (AGE
Platform, European Patients Forum), as well as professional associations dedicated to quality and certification to
care processes and eHealth services (ESQH, EuroRec).
The multitude of backgrounds and interests of these stakeholders enable EHTEL, as a neutral forum, to draw a more
complete picture of the benefits and challenges of the deployment of ICT in the fields of health and social care,
thereby also identifying topics requiring particular attention and further developments at European level.
European Health Telematics Association
645
History
EHTEL was founded in 1999 and the organization represents about 100 organisations and individuals from 30
countries in and outside Europe.
Source
Dierks C., Legal and social implications of health telematics in the EU, Stud Health Technol Inform.
2003;96:143-8.
Range P., Video communication visions, Health Estate. 2002 Jan;56(1):30-1
Richardson R., eHealth for Europe, Stud Health Technol Inform. 2003;96:151-6
Paving the way to sustainable healthcare: telemedicine takes centre stage
[1]
EHTEL Telemedicine FAQ
[2]
External links
EHTEL
[3]
References
[1] http:/ / www. ehtel. org/ SHBlob. asp?WCI=ShowD& F=english%2Fdti82507%2Fti135. HITE+ article. pdf
[2] http:/ / www. ehtel. org/ SHBlob. asp?WCI=ShowD& F=english%2Fdti82498%2Fti137. EHTEL+ telemedicine+ FAQ+ final. doc
[3] http:/ / www. ehtel. org/
European Health Telematics Observatory
The European Health Telematics Observatory (EHTO) is a non-profit organization which collects, analyses and
makes available in a user-friendly form information on developments in the field of health telematics. The
organization contributes to the deployment of health telematics applications and standards in Europe. EHTO works
on the dissemination of results of the European Telematics Applications Programme (TAP) of the Fourth Framework
Programme to the European health care sector.
Participants
Portugal: Portugal Telecom
Belgium: RAMIT (Research in Advanced Medical Informatics and Telematics)
France: CNEH (Centre National de lEquipement Hospitalier)
Ireland: IHC Centre for Health Informatics
Spain: IETT Ingenieria y Prevencion de Riesgos
Greece: BIOTRAST
Finland: VTT Information Technology
European Health Telematics Observatory
646
Source
EHTO
[1]
(Doc)
European Telematics
[2]
External links
European Health Telematics Observatory
[3]
References
[1] http:/ / www. katelco. kz/ UNESCO/ presentations/ HC/ Thienpont. doc
[2] http:/ / cordis. europa. eu/ telematics/
[3] http:/ / www. ehto. org/
European Institute for Health Records
The European Institute for Health Records or EuroRec Institute is a non-profit organization founded in 2002 as
part of the ProRec initiative. On 13 May 2003, the institute was established as a non-profit organization under
French law. Current President of EuroRec is Prof. Dipak Kalra. The institute is involved in the promotion of high
quality Electronic Health Record systems in the European Union. One of the main missions of the institute is to
support, as the European authorised certification body, EHRs certification development, testing and assessment by
defining functional and other criteria.
The objectives of the institute are:
1. 1. To federate the established ProRec centres that comply with a set of explicit criteria.
2. To develop specifically those activities that cannot be handled at the level of ProRec centres and/or within their
scope, according to the principle of subsidiarity and in view of both synergy and economy of scale.
European Projects
ARGOS
The main goal of the ARGOS project was to contribute to creating Transatlantic Observatory for Meeting Global
Health Policy Challenges through ICT-Enabled Solutions to allow promotion of Common Methods for Responding
to Global eHealth Challenges in the EU and the US. The results are used to provide various users recommendations
in sustaining co-odinated actions. Its is important to both Europe and America of United States because:
There is a barrier in fostering healthcare globally as citizens travel and migrate
It will help improve their products to better promote themselves in global markets
The global experiences will become important information for both Europe and America
Through the challenges of enhancing ehealth strategy development, promoting benefits of consistent strategies and
supporting large scale ehealth infrastructure implementations will allow Europe and United States researchers and
policy makers gain mutual understanding and learning.
The main topics that were address within this project was; ehealth interoperability an EHR certifications,
establishing an approach and identification of indicators of the usage and benefits of ehealth, and aiding clinicians in
diagnosis and treatment of rare diseases through human physiology and disease modelling and simulation. However
the project has highlighted challenges in establishing competent ehealth informatics staff. There are variations of
understanding, qualification and definition of workforce requirements through Europe and The United States.
European Institute for Health Records
647
HITCH: Healthcare Interoperability Testing and Conformance Harmonisation
HITCH project begun 01/01/10 and ended on the 30/06/11. The objective of this project was to involve major
stakeholders in defining and agreeing a roadmap that is essential to the foundation for the Interoperability
Conformance Testing of information systems in the field of healthcare. HITCH project aims to propose plans on
achieving interoperability conformance testing foundation starting 2011 through evaluating existing approaches and
identifying potential gaps in initiatives. The roadmap will identify specific needs in improving processes and tools
development that will support research. The roadmap will be tested in real-world settings with healthcare IT
applications to determine the next logicals steps in establishing a credibility amongst major stakeholders (vendors,
users, patients and authorities).
Q-REC: European Quality Labelling and Certification of Electronic Health Record systems
(EHRs)
The Q-REC project started 01/01/06 and finished on 30/06/08. It is a project that is a Specific Support Action and its
objective is to supplement the existing e-Health ERA Co-ordination Project Towards the establishment of a
European e Health Research Area. It aims is to create an credible, sustainable and efficient means in certifying EHR
system in Europe by concentrating EHR Systems Quality Labeling and Certification Development, Resources for
EHR interoperatability, and Benchmarking Services.
Some of the goals stated by Q-REC and EuroREC webpage includes:
EHR Systems Quality Labelling and Certification Development
Developing a modern report on EHR-Certification Schemas that has been implemented in at least three European
countries;
Completing a Pan-European Requirements Assay;
Proposing a Labelling Terminology and Functional Profiles for EHRs to be certified;
Comparing and harmonising the EHR-Certification Procedures at a European level;
Drafting Model Certification Guidelines and Procedures;
Planning the Validation of the Guidelines.
Resources for EHR Interoperability
Producing a register for Conformance Criteria and Guidance Documents for obtaining EHR Certification;
Establishing EHR Archetypes guidelines and inventory;
Establishing a registration process for Coding Schemes in Europe (as mandated by CEN/TC 251);
Providing relevant EHR related standards inventory;
Benchmarking Services
Defining services that uses benchmarking for Manual for Quality Labelling and Certification;
Preparing the Business Plan for new EHR-Certification related Services
This project was done with EuroRec institute whose mission was to promote high quality EHRs throughout Europe.
Through its networks and its centres acting as platforms along with the collaboration with eHealth ERA consortium
and European Health Care Authorities (HCA)/ Ministries groups, EuroRec has provided various methods in
assessing the needs and optimal choice methods for quality labelling and certification of EHRs.
European Institute for Health Records
648
RIDE: A Roadmap for Interoperability of eHealth Systems in Support of COM 356 with
Special Emphasis on Semantic Interoperability
RIDE is a project that aims to provide a solid foundation for the action plans of eHealth Communication COM 356.
It begun on 01/01/06 and ended on 31/12/07. Through research and development into the interoperability of eHealth
systems, meaningful recommendations can be made for actions at a European level. The lack of complete
harmonisation between clinical practice, terminology and EHR systems have highlighted that there is an unrealistic
expectation in developing a single universally clinical data model. Hence the RIDE project objective is to provide a
roadmap through focusing on current limitations of policies and strategies in solutions for ehealth interoperability
and assessing health's European best practices in regards to providing semantic interoperability.
EHR-IMPLEMENT: National policies for EHR Implementation in the European area:
social and organizational issues
The objective of EHR-IMPLEMENT is to provide best practice, policy and strategic recommendations in the
implementation of EHR in Europe. This is done though the collection and analysis of EHR implementations in
various countries. Previous EHR projects have always addressed the technological area in EHR. Other commonly
overlooked in projects, the EHR-IMPLEMENT will focus the social and organisational on a broad national initiative,
as these factor may potentially hinder, if not ruin the EHR implementation.
This project comprised a case study approach and a foused survey at a European level. It aims to analyse and collect
information on best practices and eloborate recommendations for policy makers to facilitate EHR into member
states.
According to EuroREC, these are the main objectives of the projects:
Analysis of national policies and strategies for the implementation of EHR
Conducting a survey regarding policy and action plans for National Implementation of EHR into Member States.
Investigating EHR users in the implementation process.
Raising issues of EHR implementation
Identifying best practices towards EHR implementation in Europe
Promoting information sharing and mutual learning through supporting the development of a community of
scientific experts, technical personnel and National Health System representatives
Providing results and recommendations of the project amongst stakeholders across Europe
Sources
Iakovidis I, Purcarea O., eHealth in Europe: from Vision to Reality, Stud Health Technol Inform. 2008;134:163-8
Richardson R., eHealth for Europe, Stud Health Technol Inform. 2003;96:151-6
External links
European Institute for Health Records
[1]
CEN/TC 125
[1]
(European Standardization of Health Informatics)
COM (2004) 356 final
[2]
Directorate H - ICT For Citizens and Businesses
[3]
(Unit H1 - ICT for Health)
European Institute for Health Records
649
References
[1] http:/ / www. eurorec. org/
[2] http:/ / ec.europa.eu/ information_society/ doc/ qualif/ health/ COM_2004_0356_F_EN_ACTE. pdf
[3] http:/ / cordis. europa. eu/ ist/ health/ index.html
Health On the Net Foundation
Health On the Net Foundation
Type Nonprofit
Industry Healthcare
Founded September 1995
Headquarters Geneva, Switzerland
Products Certification, Trusted health search engine and education
Website http:/ / www. healthonnet. org
Health On the Net Foundation (HON) is a not-for-profit organization founded in 1995 under the auspices of the
Geneva Ministry of Health and based in Geneva, Switzerland. This came about following the gathering of 60 of the
world's foremost experts on telemedicine to discuss the growing concerns over the unequal quality of online health
information. The unanimous conclusion of this gathering was to create a permanent body that would, in the words of
the program, "promote the effective and reliable use of the new technologies for telemedicine in healthcare around
the world." The HON Foundation became one of the first organizations to guide both lay users and medical
professionals to reliable sources of health information in cyberspace.
Mission
The mission of the foundation is to guide the growing community of healthcare consumers and providers on the
World Wide Web to sound, reliable medical information and expertise. In this way, HON seeks to contribute to
improved health care through patient empowerment and better informed health professionals.
Certification
HON Foundation issued a code of conduct (HONcode)
[1]
for medical and health Web sites to address reliability and
usefulness of medical information on the Internet. HONCode is not designed to rate the veracity of the information
provided by a Web site. Rather, the code only states that the site holds to the standards, so that readers can know the
source and purpose of the medical information presented. The HONcode is voluntary, which means that webmasters
and information providers can apply for HONcode certification. Following this, the website is reviewed by a
specialized team of health and legal professionals. The HONcode certification is a dynamic state and is extended
every year according to site compliance. It is the oldest and the most used ethical and trustworthy code for medical
and health related information available on the Internet.
The principles of the HONcode are:
1. 1. Authority - information and advice given only by medical professionals with credentials of author/s, or a clear
statement if this is not the case
2. 2. Complementarity - information and help are to support, not replace, patient-healthcare professional relationships
which is the desired means of contact
Health On the Net Foundation
650
3. 3. Confidentiality - how the site treats personal and non-personal information of readers
4. 4. Attribution - references to source of information (URL if available online)and dates when pages was last updated
5. 5. Justifiability - any treatment, product or service must be supported by balanced, well-referenced scientific
information
6. 6. Transparency of authorship - contact information, preferably including email addresses, of authors should be
available
7. 7. Transparency of sponsorship - sources of funding for the site
8. 8. Honesty in advertising and editorial policy - details about advertising on the site and clear distinction between
advertised and editorial material
Currently the HONcode is used by over 5,000 certified websites, covering 72 countries and has been translated into
34 languages. It is used to sensitize web publishers to the need for quality information and create awareness in health
professionals and so, help guide their patients to trustworthy health information.
HON offers all users the trustworthy web sites and support groups, medical images and terminology, journal articles
and news through its search engines MedHunt
[2]
, HONcodeHunt
[3]
and HONselect
[4]
. HON also provides two
databases of trustworthy health information, one on eye diseases and the other on general medical conditions.
Provisu.ch
[5]
is a database of reliable health information on all eye diseases and is accessible by those with poor or
no vision through its variability of letter size and audio version. Santeromande.ch
[6]
is an extensive database, mainly
directed towards the French-speaking public of Switzerland and neighbouring France and provides reliable health
information, directory of registered health professionals, medical centers or hospitals, medical associations and
federal organizations.
Health On the Net Foundation was granted on 23 July 2002 NGO status by the Economic and Social Council of the
United Nations. HON also has a partnership at the French governmental level, when it was accredited in 2007 by the
French National Authority (HAS)
[7]
to be the official certifying body for all French health websites.
Misuse of HONcode
A journal article raised a number of problems with the HONcode logo, indicating that consumers may mistake it as
an award or interpret it as an indicator for assessed information. Other issues with the HONcode logo were discussed
in the Journal of Medical Internet Research (JMiR), a peer-reviewed eHealth journal.
[8]
Websites that are not in
compliance with HONcode can continue to display the logo, as Health On the Net Foundation (HON) has no means
of obligating the offending webmaster to remove the logo. Clicking on that logo (for verification) will not indicate
that the site is out of compliance, as HONcode only indicates that sites are "undergoing annual review". Hence,
websites that are not in compliance with HONcode may still be displaying the HONcode logo, calling into question
the entire principle of HONcode. Other problems with the application of the HONcode principles are that HON does
not have a means of verifying many of the principles, such as credentials (medical or otherwise) as stated on
websites displaying the logo, or that copyright or confidentiality is not violated by webmasters. HONcode relies on
the webmaster for honest representations about compliance with the principles.
In recent times however, HON has developed ways to counteract the misuse of the HONcode. One of these is the use
of an active and dynamic logo
[9]
which shows its validity and reflects the site compliance in real time. In addition,
all medical credentials are verified through national databases of registered medical professionals. HON has always
encouraged the internet community to demand for quality health information and the general public plays a large role
in the policing of the HONcode by HON.
Consumer protection advocate, Stephen Barrett, is a strong supporter of the HONcode and has made efforts to
improve compliance with its rules and to expose those who misuse it. In a whole "Special to The Washington Post",
extensive coverage of his views on the subject were provided, including suggested improvements and his criticisms
of many named misusers.
[10]
Health On the Net Foundation
651
In cases of suspected fraudulent websites, or of misuse of the HONcode, HON advises internet users to alert
Quackwatch or HON itself: "If you come across a healthcare Web site that you believe is either possibly or blatantly
fraudulent and does NOT display the HONcode, please alert Quackwatch. Of course, if such a site DOES display the
HONcode, alert us immediately."
[11]
References
[1] http:/ / www. hon. ch/ HONcode/ Conduct.html
[2] http:/ / www. hon. ch/ MedHunt/
[3] http:/ / www. hon. ch/ HONcode/ Hunt/
[4] http:/ / www. hon. ch/ HONselect/
[5] http:/ / www. provisu.ch/
[6] http:/ / www. santeromande. ch/
[7] http:/ / www. has-sante.fr/ portail/ display.jsp?id=c_453883
[8] JMIR article (http:/ / www. jmir. org/ 2000/ 2/ e13/ )
[9] http:/ / www. hon. ch/ HONcode/ policy. html
[10] Christopher Wanjek. Attacking Their HONor: Some Dispute Value of Logo Used to Verify Accuracy, Integrity Of Health Web Site
Contents. (http:/ / www.washingtonpost. com/ wp-dyn/ articles/ A25556-2004Apr19. html) Special to The Washington Post, April 20, 2004;
Page HE01
[11] "How to be a vigilant user" (http:/ / www. hon.ch/ HONcode/ audience_t. html) Health On the Net Foundation, accessed 8 April 2009.
External links
Health On the Net website (http:/ / www. hon. ch)
JMIR article (http:/ / www. jmir. org/ 2000/ 2/ e13/ )
Provisu website (http:/ / www. provisu. ch/ )
Santeromande website (http:/ / www. santeromande. ch/ )
Presentation of HONcode on French National Authority website (http:/ / www. has-sante. fr/ portail/ display.
jsp?id=c_453883)
Policing the HONcode (http:/ / www. hon. ch/ HONcode/ policy. html)
MedHunt (http:/ / www. hon. ch/ MedHunt/ )
HONcodeHunt (http:/ / www. hon. ch/ HONcode/ Hunt/ )
HONselect (http:/ / www. hon. ch/ HONselect/ )
HISA
652
HISA
The European Committee for Standardization (CEN) Standard Architecture for Healthcare Information Systems
(ENV 12967), Health Informatics Service Architecture or HISA is a standard that provides guidance on the
development of modular open information technology (IT) systems in the healthcare sector. Broadly, architecture
standards outline frameworks which can be used in the development of consistent, coherent applications, databases
and workstations. This is done through the definition of hardware and software construction requirements and
outlining of protocols for communications.
[1]
The HISA standard provides a formal standard for a Service Oriented
Architecture (SOA), specific for the requirements of health services, based on the principles of Open Distributed
Processing.
[2]
The HISA standard evolved from previous work on healthcare information systems architecture
commenced by Reseau dInformation et de Communication Hospitalier Europeen (RICHE) in 1989, and
subsequently built upon by a number of organizations across Europe.
[3]
Development of Health Informatics Service Architecture EN/ISO 12967
The HISA standard was developed by CEN Technical Committee (TC) 251, the technical committee for Health
Informatics within the federation of European national standards bodies (CEN).
[4]
The CEN/TC 251 was made up of
four working groups, covering: information models; systems of concepts and terminology; security; and technologies
for interoperable communication.
[5]
Working Group I were responsible for information models and completed the
specifications that became the HISA standard. Working Group I worked with experts from across Europe, plus
contributors from Australia and the United States in the development and finalization of ENV 12967.
The CEN HISA standard was adopted by the International Organization for Standardization (ISO) in 2009, with the
stated aim of ISO 12967 being to provide guidance on:
the description, planning and development of new electronic health systems; and
the integration of existing electronic health systems, both intra- and inter-organizationally, through architecture
that integrates common data and business logic into middleware, which is then made available throughout whole
information systems.
The Standard
EN/ISO 12967 is broken down into three parts: Enterprise Viewpoint; Information Viewpoint; and Computational
Viewpoint, all of which deal with different aspects of ensuring service architecture supports openness and
vendor-independence.
[6]
Part One: Enterprise Viewpoint
The Enterprise Viewpoint component of EN/ISO 12967 provides health services with guidance in describing,
planning and developing new IT systems, utilizing an open distributed processing approach. In addition to this it
provides direction for the integration of existing information systems, within the one enterprise and across different
healthcare organizations. Part one of the standard sets forth the common enterprise-level requirements (e.g.
workflows, authorizations) that must be supported through the HISA, which integrates the common data and
business logic into a specific architectural layer (i.e. the middleware), accessible throughout the whole information
system of the health service.
[7]
Part Two: Information Viewpoint
The Information Viewpoint component of EN/ISO 12967 sets forth the fundamental characteristics of the
information model to be implemented by the middleware to provide comprehensive, integrated storage of the
common enterprise data and to support the fundamental business processes of the healthcare organisation, as defined
in ISO 12967 Part One. The specifications were designed to be universally relevant, whilst being sufficiently specific
HISA
653
to allow implementers to derive an efficient design of the system for their organisation. This specification does not
aim to provide a fixed, complete specification of all possible data that may be necessary for any given health service.
It specifies only a set of characteristics, in terms of overall organisation and individual information objects, identified
as fundamental and common to all healthcare organizations.
[8]
Part Three: Computational Viewpoint
The Computational Viewpoint component of EN/ISO 12967 provides details on the fundamental characteristics of
the computational model to be implemented by the middleware, to provide a comprehensive and integrated interface
to the common, fundamental business processes of the health service. The computational model, like the information
model is designed to be universally relevant, whilst still being sufficiently specific to allow implementers to derive
an efficient design of the system for their organisation, irrespective of the specifics of the pre-existing information
technology environment in which it will be implemented.
[9]
Use of common services
The implementation of a modular, open architecture in healthcare IT systems (as specified by the HISA) relies upon
disparate heterogeneous applications interacting and communicating through a middleware layer, made up of
common services. In the case of the HISA, these common services are divided into Healthcare-related Common
Services and Generic Common Services.
[10]
Healthcare-related Common Services (HCS)
Healthcare-related Common Services are those middleware components responsible for supporting the
functionalities and information relevant to the healthcare business domain, including subject of care, activities,
resources, authorization, health characteristics and concepts.
[11]
Generic Common Services (GCS)
Generic Common Services are those middleware components are those middleware components responsible for
supporting the generic functionality and information requirements that are non-specific to the healthcare domain, and
may be broadly relevant to any information system in the business domain.
[12]
References
[1] Engel, Kjeld. Blobel, Bernd. Pharow, Peter. (2006) Standards for Enabling Health Informatics Interoperability, Ubiquity: Technologies for
Better Health in Aging Societies IOS Press
[2] [2] Klein, Gunnar. Sottile, Pier Angelo. Endsleff, Frederik. (2007) Another HISA - The new standard: Health Informatics - Service
Architecture,Studies in Health Technology and Informatics,129(Pt 1):478-82
[3] [3] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
[4] [4] Klein, Gunnar. Sottile, Pier Angelo. Endsleff, Frederik. (2007) Another HISA - The new standard: Health Informatics - Service
Architecture,Studies in Health Technology and Informatics,129(Pt 1):478-82
[5] [5] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
[6] [6] Klein, Gunnar. Sottile, Pier Angelo. Endsleff, Frederik. (2007) Another HISA - The new standard: Health Informatics - Service
Architecture,Studies in Health Technology and Informatics,129(Pt 1):478-82
[7] European Committee for Standardization: http:/ / www. cen. eu/ cen/ Pages/ default. aspx
[8] European Committee for Standardization: http:/ / www. cen. eu/ cen/ Pages/ default. aspx
[9] European Committee for Standardization: http:/ / www. cen. eu/ cen/ Pages/ default. aspx
[10] [10] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
[11] [11] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
[12] [12] Kalra,Dipak. (2002) Clinical Foundations and Information Architecture for the Implementation of a Federated Health Record Service,
University College, London
Indian Association for Medical Informatics
654
Indian Association for Medical Informatics
IAMI logo
The Indian Association for Medical Informatics (IAMI) is
a professional society that plays a role in promoting and
furthering the application of informatics in the fields of
healthcare, bioscience and medicine in India. It was
established in 1993.
Goals and objectives
The objectives [1] of the IAMI are to sensitize the Indian
medical community to the benefits of Information
Technology (IT), bring about awareness and ensure greater
utilization of IT in healthcare facilities across the length and
breadth of India. The IAMI also aims to provide necessary
assistance and guidance to other organizations to implement
and reap the benefits of IT for health care. It supports
introduction of computer literacy along with medical education, development of computerized as well as medical
digital libraries, access to information and creation of databases. IAMI emphasizes on research and development of
medical informatics as an independent discipline. It provides various communication and interaction channels among
its members by means of e-groups and through publication of a scholarly journal mentioned below.
Affiliation
It is the Indian National Member at IMIA [2]
History
IAMI was registered in September 1993 with its Registered Office being the Department of Clinical Pharmacology,
Nizams Institute of Medical Sciences [3], in Hyderabad, India.
It has been organising a conference every two years on roles and applications of informatics in medicine, health and
allied fields in various states of India.
The first biennial conference was held in 1995 at Hyderabad.
Second conference was held in 1997 at Indian Institute of Science, Bangalore.
A major workshop was held in 2001 at NIMS, Hyderabad in lieu of third conference. Third conference of 1999 was
postponed due to natural calamities.
The fourth conference was held in 2003 at PGIMER[4], Chandigarh.
A mid-conference was held in 2004 at the South-Eastern Railways Hospital, Kolkata.
Fifth conference was held in 2005 at Sri Guru Ram Das Institute of Medical Sciences in Amritsar.
IAMI has conducted many beginners courses for doctors, nurses, paramedical personnel and computer professional
class. This enabled the association in enrolling many hospitals, institutes and organizations as Institutional Life
Members. It is aiming at making Medical Informatics as one of the elective subjects in the UG curriculum for all
medical colleges in India and to get academic credits from the Medical Council of India and other autonomous
bodies under the Ministry of Health and Family Welfare (India)[5], Government of India for all the delegates
participating in the conferences, seminars and workshops organized by the association.
Indian Association for Medical Informatics
655
In 2001, it started a discussion group for Medical Informatics. Which has now grown as the de facto information
source for medical informatics related activities in India both for its members as well as non-members. Its active
members include almost the entire Whos Who of medical informatics scene of India. IAMI got its own web site in
2002. Its Journal "Indian Journal of Medical Informatics" (IJMI, ISSN0973-0397
[6]
) was started in May 2004 [7].
Membership
IAMI membership consists of Personal, Institutional and Honorary Members [8].
Many of its key office bearers are part of several Government of India (GOI) initiatives in the areas of telemedicine,
especially in the area of development of standards and guidelines for the practice of telemedicine, online medical
education and electronic medical records or electronic health records.
Journal
It brings out the scientific journal called Indian Journal of Medical Informatics [9].
Discussion group
Members of the association have an active discussion group
[10]
where healthcare IT enthusiasts discuss topics of
their interest.Several discussion threads run in parallel. There is also a "Topic of the month" which is the main focus
of the discussion.
External links
IAMI
[11]
List of Mentors in Healthcare Informatics
[12]
Indian Journal of Medical Informatics (IJMI)
[13]
References
[1] http:/ / www. iami. org. in/ objectives.asp
[2] http:/ / www. imia. org/ action. lasso?-database=organizations. fp5& -response=member_profile. html& -layout=CGI& -sortField=country&
-sortOrder=ascending& -op=bw& type=national& -maxRecords=1& -skipRecords=18& -search
[3] http:/ / nims.ap. nic. in/
[4] http:/ / www. pgimer.nic.in/
[5] http:/ / mohfw.nic.in/
[6] http:/ / www. worldcat.org/ search?fq=x0:jrnl& q=n2:0973-0397
[7] http:/ / www. iami. org. in/ history.asp
[8] http:/ / www. iami. org. in/ members. asp
[9] http:/ / www. medicalinformatics. org. in/ ojs/ index. php/ ijmi/ index
[10] http:/ / groups.google. com/ group/ iami_gen
[11] http:/ / www.iami.org. in/
[12] http:/ / www.iami.org. in/ index. php?option=com_content& view=article& id=96& Itemid=185
[13] http:/ / www.ijmi.org/ index. php/ ijmi
International Medical Informatics Association
656
International Medical Informatics Association
IMIA or the International Medical Informatics Association is an independent organization that plays a role in
promoting and furthering the application of information science in modern society, particularly in the fields of
healthcare, bioscience and medicine. It was established in 1967 as a technical committee of the International
Federation for Information Processing (IFIP). It became an independent organization in 1987 and was established
under Swiss law in 1989.
Goals and objectives
the promotion of informatics in health care and biomedical research
the advancement of international cooperation
the stimulation of research, development and education
the dissemination and exchange of information
Inherent in this mission is to bring together, from a global perspective, scientists, researchers, vendors, consultants
and suppliers in an environment of cooperation and sharing. The international membership network of national
member societies, IMIA regions, corporate and academic institutional members, and working and special interest
groups, constitute the "IMIA family".
IMIA organizes various conferences and events around the world and is currently focusing on "bridging the
knowledge gap" by facilitating and providing support to developing nations. Specific goals include supporting the
ongoing development of the African Region
[1]
.
Code of Ethics for Health Information Professionals
The International Medical Informatics Association approved the endorsement of the IMIA Code of Ethics for Health
Information Professionals at its General Assembly meeting on October 4, 2002 in Taipei. The code is the
culmination of several years of a global collaborative effort led by IMIA's working Group on Data Protection in
Health Information, Chaired by Professor Ab Baker.
Membership
IMIA membership consists of National, Institutional and Affiliate Members and Honorary Fellows.
National Members represent individual countries. A member is a society, a group of societies, or an appropriate
body, which is representative of the medical, and health informatics activities within that country. Where no
representative societies exist, IMIA accommodates involvement through "Corresponding" members within
developing countries.
National member societies
Argentine Association of Medical Informatics
[2]
Health Informatics Society of Australia Ltd. (HISA)
[3]
Working Group Medical Informatics (AKMI) of the Austrian Society for Biomedical Engineering GBMT) and
of the Austrian Computer Society (OCG)
[4]
Belgian Medical Informatics Association
Society for Medical Informatics of Bosnia and Herzegovina
[5]
Brazilian Society of Health Informatics
British Computer Society Health Informatics Forum
[6]
COACH: Canada's Health Informatics Association
[7]
International Medical Informatics Association
657
China Medical Informatics Association
[8]
Croatian Society for Medical Informatics
[9]
Cuban Society of Medical Informatics
[10]
Czech Society for Biomedical Engineering and Medical Informatics
[11]
The Danish Society for Medical Informatics
[12]
Ethiopian Health Informatics Association
Finnish Social and Health Informatics Association (FinnSHIA)
[13]
French Medical Informatics Association (AIM)
[14]
German Association for Medical Informatics, Biometry and Epidemiology
[15]
Greek Health Informatics Association
[16]
Hong Kong Society of Medical Informatics
John von Neumann Computer Society (Hungary)
Indian Association for Medical Informatics
Iranian Medical Informatics Association
[17]
Healthcare Informatics Society of Ireland
[18]
The Israeli Association for Medical informatics
[19]
Italian Medical Informatics Society (AIIM)
[20]
Ivorian Society of Biosciences and Health Informatics (ISBHI)
[21]
Japan Association for Medical Informatics
[22]
Medical Pharmaceutical Information Association (MedPharmInfo)(Kazakhstan)
[23]
Korea Society of Medical Informatics (KOSMI)
[24]
Medical Informatics Association of Malawi (MIAM)
[25]
Malaysian Health Informatics Association (MHIA)
[26]
The Mali Society of Biomedical and Health Information (SOMBIS)
[27]
Health Informatics New Zealand
[28]
Association for Health Informatics of Nigeria (AHIN)
[29]
Norwegian Society for Medical Informatics
[30]
Philippine Medical Informatics Society, Inc.
[31]
Polish Society of Medical Informatics
Romanian Society of Medical Informatics
[32]
The Saudi Association for Health Informatics (SAHI)
[33]
Association for Medical and Bio-Informatics, Singapore (AMBIS)
[34]
Slovak Society of Biomedical Engineering and Medical Informatics
[35]
Slovenian Medical Informatics Association (SIMIA)
[36]
South African Health Informatics Association
[37]
Spanish Society of Health Informatics
[38]
Swedish Federation for Medical Informatics
[39]
Swiss Society for Medical Informatics
[40]
Taiwan Association for Medical Informatics (TAMI)
[41]
VMBI, Society for Healthcare Informatics (Netherlands)
[42]
Turkish Medical Informatics Association (TURKMIA)
[43]
The Ukrainian Association for Computer Medicine (UACM)
[44]
American Medical Informatics Association
Uruguayan Society of Health Informatics
[45]
Venezuelan Association of Computer Science in Health (AVIS)
[46]
International Medical Informatics Association
658
Working and special interest groups
The IMIA family includes a growing number of Working and Special Interest Groups, which consist of individuals
who share common interests in a particular focal field. The groups hold Working Conferences on leading edge and
timely health and medical informatics issues.
IMIA Working Groups and Special Interest Groups include:
Biomedical Pattern Recognition (WG 07)
Biomedical Statistics and Information Processing (WG 12)
Consumer Health Informatics (WG2)
Dental Informatics (WG 11)
Health and Medical Informatics Education (WG1)
Health Informatics for Development (WG 09)
Health Information Systems (WG 10)
Informatics in Genomic Medicine (IGM)
Intelligent Data Analysis and Data Mining (WG 03)
Medical Concept Representation (WG 06)
Mental Health Informatics (WG 08)
Open Source Health Informatics
Organizational and Social Issues (WG 13)
Primary Health Care Informatics (WG 05)
Security in Health Information Systems (WG 04)
SIG NI Nursing Informatics
Social Media Working Group
[47]
Standards in Health Care Informatics (WG 16)
Technology Assessment & Quality Development in Health Informatics (WG 15)
Telematics in Health Care (WG 18)
Wearable Sensors in Healthcare
[48]
External links
International Medical Informatics Association
[49]
IMIA Yearbook
[50]
ACI - Applied Clinical Informatics
[51]
References
[1] http:/ / helina. org
[2] http:/ / www. aaim. org.ar/
[3] http:/ / www. hisa.org. au/
[4] http:/ / iig.umit. at/ akmi/ akmi. htm
[5] http:/ / www. bhsmi. ba/
[6] http:/ / www. bcs. org/ BCS/ Forums/ health
[7] http:/ / www. coachorg. com/
[8] http:/ / www. cmia. info/
[9] http:/ / www. snz. hr/ wnew/ csmi. html
[10] http:/ / www.socim. sld. cu/
[11] http:/ / www.cls. cz/
[12] http:/ / www.dsmi. dk/
[13] http:/ / www.stty. org/ english.htm
[14] http:/ / documvf. crihan. fr/ aim/
[15] http:/ / www.gmds. de/
[16] http:/ / ghia. nurs. uoa. gr/
International Medical Informatics Association
659
[17] http:/ / www.irmia.org
[18] http:/ / www.hisi. ie/
[19] http:/ / www.ila. org.il/ Index.asp?CategoryID=134& ArticleID=92
[20] http:/ / www.aiim.it/
[21] http:/ / sibim.net/
[22] http:/ / www.jami.jp/
[23] http:/ / www.med. kz
[24] http:/ / www.kosmi.org/
[25] http:/ / www.miam.org. mw/
[26] http:/ / www.mhia. org. my/
[27] http:/ / www.somibs. net/
[28] http:/ / www.hinz. org.nz/
[29] http:/ / ahin. wordpress.com/
[30] http:/ / www.fdh.no/ mambo/ index.php
[31] http:/ / www.philmedinfo.org/
[32] http:/ / medinfo. umft. ro/ rsmi/
[33] http:/ / www.sahi.org. sa/
[34] http:/ / www.ambis. org. sg/
[35] http:/ / www.sbimi.sk/ index_en. htm
[36] http:/ / www.sdmi. si/
[37] http:/ / www.sahia.org. za/
[38] http:/ / www.seis. es/
[39] http:/ / www.sfmi.se/
[40] http:/ / www.sgmi-ssim. ch/
[41] http:/ / www.medinfo. org.tw/ html/ intro_eng.html
[42] http:/ / www.vmbi.nl/
[43] http:/ / www.turkmia. org/
[44] http:/ / www.uacm. kharkov. ua/ eng/ index.html
[45] http:/ / www.suis.org. uy/
[46] http:/ / www.avis. org.ve/
[47] http:/ / imiasocialmedia. wordpress. com/
[48] http:/ / www.wearable-sensors. org/
[49] http:/ / www.imia. org/
[50] http:/ / imia. schattauer.de
[51] http:/ / www.aci-journal. org
Medinfo
660
Medinfo
MedInfo is the name of the international medical informatics conference organized every 3 years by the
International Medical Informatics Association. It is the most important international conference in the field with
3000+ health and medical informatics professions attending from all over the world. MedInfo also serves to bring
together all officers of the International Medical Informatics Association (IMIA) Board together with national
representatives in the General Assembly of IMIA.
The General Assembly elects the officers of IMIA. The IMIA Board consists of the President (the Past or the Elect
President), Treasurer and Secretary as its officers. In addition it has other Vice Presidents for targeted areas:
Membership, MedInfo, Services, Special Affairs, Strategic Plan Implementation, and Working Groups. With the
exception of the President and the Vice President of MedInfo all officers serve a three year term that can be extended
for a second three year term. The President is on a 5 year cycle and the Vice President of MedInfo has one 3 year
cycle and elected the year before the next Medinfo meeting so that he/she can be mentored through one MedInfo
cycle.
MedInfo conferences
MedInfo has been held every 3 years since its inception in 1974. The table below gives an overview of these
conferences.
Number Year Date Location Organizing Partner Organizing
Committee
Chair(s)
Scientific Program
Committee Chair(s)
Editorial Committee
1 1974 Aug 5-10 Stockholm,
Sweden
IFIP World Congress Francois Grmy John Anderson, J. Malcolm
Forsythe
2 1977 Aug 8-12 Toronto,
Canada
IFIP TC-4 Meeting Werner
Schneider
David B. Shires, Hermann K.
Wolf
3 1980 Sep
29-Oct 4
Tokyo, Japan Masamitsu
Oshima
Morris F. Collen Donald A. B. Lindberg,
Shigekoto Kaihara
4 1983 Aug
22-27
Amsterdam,
The Netherlands
Jan Roukens Gwilym S. Lodwick Jan Hendrik van Bemmel,
Marion J. Ball, Ove Wigertz
5 1986 Oct 26-30 Washington
DC, USA
American Medical
Informatics
Association
Donald A. B.
Lindberg
Jan van Bemmel,
Edward H. Shortliffe
Roger Salamon, Bruce I.
Blum, Mogens Jrgensen
6 1989 Oct
17-20,
Dec
11-15
Beijing, China
and Singapore
K. C. Lun Barry Barber, Dexian Cao,
Dulie Qin, Gustav Wagner
7 1992 Sep 6-10 Geneva,
Switzerland
Swiss Society for
Medical Informatics
[40]
Jean-Raoul
Scherrer
Salah Mandil K. C. Lun, Patrice Degoulet,
Thomas E. Piemme, Otto
Rienhoff
8 1995 July
2327
Vancouver,
Canada
Canada's Health
Informatics
Association
[1]
Kathryn Hannah Shigekoto Kaihara Robert A. Greenes, Hans E.
Petersen, Denis J. Protti
9 1998 Aug
14-21
Seoul, South
Korea
Korean Society of
Medical Informatics
[24]
Chang Soon
Koh
Charles Safran, Patrice
Degoulet
Branko Cesnik, Alexa
Thorlichen McCray,
Jean-Raoul Scherrer
Medinfo
661
10 2001 Sep 2-5 London, UK
British Computer
Society Health
Informatics Forum
[6]
Jean Roberts Arie Hasman, Hiroshi
Takeda
Vimla L. Patel, Ray Rogers,
Reinhold Haux, Beatriz de
Faria Leo
11 2004 Sep 7-11 San Francisco,
USA
American Medical
Informatics
Association
Edward H.
Shortliffe
Mario Stefanelli,
Casimir Kulikowski
Marius Fieschi, Enrico Coiera,
Yu-Chan Jack Li
11 2007 Aug
2024
Brisbane,
Australia
Health Informatics
Society of Australia
[3]
Evelyn J.S.
Hovenga
Alexa T. McCray,
Heimar de Ftima
Marin
Klaus. A. Kuhn, James R.
Warren, Tze-Yun Leong
12 2010 Sep
13-16
Cape Town,
South Africa
South African Health
Informatics
Association
[2]
Lyn Hanmer Riccardo Bellazzi,
Johanna Westbrook
Charles Safran, Heimar de
Ftima Marin, Shane Reti
13 2013 Aug
2023
Copenhagen,
Denmark
Danish Society of
Medical Informatics
(DSMI)
Lene Vistisen
(Denmark)
Dominik Aronsky
(Switzerland), TzeYun
Leong (Singapore)
Christoph U. Lehmann (US,
Chair), Christian Nhr
(Denmark), Elske
Ammenwerth (Austria)
14 2015 Sao Paulo,
Brasil
15 2017 Bejing, China
Other definitions
Medinfo is also an acronym for Medical Information, often a pharmaceutical information service provided by
pharmacovigilance or medical affairs departments.
References
Peterson, H. and Hutter, M. (2007). "IMIA's publication history". IMIA Yearbook of Medical Informatics Methods
Inf. Med. v46 iSuppl. 1. 192-196. ISBN978-3-7945-2608-6.
Anderson, J., Forsythe, J.M. (Eds.). MEDINFO 74. Amsterdam: North-Holland. ISBN0-444-10771-1.
Shires, D.B., Wolf, H. (Eds.). MEDINFO 77. Amsterdam: North-Holland. ISBN978-0-7204-0754-9.
Lindberg, D.A.B., Kaihara, S. (Eds.). MEDINFO 80. Amsterdam: North-Holland. ISBN0-444-86029-0.
van Bemmel, J.H., Ball, M.J., Wigertz, O. (Eds.). MEDINFO 83. Amsterdam: North-Holland.
ISBN0-444-86525-X.
Salamon, R., Blum, B.I., Jrgensen, M. (Eds.). MEDINFO 86. Amsterdam: North-Holland. ISBN0-444-70110-9.
Barber, B., Cao, D., Qin, D., Wagner, G. (Eds.). MEDINFO 89. Amsterdam: North-Holland.
ISBN0-444-88138-7.
Lun, K.C., Degoulet, P., Piemme, T.E., Rienhoff, O. (Eds.). MEDINFO 92. Amsterdam: North-Holland.
ISBN978-0-444-89668-1.
Greenes, R.A., Peterson, H.E., Protti, D.J. (Eds.). MEDINFO 95. Amsterdam: North-Holland.
ISBN978-0-9697414-1-1.
Cesnik, B., McCray, A.T., Scherrer, J.R. (Eds.). MEDINFO 98. Amsterdam: IOS Press.
ISBN978-90-5199-407-0.
Patel, V., Rogers, R., Haux, R. (Eds.). MEDINFO 01. Amsterdam: IOS Press. ISBN978-1-58603-194-7.
Fieschi, M., Coiera, E., Li, Y.-C. (Eds.). MEDIFNO 04. Amsterdam: IOS Press. ISBN978-1-58603-444-3.
Kuhn, K.A., Warren, J.R., Leong, T.-Y. (Eds.). MEDINFO 2007. Amsterdam: IOS Press.
ISBN978-1-58603-774-1.
Medinfo
662
External links
http:/ / www. imia-medinfo. org/ medinfo2010/ (Cape Town, South Africa)
http:/ / www. imia-medinfo. org/ new2/ node/ 9
References
[1] http:/ / coachorg. com/
[2] http:/ / www. sahia. org. za
National Resource Center for Health Information
Technology
In 2004, the Agency for Healthcare Research and Quality of the United States Department of Health and Human
Services created the AHRQ National Resource Center for Health Information Technology
[1]
(the National Resource
Center or NRC) to support over 125 federal grants and contracts that are demonstrating the value and
implementation of information technology in health care (health information technology).
With leadership from the National Opinion Research Center (NORC), the Regenstrief Institute
[2]
, the Vanderbilt
Center for Better Health
[3]
, the Center for IT Leadership (CITL)
[4]
and the eHealth Initiative
[5]
, the NRC monitors
and provides technical assistance to federal grants that are implementing technologies such as Electronic health
records, Computerized Physician Order Entry, Health information exchange (HIE) and Telemedicine. The NRC
directs almost half of its efforts and funding towards monitoring health IT development in rural communities.
In addition to its support of federal grants and agencies, the National Resource Center disseminates knowledge and
best practices observed by the projects it supports. By way of the NRC's web site, health providers, administrators
and researchers share lessons learned for how best to improve health care quality, safety, and efficiency in the United
States through successful health IT adoption and usage.
The NRC does not provide grant money to individuals or organizations to do research in the fields of health care or
health informatics. The NRC does provide, however, free educational resources and events where theory and case
examples are presented by researchers active in these fields.
External links
National Resource Center for Health Information Technology
[1]
Agency for Healthcare Research and Quality (AHRQ)
[6]
Glossary of Health Care Informatics Terms
[7]
References
[1] http:/ / healthit.ahrq.gov
[2] http:/ / www. regenstrief. org
[3] http:/ / www. mc. vanderbilt.edu/ vcbh/
[4] http:/ / www. citl. org
[5] http:/ / www. ehealthinitiative. org
[6] http:/ / www. ahrq. gov
[7] http:/ / theinformatician. com/ hci-glossary/
Open Source Health Care Alliance
663
Open Source Health Care Alliance
The Open Source Health Care Alliance is an international collaboration promoting the development and use of
open source software and open access publications in the health care domain.
Membership is open to persons worldwide who are interested in furthering the objects of OSHCA and shall consist
of anyone who has accepted the premise of OSHCAs Vision, Mission Statements and Principles by indicating such
acceptance via OSHCAs Internet Registration
[1]
process.
OSHCA was first formed in 1999 as an informal organization of interested parties. The organization achieved formal
non-profit status in Malaysia on 31 October 2006 under the leadership of Dr. Molly Cheah and a protem committee
of industry leaders. The first AGM will be held in 2007 following the OSHCA2007 conference (May 811) at the
Federal Hotel in Kuala Lumpur, Malaysia.
Mission
OSHCA defines its mission as
Promote to policy makers the concept of Free/Open Source Software in Health Care so as to adopt or give equal
opportunity to Free/Open Source Solutions.
Provide leadership role in refining the Free/Open Source Software Concepts as applied to health care to ensure
best practices and patient safety are not compromised.
Make recommendations on the development and use of Health information Standards for data interchange and
representation formalisms.
Provide Guidelines for Quality Control on Free/Open Source Health Care Software development.
Participate in and support Human Capacity Building, including contributing/participating in project proposals and
project management to achieve developing country priorities.
Enable collaboration of members including, sharing technical knowledge in Free/Open Source Health Care
Projects and providing information Resources to Free/Open Source Health Care software developers.
Promote and help the formation of development consortia for health care related projects, including assisting in
finding funding for projects to reach critical mass for a visible and lasting impact on health related Millennium
Development Goals (MDGs).
Use collaboration with strategic organisations with compatible goals as a means of achieving the mission.
External links
official website
[2]
References
[1] http:/ / www. oshca. org/ membership/
[2] http:/ / www. oshca. org
The Continua Health Alliance
664
The Continua Health Alliance
Continua Health Alliance
Industry Trade association
Founded June 2006
Headquarters Beaverton, Oregon, United States
Area served Worldwide
Key people Clint McClellan
(President)
Charles Parker
(Executive Director)
Website
ContinuaAlliance.org
[1]
Continua Health Alliance is an international non-profit, open industry group of nearly 240 healthcare providers,
communications, medical, and fitness device companies. Continua Health Alliance members aim to develop a
system to deliver personal and individual healthcare.
Overview
Continua Health Alliance is an international not-for-profit industry organization enabling end-to-end, plug-and-play
connectivity of devices and services for personal health management and healthcare delivery. Its mission is to
empower information-driven health management and facilitate the incorporation of health and wellness into the
day-to-day lives of consumers. Continua is a pioneer in establishing industry standards and security for connected
health technologies such as smart phones, gateways and remote monitoring devices. Its activities include a
certification and brand support program, events and collaborations to support technology and clinical innovation, as
well as outreach to employers, payers, governments and care providers. With nearly 220 member companies
reaching across the globe, Continua comprises technology, medical device and healthcare industry leaders and
service providers dedicated to making personal connected health a reality.
Continua Health Alliance is working toward establishing systems of interoperable telehealth devices and services in
three major categories: chronic disease management, aging independently, and health and physical fitness.
Devices and services
Continua Health Alliance version 1 design guidelines are based on proven connectivity technical standards and
include Bluetooth for wireless and USB for wired device connection. The group released the guidelines to the public
in June 2009.
[2]
The group is establishing a product certification program using its recognizable logo, the Continua Certified Logo
program, signifying that the product is interoperable with other Continua-certified products. Products made under
Continua Health Alliance guidelines will provide consumers with increased assurance of interoperability between
devices, enabling them to more easily share information with caregivers and service providers.
Through collaborations with government agencies and other regulatory bodies, Continua works to provide guidelines
for the effective management of diverse products and services from a global network of vendors. Continua Health
Alliance products make use of the ISO/IEEE 11073 Personal Health Data (PHD) Standards.
Continua design guidelines are not available to the public without signing a Non-disclosure agreement. Continua's
guidelines help technology developers build end-to-end, plug-and-play systems more efficiently and cost effectively.
The Continua Health Alliance
665
Milestones
Continua Health Alliance was founded on June 6, 2006
[3]
Continua Health alliance performed its first public demonstration of interoperability on October 27, 2008 at the
Partners Center for Connected Health 5th Annual Connected Health Symposium in Boston.
[4]
Continua Health Alliance certified its first product
[5]
, the Nonin 2500 PalmSAT handheld pulse oximeter with USB,
on January 26, 2009.
[6]
By the end of September 2010 there were fourteen certified products.
[7]
Continua selected Bluetooth Low Energy and ZigBee wireless protocols as the wireless standards for its Version 2
Design Guidelines which are yet to be released. Bluetooth Low Energy is to be used for low-power mobile devices.
ZigBee will be used for networked low-power sensors such as those enabling independent living.
[8]
Through July 2012, Continua now has 69 certified devices.
[9]
Beginning in 2012, Continua invites non-members to request a copy of its Design Guidelines after signing a
non-disclosure agreement.
[10]
Continua has working groups and operations in the U.S., EU, Japan, India and China.
Members
Continua Health Alliance currently has nearly 220 member companies.
[11]
Continua's Board of Directors is currently composed of the following companies:
[12]
Intel Corporation
Roche Diagnostics
Partners HealthCare
Price Waterhouse Coopers
Oracle Corporation
Cisco Systems
Panasonic
Philips
Fujitsu
Orange
Qualcomm
UnitedHealth Group
Samsung Electronics
Sharp
Organisational Structure
The Organisation is primarily staffed by volunteers from the member organisations that are organised in to working
groups that address the goals of the alliance. Below the board of directors sit the following main working groups:
[13]
Emerging Markets Working Group
EU Working Group
Global Development and Outreach Working Group
Marketing Council
Market Adoption Working Group
Regulatory Working Group
Technical Working Group
Test & Certification Work Group
The Continua Health Alliance
666
Use Case Working Group
U.S. Policy Working Group
Relevant standards
ISO/IEEE 11073
ISO/IEEE 11073 Personal Health Data (PHD) Standards
Bluetooth
USB
HL7
Integrating the Healthcare Enterprise
Zigbee
Website
The Continua Alliance website contains a full listing of member organisations, a directory of qualified products, and
a clear statement of their mission.
External links
Continua Health Alliance website
[1]
American Telemedicine Association
[14]
MobiHealthNews
[15]
Telemedicine History
[16]
Association of Telehealth Service Providers
[17]
References
[1] http:/ / www. continuaalliance. org
[2] http:/ / www. continuaalliance. org/ static/ cms_workspace/ Continua_Version_One_Design_Guidelines_Now_Available_final. pdf
[3] http:/ / continuaalliance. org/ news-and-media/ press-releases/ founding-continua. html
[4] http:/ / continuaalliance. org/ static/ binary/ cms_workspace/ Continua_Update_release_v_FINAL_2_. pdf
[5] http:/ / continuaalliance. org/ certified-products/ nonin-2500-palmsat%C2%AE-pulse-oximeter. html
[6] http:/ / www. nonin.com/ News. aspx?NewsID=86
[7] http:/ / www. continuaalliance. org/ products/ certified-products. html
[8] http:/ / www. continuaalliance. org/ static/ cms_workspace/ Continua_06082009_vFINAL. pdf
[9] http:/ / www. continuaalliance. org/ products/ certified-products. html
[10] http:/ / www.continuaalliance.org/ products/ design-guidelines. html
[11] Member Companies (English) (http:/ / www. continuaalliance. org/ about-the-alliance/ member-companies. html)
[12] Board of Directors (English) (http:/ / www.continuaalliance. org/ about-the-alliance/ board-of-directors. html)
[13] http:/ / www.continuaalliance.org/ static/ cms_workspace/ Continua_Overview_Presentation_7. 16. 12_web. pdf
[14] http:/ / www.americantelemed.org/ i4a/ pages/ index.cfm?pageid=1
[15] http:/ / mobihealthnews. com/
[16] http:/ / www.depts. ttu. edu/ communications/ vistas/ archive/ 02-summer/ stories/ miracle-of-telemedicine. php
[17] http:/ / atsp. org/ default. asp
UNESCO Chair in Telemedicine
667
UNESCO Chair in Telemedicine
UNESCO Chair of Telemedicine (UNES_CT) is a portion of UNESCO that was founded in 1999. It undertakes
international activities related to the promotion of the information society and fights against technology transfer
problems having the role of an intermediate body. The Chair is the first UNESCO Telemedicine Chair
[1]
, and his
activity is related with development and diffusion of Telemedicine and Information Society in Health Care in
developing areas and undeveloped countries particularly South-America and Africa.
The expertise of the UNESCO chair of Telemedicine as a University Institution is based in the previous CATAIs
[2]
expertise founded in 1994 in the field of Information Society/Telemedicine with which is collaborating closely and
from which received part of the sponsorship:
Training and teaching aspects, to gain a minimal structured knowledge in Medical Informatics, have established
the Telemedicine Body of Knowledge covering sociology, economics, technology transfer, technology and
organizational issues, standardization, security and liability aspects in co-operation with the Universities of
Queens-UK, Aveiro-PT, Belfast-IRL, Genova-IT, Innsbruck-AU, Udine-IT, Berlin-D, Athens-GR. CATAI
published the first text-book of Telemedicine in English, complemented with a CD multimedia material
particularly designed for developing countries, world wide known by Winter and Summer Courses of
Telemedicine training following the Telemedicine Body of Knowledge". At the present moment the book is
translated into 6 languages (SP,E,IT,GR,FR,D) and is published in Spanish (PanAmerican Editorial) with title :
Telemedicine 2001. Is participating in all editions of the European Telemedicine Glossary edited by the EC-DG
Information Society. In the 4th Ed-2002 is the author of the Electronic Clinical Record.
CATAI developed the Videophone network in Canary Islands in 1991 for distant support. At the present it
includes the best practice implementation pilots in phone medicine (oncology -particularly home-care- and
psychiatry -particularly childhood psychiatry), Tele-ECG and Tele-ultrasounds -particularly obstetrics &
gynaecology.
Fist in the world (1991) to carry out distant DNA quantitation, it was applied to image analysis prognostic factors
in breast cancer. Objective image analysis and prognostic factors have been incorporated into the regional breast
cancer registry of 3000 patients (see above);
CATAI was the promoter of the Centre of Excellence in Telemedicine, sponsored by Science Park DG-XIII, with
enrolment of 3 continents: Europe, Africa and America to concentrate best practice examples as well as top
experts to implement real world applications and development of hardware-software systems ready to be used.
These activities link mainly technological firms of the UK and Germany.
Leader of two EU projects (Leonardo-DG XXII ; Science Park-DGXIII) and participating in other two (DGXIII-
Teleultrasound for developing countries; Leonardo-DGXXII Teaching Medical informatics). Leader in Canary
Islands and in the main land - Barcelona- of a project on Telephonic Medicine. Partner in 5 EU projects (
Smart-USB; KOD or knowledge on demand, ASKLEPIOS, CHS or Citizen Home Services, CATAI-CTC)
UNESCO Chair of Telemedicine was involved in developing countries health support through the Midjan
group-ITU-D working group of Telemedicine, TeleInViVo ultrasound devices with pilots in Katastan, Mali and
Uganda. Promoting the network of Telemedicine together with Argentina, Venezuela, Peru, and participated in
ITU-Developing Word Congress in Malta 1997, and Georgia Telemedicine meeting in 1999. Is currently actively
working with South-America ( Venezuela, Argentina, Cuba, Chile, Peru) and Africa (Uganda, Kenya)
UNESCO Chair in Telemedicine
668
Awards
Economical initiatives, Canary islands 1995;
Ordesa award in paediatrics 1989;
Award Portugal-Spanish cooperation 1994;
Award Royal Academy Medicine 1993 and 1999.
Included in Who is Who in the World since 1996 scheduled up to 2000. Included in the 3rd Ed. of Who is Who
in Science and Engineering.
the Lattice Price 99 of ESF (European Science Foundation) in Innovation & Research in teaching, nominated by
the STOA European Parliament Office.
References
UNESCO Chair in Telemedicine - CATAI - University of La Laguna (Spain)
[2]
UNESCO Education Portal
[3]
University of La Laguna
[4]
References
[1] http:/ / portal. unesco. org/ education/ en/ ev.php-URL_ID=2989& URL_DO=DO_TOPIC& URL_SECTION=-465. html
[2] http:/ / www. teide. net/ catai
[3] http:/ / portal. unesco. org/ education/ en/ ev.php-URL_ID=48712& URL_DO=DO_TOPIC& URL_SECTION=201. html
[4] http:/ / www. ull. es
World Health Imaging, Telemedicine, and Informatics Alliance
669
World Health Imaging, Telemedicine, and
Informatics Alliance
World Health Imaging, Telemedicine and Informatics Alliance
Type 501(c)(3) Non-profit Organization
Founded Chicago, IL, US
Founder(s) Mike Hoaglin, Dave Kelso, Matt Glucksberg, Michael Diamond
Headquarters Chicago, Illinois
United States
Key people Newton N. Minow, Chair of the Board
Michael W. Ferro, Jr., Vice Chair
Ivy Walker, CEO
Area served Worldwide
Focus(es) Low-cost medical imaging, X-ray, Health Information technology, sustainability
Motto One digital image can save a life
Website
worldhealthimaging.org
[1]
The World Health Imaging, Telemedicine and Informatics Alliance (WHITIA) is a non-profit global health
technology and social venture established in 2006 by affiliates of Northwestern University near Chicago, Illinois.
WHITIA cultivates high-level strategic relationships with non-governmental organizations, imaging industry
innovators and academic institutions in order to integrate and deliver meaningful, sustainable, diagnostic technology
to underserved communities worldwide. WHITIAs vision is to facilitate the deployment of thousands of digital
medical imaging systems worldwide, providing one billion people with access to diagnostic imaging. WHITIA was
formerly known as the World Health Imaging Alliance (WHIA) until it formally expanded its scope in June 2009.
WHITIA's first formal public launch was in April 2009 at the Healthcare Information and Management Systems
Society (HIMSS) Annual Conference & Exhibition in Chicago, Illinois. WHITIA announced strategic partners
including SEDECAL, Carestream Health and Merge Healthcare, receiving extensive coverage in Health IT
magazines and publications. At the 2009 Annual Conference of the Society for Imaging Informatics in Medicine
(SIIM) in Charlotte, North Carolina, WHITIA announced its partnership with SIIM, which will allow both
organizations to collaborate on specific initiatives. WHITIA was recently ranked #15 of the top 25 most influential
people, institutions, and organizations in the radiology industry.
At the 2009 RSNA Annual Meeting, WHITIA launched, Remi-d, a remote-operated screening X-ray system for use
in the developing world. Its strengths in these areas stem from the higher burden of Human Immunodeficiency Virus
(HIV) and Tuberculosis (TB) co-infection, high incidences of Black Lung disease, or outbreaks of other infectious
respiratory diseases. The teleradiology and remote-controlled features of Remi-d allow resource-limited areas such
as sub-Saharan Africa, South and Central America and Southeast Asia, where radiologists and technologists are in
short supply to have a functioning X-ray service.
World Health Imaging, Telemedicine, and Informatics Alliance
670
WHITIA currently has pilot integrated digital X-ray sites in South Africa and Guatemala at established clinics in
need and is expanding to new qualified sites in partnership with NGOs such as Rotary International while
cooperating with the local and national governments.
Guatemala clinics
The Guatemala pilot sites in urban Guatemala City and rural Ro Hondo provide essential healthcare technology to
thousands of people in the communities served. They are designed to be models for the wider expansion of the
WHITIA network throughout the clinics in need in urban and rural Guatemala. The system's specific design for
Guatemala City is an integration of some of WHITIA's partners' strengths and generosity:
SEDECAL provides the X-ray generator and controls
Carestream Health donates the computed radiography (CR) digital scanner and plates
Kane X-ray donates personnel to perform installation and set up of the CR and PACS
This project was largely funded by several US and Guatemalan Rotary clubs along with the key resource support of
the Guatemalan municipal and national governments.
References
[1] http:/ / www. worldhealthimaging. org
External links
Official webpage (http:/ / www. worldhealthimaging. org/ )
Video interview with WHITIA staff and overview of mission. Shown at Rotary International Convention 2008
(http:/ / www. youtube. com/ watch?v=sv0q0hD-flM)
671
Publications
List of medical and health informatics journals
This is a list of journals related to medical and health informatics.
Journal of Information Professionals in Health
BMC Medical Informatics and Decision Making
Computers in Biology and Medicine
Health Care and Informatics Review Online
Informatics for Health & Social Care
Journal of the American Medical Informatics Association
Journal of Biomedical Informatics
Journal of Medical Internet Research
Medical & Biological Engineering & Computing
Methods of Information in Medicine
Statistics in Medicine
Journal of Health Informatics in Developing Countries
Online Journal of Public Health Informatics
[1]
Health Informatics Journal
References
[1] http:/ / www. firstmonday. dk/ ojs/ index. php/ ojphi|
Journal of Information Professionals in Health
672
Journal of Information Professionals in Health
ACIMED
Discipline Medicine
Language Spanish
Edited by Jehov Oramas Daz
Publication details
Publisher Centro Nacional de Informacin de Ciencias Mdicas (Cuba)
Publication history 1993present
Open access Yes
Indexing
ISSN
1024-9435
[1]
(print)
1561-2880
[2]
(web)
Links
Journal homepage
[3]
ACIMED (Journal of Information Professionals in Health) is a Spanish language journal of medical informatics
published by the National Center of Information on Medical Sciences in Cuba. It was first published in 1993 and is
the first Spanish language journal to be published on the subject of medical informatics.
References
[1] http:/ / www. worldcat.org/ issn/ 1024-9435
[2] http:/ / www. worldcat.org/ issn/ 1561-2880
[3] http:/ / scielo. sld. cu/ scielo. php?script=sci_serial& pid=1024-9435& lng=en& nrm=iso
Journal of Medical Internet Research
673
Journal of Medical Internet Research
Journal of Medical Internet Research
Abbreviated title (ISO4) J. Med. Internet Res.
Discipline Medicine, eHealth
Language English
Edited by Gunther Eysenbach
Publication details
Publisher JMIR Publications Inc.
Publication history 1999-present
Frequency Upon acceptance (issues aggregated monthly)
Open access Yes
Impact factor
(2010)
4.663
Indexing
ISSN
1438-8871
[1]
LCCN
00252482
[2]
OCLC number
42705591
[3]
Links
Journal homepage
[4]
The Journal of Medical Internet Research is a peer-reviewed open-access medical journal established in 1999
covering eHealth and "healthcare in the Internet age". The editor-in-chief is Gunther Eysenbach. According to the
Journal Citation Reports, the journal has a 2010 impact factor of 4.663, ranking it first out of 22 in the category
"Medical Informatics" and 2nd among 71 journals in the category "Health Care Sciences & Services".
References
[1] http:/ / www. worldcat.org/ issn/ 1438-8871
[2] http:/ / lccn. loc. gov/ 00252482
[3] http:/ / www. worldcat.org/ oclc/ 42705591
[4] http:/ / www. jmir.org
External links
Official website (http:/ / www. jmir. org)
674
National Projects
BeHealth
BeHealth is a Belgian eHealth digital platform which provides digital access to all health information and
applications through one portal site, on behalf of both healthcare providers and patients. BeHealth has been created
on 23 December 2004. It first aim is to interconnect multiple applications from a number of social security actors,
but with the goal to provide broader services over time.
External links
e-Health
[1]
References
[1] https:/ / www. ehealth.fgov.be/
Canada Health Infoway
Canada Health Infoway is an independent, federally funded, not-for-profit organization tasked with accelerating
the development of electronic health records (EHR) across Canada. As a strategic investor, they work with Canadian
provinces and territories with the goal of creating an electronic health record for 50% of Canadians by the end of
2010. Infoways members are Canada's 14 federal, provincial and territorial Deputy Ministers of Health. Infoway's
investments are prioritized toward local, provincial and national projects which align with the Pan-Canadian EHR
Blueprint, itself developed by Infoway. Beyond these strategic investments, Infoway has no mandate to enforce
compliance, as Canadian healthcare is generally governed at the Provincial level.
Development of a network of effective interoperable electronic health record solutions across Canada linking
clinics, hospitals, pharmacies and other points of care is intended to improve access to health care services for
Canadians, enhance their quality of care and make the health care system more efficient.
Projects
Since 2001, Infoway has approved projects
[1]
in the following targeted program areas:
Diagnostic Imaging Systems
[2]
Drug Information Systems
[3]
Infostructure
[4]
Innovation and Adoption
[5]
Interoperable EHR
[6]
Laboratory Information Systems
[7]
Patient Access to Quality Care
[8]
Public Health Surveillance
[9]
Registries
[10]
Telehealth
[11]
Canada Health Infoway
675
Goals
The goal of Canada Health Infoway is to contribute to the development of a network of EHR systems, in order to
enable efficient communication between health care professionals and bringing a deeper understanding of patient
needs. The results of the project may include shorter medical procedure wait times, safer prescriptions and better
access to quality health care, and may dramatically improve health care for Canadians.
Infoway has also recently developed a pan-Canadian electronic health information standard, leveraging the existing
HL7v3 standards.
It is reported that as of December 31, 2008 there were 276 EHR projects under way in Canadian hospitals, other
health-care facilities, pharmacies and laboratories, with an investment value of $1.5-billion from Canada Health
Infoway.
[12]
Auditor General report
A 2009 report by the Auditor General of Canada found that Canada Health Infoway showed "due regard" for
taxpayers' money in its financial management. Canada Health Infoway accepted all recommendations listed in the
report.
Notes
[1] http:/ / www. infoway-inforoute. ca/ lang-en/ about-ehr/ ehr-progress-map
[2] http:/ / www. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ diagnostic-imaging-systems
[3] http:/ / www. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ drug-information-systems
[4] http:/ / www. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ infostructure
[5] http:/ / www. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ innovation-and-adoption
[6] http:/ / www. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ interoperable-ehr
[7] http:/ / www. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ laboratory-information-systems
[8] http:/ / www. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ patient-access-to-quality-care
[9] http:/ / www. infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ public-health-surveillance
[10] http:/ / www.infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ registries
[11] http:/ / www.infoway-inforoute. ca/ lang-en/ about-infoway/ approach/ investment-programs/ telehealth
[12] http:/ / www.theglobeandmail. com/ servlet/ story/ RTGAM. 20080218. wmychart18/ BNStory/ specialScienceandHealth/
External links
Canada Health Infoway (http:/ / www. infoway-inforoute. ca/ )
2009 Auditor General Report (http:/ / www. oag-bvg. gc. ca/ internet/ English/ parl_oag_200911_04_e_33205.
html)
Distance Learning and Telemedicine Grant and Loan Program
676
Distance Learning and Telemedicine Grant and
Loan Program
The Distance Learning and Telemedicine Grant and Loan Program (DLT) is a program authorized by the 1990
farm bill (P.L. 101-624) to provide grants to rural schools and health care providers to help them invest in
telecommunications facilities and equipment to bring educational and medical resources to rural areas where the
services otherwise might be unavailable. The 1996 farm bill (P.L. 104-127) reauthorized and streamlined the
program.
The program was also reauthorized in the 2002 farm bill (P.L. 107-171, Sec. 6203).
DLT is administered by the Rural Utilities Service.
References
This article incorporatespublic domain material from the Congressional Research Service document "Report
for Congress: Agriculture: A Glossary of Terms, Programs, and Laws, 2005 Edition"
[1]
by Jasper Womach.
External links
Distance Learning and Telemedicine Grant and Loan Program
[2]
official website
References
[1] http:/ / ncseonline.org/ nle/ crsreports/ 05jun/ 97-905. pdf
[2] http:/ / www. rurdev.usda.gov/ UTP_DLT.html
EHealth Ontario
677
EHealth Ontario
eHealth Ontario is the agency tasked with facilitating the development of Ontario's proposed public Electronic
Health Record system. Health Informatics in Canada is run provincially, with different provinces creating different
systems, albeit sometimes under voluntary Pan-Canadian guidelines published by the federal body Canada Health
Infoway. eHealth Ontario was created in September 2008 out of a merger between the Ontario Ministry of Health's
electronic health program and the Smart Systems for Health Agency (SSHA), with a mandate to create electronic
health records for all patients in the province by 2015. It has been plagued by delays and its CEO was fired over a
multimillion-dollar contracts scandal in 2009. Today eHealth employs approximately 700 people.
Drug Profile Viewer System
The Drug Profile Viewer System tracks the prescription drug claims information of 2.5 million Ontario Drug Benefit
Program and Trillium Drug Program recipients. This system is in use in hospitals throughout Ontario and access is
being expanded to health care providers outside of the hospital setting.
ePrescribing
eHealth Ontario created a pilot project through which some doctors are now able to electronically send prescriptions
to participating local pharmacies instead of having to manually write down the prescriptions on paper. That pilot
project is ongoing.
Media Attention over Consultant Use and Contracting Practices
In May 2009, there were opposition calls for Ontario Health Minister David Caplan's resignation after it was
revealed that eHealth Ontario CEO Sarah Kramer had approved about $4.8 million in no-bid contracts during the
first four months of the agency's operation, while also spending $50,000 to refurnish her office, and paying
consultants up to $300 an hour. One consultant earned about $192,000 in five months. Additionally, nine senior
eHealth employees had been fired in a four month period, some reportedly for challenging the agency's tendering
practices.
Kramer was later forced to resign in June 2009, amid questions surrounding a $114,000 bonus paid to her. She
received a $317,000 severance package with benefits for 10 months.
eHealth Ontario argued that the no-bid contracts were necessary due to the rapid transition process to eHealth from
its predecessor Smart Systems for Health Agency, while Caplan defended Kramer's bonus as part of her move from
another agency. The opposition argued that the government of Premier Dalton McGuinty spent five years and $647
million on the forerunner of eHealth Ontario: the Smart Systems for Health Agency, which used 15 per cent of its
$225-million annual budget on consultants despite employing 166 people with annual salaries exceeding $100,000,
before the project was shut down and restarted as eHealth Ontario.
In a public statement, Kramer argued that when she took over as CEO of eHealth Ontario, she was charged with
turning around a failing behemoth - SSHA - which had already run through more than $600 million dollars with
hardly anything to show for it in terms of moving Ontario closer to the goal of eHealth, and modernizing and
improving the quality and safety of health care for Ontarians.
Journalists have argued that Sarah Kramer received a trial by media and that the province of Ontario will be at a
loss with her departure, as delivery of eHealth initiatives will be slowed. Marcus Gee from the Globe and Mail
writes, what happened at eHealth may or may not qualify as scandalous. What happened to Ms. Kramer certainly
does. This was media lynching. A good woman and a first-rate civil servant has been hounded from public life, and
all of us will suffer for it.
EHealth Ontario
678
Journalists and former health policy advisors have noted that this media attention detracted from the organizations
mandate and ability to deliver on much needed eHealth initiatives and healthcare reform in the province of Ontario.
One past policy director for a former Ontario Minister of Health, argued that the publics focus should be on holding
the government accountable for mitigating the problems that have resulted and demanding progress on eHealth.
Andre Picard, a Canadian public health reporter, argued that the publics focus should be on the delivery of
electronic health records and not disingenuous tsk-tsking about the hiring of consultants. He writes, the true
scandal in Ontario is the utter failure of the Ministry of Health to create electronic health records, which will
ultimately lead to better and more efficient patient care. Picard argued that Ministry of Health bureaucrats are
powerless when it comes to making real change in healthcare, as their political bosss only vision for healthcare is
not irritating the public so they can be re-elected. The result is change and innovation can, seemingly, only come
from independent agencies or outside consultants.
Two inquiries were launched, but in August 2009, the independent review of eHealth Ontario had been dropped,
with Caplan saying it would duplicate the work of Ontario's auditor general.
On October 6, 2009, David Caplan resigned, one day before the release of the report into spending scandals.
References
External links
Official website (http:/ / www. ehealthontario. on. ca/ )
HealthConnect
HealthConnect has been Australias change management strategy to transition from paper-based and legacy digital
health records towards electronic health records planned system of electronic health records.
The long term goal of the HealthConnect strategy is to deliver better health outcomes through standardised, sharable
clinical information. The "better health outcomes" would translate to improved quality and safety in health care and
disease prevention.
[citation needed]
These would be achieved by ensuring important clinical information is available
and of high quality, when and where it is needed.
Trials were carried out as part of the HealthConnect strategy in various parts of Australia during 2004. These
included an EHR pilot in Brisbane South and a surgical patient information sharing trial at Townsville
Hospital.
[citation needed]
In 2005 trials were conducted in Tasmania at the Launceston General Hospital and across the
Northern Territory. Defunct research consortium Distributed Systems Technology Centre (DSTC) was awarded a
A$2.9 million contractWikipedia:Manual of Style/Dates and numbers#Chronological items to develop technology
for HealthConnect.
[citation needed]
After the first round of trials the vision for HeathConnect was greatly altered. In
2007 a second phase of testing began.
[citation needed]
The NT Health Connect Trial was largely successful and is "the most advanced eHealth implementations of their
kind in Australia in terms of range of services, service coverage and consumer and health professional participation",
according to their website. The project was upgraded and rename "Shared Electronic Health Record". A 2008 review
of SEHR found it to be rated very highly among end users, accelerated rollouts and upgrades continued through 2009
and 2010. Of particular note was the ability for SEHR to achieve an estimated 90% uptake of residents from
participating remote indigenous communities. (In such communities, it is difficult to maintain accurate records. The
2011 Census, for example, had focused action towards remote communities in an attempt to identify the extent of
this problem )
HealthConnect
679
References
External links
"HealthConnect archive site" (http:/ / www. health. gov. au/ internet/ hconnect/ publishing. nsf/ Content/ home).
Department of Health and Aging, Government of Australia. 27 June 2008. Retrieved 22 June 2010.
Health Information Systems Programme
The Health Information Systems Programme (HISP), aims to support the improvement of health care systems in
the southern hemisphere by increasing the capacity of health care workers to make decisions based on accurate
information. HISP provides training and support for users of the open source District Health Information System
(DHIS 2) software, which is under continuous development. The global network of HISP is managed and
coordinated by the Department of Informatics at the University of Oslo.
The project started in post-apartheid South Africa, and has been introduced in a number of countries in Africa and
Asia.
External links
The HISP Network
[1]
Department of Informatics, University of Oslo
[2]
The DHIS 2 software
[3]
HISP South Africa
[4]
HISP India
[5]
References
[1] http:/ / www. hisp.uio. no
[2] http:/ / www. mn. uio.no/ ifi/
[3] http:/ / www. dhis2. org
[4] http:/ / www. hisp.org
[5] http:/ / www. hispindia. org
District Health Information System
680
District Health Information System
DHIS
Developer(s) Health Information Systems Programme
Type Health management information system
License DHIS 1: proprietary
DHIS 2: BSD
Website http:/ / www. dhis2. org/
The District Health Information System (DHIS) is a highly flexible, open-source health management information
system and data warehouse. It is developed by the Health Information Systems Programme (HISP). The core
development activities are managed and coordinated by the Department of Informatics at the University of Oslo, and
supported by The Norwegian Research Council, NORAD, The University of Oslo, and The Norwegian Centre for
International Cooperation in Education.
The solution covers aggregated routine data, semi-permanent data (staffing, equipment, infrastructure, population
estimates), survey/audit data, and certain types of case-based or patient-based data (for instance disease notification
or patient satisfaction surveys). The system supports the capture of data linked to any level in an organisational
hierarchy, any data collection frequency, a high degree of customisation at both the input and output side. It has been
translated into a number of languages.
The DHIS was originally developed for three health districts in Cape Town in 1998-99, but has since spread via the
HISP network to nearly half of sub-Saharan Africa, where its use covers a population of 300-400 million people, and
to a number of countries in Asia. The initial scope - routine monthly Primary Health Center data has systematically
been expanded to cover nearly all aspects of health data and information (excluding electronic health records).
Available aggregated data for South Africa from 19982007, for instance, represent close to one billion patient
encounters.
For electronic health records, DHIS is collaborating with the WHO-backed OpenMRS system.
Releases
DHIS is available in several releases:
DHIS 1.3
DHIS 1.4
DHIS 2.0
DHIS 1.3 and 1.4
The DHIS was developed on the Microsoft Access platform consisting of VBA for the interface or program logic
(front-end), Access as a database (back-end), Excel for reporting and Windows as the OS. DHIS 1.4 is a significant
overhaul of the version 1.3 database structure, using various output formats for reporting. It bridges the gap between
DHIS 1.3 and 2.0.
District Health Information System
681
DHIS 2
DHIS 2 is an open source alternative to the earlier releases. The software development process is a global
collaboration between students, researchers and experienced developers in Norway, India, South Africa, Ethiopia,
Vietnam and Nigeria. The first release, version 2.0, came in February 2008 after three years of development releases.
DHIS 2 is developed using open-source Java frameworks and tools, such as the Spring Framework, Hibernate,
Struts2, Maven, and JUnit.
References
External links
DHIS 2 site (http:/ / dhis2. org)
DHIS 2 on Launchpad (development platform) (https:/ / launchpad. net/ dhis2)
DHIS 2 penetration map and more information about the DHIS 2 project (http:/ / www. hisp. uio. no/ )
DHIS2 translations site (http:/ / translate. dhis2. net)
FLOW
FLOW is a Belgian national health care network, meant for health care providers and patients. It is an acronym
which stands for Facilities (services and related infrastructure), Legal implementation (the telex files), Organisations
(locoregional teams) and Wisdom (coordination and supervision center). The system is built around the principle of a
shared health patient record.
Regions
FLOW Alfa: Wallonia
FLOW Beta: Brussels
FLOW Gamma: Flanders
Source
FLOW
[1]
Note de Politique Generale
[2]
(3 Dec. 2004)
References
[1] http:/ / www. vzwgo. be/ images/ newsflash/ 2000611/ flow%20gamma%20II. pdf
[2] http:/ / www. lachambre. be/ FLWB/ pdf/ 51/ 1371/ 51K1371031. pdf
Health informatics in China
682
Health informatics in China
Health informatics in China (Chinese: ) is about the Health informatics or Medical informatics or
Healthcare information system/technology in China.
The main review and assessment of health informatics in China
[1]
for the WHO-Health Metrics Network was
conducted in 2006 which details Provincial assessments, developing strategic plan outline, improving community
health monitoring system, household surveys, routine health statistics system.
Due to the Health Informatization Development Plan
[2]
, all hospitals are required to increase investment in building
digitized hospitals. This requirement is expected to accelerate the growth of China's HIT market by about 25 to 30%
a year during 2006-2010.
[3]
By the end of 2006, Chinas investment in its healthcare information systems (HIS) had increased by nearly 16
percent to RMB 5.8 billion, year-on-year. This amount accounts for approximately 0.5% of the countrys total
healthcare expenditures of RMB 866 billion during the same period.
The market size is expected to expand to approximately RMB 15 billion in 2010. The development of Chinas HIT
industry is generally considered to be at a preliminary stage, resembling that of western countries 20 years ago.
However, as China learns more about available and emerging technologies, it now has the opportunity to leapfrog
ahead.
Healthcare overview
Expenditure
China spent $97 billion, or 5.6% of its GDP, on healthcare in 2004. As previously stated, public spending on
healthcare remains low; public spending in 2004 accounted for only 17% of total healthcare expenditure while
out-of-pocket expenses reached 53.6%.
Coverage
About 130 million people are covered under the National Social Insurance Program for Urban Employees, a program
established in 2005. Another 50 million people are covered through government insurance. Yet less than 30% of the
Chinas population has medical insurance. Indeed, over 40% of the urban population and 57% of people in rural
areas have no coverage at all.
Infrastructure
China's current healthcare system is primarily composed of large public hospitals, supplemented by a small number
of private, for-profit hospitals. As of 2005, there were 18,703 hospitals in China. Among them, 2,027 were private
hospitals (10.83%). Chinese hospitals can be divided into three categories: general hospitals (70%), traditional
Chinese medicine (TCM) hospitals (14%), and specialty hospitals (16%).
In addition, China has 5,895 outpatient facilities: 1,266 outpatient facilities and 541 traditional medicine facilities.
As of 2005 China had 1,938,272 registered doctors who are primarily employed by hospitals.
Health informatics in China
683
History
Economic reforms in the early 1980s resulted in major changes in China's healthcare system, especially as a result of
the dismantling of the rural cooperative medical system. After being given considerable financial independence,
hospitals began to generate the majority of their income through user fees, a practice that continues today. Healthcare
is now provided on a fee-for-service basis. The pricing structure attempts to facilitate equity by providing basic care
below cost, with profits reaped through the (often excessive) sale of drugs and high-technology services; this
structure leads to inefficiency and inappropriate patient care. Healthcare insurance coverage in China is low, with
less than 30% of the population receiving any medical insurance.
China's health information technology HIT development has a brief history. Development commenced in the
mid-1990s with financial management systems; only in the last five years or so have clinical systems been
implemented. China has made progress in a relatively short time period, but weak application software and a scarcity
of implementation skills delay further progress. Most Chinese hospitals are attempting to dramatically improve and
extensively digitize their work processes in the near future.
Project on Construction of National Public Health Information System
The work group of the Ministry of Health for information construction has drafted the Project on Construction of
National Public Health Information System. The "Project" confirmed the guideline, objectives and principles of
public health information system construction, proposed framework for further actions. On September 17, 2003,
information construction workgroup of the Ministry of Health held a Meeting via television and telephone on
construction of public health information system in China. The agenda included a work report in the field of
information construction of the Ministry of Health, the introduction of Construction Project of the National Public
Health Information System (Draft) and a report from the National Center of Disease Control on relevant
requirements of SARS report system via network.
[4]
Mortality statistics
As part of a major revamp of its health information system, China is merging two systems for collecting mortality
data to gain a more accurate picture of how many people die and why. Cause-of-death data are playing an
increasingly important role in the public health policy of China. Recently, CDC
[5]
took part in a research project led
by the Center for Statistics of the Ministry of Health on the disease burden and long-term health problems in China;
the results were dramatic.
[6]
HIT Adoption
Health information technology is now entering its second software generation in China, and IT usage in hospitals
resembles that of the late 1970s in the United States. Most hospitals in China incorporate IT software into their
payment and billing systems, and many have also begun integrating IT into clinical systems in the past five years.
The use of IT in clinical systems has emerged on a departmental basis. As a result of inexperience with IT
infrastructure, however, hospitals have encountered several obstacles. Fragmentation, duplicative systems, and poor
integration between diverse software systems have created "information islands" that impede data sharing.
Three valuable lessons are evident from China's HIT development over the past ten years:
Medical information should be integrated across all departments in the hospital. Poor integration of diverse
software systems within hospitals impedes inter-hospital information exchanges and creates problems as IT use
expands.
In order for IT systems to benefit clinical services and hospital management, effective overall IT planning is
necessary. Oversimplification of IT planning and a lack of clinician engagement have in the recent past led to
poor return on investment (ROI) in HIT.
Health informatics in China
684
Implementation requires not only strong project-management skills but also attention to end-user requirements
and needs as well as to work processes re-engineering. Poor implementation has resulted in a large amount of
work-process redundancy.
Government policy
The Chinese government adopted an "informatization" approach in the 1990s, promoting IT development in all
major industries, including the health sector, with one goal being to bridge the information divide. HIT policy began
in 1995 with the "Golden Health Project," which sought to create the foundation for electronically linking health
administration departments and hospitals as well as medical education and research institutes. Government efforts in
the 21st century increasingly focus on health IT. For example, the 20032010 Ministry of Health Guidelines for HIT
Development in China call for the introduction of EHRs and regional health information networks to be
implemented throughout the country. Many hospitals are considering system-wide upgrades, and larger budgets are
more readily available for these kinds of investments.
Organizations
The Ministry of Health within the government and independent hospital administrators are the primary drivers of
HIT adoption in China. Following the SARS epidemic, the Chinese government realized the importance of
integrating an effective IT infrastructure into the country's health system. Additionally, after a decade of small
investments in IT systems hospital leaders have become aware that IT can improve work processes and increase
management efficiency.
Many other associations involved in HIT exist in China, including the
National Medical Information Education
[7]
(NMIE),
Association of Chinese Health Informatics,
Chinese Health Information Association, and
Chinese Hospital Information Management Association
[8]
(CHIMA). CHIMA is a branch of the Chinese
Hospital Association, a nonprofit national industry and academic association focused on Health IT (similar to the
AMIA in the United States).
Funding
Provincial and local governments in China are the primary funders for regional health information networks and HIT
in public hospitals. The national government facilitates investigation of standards and IT infrastructure development.
Hospitals invest their own funds into clinical and institutional HIT systems. As of 2006, China spends a little over
0.7% ($700 million) of its national health budget on HIT. Of these funds: 70% goes toward hardware, 20% toward
software, and 10% toward services.
Planning
Spending on healthcare in China will grow dramatically over the next five years, potentially rising to 7% of GDP.
HIT spending in China will likely grow even faster, with China's national goal to create EHR and regional health
information networks throughout China. Major IT upgrades are now being considered in many hospitals. The focus
of future HIT development in China includes the following:
electronic health records
regional health information networks to share electronic health data
better integration of diverse systems within individual hospitals, including agreement upon standards to support
IT progress, and better management of change so that the new IT systems will make Chinese hospitals operate
more efficiently. In order to accomplish these objectives over the next several years, hospitals will involve experts
for IT planning and implementation of the new systems.
Health informatics in China
685
Challenges
Issue Description
Chinese software in its
infancy
Chinese hospital application software currently has limited capabilities, and Chinese software
vendors are not as experienced in healthcare applications as foreign vendors. Proven products for
clinical information systems do not yet exist.
Lack of skilled HIT
professionals
Skilled workers with IT and healthcare and hospital management knowledge are lacking in China.
Lack of strong change
management expertise
Strong change-management expertise is missing in China. The great challenge facing many
Chinese hospitals is that they have limited experience to manage the changes after implementing
major IT systems. Thus, many hospital leaders are hesitant to increase IT investment.
Shenzhen Regional
Health Information
Network (RHIN)
The Chinese government established as a national goal the implementation of a series of RHINs
supported by digital hospitals throughout the country by 2010. The Ministry of Health selected the
city of Shenzhen as a pilot site for the development of these RHINs.
Chinese CDC
surveillance system
Responding to a request by the Ministry of Health in 2003, the Chinese CDC created a national
web-based surveillance system for 37 communicable diseases to receive direct reporting from the
majority of hospitals at the county level and above and from more than half of hospitals and
clinics at the township level.
Lack of strong change
management expertise
Shenzhen will support this RHIN by digitizing all of its hospitals, thus creating more efficient
work processes and better management systems to improve healthcare delivery. The Ministry of
Health hopes that the Shenzhen RHIN will become a model of what can be done in all across
China.
Hospital information system
Progress of hospital information system (HIS) in China has made significant progress in recent years. HIS has
played a very important role in hospital, and the construction and employment of HIS can improve the efficiency and
quality of healthcare work. But the development of HIS in China is unbalanced and there are many problems such as
nonstandard hospital management, poor standardization, and lack of consolidation of software development. As a
consequence, the current HIS is not able to meet the needs of reform in China's healthcare system. In the future, for
the sake of medical information sharing, telemedicine, hospital efficiency enhancement, integration needs to be
realized.
In recent years, Hospital Information System (HIS) has been developed in several areas. Many hospitals have
constructed HIS. According to the Ministry of Health in 2004, there were 6,063 hospitals out of 15,924 that had
established hospital information systems.
[9]
It is estimated that about 70% of county-level hospitals and above have
constructed HIS by mid-2007.
In 2004, the total cost for information technology (IT) in health sector was estimated at approximately RMB 3.5
billions (US$423.5 million), which increased 25% compared with 2003. Most of the resources were committed to
HIS. Construction of HIS has taken good effect, which changed the style of hospital management, offered
tremendous opportunities to reduce clinical errors (e.g. medication errors, diagnostic errors), to support health care
professionals (e.g. availability of timely, up-to-date patient information), to increase the efficiency of care (e.g. less
waiting times for patients), or even to improve the quality of patient care.
[10]
Today, HIS is not only a symbol of
modern management, but also one of core competence of a hospital.
Nowadays, with reform in healthcare system and the entry into WTO, HISs is confronting many challenges in China.
Medical domain will develop into standardization and internationalization, which stimulate different grade hospitals
and many related organizations (e.g. insurance agents, finance organizations, community station), into a big integer.
But the forepart HIS didn't consider medical information standards, and can't share medical information.
Health informatics in China
686
Current status
Computers began to be used in hospitals in China in 1970s, but used as hospital information management since
1984. According to the contents, styles and scopes, HIS in China experienced four phases.
[11]
They are as follows:
(1) Stand-alone. Mostly used in out-patients charge, in-patient charge and drug warehouse management during the
late 1970s and early 1980s.
(2) Department local area network. Representative applications are inpatient management; outpatient charge and
drug deliver system, and drug management system.
(3) Integrity of hospital information system. Many big hospital constructed integrity hospital information system on
ethernet over 100m since early 1990s.
(4) Telemedicine. With the development of IT and network, many big hospitals commenced to study implement
telemedicine, through which the diagnostic digital images such as CT scans, MRIs and ultrasound CT can be
transmitted.
The first three phases focus on hospital information management and the fourth phase patient-centered.
In general, construction of HIS in China has made significant progress since the 1990s. According to some sample
investigation about HIS, there are many characters as follows: the development of HIS are imbalanced, the
differences among different regions are very significant. In more developed regions, the proportion of hospitals with
HIS is high, and the level of HIS is also high, most of them are in the third phase, and a few hospitals are in fourth
phase.
In fact, the HIS in many hospitals is no worse than that in advanced foreign hospitals. On the other hand, the level of
HIS in developing regions is low, the proportion of hospitals with HIS is also low, and most of them are in the
second phase. But the potential market of HIS is very good. By 2004, the proportion of hospitals with HIS in East
China was above 80%, whereas, it was less than 20% in Northwest China.
"No. 1 Military Project"
"No. 1 Military Project" was important in China's HIS development. This project is a hospital information system
consisting of over 30 basic subsystems. It was developed by General Logistics Department of PLA collaborating
with Hewlett-Packard in 1997. The project has achieved success and improved the development of health
informatics in China. So far, over 200 hospitals have adopted this system. This kind of HIS has become a succeeded
and advanced representative one in China. The HIS of "No. 1 Military Project" was applied in Xiaotangshan hospital
during the outbreak of SARS in 2003. The patients suffered SARS were treated and the system played an important
role and was praised highly by specialists.
Although construction of HIS has achieved greatly, yet most HIS concentrates more on the fiscal operations of a
hospital and the administrative aspects. Only 10% of hospitals with HIS have developed patient-centered Clinical
Information System, while 5% are constructing Picture Archiving and Communication System.
Main problems
Although there has been good progress during last two decades, especially during last 10 years, there have been
many problems which limit further progress. The main problems are as follows.
1. Lack of Standardization/Interoperability
Hospital information relate to medical treatment, education, medical research, personnel, money, and substance, et
al. Unification of the titles, the concept, the classification and the codes are the basic precondition for information
interchange. But the most difficulty is that the standards are not unified. For example, the titles and codes of the case
reports, drugs, personnel, equipment, inspection and examination differ in different hospitals. The definition,
description and practice operation for the same thing are different. Owing to without unified and authoritative
Health informatics in China
687
hospital standardization data dictionaries, as well as different HIS developed by different companies with different
codes and standards, two bad results come into being. The first one is that every hospital has to develop consumer
dictionary, which result in tremendous waste of personnel, money, substance and time. The second one is that
standards and user dictionaries are established differently, which affect the unit into the internet and can't share
information. As discussed in the previous section, the HIS of "Np. 1 Military Project" was excellent. Even though,
there are many problems in standardization. Results from some researchers investigation revealed that 99 code
tables should be consistent, but there are only 31 are consistent. Even worse, 27 codes in 27 military hospitals have
27 formats.
[12]
Using message standards, including the Health Level 7 (HL7), is the precondition to ensure
interoperability between different hospitals systems. However most hospitals havent considered this problem and
few HIS apply HL7. Only in some developed regions, such as Guangdong province, the governments require that
developers of HIS must adopt or refer to HL7 standard to transmit patient clinical information. The reform in
Chinese healthcare system requires different grade hospitals and many related organizations, such as insurance
agents, finance organizations, community station, can share and interoperate in-patients information. But the poor
information standardization in HIS cant meet the need.
2. Unified Layout of Software Systems
HIS developments began to accelerate since the early 1990s. All level of health administrations, hospitals and some
information development companies invested huge personnel and money into HIS developing. Especially in
developed regions such as Beijing, Shanghai, Guangdong, Shandong, Jiangsu, the HIS achieved success and have
larger scale. Yet the reasons those without plans as a whole and control for HIS by the related health administrations,
without standards to comply with and without surveillance by some related administrations lead to non-normative
HIS developing processes. These are two poor results. The first one is that HIS were developed free, the software
had no standards, the developed platform therefore varied. The second problem is that the HIS develop companies
were in different levels, and many of them didnt specialize in HIS develop, they were not familiar with the style of
hospital management and workflows, or they only knew some specific hospitals. Furthermore, some companies have
the idea of eager for quick success and instant benefit, and only considered the current benefits without long term
investment. Some companies even thought that HIS market had potential, so they made some simple system
packages together, and took some measures to deceive the users. All above brought severe negative influence to HIS
development.
[13]
3. Models of Hospital Management
The models of hospitals management have major influences on HIS construction. HIS implementation requires both
technical structural and behavioral sense, and development of HIS should be carried out within the context of the
development itself.
[14]
Application with HIS but without studying and absorbing has become one bottle neck for HIS
development. Compared with hospitals' directors with MBA diploma in developed countries, who manage the
hospitals, most of hospitals directors in China are good medicine experts, however, they arent familiar with
modernization management. They have experience in management methods, but didnt know normative and science
management. When constructing HIS in their hospitals, they usually requested the HIS accommodate with their
existing management modes in spite of their management modes were nonscientific and unreasonable. Besides the
complexity of hospitals management, workflows and circumstances in different hospitals differ very much. To meet
the need of the hospitals management, the developers had to act according to actual circumstance, which lead to the
HISs cant meet the need of information communication and share because of low currency and commercialization.
Good HIS should optimize hospital process, but in many Chinese hospitals, this was not the case, poor hospital
process flow compromises the good HIS.
Health informatics in China
688
National standardization priorities
There are many problems in HIS construction in China, among which interoperability is one of the most important.
The absence of universal and consistent standards for managing and exchanging clinical and administrative
information has been identified as bottleneck to utilize and improve the HIS. Therefore, one of priorities in national
standardization actions is to accelerate the development of essential standards for HIS. In fact, after several years of
running information systems, health providers recognized that standards were the basis for the information sharing
and interoperability. The government of China also realized this problem and has taken efforts to construct the health
information platform and network. One hypothesis is that because standardization for health informatics is an
authoritative field, in which market mechanism does not work. Also, due to misalignment of incentives, often
providers who invest in standardization cannot gain benefit directly, therefore they might prefer to invest in network
than in standardization. The government may play a role to stimulate adoption by setting standards. In fact, the
government had indeed taken measures to enforce the construction of standardization. In 2003, Ministry of Health
released the Development Layout of National Health Informatics (20032010).
[15]
The layout indicates one of principles of standardization for health informatics: combining adoption of international
standards and development of national standards. In the late 2003, the Leading Group for Health Informatics in the
Ministry of Health started three projects to solve the problem of lacking health informatics standards, including
Chinese National Health Information Framework and Standardization, Basic Data Set Standards of Public Health
and Basic Data Set Standardization of Hospital System (CBDSS). CBDSS is one important project of the medical
information standardization programs, which would improve information progress of hospital and the whole health
system. Chinese Hospital Information Management Association
[8]
(CHIMA) undertook the task of CBDSS project
.The goal of this project is to produce a set of data set standards, which is necessary for HIS. By now, most of this
project is completed, 11 subgroups and 1 shared group CBDSS came into being.
[16]
Since 2003, the government had
launched over ten projects related health standardization in succession, and substantial progress was made in
standardization of medical information.
Dependency theory
At present, the majority HISs running in China are Hospital Management Information Systems (HIMIS), and they
are not able to share medical images diagnostic information due to the various standards and formats adopted by
different manufactures. Now there are HIS, Radiology Information System (RIS), Laboratory Information System
(LIS) and Picture Archiving and Communication System (PACS) in many bigger hospitals, each system run
independently in most hospitals. With the development of health researches and health standardization, this problem
can be solved with HIS.
[17]
In the future, for the sake of medical information sharing, telemedicine, hospital
efficiency enhancement, medical service extension, optimizing the working procedure,
[18]
HIMIS will develop into
patient-centered HIS, all the independent systems including the electronic patient record will realize integration.
Furthermore HIS will shift from supporting health care professionals to patients and consumers, from
institution-centered to regional and global health information system with new and strongly extended functionalities
and tasks.
[19]
International cooperation
SGER: Transnational Public Health Informatics Research: US-China Collaboration
This public health informatics Small Grant for Exploratory Research is a small-scale, exploratory, high-risk proposal
that is potentially transformative in its research collaborations between the US and China. The proposal team is
building on the momentum gained from two US-China public health informatics workshops held in Beijing in March
2008. New partnerships are expected to emerge. The outcomes have the potential to transform approaches to public
health informatics, not only in US and China, but potentially across the globe, in particular in exploring transnational
Health informatics in China
689
social networks and taking advantage of the kinds of data collection and integration methodologies and technologies
employed by the two countries' public health agencies. It affords the opportunity to provide new and longer-term
research and educational programs between US and Chinese institutions and practitioners.
[20]
References
Footnotes
[1] review and assessment of health informatics in China (http:/ / www. who. int/ healthmetrics/ library/ countries/ hmn_chn_his_2007_en. pdf)
[2] http:/ / www. acsi. gov.cn/ en/
[3] unpan1.un.org (http:/ / unpan1. un. org/ intradoc/ groups/ public/ documents/ APCITY/ UNPAN025040. pdf)
[4] www.chinafdc-law.com (http:/ / www.chinafdc-law.com/ news/ detail_32. html)
[5] CDC (http:/ / www.chinacdc. net. cn)
[6] www.scielosp.org (http:/ / www. scielosp. org/ scielo.php?script=sci_arttext& pid=S0042-96862006000300007)
[7] http:/ / www. nmie. org.cn/
[8] http:/ / www. chima. org.cn/
[9] Zhang, Y.H., Xu, Y., Shang, L., et al. An Investigation into Health Information and Related Standards in China. [online]. Int J Med Inf.
ScienceDirect Ltd. [2006-07-18]. http:/ / www.sciencedirect. com/ science?_ob=MImg& _=B6T7S-4K7FJR9-1
-3&_cdi=5066&_user=1491948&_orig=search&_coverDate=06%2F21%2F2006&_sk=999999999&view=c&wchp=dGLbVzb-zSkzS&md5=734fbcd03e2fd1b5109ca6818e4e72c1&ie=/sdarticle.pdf.
[10] [10] Ammenwerth, E., Graber, S., Herrmann, G., et al. Evaluation of Health Information Systems- problems and Challenges. Int J Med Inf, 2003,
71(2-3): 125-135.
[11] [11] Yu, G.Y. Established and Application of "No. 1 Military Project". Hosp Admin J Chin PLA, 2000, 7(6): 402-404.
[12] [12] Gao, X.P., Xu, Y.Y., Liu, D.H. Investigation and Analyses of Problems in Standardization of "NO.1 Military Project". Hosp Admin J Chin
PLA, 2005, 12(1): 86-87.
[13] Wang, N. & Hu, W. Problems and Solution for Domestic HISs Standardization .Chin Hosp Manage, 2005, 25(10): 37-39.
[14] [14] Ball, M.J. Hospital Information Systems: Perspectives on Problems and Prospect, 1979 and 2002. Int J Med Inf, 2003, 69(2-3): 83-89.
[15] Ministry of Health of Peoples Republic of China. The Development Layout of National Health Informatics (2003-2010). [online]. Beijing.
[2005-05-26]. http:/ / www.moh. gov.cn/ uploadfile/ 200406/ 2004629144259379. doc.
[16] [16] Li, B.L., Ma, L., Liang, M.H. Standard of Basic Information Database for Hospital Information System in China. Chin Hosp, 2005, 9(7):
12-14.
[17] Chang, Z.J., Mei, S., Gu, Z., et al. Realization of Integration and Working Procedure on Digital Hospital in Formation System. Computer
Standards & Interfaces, 2003, 25(5): 529-537.
[18] [18] Toussaint, P.J., Lodder, H. Component-based Development for Supporting Workflows in Hospitals. Int J Med Inf, 1998, 52(1-3): 53-60.
[19] Haux, R. Health Information Systems Past, Present, Future. Int J Med Inf, 2006, 75(3-4): 268-281.
[20] http:/ / www.nsf. gov/ awardsearch/ showAward. do?AwardNumber=0839990
Further reading
Zhang Y, Xu Y, Shang L, Rao K. "An investigation into health informatics and related standards in China." Int J
Med Inform. 2007 Aug;76(8):614-20. Epub 2006 Jun 21.
M. X. Wu, P. Yu, J Soar. "The Current Status of Health Informatics Higher Education in China." Health
Informatics Journal, Vol. 9, No. 4, 211-223 (2003)
E . Ammenwerth, J . Brender, P . Nyknen, H . Prokosch, M . Rigby, J . Talmon. Visions and strategies to
improve evaluation of health information systems. Reflections and lessons based on the HIS-EVAL workshop in
Innsbruck. International Journal of Medical Informatics, Volume 73, Issue 6, Pages 479 - 491
Liming Lee. "The Current State of Public Health in China." Annual Review of Public Health. Vol. 25: 327-339
(April 2004)
Informatics in clinical practice in developing countries: still early days (http:/ / bmj. bmjjournals. com/ cgi/
reprint/ 319/ 7220/ 1297. pdf). S Arunachalam - British Medical Journal, 1999
H . Liang, Y . Xue. Investigating public health emergency response information system initiatives in China.
International Journal of Medical Informatics, Volume 73, Issue 9 - 10, Pages 675 - 685
Lange, A. (1998). Health informatics in China: Skipping steps on the way to the EPR. Proceedings of the 6th
National Health Informatics Conference. Brisbane: 55.
Health informatics in China
690
Lange, A. (1998). HIM in China makes great progress. Advance for Health Information Professionals 8: 18 and
90.
M . Jaspers, E . Ammenwerth, W . Ter Burg, F . Kaiser, R . Haux. An international course on strategic
information management for medical informatics students: international perspectives and evaluation .
International Journal of Medical Informatics, Volume 73, Issue 11 - 12, Pages 807 - 815
M . Diomidus, J . Mantas. Assessing the progress of the M.Sc. course in health informatics under the ERASMUS
programme . International Journal of Medical Informatics, Volume 50, Issue 1 - 3, Pages 159 - 163
Callen JL. (2003). From Shanghai to Guangzhou: interest in health information management from China
Report. Health Information Management. 31(4): 28.
Application of VPN technique in the construction of public health information system (http:/ / www. springerlink.
com/ content/ 99287706k3q5nt29/ ) Volume 25, Number 5 / September, 2005
Standardizing basic data set in public health information system (http:/ / lib. bioinfo. pl/ pmid:18206003)
Zhonghua Yu Fang Yi Xue Za Zhi. 2007 Sep ;41 (5):353-6 18206003 (P,S,G,E,B)
Impact of implementation of Integrated Management of Childhood Illness on improvement of health system in
China. (http:/ / pt. wkhealth. com/ pt/ re/ jpch/ abstract. 00002208-200710000-00007.
htm;jsessionid=JQYN1cn1tpt0Qhh2TMpYVSpywZpFbyZNjvLJsVHhDnhBL42NdnYm!-749683226!181195629!8091!-1)
Journal of Paediatrics & Child Health. 43(10):681-685, October 2007.
A handheld wireless medical information system (http:/ / ieeexplore. ieee. org/ xpl/ freeabs_all. jsp?tp=&
arnumber=4570531& isnumber=4570483) Zhelong Wang Linbin Shi Sch. of Electron. & Inf. Eng., Dalian Univ.
of Technol., Dalian;
A Wireless Medical Information Query System Based on Unstructured Supplementary Service Data (USSD)
(http:/ / www. liebertonline. com/ doi/ abs/ 10. 1089/ tmj. 2007. 0069) Zhelong Wang, Hong Gu, Dewei Zhao,
Weiming Wang. Telemedicine and e-Health. June 1, 2008, 14(5): 454-460. doi: 10.1089/tmj.2007.0069 (http:/ /
dx. doi. org/ 10. 1089/ tmj. 2007. 0069).
Web-based infectious disease reporting using XML forms. (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 18060833)
Int J Med Inform. 2008 Sep;77(9):630-40. Epub 2007 Dec 3.
Enhancement of CLAIM (Clinical Accounting Information) for a Localized Chinese Version (http:/ / portal. acm.
org/ citation. cfm?id=1081812)
Integration of Hospital Information Systems in China (http:/ / ideas. repec. org/ a/ wsi/ nmncxx/
v03y2007i01p135-151. html)
Hospital Information System (HIS) (http:/ / denquelle. com/ pdf/ HIS-Fin-CN. pdf)
China Hospital Information System (HIS) (http:/ / www. cisco. com/ web/ CN/ aboutcisco/ success_story/ pdf/ bb.
pdf)
The Architecture of Enterprise Hospital Information System (http:/ / ieeexplore. ieee. org/ Xplore/ login. jsp?url=/
iel5/ 10755/ 33900/ 01616106. pdf?temp=x)
A Web-Based and Integrated Hospital Information System (http:/ / portal. acm. org/ citation. cfm?id=1053726.
1054335)
(http:/ / www. agfa. com/ en/ he/ news_events/ news/ archive/ he20060809_shenyang. jsp)
(http:/ / www. ehealtheurope. net/ news/ 3848/ agfa_to_expand_chinese_pacs/ ris_deal)
Health informatics in China
691
Journals
Journal of Medical Informatics (http:/ / www. cnki. com. cn/ Journal/
E-ED-YXQB-2007-06. htm)
Chinese Journal of Health Informatics and Management (http:/ / zgwsxxglzz. periodicals. net. cn/ default. html)
International Journal of Software and Informatics
Journal of Health Informatics in Developing Countries (http:/ / jhidc. org)
External links
China Hospital Information Management Association (http:/ / www. chima. org. cn)
CMIA China Medical Informatics Association (http:/ / www. cmia. info)
China HIS (http:/ / www. china-his. com)
China National Institute of Standardization (http:/ / www. cnis. gov. cn/ )
Chinese Health Information Standardization Society CHISS (http:/ / www. chiss. org. cn/ )
Chinese LOINC Interface System (http:/ / www. chiss. org. cn/ documents/ gwyj/ CLISOL/ Search_Keywords.
asp) - a pilot project that aims to show a simplified Chinese version of LOINC terms.
National Medical Information Education (http:/ / www. nmie. org. cn)
Department of Medical Informatics (http:/ / medinfo. bjmu. edu. cn/ ) - Peking University
Chinese Medical & Biological Information (http:/ / cmbi. bjmu. edu. cn/ default_en. htm)
EVIPNet Beijing (http:/ / evipnet. b19. 99to. com/ bj_home. html)
Courses
"Medical informatics" (http:/ / www. miforum. net/ mi/ index. htm)
HL7
Health Level Seven (HL7) (http:/ / www. hl7china. com. cn/ )
PACS
PACS Development in China and the Component PACS System (http:/ / www. public. iastate. edu/ ~baojie/ pub/
2001-01-23_pacs. pdf)
Picture archiving and communication system (PACS) in China: Current trends and future directions (http:/ /
www. biij. org/ 2007/ 1/ e12/ abstract. asp?ID=182)
Other
Dorenfest China Healthcare Group (http:/ / www. dorenfest. com/ ASP/ default. asp)
Chinese health experts look at NHS knowledge management (http:/ / www. bjhcim. co. uk/ news/ 2008/ n804034.
htm) April 2008
International conference on Emergency Health Response Systems (http:/ / www. eu-china-infso. org/ events/
events150340@2007-06-11. html)
Information standards regulation and training (http:/ / www. eu-china-infso. org/ events/
events095137@2007-11-21. html)
Some Perspectives on Affordable Healthcare Systems in China (http:/ / ieeexplore. ieee. org/ xpl/ freeabs_all.
jsp?tp=& arnumber=4353757& isnumber=4352185)
Health informatics (http:/ / www. trp. hku. hk/ tif/ papers/ 2005/ apr/ briefing_050407. pdf) Telecoms Infotech
Forum in Hong Kong
Health informatics in China
692
IEEEP2407 Standard for Personalised Health Informatics (PHI) (http:/ / www. ieee2407. org/ files/ /
ws01_zelin_li. doc)
Priorities and Strategies for Health Information System Development in China - How Provincial Health
Information Systems Support Regional Health Planning (2004) (http:/ / en. scientificcommons. org/ 35890010)
Yang, Hui
CEIBS Hosts 3rd Annual China Health-Care Management Forum (http:/ / portal. acm. org/ citation.
cfm?id=1391398& jmp=cit& coll=& dl=)
NHS Direct
NHS Direct is the health advice and information service provided by the National Health Service (NHS) for
residents and visitors in England, with advice offered 24 hours a day, every day of the year through telephone
contact on the national non-geographic 0845 46 47 number, web based symptom checkers at www.nhsdirect.nhs.uk
[1]
and via mobile, both as apps for iPhone and Android smart phones and a mobile website. As a part of the National
Health Service, NHS Direct services are free, although the 0845 number is usually chargeable as a non-geographic
number. Some landline providers allow 0845 calls within "inclusive" minutes. The website remains free, including
call backs.
Users of the service, through whichever channel, are asked questions about their symptoms or problem. Common
problems are often given simple self care advice, which they can follow thereby avoiding an expensive visit to a
health care professional. More complex problems are assessed by a nurse and can then be given treatment advice or
referred on to another service within the NHS.
As well as these core services, NHS Direct provides a number of commissioned services throughout the NHS, such
as specialised support for patients with long term conditions, access to GP and dental healthcare out of hours, and a
professional response system for times of public health anxiety.
NHS Direct only provides its service for residents and visitors in England, and there are corresponding public
services covering Scotland (NHS 24) and Wales (NHS Direct Wales). Northern Ireland does not have such a service.
In August 2010, the BBC reported that David Cameron's coalition government was planning to scrap the NHS Direct
0845 46 47 helpline telephone service in favour of the cheaper NHS 111 number. This intention was set out in the
white paper, but was portrayed in the media as a leak by the Conservative Health Secretary Andrew Lansley.
[2]
Health and symptomatic advice
NHS Direct's core service is the provision of health advice to the public through the national telephone service or
through digital channels including the website.
Telephone service
In England and Wales, the NHS Direct telephone service is available on 0845 46 47 and is run by a specially trained
team of information handlers and healthcare professionals, including nurses and dental nurses. The service is
equipped to deal with a huge range of health enquiries, from symptomatic queries that require assessment and
treatment, to requests for local healthcare services and healthy living advice.
Every person that calls NHS Direct feeling unwell is assessed to establish the severity of their symptoms, so as to
re-route any urgent or life-threatening situations to the emergency services as quickly as possible.
Other symptomatic callers are able to speak to a nurse, who will ask about their condition in order to recommend the
best course of action. This could be giving advice about treating the problem at home, suggesting a visit to a
pharmacist, or advising an appointment with their GP, which, if in the out of hours period (when the GP surgeries are
NHS Direct
693
closed), can possibly be arranged over the phone.
As many callers are advised to look after their symptoms at home without seeing their GP, the NHS Direct telephone
service reduces the demand on NHS resources and helps to avoid unnecessary trips to the doctor, dentist and
accident and emergency department.
The NHS Direct telephone service also provides a confidential interpreter service in many different languages, which
can be accessed by stating the language required when the call is answered. For those who are deaf or hard of
hearing, there is a textphone service available on 0845 606 4647.
Website
The NHS Direct website can be found at www.nhsdirect.nhs.uk
[1]
, and has a variety of symptom checkers, based on
the same system used on the telephone service and can either give self care advice or direct a user to another NHS
service. For more complex queries, the symptom checkers allow the user to receive a call back from a nurse or to
take part in a webchat for further information and help.
All NHS Direct health advice and information on the website passes through a rigorous clinical check by medical
professionals before it is published.
[3]
Non-urgent health queries can be submitted to the NHS Direct online enquiry service and the website also offers a
confidential webchat service for those needing advice about unprotected sex or emergency contraception.
Mobile services
NHS Direct offers its full range of symptom checkers optimised for mobile devices on its mobile website
[4]
and has
also launched stand alone 'apps' for iPhone and Android smart phones, both available in the normal app stores.
Other services
Digital television channel
NHS Direct provided an interactive TV service via Sky Interactive until 31 March 2009, when the service was
closed.
[5]
The Freeview service, on channel 100 is now hosted by NHS Choices [6].
The digital television service contained condensed versions of many of the most common and popular health
encyclopaedia topics and common health questions.
Commissioned services
Although it is not well known, NHS Direct supplies a multitude of additional commissioned services within the
NHS.
NHS Direct supports many local health authorities in England, including Primary Care Trusts (PCTs), helping them
to deliver the best possible standards of healthcare to people in each region.
These services range from dedicated projects in particular areas, such as the local telephone helpline set up for
Sandwell PCT after a dental health scare, to schemes that are developed nationwide. These include a
telephone-based pre and post operative assessment for patients having surgery, and allocating care managers to give
regular coaching and advice to those with long term conditions, such as diabetes and cardiovascular disease.
NHS Direct
694
History and background
NHS Direct was launched in 1998 after the government identified a need for a telephone health advice line staffed by
nurses as part of its plans to modernise the NHS.
[7]
The aim of NHS Direct, as stated by the government in the NHS White Paper, The New NHS, was "to provide people
at home with easier and faster advice and information about health, illness, and the NHS, so that they are better able
to care for themselves and their families".
[8]
The NHS Direct telephone service began taking calls in three contact centres in Lancashire, Northumbria and Milton
Keynes in March 1998.
[9]
These original sites were set up as pilots but soon proved successful, reaching over 1
million people and earning highly positive feedback. Additional waves of pilots were established in contact centres
around England until the whole country was covered by the NHS Direct telephone service in 2000.
NHS Direct added a website to its services at the end of 1999, allowing users to find clinically accurate health advice
and information anonymously and at their leisure. Since its creation, the NHS Direct website has steadily improved
and developed, attracting more and more users. Currently, there are over 1.5 million visitors to the website every
month.
NHS Direct's services continue to expand and improve, as do the ways in which they reach their users. It has been
said that this has made the organisation "the largest and most successful healthcare provider of its kind, anywhere in
the world".
[10]
It was reported that each call made to NHS Direct cost 25 to answer - an earlier official report had put the total at
16.
[11]
Abolition of NHS Direct helpline (England)
The Department of Health has confirmed that NHS Direct's telephone number is to be phased out in favour of the
new non-emergency NHS 111 number, following three pilots in the North East, East Midlands and East of England.
NHS 111 is intended to work in an integrated way with local GPs, out-of-hours services, ambulance services and
hospitals, for the benefit of patients and to help the NHS become more efficient. NHS Direct as an organisation is
not being closed down, nor was this ever the Governments intention. NHS Direct will have an ongoing role, along
with other providers, in helping to deliver the NHS 111 Service and, in the interim, will continue providing local and
national telephone and web-based services on behalf of its commissioners. The Labour party, which founded NHS
Direct, voiced its opposition to the proposal, although it had promised to introduce the new 111 hotline nationally in
its election manifesto.
[12][13]
External links
NHS Direct
[1]
NHS Direct
[14]
on Facebook
NHS Direct
[15]
on Twitter
NHS Direct's channel
[16]
on YouTube
Notes
[1] http:/ / www. nhsdirect. nhs. uk/
[2] BBC News (2010-08-28). Government confirms plan to scrap NHS Direct helpline (http:/ / www. bbc. co. uk/ news/ uk-11120853). BBC.
Retrieved 2010-08-28.
[3] NHS Direct. "Clinical Supervision Policy" (http:/ / www. nhsdirect. nhs. uk/ article. aspx?SectionId=5&
Name=FreedomOfInformationDocuments#policiesandproceduresrelatingtotheconductofbusinessandtheprovisionofnhsdirectservices).
Retrieved 2009-01-14.
[4] http:/ / mobile.nhsdirect.nhs.uk/
[5] NHS Direct. Digital TV (http:/ / www. nhsdirect.nhs.uk/ article. aspx?name=DigitalTV)
NHS Direct
695
[6] http:/ / www. nhs. uk
[7] Department of Health. "The New NHS: Modern, Dependable" (http:/ / www. dh. gov. uk/ en/ Publicationsandstatistics/ Publications/
PublicationsPolicyAndGuidance/ DH_4008959). Retrieved 2009-01-14.
[8] NHS Direct. "History of NHS Direct" (http:/ / www.nhsdirect. nhs. uk/ article. aspx?name=HistoryOfNHSDirect). Retrieved 2009-01-14.
[9] Department of Health. "Evaluation of NHS Direct first wave sites first interim report to the Department of Health" (http:/ / www. dh. gov. uk/
en/ Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_4006050). Retrieved 2009-01-14.
[10] Department of Health. "Developing NHS Direct: Strategy Document for the next three years" (Foreword) (http:/ / www. dh. gov. uk/ en/
Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ Browsable/ DH_4920815). Retrieved 2009-01-15.
[11] Kate Devlin (2008-10-24). Every call to NHS Direct costs 25 (http:/ / www. telegraph. co. uk/ health/ 3253245/
Every-call-to-NHS-Direct-costs-25.html) Telegraph.co.uk.
[12] 'Medical Helpline NHS Direct is to be axed' (http:/ / news. sky. com/ skynews/ Home/ UK-News/
Medical-Helpline-NHS-Direct-Is-To-Be-Axed-And-Replaced-By-The-New-111-Service/ Article/
201008415708224?lpos=UK_News_First_UK_News_Article_Teaser_Region_0&
lid=ARTICLE_15708224_Medical_Helpline_NHS_Direct_Is_To_Be_Axed_And_Replaced_By_The_New_111_Service) Sky News 28
August 2010 Sky.com Retrieved 28 August 2010
[13] Labour Party Manifesto 2010 'A new national 111 telephone number will make non-emergency services far easier for people to access and
book' (http:/ / www. labour. org.uk/ manifesto/ a-personal-nhs) Labour Party. Retrieved 29 August 2010
[14] https:/ / www.facebook. com/ nhsdirect.uk
[15] https:/ / twitter. com/ nhsdirect
[16] https:/ / www.youtube. com/ user/ nhsdirectvideos
NHS National Programme for IT
NHS Connecting for Health is part of the UK Department of Health and was formed on 1 April 2004, replacing the
former NHS Information Authority. NHS Connecting for Health ceased to exist on 31 March 2013 and the tasks
have been taken over by Health and Social Care Information Centre. It has the responsibility of delivering the NHS
National Programme for IT (NPfIT), an initiative by the Department of Health in England to move the National
Health Service (NHS) in England towards a single, centrally-mandated electronic care record for patients and to
connect 30,000 General practitioners to 300 hospitals, providing secure and audited access to these records by
authorised health professionals.
It was planned that patients would also have access to their records online through a service called HealthSpace
[1]
.
NPfIT is said by NHS CFH to be "the world's biggest civil information technology programme".
The cost of the programme, together with its ongoing problems of management and the withdrawal or sacking of two
of the four IT providers, have placed it at the centre of ongoing controversy, and the Commons Public Accounts
Committee has repeatedly expressed serious concerns over its scope, planning, budgeting, and practical value to
patients. As of January 2009, while some systems were being deployed across the NHS, other key components of the
system were estimated to be four years behind schedule, and others had yet to be deployed outside individual trusts
at all.
While the Daily Mail announced on 22 September 2011 that "12bn NHS computer system is scrapped...", The
Guardian noted that the announcement from the Department of Health on 9 September, had been "part of a process
towards localising NHS IT that has been under way for several years". Whilst remaining aspects of the National
Programme for IT were cancelled, most of the spending would proceed with the Department of Health seeking for
local software solutions rather than a single nationally imposed system.
NHS National Programme for IT
696
Structure and scope of the programme
The programme was established in October 2002 following several Department of Health reports on IT Strategies for
the NHS., and on April 1, 2005 a new agency called NHS Connecting for Health (CfH) was formed to deliver the
programme. CfH absorbed both staff and workstreams from the abolished NHS Information Authority, the
organisation it replaced. CfH is based in Leeds, West Yorkshire.
As of 2009, it is still managed nationally by CfH, with responsibility for delivery shared with the chief executives of
the ten NHS strategic health authorities.
Reviews
The refusal of the DoH to make "concrete, objective information about NPfIT's progress [...]available to external
observers", nor even to MPs, has attracted significant criticism, and was one of the issues which in April 2006
prompted 23 academics
[2]
in computer-related fields to raise concerns about the programme in an open letter to the
Health Select Committee. 2006-10-06 the same signatories wrote a second open letter
A report by the King's Fund in 2007 also criticised the government's "apparent reluctance to audit and evaluate the
programme", questioning their failure to develop an ICT strategy whose benefits are likely to outweigh costs and the
poor evidence base for key technologies.
A report by the Public Accounts Committee in 2009 called the risks to the successful deployment of the system "as
serious as ever", adding that key deliverables at the heart of the project were "way off the pace", noting that "even
the revised completion date of 2014-2015 for these systems now looks doubtful in the light of the termination last
year of Fujitsu's contract covering the South", and concluding "essential systems are late, or, when deployed, do not
meet expectations of clinical staff".
The initial reports into the feasibility of the scheme, known to have been conducted by McKinsey, and subsequent
reports by IT industry analyst Ovum among others have never been published nor made available to MPs.
Costs
Originally expected to cost 2.3 billion (bn) over three years, in June 2006 the total cost was estimated by the
National Audit Office to be 12.4bn over 10 years, and the NAO also noted that "...it was not demonstrated that the
financial value of the benefits exceeds the cost of the Programme". Similarly, the British Computer Society (2006)
concluded that "...the central costs incurred by NHS are such that, so far, the value for money from services deployed
is poor". Officials involved in the programme have been quoted in the media estimating the final cost to be as high as
20bn, indicating a cost overrun of 440% to 770%.
In April 2007, the Public Accounts Committee of the House of Commons issued a damning 175-page report on the
programme. The Committee chairman, Edward Leigh, claimed "This is the biggest IT project in the world and it is
turning into the biggest disaster." The report concluded that, despite a probable expenditure of 20 billion pounds "at
the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract
period."
The costs of the venture should have been lessened by the contracts signed by the IT providers making them liable
for huge sums of money if they withdrew from the project; however, when Accenture withdrew in September 2006,
then Director-General for NPfIT Richard Granger charged them not 1bn, as the contract permitted, but just 63m.
Granger's first job was with Andersen Consulting, which later became Accenture.
NHS National Programme for IT
697
Deliverables
The programme is divided into a number of key deliverables.
Deliverable Since Name of software Original
delivery
date
Progress 2007 Progress 2009
Integrated care
records service
2002 NHS Care Records
Service (NCRS) /
Lorenzo
2004 "Real progress only just
beginning", no go-live date
specified
"Recent progress...very disappointing",
completion date of 2014-2015 now looks
unlikely following withdrawal of Fujitsu,
arrangements for South region not resolved,
Lorenzo still not live in a single acute Trust
Electronic
prescribing
2002 NHS Electronic
Prescription Service
2007 Implementation began in early
2005, used for 8% of daily
prescriptions
70% of GPs and pharmacies had 1st release of
software, but only 40% of prescriptions issued
with readable barcodes
Electronic
appointments
booking
2002 Choose and Book 2005 Take-up slow, system reliant on
outdated technology, GPs
dissatisfied, target of 90% of
referrals on system by March
2007 missed
Mixed, around half of new appointments made
using system, additional training and time
required
Underpinning IT
infrastructure
2002 New National
Network (N3)
March
2002
On schedule, with 98% of GP
practices connected
Medical imaging
software
Picture Archiving and
Communication
System (PACS)
Performance
management of
primary care
Quality Management
and Analysis System
(QMAS)
Central e-mail
and directory
service
NHSmail*
*NHSmail was renamed to Contact in late 2004, before being reverted to NHSmail in April 2006.
The Spine (including PDS & PSIS)
The Spine is a set of national services used by the NHS Care Record Service. These include:
The Personal Demographics Service (PDS), which stores demographic information about each patient and their
NHS Number. Patients cannot opt-out from this component of the spine, although they can mark their record as
'sensitive' to prevent their contact details being viewed by 831,000 staff.
The Summary Care Record (SCR). The Summary Care Record is a summary of patient's clinical information,
such as allergies and adverse reactions to medicine.
The Secondary Uses Service (SUS), which uses data from patient records to provide anonymised and
pseudonymised business reports and statistics for research, planning and public health delivery.
The Spine also provides a set of security services, to ensure access to information stored on the Spine is
appropriately controlled. These security measures were queried during the early stages of Spine development, with
leaked internal memos seen by the Sunday Times mentioning "fundamental" design flaws. In addition, government
spokeswoman Caroline Flint failed to dispel concerns regarding access to patients' data by persons not involved in
their care when she commented in March 2007 that "in general only those staff who are working as part of a team
that is providing a patient with care, that is, those having a legitimate relationship with the patient, will be able to see
a patient's health record."
NHS National Programme for IT
698
Exceptions
The NHS in Wales is also running a national programme for service improvement and development via the use of
Information Technology - this project is called Informing Healthcare. A challenge facing both NHS CFH and
Informing Healthcare is that the use of national systems previously developed by the NHS Information Authority are
shared by both of these organisations and the Isle of Man. Separate provision needs to be made for devolution, while
maintaining links for patients travelling across national borders.
NPfIT is currently focussed on delivering the NHS Care Record Service to GPs, Acute and Primary Hospitals,
medical clinics and local hospitals and surgeries. Whilst there are no immediate plans to include opticians or dentists
in the electronic care record, services are delivered to these areas of the NHS.
Clusters and Local Service Providers
The programme originally divided England into five areas known as "clusters": Southern, London, East & East
Midlands, North West & West Midlands, and North East. For each cluster, a different Local Service Provider (LSP)
was contracted to be responsible for delivering services at a local level. This structure was intended to avoid the risk
of committing to one supplier which might not then deliver; by having a number of different suppliers implementing
similar systems in parallel, a degree of competition would be present which would not be if a single national contract
had been tendered. However, in July 2007 Accenture withdrew from the project, and in May 2008 Fujitsu had their
contract terminated, meaning that half the original contractors had dropped out of the project. As of May 2008, two
IT providers were LSPs for the main body of the programme:
Computer Sciences Corporation (CSC) - North, Midlands & Eastern (NME) cluster
BT Health London
[3]
(formerly BT Capital Care Alliance) - London cluster
Accenture had full responsibility for the North East and East/East Midlands clusters until January 2007, when it
handed over the bulk of its responsibilities to the CSC, retaining responsibility for Picture archiving and
communication system (PACS) rollout only.
Fujitsu - had responsibility for the Southern cluster until May 2008 when their contract was terminated. Most of
their responsibilities were subsequently transferred to BT Health except for PACS which was transferred to the
CSC Alliance.
Local ownership
In the first half of 2007, David Nicholson announced the "National Programme, Local Ownership programme"
(known as "NLOP") which dissolved the 5 clusters and devolved responsibility for the delivery of the programme to
the ten English NHS strategic health authorities (SHAs). Connecting for Health retains responsibility for the
contracts with the LSPs.
Under NLOP, staff employed by CfH in the Clusters had their employment transferred to the SHAs, with some being
recruited to revised national CfH posts.
NHS National Programme for IT
699
National Application Service Providers
In addition to these LSPs the programme has appointed National Application Service Providers (NASPs) who are
responsible for services that are common to all users e.g. Choose and Book and the national elements of the NHS
Care Records Service that support the summary patient record and ensure patient confidentiality and information
security. As of October 2005, the NASPs are:
BT - NHS Care Records Service and N3
Atos Origin and Cerner - Choose & Book
Cable and Wireless - NHSmail
Changes to service providers
In March 2004, EDS had their 10-year contract to supply the NHSMail service terminated. On 1 July 2004, Cable
and Wireless were contracted to provide this service, which was initially renamed Contact.
IDX Systems Corporation was removed from the Southern Cluster Fujitsu Alliance in August 2005 following
repeated failure to meet deadlines. They were replaced in September 2005 by Cerner Corporation.
In early 2006, ComMedica's contract for supply of PACS to the North-West/West-Midlands cluster was terminated,
and they were replaced by GE Healthcare.
In July 2006, the London region started the contractual replacement of IDX (which had been bought out by GE
Healthcare in January 2006) as its supplier. Systems for secondary care, primary care and community and mental
health services are proposed by BT to be provided by Cerner, INPS
[4]
(formerly In Practice Systems) and CSE
Healthcare Systems, part of the CSE-Global group of companies
[5]
, respectively. This is subject to contractual
negotiation known as 'CCN2'.
In September 2006, the CSC Alliance, Accenture and Connecting for Health signed a tripartite agreement that as of
January 2007, the CSC Alliance would take over the responsibility for the majority of care systems the North East
and Eastern clusters from Accenture, with the exception of PACS. As part of the handover process, around 300
Accenture personnel transferred under a TUPE process to CSC, and CSC took over the leases for some of
Accenture's premises in Leeds. Accenture now retains only a small presence in the city for the delivery of its PACS
responsibilities.
In May 2008 it was announced that following the failure to conclude renegotiation of the contract for the Southern
Cluster, CfH terminated the contract with Fujitsu. The majority of the Southern Cluster care systems were
subsequently transferred to BT Health except for PACS which was transferred to the CSC Alliance, aligning with the
technology deployed by each company.
Criticisms of the programme
Failure to deliver clinical benefits
The 2009 Public Accounts Committee report noted that the NPfIT had provided "little clinical functionality...to-date"
The latest PAC report here 18 July 2011
The National Programme for IT in the NHS: an update on the delivery of detailed care records systems
[6]
Data security risks
NPfIT has been criticised for inadequate attention to security and patient privacy, with the Public Accounts
Committee noting "patients and doctors have understandable concerns about data security", and that the Department
of Health did not have a full picture of data security across the NHS. In 2000, the NHS Executive won the "Most
Heinous Government Organisation" Big Brother Award from Privacy International for its plans to implement what
NHS National Programme for IT
700
would become the NPfIT. In 2004 the NPfIT won the "Most Appalling Project" Big Brother Award because of its
plans to computerise patient records without putting in place adequate privacy safeguards.
The balance between the right to privacy and the right to the best quality care is a sensitive one. Also there are
sanctions against those who access data inappropriately, specifically instant dismissal and loss of professional
registration
[citation needed]
.
More worryingly, a January 2005 survey among doctors indicates that support for the initiative as an 'important NHS
priority' has dropped to 41%, from 70% the previous year. There have been concerns raised by clinicians that
clinician engagement has not been addressed as much as might be expected for such a large project.
Concerns over confidentiality, and the security of medical data uploaded to the Spine have also led to opposition
from civil liberties campaigners such as NO2ID the anti-database state pressure group and The Big Opt Out
[7]
who
provide patients with a letter to send to their doctor so that their records are withheld from the database.
Reservations of medical staff
As of August 5, 2005, research carried out across the NHS in England suggested that clinical staff felt that the
programme was failing to engage the clinicians fully, and was at risk of becoming a white elephant. The Public
Accounts Committee observed in 2009 that "the current levels of support reflect the fact that for many staff the
benefits of the Programme are still theoretical".
Surveys in 2008 suggested that two-thirds of doctors will refuse to have their own medical records on the system.
Impact on IT providers
According to the Daily Telegraph, the head of NPfIT, Richard Granger, 'shifted a vast amount of the risk associated
with the project to service providers, which have to demonstrate that their systems work before being paid.' The
contracts meant that withdrawing from the project would leave the providers liable for 50% of the value of the
contract; however, as previously mentioned, when Accenture withdrew in September 2006, Granger chose not to use
these clauses, saving Accenture more than 930m.
The programme's largest software provider iSOFT has been seriously affected by this process and is under
investigation by the UK Financial Services Authority for irregular accounting. On 28 September 2006, the
consultancy Accenture announced its intention to withdraw from 2bn of 10 year contracts with NPfIT, which were
taken over in January 2007 by the CSC Alliance
[8]
- both Accenture and CSC laid blame with iSOFT, although CSC
has said it will be retaining iSOFT as its software provider for all its clusters. Earlier in the year Accenture had
written off $450m from its accounts because of 'significant delays' in the programme. iSOFT announced in March
2011 that trading in its shares would be suspended pending a corporate announcement. Subsequently in April 2011,
the company announced that it was recommending a cash offer from CSC. CSC acquired iSOFT in August, 2011
Implementation
The first trusts in the London & Southern Clusters to implement the new Cerner system found it problematic, with
NHS hospital trust board minutes revealing a catalogue of errors. Difficulties with the system meant that:
2007: Enfield PCT were unable to obtain vital data on patients awaiting operations and were obliged to delay 63
patients of the Barnet and Chase Farm Hospitals. Further, 20 patients were not readmitted for treatment within 28
days towards the end of the year because the surveillance system for tracking them "was not operational in the
new ... system". Buckinghamshire Hospitals NHS Trust found that problems with the system had meant
potentially infectious patients with MRSA were not isolated for up to 17 days, requiring six weeks work by staff
to update them manually.
April 2008: Enfield PCT found that the system had failed to flag up possible child-abuse victims entering hospital
to key staff, "leaving the responsibility to the receptionist"
NHS National Programme for IT
701
May 2008: Enfield PCT found that 272 elective operations were cancelled at the last minute for "non-clinical
reasons"
May 2008: Barts and The London NHS Trust blamed their failure over the preceding six months to meet targets
for treating emergency patients within four hours on staff not being familiar with the new computer system. The
same report cited "breaches of the two-week urgent cancer access guarantee" and delays in assessing 11 patients
with possible cancer as being due to the computer system.
July 2008: the Royal Free Hampstead NHS Trust said 12,000 patient records had to be manually amended over a
three-week period due to the system, and noted that "The outpatient appointment centre has experienced a
significant increase in the time taken to process individual patient appointment bookings. This has had a
consequent and negative effect on call-answer performance."
Management team
The NHS appointed a management team, responsible for the delivery of the system:
Richard Granger - is the former Director General of IT for the NHS. He took up his post in October 2002,
before which he was a partner at Deloitte Consulting, responsible for procurement and delivery of a number of
large scale IT programmes, including the Congestion Charging Scheme for London. In October 2006, he was
suggested by The Sunday Times to be the highest paid Civil Servant, on a basic of 280,000 per year, 100,000
per year more than former Prime Minister Tony Blair. Granger announced on 16 June 2007 that he would leave
the agency "during the latter part" of 2007.
[9]
Granger finally left the programme in February 2008. Granger's
credentials were questioned by his own mother, a campaigner for the preservation of local health services in her
area, who expressed her amazement at his appointment, criticising the whole scheme as "a gross waste of money".
Gordon Hextall - Chief operating officer for NHS Connecting for Health. A career civil servant. On Richard
Granger's departure, Hextall assumed overall responsibility for the programme.
Richard Jeavons - Senior responsible owner for service implementation. Previous posts include being CEO of
the West Yorkshire NHS strategic health authority.
Harry Cayton - Chair of the Care Record Development Board.
As of 2009, overall leadership of CfH was described by the Public Accounts Committee as having been "uncertain"
since the announcement that Richard Granger would be leaving the project.
References
[1] https:/ / www. healthspace. nhs. uk/
[2] Signatories of the open letter to the Health Select Committee: Ross Anderson, Professor of Security Engineering, Cambridge University;
James Backhouse, Director, Information System Integrity Group, London School of Economics; David Bustard, Professor and Head of
Computing and Information Engineering, University of Ulster; Ewart Carson, Professor of Systems Science, Centre for Health Informatics,
City University; Patrik O'Brian Holt, Professor, School of Computing, The Robert Gordon University; Roland Ibbett, Professor, School of
Informatics, University of Edinburgh; Ray Ison, Professor of Systems, The Open University; Achim Jung, Professor, School of Computer
Science, University of Birmingham; Frank Land, Emeritus Professor, Information Systems Department, London School of Economics; Bev
Littlewood, Professor of Software Engineering, City University; John A McDermid, Professor of Software Engineering, University of York;
Julian Newman, Professor of Computing, Glasgow Caledonian University; Brian Randell, Professor, School of Computing Science,
University of Newcastle; Uday Reddy, Professor, School of Computer Science, University of Birmingham; Peter Ryan, Professor of
Computing Science, University of Newcastle; Geoffrey Sampson, Professor, Department of Informatics, University of Sussex; Martin
Shepperd, Professor of Software Technologies, Brunel University; Michael Smith, Visiting Professor, Department of Computer Science,
University College London; Tony Solomonides, Reader in Computer Science and Medical Informatics, University of the West of England; Ian
Sommerville, Professor, Computing Department, Lancaster University; Harold Thimbleby, Professor of Computer Science, Swansea
University; Martyn Thomas, Visiting Professor of Software Engineering, Computing Laboratory, Oxford University; Colin Tully, Professor of
Software Practice, School of Computing Science, Middlesex University
[3] http:/ / www. btplc. com/ health/
[4] http:/ / www. inps. co.uk
[5] http:/ / www. cse-healthcare.com/
[6] http:/ / www. publications.parliament.uk/ pa/ cm201012/ cmselect/ cmpubacc/ 1070/ 107002. htm
NHS National Programme for IT
702
[7] http:/ / www. nhsconfidentiality.org/
[8] http:/ / www. cscalliance. com
[9] E-Health Insider :: Granger to leave in transition by end of 2007 (http:/ / www. e-health-insider. com/ news/ item. cfm?ID=2784)
External links
NHS Connecting for Health website (http:/ / www. connectingforhealth. nhs. uk)
NHS number (http:/ / www. connectingforhealth. nhs. uk/ systemsandservices/ nhsnumber)
Personal Demographics Service (PDS) (http:/ / www. connectingforhealth. nhs. uk/ demographics)
"A guide to the National Programme for Information Technology" (PDF) (http:/ / www. connectingforhealth. nhs.
uk/ all_images_and_docs/ NPfIT brochure Apr 05 final. pdf), NHS Connecting for Health, April 2005
PC Coaching appointed to provide Trainers & MTUs for NPfIT (http:/ / www. pccoachingnhs. com/ ), NHS
Connecting for Health award contract for NPfIT Trainers and Mobile Training Units
Programmes and Systems Delivery (http:/ / www. connectingforhealth. nhs. uk/ delivery/ programmes/ ), NHS
Connecting for Health, retrieved October 30, 2005
NHS Connecting for Health NPfIT site (http:/ / www. connectingforhealth. nhs. uk)
NHS Connecting for Health History Page (http:/ / www. connectingforhealth. nhs. uk/ aboutus/ history)
BT Health (http:/ / www. btplc. com/ health), Delivering three major contracts to the NHS as part of the NPfIT
June 2006: NHS risks 20bn white elephant, say auditors (http:/ / society. guardian. co. uk/ e-public/ story/
0,,1799088,00. html)
Times Online: Patient records go on database (http:/ / www. timesonline. co. uk/ newspaper/ 0,,2710-751992,00.
html)
Computer loophole hits hi-tech NHS trial (http:/ / www. timesonline. co. uk/ newspaper/ 0,,176-1358226,00.
html)
NHS IT upgrade success 'at risk' (http:/ / news. bbc. co. uk/ 1/ hi/ health/ 4745915. stm)
The Big Opt Out (http:/ / www. nhsconfidentiality. org/ ?page_id=9,), Advice to patients - How to opt out
Opting out of the NHS Database (http:/ / www. summarycarerecord. info/ ) Detailed information from Dr Neil
Bhatia, a GP in Hampshire
NHS Information Standards Board for Health and Social Care (http:/ / www. isb. nhs. uk)
Ontario Telemedicine Network
703
Ontario Telemedicine Network
Ontario Telemedicine Network
Industry Telemedicine
Founded April 2006
Headquarters Toronto, Ontario, CANADA
Employees 195 (2011)
Website
www.otn.ca
[1]
The Ontario Telemedicine Network (OTN) is one of the largest telemedicine networks in the world. It uses two-way
videoconferencing to provide access to care for patients in every hospital and hundreds of other health care locations
across the province. In addition to clinical care, OTN facilitates the delivery of distance education and meetings for
health care professionals and patients.
OTN Members and Network Partners
The Network has nearly 600 Members, including all public hospitals, Family Health Teams, clinics, physician
offices, nursing stations, medical and nursing schools, professional organizations, Community Care Access Centres,
LHIN offices, First Nations Communities, long-term care homes, educational facilities and public health.
OTN Utilization
The Network consists of more than 1200 sites and 2200 endpoints and more than 3200 health care referrers and
consultants use the Network to provide care to patients. In fiscal 2010-11, more than 134,000 patients received care
via OTN, a 30% increase over the same period the previous year.
OTN supports access to care across a wide variety of clinical therapeutic areas of care. The top five clinical
categories supporting patient care are mental health and addictions; internal medicine; oncology; surgery and
rehabilitation services.
In addition to facilitating the delivery of patient care, OTN enables teaching and learning at a distance via
videoconferencing and webcasting. More than 390,000 health care professionals participate in OTN-facilitated
education each year. In fiscal 2010-11, OTN hosted 11,595 educational events, and 13,146 administrative events. In
fiscal 2010-11, OTN hosted more than 1,500 webcasts, a 67% increase over the previous year. There was also a 19%
increase in viewership of archived webcasts over 2009-2010, for a total of 28,264 views.
Use of Telemedicine in the Province resulted in an avoidance of 121 million kilometres of patient travel and an
elimination of nearly 33.5KG of pollutants.
References
[1] http:/ / www. otn. ca/
External links
Ontario Telemedicine Network website (http:/ / www. otn. ca/ )
Public Health Information Network
704
Public Health Information Network
The Public Health Information Network (PHIN) is a national initiative, developed by the Centers for Disease
Control and Prevention (CDC), for advancing fully capable and interoperable information systems in public health
organizations. The initiative involves establishing and implementing a framework for public health information
systems.
PHIN Design
PHIN is designed to do the following:
Enable the consistent exchange of health data
Protect the security of the health data exchanged
Ensure that the network will be available at all times
PHIN Structure
The 5 Functional Areas of PHIN:
1. 1. Detection and Monitoring
2. 2. Data Analysis
3. 3. Knowledge Management
4. 4. Alerting
5. 5. Response
The PHIN Framework
"PHIN will elevate and integrate the capabilities of public health information systems across the wide variety of
organizations that participate in public health and across the wide variety of interrelated public health functional
needs. PHIN is both a response to the needs for better integration among public health systems and a plan for
developing systems and infrastructure to better support public health activities and improve public health outcomes.
PHIN targets the support and integration of systems for disease surveillance, national health status indicators, data
analysis, public health decision support, information resources and knowledge management, alerting and
communications and the management of public health response. PHIN includes a portfolio of software solutions and
artifacts necessary in building and maintaining interconnected information systems throughout public health at the
local, state and federal levels. PHIN advances the National Health Information Infrastructure and federal E-Gov
agendas by working with the Federal Health Architecture (FHA) and implementing the Consolidated Health
Informatics (CHI) standards for reducing the burden of private sector reporting through the automated use of
electronic clinical data for public health purposes as an alternative to manual reporting. It is consistent with other
private sector initiatives such as Connecting for Health and e-Health as well as the industry standards for clinical
data messaging such as HL7. PHIN also aligns with the federal e-Gov technical architecture standards such as
ebXML and public key infrastructure (PKI). See Standards Development Organizations for more information on
national standards."
Public Health Information Network
705
PHINs Impact on Public Health
PHIN attempts to provide the public health sector with continuous access to necessary health care information.
Access to near real-time data attempts to improve community based interventions that are implemented as a result of
terrorism or disease outbreaks.
PHIN provides supports and helps improve the outcomes of various public health programs including the following:
The U.S. Department of Health and Human Services
Desired outcome: improving public health information systems.
The Secretary of the U.S. Department of Health and Human Services
Supports: Terrorism Defense, Healthcare Delivery Improvement, and IT Enhancements.
Healthy People 2010
Supports: Focus area 23 - ensure that public health agencies have the adequate infrastructure to effectively
provide essential public health services.
Partners in public health
Desired outcome: "Roadmap" for establishing national capacity for public health systems.
Budget and Funding
PHIN first received funding in 2004 through the Department of Health and Human Services and the Centers for
Disease Control and Prevention. Between 25% and 30% of the $849 million of funding received through the Public
Health Response and Preparedness Cooperative Agreement was to be used to focus on improving public health
preparedness in all 50 states, 4 metropolitan areas and 8 US territories. In 2004 the initiative of the program was to
ensure that all public health partners have, or at least will have, access to a system or systems to accomplish
established preparedness functions. For year 2005, additional finances will be available to states through the
terrorism cooperative agreement. This agreement will support the development of current and new systems, in state
health and public health departments, which will meet the PHIN standards and specifications.
Partnerships
In order to collect and assess information system requirements for PHIN, the CDC works with public health partners,
some of which include:
NACCHO - National Association of County and City Health Officials
ASTHO - Association of State and Territorial Health Officials
With the assistance of these partners, PHIN can target the following functional areas regarding preparedness:
1. 1. Early Event Detection
2. 2. Outbreak Management
3. 3. Connecting Laboratory Services
4. 4. Partner Communications and Alerting
5. 5. Countermeasure/Response Administration
Governance
The approval of technical and data standards for PHIN is completed by two working groups in the CDC Information
Council (CIC). The following organizations are represented on each working group by 2 members of its staff:
Association of State and Territorial Health Officials (ASTHO), National Association of County and City Health
Officials (NACCHO), and Centers for Disease Control and Prevention (CDC). By regulation the standards conform
to Department of Health and Human Services (HHS) requirements and the Federal Health architecture.
Public Health Information Network
706
CIC also ensures that the following standards are met:
E-Gov activities, which includes all regulations contained in the Government Paperwork Elimination Act (GPEA)
goals
Consolidated Health Informatics (CHI) initiative
Federal Geographic Data Committee standards required by Office of Management and Budget (OMB) Circular
A-16
Public Health line of business and Public Health Monitoring Sub-function of the Federal Enterprise Architecture
Business Reference Model
For more information on these standards, refer to the PHIN Conceptual Diagram
[1]
provided by PHIN and the CDC.
Preparedness
Early Event Detection
In the realm of preparedness, the PHIN has developed systems to promote early event detection. Information systems
that connect health care providers to the PHIN allow for rapid reporting of cases that may lead to public health
emergencies. These information systems include call reporting systems, web-based systems, and other electronic
case reporting systems. The PHIN has set up technical requirements so that facilities can be equipped to participate
in these rapid reporting systems. These requirements also ensure that facilities can protect patient privacy in their
reports and ensure integration with outbreak management.
Outbreak Management
Another component in preparedness, the PHIN has a division of outbreak management which allows public health
agencies to be adequately prepared for true outbreaks. The outbreak management system is integrated with the early
event detection systems to ensure rapid, smooth awareness of outbreaks. The CDC and PHIN currently employ an
Outbreak Management System software application to effectively manage data related to outbreaks. OMS
demonstration
[2]
Connecting Laboratories
Another component of PHIN is connecting laboratories through a set of computer communication standards called
HL7. This allows specimen receipts and laboratory results to be exchanged between health organizations and
agencies. This is especially useful in times of a health outbreak or other disaster.
Countermeasure and Response Administration
The PHIN also works to track and support the supply of vaccinations and as well as the administration of these tasks.
As part of this functionality, the PHIN allows limited supplies of vaccines and other needed drugs to be allocated
properly when they are in short supply. Some vaccines and drugs will be traceable to clinics and drug administrators.
PHIN also supports response administration by allowing adverse events to be monitored and quarantined populations
to be monitored if necessary.
Public Health Information Network
707
Standards and Specifications
PHIN has a set of Vocabulary Standards and Specifications that:
1. 1. Supports the development and deployment of standards-based public health information systems.
2. 2. Seeks to promote the use of standards-based vocabulary
3. 3. Fosters the use and exchange of consistent information among public health collaborators.
4. 4. Ensures that the vocabularies are aligned with PHIN and CHI standards.
Training
If you are interested in training, CDC offers online trainings on different topics such as: Outbreak Management,
Countermeasure and Response Administration, Certification and it also offers PHIN Roadshow Webinairs. Please
check calendar of available trainings at:
http:/ / www. cdc. gov/ phin/ webinars-and-training. html
External links
CDC Overview
[3]
Official NHIN Website
[4]
NHIN Watch Website
[5]
CDC Vocabulary
[6]
References
[1] http:/ / www. cdc.gov/ phin/ images/ PHIN_Overview.gif
[2] http:/ / www. cdc.gov/ phin/ software-solutions/ oms/ oms_demo. html
[3] http:/ / www. cdc.gov/ phin/ overview.html
[4] http:/ / www. nhin. com
[5] http:/ / nhinwatch.com
[6] http:/ / www. cdc.gov/ phin/ vocabulary/ index. html
SAPPHIRE
708
SAPPHIRE
The Situational Awareness and Preparedness for Public Health Incidences and Reasoning Engines
(SAPPHIRE) is a semantics-based health information system capable of tracking and evaluating situations and
occurrences that may affect public health. It was developed in 2004 by Dr. Parsa Mirhaji at the University of Texas
Health Science Center at Houston using the Semantic Web technologies.
Technology
SAPPHIRE is based upon developing Semantic Web technologies a set of formats and programming languages
(such as the Resource Description Framework language and the Web Ontology Language (OWL)) that find and
analyze data on the World Wide Web to enable users to understand and utilize organized information online. The
system is used to gather, organize and impart information on important happenings and events, assisting public
health-care professionals to prepare and act. It permits data to be interpreted distinctly, meeting the specific needs of
diverse industries, users and disciplines rather than a generalized, universal format. The SAPPHIRE system was
developed by the Health Science Center using the RDF technologies developed by Oracle, Inc. and TopQuadrant,
Inc.
[1]
Function
SAPPHIRE helps track specific incidences such as the spread and treatment of influenza, AIDS and related
information. The system frequently gathers information from select public hospitals, emergency services and care
providers and their electronic health records and information provided by medical professionals. The information is
integrated and categorized - flu-related symptoms are analyzed for trends that may indicate probabilities of flu
epidemics. Such data is transmitted to institutions such as the Centers for Disease Control and Prevention.
SAPPHIRE's processes have also reduced the administrative burdens and inefficiencies at hospitals and clinics.
Usage after Hurricane Katrina
The University of Houston conducted a pilot test of SAPPHIRE in the aftermath of Hurricane Katrina in the fall of
2005, which devastated the populations and infrastructures of southern Mississippi, Louisiana, Alabama and Texas.
Implemented swiftly within hours of mass evacuations, the SAPPHIRE system successfully monitored and analyzed
public health information for the usage of government officials and services, who feared outbreaks of epidemics.
Officials used hand-held computers to gather data from the evacuees and transmit directly to the SAPPHIRE
database. SAPPHIRE was specifically used to analyze the health of the evacuees at the Astrodome, Reliant Park and
the George R. Brown Convention Center. A PDA extension of SAPPHIRE enabled more than 300 volunteers, led by
the UT School of Public Health, to collect and analyze critical health data. SAPPHIRE gathered information from
nearly 9,000 confidential patient cases of the past to help services respond to the specific needs of the evacuees,
helping to identify environment-specific vulnerabilities, prevalence and conditions for diseases and epidemics.
SAPPHIRE was recorded to have assisted in identifying outbreaks of gastrointestinal, respiratory diseases and
conjunctivitis much sooner than previously possible.
SAPPHIRE
709
References
[1] Oracle.com (http:/ / www. oracle. com/ corporate/ press/ 2007_feb/ UT Houston-TopQ. html)
External links
Press Release (http:/ / www. uthouston. edu/ distinctions/ archive/ 2007/ may/ archive. htm?id=792574)
The KnowMED Incorporation (http:/ / www. knowmed. com/ )
Parsa Mirhaji (http:/ / tmc. academia. edu/ ParsaMirhaji)
SmartCare
The SmartCare electronic health record system (EHR) has been developed and deployed by The Ministry of Health
(MOH) Zambia, in collaboration with the Centers for Disease Control and Prevention (CDC) and many other
implementing partners.
SmartCare is:
A fully integrated electronic health record system to provide continuity of care
A clinical management information system at the facility and district (management/admin) level
A key component in 'one National M&E system'
Programme vision
Every Zambian receives cost-effective, confidential, quality health care whenever and wherever they need it.
Every man, woman and child has an electronic health record;
Every point of clinical service can access and update this record;
Every clinician understands the value of this record and is committed to maintaining it;
Each clinical facility, District, Provincial and the national Ministry of Health HQ routinely monitors & evaluates
reports from this data, and uses this information to optimally allocate human and other resources, and to assure
continuous systematic improvement in health services.
Programme mission
To enable the delivery of cost-effective, confidential, quality health care for everyone, everywhere, every time, by
improving health records and related health information systems.
System innovations
Distributed database system: Given resource constraints in developing countries such as Zambia where
electricity is still not available in some parts of the nation, having Internet access throughout the nation will take
many more year. SmartCare data is held at each facility in a distributed design; unlike centralized designs of most
systems. Internet is not essential, merely an added benefit.
Smart Card: SmartCare uses client carried smart cards or staff carried flash drives for a lower-tech connectivity
solution that works today. An individual's health information is stored on a very compressed, secure smart card to
maintain continuity of care between visits, health services and health facilities. The individual's health record is
also stored on the health facility installation database for backup and generation of facility level and health
management information system reports.
SmartCare
710
Touchscreen: Making the data capture task bearable can be the most challenging part of EHR design. SmartCare
extends a successful Malawi idea, where touchscreen data entry by existing staff lowers this barrier. The software
works well with a touch screen monitor enabling the clinician to view and record patient data. This tool, in
combination with client specific data, can provide decision support for over-extended clinicians, and clinician
assistants. Clinicians can read and touch to enter data; no typing is required. See the image at top for example
screen with touch screen technology enabled.
GIS data visualization: Aggregate health data stored at health facilities can be visualized in GIS maps. This
includes live patient data as well as static data from health surveys.
Deployment status in Zambia
Ministry of Health, Zambia has deployed SmartCare in > 200 facilities (clinical and district/provincial/national
levels), in all districts (mid-2008); patient enrollment >200,000
Partners are supporting deployment in government and private facilities (for instance: ZPCT >44, CIDRZ >56,
AIDSRelief >12), but government deployment & enrollment rates are increasing most rapidly
Future plans in Zambia
Capacity building and systems strengthening by developing SmartCare Training Videos, Certification
Completion of ambulatory service modules e.g. OPD, family planning, and childrens clinic
Systems integrations with other health record systems in Zambia ex: ZEPRS
Integration of drug stock management system
Customizations
Ethiopia - Electronic Health Record System called SmartCare-Ethiopia. The system is currently being piloted in
one of the hospitals (as of December 2007)
Zambian National Blood Transfusion Service - Blood donor data collection and reporting system called the
SmartDonor module. The system is being piloted at the national blood transfusion centre head quarters (as of Jan
2009) and plans to deploy to the 9 provincial transfusion centres are underway
Related systems
OpenMRS
OpenEMR
WorldVistA
ZEPRS
External links
http:/ / www. smartcare. org. zm Official SmartCare Website
[1]
References
[1] http:/ / www. smartcare. org. zm
711
International Projects
Building Europe-Africa Collaborative Network
for Applying IST in Health Care Sector
The BEANISH initiative (Building Europe Africa collaborative Network for applying IST in Health care
sector) seeks to support the application and sharing of IST application development in the African health-care sector.
In order to do so, the initiative will involve various institutional actors (government, universities, private sector and
NGOs) to strengthen and extend an existing Europe-Africa collaborative R&D network, namely HISP (Health
Information Systems Programme). This is intended to strengthen cooperation, learning and innovation on both
continents.
The initiative is formally a WITFOR (World Information Technology Forum) project, proposed by EU-African
partners and IFIP (International Federation for Information Processing).
External links
BEANISH Home Page
[1]
References
[1] http:/ / 208. 76. 222. 114/ confluence/ display/ BEANISH/ Home
Global Infectious Disease Epidemiology Network
712
Global Infectious Disease Epidemiology Network
Global Infectious Diseases Epidemiology Network (GIDEON) is a web-based program for decision support and
informatics in the fields of Infectious Diseases and Geographic Medicine. As of 2005, more than 300 generic
infectious diseases occur haphazardly in time and space and are challenged by over 250 drugs and vaccines. 1,500
species of pathogenic bacteria, viruses, parasites and fungi have been described. Printed media can no longer follow
the dynamics of diseases, outbreaks and epidemics in "real time."
Organization
GIDEON consists of four modules. The first Diagnosis module generates a Bayesian ranked differential diagnosis
based on signs, symptoms, laboratory tests, country of origin and incubation period - and can be used for diagnosis
support and simulation of all infectious diseases in all countries. Since the program is web-based, this module can
also be adapted to disease and bioterror surveillance.
The second module follows the epidemiology of individual diseases, including their global background and status in
each of 205 countries and regions. All past and current outbreaks of all diseases, in all countries, are described in
detail. The user may also access a list of diseases compatible with any combination of agent, vector, vehicle,
reservoir and country (for example, one could list all the mosquito-borne flaviviruses of Brazil which have an avian
reservoir). Over 30,000 graphs display all the data, and are updated in "real time." These graphs can be used for
preparation of PowerPoint displays, pamphlets, lecture notes, etc. Several thousand high-quality images are also
available, including clinical lesions, roentgenograms, Photomicrographs and disease life cycles.
The third module is an interactive encyclopedia which incorporates the pharmacology, usage, testing standards and
global trade names of all antiinfective drugs and vaccines.
The fourth module is designed to identify or characterize all species of bacteria, mycobacteria and yeasts. The
database includes 50 to 100 taxa which may not appear in standard texts and laboratory databases for several months.
Additional options allow users to add data (in their own font / language) relevant to their own institution, electronic
patient charts, material from the internet, important telephone numbers, drug prices, antimicrobial resistance
patterns, etc. This form of custom data is particularly useful when running GIDEON on institutional networks. The
data in GIDEON are derived from:
all peer-reviewed journals in the fields of Infectious Diseases, Pediatrics, Internal Medicine, Tropical Medicine,
Travel Medicine, Antimicrobial Pharmacology and Clinical Microbiology
a monthly electronic literature search based on all relevant keywords
all available health ministry reports (both printed and electronic)
standard texts
abstracts of major meetings
Global Infectious Disease Epidemiology Network
713
Related products
VIPatients
[1]
created by the author of GIDEON
External links
GIDEON description at EBSCO
[2]
GIDEON
[3]
References
[1] http:/ / www. vipatients. com
[2] http:/ / www. ebscohost.com/ pointOfCare/ gideon-about
[3] http:/ / www. GIDEONonline. com
Integrating the Healthcare Enterprise
714
Integrating the Healthcare Enterprise
Integrating the
Healthcare Enterprise
Abbreviation IHE
Formation 1998
Legalstatus Non-profit
Headquarters Oak Brook, Illinois
Website
www.ihe.net
[1]
Integrating the Healthcare Enterprise (IHE) is a non-profit organization based in the US state of Illinois. It
sponsors an initiative by the healthcare industry to improve the way computer systems share information. IHE was
established, in 1998, by a consortium of radiologists and information technology (IT) experts.
Operations
IHE created and operates a process through which interoperability of health care IT systems can be improved. The
group gathers case requirements, identifies available standards, and develops technical guidelines that manufacturers
can implement. IHE also stages "connectathons" and "interoperability showcases" in which vendors assemble to
demonstrate the interoperability of their products.
Sponsorship
IHE is sponsored by the Healthcare Information and Management Systems Society (HIMSS), the Radiological
Society of North America (RSNA), and the American College of Cardiology (ACC). The eye care domain is
sponsored by the American Academy of Ophthalmology.
Projects
IHE integration profiles describe a clinical information need or workflow scenario and document how to use
established standards to accomplish it. A group of systems that implement the same integration profile address the
need/scenario in a mutually compatible way. For example, the Digital Imaging and Communications in Medicine
(DICOM) standards specify many different formats for image data. A given set a images that might comply with
some optional parts of the standards might still not be accepted by an application in use by a particular radiologist.
Profiles reduce the chances of these incompatibilities. The Logical Observation Identifiers Names and Codes
(LOINC) standard codes for use in databases are often used in IHE profiles.
A model for cross-enterprise document sharing called XDS allows hospitals to share electronic records that use the
Health Level 7 (HL7) standards and LOINC codes. The United States Department of Veterans Affairs revised its
plans in 1999 to adopt IHE recommendations.
IHE integration statements are prepared and published by a vendor to list the IHE profiles supported by a specific
release of a specific product. IHE technical frameworks are detailed documents which specify the integration profiles
and associated actors (systems) and transactions. For example, one specification is for a common way of binding
identification numbers to patients. IHE connectathons are annual events where equipment vendors bring products
with IHE profiles and test them with other vendors. The term "connectathon" was coined in the 1980s by Sun
Microsystems for similar vendor-neutral interoperability testing of the Network File System protocols and related
technologies. The events are held in Europe as well as the US. In 2008, an agreement was announced for cooperation
Integrating the Healthcare Enterprise
715
with the Continua Health Alliance. In 2012, a guide was published on access to health data from mobile devices.
Although in 2004 an estimate was complete interoperability could be completed in ten years, by 2013 results were
still mixed. In 2013, co-chairs were David Mendelson, director of clinical informatics at Mount Sinai Medical Center
and Elliot B. Sloane of the Center for Healthcare Information Research and Policy and research professor at Drexel
University.
References
[1] http:/ / www. ihe. net
External links
Official website (http:/ / www. ihe. net)
IHE Eye Care (http:/ / www. iheeyecare. org)
IHE Asia-Pacific (http:/ / www. ihe. net. au)
IHE in Europe (http:/ / www. ihe-europe. net)
IHE-UK (http:/ / www. ihe-uk. org/ )
716
Miscellanea
GIS and Public Health
Geographic information systems (GISs), or increasingly geographic information science (GIScience), centers around
combining computer-mapping capabilities with additional database management and data analysis tools.
Commercial GIS systems are very powerful and have touched many applications and industries, including
environmental science, urban planning, agricultural applications, and others.
Public health is another focus area that has made increasing use of GIS techniques. A strict definition of public
health is difficult to pin down, as it is used in different ways by different groups. In general, public health differs
from personal health in that it is (1) focused on the health of populations rather than of individuals, (2) focused more
on prevention than on treatment, and (3) operates in a mainly governmental (rather than private) context.
[1]
These
efforts fall naturally within the domain of problems requiring use of spatial analysis as part of the solution, and GIS
and other spatial analysis tools are therefore recognized as providing potentially transformational capabilities for
public health efforts.
This article presents some history of use of geographic information and geographic information systems in public
health application areas, provides some examples showing the utilization of GIS techniques in solving specific
public health problems, and finally addresses several potential issues arising from increased use of these GIS
techniques in the public health arena.
History
Dr. Snow's map showing cholera cases in London during
the epidemic of 1854.
Public health efforts have been based on analysis and use of
spatial data for many years. Dr. John Snow (physician), often
credited as the father of epidemiology, is arguably the most
famous of those examples.
[2]
Dr. Snow used a hand-drawn map
to analyze the geographic locations of deaths related to cholera
in London in the mid-1850s. His map, which superimposed the
locations of cholera deaths with those of public water supplies,
pinpointed the Broad Street pump as the most likely source of
the cholera outbreak. Removal of the pump handle led to a
rapid decline in the incidence of cholera, helping the medical
community to eventually conclude that cholera was a
water-borne disease.
Dr. Snow's work provides an indication of how a GIS could
benefit public health investigations and other research. He
continued to analyze his data, eventually showing that the
incidence rate of cholera was also related to local elevation as well as soil type and alkalinity. Low-lying areas,
particularly those with poorly draining soil, were found to have higher incidence rates for cholera, which Dr. Snow
attributed to the pools of water that tended to collect there, again showing evidence that cholera was in fact a
water-borne disease (rather than one borne by 'miasma' as was commonly believed at the time.
[3]
This is an early example of what has come to be known as disease diffusion mapping, an area of study based on the
idea that a disease starts from some source or central point and then spreads throughout the local area according to
GIS and Public Health
717
patterns and conditions there. This is another area of research where the capabilities of a GIS have been shown to be
of help to practitioners.
GIS for public health
More modern disease map showing deaths from heart disease among white males in the
US from 20002004.
Todays public health problems are
much larger in scope than those Dr.
Snow faced, and researchers today
depend on modern GIS and other
computer mapping applications to
assist in their analyses. For example,
see the map to the right depicting death
rates from heart disease among white
males above age 35 in the US between
2000 and 2004.
[4]
Public health informatics (PHI) is an
emerging specialty which focuses on
the application of information science
and technology to public health
practice and research.
[5]
As part of that
effort, a GIS or more generally a
Spatial Decision Support System (SDSS) offers improved geographic visualization techniques, leading to faster,
better, and more robust understanding and decision-making capabilities in the public health arena.
[6]
For example, GIS displays have been used to show a clear relationship between clusters of emergent Hepatitis C
cases and those of known intravenous drug users in Connecticut.
[7]
Causality is difficult to prove conclusively
collocation does not establish causation but confirmation of previously established causal relationships (like
intravenous drug use and Hepatitis C) can strengthen acceptance of those relationships, as well as help to
demonstrate the utility and reliability of GIS-related solution techniques. Conversely, showing the coincidence of
potential causal factors with the ultimate effect can help suggest a potential causal relationship, thereby driving
further investigation and analysis (source needed?).
Alternately, GIS techniques have been used to show a lack of correlation between causes and effects or between
different effects. For example, the distributions of both birth defects and infant mortality in Iowa were studied, and
the researchers found no relationship in those data.
[8]
This led to the conclusion that birth defects and infant mortality
are likely unrelated, and are likely due to different causes and risk factors.
GIS can support public health in different ways as well. First and foremost, GIS displays can help inform proper
understanding and drive better decisions. For example, elimination of health disparities is one of two primary goals
of Healthy People 2010, one of the preeminent public health programs in existence today in the US. GIS can play a
significant role in that effort, helping public health practitioners identify areas of disparities or inequities, and ideally
helping them identify and develop solutions to address those shortcomings. GIS can also help researchers integrate
disparate data from a wide variety of sources, and can even be used to enforce quality control measures on those
data. Much public health data is still manually generated, and is therefore subject to human-generated mistakes and
miscoding. For example, geographic analysis of health care data from North Carolina showed that just over 40% of
the records contained errors of some sort in the geographic information (city, county, or zip code), errors that would
have gone undetected without the visual displays provided by GIS.
[9]
Correction of these errors led not only to more
correct GIS displays, but also improved ALL analyses using those data.
GIS and Public Health
718
Issues with GIS for public health
There are also concerns or issues with use of GIS tools for public health efforts. Chief among those is a concern for
privacy and confidentiality of individuals.
[10]
Public health is concerned about the health of the population as a
whole, but must use data on the health of individuals to make many of those assessments, and protecting the privacy
and confidentiality of those individuals is of paramount importance. Use of GIS displays and related databases raises
the potential of compromising those privacy standards, so some precautions are necessary to avoid pinpointing
individuals based on spatial data. For example, data may need to be aggregated to cover larger areas such as a zip
code or county, helping to mask individual identities. Maps can also be constructed at smaller scales so that less
detail is revealed. Alternately, key identifying features (such as the road and street network) can be left off the maps
to mask exact location, or it may even be advisable to intentionally offset the location markers by some random
amount if deemed necessary.
[11]
It is well established in the literature that statistical inference based on aggregated data can lead researchers to
erroneous conclusions, suggesting relationships that in fact do not exist or obscuring relationships that do in fact
exist. This issue is known as the Modifiable Areal Unit Problem. For example, New York public health officials
worried that cancer clusters and causes would be misidentified after they were forced to post maps showing cancer
cases by ZIP code on the internet. Their assertion was that ZIP codes were designed for a purpose unrelated to public
health issues, and so use of these arbitrary boundaries might lead to inappropriate groupings and then to incorrect
conclusions.
[12]
Summary
Use of GIS in public health is an application area still in its infancy. Like most new applications, there is a lot of
promise, but also a lot of pitfalls that must be avoided along the way. Many researchers and practitioners are
concentrating of this effort, hoping that the benefits outweigh the risks and the costs associated with this emerging
application area for modern GIS techniques.
Footnotes
[1] OCarroll, P.W. (2003). Introduction to public health informatics. In P.W. OCarroll, Y.A. Yasnoff, M.E. Ward, L.H. Ripp, and E.L. Martin
(Ed.), Public Health Informatics (pp. 115). New York, NY: Springer.
[2] Lumpkin, J.R. (2003). History and significance of information systems and public health. In P.W. OCarroll, Y.A. Yasnoff, M.E. Ward, L.H.
Ripp, and E.L. Martin (Ed.), Public Health Informatics (pp. 1638). New York, NY: Springer.
[3] Hanchette, C.L. (2003). Geographic Information Systems. In P.W. OCarroll, Y.A. Yasnoff, M.E. Ward, L.H. Ripp, and E.L. Martin (Ed.),
Public Health Informatics (pp. 431466). New York, NY: Springer.
[4] http:/ / www. cdc.gov/ nchs/ data/ gis/ atmappne. pdf, retrieved March 29, 2009.
[5] Hanchette, C.L. (2003). Geographic Information Systems. In P.W. OCarroll, Y.A. Yasnoff, M.E. Ward, L.H. Ripp, and E.L. Martin (Ed.),
Public Health Informatics (pp. 431466). New York, NY: Springer.
[6] Yasnoff, W.A. and Miller, P.L. (2003). Decision Support and Expert Systems in Public Health. In P.W. OCarroll, Y.A. Yasnoff, M.E. Ward,
L.H. Ripp, and E.L. Martin (Ed.), Public Health Informatics (pp. 494512). New York, NY: Springer.
[7] Trooskin S, Hadler J, St. Louis T, and Navarro V (2005). Geospatial analysis of hepatitis C in Connecticut: a novel application of a public
health tool. Public Health, 119(11), 10427. Retrieved from Academic Search Premier database.
[8] Rushton, G., Krishnamurthy, R., Krishnamurti, D., Lolonis, P., and Song, H. (1996). The spatial relationship between infant mortality and
birth defects rates in a US city. Statistics in Medicine, 15, Retrieved from Academic Search Premier database.190719. Retrieved from
Academic Search Premier database.
[9] Hanchette, C.L. (2003). Geographic Information Systems. In P.W. OCarroll, Y.A. Yasnoff, M.E. Ward, L.H. Ripp, and E.L. Martin (Ed.),
Public Health Informatics (pp. 431466). New York, NY: Springer.
[10] Hanchette, C.L. (2003). Geographic Information Systems. In P.W. OCarroll, Y.A. Yasnoff, M.E. Ward, L.H. Ripp, and E.L. Martin (Ed.),
Public Health Informatics (pp. 431466). New York, NY: Springer.
[11] Hanchette, C.L. (2003). Geographic Information Systems. In P.W. OCarroll, Y.A. Yasnoff, M.E. Ward, L.H. Ripp, and E.L. Martin (Ed.),
Public Health Informatics (pp. 431466). New York, NY: Springer.
[12] Rushton G, Elmes G, McMaster R (2003). Considerations for improving geographic information research in public health. URISA Journal,
12(2), 3149.
Neuroinformatics
719
Neuroinformatics
Neuroinformatics is a research field concerned with the organization of neuroscience data by the application of
computational models and analytical tools. These areas of research are important for the integration and analysis of
increasingly large-volume, high-dimensional, and fine-grain experimental data. Neuroinformaticians provide
computational tools, mathematical models, and create interoperable databases for clinicians and research scientists.
Neuroscience is a heterogeneous field, consisting of many and various sub-disciplines (e.g., Cognitive Psychology,
Behavioral Neuroscience, and Behavioral Genetics). In order for our understanding of the brain to continue to
deepen, it is necessary that these sub-disciplines are able to share data and findings in a meaningful way;
Neuroinformaticians facilitate this.
Neuroinformatics stands at the intersection of neuroscience and information science. Other fields, like genomics,
have demonstrated the effectiveness of freely-distributed databases and the application of theoretical and
computational models for solving complex problems. In Neuroinformatics, such facilities allow researchers to more
easily quantitatively confirm their working theories by computational modeling. Additionally, neuroinformatics
fosters collaborative researchan important fact that facilitates the field's interest in studying the multi-level
complexity of the brain.
There are three main directions where neuroinformatics has to be applied:
1. the development of tools and databases for management and sharing of neuroscience data at all levels of analysis,
2. the development of tools for analyzing and modeling neuroscience data,
3. the development of computational models of the nervous system and neural processes.
In the recent decade, as vast amounts of diverse data about the brain were gathered by many research groups, the
problem was raised of how to integrate the data from thousands of publications in order to enable efficient tools for
further research. The biological and neuroscience data are highly interconnected and complex, and by itself,
integration represents a great challenge for scientists.
Combining informatics research and brain research provides benefits for both fields of science. On one hand,
informatics facilitates brain data processing and data handling, by providing new electronic and software
technologies for arranging databases, modeling and communication in brain research. On the other hand, enhanced
discoveries in the field of neuroscience will invoke the development of new methods in information technologies
(IT).
History
Starting in 1989, the United States National Institute of Mental Health (NIMH), the National Institute of Drug Abuse
(NIDA) and the National Science Foundation (NSF) provided the National Academy of Sciences Institute of
Medicine with funds to undertake a careful analysis and study of the need to create databases, share neuroscientific
data and to examine how the field of information technology could create the tools needed for the increasing volume
and modalities of neuroscientific data.
[citation needed]
The positive recommendations were reported in 1991
(Mapping The Brain And Its Functions. Integrating Enabling Technologies Into Neuroscience Research." National
Academy Press, Washington, D.C. ed. Pechura, C.M., and Martin, J.B.) This positive report enabled NIMH, now
directed by Allan Leshner, to create the "Human Brain Project (HBP), with the first grants awarded in 1993. The
HBP was led by Koslow along with cooperative efforts of other NIH Institutes, the NSF, the National Aeronautics
and Space Administration and the Department of Energy. The HPG and grant-funding initiative in this area slightly
preceded the explosive expansion of the World Wide Web. From 1993 through 2004 this program grew to over 100
million dollars in funded grants.
Next, Koslow pursued the globalization of the HPG and neuroinformatics through the European Union and the
Office for Economic Co-operation and Development (OECD), Paris, France. Two particular opportunities occurred
Neuroinformatics
720
in 1996.
The first was the existence of the US/European Commission Biotechnology Task force co-chaired by Mary
Clutter from NSF. Within the mandate of this committee, of which Koslow was a member the United States
European Commission Committee on Neuroinformatics was established and co-chaired by Koslow from the
United States. This committee resulted in the European Commission initiating support for neuroinformatics in
Framework 5 and it has continued to support activities in neuroinformatics research and training.
A second opportunity for globalization of neuroinformatics occurred when the participating governments of the
Mega Science Forum (MSF) of the OECD were asked if they had any new scientific initiatives to bring forward
for scientific cooperation around the globe. The White House Office of Science and Technology Policy requested
that agencies in the federal government meet at NIH to decide if cooperation were needed that would be of global
benefit. The NIH held a series of meetings in which proposals from different agencies were discussed. The
proposal recommendation from the U.S. for the MSF was a combination of the NSF and NIH proposals. Jim
Edwards of NSF supported databases and data-sharing in the area of biodiversity; Koslow proposed the HPG as a
model for sharing neuroscientific data, with the new moniker of neuroinformatics.
The two related initiates were combined to form the United States proposal on Biological Informatics. This
initiative was supported by the White House Office of Science and Technology Policy and presented at the OECD
MSF by Edwards and Koslow. An MSF committee was established on Biological Informatics with two
subcommittees: 1. Biodiversity (Chair, James Edwards, NSF), and 2. Neuroinformatics (Chair, Stephen Koslow,
NIH). At the end of two years the Neuroinformatics subcommittee of the Biological Working Group issued a report
supporting a global neuroinformatics effort. Koslow, working with the NIH and the White House Office of Science
and Technology Policy to establishing a new Neuroinformatics working group to develop specific recommendation
to support the more general recommendations of the first report. The Global Science Forum (GSF; renamed from
MSF) of the OECD supported this recommendation.
The International Neuroinformatics Coordinating Facility
This committee presented 3 recommendations to the member governments of GSF. These recommendations were:
1. 1. National neuroinformatics programs should be continued or initiated in each country should have a national node
to both provide research resources nationally and to serve as the contact for national and international
coordination.
2. An International Neuroinformatics Coordinating Facility (INCF) should be established. The INCF will coordinate
the implementation of a global neuroinformatics network through integration of national neuroinformatics nodes.
3. 3. A new international funding scheme should be established. This scheme should eliminate national and
disciplinary barriers and provide a most efficient approach to global collaborative research and data sharing. In
this new scheme, each country will be expected to fund the participating researchers from their country.
The GSF neuroinformatics committee then developed a business plan for the operation, support and establishment of
the INCF which was supported and approved by the GSF Science Ministers at its 2004 meeting. In 2006 the INCF
was created and its central office established and set into operation at the Karolinska Institute, Stockholm, Sweden
under the leadership of Sten Grillner. Sixteen countries (Australia, Canada, China, the Czech Republic, Denmark,
Finland, France, Germany, India, Italy, Japan, the Netherlands, Norway, Sweden, Switzerland, the United Kingdom
and the United States), and the EU Commission established the legal basis for the INCF and Programme in
International Neuroinformatics (PIN). To date, fourteen countries (Czech Republic, Finland, France, Germany, Italy,
Japan, Norway, Sweden, Switzerland, and the United States) are members of the INCF. Membership is pending for
several other countries.
The goal of the INCF is to coordinate and promote international activities in neuroinformatics. The INCF contributes
to the development and maintenance of database and computational infrastructure and support mechanisms for
neuroscience applications. The system is expected to provide access to all freely accessible human brain data and
Neuroinformatics
721
resources to the international research community. The more general task of INCF is to provide conditions for
developing convenient and flexible applications for neuroscience laboratories in order to improve our knowledge
about the human brain and its disorders.
Society for Neuroscience Brain Information Group
On the foundation of all of these activities, Huda Akil, the 2003 President of the Society for Neuroscience (SfN)
established the Brain Information Group (BIG) to evaluate the importance of neuroinformatics to neuroscience and
specifically to the SfN. Following the report from BIG, SfN also established a neuroinformatics committee.
In 2004, SfN announced the Neuroscience Database Gateway (NDG) as a universal resource for neuroscientists
through which almost any neuroscience databases and tools may be reached. The NDG was established with funding
from NIDA, NINDS and NIMH. The Neuroscience Database Gateway has transitioned to a new enhanced platform,
the Neuroscience Information Framework <http://www.neuinfo.org>. Funded by the NIH Neuroscience BLueprint,
the NIF is a dynamic portal providing access to neuroscience-relevant resources (data, tools, materials) from a single
search interface. The NIF builds upon the foundation of the NDG, but provides a unique set of tools tailored
especially for neuroscientists: a more expansive catalog, the ability to search multiple databases directly from the
NIF home page, a custom web index of neuroscience resources, and a neuroscience-focused literature search
function.
Collaboration with other disciplines
Neuroinformatics is formed at the intersections of the following fields:
neuroscience
computer science
biology
experimental psychology
medicine
engineering
physical sciences
mathematics
chemistry
Biology is concerned with molecular data (from genes to cell specific expression); medicine and anatomy with the
structure of synapses and systems level anatomy; engineering electrophysiology (from single channels to scalp
surface EEG), brain imaging; computer science databases, software tools, mathematical sciences models,
chemistry neurotransmitters, etc. Neuroscience uses all aforementioned experimental and theoretical studies to
learn about the brain through its various levels. Medical and biological specialists help to identify the unique cell
types, and their elements and anatomical connections. Functions of complex organic molecules and structures,
including a myriad of biochemical, molecular, and genetic mechanisms which regulate and control brain function,
are determined by specialists in chemistry and cell biology. Brain imaging determines structural and functional
information during mental and behavioral activity. Specialists in biophysics and physiology study physical processes
within neural cells neuronal networks. The data from these fields of research is analyzed and arranged in databases
and neural models in order to integrate various elements into a sophisticated system; this is the point where
neuroinformatics meets other disciplines.
Neuroscience provides the following types of data and information on which neuroinformatics operates:
Molecular and cellular data (ion channel, action potential, genetics, cytology of neurons, protein pathways),
Data from organs and systems (visual cortex, perception, audition, sensory system, pain, taste, motor system,
spinal cord),
Neuroinformatics
722
Cognitive data (language, emotion, motor learning, sexual behavior, decision making, social neuroscience),
Developmental information (neuronal differentiation, cell survival, synaptic formation, motor differentiation,
injury and regeneration, axon guidance, growth factors),
Information about diseases and aging (autonomic nervous system, depression, anxiety, Parkinson's disease,
addiction, memory loss),
Neural engineering data (brain-computer interface), and
Computational neuroscience data (computational models of various neuronal systems, from membrane currents,
proteins to learning and memory).
Neuroinformatics uses databases, the Internet, and visualization in the storage and analysis of the mentioned
neuroscience data.
Research achievements
Several animal brains have been mapped and at least partly simulated.
Simulation of C. elegans roundworm neural system
Brain map of the C. elegans roundworm 302
neurons, interconnected by 5000 synnapses.
The connectivity of the neural circuit for touch sensitivity of the simple
C. elegans nematode (roundworm) was mapped in 1985,
[1]
and partly
simulated in 1993.
[2]
Several software simulation models of the
complete neural and muscular system, and to some extent the worm's
physical environment, have been presented since 2004, and are in some
cases available for downloading.
[3]
However, we still lack
understanding of how the neurons and the connections between them
generate the surprisingly complex range of behaviors that are observed
in this relatively simple organism.
[4]
Simulation of Drosophila fruit fly neural system
The brain belonging to the fruit fly Drosophila is also thoroughly studied, and a simplified model simulated.
[5]
Mouse brain mapping and simulation
Between 1995 and 2005, Henry Markram mapped the types of neurons and their connections in such a column.
The Blue Brain project, completed in December 2006, aimed at the simulation of a rat neocortical column, which can
be considered the smallest functional unit of the neocortex (the part of the brain thought to be responsible for higher
functions such as conscious thought), containing 10,000 neurons (and 10
8
synapses). In November 2007, the project
reported the end of the first phase, delivering a data-driven process for creating, validating, and researching the
neocortical column.
An artificial neural network described as being "as big and as complex as half of a mouse brain" was run on an IBM
blue gene supercomputer by a University of Nevada research team in 2007. A simulated time of one second took ten
seconds of computer time. The researchers said they had seen "biologically consistent" nerve impulses flowed
through the virtual cortex. However, the simulation lacked the structures seen in real mice brains, and they intend to
improve the accuracy of the neuron model.
Neuroinformatics
723
Research programs and groups
Neuroscience Information Framework
The Neuroscience Information Framework (NIF) is an initiative of the NIH Blueprint for Neuroscience Research,
which was established in 2004 by the National Institutes of Health. Unlike general search engines, NIF provides
deeper access to a more focused set of resources that are relevant to neuroscience, search strategies tailored to
neuroscience, and access to content that is traditionally hidden from web search engines. The NIF is a dynamic
inventory of neuroscience databases, annotated and integrated with a unified system of biomedical terminology] (i.e.
NeuroLex). NIF supports concept-based queries across multiple scales of biological structure and multiple levels of
biological function, making it easier to search for and understand the results. NIF will also provide a registry through
which resources providers can disclose availability of resources relevant to neuroscience research. NIF is not
intended to be a warehouse or repository itself, but a means for disclosing and locating resources elsewhere available
via the web.
Genes to Cognition
A neuroscience research programme that studies genes, the brain and behaviour in an integrated manner. It is
engaged in a large-scale investigation of the function of molecules found at the synapse. This is mainly focused on
proteins that interact with the NMDA receptor, a receptor for the neurotransmitter, glutamate, which is required for
processes of synaptic plasticity such as long-term potentiation (LTP). Many of the techniques used are
high-throughput in nature, and integrating the various data sources, along with guiding the experiments has raised
numerous informatics questions. The program is primarily run by Professor Seth Grant at the Wellcome Trust Sanger
Institute, but there are many other teams of collaborators across the world.
Neurogenetics: GeneNetwork
Genenetwork started as component of the NIH Human Brain Project in 1999 with a focus on the genetic analysis of
brain structure and function. This international program consists of tightly integrated genome and phenome data sets
for human, mouse, and rat that are designed specifically for large-scale systems and network studies relating gene
variants to differences in mRNA and protein expression and to differences in CNS structure and behavior. The great
majority of data are open access. GeneNetwork has a companion neuroimaging web sitethe Mouse Brain
Librarythat contains high resolution images for thousands of genetically defined strains of mice.
The Blue Brain Project
The Blue Brain Project was founded in May 2005, and uses an 8000 processor Blue Gene/L supercomputer
developed by IBM. At the time, this was one of the fastest supercomputers in the world. The project involves:
Databases: 3D reconstructed model neurons, synapses, synaptic pathways, microcircuit statistics, computer
model neurons, virtual neurons.
Visualization: microcircuit builder and simulation results visualizator, 2D, 3D and immersive visualization
systems are being developed.
Simulation: a simulation environment for large scale simulations of morphologically complex neurons on 8000
processors of IBM's Blue Gene supercomputer.
Simulations and experiments: iterations between large scale simulations of neocortical microcircuits and
experiments in order to verify the computational model and explore predictions.
The mission of the Blue Brain Project is to understand mammalian brain function and dysfunction through detailed
simulations. The Blue Brain Project will invite researchers to build their own models of different brain regions in
different species and at different levels of detail using Blue Brain Software for simulation on Blue Gene. These
models will be deposited in an internet database from which Blue Brain software can extract and connect models
Neuroinformatics
724
together to build brain regions and begin the first whole brain simulations.
The Neuroinformatics Portal Pilot
The project is part of a larger effort to enhance the exchange of neuroscience data, data-analysis tools, and modeling
software. The portal is supported from many members of the OECD Working Group on Neuroinformatics. The
Portal Pilot is promoted by the German Ministry for Science and Education.
The Neuronal Time Series Analysis (NTSA)
NTSA Workbench is a set of tools, techniques and standards designed to meet the needs of neuroscientists who work
with neuronal time series data. The goal of this project is to develop information system that will make the storage,
organization, retrieval, analysis and sharing of experimental and simulated neuronal data easier. The ultimate aim is
to develop a set of tools, techniques and standards in order to satisfy the needs of neuroscientists who work with
neuronal data.
Japan national neuroinformatics resource
The Visiome Platform is the Neuroinformatics Search Service that provides access to mathematical models,
experimental data, analysis libraries and related resources.
An online portal for neurophysiological data sharing is also available at BrainLiner.jp
[6]
as part of the MEXT
Strategic Research Program for Brain Sciences (SRPBS).
The CARMEN project
The CARMEN
[7]
project is a multi-site (11 universities in the United Kingdom) research project aimed at using
GRID computing to enable experimental neuroscientists to archive their datasets in a structured database, making
them widely accessible for further research, and for modellers and algorithm developers to exploit.
The Cognitive Atlas
The Cognitive Atlas
[8]
is a project developing a shared knowledge base in cognitive science and neuroscience. This
comprises two basic kinds of knowledge: tasks and concepts, providing definitions and properties thereof, and also
relationships between them. An important feature of the site is ability to cite literature for assertions (e.g. "The
Stroop task measures executive control") and to discuss their validity. It contributes to NeuroLex and the
Neuroscience Information Framework, allows programmatic access to the database, and is built around semantic
web technologies.
Research groups
The Institute of Neuroinformatics (INI) was established at the University of Zurich at the end of 1995. The
mission of the Institute is to discover the key principles by which brains work and to implement these in artificial
systems that interact intelligently with the real world.
The THOR Center for Neuroinformatics was established April 1998 at the Department of Mathematical
Modelling, Technical University of Denmark. Besides pursuing independent research goals, the THOR Center
hosts a number of related projects concerning neural networks, functional neuroimaging, multimedia signal
processing, and biomedical signal processing.
Netherlands state program in neuroinformatics started in the light of the international OECD Global Science
Forum which aim is to create a worldwide program in Neuroinformatics.
Shun-ichi Amari, Laboratory for Mathematical Neuroscience, RIKEN Brain Science Institute Wako, Saitama,
Japan. The target of Laboratory for Mathematical Neuroscience is to establish mathematical foundations of
Neuroinformatics
725
brain-style computations toward construction of a new type of information science.
Gary Egan, Neuroimaging & Neuroinformatics, Howard Florey Institute, University of Melbourne, Melbourne,
Australia. Institute scientists utilize brain imaging techniques, such as magnetic resonance imaging, to reveal the
organization of brain networks involved in human thought.
Andreas VM Herz Computational Neuroscience, ITB, Humboldt-University Berlin, Berlin Germany. This group
focuses on computational neurobiology, in particular on the dynamics and signal processing capabilities of
systems with spiking neurons.
Nicolas Le Novre, EBI Computational Neurobiology, EMBL-EBI Hinxton, United Kingdom. The main goal of
the group is to build realistic models of neuronal function at various levels, from the synapse to the micro-circuit,
based on the precise knowledge of molecule functions and interactions (Systems Biology)
The Neuroinformatics Group in Bielefeld has been active in the field of Artificial Neural Networks since 1989.
Current research programmes within the group are focused on the improvement of man-machine-interfaces,
robot-force-control, eye-tracking experiments, machine vision, virtual reality and distributed systems.
Books in the field
Computing the Brain: A Guide to Neuroinformatics by Michael A. Arbib and Jeffrey S. Grethe (2001),
Electronic Collaboration in Science (Progress in Neuroinformatics Research Series) by Stephen H. Koslow and
Michael F. Huerta (2000),
Databasing the Brain: From Data to Knowledge (Neuroinformatics) by Steven H. Koslow and Shankar
Subramaniam, (2005),
Neuroinformatics: An Overview of the Human Brain Project (Progress in Neuroinformatics Research Series) by
Stephen H. Koslow and Michael F. Huerta (1997),
Neuroscience Databases: A Practical Guide by Rolf Ktter (2002),
Brain Mapping: The Methods, Second Edition by Arthur W. Toga and John C. Mazziott (2002),
Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Health Informatics) by James J.
Cimino and Edward H. Shortliffe. (2006),
Computational Neuroanatomy: Principles and Methods edited by Giorgio Ascoli (2002),
Observed Brain Dynamics by Partha P. Mitra and Hemant Bokil (2007),
Neuroinformatics In: Methods in Molecular Biology. Ed. Chiquito J. Crasto, (2007),
Principles of Computational Modelling in Neuroscience by David Steratt et al. (2011)
Journals in the field
Frontiers in Neuroinformatics
[9]
. Open-access journal receiving submissions from all areas of neuroinformatics
Neuroinformatics. The aim of this journal is to encourage, facilitate, and disseminate the use of software tools and
databases in the neuroscience community to discover the key principles by which brains work
Journal of Computational Neuroscience
[10]
PLoS Computational Biology
[11]
Biological Cybernetics
[12]
Neural Computation
[13]
Journal on Web Semantics
[14]
. Theory and Applications, Artificial Intelligence
Journal of Integrative Neuroscience. Journal of Neuroscience
Neural Information Processing. Letters and Review Neuroscience, Computational, Neuroinformatics, Theory and
Applications
Interdisciplinary Description of Complex Systems. General science
Neuron. General Neuroscience, Cellular Neuroscience
Science. General Science
Neuroinformatics
726
Technologies and developments
The main technological tendencies in neuroinformatics are:
1. 1. Application of computer science for building databases, tools, and networks in neuroscience;
2. 2. Analysis and modeling of neuronal systems.
In order to organize and operate with neural data scientists need to use the standard terminology and atlases that
precisely describe the brain structures and their relationships.
BrainML is a system that provides a standard XML metaformat for exchanging neuroscience data. Grid computing
is an emerging computing model that provides the ability to perform higher productivity and speed in computing by
using connection of many networked computers to model a virtual computer architecture that is able to distribute
process execution across a parallel infrastructure. Grids use the resources of many separate computers connected by
a network (usually the Internet) to solve large-scale computation problems. Grids provide the ability to perform
computations on large data sets, by breaking them down into many smaller ones, or provide the ability to perform
many more computations at once than would be possible on a single computer. Grid network systems are very
important in the neuroscience research because of temporary nature of the neurosciences web-sources; its common
for such data to disappear due to maintain problems of the websites. Storage Resource Broker one of the most
advanced grid systems can offer the obvious advantages for neuronal research.
The Biomedical Informatics Research Network (BIRN) is a good example of the advance grid system for
neuroscience. BIRN is a geographically distributed virtual community of shared resources offering vast scope of
services to advance the diagnosis and treatment of disease. The BIRN enhance the communication and collaboration
between research disciplines, such as biomedical and clinical by providing necessary tools and technologies for
biomedical community. BIRN allow combining databases, interfaces and tools into a single environment. The data
exchange between cells and structures of the brain are very complicated and interconnected process. The expressed
genes and changes in their expressions are good tools for determining current state of the brain and for evaluating its
function. The gene expression analysis helps to find out the reasons of brain disease rising from genes.
GeneWays system concerned with cellular morphology and circuits. GeneWays is a system for automatically
extracting, analyzing, visualizing and integrating molecular pathway data from the research literature. The system
focuses on interactions between molecular substances and actions, providing a graphical view on the collected
information and allows researchers to review and correct the integrated information. Mathematical modeling is very
important for neuroinformatics such as models on cellular and neuronal levels.
Neocortical Microcircuit Database (NMDB). A profound database of versatile brains data from cells to complex
structures. Researchers are able not only to add data to the database but also to acquire and edit one.
SenseLab a collection of multilevel neuronal databases and tools. SenseLab contains six related databases that
support experimental and theoretical research on the membrane properties that mediate information processing in
nerve cells, using the olfactory pathway as a model system. Detailed imaging of brain structure and function is
provided by the web-based high-resolution anatomical brain atlases. One of the examples is a BrainMaps.org.
BrainMaps.org is an interactive high-resolution digital brain atlas using a high-speed database and virtual
microscope that is based on over 12 million megapixels of scanned images of several species, including human.
Another approach in the area of the brain mappings is the probabilistic atlases obtained from the real data from
different group of people, formed by specific factors, like age, gender, diseased etc. Provides more flexible tools for
brain research and allow obtaining more reliable and precise results, which cannot be achieved with the help of
traditional brain atlases.
Neuroinformatics
727
References
[1] Chale, M., Sulston, J. E., White, J. G., Southgate, E., Thomson, J. N., and Brenner, S. (1985). The neural circuit for touch sensitivity in
Caenorhabditis elegans (http:/ / www. jneurosci.org/ content/ 5/ 4/ 956. full. pdf). The Journal of Neuroscience, 5(4):95696.
[2] Niebur, E. and Erdos, P. (1993). Theory of the locomotion of nematodes: Control of the somatic motor neurons by interneurons (http:/ / www.
ncbi.nlm. nih.gov/ pubmed/ 8260760). Mathematical Biosciences, 118(1):5182.
[3] Bryden, J. and Cohen, N. (2004). A simulation model of the locomotion controllers for the nematodode Caenorhabditis elegans. In Schaal, S.,
Ijspeert, A., Billard, A., Vijayakumar, S., Hallam, J., and Meyer, J.-A., editors, From Animals to Animats 8: Proceedings of the eighth
international conference on the Simulation of Adaptive Behaviour, pages 183192.
[4] Mark Wakabayashi (http:/ / itee. uq. edu. au/ ~markw/ celegans/ ), with links to MuCoW simulation software, a demo video and the doctoral
thesis COMPUTATIONAL PLAUSIBILITY OF STRETCH RECEPTORS AS THE BASIS FOR MOTOR CONTROL IN C. elegans, 2006.
[5] Arena, P.; Patane, L.; Termini, P.S.; An insect brain computational model inspired by Drosophila melanogaster: Simulation results (http:/ /
scholar.google. se/ scholar?cluster=12345296403665184996& hl=sv& as_sdt=0,5), The 2010 International Joint Conference on Neural
Networks (IJCNN).
[6] http:/ / brainliner. jp
[7] http:/ / www. carmen. org.uk/
[8] http:/ / www. cognitiveatlas. org/
[9] http:/ / frontiersin. org/ neuroinformatics
[10] http:/ / www.springerlink.com/ content/ 100282/
[11] http:/ / www.ploscompbiol. org
[12] http:/ / www.springerlink.com/ content/ 100465/
[13] http:/ / www.mitpressjournals. org/ loi/ neco
[14] http:/ / ees. elsevier. com/ jws/
Notes
Adee, S. (2008). "Reverse Engineering the Brain". Spectrum, IEEE 45 (6): 5153. doi:
10.1109/MSPEC.2008.4531462 (http:/ / dx. doi. org/ 10. 1109/ MSPEC. 2008. 4531462).
INCF (2010). "INCF Strategy Overview 2008-2010". Missing or empty |url= (help)
Daniel Gardner and Gordon M. Shepherd (2004). "A gateway to the future of Neuroinformatics".
Neuroinformatics 2 (3): 271274. doi: 10.1385/NI:2:3:271 (http:/ / dx. doi. org/ 10. 1385/ NI:2:3:271). PMID
15365191 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 15365191).
Giorgio A. Ascoli, Erik De Schutter and David N. Kennedy (2003). "An information science infrastructure for
neuroscience". Neuroinformatics 3 (1): 12. doi: 10.1385/NI:1:1:001 (http:/ / dx. doi. org/ 10. 1385/ NI:1:1:001).
ISSN 1539-2791 (http:/ / www. worldcat. org/ issn/ 1539-2791). PMID 15055390 (http:/ / www. ncbi. nlm. nih.
gov/ pubmed/ 15055390).
Society for neuroscience Annual Report. Navigating a changing landscape. FY2006
Stephen H. Koslow, Michael F. Huerta, Neuroinformatics. An overview of the Human Brain Project
F. Beltrame and Stephen H. Koslow (September 1999). "Neuroinformatics as a megascience issue". IEEE Trans.
Inf. Technol. Biomed. 3 (3): 239240. doi: 10.1109/4233.788587 (http:/ / dx. doi. org/ 10. 1109/ 4233. 788587).
Steven H. Koslow and Shankar Subramaniam (2005). Databasing the Brain: From Data to Knowledge,
(Neuroinformatics). John Wiley & Sons. ISBN0-471-30921-4.
M. A. Arbib and J. S. Grethe, Computing the Brain, A Guide to Neuroinformatics. San Diego, CA, USA, 2001.
Healthcare Effectiveness Data and Information Set
728
Healthcare Effectiveness Data and Information
Set
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in
the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).
HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or
regional benchmarks. Although not originally intended for trending, HEDIS results are increasingly used to track
year-to-year performance. HEDIS is one component of NCQA's accreditation process, although some plans submit
HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a Centers for
Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs) submit
Medicare HEDIS data in order to provide HMO services for Medicare enrollees under a program called Medicare
Advantage.
HEDIS was originally titled the "HMO Employer Data and Information Set" as of version 1.0 of 1991.
[1]
In 1993,
Version 2.0 of HEDIS was known as the "Health Plan Employer Data and Information Set".
[2]
Version 3.0 of HEDIS
was released in 1997. In July 2007, NCQA announced that the meaning of "HEDIS" would be changed to
"Healthcare Effectiveness Data and Information Set."
[3]
In current usage, the "reporting year" after the term "HEDIS" is one year following the year reflected in the data; for
example, "HEDIS 2009" reports, which will be available in June 2009, will contain analyses of data collected from
"measurement year" JanuaryDecember 2008.
[4]
Structure
The 75 HEDIS measures are divided into eight "domains of care"<ref
name=<http://blackboard.fresnocitycollege.edu/courses/1/HIT-12-26552-2013SP/content/_1882003_1/HIT%2012%20article%20C4%20MCO%20Data.PDF>WhatIsHEDIS>What
is HEDIS?
[5]
Washington, D.C.: National Committee for Quality Assurance. Accessed 2009 Apr 25.</ref>:
[6]
Effectiveness of Care
Access/Availability of Care
Experience of Care
Health plan stability
Utilization and Relative Resource Use
Informed healthcare choices (availability of new member orientation, education,
language translation services, etc.)
Health Plan Descriptive Information
Measures are added, deleted, and revised annually. For example, a measure for the length of stay after giving birth
was deleted after legislation mandating minimum length of stay rendered this measure nearly useless. Increased
attention to medical care for seniors prompted the addition of measures related to glaucoma screening and
osteoporosis treatment for older adults. Other health care concerns covered by HEDIS are immunizations, cancer
screenings, treatment after heart attacks, diabetes, asthma, flu shots, access to services, dental care, alcohol and drug
dependence treatment, timeliness of handling phone calls, prenatal and postpartum care, mental health care,
well-care or preventive visits, inpatient utilization, drug utilization, and distribution of members by age, sex, and
product lines.
New measures in HEDIS 2013 are Asthma Medication Ratio, Diabetes Screening for People With Schizophrenia
and Bipolar Disorder Who Are Using Antipsychotic Medications, Diabetes Monitoring for People With Diabetes
and Schizophrenia, Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia, and
Adherence to Antipsychotic Medications for Individuals With Schizophrenia.
[citation needed]
Healthcare Effectiveness Data and Information Set
729
Data collection
HEDIS data are collected through surveys, medical charts and insurance claims for hospitalizations, medical office
visits and procedures. Survey measures must be conducted by an NCQA-approved external survey organization.
Clinical measures use the administrative or hybrid data collection methodology, as specified by NCQA.
Administrative data are electronic records of services, including insurance claims and registration systems from
hospitals, clinics, medical offices, pharmacies and labs. For example, a measure titled Childhood Immunization
Status requires health plans to identify 2 year old children who have been enrolled for at least a year. The plans
report the percentage of children who received specified immunizations. Plans may collect data for this measure by
reviewing insurance claims or automated immunization records, but this method will not include immunizations
received at community clinics that do not submit insurance claims. For this measure, plans are allowed to select a
random sample of the population and supplement claims data with data from medical records. By doing so, plans
may identify additional immunizations and report more favorable and accurate rates. However, the hybrid method is
more costly, time-consuming and requires nurses or medical record reviewers who are authorized to review
confidential medical records.
Reporting
HEDIS results must be audited by an NCQA-approved auditing firm for public reporting. NCQA has an on-line
reporting tool called Quality Compass that is available for a fee of several thousand dollars. It provides detailed data
on all measures and is intended for employers, consultants and insurance brokers who purchase health insurance for
groups. NCQA's web site includes a summary of HEDIS results by health plan. NCQA also collaborates annually
with U.S. News & World Report to rank HMOs using an index that combines many HEDIS measures and
accreditation status. The "Best Health Plans" list is published in the magazine in October and is available on the
magazine's web site. Other local business organizations, governmental agencies and media report HEDIS results,
usually when they are released in the fall.
Advantages and disadvantages
Advantages
Proponents cite the following advantages of HEDIS measures:
HEDIS measures undergo a selection process that has been described as "rigorous"
[7](p.205)
. Steps in the process
include assessment of a measure's "importance, scientific soundness and feasibility"; field testing; public
comment; a one-year trial period in which results are not reported publicly; and evaluation of publicly reported
measures by "statistical analysis, review of audit results and user comments".
[8]
HEDIS data are useful for "evaluating current performance and setting goals".
[9]
In some studies, attainment of HEDIS measures is associated with cost-effective practices or with better health
outcomes.
In a 2002 study, HEDIS measures "generally reflect[ed] cost-effective practices".
[10]
A 2003 study of Medicare managed care plans determined that plan-level health outcomes were associated
with HEDIS measures.
[11]
An "Acute Outpatient Depression Indicator" score based on a HEDIS measure predicted improvement in
depression severity in one 2005 study.
[12]
As stated in a 2006 Institute of Medicine (IOM) report, "HEDIS measures focus largely on processes of care";
[13]
the strengths of process measures include the facts that they "reflect care that patients actually receive," thereby
leading to "buy-in from providers," and that they are "directly actionable for quality improvement
activities"
(p.179)
.
Healthcare Effectiveness Data and Information Set
730
HEDIS measures are "widely known and accepted"
(p.205)
. The NCQA claims that over 90% of U.S. health plans
use HEDIS measures.
[14]
Disadvantages
HEDIS was described in 1995 as "very controversial".
[15]
Criticisms of HEDIS measures have included:
HEDIS measures do not account for many important aspects of health care quality.
In 1998, HEDIS measures were said to "offer little insight into... [a health] plans ability to treat serious
illnesses".
[16]
A 2002 study found "there are numerous non-HEDIS interventions with some evidence of cost effectiveness,
particularly interventions to promote healthy behaviors".
According to a 2005 study, HEDIS-Medicaid 3.0 measures covered only 22% of the services recommended by
the second U.S. Preventive Services Task Force (USPSTF).
[17]
Attempts by health care providers to improve their HEDIS measures may cause harm to patients.
As of 2001, there was concern that the asthma HEDIS measure may "encourag[e] more casual prescribing of
controller medications" and may place emphasis "on the prescribing of a controller medication rather than on
its actual use".
[18]
There is a risk of hypoglycemia if a provider strives to meet the HEDIS measure concerning a hemoglobin A1c
(HbA1c) level of <7% that was adopted in 2006 for HEDIS 2007.
[19]
NCQA later decided to not report results
of the HbA1c<7% measure publicly in 2008, to modify the HbA1c<7% measure for HEDIS 2009 "by adding
exclusions for members within a specific age cohort and with certain comorbid conditions," and to add a new
HbA1c<8% measure.
[20]
The process to develop HEDIS measures may be flawed.
There is a possible conflict of interest because NCQA "works closely with the managed-care industry".
Furthermore, approximately half of NCQA's budget is derived from accreditation fees, "which may create an
incentive against setting [HEDIS] standards too high".
[21]
The process to develop the measures is not completely "transparent," that is, "information about existing
conditions, decisions and actions" is not completely "accessible, visible and understandable.
In some cases, attainment of HEDIS measures is not proven to be associated with better health outcomes.
In 2004, a multi-site study determined that persons with persistent asthma per the HEDIS definition at the time
had more "asthma-related adverse events" if they were classified by HEDIS as having appropriate asthma
therapy than if they did not have appropriate therapy.
[22]
This cause of this "unexpected" finding was thought
to be that some people with intermittent asthma were miscategorized by HEDIS as having persistent asthma.
A 2008 study of 1056 adults with asthma found that "compliance with the HEDIS asthma measure is not
favorably associated with relevant patient-oriented outcomes" such as scores on an Asthma Control Test.
[23]
Although "glaucoma screening in older adults" is a current HEDIS measure, the USPSTF found "insufficient
evidence to recommend for or against screening adults for glaucoma" in 2005;
[24]
as of 2008, the American
Academy of Ophthalmology was attempting to convince the USPSTF to review its statement.
[25]
Furthermore,
a 2006 Cochrane review ("last assessed as up-to-date" in 2009) concluded that there was "insufficient evidence
to recommend population based screening" for glaucoma because no pertinent randomized controlled trials
exist.
[26]
One summary of the Cochrane review was "population-based screening for glaucoma... is not
clinically or cost-effective".
[27]
A 2001 IOM report noted that "there is incomplete reporting of [HEDIS] measures and health plans resulting in
lack of representativeness at the national level"
(p.205)
.
As stated in the 2006 IOM report, the limitations of HEDIS process measures include "sample size constraints for
condition-specific measures," "may be confounded by patient compliance and other factors," and "variable extent
Healthcare Effectiveness Data and Information Set
731
to which process measures link to important patient outcomes"
(p.179)
.
References
http:/ / www. ncqa. org/ Portals/ 0/ HEDISQM/ HEDIS2013/ HEDIS_2013_October_Update_Final_10. 1. 12. pdf
[28]
[1] Mainous AG 3rd, Talbert J. Assessing quality of care via HEDIS 3.0. Is there a better way? (http:/ / archfami. ama-assn. org/ cgi/ reprint/ 7/ 5/
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[4] HEDIS 2010 public comment overview. (http:/ / www. ncqa. org/ Portals/ 0/ PublicComment/ HEDIS2010/
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[19] Aron D, Pogach L. Transparency standards for diabetes performance measures. (http:/ / jama. ama-assn. org/ cgi/ content/ extract/ 301/ 2/
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2009_Vol2_Technical_Update.pdf) Washington, D.C.: National Committee for Quality Assurance, 2008 Oct 1. Accessed 2009 May 6.
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SD, Vollmer B, Weiss KB. The utility of the Health Plan Employer Data and Information Set (HEDIS) asthma measure to predict
asthma-related outcomes. (http:/ / www.worldcongress.com/ pdf/ Reprint_HEDIS_12. 2004. pdf) Ann Allergy Asthma Immunol 2004
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[24] U.S. Preventive Services Task Force (USPSTF). Screening for glaucoma. Recommendation statement. (http:/ / www. ahrq. gov/ clinic/
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Glaucoma+ Society+ Meeting/ Lobbyist-outlines-glaucoma-related-initiatives/ ArticleStandard/ Article/ detail/ 501399) Ophthalmology
Times 2008 Mar 7. Accessed 2009 May 6.
[26] Hatt SR, Wormald R, Burr J. Screening for prevention of optic nerve damage due to chronic open angle glaucoma. (http:/ / www. cochrane.
org/ reviews/ en/ ab006129. html) Cochrane Database of Systematic Reviews 2006 Oct 18;4. Accessed 2009 May 6.
[27] McKinnon SJ, Goldberg LD, Peeples P, Walt JG, Bramley TJ. Current management of glaucoma and the need for complete therapy. (http:/ /
www.ajmc. com/ media/ pdf/ A195_McKinnonS20toS27. pdf) Am J Manag Care 2008 Feb;14(1 Suppl):S20-7. Accessed 2009 May 6.
[28] http:/ / www.ncqa.org/ Portals/ 0/ HEDISQM/ HEDIS2013/ HEDIS_2013_October_Update_Final_10. 1. 12. pdf
External links
U.S. News & World Report. America's best health plans. (http:/ / health. usnews. com/ sections/ health/
health-plans/ )
Health plan report card. (http:/ / reportcard. ncqa. org/ plan/ external/ plansearch. aspx) Washington, D.C.:
National Committee for Quality Assurance.
HEDIS & quality measurement. (http:/ / www. ncqa. org/ tabid/ 59/ Default. aspx) Washington, D.C.: National
Committee for Quality Assurance.
The ironic conundrum of the preference sensitive measures, P4P and HEDIS criteria. (http:/ / stanford.
wellsphere. com/ healthcare-industry-policy-article/
the-ironic-conundrum-of-the-preference-sensitive-measures-p4p-and-hedis-criteria/ 622142) Disease
Management Care Blog, 2009 Mar 8.
Dalzell MD. Will integrity of HEDIS data improve with '98 version? (http:/ / www. managedcaremag. com/
archives/ 9802/ 9802. hedis. shtml) Managed Care, 1998 February.
E-epidemiology
E-epidemiology is the science underlying the acquisition, maintenance and application of epidemiological
knowledge and information using digital media such as the internet, mobile phones, digital paper, digital TV.
E-epidemiology also refers to the large-scale epidemiological studies that are increasingly conducted through
distributed global collaborations enabled by the Internet.
The traditional approach in performing epidemiological trials by using paper questionnaires is both costly and time
consuming. The questionnaires have to be transformed to analyzable data and a large number of personnel are
needed throughout the procedure. Modern communication tools, such as the web, cell phones and other current and
future communication devices, allow rapidly and cost-efficient assembly of data on determinants for lifestyle and
health for broad segments of the population. Modern IT technology provides means for storage, organization and
retrieval of large amounts of biological and lifestyle data, which will ensure more data and more reliable statistical
results. Efficient number crunching computing, using modern analytical tools and simulation based inference
procedures allow knowledge to be extracted from the resulting large and complex data-structures. Web portals
directly connected to the studies enables instant feedback and information to the participants. It also allows
animations and other web based tools linked to the questionnaires, which can increase the interactivity and facilitates
flow of information between the study participant and the study centre. The web portal will also generate a
possibility for the Universities to carry out the third assignment, which is to spread the knowledge generated at the
University to the public.
Important aspects of e-epidemiology include the development of security and confidentiality preserving solutions to
protect individual integrity and research data ownership. But entering an epidemiological trial via the Internet is
probably safer then traditional manners. Accurate security programmes and firewalls are a critical condition for
E-epidemiology
733
handling personal records over the Internet.
References
External links
MEB.ki.se (http:/ / www. meb. ki. se/ staff/ profiles/ litton_je_se. html) - Professor Jan-Eric Litton (faculty
homepage), Karolinska Institutet (Swedish website)
http:/ / www. phi. man. ac. uk/ Presentations/ e-epidemiology. pdf
Epi Info
734
Epi Info
Epi Info
Developer(s) Centers for Disease Control and Prevention
Stable release 7.1.0.6 / August9, 2012
Written in Microsoft Visual C# 3.5
Operating system Windows
Type Statistical software, epidemiology
License Public domain
Website
http:/ / www. cdc. gov/ epiinfo
[1]
Epi Info is public domain statistical software for epidemiology developed by Centers for Disease Control and
Prevention (CDC) in Atlanta, Georgia (USA).
Epi Info has been in existence for over 20 years and is currently available for Microsoft Windows. The program
allows for electronic survey creation, data entry, and analysis. Within the analysis module, analytic routines include
t-tests, ANOVA, nonparametric statistics, cross tabulations and stratification with estimates of odds ratios, risk
ratios, and risk differences, logistic regression (conditional and unconditional), survival analysis (Kaplan Meier and
Cox proportional hazard), and analysis of complex survey data. The software is in the public domain, free, and can
be downloaded from http:/ / www. cdc. gov/ epiinfo. Limited support is available.
An analysis conducted in 2003 documented over 1,000,000 downloads of Epi Info from 180 countries.
History
Epi Info has been in development for over 20 years. The first version, Epi Info 1, was originally implemented as an
MS-DOS batch file on 5.25" floppy disks and released in 1985. MS-DOS continued to be the only supported
operating system until the release of Epi Info 2000, which was written in Microsoft's Visual Basic and became the
first Windows-compatible version. The last MS-DOS version was Epi Info 6.04d released in January 2001.
Epi Info 2000 changed the way data was stored by adopting the Microsoft Access database format, rather than
continuing to use the plain-text file format from the MS-DOS versions. Following the release of Epi Info 2000 was
Epi Info 2002, then Epi Info version 3.0, and finally the open-source Epi Info 7. The 7 series is the presently
maintained Epi Info product line. Note that Epi Info 3 for Windows is different than Epi Info 3 for MS-DOS even
though they share the same version number.
Windows Vista was officially supported with version 3.5.1, released on August 13, 2008.
The next iteration of the Epi Info series, Epi Info 7, was made open source on November 13, 2008 when its source
code was uploaded to Codeplex for the first time.
Epi Info
735
Features
From a user's perspective, one of the most important functions of Epi Info is the ability to rapidly develop a
questionnaire, customize the data entry process, quickly enter data into that questionnaire, and then analyze the data.
For epidemiological uses, such as outbreak investigations, being able to rapidly create an electronic data entry screen
and then do immediate analysis on the collected data can save considerable amounts of time versus using paper
surveys.
Epi Info uses three distinct modules to accomplish these tasks: Form Designer, Enter, and Analysis. Other modules
include the Report module, a mapping module, a menu module, and various utilities such as StatCalc.
Electronic questionnaires are created in the Form Designer module. Individual questions can be placed anywhere on
a page and each form may contain multiple pages. The user is given a high degree of control over the form's
appearance and function. The user defines both the question's prompt and the format of the data that is to be
collected. Data types include numbers, text strings, dates, times, and Boolean. Users can also create drop-down lists,
code tables, and comment legal fields. One of the more powerful features of Form Designer is the ability to program
intelligence into a form through a feature called "check code". Check code allows for certain events to occur
depending on what action a data entry person has taken. For example, if the data entry person types "Male" into a
question on gender, any questions relating to pregnancy might then be hidden or disabled. Skip patterns, message
boxes, and math operations are also available. Relational database modeling is supported, as users may link their
form to any number of other forms in their database.
The "Classic Analysis" module is where users analyze their data. Import and export functions exist that allow for file
types to be converted between plain-text, CSV, Microsoft Excel, Microsoft Access, dBase, FoxPro, and other
formats. Many advanced statistical routines are provided, such as t-tests, ANOVA, nonparametric statistics, cross
tabulations and stratification with estimates of odds ratios, risk ratios, and risk differences, logistic regression
(conditional and unconditional), survival analysis (Kaplan Meier and Cox proportional hazard), and analysis of
complex survey data.
The "Visual Dashboard" module is a lighter-weight Analysis component that is designed to be easy to use, but does
not contain the full set of data management and statistical commands that the "Classic Analysis" module does.
Using the Map module, data can be displayed either by geographic reference or by GPS coordinates. The Report
module (planned) allows the user to edit and format output from various Epi Info tools and modules. The resulting
HTML document can then be printed or emailed to others.
The menu module (planned) allows for the editing and re-arranging of the basic Epi Info menu structure. This
module is powerful enough that several applications have been built off of it (in versions of Epi Info prior to version
7), including the National Electronic Telecommunications System for Surveillance (NETSS) for Epi Info 6. Unlike
the other modules, the menu module does not have a design-mode user interface, but instead resides in a .mnu file
whose scripts must be edited manually.
Epi Info 7 also includes a number of nutritional anthropometric functions that can assist in recording and evaluating
measurements of length, stature, weight, head circumference, and arm circumference for children and adolescents.
They can be used to calculate percentiles and number of standard deviations from the mean (Z-scores) using the
CDC/WHO 1978 growth reference, CDC 2000 growth reference, the WHO Child Growth Reference, or the WHO
Reference 2007. It replaces the NutStat and EpiNut modules found in prior versions of Epi Info.
Epi Info
736
Future developments
Version 7 is currently in continuing development as an open-source project and written using Microsoft's C# .NET
programming language. Source code distribution and contribution currently takes place through Codeplex.
Web-based data entry, reporting capabilities, a fully featured menu module, and handheld/mobile data entry (for
Android-based devices) are planned for 2012.
Release history
Series Version Operating
System
Support
Support
status
Release
date
Significant changes
Epi
Info for
DOS
1 MS-DOS 1 Sep
1985
2 MS-DOS 20 Aug
1986
3 MS-DOS 1988
4.1 MS-DOS 15 Nov
1988
5.01 MS-DOS Oct
1990
Allowed European date formats and non-English characters in data fields.
6.0 MS-DOS 1992 Added programmable menu system
6.02 MS-DOS Oct
1994
6.04c MS-DOS 1998 Year 2000 compatibility upgrade
6.04d MS-DOS Jan
2001
Epi
Info
2000
2000
1.1.2
Windows 9x,
NT 4.0, 2000
2 Nov
2001
First Windows-compatible version of Epi Info.
2002 R2 Windows 9x,
NT 4.0, 2000,
XP
30 Jan
2003
Epi Info
737
Epi
Info 3
3.0 Windows 9x,
NT 4.0, 2000,
XP
n/a
3.01 Windows 9x,
NT 4.0, 2000,
XP
3 Nov
2003
3.2 Windows 9x,
NT 4.0, 2000,
XP
4 Feb
2004
3.2.2 Windows 9x,
NT 4.0, 2000,
XP
14 Apr
2004
3.3 Windows 98,
NT 4.0, 2000,
XP
5 Oct
2004
Windows 95 no longer supported, case-based mapping functionality added to the
Analysis MAP command.
3.3.2 Windows 98,
NT 4.0, 2000,
XP
9 Feb
2005
3.4 Windows 98,
NT 4.0, 2000,
XP
30 Apr
2007
Ability to use standard ISO date formats, disallowed multiple instances of the
Analysis module, added ability to run reports from Analysis, and CDC flags added to
the Nutrition module.
3.4.1 Windows 98,
NT 4.0, 2000,
XP
9 Jul
2007
Added a right-to-left language controller in Analysis
3.4.2 Windows 98,
NT 4.0, 2000,
XP
20 Sep
2007
3.4.3 Windows 98,
NT 4.0, 2000,
XP
17 Oct
2007
3.5 Windows 98,
NT 4.0, 2000,
XP SP3
9 Jun
2008
Added feature to use standardized vocabularies. First version to require Service Pack
3 if running Epi Info on a computer with Windows XP.
3.5.1 Windows 98,
NT 4.0, 2000,
XP SP3, Vista
13 Aug
2008
First version compatible with Windows Vista. This version also fixed compatibility
for languages that are read right-to-left.
3.5.2 Windows 98,
NT 4.0, 2000,
XP SP3, Vista, 7
17 Dec
2010
First version compatible with Windows 7. Also included a preview of the new Epi
Info 7 MakeView and Enter tools.
3.5.3 Windows 98,
NT 4.0, 2000,
XP SP3, Vista, 7
26 Jan
2011
Minor update to the Epi Info Enter tool released with 3.5.2.
3.5.4 Windows 98,
NT 4.0, 2000,
XP SP3, Vista, 7
10 Aug
2012
Modified installation packaging.
Epi Info
738
Epi
Info 7
7.0.5
(Alpha)
Windows XP,
Vista, 7, Ubuntu
5 Jan
2009
Programming language changed to Visual C# .NET; MySQL and SQL Server
database support added; XML meta-data support added; Linux compatibility added;
first Windows version of Epi Info to be open source.
7.0.7.0 Windows XP,
Vista, 7
27 Sep
2011
Upgraded framework to .NET version 3.5; Added ability to run Epi Info 7 from a
flash drive without administrator rights; Added ability for Epi Info 7 forms to work
with essentially unlimited number of fields; Mapping module added; Geocoding
added; Visual Dashboard module added; plugin-based data driver model added;
Linux and MySQL support removed; Growth charting added.
7.0.8.0 Windows XP,
Vista, 7
28 Oct
2011
Release build. Added ability to install Epi Info 7 using a traditional setup file; Added
new check code commands; Added ability to calculate z-scores for the WHO Child
Growth Standards and WHO Reference 2007.
7.1.0.6 Windows XP,
Vista, 7
9 Aug
2012
Major updates to Dashboard module; Added web-based data entry capability; Added
features to allow compatibility with the Epi Info for Android app.
Series Version Operating
System
Support
Support
status
Release
date
Significant changes
References
[1] http:/ / www. cdc.gov/ epiinfo/
External links
Epi Info (http:/ / www. cdc. gov/ EpiInfo/ )
Epi Info Community of Users (http:/ / forums. myepi. info/ )
Epi Info Community Portal (http:/ / www. phconnect. org/ group/ epiinfo)
Epi Info Community Edition (open source version) (http:/ / epiinfo. codeplex. com/ )
OpenEpi
739
OpenEpi
OpenEpi
OpenEpi 2.3
Developer(s) AG Dean, KM Sullivan, MM Soe
Stable release 2.3.1 / September1, 2010
Operating system Cross-platform
Platform HTML, JavaScript
Type Web application, Statistical analysis
License MIT License
Website
www.openepi.com
[1]
OpenEpi is a free, web-based, open source, operating system-independent series of programs for use in
epidemiology, biostatistics, public health, and medicine, providing a number of epidemiologic and statistical tools
for summary data. OpenEpi was developed in JavaScript and HTML, and can be run in modern web browsers. The
program can be run from the OpenEpi website or downloaded and run without a web connection. The source code
and documentation is downloadable and freely available for use by other investigators. OpenEpi has been reviewed,
both by media organizations and in research journals.
[2][3]
The OpenEpi developers have had extensive experience in the development and testing of Epi Info, a program
developed by the Centers for Disease Control and Prevention (CDC) and widely used around the world for data entry
and analysis. OpenEpi was developed to perform analyses found in the DOS version of Epi Info modules StatCalc
and EpiTable, to improve upon the types of analyses provided by these modules, and to provide a number of tools
and calculations not currently available in Epi Info. It is the first step toward an entirely web-based set of
epidemiologic software tools. OpenEpi can be thought of as an important companion to Epi Info and to other
programs such as SAS, PSPP, SPSS, Stata, SYSTAT, Minitab, Epidata, and R (see the R programming language).
Another functionally similar Windows-based program is Winpepi. See also list of statistical packages and
comparison of statistical packages. Both OpenEpi and Epi Info were developed with the goal of providing tools for
low and moderate resource areas of the world. The initial development of OpenEpi was supported by a grant from
the Bill and Melinda Gates Foundation to Emory University.
[4]
The types of calculations currently performed by OpenEpi include:
Various confidence intervals for proportions, rates, standardized mortality ratio, mean, median, percentiles
2x2 crude and stratified tables for count and rate data
Matched case-control analysis
Test for trend with count data
Independent t-test and one-way ANOVA
Diagnostic and screening test analyses with receiver operating characteristic (ROC) curves
OpenEpi
740
Sample size for proportions, cross-sectional surveys, unmatched case-control, cohort, randomized controlled
trials, and comparison of two means
Power calculations for proportions (unmatched case-control, cross-sectional, cohort, randomized controlled trials)
and for the comparison of two means
Random number generator
For epidemiologists and other health researchers, OpenEpi performs a number of calculations based on tables not
found in most epidemiologic and statistical packages. For example, for a single 2x2 table, in addition to the results
presented in other programs, OpenEpi provides estimates for:
Etiologic or prevented fraction in the population and in exposed with confidence intervals, based on risk, odds, or
rate data
The cross-product and MLE odds ratio estimate
Mid-p exact p-values and confidence limits for the odds ratio
Calculations of rate ratios and rate differences with confidence intervals and statistical tests.
For stratified 2x2 tables with count data, OpenEpi provides:
Mantel-Haenszel (MH) and precision-based estimates of the risk ratio and odds ratio
Precision-based adjusted risk difference
Tests for interaction for the risk ratio, odds ratio, and risk difference
Four different confidence limit methods for the odds ratio.
Similar to Epi Info, in a stratified analysis, both crude and adjusted estimates are provided so that the assessment of
confounding can be made. With rate data, OpenEpi provides adjusted rate ratios and rate differences, and tests for
interaction. Finally, with count data, OpenEpi also performs a test for trend, for both crude data and stratified data.
In addition to being used to analyze data by health researchers, OpenEpi has been used as a training tool for teaching
epidemiology to students at: Emory University, University of Massachusetts, University of Michigan, University of
Minnesota, Morehouse College, Columbia University, University of Wisconsin, San Jose State University,
University of Medicine and Dentistry of New Jersey, University of Washington, and elsewhere. This includes
campus-based and distance learning courses. Because OpenEpi is easy to use, requires no programming experience,
and can be run on the internet, students can use the program and focus on the interpretation of results.
Version 2.2 of OpenEpi was released Nov 11 2007 with the improvement of being able to run in English, French,
Spanish, or Italian. Version 2.3 was released May 20, 2009 and fixes a number of issues identified by users.
Comments and suggestions for improvements are welcomed and the developers respond to user queries. The
developers encourage others to develop modules that could be added to OpenEpi and provide a developers tool at
the website. Planned future development include improvements to existing modules, development of new modules,
translation into other languages, and add the ability to cut and paste data and/or read data files.
References
[1] http:/ / www. openepi. com/
[2] OpenEpi online Technology, Health & Development (http:/ / thdblog. wordpress. com/ 2007/ 09/ 24/ openepi-online/ )
[3] Great free tools for teaching statistics | Education IT | ZDNet.com (http:/ / education. zdnet. com/ ?p=1220)
[4] http:/ / www. gatesfoundation. org/ nr/ public/ media/ annualreports/ annualreport01/ pdf/ BMGF2001GlobalHealth. pdf
External links
Official website (http:/ / www. openepi. com/ )
Living Human Project
741
Living Human Project
The Living Human Project (LHP) is developing a worldwide, distributed repository of anatomo-functional data
and of simulation algorithms relative to the human musculoskeletal apparatus, fully integrated into a seamless
simulation environment and directly accessible by any researcher in the world. This infrastructure will be used to
create the physiome of the human musculoskeletal system.
The Story so far
This initiative started in 2002 as a result of the BioNet coordination action, aimed to establish the grand challenges
for European biomechanics. The BioNet consensus document
[1]
clearly pointed out the need for an Internet-based
virtual community as a mean to share biomechanics data.
In 2003 a group of partners who were also involved with the BioNet action wrote a public document
[2]
drafting a
possible strategy to have the LHP started.
In the meanwhile Marco Viceconti, a researcher at the Rizzoli Institute
[3]
in Bologna (Italy) started a voluntary
effort called Biomechanics European Lab (BEL). The idea was to create a community of interested colleagues, who
would develop the LHP without any centralised funding.
In 2006 The BEL was merged with to Biomed Town
[4]
, a new Internet community reserved to all those who have
professional interest in biomedical research. The BEL data repository
[5]
remains available on Biomed Town for
historical reasons.
It was evident that the most important limiting factor for LHP was the lack of an adequate information technology
infrastructure. This need is now being matched by two separate provisions.
Living Human Digital Library
A consortium of European institutions
[6]
is developing the Living Human Digital Library
[7]
, as part of the LHDL
STRP project
[8]
supported by the European Commission. This wiki page
[7]
contains constantly updated information
on the LHDL project.
The LHDL project will end in January 2009; soon after, the LHDL consortium will release a biomedical data
management and sharing service, called Physiome
Space.Wikipedia:Manual_of_Style_(dates_and_numbers)#Chronological_items Physiome Space will make possible
for single researchers as well as for large consortia to share with their peers very large collections of biomedical data,
including medical imaging, computer simulations, etc. It is possible to sign up for the beta users group
[9]
, which
should start in the last quarter of 2008.Wikipedia:Manual_of_Style_(dates_and_numbers)#Chronological_items
Biomed Town
The users of LHP, e.g. all those research, industry, or clinical professionals that are interested in the musculoskeletal
system in every possible way and at every dimensional scale, from the whole body down to the cell and the proteins,
created a collaborative community within Biomed Town. The activities of the LHDL Consortium are hosted in the
LHDL Building
[10]
. The community consensus process takes place in the Living Human Square
[11]
.
References
Viceconti, M., Taddei, F., Petrone, M., Galizia, S., Jan, S. V. S., and Clapworthy, G., 2006, "Towards the Virtual
Physiological Human: the Living Human Project," The 7th International Symposium on Computer Methods in
Biomechanics and Biomedical Engineering (CMBBE 2006), Antibes Cte dAzur, France.
Living Human Project
742
Viceconti, M., Taddei, F., Montanari, L., Testi, D., Leardini, A., Clapworthy, G., and Van Sint Jan, S., 2007,
"Multimod Data Manager: A tool for data fusion," Computer Methods and Programs in Biomedicine, 87(2),
pp.148159.
Viceconti, M., Taddei, F., Van Sint Jan, S., Leardini, A., Clapworthy, G., Galizia, S., and Quadrani, P., 2007,
"Towards the multiscale modelling of musculoskeletal system," Bioengineering Modeling and Computer
Simulation, Barcelona, Spain.
Viceconti, M., Zannoni, C., Testi, D., Petrone, M., Perticoni, S., Quadrani, P., Taddei, F., Imboden, S., and
Clapworthy, G., 2007, "The multimod application framework: A rapid application development tool for computer
aided medicine," Computer Methods and Programs in Biomedicine, 85(2), pp.138151.
Viceconti, M., Taddei, F., Van Sint Jan, S., Leardini, A., Cristofolini, L., Stea, S., Baruffaldi, F., and Baleani, M.,
2008, "Multiscale modelling of the skeleton for the prediction of the risk of fracture," Clinical biomechanics
(Bristol, Avon).
Zhao, X., Liu, E., and Clapworthy, G., 2008, "Service-Oriented Digital Libraries: A Web Services Approach,"
Internet and Web Applications and Services, 2008. ICIW'08. Third International Conference on, pp.608613.
External links
Apply to become a Biomed Town citizen
[12]
LHDL - The Living Human Digital Library
[13]
Physiome
[14]
- Links
Wellcome Trust Heart Physiome Project
[15]
- Links
Strategy for the European Physiome
[16]
- (STEP)
NSR Physiome Project
[17]
IUPS Physiome Project
[18]
References
[1] http:/ / www. biomedtown. org/ biomed_town/ LHDL/ Reception/ lhp-public-repository/ BioNet_WG_B_consensus. pdf
[2] http:/ / www. biomedtown. org/ biomed_town/ LHDL/ Reception/ lhp-public-repository/ LHP_global_plan_R3. pdf
[3] http:/ / www. ior. it/ tecno/
[4] http:/ / www. biomedtown. org
[5] http:/ / www. biomedtown. org/ biomed_town/ LHDL/ Reception/ datarepository
[6] http:/ / www. biomedtown. org/ biomed_town/ LHDL/ Reception/ lhpdef/ LHDLConsortium
[7] http:/ / www. biomedtown. org/ biomed_town/ LHDL/ Reception/ lhpdef/ LivingHumanDigitalLibrary
[8] http:/ / www. biomedtown. org/ biomed_town/ LHDL/ Reception/ lhpdef/ LHDLResearchProject
[9] http:/ / www. biomedtown. org/ biomed_town/ LHDL/ Reception/ betauser/
[10] http:/ / www.biomedtown. org/ biomed_town/ LHDL/
[11] http:/ / www.biomedtown. org/ biomed_town/ lhpsquare/
[12] http:/ / www.biomedtown. org/ join_form
[13] http:/ / www.livinghuman.org
[14] http:/ / www.physiome.org/ Links/
[15] http:/ / www.physiome.ox. ac. uk/
[16] http:/ / www.europhysiome.org
[17] http:/ / www.physiome.org/
[18] http:/ / www.physiome.org. nz/
Stereolithography
743
Stereolithography
Stereolithographic model of a skull, using an
infrared system
Stereolithographic models have been used in medicine since the 1990s,
for creating 3D corporeal models of various anatomical regions of a
patient, based on datasets from CT-scans.
Usage
Stereolithography is a Rapid prototyping process that creates solid
physical models directly from computer data. In industry this data
comes from 3D computer-aided design (CAD) data. The process
can also be used to build highly accurate replicas of human (or
animal) anatomy by using computer images from medical scanners.
Typically Computed tomography (CT) is used but Magnetic
Resonance Imaging (Mri) can also be used. Models have also been
made from Ultra Sound and more recently from lower cost Cone
Beam CT scanners. Medical models can also be made using a range
of other Rapid Prototyping processes although stereolithography
remains popular.
Medical models are used in medicine and surgery to provide
surgeons with a better appreciation of the anatomical situation of a patient, before surgery. Although the advent of
improved 3D computer reconstruction and virtual surgical planning means that in some cases models are not
needed they remain popular for complex surgeries particularly in cranial surgery, maxillofacial surgery, oral
surgery and neurosurgery.
Stereolithographic models are used as an aid to diagnosis, preoperative planning and implant design and
manufacture. This might involve for example planning and rehearsing osteotomies. Surgeons use models to help
plan surgeries but prosthetists and technologists also use models as an aid to the design and manufacture of
custom-fitting implants. Medical models are frequently used to help in the construction of Cranioplasty plates for
example.
Medical Modelling Process
The process of medical modelling involves several stages including image acquisition, image segmentation, data
translation, model building and post-processing. Medical modelling involves first acquiring a 3D CT scan (or other
form of scan data). The CT data should be in a suitable format and acquired using suitable parameters to obtain a
high quality model. This data consists of a series of cross sectional images of the human anatomy. In these images
different tissues show up as different levels of grey. Selecting a range of grey values enables specific tissues to be
isolated. A region of interest is then selected and all the pixels connected to the target point within that grey value
range are selected. This enables a specific organ to be selected. Most frequently this will be bone but it could be any
tissue that can be identified in the scan image. This process is referred to as segmentation. The segmented data may
then be interpolated and have other processes performed on it to translate it into a format suitable for the
stereolithography process.
Whilst the stereolithography process is inherently accurate the accuracy of a medical model depends on many
factors, especially the operator performing the segmentation correctly. There are potential errors possible when
making medical models using stereolithography but these are easy to avoid with practice and well trained operators.
Stereolithography
744
Commercial Services
There are several specialist companies that provide medical modelling services such as for example PDR
[1]
in the
United Kingdom, Medical Modeling Inc.
[2]
in the USA and Materialise
[3]
in Belgium. As Rapid Prototyping
machines become more affordable many hospitals are investing in their own medical modelling facilities.
References
[1] http:/ / pdronline.info/ en/ consultancy/ what-we-do/ medical-applications
[2] http:/ / www. medicalmodeling. com
[3] http:/ / biomedical.materialise.com/ other-anatomical-models
Virtual Physiological Human
The Virtual Physiological Human (VPH) is a methodological and technological framework that, once established,
will enable collaborative investigation of the human body as a single complex system.
[1][2]
The collective framework
will make it possible to share resources and observations formed by institutions and organizations creating disparate,
but integrated computer models of the mechanical, physical and biochemical functions of a living human body.
The Virtual Physiological Human (VPH) is a framework which aims to be descriptive, integrative and predictive:
[3]
Descriptive. The framework should allow observations made in laboratories, hospitals and the field, at a variety of
locations situated anywhere in the world, to be collected, catalogued, organized, shared and combined in any
possible way.
Integrative. The framework should enable experts to analyse these observations collaboratively and develop
systemic hypotheses that involve the knowledge of multiple scientific disciplines.
Predictive. The framework should make it possible to interconnect predictive models defined at different scales,
with multiple methods and varying levels of detail, into systemic networks that solidify those systemic
hypotheses; it should also make it possible to verify their validity by comparison with other clinical or laboratory
observations.
The framework is formed by large collections of anatomical, physiological, and pathological data stored in digital
format, by predictive simulations developed from these collections, and by services intended to support researchers
in the creation and maintenance of these models, as well as in the creation of end-user technologies to be used in the
clinical practice. Virtual Physiological Human (VPH) models aim to integrate physiological processes across
different length and time scales (multi-scale modelling). These models make possible the combination of
patient-specific data with population-based representations. The objective is to develop a systemic approach which
avoids a reductionist approach and seeks not to subdivide biological systems in any particular way by dimensional
scale (body, organ, tissue, cells, molecules), by scientific discipline (biology, physiology, biophysics, biochemistry,
molecular biology, bioengineering) or anatomical sub-system (cardiovascular, musculoskeletal, gastrointestinal,
etc.).
History of Virtual Physiological Human (VPH)
The initial concepts that brought to the Virtual Physiological Human came from the IUPS physiome project. The
IUPS physiome project was formed in 1997, and was the first worldwide effort to define the physiome through the
development of databases and models which facilitated the understanding of the integrative function of cells, organs,
and organisms. The project focused on compiling and providing a central repository of databases, linking
experimental information and computational models from many laboratories into a single, self-consistent framework.
Virtual Physiological Human
745
'The Physiome is the quantitative and integrated description of the functional behaviour of the physiological state of
an individual or species.
[4]
Following the launch of the Physiome Project, there were many other worldwide initiatives of loosely coupled
actions all focusing on the development of methods for modelling and simulation of human pathophysiology. In
2005, an expert workshop of the Physiome was held as part of the Functional Imaging and Modelling of the Heart
Conference in Barcelona where a White Paper was created. The paper was entitled Towards Virtual Physiological
Human: Multilevel modelling and simulation of the human anatomy and physiology. The goal of this paper was to
shape a clear overview of on-going relevant VPH activities, to build a consensus on how they can be complemented
by new initiatives for researchers in the EU and to identify possible mid-term and long term research challenges.
In 2006 the European Commission funded a coordination and support action entitled STEP: Structuring The
EuroPhysiome. The STEP consortium promoted a very large consensus process that involved more than 300
stakeholders including researchers, industry experts, policy makers, clinicians, etc. The prime result of this process
was a booklet entitled Seeding the EuroPhysiome: A Roadmap to the Virtual Physiological Human. The STEP
action and the resulting research roadmap were instrumental in the development of the concept of Virtual
Physiological Human here provided, and in the initiation of much larger process that involves significant research
funding, large collaborative projects, and a number of connected initiatives, not only in Europe but also in the United
States, Japan, and China.
The Virtual Physiological Human now forms a core target of the 7th Framework Programme
[5]
of the European
Commission, and aims to support the development of patient-specific computer models and their application in
personalised and predictive healthcare. The Virtual Physiological Human Network of Excellence VPH NoE aims to
connect the various VPH projects within the 7th Framework Programme.
Aim of the Virtual Physiological Human
VPH related projects have received substantial funding from the European Commission in order to further scientific
progress in this area. The European Commission is insistent that VPH-related projects demonstrate strong industrial
participation and clearly indicate a route from basic science into clinical practice. In the future, it is hoped that the
VPH will eventually lead to a better healthcare system which aims to have the following benefits:
personalized care solutions
reduced need for experiments on animals
more holistic approach to medicine
preventative approach to treatment of disease
Personalized care solutions are a key aim of the VPH, with new modelling environments for predictive,
individualized healthcare to result in better patient safety and drug efficacy. It is anticipated that the VPH could also
result in healthcare improvement through greater understanding of pathophysiological processes. The use of
biomedical data from a patient to simulate potential treatments and outcomes could prevent the patient from
experiencing unnecessary or ineffective treatments. The use of in silico (by computer simulation) modelling and
testing of drugs could also reduce the need for experiments on animals.
A future goal is that there will be also be a more holistic approach to medicine with the body treated as a single multi
organ system rather than as a collection of individual organs. Advanced integrative tools should further help to
improve the European healthcare system on a number of different levels that include diagnosis, treatment and care of
patients and in particular quality of life.
The Virtual PHysiological Human is in conclusion a framework of methods and technologies that once fully
established will make possible Personalised, Predictive, and Integrative medicine.
Virtual Physiological Human
746
References
[1] [1] Clapworthy et al. 2007
[2] According to the STEP research road map (http:/ / www. europhysiome. org/ roadmap)
[3] STEP research road map (http:/ / www.europhysiome. org/ roadmap)
[4] NSR Physiome Project (http:/ / www. physiome.org/ )
[5] 7th Framework Programme (http:/ / cordis.europa. eu/ fp7/ )
Bibliography
Clapworthy, G., Kohl, P., Gregerson, H., Thomas, S., Viceconti, M., Hose, D., Pinney, D., Fenner, J.,
McCormack, K., Lawford, P., Van Sint Jan, S., Waters, S., & Coveney, P. 2007, "Digital Human Modelling: A
Global Vision and a European Perspective," In Digital Human Modelling: A Global Vision and a European
Perspective, Berlin: Springer, pp.549558.
Hunter, P.J. 2006. Modeling living systems: the IUPS/EMBS Physiome project. Proceedings IEEE, 94, 678-991
Viceconti, M., Testi, D., Taddei, F., Martelli, S., Clapworthy, G. J., Van Sint Jan, S., 2006. Biomechanics
Modeling of the Musculoskeletal Apparatus: Status and Key Issues. Proceedings of the IEEE 94(4), 725-739.
Links to External Resources
EuroPhysiome (http:/ / www. europhysiome. org) The Europhysiome initiative was coordinated by the STEP
Coordination action, which aimed to establish a better coordination between European Physiome projects. STEP
is now completed; its primary results were the establishment of the Virtual Physiological Human (VPH) concept,
and the production of a European research roadmap to the realisation of the VPH.
STEP Roadmap (http:/ / www. europhysiome. org/ roadmap) STEP Consortium. Seeding the EuroPhysiome: A
Roadmap to the Virtual Physiological Human. [Online] 5 July 2007,
IUPS Physiome Project (http:/ / www. physiome. org. nz/ ) The Physiome Project is a worldwide public domain
effort to provide a computational framework for understanding human and other eukaryotic physiology. It aims to
develop integrative models at all levels of biological organisation, from genes to the whole organism via gene
regulatory networks, protein pathways, integrative cell function, and tissue and whole organ structure/function
relations. University of Auckland, Auckland, New Zealand.
VPH NoE (http:/ / www. vph-noe. eu/ ) The VPH NoE was launched in 2008 and aims to provide the necessary
infrastructure including computational methodologies, tools and databases that will enable academic, clinical and
industrial researchers to communicate, and to exchange data and technologies in a standardised way. The website
has the latest news, events and progress of the VPH NoE, contains further information on the VPH I projects and
is a useful resource to find out more about the VPH.
BioMed Town (http:/ / www. biomedtown. org/ ) is an online resource, borne out of the Sixth Framework
Programme Coordination Action STEP (A Strategy for the Europhysiome). It is a meeting place open to
Biomedical Research & Technology, Biomedical Industry and Clinical Practice, and aims to support networking
and information sharing - key activities underpinning any integrative/interdisciplinary research community. It is
open to all those who have a professional or educational interest in biomedical research & technology.
Operating on the Virtual Human (http:/ / news. bbc. co. uk/ 2/ hi/ health/ 7774016. stm) BBC news feature on
Heart Surgery as part of the VPH Initiative (January 2009)
PhysiomeSpace (http:/ / www. physiomespace. com) is new service currently running in beta, which makes
possible the creation of heterogeneous collection of biomedical data including medical imaging, biomedical
instrumentation recordings, geometries, scalar, vector and tensor fields, results from finite element, multibody
dynamics, and computer fluid dynamics simulations, etc., and to share these collections, properly annotated
through a powerful ontology with any other researcher you like.
Virtual Physiological Human
747
External Links to VPH projects
EU FP7 VPH related Projects
Several projects have been funded within various VPH FP7-ICT EU calls:
ICT-2009.5.3.
AIRPROM Airway Disease PRedicting Outcomes through Patient Specific Computational Modelling.
FUSIMO Patient specific modelling and simulation of focused ultrasound in moving organs.
GRANATUM (http:/ / www. granatum. org) A Social Collaborative Working Space Semantically Interlinking
Biomedical Researchers, Knowledge And Data For The Design And Execution Of In-Silico Models And
Experiments In Cancer Chemoprevention
INBIOMEDVision Promoting and Monitoring Biomedical Informatics in Europe- aims to become a
European-wide initiative intended to monitor the evolution of the Biomedical Informatics field and address its
scientific challenges by means of collaborative efforts performed by a broad group of experts with
complementary perspectives on the field.
INTEGRATE Driving Excellence in Integrative Cancer Research through Innovative Biomedical Infrastructures.
MYSPINE Functional prognosis simulation of patient-specific spinal treatment for clinical use.
P-Medicine From data sharing and integration via VPH models to personalised medicine. P-Medicine will create
an infrastructure that will facilitate the translation from current practice to personalized medicine. The project is
designed to bring VPH methods to three sets of clinical trials treating various cancers (leukaemia, breast cancer,
Wilms' tumour).
SYNERGY-COPD: Modelling and simulation environment for systems medicine (Chronic obstructive pulmonary
disease -COPD- as a use case).
TBICARE Evidence based Diagnostic and Treatment Planning Solution for Traumatic Brain Injuries.
THROMBUS (http:/ / www. vph-noe. eu/ vph-projects/ 74-eu-fp7-vph-projects/ 504-thrombus/ ) A quantitative
model of thrombosis in intracranial aneurysms.
VIGOR++ Virtual GastrOintestinal tRact.
VPH-SHARE (IP) Virtual Physiological Human: Sharing for Healthcare - A Research Environment. VPH
SHARE (IP) is developing an organisational framework for the widespread integration of VPH services.
ICT-2007.5.3.
euHeart (http:/ / www. euheart. eu/ ) (IP) Personalised and integrated cardiac care: Patient-specific cardiovascular
modelling and simulation for in silico disease understanding and management and for medical device evaluation
and optimisation. (Project dates: 06/08 - 05/12).
VPHOP (http:/ / www. vphop. eu/ ) (IP) Osteoporotic Virtual Physiological Human. Body to molecule
patient-specific modelling technology for the diagnosis, prognosis and treatment planning of osteoporotic
fractures. (Project dates: 08/08 - 08/12).
ARTreat (http:/ / www. vph-noe. eu/ vph-projects/ 74-eu-fp7-vph-projects/ 46-artreat-ip) (IP) Multi-level
patient-specific artery and atherogenesis model for outcome prediction, decision support treatment, and virtual
hand-on training. (Project dates: 09/08 - 08/11).
Synergy-COPD (http:/ / www. synergy-copd. eu/ ) (STREP) Modelling and simulation environment for systems
medicine (Chronic obstructive pulmonary disease -COPD- as a use case). (Project dates: 02/11 - 01/14).
preDiCT (http:/ / www. vph-predict. eu/ ) (STREP) Virtual research environment for in silico assessment of
efficacy and safety of specific drugs (cell to ventricle-level models) and faster than-real-time simulation. (Project
dates: 06/08 - 05/11).
ContraCancrum (http:/ / www. contracancrum. eu/ ) (STREP) Clinically oriented translational cancer multilevel
modelling. Composite multilevel platform for simulating malignant tumour development and tumour and normal
Virtual Physiological Human
748
tissue response to therapeutic modalities and treatment schedules. (Project dates: 08/08 - 07/11).
ARCH (http:/ / www. vph-arch. eu/ ) (STREP) Patient specific image-based computational modelling for
improvement of short- and long-term outcome of vascular access in patient on hemodialysis therapy. (Project
dates: 06/08 - 05/11).
PASSPORT (http:/ / www. passport-liver. eu/ Homepage. html) (STREP) Patient specific simulation and
preoperative realistic training for liver surgery. Patient specific liver modelling combinging anatomical,
mechanical, appearance and biological preoperative modelled information. (Project dates: 06/08 - 05/11).
p-medicine (http:/ / p-medicine. eu) (IP) From data sharing and integration via VPH models to personalised
medicine. P-Medicine will create an infrastructure that will facilitate the translation from current practice to
personalized medicine. The project is designed to bring VPH methods to three sets of clinical trials treating
various cancers (leukaemia, breast cancer, Wilms' tumour). (Project dates: 02/11 - 01/15).
PredictAD (http:/ / www. predictad. eu) (STREP) From patient data to personalised healthcare in Alzheimer's
Disease. New biomarkers and clinically useful tools for early Alzheimer's disease diagnosis. (Project dates: 06/08
- 05/11).
NeoMARK (http:/ / www. neomark. eu/ ) (STREP) ICT enabled prediction of cancer reoccurrence. Multiscale
and multilevel modelling, aimed at advancing models and methods currently in use to predict neoplastic
reoccurrences, and to apply it to the study of oral cancer. (Project dates: 06/08 - 08/10).
VPH2 (http:/ / www. vph2. eu/ ) (STREP) Virtual pathological heart of the virtual physiological human.
Patient-specific computational modelling and simulation of the human heart to assist the cardiologist and cardiac
surgeon in defining the severity and extent of disease in patients with post-ischemic Left Ventricular Dysfunction
(LVD), with or without ischemic mitral regurgitation. (Project dates: 07/08 - 06/11).
IMPPACT (http:/ / www. imppact. eu/ ) (STREP) Image-based multi-scale physiological planning for ablation
cancer treatment. Physiological model of the liver and simulation of result of Radiofrequency Ablation (RFA) of
malignant liver tumours, accounting for patient specific physiological factors. (Project dates: 08/08 - 08/11).
HAMAM (http:/ / hamam-project. org/ cms/ website. php) (STREP) Highly accurate breast cancer diagnosis
through integration of biological knowledge, novel imaging modalities, and modelling. (Project dates: 08/08 -
08/11).
Action-Grid (http:/ / www. action-grid. eu/ ) (CA) International cooperative action on grid computing and
biomedical informatics between the European Union, Latin America, the Western Balkans and North Africa.
(Project dates: 08/08 - 11/11).
RADICAL (http:/ / www. radicalhealth. eu/ ) (CA) Road mapping technology for enhancing security to protect
medical and genetic data. In depth study to determine policy roadmap for security and privacy enhancement in
Virtual Physiological Human. (Project dates: 00/00 - 00/00).
VPH-Share (http:/ / www. vph-share. eu) (CA) Virtual Physiological Human Share. Infostructure for the VPH
community especially for data and knowlededge share and development for multiscale models for new VPH
workflows. (Project dates: 00/00 - 00/00).
EU FP6 VPH related Projects
@neurIST (http:/ / www. cilab. upf. edu/ aneurist1/ ) (IP) @neurIST will develop an IT infrastructure for the
management of heterogeneous data associated with the diagnosis and treatment of cerebral aneurysms. (Project
dates: 02/06 - 01/10).
ACGT (http:/ / www. eu-acgt. org/ ) (IP) Advancing Clinico-genomic trials on cancer: Open Grid services for
improving medical knowledge discovery The ACGT project aims to develop a GRID platform to support and
stimulate further exchanges of both clinic and genetic information, with a particular focus on breast cancer
treatment. (Project dates: 02/06 - 01/10).
Health-e-Child (http:/ / www. health-e-child. org/ ) (IP) The Health-e-Child project aims at developing an
integrated healthcare platform for European paediatrics, providing seamless integration of traditional and
Virtual Physiological Human
749
emerging sources of biomedical information. (Project dates: 01/06 - 12/09).
I KNOW (http:/ / www. ist-world. org/ ProjectDetails. aspx?ProjectId=4b856c895010468e95611ffd08d39660)
(STREP) I-Know is a knowledge discovery IT -based tool designed to aid early stroke diagnosis, stroke treatment,
drug development and identification of risk factors as targets in disease prevention for the benefit of European
industry and citizens. (Project dates: 05/06 - 04/09).
Sealife (http:/ / www. biotec. tu-dresden. de/ sealife) (NoE) A Semantic Grid Browser for the Life Sciences
applied to the study of Infectious Diseases. The development of a browser, which will link the existing Web to the
currently emerging eScience infrastructure. (Project dates: 04/06 - 03/09).
VIROLAB (http:/ / www. virolab. org/ ) (STREP) ViroLab enables easy access to distributed resources as well as
the sharing, processing, and analysis of virological, immunological, clinical and experimental data. (Project dates:
03/06 - 03/09).
ImmunoGrid (http:/ / www. immunogrid. org/ ) (STREP) The project will focus on establishing an infrastructure
for the simulation of the immune system that integrates processes at molecular, cellular, and organ levels.It will
be designed for applications that support clinical outcomes. (Project dates: 02/06 - 01/09).
LHDL (http:/ / www. livinghuman. org/ ) (STREP) Living Human Digital Library: interactive digital library
services to access collections of complex biomedical data on the musculoskeletal apparatus. (Project dates: 02/06
- 01/09).
Simap (http:/ / www. simap-project. org/ simap/ public/ ) (STREP) Simulation modelling of the MAP kinase
pathway SIMAP will develop a simulation model of the cancer related MAP-kinase pathway, integrating and
analyzing data from various types of resources, which may assist in the development of better cancer treatment.
(Project dates: 01/06 - 12/08)
ASSIST (http:/ / assist. iti. gr/ ) (STREP) Association studies assisted by inference and semantic technologies.
The main objective of ASSIST is to facilitate the research for cervical cancer through a system that will virtually
unify multiple patient record repositories, physically located in different medical centres/hospitals. (Project dates:
01/06 - 12/08).
STEP (http:/ / www. europhysiome. org/ ) (CA) STEP was a Coordination Action that sought to coordinate
European activity relating to the physiome a description of human physiology that will span multiple levels
from the whole body down through the organs to the cells and beneath in an integrated manner. (Project dates:
01/06 - 03/07).
BIOPATTERN (http:/ / www. biopattern. org/ Main/ index. aspx) (NoE) Computational intelligence for
Bio-pattern analysis in support of eHealthcare. The goal of BIOPATTERN is to develop a pan-European,
coherent and intelligent analysis of a citizen's bio-profile. (Project dates: 01/04 - 12/07).
MATCH (http:/ / www. match-project. com/ ) (STREP) MATCH project entitle the development of an automatic
diagnosis system that aims to support treatment of colon cancer diseases by discovering mutations that occurs to
tumour suppressor genes (TSGs) and contributes to the development of cancerous tumours. (Project dates: 08/06 -
07/08).
MULTI - KNOWLEDGE (http:/ / www. multiknowledge. org/ page. asp?IDCategoria=574& IDSezione=3185)
(STREP)The MULTI-KNOWLEDGE Project aims to integrate different biomedical information from
heterogeneous sources (clinical, laboratory and metabolic) with data on gene and protein expression provided by
new high throughput technologies in a system committed to cardiovascular risk profiling. (Project dates: 01/06 -
03/08).
NEUROWEB (http:/ / www. neurowebkc. eu/ ) (STREP) NEUROWEB project improved healthcare delivery
achieving knowledge-based, personalised diagnosis and therapy through vertical integration of existing clinical
and genetic databases. (Project dates: 08/06 - 07/08).
e-Health ERA (http:/ / www. ehealth-era. org/ )(CA) The overall goal of the eHealth ERA project is to contribute
to greater transparency of national eHealth strategies and implementation activities as well as innovation oriented
research and technology development (RTD) initiatives. (Project dates: 04/05 - 06/07).
Virtual Physiological Human
750
SemanticHEALTH (http:/ / www. semantichealth. org/ ) (CSA) SemanticHEALTH aims to develop a European
and global roadmap for deployment and research in health-ICT, focusing on semantic interoperability issues of
e-Health systems and infrastructures. (Project dates: 01/06 - 12/07).
SemanticMining (http:/ / www. semantichealth. org/ ) (NoE) Semantic Interoperability and Data Mining in
Biomedicine. The aim of this project is to establish Europe as the international scientific leader in medical and
biomedical informatics. The long-term goal was to develop generic methods and tools to support the critical tasks
of the field. (Project dates: 01/04 - 07/07).
SYMBIOmatics (http:/ / www. symbiomatics. org/ ) (SSA) SYMBIOmatics is a Specific Support Action that
aims to identify and exploit synergies between bioinformatics and medical informatics.The project will document
the state-of-the art in biomedical informatics in Europe. (Project dates: 05/05 - 11/06).
INFOBIOMED (http:/ / www. infobiomed. org/ ) (NoE) INFOBIOMED aims at enforcing European Biomedical
Informatics as an integrative discipline with a view on supporting individualised healthcare. (Project dates: 01/04
- 06/07).
TACIT (http:/ / www. tacit-ist. org/ )(STREP) Technologies Augmenting Clinical InsighT. The TACIT project
aim is to unlock the tacit knowledge of Europe's senior clinicians both by linguistically analysed multimedia
recording and by expert location and communications. (Project dates: 06/04 - 08/06).
WoundMonitor (http:/ / www. manchester. ac. uk/ woundmonitor) (STREP) WOUNDMONITOR will apply gas
sensor array technology in an innovative diagnostic system that will enable non-invasive sampling of volatiles,
helping diagnosis of the onset and type of bacterial infections in critically ill patients suffering from burns or
serious wounds. (Project dates: 01/06 - 12/08).
SHARE (http:/ / www. eu-share. org/ ) (SSA) The goal of SHARE was to ensure the successful take up of
HealthGrids in the next 10 years by creating a roadmap for essential technology development years. (Project
dates: 01/06 - 03/08).
EuResist (http:/ / www. euresist. org/ ) (STREP) The EuResist project aims to develop a European integrated
system for the clinical management of antiretroviral drug resistance. (Project dates: 01/06 - 06/08).
normaCOR (http:/ / www. normacor. eu/ ) The aim of normaCOR is to provide novel insight into novel
arrhythmogenic mechanisms, quantify their interrelation, target preventive and therapeutic interventions to reduce
the societal and economical impact of cardiac arrhythmia.
Visible Human Project
751
Visible Human Project
Cryosection through the head of a human male.
The Visible Human Project is an effort to create a detailed data set of
cross-sectional photographs of the human body, in order to facilitate
anatomy visualization applications. A male and a female cadaver were
cut into thin slices which were then photographed and digitized. The
project is run by the U.S. National Library of Medicine (NLM) under
the direction of Michael J. Ackerman. Planning began in 1989; the data
set of the male was completed in November 1994 and the one of the
female in November 1995. The project can be viewed today at the
National Museum of Health and Medicine in Washington, DC. There
are currently efforts to repeat this project with higher resolution images
but only with parts of the body instead of a cadaver.
Data
Cryosection through the abdomen of a human
male, including the upper extremities.
The male cadaver was encased and frozen in a gelatin and water
mixture in order to stabilize the specimen for cutting. The specimen
was then cut in the axial plane at 1 millimeter intervals. Each of the
resulting 1,871 slices were photographed in both analog and digital,
yielding 15 gigabytes of data. In 2000, the photos were rescanned at a
higher resolution, yielding more than 65 gigabytes. The female cadaver
was cut into slices at .33 millimeter intervals, resulting in some 40
gigabytes of data.
The term cut is a bit of a misnomer, yet it is used to describe the
process of grinding away the top surface of a specimen at regular intervals. The term slice, also a misnomer, refers
to the revealed surface of the specimen to be photographed; the process of grinding the surface away is entirely
destructive to the specimen and leaves no usable or preservable slice of the cadaver.
The data is supplemented by axial sections of the whole body obtained by computed tomography, axial sections of
the head and neck obtained by magnetic resonance imaging, and coronal sections of the rest of the body also
obtained by magnetic resonance imaging.
The scanning, slicing and photographing took place at the University of Colorado's Health Sciences Center, where
additional cutting of anatomical specimens continues to take place.
Visible Human Project
752
Donors
The male cadaver is from Joseph Paul Jernigan, a 38-year-old Texas murderer who was executed by lethal injection
on August 5, 1993. At the prompting of a prison chaplain he had agreed to donate his body for scientific research or
medical use, without knowing about the Visible Human Project. Some people have voiced ethical concerns over this.
One of the most notable statements came from the University of Vienna which demanded that the images be
withdrawn with reference to the point that the medical profession should have no association with executions, and
that the donor's informed consent could be scrutinised.
[1]
The 59-year-old female donor remains anonymous. In the press she has been described as a Maryland housewife
who died from a heart attack and whose husband requested that she be part of the project.
Problems with the data sets
Freezing caused the brain of the man to be slightly swollen, and his inner ear ossicles were lost during preparation of
the slices. Nerves are hard to make out since they have almost the same color as fat, but many have nevertheless
been identified. Small blood vessels were collapsed by the freezing process. Tendons are difficult to cut cleanly, and
they occasionally smear across the slice surfaces.
The male has only one testicle, is missing his appendix, and has tissue deterioration at the site of lethal injection.
Also visible are tissue damage to the dorsum of each forearm by formalin injection and damage to the right sartorius
from opening the right femoral vein for drainage. The male was also not "cut" while in standard anatomical position,
so the cuts through his arms are oblique.
The reproductive organs of the woman are not representative of those of a young woman. The specimen contains
several pathologies, including cardiovascular disease and diverticulitis.
Discoveries
By studying the data set, researchers at Columbia University found several errors in anatomy textbooks, related to
the shape of a muscle in the pelvic region and the location of the urinary bladder and prostate.
License
The data may be bought on tape or downloaded free of charge; one has to specify the intended use and sign a license
agreement that allows NLM to use and modify the resulting application. NLM can cancel the agreement at any time,
at which point the user has to erase the data files.
Applications using the data
Various projects to make the raw data more useful for educational purposes are under way. It is necessary to build a
three-dimensional virtual model of the body where the organs are labeled, may be removed selectively and viewed
from all sides, and ideally are even animated. Two commercial software products accomplish the majority of these
goals, the VH Dissector from Touch of Life Technologies and Voxel-Man-Man 3D-Navigator from the University
of Hamburg
[2]
NLM itself has started an open source project, the Insight Toolkit, whose aim is to automatically
deduce organ boundaries from the data.
The data were used for Alexander Tsiaras's book and CD-ROM Body Voyage which features a three-dimensional
tour through the body.
[3]
A "Virtual Radiography" application creates Digitally Reconstructed Radiographs and virtual surgery, where
endoscopic procedures or balloon angioplasty are simulated: the surgeon can view the progress of the instrument on
a screen and receives realistic tactile feedback according to what kind of tissue the instrument would currently be
touching.
Visible Human Project
753
The male data set was used in "Project 12:31", a series of photographic light paintings by Croix Gagnon and Frank
Schott.
References
[1] Roeggla G., U. Landesmann and M. Roeggla: Ethics of executed person on Internet. [Letter]. Lancet. 28. January 1995; 345(0):260.
[2] Hoehne K. H. et al.: VOXEL-MAN 3D-Navigator: Inner Organs. Regional, Systemic and Radiological Anatomy. (http:/ / www. voxel-man.
de/ 3d-navigator/ inner_organs/ ) Springer Electronic Media, New York, 2003 (DVD-ROM, ISBN 978-3-540-40069-1).
[3] [3] Tsiaras A.: Body Voyage: A Three-Dimensional Tour of a Real Human Body. Warner Books, New York, 1997 (ISBN 0-446-52009-8).
External links
Home page of the project (http:/ / www. nlm. nih. gov/ research/ visible/ visible_human. html), including links to
the various other projects that use the data
The Visible Human Male: A Technical Report (http:/ / jamia. bmj. com/ content/ 3/ 2/ 118. full. pdf), Detailed
history of methods used to prepare the male cadaver and gather image data as published in the free article in the
Journal of the American Medical Informatics Association 1996
Visible Human Viewer (http:/ / www. dhpc. adelaide. edu. au/ projects/ vishuman2/ VisibleHuman. html), Java
applets to view this project in axial, sagittal and coronal slices
Visible Human Server (http:/ / visiblehuman. epfl. ch/ index. php) by the EPFL (Ecole Polytechnique Fdrale de
Lausanne). Extensive Java applets to view, extract and animate slices. Also applets for 3D feature extraction.
Center for Human Simulation at UCHSC (http:/ / www. visiblehuman. org) A collection of several applications
using the Visible Human Datasets
Touch of Life Technologies (http:/ / www. toltech. net) A commercial website which produces the VH Dissector,
a virtual dissection program that uses the Visible Human datasets.
University of Michigan Visible Human Project page (http:/ / vhp. med. umich. edu)
754
People
Edward H. Shortliffe
Edward Hance Shortliffe
Born 1947
Edmonton, Alberta, Canada
Other names Ted
Education Harvard University
Stanford University
Knownfor MYCIN, Biomedical informatics
Website
www.shortliffe.net
[1]
Edward ("Ted") Hance Shortliffe (born 1947) is a Canadian-born American biomedical informatician, physician,
and computer scientist. Shortliffe is a pioneer in the use of artificial intelligence in medicine. He was the principal
developer of the clinical expert system MYCIN, one of the first rule-based artificial intelligence expert systems,
which obtained clinical data interactively from a physician user and was used to diagnose and recommend treatment
for severe infections. While never used in practice (because it preceded the era of local-area networking and could
not be integrated with patient records and physician workflow), its performance was shown to be comparable to and
sometimes more accurate than that of Stanford infectious disease faculty.
[2]
This spurred the development of a wide
range of activity in the development of rule-based expert systems, knowledge representation, belief nets and other
areas, and its design greatly influenced the subsequent development of computing in medicine.
He is also regarded as a founder of the field of biomedical informatics, and in 2006 received one of its highest
honors, the Morris F. Collen Award given by the American College of Medical Informatics.
He has held administrative positions in academic medicine, research and national bodies including the Institute of
Medicine, American College of Physicians, the National Science Foundation, National Institutes of Health, and
National Library of Medicine (NLM), and been influential in the development of medicine, computing and
biomedical informatics nationally and internationally. His interests include the broad range of issues related to
integrated medical decision-support systems and their implementation, biomedical informatics and medical
education and training, and the Internet in medicine.
In March 2007, he became founding dean of the University of Arizona's new College of Medicine campus in
Phoenix. He stepped down from this position in May 2008 and in January 2009 transferred his primary academic
appointment to Arizona State University where he became professor of biomedical informatics. He maintained a
secondary appointment as professor of basic medical sciences and of medicine at the University of Arizona College
of Medicine (Phoenix Campus). In November 2009 he transferred his academic home to a part-time appointment as
professor at the School of Biomedical Informatics, University of Texas Health Science Center at the Texas Medical
Center in Houston, where he lived until November 2011. Since that time he has returned to New York City where he
continues as an adjunct professor of biomedical informatics at Columbia University.
In July 2009, Shortliffe assumed a position as president and chief executive officer of the American Medical
Informatics Association, an organization that he helped to form between 1988 and 1990 when he was President of
the Symposium on Computer Applications in Medical Care. In late 2011 he announced his intention to step down
Edward H. Shortliffe
755
from this position in 2012.
Biography and career
Shortliffe grew up in Edmonton, Alberta, until his family moved to Connecticut when he was 6. He attended the
Loomis School in Connecticut (now Loommis-Chaeffee School) and later Gresham's School in the United Kingdom.
His father was a physician and hospital administrator; his mother, an English teacher. He has one brother and one
sister.
As an undergraduate at Harvard, he started working in the computer laboratory of G. Octo Barnett at Massachusetts
General Hospital and realized that he could have a career spanning both medicine and computing.
After receiving an AB in applied mathematics magna cum laude from Harvard College in 1970, he received an M.D.
(1976) and Ph.D. in Medical Information Systems (1975) from Stanford University, with a dissertation on the
MYCIN system, for which he also won the 1976 Grace Murray Hopper Award for outstanding computer scientists
under the age of 30. He completed internal medicine house-staff training from 1976-1979 at Massachusetts General
Hospital and Stanford Hospital. In 1979 he joined the Stanford faculty in internal medicine and computer science,
where he directed the Stanford University Medical EXpertimental computer resource (SUMEX) and subsequently
the Center for Advanced Medical Informatics at Stanford (CAMIS), continuing his work on expert systems,
including ONCOCIN (an oncology decision support program), T-HELPER, and other projects in the Stanford
Heuristic Programming Project.
[3]
He also simultaneously served as chief of general internal medicine and associate
chair of medicine for primary care, and was principal investigator of the InterMed Collaboratory, which developed
the science of computable guidelines for medical decision support.
In 1980 he founded one of the earliest formal degree programs in biomedical informatics at Stanford University,
emphasizing a rigorous and experimentalist approach. From 2003-2007 he served on the Board of Directors of
Medco Health Solutions, a large pharmacy benefits manager headquartered in Franklin Lakes, New Jersey.
In 2000 he moved to Columbia University as chair of the department of biomedical informatics, deputy vice
president (Columbia University Medical Center), senior associate dean for strategic information resources (College
of Physicians and Surgeons), professor of medicine, professor of computer science, and director of medical
informatics services for the New York-Presbyterian Hospital. He continued work on decision support guidelines
including the development of the Guideline Interchange Format (GLIF3).
[4]
From March 2007 until May 2008 he served as the founding dean of the Phoenix campus of the University of
Arizona's College of Medicine and from November 2009 to October 2011 he served as professor in the School of
Biomedical Informatics at the University of Texas Health Sciences Center in Houston, Texas. He has served as
president and chief executive officer of the American Medical Informatics Association from 2009-2012 and
continues to hold adjunct faculty appointments in biomedical informatics at Columbia University and Arizona State
University.
Advisory activities
At age 39, Shortliffe was elected to the Institute of Medicine of the United States National Academy of Sciences
(where he has served on the IOM executive council). He is also an elected member or fellow of the American
Association for Artificial Intelligence, American Society for Clinical Investigation, the Association of American
Physicians, and the American Clinical and Climatological Association.
He is a founding member of the American Medical Informatics Association and was one of five founding fellows of
the American College of Medical Informatics. He is a master of the American College of Physicians and was a
member of that organization's Board of Regents from 1996-2002. He is editor-in-chief of the Journal of Biomedical
Informatics and serves on the editorial boards for several other biomedical informatics publications.
Edward H. Shortliffe
756
He has served on the oversight committee for the Division of Engineering and Physical Sciences (National Academy
of Sciences) and the Biomedical Informatics Expert Panel (National Center for Research Resources at the National
Institutes of Health). He also served on the National Committee for Vital and Health Statistics (NCVHS) and on the
President's Information Technology Advisory Committee. Earlier he served on the Computer Science and
Telecommunications Board (National Research Council), the Biomedical Library Review Committee (National
Library of Medicine), and was recipient of a research career development award from the latter agency.
He is the author of more than 300 publications including seven books.
Honors
Morris F. Collen Award for Distinguished Contributions to Medical Informatics, American Medical Informatics
Association, November 2006
Appointed Rolf H. Scholdager Professor of Biomedical Informatics, Columbia University, June 2005
National Associate, National Academies, Washington, DC, December 2004.
Mastership, American College of Physicians, November 2002
Young Investigator Award, Western Society for Clinical Investigation, February 1987.
Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine, July 1983June 1988.
Research Career Development Award, National Library of Medicine, July 1979June 1984.
Grace Murray Hopper Award (Distinguished computer scientist under age 30), Association for Computing
Machinery, October 1976.
Books and Representative Papers
1. 1. Shortliffe, E.H. Computer-Based Medical Consultations: MYCIN, Elsevier/North Holland, New York, 1976.
(Japanese language version by Bunkodo Blue Books, Tokyo, 1981, translated by T. Kaminuma)
2. Buchanan, B.G. and Shortliffe, E.H. (eds). Rule-Based Expert Systems: The MYCIN Experiments of the Stanford
Heuristic Programming Project. Reading, MA: Addison-Wesley, 1984. See http:/ / aaai. org/ AITopics/
RuleBasedExpertSystems.
3. Clancey, W.J. and Shortliffe, E.H. (eds). Readings in Medical Artificial Intelligence: The First Decade. Reading,
MA: Addison-Wesley, 1984. See http:/ / aaai. org/ AITopics/ ReadingsInMedicalArtificialIntelligence.
4. 4. Shortliffe, E.H., Wulfman, C.E., Rindfleisch, T.C., and Carlson, R.W. An Integrated Oncology Workstation.
Bethesda, MD: National Cancer Institute, 1991. [Received the 1991-92 Award of Excellence from The Society
for Technical Communication.]
5. 5. Shortliffe, E.H. (ed) and Cimino, J.J. (assoc. ed.). Biomedical Informatics: Computer Applications in Health Care
and Biomedicine. New York: Springer-Verlag, 2006. (3rd edition; 2nd edition in 2000; 1st edition in 1990
(Addison Wesley)).
6. 6. Boxwala AA, Peleg M, Tu S, Ogunyemi O, Zeng QT, Wang D, Patel VL, Greenes RA, Shortliffe EH. `GLIF3: a
representation format for sharable computer-interpretable clinical practice guidelines.' Journal of Biomedical
Informatics 2004;37(3):147-161.
7. 7. Shortliffe, E.H. and Buchanan, B.G. A model of inexact reasoning in medicine. Math. Biosci. 1975;23:351-379.
8. 8. Duda, R.O. and Shortliffe, E.H. Expert systems research. Science, 1983;220:261-268.
9. Greenes, R.A. and Shortliffe, E.H. Medical informatics: an emerging academic discipline and institutional
priority. JAMA 1990;263:1114-1120. See http:/ / jama. jamanetwork. com/ pdfaccess.
ashx?ResourceID=517040& PDFSource=13
10. 10. Detmer, W.M. and Shortliffe, E.H. Using the Internet to improve knowledge diffusion in medicine. Commun
ACM, 1997;40(8):101-108.
11. 11. Shortliffe EH. Strategic Action in Health Information Technology: Why the Obvious Has Taken So Long.
Health Affairs 2005;24:1222-1233.
Edward H. Shortliffe
757
12. 12. Shortliffe EH. Biomedical informatics in the education of physicians. J Am Med Assoc
2010:304(11):1227-1228.
References
[1] http:/ / www. shortliffe. net
[2] 1. Rule-Based Expert Systems: The MYCIN Experiments of the Stanford Heuristic Programming Project -(edited by Bruce G. Buchanan and
Edward H. Shortliffe; ebook version http:/ / www. aaaipress. org/ Classic/ Buchanan/ buchanan. html )
[3] [3] Clancey WJ, Shortliffe EH, eds. Readings in medical artificial intelligence:the first decade. Reading, Mass.: Addison-Wesley, 1984
[4] [4] Boxwala AA, Peleg M, Tu S, Ogunyemi O, Zeng QT, Wang D, Patel VL, Greenes RA, Shortliffe EH. `GLIF3: a representation format for
sharable computer-interpretable clinical practice guidelines.' Journal of Biomedical Informatics 2004;37(3):147-161.
External links
Official website (http:/ / www. shortliffe. net)
Video of Morris Collen award ceremony (http:/ / video. google. com/ videoplay?docid=3338373186040343401)
Tree of Shortliffe's students (http:/ / infolab. stanford. edu/ pub/ voy/ museum/ shortliffetree. html)
Don E. Detmer
758
Don E. Detmer
Don E. Detmer
Born
Residence Virginia, USA
Fields National health information policy, quality improvement, administrative medicine, medical informatics
Institutions
American Medical Informatics Association
[1]
, University of Virginia
[2]
Alma mater
University of Kansas Medical Center
[3]
Knownfor Medical Informatics, Health informatics, electronic health records
Don E. Detmer, MD, MA, FACMI, FACS is Professor Emeritus and Professor of Medical Education at the
University of Virginia and Visiting Professor at CHIME, University College of London.
Biography and career
Don Detmer chaired the 1991 study, "The Computer-based Patient Record".[4] He was a member of the committee
that developed the IOM Reports, "To Err is Human"[5] and "Crossing the Quality Chasm."[6] From 1999-2003 he
was the Dennis Gillings Professor of Health Management at Cambridge University and is a lifetime member of Clare
Hall College, Cambridge.
Considered to be a mover of the US National Health Information Infrastructure, Dr. Detmer has also been a
consultant to the government of England and the Hospital Authority of Hong Kong. Prior to the years in England, he
was Vice President for Health Sciences at the Universities of Virginia and Utah. While at Virginia he led
implementation of a physician order entry system and was principal investigator of its IAIMS grant. While at the
University of WisconsinMadison, he developed the nations first Administrative Medicine Program, a Masters
degree program for clinician-executives. As a surgeon, he was instrumental in the adoption and development of
ambulatory surgery in the early 1970s and was team physician for the Wisconsin Badgers for ten years while also
serving as President of the Medical Staff. He won a UWMadison Chancellors Distinguished Teaching Award.
Detmer was appointed as President and CEO of the American Medical Informatics Association in 2004 until 2009
when he became Senior Advisor to AMIA until 2011.
Detmer's education includes a medical degree from the University of Kansas with subsequent training at the National
Institutes of Health, the Johns Hopkins Hospital, Duke University Medical Center, the Institute of Medicine, and
Harvard Business School. His MA is from the University of Cambridge.
Don's research interests include national health information policy, quality improvement, administrative medicine,
vascular surgery, sports medicine, and management of academic health centers. He has written and edited a number
of research articles, books, book chapters, and monographs on these topics. He enjoys grandchildren, horse riding,
fly-fishing, reading biographies, and various crafts.
Advisory Activities
Don Detmer is a former trustee of the Nuffield Trust, a member of the Institute of Medicine as well as a lifetime
Associate of the US National Academies, a fellow of AAAS, and the American Colleges of Medical Informatics,
Sports Medicine, and Surgeons. He founded the Blue Ridge Academic Health Group and co-chaired it through 2011.
He chairs the board of Medbiquitous. He was on the steering committee of a policy report for the Office of the
National Coordinator on Health Information Technology to create a national framework for clinical decision support.
Don E. Detmer
759
Dr. Detmer is past chairman of the Board on Health Care Services of the IOM, the National Committee on Vital and
Health Statistics, and the Board of Regents of the National Library of Medicine. He was a Commissioner on the
Commission on Systemic Interoperability.[7] In 2013 he stepped down from his position as the inaugural Medical
Director for Advocacy and Health Policy of the American College of Surgeons.
Awards and honors
Fellow, American Academy of Nursing (Hon), 2012
Walsh McDermott Medal, Institute of Medicine, Washington, DC, 2009
Inaugural recipient, Don Eugene Detmer Signature Award in Health Policy Contributions in Informatics, AMIA,
2008
National Associate, National Academies, Washington, DC, 2002
Medal of Respect from Mongolian State University, Ulan Bator, 2001
Fellow, American Association for the Advancement of Science, 1998
President's Award, American Medical Informatics Association, 1996, 1998
Distinguished Alumnus, Duke University Medical Alumni Association
Publications
Books
Dick, Richard; Detmer, Don E.; Steen, Elaine B. (eds.) (1997). The Computer-Based Patient Record. Washington:
National Academy Press. ISBN0-309-05532-6. [4]
Lohr, Kathleen; Vanselow, Neal A.; Detmer, Don E. (eds.) (1996). The Nation's Physician Workforce: Options
for Balancing Supply and Requirements. Washington: National Academy Press. ISBN0-309-05431-1. [8]
Detmer, Don E.; Steen, Elaine B. (eds.) (2005). The Academic Health Center: Leadership and Performance.
Cambridge: Cambridge University Press. ISBN0-521-82718-3. [9]
Reports
Detmer D, Steen E. Learning from abroad: lessons and questions on personal health records for national policy.
AARP. Mar 2006.[10]
Journal Articles
Google Scholar publications
[11]
Medline (Pubmed) publications
[12]
References
http:/ / aspe. hhs. gov/ sp/ nhii/ Conference03/ DetmerBio. htm
http:/ / www. amia. org/ inside/ leadership/ boardbios. asp#Detmer
Don E. Detmer
760
External links
American Medical Informatics Association
[1]
Medbiquitous
[8]
References
[1] http:/ / www. amia. org
[2] http:/ / www. virginia. edu
[3] http:/ / www. kumc. edu/
[4] http:/ / www. nap. edu/ openbook. php?isbn=0309055326
[5] http:/ / www. nap. edu/ openbook. php?isbn=0309068371
[6] http:/ / books. nap.edu/ openbook. php?isbn=0309072808
[7] http:/ / endingthedocumentgame. gov/
[8] http:/ / www. nap. edu/ html/ physicians/
[9] http:/ / www. cambridge.org/ catalogue/ catalogue. asp?isbn=0521827183
[10] http:/ / www.aarp. org/ research/ health/ carequality/ 2006_10_phr_abroad. html
[11] http:/ / scholar. google.com/ scholar?hl=en& lr=& sa=G& oi=qs& q=author:d-detmer
[12] http:/ / www.ncbi. nlm.nih. gov/ entrez/ query. fcgi?db=PubMed& cmd=Search& term=Detmer+ D
Homer R. Warner
761
Homer R. Warner
Homer Richards Warner
Born October 20, 1911
Salt Lake City
Died November 30, 2012 (aged90)
Salt Lake City
Causeof death Pancreatitis
Education University of Utah (B.S., M.D.)
University of Minnesota (Ph.D.)
Knownfor Medical informatics
Spouse(s) Katherine Anne Romney (died 2007)
Jean Okland (died 2011)
June Okland
Children Homer Warner III, Stephen Warner and Willard Warner, daughters, Kathy Black, Ann Bradley and Jodi Wagner
Parents Homer Warner
Homer Richards Warner (April 18, 1922 - November 30, 2012) was an American cardiologist who was an early
proponent of medical informatics.
[1]
He has pioneered many aspects of computer applications to medicine. Author of
the book, Computer-Assisted Medical Decision-Making, published in 1979, he served as CIO for the Universitys
Health Sciences Center, as president of the American College of Medical Informatics (where an award has been
created in his honor), and was actively involved with the National Institutes of Health.He was first chair of the
Department of Medical Informatics. University of Utah was the first medical school in the U.S. to formally organize
a degree in medical informatics.
[]
Dr. Homer was emeritus chair of the University of Utah's Department of Medical Informatics. He was also a senior
member of the Institute of Medicine of the National Academy of Sciences and president of the American College of
Medical Informatics. For over 25 years, Dr. Warner served almost continuously on research review groups for the
National Institutes of Health, the National Center for Health Services Research and the National Library of
Medicine.
Biography
He was born in Salt Lake City on April 18, 1922 to Homer Warner. He joined the United States Navy during World
War II and was trained as a pilot but never saw combat.
Warner received his B.S. in 1946 from the University of Utah. He received his M.D., also from the University of
Utah, in 1949. By 1953 he had worked at Parkland Hospital in Dallas, Texas and at the Mayo Clinic in Rochester,
Minnesota and had earned a Ph.D. in physiology from the University of Minnesota.
Medical Informatics
Beginning in the mid-1950s, Dr. Warner began his work using computers for decision support in cardiology at
Intermountain Healthcare
[2]
LDS Hospital in Salt Lake City. His ground-breaking work set the stage for the growth
of the new field of academic study called medical informatics. In the 1970s, Dr. Warner and his Intermountain
colleagues created one of the nations first versions of an electronic medical record. Designed to assist clinicians in
decision-making, Intermountains now famous HELP system has been operational for nearly 40 years.
Homer R. Warner
762
University of Utah
In 1964, Warner and his associates formally taught computer applications to medicine at the University of Utah in
the Department of Biophysics and Bioengineering within the School of Engineering. In 1972, the department was
split in two and Warner directed one of the splits: the Department of Medical Biophysics and Computing in the
School of Medicine.
[3]
The department is internationally recognized for its contributions to computer applications in clinical care, medical
education and research. The mission of the department is to improve health care outcomes through information
systems in both the private and public sectors of the health care industry.
Much of the department's success is directly attributable to Warner's accomplishments. The department has produced
the largest group of medical informatics professionals educated at any institution in the United States.
Warner served as director of the cardiovascular laboratory at LDS Hospital from 1954 to 1970 and was honored as
Physician of the Year in 1985.
In 1988, he was elected to senior membership in the Institute of Medicine of the National Academy of Sciences.
New members are chosen for major contributions to health and medicine as well as from related fields.
Death
He died on November 30, 2012 in Salt Lake City from complications of pancreatitis.
Awards
Morris F. Collen Award.
[4]
Homer Warner wing of the IHC Medical Center in Utah
[5]
Intermountain Homer Warner Center for Informatics Research
Intermountain Healthcare officially opened a new center to support its clinical information systems on February 16,
2011 on the campus of Intermountain Medical Center in Salt Lake City. Named after Dr. Warner, the Homer Warner
Center for Informatics Research
[6]
honors one of the industrys recognized fathers of clinical computer systems.
Advanced information systems help caregivers improve medical delivery and outcomes. For example, these systems
automate routine functions, facilitate communication among caregivers, support decision-making processes, and
allow statistical analysis to help improve care processes and implement best medical practices.
Intermountain
[7]
has been an industry leader in using computers in the practice of medicine for several decades.
Thanks to the hard work and vision of Dr. Homer Warner and his colleagues, Intermountain has an outstanding
legacy on which to build all of its future information systems. Beginning in the mid-1950s, Dr. Warner began his
work using computers for decision support in cardiology at Intermountain's LDS Hospital in Salt Lake City. In the
1970s, Dr. Warner and his Intermountain colleagues created one of the nations first versions of an electronic
medical record. Designed to assist clinicians in decision-making, Intermountains now famous HELP system has
been operational for nearly 40 years.
Homer R. Warner
763
Homer R. Warner award
The award was created by the Object Management Group (OMG), self described as "an international, open
membership, not-for-profit computer industry consortium".
[8][9]
It includes a $1000 prize, and is presented each year at the American Medical Informatics Association (AMIA). It is
named for Warner. It is awarded for the paper that best describes approaches to improving computerized information
acquisition, knowledge data acquisition and management, and experimental results documenting the value of these
approaches.
[10]
Recipients
Dr. Kensaku Kawamoto in 2012.
[11]
Dr. Per H. Gesteland in 2011.
Dr. Milos Hauskrecht in 2010.
Dr. Hua Xu in 2009.
Dr. Joshua C. Denny in 2008.
Dr. Charlene R. Weir in 2007.
Dr. Hamish S. F. Fraser, Director of Informatics and Telemedicine for Partners in Health, in 2006.
[12]
Dr. Paul D. Clayton of Intermountain Health Care in 2005.
[13]
Drs. Paul Biondich and David Taylor jointly in 2003.
[14]
Dr. Randolph A. Miller, professor and chair of Biomedical Informatics, and David Sanders, research fellow in
Biomedical Informatics, on November 2001.
Dr. Peter Elkin for outstanding contribution to the field of Medical Informatics.
[15]
Bibliography
Some relevant books listed at Oregon Health & Science University (OSHU) library:
Knowledge engineering in health informatics
[16]
Homer R. Warner, Dean K. Sorenson, Omar Bouhaddou. New
York : Springer, c1997.
Computer-assisted medical decision-making
[17]
Homer R. Warner. Imprint New York : Academic Press, 1979.
Papers published at Journal of the American Medical Informatics Association [18]
"Medical informatics: a real discipline?" HR Warner. J Am Med Inform Assoc 1995;2(4):207-214.
"An event model of medical information representation", SM Huff, RA Rocha, BE Bray, HR Warner, and PJ
Haug. J Am Med Inform Assoc 1995;2(2):116-134.
To illustrate his contribution to informatics applied to medicine, on the patent called "Rules-based patient care
system for use in healthcare locations" issued on January 1, 2008, the references list includes seven works where he
has collaborated.
[19]
Homer R. Warner
764
References
[1] Father of medical informatics, Utahs Homer Warner dies (http:/ / www. sltrib. com/ sltrib/ news/ 55391911-78/ warner-medical-homer-utah.
html. csp), retrieved December 4, 2012
[2] http:/ / www. intermouuntainhealthcare. org
[3] department of medical informatics at University of Utah (http:/ / www. pubmedcentral. nih. gov/ articlerender. fcgi?artid=61389)
[4] Presentation of the Morris F. Collen Award to Homer R. Warner, MD, PhD: "why not? Let's do it!" (http:/ / www. jamia. org/ cgi/ content/
citation/ 2/ 2/ 137), retrieved March 17, 2008
[5] http:/ / statues.com/ mrc/ index. php?option=com_content& view=article& id=149& Itemid=173
[6] http:/ / intermountainis. org/ homer. html
[7] http:/ / www. intermountainhealthcare.org
[8] Object Management Group website (http:/ / www.omg. org/ ), retrieved March 17, 2008
[9] The Homer R. Warner Healthcare Interoperability Award;Call for Nominees. (http:/ / www. allbusiness. com/ technology/
software-services-applications-information/ 6539339-1. html)
[10] The Reporter: Miller, Sanders receive award (http:/ / www. mc. vanderbilt. edu/ reporter/ index. html?ID=1835), retrieved March 17, 2008
[11] http:/ / www.amia. org/ news-and-publications/ amia-enews/ amia-e-news-111512-amia-2012-winnerscollendistinguished-papersvideo
[12] http:/ / deimos3. apple. com/ WebObjects/ Core.woa/ FeedEnclosure/ utah. edu. 1356509518. 01392594598. 1390525251/ enclosure. pdf
[13] http:/ / www.amia. org/ files/ as05_paper_warner_0.pdf
[14] http:/ / www2.amia. org/ meetings/ f03/ post/ awards.html
[15] Human Factors Engineering in HEALTH INFORMATICS (http:/ / www. v-chi. dk/ HFEinHI2007/ index. php?page=people) Presentation of
the members of the Scientific Program Committee and the presenters at the second conference on Human Factors Engineering and Usability
for Healthcare Information Technology Applications
[16] http:/ / ohsucr11. ohsu.edu:2082/ search?/ XHomer+ R. + Warner& searchscope=8& SORT=D/ XHomer+ R. + Warner& searchscope=8&
SORT=D& SUBKEY=Homer%20R.%20Warner/ 1%2C2%2C2%2CB/ frameset& FF=XHomer+ R. + Warner& searchscope=8&
SORT=D& 1%2C1%2C
[17] http:/ / ohsucr11. ohsu.edu:2082/ search?/ XHomer+ R. + Warner& searchscope=8& SORT=D/ XHomer+ R. + Warner& searchscope=8&
SORT=D& SUBKEY=Homer%20R.%20Warner/ 1%2C2%2C2%2CB/ frameset& FF=XHomer+ R. + Warner& searchscope=8&
SORT=D& 2%2C2%2C
[18] http:/ / www.jamia. org/ cgi/ search?sendit=Search& pubdate_year=& volume=& firstpage=& DOI=& author1=Homer+ R. + Warner&
author2=& title=& andorexacttitle=and& titleabstract=& andorexacttitleabs=and& fulltext=& andorexactfulltext=and&
resourcetype=1%2C10& fmonth=Jan& fyear=1994& tmonth=Mar& tyear=2008& fdatedef=1+ January+ 1994& tdatedef=1+ March+ 2008&
hits=10& sortspec=relevance
[19] United States Patent 7315825 (http:/ / www.patentstorm. us/ patents/ 7315825. html) Rules-based patient care system for use in healthcare
locations, retrieved March 17, 2008
Robert Ledley
765
Robert Ledley
Robert Ledley
Robert Ledley
Born June 28, 1926
Flushing, Queens, New York, USA
Died July 24, 2012 (aged86)
Kensington, MD, USA
Residence USA
Citizenship USA
Fields mathematics, physics, computing, biology, medicine, dentistry
Institutions National Bureau of Standards
George Washington University
Georgetown University
National Biomedical Research Foundation
Alma mater New York University
Columbia University
Knownfor Whole-body CT/CAT Scanner
Optical Pattern Recognition
Bioinformatics
Computing Advocacy
Notable awards National Medal of Technology
National Inventors Hall of Fame
Spouse Terry Ledley (ne Wachtell)
Robert Steven Ledley (June 28, 1926 July 24, 2012), Professor of Physiology and Biophysics and Professor of
Radiology at Georgetown University School of Medicine, pioneered the use of electronic digital computers in
biology and medicine. In 1959, he wrote two influential articles in Science: "Reasoning Foundations of Medical
Diagnosis" (with Lee B. Lusted) and "Digital Electronic Computers in Biomedical Science". Both articles
encouraged biomedical researchers and physicians to adopt computer technology. In 1960 he established the
National Biomedical Research Foundation (NBRF), a non-profit research organization dedicated to promoting the
use of computers and electronic equipment in biomedical research. At the NBRF Ledley pursued several major
projects: the early 1960s development of the Film Input to Digital Automatic Computer (FIDAC), which automated
the analysis of chromosomes; the invention of the Automatic Computerized Transverse Axial
[1]
(ACTA)
whole-body CT scanner in the mid-1970s; managing the Atlas of Protein Sequence and Structure
[2]
(created in 1965
by Margaret O. Dayhoff); and the establishment of the Protein Information Resource in 1984. Ledley also served as
editor of several major peer-reviewed biomedical journals. In 1990, Ledley was inducted into the National Inventors
Hall of Fame. He was awarded the National Medal of Technology in 1997. He retired as president and research
Robert Ledley
766
director of the NBRF in 2010.
Family and Education
Robert Ledley was born on June 28, 1926 in Flushing Meadows, Queens, New York City, USA.
[3]
His father, Joseph
Levy, was an accountant and his mother, Kate Levy, was a schoolteacher before becoming a homemaker. Robert had
a sister, Marion, and a half-brother, Ralph. All three siblings were surnamed Ledley.
Among Ledleys childhood friends in Flushing was Margaret Oakley Dayhoff, who would later spend most of her
career working at the National Biomedical Research Foundation and who would become a founder of the field of
bioinformatics. Ledley attended the Horace Mann School, from which he graduated in 1943.
[4]
As an undergraduate student at Columbia University Ledley excelled in physics, taking undergraduate and graduate
courses within his first two years as a student. When, however, he informed his parents of his desire to become a
physicist, they objected on the grounds that a career in physics would not be feasible for him given the scarcity of
steady jobs in that field. Instead, they urged him to make his living as a dentist. Ledley attempted to follow both
paths at once; he enrolled in the New York University College of Dentistry while continuing to pursue his education
in physics at Columbia.
[5]
During the day, Ledley would take dentistry training courses at NYU, then he would take
the subway to Columbia to take evening courses in physics. After receiving his DDS from NYU in 1948, Ledley
became a full-time physics graduate student at Columbia, where he took courses from many noted physicists
including I.I. Rabi (who joked that Ledley was the only physicist who could pull a mans tooth), Enrico Fermi, Hans
Bethe, and J.A. Wheeler. Ledley received a MS in physics from Columbia in 1950.
[6]
In 1949, Ledley married Terry Wachtell (born 1926), a mathematics teacher at Queens College, and sister of Herbert
Wachtell.
[7]
The couple had two sons, Fred (born 1954) and Gary (born 1957). When the couple moved to the DC
area in the early 1950s, Terry was employed as a computer programmer until leaving work to raise their sons. Both
sons graduated from Georgetown University School of Medicine. Fred Ledley is Professor of Natural and Applied
Sciences at Bentley University and is the author of numerous scientific papers as well as the novel, Sputniks Child
(2011).
[8]
Gary Ledley is a practicing cardiologist associated with Drexel University.
[9]
Robert Ledley died of Alzheimer's disease in Kensington, Maryland, USA on July 24, 2012.
Early Research Career
U.S. Army Dental Research
In 1950, shortly after the outbreak of the Korean War, Ledley was contacted by a U.S. Army recruitment officer,
who offered him a choice: he could volunteer to join the U.S. Army Dental Corps as a First Lieutenant or be
conscripted into the infantry as a private. Ledley promptly volunteered, and was sent to the U.S. Army Medical Field
Service School for training. Because Ledley was also trained in physics, he was assigned to a dental research unit at
Walter Reed General Hospital, in Washington, D.C..
During his time in the Army Ledley was responsible for improving prosthetic dental devices (such as dentures) then
widely used by Army personnel. Notably, Ledley drew on his training in dentistry and physics to develop a system
that optimized the process of fitting dentures by allowing dentists to determine the angle of chew, or the mean
slope of each tooth relative to the surface of an object (e.g. a piece of food) being bitten. Ledley presented this work
to the American Physical Society in 1952, and it generated nationwide attention via an Associated Press newspaper
story titled Mathematics Used to Keep False Teeth in Place.
[10]
Robert Ledley
767
Work with Standards Eastern Automatic Computer
Terry Ledley operating the Standards Eastern Automatic Computer (SEAC) at the
National Bureau of Standards in the early 1950s. Robert Ledley learned to program on
this computer, first via paper tapes Terry brought to him and then by using the machine
extensively himself.
Ledley's work on dental prosthetics
brought him into collaboration with
researchers based at the National
Bureau of Standards Dental Materials
Research Section, where he was
offered a research job in 1952
following his discharge from the
Army. There he encountered the
Standards Eastern Automatic
Computer, one of the earliest
stored-program electronic digital
computers. Ledley's first interaction
with SEAC came via his wife, Terry,
who worked as one of the machine's
programmers Robert taught himself
to program by examining programs (on
perforated paper tape) and manuals
Terry brought home. Ledley started to
use SEAC himself for his dental research, but after proving an adept programmer and troubleshooter, he found
himself working with SEAC (and later DYSEAC) full-time on a wide variety of projects, including a
remote-controlled aircraft guidance system.
[11]
For Ledley, working with SEAC produced an epiphany, concerning both his career and the potential importance of
computers to biomedical research. He recalled: I had previously realized that although, conceptually, physics
equations could be written to describe any biomedical phenomenon, such equations would be so complex that they
could not feasibly be solved in closed form. Thus SEAC would be my panacea, because the equations would become
tractable to numerical methods of solutions. Or so I truly believed at the time. That was to be my field, application of
computers to biomedical problems.
Operations Research and the RNA Tie Club
Though Ledley had envisioned a career of employing computers to solve biomedical problems as early as the early
1950s, it would be several years before he would pursue that career full-time. At the National Bureau of Standards,
Ledleys work was primarily related to solving military problems using the techniques of operations research. For
instance, he published an article in the journal Operations Research showing how one could use Boolean algebra to
reduce complex military decision-making problems to the point where they could be resolved using a collection of
truth tables and yes-or-no questions.
[12]
When Ledley lost his job at the NBS in 1954 due to budget cuts, he turned down an offer to work for IBM (which
hired Ledleys colleagues en masse). Instead, he found employment as an Operations Research Analyst at the
Operations Research Office at Johns Hopkins University. There, his work remained mostly focused on military
problems, but his expertise in biology, physics, mathematics, and computing caught the attention of one of his new
ORO colleagues, George Gamow. Gamow, who was renowned for his contributions to the Big Bang cosmological
model, had taken an interest in molecular biology immediately after James D. Watson and Francis Crick elucidated
the double helix structure of DNA in 1953. Gamow believed Ledleys skills could be instrumental in helping to crack
the genetic code, that is, by solving the problem of how a DNA sequence translates into proteins. In 1954, Gamow
invited Ledley to join the elite RNA Tie Club; some other members of the club were Watson, Crick, Richard
Robert Ledley
768
Feynman, Max Delbrck, Edward Teller, and Sydney Brenner.
[13]
Ledleys main work for the RNA Tie Club was an effort to generate a set of contingency tables for the purpose of
writing a computer program that would determine the correspondence between any three-letter sequence (triplet) of
nucleotide bases and any amino acid (the building blocks of proteins). Sponsored by Gamow, Ledley published his
work in 1955 in the Proceedings of the National Academy of Sciences.
[14]
Though Ledley had produced a
combinatorial table that could theoretically be used to determine which three-letter sequence of DNA bases
corresponded to which amino acid, the problem required several thousand years of computation time on the worlds
fastest computers (circa 1955) to produce a solution.
Having established that computers could not be used reasonably quickly to decode DNA, Ledley drifted away from
the RNA Tie Club. Ultimately the code was broken in the 1961 Nirenberg and Matthaei experiment, which did not
use computers and which was not carried out by RNA Tie Club members.
[15]
Electrical Engineering
In 1956, Ledley was hired as an assistant professor of electrical engineering at the George Washington University
School of Engineering and Applied Science. There, he taught some of the earliest courses on computer programming
and wrote his first book, Digital Computer and Control Engineering (1960). At GWU, Ledley acquired the Florida
Automatic Computer I and II, two descendants of SEAC that had been discarded by the US Air Force as surplus, for
the purpose of establishing a computation center that would use the computers to automate Frederick Sangers
process of determining the amino acid sequence of proteins. The center was never built, however, because the
National Institutes of Health rejected Ledleys request for a grant to fund it, and because the university balked at the
prospect of installing and supporting the two enormous computers.
Collaboration with Lee B. Lusted
Lee B. Lusted (1922-1994), a radiologist with a background in electrical engineering, became aware of Ledleys
work in 1956 after Ledley gave a presentation titled An Operations-Research View of Medicine and Health to the
annual meeting of the Operations Research Society of America. After the meeting, Lusted telephoned Ledley, and
the two found that they shared a strong interest in using electronics and mathematics to improve medicine. The two
men immediately began to collaborate on developing ways to teach physicians and biomedical researchers, who
rarely had much training in electronics or mathematics, to use electronic digital computers in their work.
[16]
In 1959, Ledley and Lusted published Reasoning Foundations of Medical Diagnosis, a widely-read article in
Science, which introduced operations research techniques to medical workers. Areas covered included: symbolic
logic, Bayes theorem (probability), and value theory. In the article, physicians were instructed how to create
diagnostic databases using edge-notched cards to prepare for a time when they would have the opportunity to enter
their data into electronic computers for analysis. Ledley and Lusted expressed hope that by harnessing computers,
much of physicians work would become automated and that many human errors could therefore be avoided.
[17]
Within medicine, Ledley and Lusteds article has remained influential for decades, especially within the field of
medical decision making. Among its most enthusiastic readers was cardiologist Homer R. Warner, who emulated
Ledley and Lusteds methods at his research clinic at LDS Hospital in Utah. Warners work, in turn, shaped many of
the practices and priorities of the heavily computerized Intermountain Healthcare, Inc., which was in 2009 portrayed
by the Obama administration as an exemplary model of a healthcare system that provided high-quality and low-cost
care.
The article also brought national media attention to Ledley and Lusteds work. Articles about the work of the two
men ran in several major US newspapers. A small demonstration device Ledley built to show how electronic
diagnosis would work was described in the New York World Telegram as a A Metal Brain for Diagnosis, while the
New York Post ran a headline: Dr. Univac Wanted in Surgery.
[18]
On several occasions, Ledley and Lusted
explained to journalists that they believed that computers would aid physicians rather than replace them, and that the
Robert Ledley
769
process of introducing computers to medicine would be very challenging due to the non-quantitative nature of much
medical information. They also envisioned, years before the development of ARPANET, a national network of
medical computers that would allow healthcare providers to create a nationally-accessible medical record for each
American and would allow rapid mass data analysis as information was gathered by individual clinics and sent to
regional and national computer centers.
NAS-NRC Survey and Computer Advocacy
In early 1957, Ledley was hired on a part-time basis by the National Academy of Sciences - National Research
Council (NAS-NRC) to conduct a national survey of current and potential computer use in biology and medicine in
the United States. Supported by Senator Hubert Humphrey and NIH Director James A. Shannon, the NAS-NRC
commissioned the survey in an effort to help physicians and life scientists overcome their reluctance to use
computers.
[19]
Ledley published his survey findings in a November 6, 1959 Science article, Digital Electronic Computers in
Biomedical Science, in which he called on biologists to train in mathematics and engineering in order to effectively
use electronic digital computers. He predicted that in the long run, perhaps the greatest utilization of computers will
be in biomedical applications." Like the earlier Science article co-authored with Lusted, Ledleys new piece was
widely read among its most influential and enthusiastic readers was Joshua Lederberg, who spent much of the later
part of his career using computers to solve problems in biology research.
[20]
Ledleys survey and article also shaped the National Institutes of Healths first major effort to encourage biomedical
researchers to use computers.
[21]
This effort began shortly after the Soviet launch of Sputnik in October 1957in
reaction to Sputnik, the U.S. Congress sought means boost U.S. scientific and technological productivity. Beginning
in 1960, Congress allocated roughly $40 million to the NIH for the purpose of stimulating computer use in
biomedical research. Ledleys survey recommendations, particularly his call for biomedical workers to train
extensively in mathematics and engineering, served as a guide for the NIH effort, which was carried out by the NIHs
Advisory Committee on Computers in Research (ACCR). The ACCR was led from 1960 to 1964 by Ledleys
collaborator, Lee Lusted. During those years, the committee established several major biomedical computing centers
around the USA and sponsored the development of the LINC. The ACCRs successor, the Computers in Research
Study Section, was headed by Homer Warner, one of the first research physicians to employ Ledley and Lusteds
techniques in a clinical setting.
[22]
Robert Ledley
770
National Biomedical Research Foundation
Establishment and Goals of the NBRF
NBRF "Christmas Tree" showing projects and journals initiated by
the organization up to 1991. At the base is the establishment of the
foundation in 1960. The ornaments represent (moving from bottom
to top and from left to right): the Atlas of Protein Sequence and
Structure (initiated in 1965), Computers in Biology and Medicine
(journal founded in 1969), Pattern Recognition (journal founded in
1967), first protein datatape (1972), ACTA (prototype built 1974),
Computer Languages (journal founded in 1972), first nucleic acid
datatape (1979), Computerized Medical Imaging and Graphics
(journal founded in 1981 -- this grew out of the 1976 journal
Computerized Tomography and the 1977 journal Computerized
Radiology), CENOG (prototype built 1978), Protein Information
Resource (launched in 1984), 1990 was the NBRF's 30th year.
Following his survey work for the NAS-NRC and the
publication of his and Lusteds articles in Science,
Ledley sought federal government and university
support his efforts to development computers and
computer programs for use by biomedical researchers.
With the support of the NAS-NRC, Ledley chartered in
1960 the National Biomedical Research Foundation
(NBRF), a nonprofit organization, initially based in an
NAS-NRC-owned building near Dupont Circle,
Washington, D.C.
[23]
Believing that his career as a university faculty member
would ultimately constrain his research, Ledley left his
position at GWU in order to dedicate his full-time to
running the NBRF. Ledley would lead the NBRF until
his retirement in 2010. Early employees included: Louis
S. Rotolo (Ledleys assistant in the NAS-NRC survey),
James B. Wilson (Ledleys former graduate student at
GWU), and Margaret O. Dayhoff (a quantum chemist
with a Ph.D. from Columbia and Ledleys childhood
friend from Flushing).
Grounded in Ledleys belief that computer use would
substantially improve biology and medicine by helping
to mathematize those areas, the NBRFs mission was to
stimulate biomedical research scientists to utilize
computers by setting an example through its own
pioneering research and development in new areas of
computer applications. Starting with an annual budget
of under $100,000 and a half-dozen employees, the
NBRF grew into a multi-million dollar operation with
more than 20 employees by the early 1980s. Initially the
vast majority of NBRFs support came from the NIH,
but by 1980 it drew support from a variety of federal,
university, and corporate sources, in addition to
generating revenue through the publication of journals and the sale of electronic instruments, software, and patents.
In 1970, the NBRF began its affiliation with the Georgetown University Medical Center. The university, which had
allocated space for a biomedical computing facility that had never been built, provided office and laboratory space
for the NBRF, while the NBRF would serve as a computing resource for the university as well as bring funding and
prestige to the university through its research and development activities.
As part of the move, Ledley was appointed to Georgetown Universitys faculty as a professor of radiology,
physiology, and biophysics. The NBRF was physically located at Georgetown from 1970 to 2006. Between 2006 and
2010 it was based in offices in Washington, D.C. and Bethesda, MD.
In 2011, the NBRF was reincorporated in Massachusetts and has adopted a new mission statement.
Robert Ledley
771
FIDAC and Pattern Recognition
Robert Ledley pictured with FIDAC in 2007.
Robert Ledley posing with an IBM 360 that was used in conjunction with FIDAC. The
sheets of paper on the left side of the photograph are printouts of digitized chromosome
micrographs. Stacks of IBM punched cards are present near Ledley's right arm.
The NBRFs earliest area of emphasis
was developing optical pattern
recognition technology. Working with
Wilson in 1960 and 1961, Ledley built
the Automatic Device for Antibiotic
Determination (ADAD), a
computerized light-measuring device
that tested for efficacy of antibiotic
drugs by measuring transparency in
petri dish cultures. Areas that were
transparent were likely areas where the
antibiotics had killed the bacterial
populations; areas that were opaque
likely areas where the bacteria were
still alive. The NBRF sold several
ADAD units to the Food and Drug
Administration, and to large
pharmaceutical companies.
Building on the success of ADAD,
Ledley, Wilson, and a newcomer to the
NBRF, electrical engineer Thomas
Golab, developed the Film Input to
Digital Automatic Computer (FIDAC)
in the mid-1960s.
[24]
FIDAC was
designed to scan a photograph into its
memory and then send that information
to a larger computer (e.g. IBM 360) in
order to recognized patterns in the
scanned image. To digitize a
photograph, FIDAC would impose a
700 x 500 point grid (of arbitrary size)
onto it and then measure the light level
at each point. Depending on the light
level detected at it, each point was
assigned an integer ranging from 0 to 9. FIDAC could generate a 350,000-point scan in under 0.5 seconds.
Ledley designed FIDAC to scan photomicrographs of chromosomes in order to automate the labor-intensive task of
karyotype analysis, which is used to detect conditions such as Turner syndrome and Down Syndrome). Once
programmed to distinguish chromosomes from the background and then to recognize abnormalities in a given
sample (e.g. the presence of extra chromosome(s), abnormally-shaped chromosome(s)), FIDAC could perform in 40
seconds a chromosome analysis that took a skilled technician 15 minutes to complete by hand.
Beyond chromosome analysis, FIDAC was adapted to digitize and analyze photographs of neurons and Pap smears
as well as schlieren photographs. About a dozen FIDAC units were sold during the 1960s, and by the early 1970s
there was considerable demand for a smaller version of the machine. Ultimately the Jet Propulsion Laboratory was
awarded an NIH grant to develop a small, FIDAC-like instrument for use in laboratories and clinics.
Robert Ledley
772
To facilitate discussion among users and developers of FIDAC, Ledley founded in 1969 the peer-reviewed journal '
Pattern Recognition
[25]
', the official journal of the Pattern Recognition Society. Ledley remained the editor of
Pattern Recognition until 2010.
ACTA and Computerized Tomography (CT/CAT scanning)
Robert Ledley at the exhibit of the ACTA whole-body CT scanner at the Smithsonians
National Museum of American History.
Ledley is most widely known for his
1970s efforts to develop computerized
tomography (CT) or CAT scanners.
This work began in 1973, when the
NBRF lost most of its NIH funding
due to federal budget cuts. During this
time, the NBRF had also become
increasingly involved in on-campus
computing projects. Quickly trying to
raise enough funds to cover the NBRF
employee salaries, Ledley looked for
projects the organization could
undertake for Georgetown University.
After learning that Georgetown
research physicians were frustrated by
the $500,000 cost of a CT scanner they
wished to buy from EMI (EMI-Scanner), Ledley promised them that the NBRF could build a similar machine for
only half the price. The university agreed to give Ledley a chance, and for the next several months a team led by
Ledley, Golab, Wilson, and Frank Rabbitt, worked to develop a prototype.
[26]
Aside from reducing cost, the NBRF team aimed to overcome the major constraint of the EMI-Scanner, namely that
it required X-rays to be shone through a water tank enclosing the object being scannedthis constraint limited the
use of the scanner to only patients heads and required physicians to place patients heads into a rubber bladder
extending into a water tank. Building on their experience in medical imaging, and working with Godfrey
Hounsfield's early designs for the EMI machine as well as the theoretical papers of Allan McLeod Cormack and
William H. Oldendorf, the NBRF team concluded that the necessity of using a water tank could be eliminated by
changing the algorithm used to assemble X-rays into a 3-D image. Unlike the EMIs head-only scanner, which used a
relaxation algorithm, the NBRF machine used a convolution algorithm.
In 1974, after several months of working with Georgetowns machinists and auto body specialists at a nearby
Cadillac dealer, Ledleys team completed construction of the Automatic Computerized Transverse Axial (ACTA)
scanner. The machine had 30 photomultiplier tubes as detectors and completed a scan in 9 translate/rotate cycles,
much faster than the EMI-scanner. It used a DEC PDP-11/34 minicomputer both to operate the servo-mechanisms
and to acquire and process the images. Most importantly, ACTA could scan the entire body, whereas the
EMI-scanner could only scan the head.
ACTA was immediately successful at Georgetown. Late in the prototypes development, David C. McCullough, a
pediatric neurosurgeon at Georgetown University Hospital used ACTAwithout Ledleys knowledgeto examine a
child who hit his head in a bicycle accident. McCullough used the machine to detect brain bleeding in the boy and
the precise information about the location of the bleeding to quickly plan and perform life-saving surgery. News of
this and other similar cases spread quickly and Ledley soon faced worldwide demand for machines like ACTA.
Ledley established Digital Information Science Corporation (DISCO) in 1974, which sold the ACTA scanners for
$300,000 each. On November 25, 1975, Ledley was issued the patent for the design of ACTA. Later in 1975, DISCO
sold the ACTA rights to Pfizer for $1.5 million in cash and $10 million in guaranteed research funding (paid out over
Robert Ledley
773
10 years) for the NBRF. Pfizers ACTA 0100 and its successor, the 200FS, were sold to hospitals worldwide
between 1975 and 1977, but Pfizer lost the medical imaging market to G.E. and Technicare, which both sold
next-generation CT scanners.
As the use of CT scanners became widespread, Ledley rose to considerable prominence. The ACTA prototype was
displayed at the Smithsonians National Museum of American History, in Washington, D.C.. The Smithsonian also
established an archive for materials related to the development of ACTA. For his role in developing ACTA, Ledley
was inducted into the National Inventors Hall of Fame in 1990 and was awarded the National Medal of Technology
and Innovation in 1997.
Bioinformatics
Alongside Ledley's work on imaging technology, his NBRF colleague Margaret Oakley Dayhoff was developing
resources for the study of life on the molecular level. Her 1965 Atlas of Protein Sequence and Structure sought to
provide a comprehensive collection of the scientific communitys data on protein sequencing. Published annually by
the NBRF, first on paper then (as the volume of information grew much larger) on magnetic tape and finally on
CD-ROM, the Atlas served as an information clearinghouse for the growing community of protein sequencers. By
the mid-1970s the Atlas had become the primary repository of protein sequence data, and ultimately served as a
model for the Protein Data Bank and the nucleic acid sequence database GenBank, both now major resources for
biologists.
After Dayhoff died suddenly in 1983, Ledley and Winona Barker (who joined the NBRF in the late 1960s) took
charge of the project. During the mid-1980s Ledley and Barker led a team that developed the Protein Identification
Resource (later called the Protein Information Resource or PIR), an online version of the Atlas. Researchers using
modems or Tymnet could access the PIR to look up sequence information or add to the collection. As of 2012, the
PIR remains an important resource for biologists; it is managed jointly by the University of Delaware and
Georgetown University, and is a major component of UniProt.
Other NBRF Computing Projects
The NBRF "Bat," a 3-D mouse (left) used for interacting with stereo images (right).
From 1979 to 1980, Ledley and Golab
developed the Computerized Electro
Neuro Ophthalmograph (CENOG).
This machine enabled healthcare
providers to automatically analyze
ocular motility, an important factor in
the diagnosis of neurological and
ophthalmic disorders. CENOG
generated considerable media attention
in the early 1980s, largely because it
served as a demonstration of the
feasibility of automated medical
diagnosis.
While at the NBRF, Ledley also
carried out work related to computer
design. In 1970, when Moores Law was still a relatively new idea, and when the most powerful computers had
Robert Ledley
774
Robert Ledley operating CENOG at the NBRF circa 1980.
1,000 to 2,000 logic gates, Ledley
wrote a paper titled Realization of a
Billion-Gate Computer in which he
speculated on the capabilities of a
transistorized computer that had
1,000,000,000 logic gates. He
proposed that such a machine would:
1) have no fixed logic design; 2) be
capable of redesign some of its own
components; 3) be able to self-heal.
Billion-transistor microprocessors have
been commonplace in personal
computers since 2010, though these
machines are not as dynamic (in terms
of logic structure) as Ledley had
predicted.
In the late 1980s, Ledley lead the team that developed the Bat, a three-dimensional mouse that allowed users to
interact with objects in three-dimensional space (generated using stereo images).
Scientific Journals
During his long career at the NBRF, Ledley served as editor of four major peer-reviewed journals. In 1969, he
launched Pattern Recognition and Computers in Biology and Medicine. The former focuses on computerized
approaches to pattern recognition, while the latter publishes articles, algorithms, and technical descriptions related to
the use of computers in biomedicine. In 1972, Ledley started Computer Languages, Systems and Structures, the
mission of which is to publish papers on all aspects of the design, implementation and use of programming
languages, from theory to practice. In 1976, following the success of ACTA, Ledley initiated Computerized
Tomography, which was renamed Computerized Radiology in 1977, and subsequently renamed Computerized
Medical Imaging and Graphics in 1981. It serves as a source for the exchange of information concerning the
medical use of new developments in imaging diagnosis, intervention, and follow up. Ledley served as editor of all
four journals until his retirement in 2010. The journals are currently published by Elsevier.
Honors, memberships, and affiliations
Morris F. Collen Award, American College of Medical Informatics (AMIA) (1998)
National Inventors Hall of Fame (inducted 1990)
National Medal of Technology (1997)
Vicennial Gold Medal for Distinguished Service, Georgetown University (1990)
Member, Institute of Medicine, National Academy of Sciences (1999)
Distinguished Alumnus, New York University (1999)
Robert Ledley
775
Publications
Ledley, R. S.; Lusted, L. B. (3, July 1959). "Reasoning Foundations of Medical Diagnosis". Science 130: 921.
JSTOR1758070
[27]
.
Ledley, R. S. (6, Nov. 1959). "Digital Electronic Computers in Biomedical Science". Science 130: 12251234.
JSTOR1757193
[28]
.
Ledley, R. S. (1959). Report on the Use of Computers in Biology and Medicine. Washington, D.C.: National
Academy of Sciences. ISBN0-217-75214-4. (General Books, 2010).
Ledley, R. S. (1960). Digital Computer and Control Engineering. New York: McGraw-Hill.
ISBN9780070369818.
Ledley, Robert S.; Lusted, Lee B. (1960). "Computers in Medical Data Processing". Operations Research 8:
299310. JSTOR167094
[29]
.
Ledley, R. S. (1962). Programming and Utilizing Digital Computers. New York: McGraw-Hill.
ISBN0-070-36982-8.
Ledley, R. S. (1965). Use of computers in Biology and Medicine. New York: McGraw-Hill.
Ledley, R. S. (1966). FORTRAN IV Programming. New York: McGraw-Hill.
Ledley, Robert (July 1970). "Realization of a Billion-Gate Computer"
[30]
. NBRF Technical Report.
Ledley, R. S.; Huang, H.K.; Mazzioti, J.C., eds. (1977). Cross-Sectional Anatomy: An Atlas for Computerized
Tomography. Baltimore, MD: Williams & Wilkins. ISBN0-683-04920-8.
Notes
[1] http:/ / americanhistory. si. edu/ collections/ object. cfm?key=35& objkey=115
[2] http:/ / www. dayhoff. cc/ MODAtlasSummary.html
[3] "Lemelson Center for the Study of Innovation & Innovation" (http:/ / invention. smithsonian. org/ resources/ fa_ledley_index. aspx),
Smithsonian-Lemelson: Robert Ledley Papers 1972-1981, Retrieved Apr 14, 2012.
[4] "Robert S. Ledley, DDS '43" (http:/ / www.horacemannalumni. org/ award2000. htm), Horace Mann School: 2000 Award for Distinguished
Achievement Recipients, Retrieved Apr 14, 2012.
[5] [5] Ledley, Robert. (1990) "Medical Informatics: A Personal View of Sowing the Seeds." p. 89.
[6] [6] Ledley, Robert. (1990) "Medical Informatics: A Personal View of Sowing the Seeds." p. 90.
[7] TERRY WACHTELL WED; Queens College Teacher Is Bride of Dr. Robert S. Ledley (http:/ / spiderbites. nytimes. com/ pay_1949/
articles_1949_08_00003. html), New York Times (Aug. 1949), Retrieved Apr 14, 2012.
[8] "Faculty Profile: Fred D. Ledley" (https:/ / faculty.bentley. edu/ details. asp?uname=fledley), Bentley University, accessed Apr. 14, 2012.
[9] "Gary Ledley, M.D." (http:/ / www.drexelmed.edu/ Home/ AboutOurFaculty/ GaryLedley. aspx), Drexel University College of Medicine,
Retrieved Apr 14, 2012.
[10] Ledley formally published his research in R. S. Ledley, An Important Property of the Masticatory Force, J DENT RES 44 (1965): 405.
Sagepub PDF (http:/ / jdr. sagepub. com/ content/ 44/ 2/ 405. full. pdf)
[11] [11] pp. 46-47
[12] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. p. 48.
[13] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 42-43.
[14] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. p. 49. See: Ledley, R.S. Digital Computational
Methods in Symbolic Logic, with Examples in Biochemistry, Proceedings of the National Academy of Sciences 41 (July 1955): 498511.
[15] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. p. 52.
[16] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 54-57.
[17] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. p. 60.
[18] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 62-66.
[19] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 78-80.
[20] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 81-85.
[21] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 88-97.
[22] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. p. 113.
[23] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 209-210.
[24] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 211-214.
[25] http:/ / www.journals.elsevier.com/ pattern-recognition/
[26] November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. pp. 215-219.
[27] http:/ / www.jstor.org/ stable/ 1758070
Robert Ledley
776
[28] http:/ / www.jstor.org/ stable/ 1757193
[29] http:/ / www.jstor.org/ stable/ 167094
[30] http:/ / oai. dtic. mil/ oai/ oai?verb=getRecord& metadataPrefix=html& identifier=AD0714009
References
Bleich, H L (1991), "Enemy radar, theoretical physics, and computer-assisted diagnosis", M.D. Computing :
computers in medical practice 8 (5): 26970, PMID 1749336 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/
1749336)
Broering, N C (1999), "Presentation of the Morris F. Collen Award to Robert S. Ledley, DDS.", Journal of the
American Medical Informatics Association : JAMIA 6 (3): 2604, doi: 10.1136/jamia.1999.0060260 (http:/ / dx.
doi. org/ 10. 1136/ jamia. 1999. 0060260), PMC 61367 (http:/ / www. ncbi. nlm. nih. gov/ pmc/ articles/
PMC61367), PMID 10332660 (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 10332660)
Ledley, Robert (1990). "Medical Informatics: A Personal View of Sowing the Seeds". In Blum, Bruce; Duncan,
Karen. A History of Medical Informatics: Proceedings of Association for Computing Machinery Conference on
History of Medical Informatics. ACM Press. pp.84110. ISBN9780201501285.
Ledley, Robert; November, Joseph (Feb 21, 2008). "A Lifetime of Biomedical Computing: A Conversation with
Robert Ledley" (http:/ / web. archive. org/ web/ 20090704213053/ http:/ / dcb. cit. nih. gov/ events/ Dr. Joe
November - A Lifetime in Biomedical Computing/ ). Retrieved April 14, 2012.
Leonhard, David (November 3, 2009). "Making Health Care Better" (http:/ / www. nytimes. com/ 2009/ 11/ 08/
magazine/ 08Healthcare-t. html). New York Times Magazine. Retrieved April 15, 2012.
Moody, Glyn (2004). Digital Code of Life: How Bioinformatics is Revolutionizing Science, Medicine, and
Business. ISBN978-0471327882.
November, Joseph (2012). Biomedical Computing: Digitizing Life in the United States. Baltimore: Johns Hopkins
University Press. ISBN1421404680.
November, Joseph A. (Apr-Jun 2011). "Early Biomedical Computing and the Roots of Evidence-Based
Medicine". IEEE Annals of the History of Computing 33 (2): 923. doi: 10.1109/MAHC.2011.35 (http:/ / dx. doi.
org/ 10. 1109/ MAHC. 2011. 35).
Pyle, Kathryn I.; Lobel, Robert W.; Beck, J.Robert (1988). "Citation Analysis of the Field of Medical Decision
Making" (http:/ / mdm. sagepub. com/ content/ 8/ 3/ 155). Medical Decision Making 8 (3): 155164. doi:
10.1177/0272989X8800800302 (http:/ / dx. doi. org/ 10. 1177/ 0272989X8800800302).
Sittig, Dean F; Ash, Joan S; Ledley, Robert S (2006), "The story behind the development of the first whole-body
computerized tomography scanner as told by Robert S. Ledley.", Journal of the American Medical Informatics
Association : JAMIA 13 (5): 4659, doi: 10.1197/jamia.M2127 (http:/ / dx. doi. org/ 10. 1197/ jamia. M2127),
PMC 1561796 (http:/ / www. ncbi. nlm. nih. gov/ pmc/ articles/ PMC1561796), PMID 16799115 (http:/ / www.
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Strasser, Bruno J. (2010). "Collecting, comparing, and computing sequences: the making of Margaret O.
Dayhoff's Atlas of Protein Sequence and Structure, 1954-1965.". J. Hist. Bio. 43 (4): 62360. doi:
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Robert Ledley
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External links
Protein Information Resource (http:/ / pir. georgetown. edu/ ) (Georgetown University)
Presentation of Morris F. Collen Award to Robert S. Ledley (http:/ / www. youtube. com/
watch?v=NMCi4uB0ip4) American College of Medical Informatics (AMIA), 1998 (video hosted on YouTube)
"A Lifetime of Biomedical Computing: A Conversation with Robert Ledley" (http:/ / web. archive. org/ web/
20090704213053/ http:/ / dcb. cit. nih. gov/ events/ Dr. Joe November - A Lifetime in Biomedical Computing/ )
public lecture, National Institutes of Health, February 21, 2008. (archive.org)
Vimla L. Patel
778
Vimla L. Patel
Vimla L. Patel
Born Fiji
Nationality Canadian
Fields Health Informatics
Cognitive Psychology
Institutions McGill University
Columbia University
UT Houston
ASU
New York Academy of Medicine
Alma mater University of Otago
McGill University
Doctoral students Andre Kushniruk
David R Kaufman
Trevor Cohen
Jan Horsky
Other notablestudents Marco Ramoni
Knownfor Cognitive science methods applied to understanding physicians
reasoning
International Health
Decision making and Medical errors
Human factors and health information technology
Notable awards Fellow, Royal Society of Canada
Fellow, ACMI
Fellow, New York Academy of Medicine
Vimla Lodhia Patel, is a Fijian-born Canadian cognitive psychologist and biomedical informaticist.
In the past decade, Dr. Patel has worked in the area of biomedical informatics, in particular studying the mediating
roles of technology on performance. Her work includes studies of medical errors and error reduction in emergency
care and other critical medical environments, (including telephone triage). Her past work in health cognition includes
studies of risk-taking behavior and sexual decision making as it pertains to HIV in youth and adolescents.Her current
work focuses mostly on identifying underlying cognition in medical error and learning.
Biography and career
Dr. Patel was born in Fiji and obtained a degree in biochemistry and microbiology from University of Otago in New
Zealand, and MA and PhD in Educational Psychology (Medical Cognition,1980,1981) from McGill University in
Montreal, where she also served as professor of Medicine and Psychology and director of the Centre for Medical
Education. She was a founding member of HEALnet
[1]
(Health Evidence Application and Linkage Network), which
made seminal contributions furthering informatics research and application in Canada. She was also a member of the
InterMed Collaboratory
[2]
, which developed guidelines for medical decision support, and has done extensive work
in India, Africa, and Colombia in cross-cultural cognition research.
In 2000 she became director of the Laboratory of Cognition and Decision Making in the department of Biomedical
Informatics at Columbia University, where she was also faculty in the department of Psychiatry and Teacher's
College. From 2007-09, she served as interim chair and vice chair of Department of BMI at Arizona State
University. Dr. Patel was a Professor of Biomedical Informatics and Co-Director of the Center for Cognitive
Vimla L. Patel
779
Informatics and Decision Making at the University of Texas at Houston from 2009-11.As of November 2011,
Dr.Patel joined the New York Academy of Medicine as a Senior Research Scientist and is the head of the Center for
Cognitive Studies in Medicine and Public Health and is an adjunct professor of Biomedical informatics at Columbia
University in NY.
Research
In 1978 Elstein, Shulman and Sprafka
[3]
applied cognitive science methods to investigate physicians clinical
competence, developing a model of hypothetico-deductive reasoning which proposed that physicians reason by
generating and testing a set of hypotheses to explain clinical data. This is an example of backward
(hypothesis-to-data) reasoning. In 1986, Patel and Groen
[4]
demonstrated that experts who accurately diagnosed
complex clinical problems used forward reasoning (data to hypothesis), in contrast to novice subjects who used
backward reasoning and misdiagnosed or partially diagnosed the same problems.
Patel also applied text comprehension methods to understanding the use of clinical practice guidelines with the goal
of increasing adoption of best practices.
[5]
Patel and colleagues have recently argued for new paradigm for error
studies, where instead of zero error tolerance, detection and correction of potential error is viewed as an integral part
of cognitive work in a complex workplace.
[6]
She is the author of more than 300 publications in cognitive psychology, biomedical informatics, medical education
and related fields.
Honors
Member, Committee on Patient Safety and Health Information Technology, Institute of Medicine (IOM).
2010-2011.
Science and Technology Research Award (STAR) with Edward Shortliffe, UTH System, Houston,Texas. 2009
Vice Chair, AMIA Program Committee. 2009
Service Faculty of the Year Award, School of Computing and Informatics, Arizona State University. 2008
Member, Clinical Research Review Committee, The National Center for Research Resources (NCRR).
2007-2009
Selected for Marquis Whos Who in the World. 2007
Member, Committee on Opportunities in Basic Research in the Behavioral and the Social Sciences for the
Military, National Research Council, U.S.A. 2006
Elected Fellow, New York Academy of Medicine. 2004
Vice President (Member Service), International Medical Informatics Association Governing Board. 2003-2006
Outstanding Manuscript Award in Educational Methodology, Journal of Dental Education. 2002
Member, Bio-engineering Training and Education Program, National Science Foundation, USA. 1999-2007
Chair, Editorial Committee, Medinfo2001, International Medical Informatics Association, London, UK. 1999
D.Sc. (honorary), University of Victoria, BC, Canada. 1998
Member, Roundtable on Work, Learning and Assessment, National Research Council, U.S.A. 1997
Elected Member, Board of Governors, Cognitive Science Society. 1997
Elected Fellow, American College of Medical Informatics. 1996
Fellow, The Royal Society of Canada (elected by the Academy of Humanities and Social Sciences). 1996
Elected Woman of Science for the year (Sweden). 1994
Vimla L. Patel
780
External links
Vimla Patel's Homepage
[7]
Publications
Journal Articles
[8]
Book Chapters
[9]
Medline Publications
[10]
Google Scholar Citations
[11]
References
[1] http:/ / nce.nserc. ca/ media/ newsrel/ archives/ 090299_e. htm
[2] http:/ / www. smi. stanford. edu/ projects/ intermed-web/ Home. htm
[3] [3] Elstein, A.S., Shulman, L.S., and Sprafka, S.A. Medical Problem-Solving: An Analysis of Clinical Reasoning. Cambridge, Mass.: Harvard
University Press, 1978.
[4] Patel, V.L. & Groen, G.J. (1986) Knowledge-based solution strategies in medical reasoning. Cognitive Science, 10, 91-116.
[5] Patel, V.L., Kaufman, D.R. (2006) Cognitive Science and Biomedical Informatics. - E.H. Shortliffe & J.J. Cimino (Eds.) Biomedical
Informatics: Computer Applications in Health Care and Biomedicine. New York: Springer-Verlag. P176.
[6] [6] Patel, V.L., Cohen, T., Murarka, T., Olsen, J., Kagita, S., Myneni, S., Ghaemmaghami, V., (2010) Recovery at the Edge of Error: Debunking
the Myth of the Infallible Expert. Journal of Biomedical Informatics.
[7] http:/ / ccsmph.nyam. org/ index. php
[8] http:/ / ccsmph.nyam. org/ journals.php
[9] http:/ / ccsmph.nyam. org/ chapters. php
[10] http:/ / www.ncbi. nlm.nih. gov/ sites/ entrez?term=patel%20vl& cmd=search& db=pubmed
[11] http:/ / scholar. google.com/ scholar?q=Vimla+ L.Patel& hl=en& lr=
Article Sources and Contributors
781
Article Sources and Contributors
Health information technology Source: https://en.wikipedia.org/w/index.php?oldid=572082799 Contributors: Arbor to SJ, Cfulwood, ChrisGualtieri, ColbyHolb, Download, Drscarlat, Dshun,
Edward, Gjholt, Glacialfox, Guitargabe21, Guptan99, Harkhail, Healthservicesresearch, Howardasher, Hu12, Ignorance is strength, Jamesmcmahon0, Jsfouche, Klmartin9, Linforest, Medicity,
Obiwankenobi, PatientSafetyGuru, Pattkait, R'n'B, Rich Farmbrough, Rjwilmsi, Rsabbatini, Ryanjo, Sjones1300, Skip1029, Sultec, Ttolmos, Upsala, Vblanton, Versageek, WhatamIdoing,
Widefox, 36 anonymous edits
Health informatics Source: https://en.wikipedia.org/w/index.php?oldid=572934054 Contributors: APH, Abduallah mohammed, Aftereight, Ahvankampen, Alexav8, Andresswift, Angela,
Angievil8x, Anindya87, AntilopeP, Argon233, ArielGold, Arthena, Asangansi, Atama, Atharhaq, BD2412, Bainca, Bainchri, BarryRobson, Basilicofresco, Bcheng23, Beasarah, Beeblebrox,
Beetstra, Bender235, Bertrow, Bio guru 2000, Bonadea, Briancrouch, CCRadvocate, CanaDanjl, Cankersore, Capricorn42, Captivatedbelle, Cforrester101, Chris Capoccia, ChrisCork, Chrislk02,
ChristofG, Christopher Mahan, Cobaltbluetony, Codish, Cpwonghkg, Cquan, Csstsrg, Cwh377, D3dtn01, Dancter, Daskalak, Davis.devries, Dawnseeker2000, Deanforrest, Decora, Devans, Difu
Wu, Dirkstanley, Djcorfield, Dmasys, Dmckay84, Dmeranda, Donama, Dpugrad01, Drkhalifa, Drscarlat, Dtparry, Dvwoodcock, Dylan Lake, Eastwest112, Edknol, Egbert J. van der Haring,
Eghdam, Eloraby, Enric Naval, Epbr123, Epsos, Erich gasboy, Euchiasmus, Falemi, Finizio, Flatterworld, Frana003, Francs2000, Funandtrvl, Gaius Cornelius, Gdavidzon, Ggspamm, Glacialfox,
Godcast, Gracetupelo, Graham87, GregWoodhouse, Guptan99, HInformatics, Hadal, Hankhuck, Hayabusa future, Hazmat2, Health Informatics Chris, Heatherkhill, Herrfous, HexiToFor,
Hiberniantears, Hmains, Hlsoinformatik, I.M.S., Ian Pitchford, Ignorance is strength, Infomd, InverseHypercube, Inversetime, InvictaHOG, JBart98, Jan1nad, Jdegreef, Jeanhcjean,
Jeanhcjean999, Jennifer Teplits, Jesanj, Jethero, Jfdwolff, Jjhert1, John L Hardy, Jovember, Jprg1966, Jsfouche, Jwojt, KVeil, Karada, Katiem222, Kauczuk, Keilana, Khalid hassani, Khazar2,
Kilo-Lima, Kilopi, Kku, Lalvers, Latorilla, Leprechaun0226, Lightmouse, Lingmac, Loop 9, Louise sch, MER-C, Magnit, MainFrame, Mako098765, Manuelhp42, MapsMan, Maralpa,
Materialscientist, McSly, Medinfodocs, Megan marie2008, Megata Sanshiro, Michaeldsuarez, Michaelmdx, Midgley, Mikeyww, MilkTheImp, Mindmatrix, Mithumukherjee, Monica murero,
Mons0122, Moonriddengirl, Mootros, Mrteabiscuit, Muzaffarmalik, Mysteryquest, Mystyc, NawlinWiki, Nen, Niceguyedc, Nishkarsh k, Novangelis, Nsaa, Obiwankenobi, Oli Filth, Optigan13,
Ostmoe, Pak21, Patrickbarmore, Paul A, Perspectoff, Peterjm, Ph.eyes, Phaedrus86, Pietrow, Podkayneofmars, Pojoman, Professor m f smith, Publicoption, Pvosta, R.alrajhi, Radagast83,
Rahilrizvi, Rds1970, Richarddav, Rjanag, Rjwilmsi, Rmccready, Rodw, Ronz, Ross Fraser, Rsabbatini, RufusScholasticus, Ruud Koot, Ryan Norton, Ryanjo, SPHer, Sabathecat, Sakaton,
SarekOfVulcan, Scsdirectories, SeaLion, Seaphoto, Severoon, Shabbirgchy, ShelleyAdams, Sirrtoby, Snipun, Spencerk, StaticGull, Stevecalloway, Stillwaterising, Stuart.turner.ucdavis, Sue
Rangell, Supten, THB, Tabletop, Tammy b530, Teleenfermeria, Terrillja, Tgeairn, The Thing That Should Not Be, TheJJJunk, Theroadislong, Tide rolls, Timtom27, Toni Lee (Tong Li),
Topbanana, True54, Udo Altmann, Ummuldrg, UseTheCommandLine, Vbhise, Vendomedpt, Versageek, Vinaitheerthan, Vojtech huser, WDavis1911, Ward20, Wavelength, Wegely, White, Jim,
William Avery, Wingnam, Winhunter, Wonglkd, Xavier Canals-Riera, Ya5irha55an, Yves.lussier, 395 anonymous edits
Clinical Informatics Source: https://en.wikipedia.org/w/index.php?oldid=346733860 Contributors: APH, Abduallah mohammed, Aftereight, Ahvankampen, Alexav8, Andresswift, Angela,
Angievil8x, Anindya87, AntilopeP, Argon233, ArielGold, Arthena, Asangansi, Atama, Atharhaq, BD2412, Bainca, Bainchri, BarryRobson, Basilicofresco, Bcheng23, Beasarah, Beeblebrox,
Beetstra, Bender235, Bertrow, Bio guru 2000, Bonadea, Briancrouch, CCRadvocate, CanaDanjl, Cankersore, Capricorn42, Captivatedbelle, Cforrester101, Chris Capoccia, ChrisCork, Chrislk02,
ChristofG, Christopher Mahan, Cobaltbluetony, Codish, Cpwonghkg, Cquan, Csstsrg, Cwh377, D3dtn01, Dancter, Daskalak, Davis.devries, Dawnseeker2000, Deanforrest, Decora, Devans, Difu
Wu, Dirkstanley, Djcorfield, Dmasys, Dmckay84, Dmeranda, Donama, Dpugrad01, Drkhalifa, Drscarlat, Dtparry, Dvwoodcock, Dylan Lake, Eastwest112, Edknol, Egbert J. van der Haring,
Eghdam, Eloraby, Enric Naval, Epbr123, Epsos, Erich gasboy, Euchiasmus, Falemi, Finizio, Flatterworld, Frana003, Francs2000, Funandtrvl, Gaius Cornelius, Gdavidzon, Ggspamm, Glacialfox,
Godcast, Gracetupelo, Graham87, GregWoodhouse, Guptan99, HInformatics, Hadal, Hankhuck, Hayabusa future, Hazmat2, Health Informatics Chris, Heatherkhill, Herrfous, HexiToFor,
Hiberniantears, Hmains, Hlsoinformatik, I.M.S., Ian Pitchford, Ignorance is strength, Infomd, InverseHypercube, Inversetime, InvictaHOG, JBart98, Jan1nad, Jdegreef, Jeanhcjean,
Jeanhcjean999, Jennifer Teplits, Jesanj, Jethero, Jfdwolff, Jjhert1, John L Hardy, Jovember, Jprg1966, Jsfouche, Jwojt, KVeil, Karada, Katiem222, Kauczuk, Keilana, Khalid hassani, Khazar2,
Kilo-Lima, Kilopi, Kku, Lalvers, Latorilla, Leprechaun0226, Lightmouse, Lingmac, Loop 9, Louise sch, MER-C, Magnit, MainFrame, Mako098765, Manuelhp42, MapsMan, Maralpa,
Materialscientist, McSly, Medinfodocs, Megan marie2008, Megata Sanshiro, Michaeldsuarez, Michaelmdx, Midgley, Mikeyww, MilkTheImp, Mindmatrix, Mithumukherjee, Monica murero,
Mons0122, Moonriddengirl, Mootros, Mrteabiscuit, Muzaffarmalik, Mysteryquest, Mystyc, NawlinWiki, Nen, Niceguyedc, Nishkarsh k, Novangelis, Nsaa, Obiwankenobi, Oli Filth, Optigan13,
Ostmoe, Pak21, Patrickbarmore, Paul A, Perspectoff, Peterjm, Ph.eyes, Phaedrus86, Pietrow, Podkayneofmars, Pojoman, Professor m f smith, Publicoption, Pvosta, R.alrajhi, Radagast83,
Rahilrizvi, Rds1970, Richarddav, Rjanag, Rjwilmsi, Rmccready, Rodw, Ronz, Ross Fraser, Rsabbatini, RufusScholasticus, Ruud Koot, Ryan Norton, Ryanjo, SPHer, Sabathecat, Sakaton,
SarekOfVulcan, Scsdirectories, SeaLion, Seaphoto, Severoon, Shabbirgchy, ShelleyAdams, Sirrtoby, Snipun, Spencerk, StaticGull, Stevecalloway, Stillwaterising, Stuart.turner.ucdavis, Sue
Rangell, Supten, THB, Tabletop, Tammy b530, Teleenfermeria, Terrillja, Tgeairn, The Thing That Should Not Be, TheJJJunk, Theroadislong, Tide rolls, Timtom27, Toni Lee (Tong Li),
Topbanana, True54, Udo Altmann, Ummuldrg, UseTheCommandLine, Vbhise, Vendomedpt, Versageek, Vinaitheerthan, Vojtech huser, WDavis1911, Ward20, Wavelength, Wegely, White, Jim,
William Avery, Wingnam, Winhunter, Wonglkd, Xavier Canals-Riera, Ya5irha55an, Yves.lussier, 395 anonymous edits
Cybermedicine Source: https://en.wikipedia.org/w/index.php?oldid=524224848 Contributors: Aetkin, Aeusoes1, Aliceh z, Andypul, Argon233, Arina.tikhonova, Ascidian, Atharhaq,
BAPHughes, Barryob, Bluemoose, Bondegezou, Capricorn42, Carl.bunderson, Carv123456, Djhaniff, Dmannsanco, Dr.Streda, DrManisha, Drscarlat, EHealth News Africa, Ehheh, Ehiadmin,
Epsos, Eysen, Funandtrvl, Goyell, Guillaume2303, Gxmorgan, Hassan210360, Healthjab, Hu12, Hyacinth 23, Interoperable, Jane023, Jeanhcjean, Jinibandelier, Johny9991, JonHarder, Jpalevy,
Jsfouche, Kattmamma, Kshuyler, Ligtvoet, MER-C, Mac, Mais oui!, Maryverito, Mcabrer, Monasharpe, Monica murero, Mootros, MrOllie, Mrnicksmith, Natep2010, Netha Hussain, Neurolysis,
Ngtm, Nintendude, Novangelis, Obiwankenobi, Ohnoitsjamie, Optigan13, Pak21, Panarchy, Petardugz, Ph.eyes, PrincessCaitlai, Pvosta, Qwyrxian, Rodw, Ron Ritzman, Rsabbatini, Sabathecat,
SarekOfVulcan, Shekharsahu, Spencerk, Susievet, Suzanne Lois Robson, THB, Tentinator, The Anome, Tnxman307, Tonk42, VeenaUK, Versageek, Vlad, Wasabi Wasabi Wasabi, Xyzzyplugh,
Yintan, Youngtiger, 113 anonymous edits
EHealth Source: https://en.wikipedia.org/w/index.php?oldid=571520146 Contributors: Aetkin, Aeusoes1, Aliceh z, Andypul, Argon233, Arina.tikhonova, Ascidian, Atharhaq, BAPHughes,
Barryob, Bluemoose, Bondegezou, Capricorn42, Carl.bunderson, Carv123456, Djhaniff, Dmannsanco, Dr.Streda, DrManisha, Drscarlat, EHealth News Africa, Ehheh, Ehiadmin, Epsos, Eysen,
Funandtrvl, Goyell, Guillaume2303, Gxmorgan, Hassan210360, Healthjab, Hu12, Hyacinth 23, Interoperable, Jane023, Jeanhcjean, Jinibandelier, Johny9991, JonHarder, Jpalevy, Jsfouche,
Kattmamma, Kshuyler, Ligtvoet, MER-C, Mac, Mais oui!, Maryverito, Mcabrer, Monasharpe, Monica murero, Mootros, MrOllie, Mrnicksmith, Natep2010, Netha Hussain, Neurolysis, Ngtm,
Nintendude, Novangelis, Obiwankenobi, Ohnoitsjamie, Optigan13, Pak21, Panarchy, Petardugz, Ph.eyes, PrincessCaitlai, Pvosta, Qwyrxian, Rodw, Ron Ritzman, Rsabbatini, Sabathecat,
SarekOfVulcan, Shekharsahu, Spencerk, Susievet, Suzanne Lois Robson, THB, Tentinator, The Anome, Tnxman307, Tonk42, VeenaUK, Versageek, Vlad, Wasabi Wasabi Wasabi, Xyzzyplugh,
Yintan, Youngtiger, 113 anonymous edits
Health 2.0 Source: https://en.wikipedia.org/w/index.php?oldid=566467407 Contributors: 1002a5, BAPHughes, Bondegezou, ChrisGualtieri, David from Downunder, Dodoste, Drilnoth, Ehheh,
EugeneBorukhovich, Fschoenm, ISkanderIT, Jeffrey Henning, Jpgs33, Mandarax, Michelon-CNGOF, Mogism, MrOllie, NCurse, Obiwankenobi, Patriciajane, PaulWicks, Petardugz,
Proorlovwiki, Rjwilmsi, Rsabbatini, SBehrs, Shekharsahu, Skariface, Socialf5, Sweet tea van, Varano, Vzach, WhatamIdoing, 52 anonymous edits
Public health informatics Source: https://en.wikipedia.org/w/index.php?oldid=559056023 Contributors: Allmightyduck, April.13.1743, Arcadian, Argon233, Carmen56, Discospinster, Dkropf,
Enochlau, Isaac.holeman, Jessica72, Jjreicher, Kurieeto, Mootros, Museumfreak, Neutrality, Novangelis, Obiwankenobi, Ph.eyes, Pojoman, PrevMedFellow, Quokly, Radagast83, Rsabbatini,
Ruud Koot, Selket, Strussify, Tgsavel, The Transhumanist, Tpbradbury, Tsavel, Wikipelli, 15 anonymous edits
Health Administration Informatics Source: https://en.wikipedia.org/w/index.php?oldid=488071107 Contributors: Chris the speller, Fabrictramp, Gbouldin, Jsfouche, Obiwankenobi, Safflle,
Squids and Chips, 2 anonymous edits
Medical integration environment Source: https://en.wikipedia.org/w/index.php?oldid=562573574 Contributors: Curious brain, DGG, Forderud, Malcolma, Medical Studies, Nadamarketing,
Rich Farmbrough, 1 anonymous edits
Health information exchange Source: https://en.wikipedia.org/w/index.php?oldid=566981302 Contributors: Alan78673, Binksternet, Careful Cowboy, Cdbrandt, Cgunde12, Chowbok, Chris
the speller, ColbyHolb, Danwayland, Dcljr, Dididavis, Dillard421, Dmeranda, Dougrmitchell, Drscarlat, Excirial, Fabrictramp, FieldsTom, Ganesha Freya, Gary King, Giraffedata, Glenn
Maddox, Gogo Dodo, Goz23, Hipravish, Ideman89, Jpanther2, Js, Kvea, Littenberg, Manomohan, Marcdb, MarcoTolo, Maryverito, Mayurpatel, Mdock88, Medicity, Mmdevon, Mootros,
Mperdomo, Nealmcb, Ohnoitsjamie, Otherlevinas, Overhage, Pattigustafson, Pearle, QHNcommunications, RDBrown, Rjwilmsi, Ronz, Ryanjo, Sabathecat, SarekOfVulcan, Seowizmaster,
Sindile, Sthlny, Theroadislong, Thielst, Tridium, Versageek, Wdr3, Wjejskenewr, WritersOne, Wsmith4474, 77 anonymous edits
Hospital information system Source: https://en.wikipedia.org/w/index.php?oldid=571229167 Contributors: Agne27, Amdescombes, Andypandy.UK, Apmis, AshwiniKalantri, Atmacausa,
BD2412, BUMRUSH, BooksXYZ, Bsadowski1, Bunnyhop11, Burlywood, Ceefour, Cereis, Cmutuku, Crdoconnor, DaGizza, David0811, Dawn Bard, Dawynn, Download, Drscarlat,
Emiellaiendiay, Erkan Yilmaz, Flabber33, Funandtrvl, Goldstarhealth, Ioeth, Irmgard, Isnow, JeepdaySock, Jessica72, JonHarder, Khalid, Kku, Kolmodin, Kuru, Lawsonstu, Luigi0405,
Luisxx24, Medicohelplinewm, Megusar, MiNombreDeGuerra, Mindmatrix, Mytto, Nesren, NishaWall, Obiwankenobi, Omnimdisment, OwenBlacker, Ozmaweezer, P.gibellini, Pak21,
Pendexgabo, Prellme1, Rentzepopoulos, SamJohnston, Sanjiv swarup, SchreiberBike, Sideways713, Spaz12, Squids and Chips, Tabletop, TastyPoutine, The Storm Surfer, TheParanoidOne,
Timmywimmy, Udo Altmann, UseTheCommandLine, Versageek, Whitney701, Widr, Wireless friend, Xavier Canals-Riera, Yoshm, Zabdiel, 63 anonymous edits
Healthcare workflow Source: https://en.wikipedia.org/w/index.php?oldid=493487404 Contributors: AED, Ego White Tray, Gaius Cornelius, Goflow6206, Khalid hassani, LincolnSt,
MeltBanana, Mild Bill Hiccup, Obiwankenobi, Pearle, Skalko, Socalblue, Tobycat, Vojtech Huser, Vojtech huser, Zzuuzz, 6 anonymous edits
Article Sources and Contributors
782
Computer physician order entry Source: https://en.wikipedia.org/w/index.php?oldid=355319428 Contributors: *Kat*, Alynna Kasmira, Arcadian, Bondegezou, Carmichael, Cbrillaz,
ChrisGriswold, Dab0mb0, DabMachine, Dancter, Denverco5513, Dirkstanley, Drscarlat, Farside6, Flynnaj, Gaius Cornelius, Habibja, Hanshool, Harkhail, Jim1138, Kyle1278, M11071,
Menglongwang, Michael Hardy, Mimifatty2005, Mominator55, Morrillonline, Natya1, Perspectoff, Peter, Polacrilex, Qelknap, R'n'B, Renegade54, Rich Farmbrough, Ryanjo, Shaggyjacobs,
Spotharaju, Tgoldst5, Timtom27, Versageek, WhatamIdoing, Xezbeth, YUL89YYZ, Zvar, 60 anonymous edits
ICU quality and management tools Source: https://en.wikipedia.org/w/index.php?oldid=541831306 Contributors: Cereis, Darth Panda, Drscarlat, Edward, Kuru, LilHelpa, MuZemike,
Orangemike, RHaworth, Ron Ritzman, Uncle G, 4 anonymous edits
Laboratory information management system Source: https://en.wikipedia.org/w/index.php?oldid=564353116 Contributors: Abdulma, Acm20, Ae36, Ahoerstemeier, Akoves, Alan Au,
Albinpaul, Alex.g, Allforrous, Amejat, Anders.eggum, Anilverma3, Atlincsales, AuroraSinclair, Auzzo, Bazonka, Bhangra.knights, Bob Palin, Bob98133, Bonzi, Bpavel, BrianOfRugby, Browck,
CLW, Castagna, Cbarringer1, ChrisHodgesUK, ChristiCobb, CodeNaked, DAWyatt, Dcdeheer, Dekisugi, Diberri, Dicklyon, Djh94001, Dkropf, Dortloff, Drscarlat, Ebyabe, EdGl, Encomiast3,
Ethosoft, Eugene van der Pijll, Fluffernutter, Fmalcus, Franz W. Kster, Gaius Cornelius, Gareth Griffith-Jones, Georgesgoossens, Gibson88, Grendzy, Guillaume2303, HappyDog, Hemanshu,
Heymar Nunes Jr., Huwloaring, IByte, JAMiller67, Japaudro, Jmgarroway, Johnmips, JonHarder, Joshua Scott, Jpbowen, Jpcoutinho, Jrjoyce, K-squire, Katelq, Kcordina, Khazar2,
Klilidiplomus, Kpaszko, Kru83, LIMS4all, Lablynx, Labscientist, Limsmaster, Limsnetwork, Limstitute, LizWarwick, Lostraven, Magioladitis, Maitri982, MartinMcRiley, Marypeterfalk,
Matvay, Mayalld, Mbio, Mbraspen, Meghana1987, Mergs, Mindmatrix, Modlab, Mythiclabs, NTox, Nettcom, Nkoker, Noca2plus, Nono64, O keyes, Obiwankenobi, Omicronpersei8, Pedant17,
Peleg72, Phansen, Phmobile, Promium, Qswitch426, R'n'B, RHaworth, RJFJR, Rajnishbhatt, RaynalddeLahondes, Requestfortranslation, RevRagnarok, Rjwilmsi, Rmandahl, Rockingmark,
Roland2, Ronz, Rpineger, Rsodavadiya, Rvoorhees, Sandstein, Sapiosciences, Savantas83, SchreiberBike, Shelbykins, Skoddet, Slett44, Smartneddy, Smn01, Spamslayer2000, Tabletop,
Tcooley07, The wub, Thorwald, Timnrw, TimothyPilgrim, Toddst1, Turnstep, Ukexpat, UnitedStatesian, Vsmith, W3markets, Wayneverost, Xmp, YUL89YYZ, ZayZayEM, 451 anonymous
edits
Laboratory information system Source: https://en.wikipedia.org/w/index.php?oldid=523180390 Contributors: Abdulma, Acm20, Ae36, Ahoerstemeier, Akoves, Alan Au, Albinpaul, Alex.g,
Allforrous, Amejat, Anders.eggum, Anilverma3, Atlincsales, AuroraSinclair, Auzzo, Bazonka, Bhangra.knights, Bob Palin, Bob98133, Bonzi, Bpavel, BrianOfRugby, Browck, CLW, Castagna,
Cbarringer1, ChrisHodgesUK, ChristiCobb, CodeNaked, DAWyatt, Dcdeheer, Dekisugi, Diberri, Dicklyon, Djh94001, Dkropf, Dortloff, Drscarlat, Ebyabe, EdGl, Encomiast3, Ethosoft, Eugene
van der Pijll, Fluffernutter, Fmalcus, Franz W. Kster, Gaius Cornelius, Gareth Griffith-Jones, Georgesgoossens, Gibson88, Grendzy, Guillaume2303, HappyDog, Hemanshu, Heymar Nunes Jr.,
Huwloaring, IByte, JAMiller67, Japaudro, Jmgarroway, Johnmips, JonHarder, Joshua Scott, Jpbowen, Jpcoutinho, Jrjoyce, K-squire, Katelq, Kcordina, Khazar2, Klilidiplomus, Kpaszko, Kru83,
LIMS4all, Lablynx, Labscientist, Limsmaster, Limsnetwork, Limstitute, LizWarwick, Lostraven, Magioladitis, Maitri982, MartinMcRiley, Marypeterfalk, Matvay, Mayalld, Mbio, Mbraspen,
Meghana1987, Mergs, Mindmatrix, Modlab, Mythiclabs, NTox, Nettcom, Nkoker, Noca2plus, Nono64, O keyes, Obiwankenobi, Omicronpersei8, Pedant17, Peleg72, Phansen, Phmobile,
Promium, Qswitch426, R'n'B, RHaworth, RJFJR, Rajnishbhatt, RaynalddeLahondes, Requestfortranslation, RevRagnarok, Rjwilmsi, Rmandahl, Rockingmark, Roland2, Ronz, Rpineger,
Rsodavadiya, Rvoorhees, Sandstein, Sapiosciences, Savantas83, SchreiberBike, Shelbykins, Skoddet, Slett44, Smartneddy, Smn01, Spamslayer2000, Tabletop, Tcooley07, The wub, Thorwald,
Timnrw, TimothyPilgrim, Toddst1, Turnstep, Ukexpat, UnitedStatesian, Vsmith, W3markets, Wayneverost, Xmp, YUL89YYZ, ZayZayEM, 451 anonymous edits
MHealth Source: https://en.wikipedia.org/w/index.php?oldid=570417428 Contributors: A930913, Adakwa, Akuoku, Anomalocaris, Azecha, BD2412, BergNerd, Billymac00, Bondegezou,
ClamDip, Closedmouth, Cookdrummer81, Cwallsdc, Denots, Devactivity, Dr Sultan Bashar, Earthinstitute, Edelmac, Edgar181, Eksimaru, Elukenich, FJM, Fdebong, Funandtrvl, Guptan99,
Hajovanbeijma, Harry istepanian, Interlingua, Iridescent, Isaac.holeman, JLaTondre, Jerryvalliasjean, Jessica72, JimIQMax, Jselanikio, Justin Ormont, Kmccorm, Kostantino, Kozuch,
LennoxMI6140, Lffinch, Macksdaddy65, Mark Arsten, Materialscientist, Mboverload, Medicfurby, Megcagley, Menaljham, Mhealth, Mobiletelephony, Mpulier, MrOllie, NaBook,
Obiwankenobi, Ohnoitsjamie, Opal8164, Padisys, Phil Boswell, Piet Delport, Polkauser, RHaworth, Rjwilmsi, Ronotten, Ronz, Rsabbatini, Ryuch, SaraBuz, Sarnquist, Saturnine42,
SeanBlaschke, Seantbrady, SlubGlub, Stevendoll, Stevens12345, Taridzo, Terrx, The Thing That Should Not Be, Themfromspace, Tomscaletta, Ukexpat, VensaAdmin, VentureBridge, 144
anonymous edits
Practice management software Source: https://en.wikipedia.org/w/index.php?oldid=516976882 Contributors: BD2412, Neutrality, 2 anonymous edits
Clinical Quality Management System Source: https://en.wikipedia.org/w/index.php?oldid=527165321 Contributors: Clarity.john, DoctorKubla, Fabrictramp, Jheald, Malcolma, Mr Stephen,
TheAMmollusc, 1 anonymous edits
Electronic health record Source: https://en.wikipedia.org/w/index.php?oldid=573640561 Contributors: 300user, Ablewasi, Abrownnsmith, Aircorn, Alan.ca, AleishaMW, AlexatEBG,
Alina2486, Alynna Kasmira, Andy4pr, Argon233, Aristoxenos, Arknascar44, Ashtango, Ashtango5, Atama, Auntof6, Awillmore, BD2412, Bader isu, Balis, Banaticus, Barek, BarryRobson,
Beland, Bender235, Benscripps, Bj45, Bjackso7, BlkMtn, Bluemoose, Bmmbassignment, Bondegezou, Borghi73, Brtwms, Burlywood, Businesswonk, Bwrobyn, CCRadvocate, Capricorn42,
Careful Cowboy, CattleGirl, Chandresh27, Chiroeditor, Chtuw, Chuongdo, ClarkFreifeld, ColbyHolb, Colonies Chris, CommonsDelinker, Cp8, DaCarpenther, Dancter, Danhash, Darylbrowne,
Deetdeet, Devsno, Dixiek8, Donama, Download, Dragusa19, Drscarlat, EMR EHR, EMR2011, Edward, EggensPaar, Elukenich, Emrsolution, Epsos, Erich gasboy, Escape828, Fatkim, Femto,
Feydey, FieldsTom, Flowanda, Fortitude0715, Fromherz, GDibyendu, Gaius Cornelius, Ganesha Freya, Garchangel, Gidget9, Gilo1969, Giraffedata, Gparker, H@r@ld, Hali3, Hamiltha,
Healthonl, Hectorthebat, Hoya2008, I dream of horses, Ihwk, Infomed, InformaticsMD, Ioeth, JLRedperson, JS494, Jcn8, Jdeutsch, Jeffthewhitegoose, Jesanj, Jessica72, JessicaJoydc, Jfdwolff,
Jfunk82, Jhcorley, Jlalonde, Joerub, John of Reading, Josve05a, Jsfouche, Jubb, Js, KPete, Kanagil, Kawanazii, Kevinp2, Kezze, Klmartin9, Knjug, Kreed719, Kthai, Kwgagel, Lalato10,
Lamoore20, Larsonbennett, Laurenm23, Ldwilson12, Library 046, Likesausages, Llyonmd, Lmelnych, Lobos, Logical Cowboy, Luxorp, Lynnflint, M.c.vd.meer, Ma993, Maddbobbs, Man docs,
Manitou99, Manomohan, Manscher, Maralia, Marsteph, Maryben777, Max.henson-stroud, Mcmartj, Mdsmedical, MedMatics, Medicity, Mel Etitis, Midwestnative, Mikael Hggstrm,
Millakilla, Miltiadis Kokkonidis, Mindmatrix, Mootros, Mr. Vernon, Mr1130, Muboshgu, Mwashin1, Natkeeran, Nb65-NJITWILL, Nbauman, Nkswiki, Nmics, Nopetro, Obankston,
Obiwankenobi, Ohnoitsjamie, OliveMan88, Optigan13, Pak21, PatienceLord, PatientSafetyGuru, Pattigustafson, Paynejd, Perspectoff, Phaedrus86, Physadvoc, Pimvolkert, Pinetop18, Prari,
Public Menace, Publicoption, PulseSystems, Pvosta, RA0808, RDBrown, Radiant!, Ragean20, Raimundo Pastor, Rashidsaeed, RemelaKhiyar, Rich Farmbrough, Richard Keatinge, Rjwilmsi,
Rmccready, Rmw38, Rotlink, Rsabbatini, Rschanhals, Rws4321, Ryanjo, Sabathecat, Sanjiv swarup, Sarah.lash, SarekOfVulcan, Sdavids6, Sdelat, Sebastian19781, Selket, Shai8181, Sharkli,
Shaunamcegan, ShelleyAdams, Sidrrap, Sintaku, Smwakram, Sotf133, Spotharaju, Stansz, Stephan Leeds, Stravishankar, Sultec, Susan118, Szafar2, Szafar21, TMoljsen, Tabletop, Tbdx511,
Tbhotch, Techtonic, Temporaluser, Tgoldst5, The Parsnip!, The Transhumanist, TheProject, Thedy111, Theemrcompany, Timbenj, Timp21337, Timtom27, Triplestop, Truthortruth, Uhhhhhno,
Uncle Milty, Versageek, Vicente1980, Vincej, Wdfarmer, Wgrussell, Will Beback, Wirehairs, Wireless friend, Woohookitty, Xman944, YUL89YYZ, Yaksha, Yureneva, Zaptag, 463 anonymous
edits
Electronic medical record Source: https://en.wikipedia.org/w/index.php?oldid=566966338 Contributors: 300user, Ablewasi, Abrownnsmith, Aircorn, Alan.ca, AleishaMW, AlexatEBG,
Alina2486, Alynna Kasmira, Andy4pr, Argon233, Aristoxenos, Arknascar44, Ashtango, Ashtango5, Atama, Auntof6, Awillmore, BD2412, Bader isu, Balis, Banaticus, Barek, BarryRobson,
Beland, Bender235, Benscripps, Bj45, Bjackso7, BlkMtn, Bluemoose, Bmmbassignment, Bondegezou, Borghi73, Brtwms, Burlywood, Businesswonk, Bwrobyn, CCRadvocate, Capricorn42,
Careful Cowboy, CattleGirl, Chandresh27, Chiroeditor, Chtuw, Chuongdo, ClarkFreifeld, ColbyHolb, Colonies Chris, CommonsDelinker, Cp8, DaCarpenther, Dancter, Danhash, Darylbrowne,
Deetdeet, Devsno, Dixiek8, Donama, Download, Dragusa19, Drscarlat, EMR EHR, EMR2011, Edward, EggensPaar, Elukenich, Emrsolution, Epsos, Erich gasboy, Escape828, Fatkim, Femto,
Feydey, FieldsTom, Flowanda, Fortitude0715, Fromherz, GDibyendu, Gaius Cornelius, Ganesha Freya, Garchangel, Gidget9, Gilo1969, Giraffedata, Gparker, H@r@ld, Hali3, Hamiltha,
Healthonl, Hectorthebat, Hoya2008, I dream of horses, Ihwk, Infomed, InformaticsMD, Ioeth, JLRedperson, JS494, Jcn8, Jdeutsch, Jeffthewhitegoose, Jesanj, Jessica72, JessicaJoydc, Jfdwolff,
Jfunk82, Jhcorley, Jlalonde, Joerub, John of Reading, Josve05a, Jsfouche, Jubb, Js, KPete, Kanagil, Kawanazii, Kevinp2, Kezze, Klmartin9, Knjug, Kreed719, Kthai, Kwgagel, Lalato10,
Lamoore20, Larsonbennett, Laurenm23, Ldwilson12, Library 046, Likesausages, Llyonmd, Lmelnych, Lobos, Logical Cowboy, Luxorp, Lynnflint, M.c.vd.meer, Ma993, Maddbobbs, Man docs,
Manitou99, Manomohan, Manscher, Maralia, Marsteph, Maryben777, Max.henson-stroud, Mcmartj, Mdsmedical, MedMatics, Medicity, Mel Etitis, Midwestnative, Mikael Hggstrm,
Millakilla, Miltiadis Kokkonidis, Mindmatrix, Mootros, Mr. Vernon, Mr1130, Muboshgu, Mwashin1, Natkeeran, Nb65-NJITWILL, Nbauman, Nkswiki, Nmics, Nopetro, Obankston,
Obiwankenobi, Ohnoitsjamie, OliveMan88, Optigan13, Pak21, PatienceLord, PatientSafetyGuru, Pattigustafson, Paynejd, Perspectoff, Phaedrus86, Physadvoc, Pimvolkert, Pinetop18, Prari,
Public Menace, Publicoption, PulseSystems, Pvosta, RA0808, RDBrown, Radiant!, Ragean20, Raimundo Pastor, Rashidsaeed, RemelaKhiyar, Rich Farmbrough, Richard Keatinge, Rjwilmsi,
Rmccready, Rmw38, Rotlink, Rsabbatini, Rschanhals, Rws4321, Ryanjo, Sabathecat, Sanjiv swarup, Sarah.lash, SarekOfVulcan, Sdavids6, Sdelat, Sebastian19781, Selket, Shai8181, Sharkli,
Shaunamcegan, ShelleyAdams, Sidrrap, Sintaku, Smwakram, Sotf133, Spotharaju, Stansz, Stephan Leeds, Stravishankar, Sultec, Susan118, Szafar2, Szafar21, TMoljsen, Tabletop, Tbdx511,
Tbhotch, Techtonic, Temporaluser, Tgoldst5, The Parsnip!, The Transhumanist, TheProject, Thedy111, Theemrcompany, Timbenj, Timp21337, Timtom27, Triplestop, Truthortruth, Uhhhhhno,
Uncle Milty, Versageek, Vicente1980, Vincej, Wdfarmer, Wgrussell, Will Beback, Wirehairs, Wireless friend, Woohookitty, Xman944, YUL89YYZ, Yaksha, Yureneva, Zaptag, 463 anonymous
edits
Personal health record Source: https://en.wikipedia.org/w/index.php?oldid=573242160 Contributors: 564dude, AHRQAdvocate, ALH, Aaron-carlock, Acroterion, Alphonsederus, Aml6888,
Andrea Parri, Androidakin97209, Angelaranelli, Barek, Bcook015, Brent.Allsop, BridgeBuilder, Bydand, Cangst, Chattercid, Courcelles, D3dtn01, DagI, David Shay, Dclunie, Ddenise,
Deltaseeker, Dennis Bratland, Dhanarajesh1, Discospinster, Download, Drscarlat, Dsearls, Edmondramly, Eezip, ElectronicHealthRecords, Fair Deal, Fan-1967, FieldsTom, Filippowiki, Gabia,
Graham87, Hiberniantears, Hu12, Idiopathic, JJJJust, JeffAtRubiconHealth, JeffreyLeeBrandt, Jeffthewhitegoose, Jrshaw, Khazar, Khazar2, Kilom691, Klmartin9, Lambiam, LilHelpa,
Mandarax, Manscher, Maximilian333, MedicalInformatics, MehreenAlex, MehreenMehreen, Methington, Mlstimson, Mmrglobal, Mogism, Mylifemine, Obiwankenobi, Ohnoitsjamie, Pak21,
PaulWicks, Pauldaly, Pb30, Pearle, Pguariglia, Physadvoc, Piotrus, PrimeHunter, RDBrown, RajivHAS, Randomtime, Rdale, Rich Farmbrough, Rjwilmsi, Rmcguirefm, Ronz, Rupertfawdry,
Sabathecat, Sadiqueakhter, Scerniglia, Sharkli, ShelleyAdams, Simone@RecordsForLiving.com, Ssgemra123, TMAHIT, That Guy, From That Show!, Thuja, TrbleClef, Uplifter, Versageek,
Whoisjohngalt, Wickethewok, WikHead, Xscott100, Zollerriia, 172 anonymous edits
Article Sources and Contributors
783
COmputer STored Ambulatory Record Source: https://en.wikipedia.org/w/index.php?oldid=520678760 Contributors: Dawynn, Delusion23, Johnpacklambert, Jsfouche, Obiwankenobi,
Petersam, Postcard Cathy
ProRec Source: https://en.wikipedia.org/w/index.php?oldid=487399315 Contributors: LilHelpa, Obiwankenobi, Pvosta, Ragib, ThaddeusB, 2 anonymous edits
Health record trust Source: https://en.wikipedia.org/w/index.php?oldid=500610605 Contributors: Auntof6, Ehrbanks, GlmIHRT, Healthrecord, JavierMC, Markiewp, Nurse54321, Oh Snap,
Spritetrain, Sultec, Tabletop
ClearHealth Source: https://en.wikipedia.org/w/index.php?oldid=487386233 Contributors: Bigweeboy, Clearhealth, EdgeOfEpsilon, EhJJ, Firsfron, Funandtrvl, Glenn, Gwen Gale, John of
Reading, John254, Jwalker1212, Lunawisp, Mafutrct, Mehta saumil, Obiwankenobi, Pinetop18, Rjwilmsi, Roleplayer, SLi, 10 anonymous edits
Laika Source: https://en.wikipedia.org/w/index.php?oldid=487417601 Contributors: Biyer, Jpbowen, Obiwankenobi, Perspectoff, Rmccready, Robomanx, 34 anonymous edits
OpenEHR Source: https://en.wikipedia.org/w/index.php?oldid=572943279 Contributors: Aksi great, AstroNomer, BD2412, Bazonka, Crystallina, Donama, JHunterJ, Jmnbatista, JukoFF,
LilHelpa, M.c.vd.meer, Matt.whitby, Obiwankenobi, Pvosta, Rjwilmsi, Samuel.heard, ThaddeusB, Twcook, UseTheCommandLine, Vpope, Wolandscat, Zotel, 36 anonymous edits
OpenEMR Source: https://en.wikipedia.org/w/index.php?oldid=574294068 Contributors: Arcadian, Bradygmiller, Cayla, Chris the speller, Clucena, Dana boomer, Dilane, Drbowen, Dryphi,
FAEP, Funandtrvl, Glenn, InverseHypercube, JHunterJ, Jpmd, Klemen Kocjancic, Longhair, MisysHC, Obiwankenobi, Pearle, Phaedrus86, Pnm, PreludeSi, Rjwilmsi, Sah2ed, Sophus Bie,
Sopoforic, SteveLoughran, Syrthiss, Tabletop, WhatamIdoing, 94 anonymous edits
OpenMRS Source: https://en.wikipedia.org/w/index.php?oldid=563868047 Contributors: 2001:18E8:3:28A5:9DC0:1EA1:9CE7:56D7, Bmamlin, Chris Capoccia, Djazayeri, Dougher,
FirefoxRocks, Hsfraser, LeadSongDog, LilHelpa, Mikeymckay, Mindmatrix, Obiwankenobi, Rettetast, Sevenp, 14 anonymous edits
Kind Messages for Electronic Healthcare Record Source: https://en.wikipedia.org/w/index.php?oldid=550097072 Contributors: EagleFan, Klemen Kocjancic, LilHelpa, Nicolas Barbier,
Obiwankenobi, Pvosta, Smirwin88, Woohookitty, 2 anonymous edits
Summarized Electronic Health Record Source: https://en.wikipedia.org/w/index.php?oldid=416919613 Contributors: Careful Cowboy, Fram, Nicolas Barbier, Obiwankenobi, Phantomsteve,
Pvosta, Versus22, 2 anonymous edits
VistA Source: https://en.wikipedia.org/w/index.php?oldid=570337793 Contributors: AManWithNoPlan, Aervanath, AlistairMcMillan, Anthony Appleyard, Art LaPella, Ashtango5, BooksXYZ,
Bostonvaulter, Bovineone, Clayton Curtis, Colonies Chris, Common Man, Connel MacKenzie, Dalmolin, Dancter, Debresser, Donkarnag, Epolk, Excirial, Fantumphool, Ftrotter, Fujidim, Gaius
Cornelius, Giraffedata, Graham H Watt, Hazmat2, Ilana, Jafijafur, Jamesontai, JavaLearner, John of Reading, Kainaw, Kocio, Kurieeto, Lightmouse, MBisanz, Midgley, Mikefullerwikip,
Monkeyfeet, Nephron, Obiwankenobi, Ohconfucius, Palosirkka, Pearle, Perspectoff, Ph.eyes, Phoenix-forgotten, Physadvoc, Pne, Prosfilaes, Retanollo, Rich Farmbrough, Rjwilmsi, Ryanjo,
Sacolcor, Serendipitousagent, ShelleyAdams, SocratesJedi, Stephan Leeds, Straussian, Sultec, Teukros, That Guy, From That Show!, The donc, Ttt9, Uplifter, VWFeature, Vincej, Zr2d2, 65
anonymous edits
VistA imaging Source: https://en.wikipedia.org/w/index.php?oldid=546162656 Contributors: Andreas Kaufmann, Arcadian, Countincr, DrTomWay, Feezo, Frap, Fujidim, Ganesha Freya,
Gracefool, Jonkerz, LilHelpa, MrOllie, N5iln, Obiwankenobi, Palosirkka, Perspectoff, Physadvoc, Retired username, Rich Farmbrough, Rjwilmsi, Robespierrette, Warren, 4 anonymous edits
VistA Web Source: https://en.wikipedia.org/w/index.php?oldid=546162667 Contributors: Ashtango5, Dancter, LilHelpa, Obiwankenobi, Palosirkka, Perspectoff, Physadvoc, Rich Farmbrough,
Rjwilmsi, Topbanana, 3 anonymous edits
WorldVistA Source: https://en.wikipedia.org/w/index.php?oldid=487460986 Contributors: Anthony Appleyard, Funandtrvl, Jed 20012, MarekMahut, Obiwankenobi, Perpsectoff, Perspectoff,
R'n'B, Tushti, 2 anonymous edits
ZEPRS Source: https://en.wikipedia.org/w/index.php?oldid=562926244 Contributors: Chowbok, Chris Capoccia, Dancter, Dl2000, Gmcressman, LincolnSt, Obiwankenobi, Ohconfucius,
Perspectoff, TheThomas, Vegaswikian, 14 anonymous edits
Clinical decision support system Source: https://en.wikipedia.org/w/index.php?oldid=563997493 Contributors: 503betty, ArglebargleIV, Ashdamle, BMDampbellc, Bchaiken, Beowulf779,
Bunnyhop11, CDDSFan, Ccricco, Cervelo58, CharlesGillingham, ChrisGualtieri, Cjlederer, Closedmouth, Codish, DXBari, Deanforrest, DoctorNNam, Eatsea, Excirial, Fcnorman, Femto,
Hirohisat, Hmbr, In7sky, Iron007, JakobSteenberg, Jlittlet, Jmaude, John, John 14:23, JonHarder, Jsfouche, Jugander, KMPreston, Khazar, Kku, Kuru, Lingmac, Llorenzi, MSUDrew84,
MZMcBride, Magioladitis, Mandarax, Martinsw6, Mcstrother, Michael Hardy, Michaeldsuarez, Mikael Hggstrm, Obiwankenobi, OrangeDog, Pattigustafson, Pdfpdf, Pgalinanes, Pgr94,
Ph.eyes, Phelfe, Rburkhal, Rich Farmbrough, Rich Tullie, Rjwilmsi, Ronz, Rror, Rsabbatini, Sarah Taj Khan, Shaggyjacobs, Shaunamcegan, Sirrtoby, Sole Soul, SomeFreakOnTheInternet,
Specs112, Splmko, Springnuts, Stephen.a.fox, Supten, Tentinator, Th3void, The Transhumanist, Tofutwitch11, Ucucha, Vojtech huser, Waghsk, WhatamIdoing, Xezbeth, 112 anonymous edits
Computer-aided diagnosis Source: https://en.wikipedia.org/w/index.php?oldid=540552738 Contributors: Alexmar983, AnAj, Bondegezou, CXCV, Epretorius, Fuzzform, Gnamor,
Happyrabbit, JBancroftBrown, Josh Parris, JMa, Ketiltrout, Knowledger9, Mathewjohnmathew, Mdd, Michael Hardy, Mikael Hggstrm, Msamulski, Nick Number, Oski, Ph.eyes, Puekai,
Rjwilmsi, Rob Hurt, Stahr, Sun Creator, 25 anonymous edits
Medical algorithm Source: https://en.wikipedia.org/w/index.php?oldid=566918274 Contributors: Andrew73, Antaeus Feldspar, Bryan Derksen, CDN99, Calliopejen, Clicketyclack, DMS,
Deville, Fred J, GCNYC, IHTFP, Jfdwolff, Karada, Lotje, Mattisse, Michael Hardy, Midgley, Mikael Hggstrm, Oicumayberight, Ombudsman, Paddles, Pariah, Ph.eyes, Remuel, Rich
Farmbrough, Rory 20 uk, 8 anonymous edits
Medical logic module Source: https://en.wikipedia.org/w/index.php?oldid=557121362 Contributors: Arx Fortis, MarSch, Michael Hardy, Midgley, SchreiberBike, Wireless friend, 2
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Arden syntax Source: https://en.wikipedia.org/w/index.php?oldid=568327050 Contributors: Arcadian, Arden man, Arunvish, Carabinieri, Caseylite, Chris Capoccia, Cnilep, Dycedarg, Idril,
Jesse V., Kku, Knownow87, Lakshmi Devineni, Lep47, Mattisse, Michael Hardy, Midgley, Obankston, Obiwankenobi, Padawan ch, Phydend, Rich Farmbrough, SimonP, Terrylrankin, Vojtech
Huser, Wavelength, Yves.lussier, 17 anonymous edits
Concept Processing Source: https://en.wikipedia.org/w/index.php?oldid=533242093 Contributors: Clicketyclack, Doctorbillasio, Donama, ESkog, Flowanda, Hu12, IBS2008,
Inglesenargentina, Ismnet1122, Johnrobertusa, LincolnSt, Michael Hardy, Obiwankenobi, Pjcmba, R'n'B, Rjaf29, Rjwilmsi, SchreiberBike, Tassedethe, Woohookitty, 17 anonymous edits
Guideline execution engine Source: https://en.wikipedia.org/w/index.php?oldid=487327410 Contributors: AxelBoldt, B. Wolterding, Gaius Cornelius, Mboverload, RDBrown, Samsontu,
Vojtech Huser, Vojtech huser, 1 anonymous edits
CADUCEUS Source: https://en.wikipedia.org/w/index.php?oldid=544286889 Contributors: Airstrike, Arjay369, DutchTreat, Ekotkie, Gurch, Gwern, JonHarder, Marudubshinki, Mmiller0712,
Obiwankenobi, Pgr94, Rjwilmsi, 3 anonymous edits
DXplain Source: https://en.wikipedia.org/w/index.php?oldid=529084617 Contributors: Fabrictramp, GregorB, JDiPierro, MrRadioGuy, Obiwankenobi, Pgr94, Ph.eyes, Planetarium24, R00m c,
Science485, Swpb, Whpq, 2 anonymous edits
Internist-I Source: https://en.wikipedia.org/w/index.php?oldid=554252881 Contributors: Bgwhite, Bigredbrain, CharlesGillingham, Crazyale, Frana003, Irbisgreif, J04n, Malcolma, Naraht,
Obiwankenobi, Pgr94, Serdar XoXo, 1 anonymous edits
Mycin Source: https://en.wikipedia.org/w/index.php?oldid=566878347 Contributors: 05dempc, 2001:470:1F05:3AC:ED31:554:76C5:393B, 3mta3, A930913, Abdull, Ahoerstemeier, AlanUS,
Arnehans, Beland, Bovlb, Broughy, Burzmali, CambridgeBayWeather, CharlesGillingham, CharlotteWebb, DMG413, Deanphd, Der Eberswalder, Dialectric, DutchTreat, Fawcett5, Frogger732,
Gurch, Gwern, Headbomb, JMSwtlk, Jaberwocky6669, Jaibe, Jazbell, Kaczor, Korath, Marudubshinki, Obiwankenobi, Pgr94, Ph.eyes, Pinethicket, Pstanton, R. fiend, Reidgsmith, RidG,
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Physicians' Information and Education Resource Source: https://en.wikipedia.org/w/index.php?oldid=489665657 Contributors: AvicAWB, Bearcat, CommonsDelinker, DGG, Docu,
Drilnoth, Green Giant, Obiwankenobi, Quarienne, Smartse, Sspadt
RetroGuide Source: https://en.wikipedia.org/w/index.php?oldid=517446647 Contributors: AManWithNoPlan, Appraiser, Bunnyhop11, Obiwankenobi, Sakaton, Skalko, Tabletop,
TenPoundHammer, Vojtech Huser, Vojtech huser, Woohookitty, 4 anonymous edits
Article Sources and Contributors
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STD Wizard Source: https://en.wikipedia.org/w/index.php?oldid=515510451 Contributors: ' rtnjkk(), 128.32.172.xxx, 2, 200.191.188.xxx, 21inchrimz, 2cool520, 2over0, 33311, 666dagon,
AJReaper, ASwann, Ace ETP, Acegikmo1, Acetic Acid, Acroterion, Adambro, Addshore, Agentrelaxed, Ahoerstemeier, Aitias, Ajax151, Alansohn, Alapratt, Alaudo, Alex '05, Alex.tan,
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Zodon, Zujua, Zundark, Zzuuzz, , 1540 anonymous edits
Digital radiography Source: https://en.wikipedia.org/w/index.php?oldid=573524615 Contributors: Albiet, Arcadian, Barek, Bouncingmolar, Californian Treehugger, Captainslowness, Cj.liang,
Dentstaff, DouglasCalvert, Drecohen, Eupedia, Femto, Fourpounds2003, Garion96, Hovonogila, JHunterJ, Jfdwolff, Jumping cheese, Leeyc0, Materialscientist, Mickesvall, Mr376, RadXman,
Radagast83, Richard416282, Scriberius, Shai8181, Skaffman, Sx2, Thomasbriggs, Tpikonen, Vinne2, 57 anonymous edits
Imaging informatics Source: https://en.wikipedia.org/w/index.php?oldid=552526662 Contributors: Fabrictramp, Guangleixiong, Icarus3, Jsfouche, Lockley, Obiwankenobi, Oddharmonic,
Open2universe, Pnagy, Roentgenradiologue, Rsabbatini, 9 anonymous edits
Patient registration Source: https://en.wikipedia.org/w/index.php?oldid=550644340 Contributors: Arcadian, Chaosdruid, Colonies Chris, Crusoe8181, Happyrabbit, Horia Ionescu, Jeff3000,
Mboverload, Michael Hardy, R'n'B, Rich Farmbrough, Rsabbatini, Rdiger Marmulla, Woohookitty, 11 anonymous edits
Radiology information system Source: https://en.wikipedia.org/w/index.php?oldid=552900158 Contributors: Amdescombes, Anthony Appleyard, BD2412, Ceejayoz, Erkan Yilmaz,
Fred.Pendleton, Hamoudafg, Hawkinsbiz, Heathd, HotHabanero, Ihealthbuzz, Kentikin, Kku, Kr-val, Menlong.Wang, Obiwankenobi, P.gibellini, Pak21, Publicoption, Solar scorch, Tonyteri,
UkPaolo, WhatamIdoing, Woohookitty, Zabdiel, 35 anonymous edits
Picture archiving and communication system Source: https://en.wikipedia.org/w/index.php?oldid=563829733 Contributors: 49oxen, AK456, Abune, Adwb, Alexf, Alfie66, AlistairMcMillan,
Amaury, Amdescombes, Ap, Arcadian, AstonishedDolphin, Belovedfreak, Blappen, Bootlace897, Ceejayoz, Chrylis, ChumpusRex, Ciscoperin, Claytont454, Clearinnova, Corto, CryptoDerk, DJ
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Analysis of Functional NeuroImages Source: https://en.wikipedia.org/w/index.php?oldid=563983674 Contributors: Amalas, Bhismadev, Jstorrs, Kl4m, Kl4m-AWB, Kslays, Magioladitis,
Nick Number, Rwcox123, SimonP, Spartaz, Stuartyeates, TheJJJunk, Tony1, Werieth, 14 anonymous edits
3DSlicer Source: https://en.wikipedia.org/w/index.php?oldid=571699804 Contributors: Adamantios, Af1523, Alisha.4m, Chris the speller, Codename Lisa, DanielPharos, DiiCinta, Edward,
Extremepro, Finetjul, Frap, Free Software Knight, Gaius Cornelius, Giancarlo Rossi, GoingBatty, GregorB, Gronky, Hoestmelankoli, JChris.FillionR, JaGa, Jeff3000, Kellereur, Lightmouse,
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Analyze Source: https://en.wikipedia.org/w/index.php?oldid=543741235 Contributors: Abductive, Alansohn, Bobo192, Christopher Parham, DeadEyeArrow, Discospinster, Fnielsen, Gogo
Dodo, GregorB, Helgese, Jacek Kendysz, Jeff3000, JonHarder, Jstorrs, Ketiltrout, Kslays, MZMcBride, Mattgirling, Matthew Desjardins, Menchi, Mendaliv, Michael Hardy, Mnemo,
Obiwankenobi, Philcock, Piano non troppo, Professor Fiendish, Quale, R, RevelationDirect, SimonP, Tubby88, Vinsfan368, X42bn6, 46 anonymous edits
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CARET Source: https://en.wikipedia.org/w/index.php?oldid=540105856 Contributors: Adavidb, Astuishin, Betacommand, Caretcortex, Closedmouth, Dawynn, Rich Farmbrough, 5 anonymous
edits
CAVEman Source: https://en.wikipedia.org/w/index.php?oldid=565586652 Contributors: Clicketyclack, Eekerz, Sturm br, TrojanDoc, 1 anonymous edits
FreeSurfer Source: https://en.wikipedia.org/w/index.php?oldid=566241974 Contributors: ArsniureDeGallium, Daniel Mietchen, Darkdigger, Dirc, Dr.alf, Dupin, John Vandenberg, Jstorrs,
Kslays, Minerva2, Ppaulojr, R'n'B, Was a bee, 25 anonymous edits
ImageJ Source: https://en.wikipedia.org/w/index.php?oldid=571696328 Contributors: 2001:67C:1220:809:0:0:93E5:90E, Akalabeth, Albertcardona, Albertcardona2, Ashimema, Bdushaw,
Bellfano, Blurysky, Bobblehead, Brossow, Chanvese, Christophmf, Daniel Mietchen, Dekart, Edward, Eroen, Evereyes, Fiftyquid, Free Software Knight, Gioto, GrummelMC, JLaTondre,
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Roy Klassen, Rubylith, Samratsubedi, Sdenn, Sethdx, Steadysteveo, Thorwald, Udittmer, Ygramul, Ytraere, Zereshk, Zundark, 79 anonymous edits
InVesalius Source: https://en.wikipedia.org/w/index.php?oldid=550223613 Contributors: Blacksqr, Harryboyles, IronGargoyle, JLaTondre, John of Reading, Klemen Kocjancic, Levi.vaieua,
Obiwankenobi, Rjwilmsi, RupertMillard, Studerby, Sturm br, Tati alchueyr, Tatiana AlChueyr, Tatiana alchueyr, Tkynerd, Woohookitty, 15 anonymous edits
ITK-SNAP Source: https://en.wikipedia.org/w/index.php?oldid=535007628 Contributors: Binary TSO, Cander0000, Chzz, Daniel Mietchen, EdJohnston, Jason Quinn, Magioladitis,
Obiwankenobi, Rjwilmsi, Rwwww, SchreiberBike, TarHippo, Woohookitty, Yushkevich, 3 anonymous edits
Mango Source: https://en.wikipedia.org/w/index.php?oldid=561890080 Contributors: Amalas, Fabrictramp, GyroMagician, Jdtyler, Laddo, Mendaliv, Nightryder84, RDBrown, Rich
Farmbrough, Tassedethe, Winkler, Wookey, , 2 anonymous edits
OsiriX Source: https://en.wikipedia.org/w/index.php?oldid=561971789 Contributors: Berean Hunter, Bignoter, Ceyockey, ChrisGualtieri, CommonsDelinker, Crazykasey, CyberSkull, Decora,
Diannaa, Dobie80, Edward, Faisal.akeel, Fratrep, Gronky, Iamunknown, Icey, Ihealthbuzz, Isilanes, Josconklin, Js2081, Karlub, Khalid hassani, Kl4m-AWB, Lox, MZMcBride, Manwichosu,
Mike.lifeguard, Mo ainm, Nandesuka, Od Mishehu, Ohconfucius, Pacsman, PeterSymonds, SatyrTN, Telencephalon2k, Wdflake, Whpq, Wizardman, Wouterstomp, Ziel00ny, rate, , 87
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Medical monitor Source: https://en.wikipedia.org/w/index.php?oldid=532670240 Contributors: 2A02:120B:C3F8:FFB0:BCC7:3622:477F:F99E, Bamyers99, Born2cycle, Cbrillaz, Ground
Zero, Gurt Posh, Jesanj, Mahahahaneapneap, Mikael Hggstrm, Rjwilmsi, Robert1947, Shirt58, Squids and Chips, Sun Creator, Vegaswikian, WhatamIdoing, Wireless friend, 2 ,
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Holter monitor Source: https://en.wikipedia.org/w/index.php?oldid=573032265 Contributors: Acsholter, Afkafka, Arcadian, Carlosguitar, Chwats, CliffC, Coldcreation, CommonsDelinker,
Cquan, Curb Chain, Dean.jenkins, Diberri, Doctormatt, Doremo, Enricoros, Facts707, Graham87, GregorB, GungaTim, HaeB, Hooperbloob, Hornet35, Jack007, Jacklee, Jason7825, Jfdwolff,
Jhaaksma, Jiezell, Jimaginator, Jrozario, Kkmurray, Ldueck, Lusum, Macro987, Martin Hogbin, Martineyre, Mattucket, Mercury, Mikael Hggstrm, NUMBER4940, Naniwako, Nanodance,
Nohat, Omegatron, Parkerjackson, Pgelliott, Philmarin, Philvollman, Pion, Rhcastilhos, SU Linguist, Sardanaphalus, Shchvova, Stevenfruitsmaak, Thatguyflint, Thismightbezach, Thundragon,
Trellemare, Tristaess, Vikom, YUL89YYZ, 66 anonymous edits
Automated ECG interpretation Source: https://en.wikipedia.org/w/index.php?oldid=570515898 Contributors: Chris the speller, ChrisGualtieri, GoingBatty, LilHelpa, Mild Bill Hiccup,
Pegasos2, Rich Farmbrough, Rsabbatini, Rubik-wuerfel, Sarahj2107, 16 anonymous edits
MECIF Protocol Source: https://en.wikipedia.org/w/index.php?oldid=508644750 Contributors: Bearcat, Josborne01, Magioladitis, Obiwankenobi, Rd232, Stephan Leeds
SCP-ECG Source: https://en.wikipedia.org/w/index.php?oldid=567781918 Contributors: Alynna Kasmira, Bazonka, Cbecc, Malcolma, Mwitz, Omegatron, Pjacobi, 4 anonymous edits
European Data Format Source: https://en.wikipedia.org/w/index.php?oldid=542459240 Contributors: Arcadian, Betacommand, Bob Kemp 1951, Borgx, Ebyabe, Ghettoblaster, Jolivan,
MrOllie, Naraht, Obiwankenobi, Pjacobi, RDBrown, Theo177, 18 anonymous edits
OpenXDF Source: https://en.wikipedia.org/w/index.php?oldid=533656404 Contributors: Cander0000, Chris the speller, Darklilac, Ghettoblaster, L3obo, Oddharmonic, Theo177, 10 anonymous
edits
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AutumnSnow, AxelBoldt, BD2412, Bananab, Barry.b.benson, Beetstra, Bluerasberry, Bunnyhop11, Camera-PR, Can't sleep, clown will eat me, Cdinesh, Cjc22, Cyberix, Dalloliogm,
DarthVader, DarylThomasUCSC, Ddove, Dilipgore12345, Dive7 0, Dmb000006, Dnaphd, Dongilbert, Dramamezzo, Duncharris, Egmonster, Fetchcomms, Flychick.al, Fratrep, FreeKill,
Frifishfry, Frogzrcoolkelsey, GHeckler, Genypholy, Giardine, Gparikh, GregorB, Hodja Nasreddin, Inocinnamon83, Ipatrol, Itskkumaran, Ivo, JSMCD, JimHu, John Vandenberg, Jthangiah,
Karasneh, Kbradnam, Kpjas, Kuleebaba, Lerdthenerd, Lexor, Linsalrob, Mai-tai-guy, Maikfr, Mais oui!, Manuelcorpas, Mark Renier, Materialscientist, Mayankkumar8, Meisterflexer, Merope,
MikeHucka, Minimac, MitraE, Mjharrison, MrOllie, My very best wishes, Mystere, NCsciencewriter, Nnkalnin, Nurg, Pengo, Peteruetz, Physicistjedi, Pisaadvocate, Pkarp11, Plindenbaum, R. S.
Shaw, RE73, Rdasari, Researchadvocate, Secretlondon, Shinwachi, Siegele, SpNeo, Speaker to wolves, Stensonpd, Stevenhwu, Thorwald, Tnabtaf, Tomtheeditor, U0171912, Walter Grlitz,
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Medical literature retrieval Source: https://en.wikipedia.org/w/index.php?oldid=548392408 Contributors: Barek, DMacks, Eleassar, Gh23, Gwernol, Healia, Ksiddiqui, Nurg, Ph.eyes,
Sleuth21, 6 anonymous edits
MEDLINE Source: https://en.wikipedia.org/w/index.php?oldid=569712754 Contributors: Andre ef, AndreasJS, Artw, AxelBoldt, Barek, Bartledan, Cbergman, Ccrohin, Chickensquare,
Christopherlin, DGG, DHN, DavidLevinson, Dmfigaro, Dr. F.C. Turner, Dreamyshade, EBMdoc, ERcheck, Epastore, Filiope, Garnerh, Gnusmas, Greg Tyler, Guillaume2303, Harryzilber,
Hoffmeier, Hongooi, Hu12, Hugh2414, Huji, Iconoclast2, Jbadger, Jfdwolff, JohnOwens, Jrcla2, K-MUS, Karol Langner, Katcher, Khalid hassani, Klunz, Kosebamse, Kpjas, Lalvers, Lexor,
LuisArmandoRasteletti, Mccready, Miguel Andrade, Moez, Mylesclough, Noisy, Nurg, Ossip Groth, PCHS-NJROTC, PFHLai, Paranthaman, Pegship, Petersam, Pifthemighty, Pmj005,
Radagast83, Randykitty, Ray3055, Rlhuffine, Rlitwin, Robert K S, Ronz, Sbharris, Scarpy, Sfan00 IMG, Shastasheen123, Slashme, Steve Quinn, StormBlade, Themfromspace, Unique85,
Warren.cheung, Widefox, Youssefsan, , , 85 anonymous edits
Entrez Source: https://en.wikipedia.org/w/index.php?oldid=565708987 Contributors: Akriasas, AlainV, Ashgene, Beetstra, Cacycle, Chickensquare, Christopherlin, Eastlaw, Eras-mus,
Freakofnurture, GregorB, Ivo, JWSchmidt, Jakob Suckale, Jcknowles, Jerome Charles Potts, Jfdwolff, Kalafati, Ketiltrout, Kevin Saff, Khym Chanur, Lexor, LucasVB, Materialscientist,
Maximus Rex, MicroBio Hawk, Miguel Andrade, Mikerussell, Narayanese, Nurg, Paranthaman, Ph.eyes, Plindenbaum, Quantum7, Qwfp, Racehorse87, Rjwilmsi, Rmky87, Ronz, SV Resolution,
Sgt Pinback, SteveChervitzTrutane, TonyW, TypoBoy, UnitedStatesian, Warren.cheung, Wavelength, Widefox, Wikiain, , 16 anonymous edits
ETBLAST Source: https://en.wikipedia.org/w/index.php?oldid=568934219 Contributors: Cherubino, Chris Capoccia, DGG, Daigaku2051, Davidruben, Garnerh, Gnusmas, Guillaume2303,
James.S, John Vandenberg, Karol Langner, Khazar2, M.errami, Nurg, Ph.eyes, R'n'B, RDBrown, Rich Farmbrough, Rjwilmsi, Tedickey, YuriyMikhaylovskiy, 13 anonymous edits
PMID Source: https://en.wikipedia.org/w/index.php?oldid=430302280 Contributors: 564dude, Acdx, AlexisCox, Allende13, Andre ef, Aude, Avb, AxelBoldt, Benbest, Bender235,
Bombomb24, Boron11, BullRangifer, Bunnyhop11, Butseriouslyfolks, Cantukarol, Cherkash, Cherubino, Chickensquare, Ciphers, Clindberg, Cmw4117, Cybercobra, DGG, Danim, Darth
Ag.Ent, Davidl53, Davidruben, Dcirovic, Deborah-jl, DexDor, Diberri, Dj55, Dkueter, Duncan.Hull, EddieVanZant, Epiding, Eras-mus, ErdnaL, Eubulides, F.chiodo, Filiope, Frankferuch,
Garnerh, Gnusmas, Guillaume2303, Hallodria, Harri J. Talvitie, Hugh2414, Huji, Jakob Suckale, Jeanie101681, Jesse V., Jessemonroy650, Jethero, Jfdwolff, Jim1138, Katcher, Kathleen.wright5,
Khalid hassani, Kkmurray, Kosebamse, Kurieeto, Lalvers, Lotje, Mayflower3, Mccready, Milkbartoilet, Molcon, Mostafa68, MrX, Mrjohncummings, Mwtoews, Mxn, NeverCeaseNeverDesist,
Novoseek, Nukeh, Nurg, OS2Warp, Onco p53, Ossip Groth, Paranthaman, PaulWicks, Pepsiman, Persilj, Ph.eyes, PhGustaf, Pharaoh of the Wizards, Philosophypsychiatry, Plindenbaum,
Ppgardne, Pratik2206, Prezense, Pro crast in a tor, Prolog, RattusMaximus, Researchadvocate, Rich Farmbrough, Rlitwin, Robert Treat, Ronz, Rror, Ryanpubget, SV Resolution, Sakaton,
SaveTheWhales, Sayerji, Sbharris, Shastasheen123, SheepNotGoats, Sleuth21, Star767, Super48paul, Ta2Ed, TenOfAllTrades, Thalamus, Theflyer, Themfromspace, Thorwald, Timwi,
Valentin31, Vsmith, W Nowicki, Warren.cheung, Wavelength, Weaddon, WhatamIdoing, Wichor, Wikidemon, Will Beback Auto, Wmahan, Yuan2085, Zarcadia, --, , ,
187 anonymous edits
PubMed Source: https://en.wikipedia.org/w/index.php?oldid=570270436 Contributors: 564dude, Acdx, AlexisCox, Allende13, Andre ef, Aude, Avb, AxelBoldt, Benbest, Bender235,
Bombomb24, Boron11, BullRangifer, Bunnyhop11, Butseriouslyfolks, Cantukarol, Cherkash, Cherubino, Chickensquare, Ciphers, Clindberg, Cmw4117, Cybercobra, DGG, Danim, Darth
Ag.Ent, Davidl53, Davidruben, Dcirovic, Deborah-jl, DexDor, Diberri, Dj55, Dkueter, Duncan.Hull, EddieVanZant, Epiding, Eras-mus, ErdnaL, Eubulides, F.chiodo, Filiope, Frankferuch,
Garnerh, Gnusmas, Guillaume2303, Hallodria, Harri J. Talvitie, Hugh2414, Huji, Jakob Suckale, Jeanie101681, Jesse V., Jessemonroy650, Jethero, Jfdwolff, Jim1138, Katcher, Kathleen.wright5,
Khalid hassani, Kkmurray, Kosebamse, Kurieeto, Lalvers, Lotje, Mayflower3, Mccready, Milkbartoilet, Molcon, Mostafa68, MrX, Mrjohncummings, Mwtoews, Mxn, NeverCeaseNeverDesist,
Novoseek, Nukeh, Nurg, OS2Warp, Onco p53, Ossip Groth, Paranthaman, PaulWicks, Pepsiman, Persilj, Ph.eyes, PhGustaf, Pharaoh of the Wizards, Philosophypsychiatry, Plindenbaum,
Article Sources and Contributors
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Ppgardne, Pratik2206, Prezense, Pro crast in a tor, Prolog, RattusMaximus, Researchadvocate, Rich Farmbrough, Rlitwin, Robert Treat, Ronz, Rror, Ryanpubget, SV Resolution, Sakaton,
SaveTheWhales, Sayerji, Sbharris, Shastasheen123, SheepNotGoats, Sleuth21, Star767, Super48paul, Ta2Ed, TenOfAllTrades, Thalamus, Theflyer, Themfromspace, Thorwald, Timwi,
Valentin31, Vsmith, W Nowicki, Warren.cheung, Wavelength, Weaddon, WhatamIdoing, Wichor, Wikidemon, Will Beback Auto, Wmahan, Yuan2085, Zarcadia, --, , ,
187 anonymous edits
GoPubMed Source: https://en.wikipedia.org/w/index.php?oldid=544615851 Contributors: Alexbateman, Artw, AxelBoldt, Kedisi, Lalvers, Medzk, Michelvoss, Radagast83, Venullian, 20
anonymous edits
Pubget Source: https://en.wikipedia.org/w/index.php?oldid=516873653 Contributors: Aimeevanzile, Amkilpatrick, BD2412, Commodore2012, DGG, Geoffspear, Guillaume2303, Headbomb,
Iconnor, Ivo, Ossip Groth, Ph.eyes, Rjwilmsi, Ryanmjones00, Ryanpubget, Tassedethe, 20 anonymous edits
PubMed Central Source: https://en.wikipedia.org/w/index.php?oldid=572078133 Contributors: Anarchangel, AxelBoldt, Barak Sh, Bobmathis, Brycen, Bunnyhop11, Cosmos1234, Daniel
Mietchen, Danny lost, Dcirovic, Deborah-jl, Debresser, DocWatson42, Graffoe, Guillaume2303, Hodja Nasreddin, Hopsyturvy, JWSchmidt, Jackmcbarn, Jakob Suckale, Jfdwolff, Jschroe,
Klortho, Lexor, Martin Jambon, Mike Chelen, NerdyPunk2ML, Nicke.me, Nurg, Pegship, Rakerman, Researchadvocate, Rjwilmsi, Rl, Rlhuffine, Rlitwin, Rockmantu, Sderose, Seren-dipper,
Theflyer, Thorwald, TillJE, Zackylee, 20 anonymous edits
UK PubMed Central Source: https://en.wikipedia.org/w/index.php?oldid=528730069 Contributors: Alexbateman, Anna M Kinsey, Anneyh, Awsb, BDD, Bg99, Buster7, Cosmos1234,
Dbm11085, DrKiernan, Drpickem, Duncan.Hull, Engagement Manager, Flyguy649, Goodwillhunting, Guillaume2303, Jfdwolff, Kwalshebl, Milton Stanley, NormanGray, Orangeaurochs,
Plindenbaum, Rakerman, Rjwilmsi, Star767, Thorwald, 4 anonymous edits
Trip Source: https://en.wikipedia.org/w/index.php?oldid=548391337 Contributors: BD2412, CaroleHenson, Curb Chain, Danim, Grafen, Jason Quinn, Jonbrassey, Jrbtrip, LilHelpa, Malcolma,
Mean as custard, Michelvoss, Nadiatalent, Nono64, Nurg, R'n'B, Rich Farmbrough
Twease Source: https://en.wikipedia.org/w/index.php?oldid=518084173 Contributors: Edward, Epastore, 1 anonymous edits
SciELO Source: https://en.wikipedia.org/w/index.php?oldid=545965250 Contributors: Asael.silva, CieloEstrellado, Dialectric, E946, Fariel, Fgnievinski, Gaius Cornelius, Guillaume2303,
Guptan99, Johann79, Lulu Margarida, Renatomurasaki, RockMagnetist, Rsabbatini, SallyForth123, Sergioruizperez, Skier Dude, Stuartyeates, Wgoodson, 10 anonymous edits
Connected Health Source: https://en.wikipedia.org/w/index.php?oldid=573377396 Contributors: Aeusoes1, BDD, Canis Lupus, Christopher Kraus, Edward, Fabrictramp, Fram, Interoperable,
Jncraton, John2bob, Jranck, Jsp22, Malcolma, Mogism, MrOllie, Novangelis, Peter Damian, Rsabbatini, Sadads, Sarahj2107, Woohookitty, 6 anonymous edits
Telehealth Source: https://en.wikipedia.org/w/index.php?oldid=570403204 Contributors: Ahmadr, Amy D. Schubert, ArmadilloFromHell, Barek, Blewisopensystemsmedia, Bmludwig,
Bobo192, Books fan, BrownHairedGirl, Bslewis1, CDN99, Camerong, Canyonchaser, Cassiemarantz, Ceyockey, Chasingsol, Chris the speller, ChrisGualtieri, DARTH SIDIOUS 2,
Danny.j.wood, Df1002, Dirk Koekemoer, Drmies, Drscarlat, Dtolj, Duffbeerforme, Edmondramly, Ego White Tray, Eilily, Erianae, Escape Orbit, FieldsTom, Flemmers, FoCuSandLeArN,
Frankie, GRIFFEY366, Glengold, Gogo Dodo, HMMcat, Harryzilber, HenryLi, Interoperable, Iridescent, JDDC1, JKofoed, Jamesfreeman404, Jessica72, Jleder, John of Reading,
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Rosoft, Mobilocalz, Mpulier, MrOllie, Mrnicksmith, Naivepanda, Nan KT, NatureBoyMD, Ngtm, Novangelis, Obiwankenobi, Pak21, PaulWicks, Pearle, Phyton 2, PigFlu Oink, Piotrus, Pvosta,
Rabinowitz, Redfarmer, Rich Farmbrough, Riggs77, Riteview, Robina Fox, Rougue scholar, Rsabbatini, Ryanphonetophone, SDaley2010, Sethdillon, Shltn, Shyamdash, Slon02, Slp1,
SpuriousQ, THB, TNHNS, Tbulger, Telehealth, Theroadislong, Thielst, Tma-medical, UseTheCommandLine, Versageek, Wavelength, Woohookitty, Xenva, Your Lord and Master, ZayZayEM,
136 anonymous edits
Telemedicine Source: https://en.wikipedia.org/w/index.php?oldid=567290612 Contributors: A. B., AbsolutDan, Aiko, Alib, Allenplanet, Anriz, Apparition11, Arcadian, Arcandam, Argon233,
Ashleyleia, Audiosmurf, AustralianMelodrama, Az1568, Badgettrg, Balsamfir, Barek, Basmah79, Bjerrk, Broadband118, Bryanrutherford0, CMBJ, Carl.bunderson, Carlitosau, Carv123456,
Celtic fairies, Ceyockey, Chillin69x, Chris the speller, Closedmouth, Cobaltbluetony, DOC DS, Danapsimer, Davidcohen, Dawnseeker2000, Deli nk, DerHexer, Deville, Dgilperez, Diannaa,
Dibnisha, Disasterlogistics, Drkhalifa, Dtolj, EBMdoc, EditingFrenzy, Eilily, Escape Orbit, Etayvas, Ewdevlin, FaradayLupin, FieldsTom, GB fan, GRBerry, GRIFFEY366, Gauri Batra, GenOrl,
Ggalonso, Ground Zero, Hadal, Harryzilber, Headbomb, HenryLi, Heron, Ianalis, Infrogmation, Interoperable, Iridescent, JHMM13, Jaeztheangel, Jihadcola, JivaGroup, Jleder, John of Reading,
JonHarder, Jwcknet, KAErps, Kate, Kauczuk, Kku, KnowledgeOfSelf, Kubanczyk, Kunalkhurana1, Lboehner-ejohnson, Lenapi, Lenapi 1980, Lenapi2009, Light current, Llorenzi, MAgrell,
Magioladitis, Mamurphy88, Martarius, Mco44, Mebrooks1969, Mereda, Middayexpress, Mini-Geek, Mochachocca, Mootros, Mpulier, MrOllie, Mrnicksmith, Mtavella, Mukherjiarnab, Nan KT,
NatureBoyMD, Neon369, Ngtm, Nixeagle, Novangelis, Obiwankenobi, Ohnoitsjamie, Omicronpersei8, Onco p53, Orenburg1, Paddles, Paf25, Pak21, Paperclip777, Pch123, Phaedrus86, Piano
non troppo, Piotrus, Pkloeb, Pratyya Ghosh, PureRED, Pvosta, R'n'B, Rich Farmbrough, Riteview, Rjwilmsi, Robert A West, Rsabbatini, Ryansean, SGogia, Sbbhattacharyya, Scatter22, Scjessey,
Shanafme, Shltn, Slipstream, Slugmaster, Spotharaju, Spsood, Stanqo, Sterling.M.Archer, Stuartyeates, Sumsum2010, Sunidesus, Supten, Terinavy, Thenthorn, Thielst, Tiggerjay, Tmulak,
Tolly4bolly, Torbinsky, Ubiquity, Velella, Vgprak, Wanscher, Wavelength, We hope, WikHead, Wmahan, WurmE, YSSYguy, Yazmnmx3, Zeeshanchattha, Zubinthakore, -,
275 anonymous edits
Telecare Source: https://en.wikipedia.org/w/index.php?oldid=560900320 Contributors: -fin, Alinja, AnotherSkierDude, Argon233, AvicAWB, Calltech, CliftonRugby, DBigXray, Darrelljon,
David111180, Fayedizard, G2003, Geologyguy, Iridescent, Jim1138, Karstenandjason, Mild Bill Hiccup, MindNoGap, Naivepanda, Number 57, OlEnglish, Paul foord, Pgillman, Presnser,
Qingostarr, Rsabbatini, Sgkay, Speechpathology, Srleffler, Stillplaygbc, Technopat, TelecareTechnology, Tleckie, Trivialist, Uncle Dick, WikiHannibal, 25 anonymous edits
Telephone triage Source: https://en.wikipedia.org/w/index.php?oldid=503617894 Contributors: Alejotheo, Amy D. Schubert, Bunnyhop11, CMBJ, Earlypsychosis, Harryzilber, Jsfouche,
Kiwi128, RJFJR, Rsabbatini, Steve carlson, THB, TenPoundHammer, The Rambling Man, Tolly4bolly, Wheeler4040, 15 anonymous edits
Remote guidance Source: https://en.wikipedia.org/w/index.php?oldid=551891124 Contributors: Fartherred, FreedomFireCom, Hamoudafg, Irubinfeld, MrOllie, Nono64, Nubiatech, Oh Snap,
Paddles, Panthouse, Rsabbatini, 4 anonymous edits
Tele-epidemiology Source: https://en.wikipedia.org/w/index.php?oldid=566787858 Contributors: Apteva, Bazonka, DGG, Dr P Michel, Emeraude, GoingBatty, Hbdragon88, JPDMichel, John
of Reading, Mhi1002, Mojo Hand, Rsabbatini, Tirkfl, Woohookitty, 11 anonymous edits
Telenursing Source: https://en.wikipedia.org/w/index.php?oldid=558311819 Contributors: Alejotheo, Amy D. Schubert, Bunnyhop11, CMBJ, Earlypsychosis, Harryzilber, Jsfouche, Kiwi128,
RJFJR, Rsabbatini, Steve carlson, THB, TenPoundHammer, The Rambling Man, Tolly4bolly, Wheeler4040, 15 anonymous edits
Teledermatology Source: https://en.wikipedia.org/w/index.php?oldid=565068261 Contributors: Edward, Ferozkal, John of Reading, Klughammer, MER-C, Magioladitis, Mission Fleg, My
Core Competency is Competency, Paddles, Phan Ni Mai, R'n'B, Rsabbatini, SimonPucher, Skattili, T-scope, TheAllSeeingEye, WhatamIdoing, WurmE, 6 anonymous edits
Telemental Health Source: https://en.wikipedia.org/w/index.php?oldid=495175775 Contributors: Aaron Kauppi, Amalas, CMBJ, FiachraByrne, Jayostrowskiwiki, Lexhor, Lilmoonbeam,
Mcculloughphd, Obiwankenobi, Plyingfig, Rougue scholar, Rsabbatini, Rvitelli, Tbulger, Telementalexpert, Whitejay251, WikHead, 2 anonymous edits
Telepsychiatry Source: https://en.wikipedia.org/w/index.php?oldid=567619940 Contributors: Afishkind, Alansohn, Anna Lincoln, Bddmagic, Belovedfreak, Bryanrutherford0, Carv123456,
Chris Capoccia, Cristiejx, Escape Orbit, Gobonobo, Harryzilber, Homepsychiatry, Khazar, Magioladitis, Obiwankenobi, Oliviaboy, Philip Trueman, Rougue scholar, Rsabbatini, Smaddaloni,
Snevetsm, Supten, Welsh, Wpwatchdog, 8 anonymous edits
Teleradiology Source: https://en.wikipedia.org/w/index.php?oldid=570688858 Contributors: Aesopos, AidenRyan, Alansohn, Apparition11, Arcadian, Asharafshahi, AvicAWB, Blabberhand,
Bryanrutherford0, CMBJ, Ciscoperin, DEE115, Davecrosby uk, Dekisugi, Ebenezerpc, FauxClaud, FreplySpang, Greasybackflop, Hercule, Hibana, Ithilias, Jeepersjoseph, Jkeirn, Jlstenger,
Jmoock, Kukini, Lamro, McSly, Michaelmdx, Mitesh harlalka, MrOllie, Mwarf, NeilN, Ourhistory153, Paf25, Radiologygenius, Rickwjenn, Riteview, Robofish, Ronz, Rsabbatini, Shanetapper,
Sueotis, Usteleradiology, WAvegetarian, WhatamIdoing, WikHead, Woohookitty, Wouterstomp, Wyatt915, 136 anonymous edits
Telerehabilitation Source: https://en.wikipedia.org/w/index.php?oldid=554694472 Contributors: Acebrock, B Pete, Barkeep, Braincricket, Briancua, CMBJ, Colinlee, Dbrienza, Ecohn, F,
Hargle, Harryzilber, J04n, Janezp, Jeff3000, Jlittlet, Jn.mdel, Joel7687, Jonkerz, Josh Parris, Koavf, Mysoberlife, Obracy, Oli Filth, PGPirate, Piotrus, Rich Farmbrough, Rsabbatini,
RyanGerbil10, STHayden, Sam Blacketer, Skysmith, Suepalsbo, SummerPhD, Sunidesus, Uanfala, Woohookitty, Zvar, 22 anonymous edits
Virtual reality in telerehabilitation Source: https://en.wikipedia.org/w/index.php?oldid=491511957 Contributors: Barkeep, Circeus, Jbkim486, Jeff3000, Lovelac7, Piotrus, Rjwilmsi,
Rsabbatini, Salamurai, Sunidesus, TeflonII, Tesseran, VishalB, Wbm1058, 2 anonymous edits
Wireless Medical Telemetry Service Source: https://en.wikipedia.org/w/index.php?oldid=556466453 Contributors: Bobwhitten, DGG, Fabrictramp, Ground Zero, Katharineamy, Le Deluge,
Magioladitis, Malcolmxl5, Pschon, RTG, Rsabbatini, Trlovejoy, Wireless friend
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Computer assisted surgery Source: https://en.wikipedia.org/w/index.php?oldid=413598746 Contributors: Alexwagner, Arcadian, Ben Ben, Billinghurst, Chaosdruid, Chris the speller, Cst17,
Danim, Darklilac, DexDor, Dlugose, Edward, Eumolpo, Fmalan, Frap, Graham87, GregorB, Ground Zero, Harry, Horia Ionescu, Hu12, Jeff3000, Kkmurray, Leggwork, Manoj.adonis,
MedicusMagnificus, Rbhavanirao, Rich Farmbrough, Rsabbatini, Rdiger Marmulla, SMEAC, Sjschen, Wingman4l7, Woohookitty, Zundark, 47 anonymous edits
Remote surgery Source: https://en.wikipedia.org/w/index.php?oldid=558122797 Contributors: Alusayman, Arcadian, Chaosdruid, CosineKitty, Courcelles, Crumley, Danim, Ddlamb, Edward,
Eleventh1, Harryzilber, Hu, Info IST, Jonpro, Kate, Khkopp, Kierano, Kkmurray, LittleWink, Magioladitis, Michaeldsuarez, Mmaurn, Networkvideo, Pearle, Piet Delport, Rayc, Recury,
Rsabbatini, Rdiger Marmulla, Sun Creator, Suruena, THEN WHO WAS PHONE?, Tahirferoz, Tentinator, Thumperward, Venice85, Vicarious, WhiteDragon, WikiPedant, Wingman4l7,
Wouterstomp, 31 anonymous edits
Robotic surgery Source: https://en.wikipedia.org/w/index.php?oldid=574331486 Contributors: 122589423KM, Abedhammoud, Acidburnben, AdjustShift, Afein, Ahzahraee, Alansohn,
AlbertBickford, Alephnyc, Alievrenkut, Almazan, Alynna Kasmira, Anetode, Animagi1981, Anupriya.khare, ArchStanton69, AuroraIT, Autocracy, Basawala, Ben Ben, BenTels, Biggleswiki,
Blinman, Bongwarrior, Booyabazooka, BrainyBroad, Brobdignagian, Bulletinchocolate, Chaosdruid, Cheeze1010101, Closedmouth, Crazymonkey1123, Culicidae, DARTH SIDIOUS 2,
DMacks, DOC DS, Danielanb, Danim, Dbfirs, DeadEyeArrow, Decltype, Dfiinter, DiverDave, Docmarcg, Drsaurabhk, Dtom, Eccejamin, Ekem, Eleassar, Emeransid, Everton47, Extransit,
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Vrenator, WODUP, Webclient101, West.andrew.g, William Avery, Wingman4l7, Wizardman, Woohookitty, Yurei-eggtart, Yworo, Z22, , 454 anonymous edits
Surgical Segment Navigator Source: https://en.wikipedia.org/w/index.php?oldid=465645969 Contributors: Drbreznjev, Horia Ionescu, Iridescent, J04n, Obiwankenobi, Rsabbatini, Rdiger
Marmulla, Tony1, Zundark, 1 anonymous edits
Bone segment navigation Source: https://en.wikipedia.org/w/index.php?oldid=556964416 Contributors: CommonsDelinker, Horia Ionescu, J04n, Jeff3000, Mohamed-Ahmed-FG, Muhammad
Hamza, Nono64, Rich Farmbrough, Rjwilmsi, Rsabbatini, Rdiger Marmulla, Tabletop, Wingman4l7, 2 anonymous edits
Robotic prostatectomy Source: https://en.wikipedia.org/w/index.php?oldid=388157553 Contributors: 122589423KM, Abedhammoud, Acidburnben, AdjustShift, Afein, Ahzahraee, Alansohn,
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Faradayplank, Fixitright, Flowanda, Fltnsplr, Flyer22, Fraggle81, Fyrael, GeneralAtrocity, GiggsHammouri, GoingBatty, GregdeGland, Gynonc, Hans Dunkelberg, Harborrat99, HardJeans,
Harrypuns, Headbomb, Helloher, Hertz1888, Holme215, Horatiot burns, Hqb, Hu12, Inlandmamba, Inoesomestuff, Isabelogden, J.delanoy, JForget, Jake Wartenberg, Jamesontai, Jaquesk, Jd027,
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Vrenator, WODUP, Webclient101, West.andrew.g, William Avery, Wingman4l7, Wizardman, Woohookitty, Yurei-eggtart, Yworo, Z22, , 454 anonymous edits
Robot-assisted heart surgery Source: https://en.wikipedia.org/w/index.php?oldid=388614159 Contributors: 122589423KM, Abedhammoud, Acidburnben, AdjustShift, Afein, Ahzahraee,
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Vincent323, Virtualerian, Vrenator, WODUP, Webclient101, West.andrew.g, William Avery, Wingman4l7, Wizardman, Woohookitty, Yurei-eggtart, Yworo, Z22, , 454 anonymous
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Cyberknife Source: https://en.wikipedia.org/w/index.php?oldid=568029010 Contributors: Ablorg, Accounting4Taste, Acdx, Anetode, Arcadian, Arrowcatcher, AskJoanne, Avg, Axl,
Beno1000, Biosthmors, Booth789, Bozgen, Byeuall, Cglassey, Chaosdruid, Chick Bowen, Chowbok, Colonies Chris, Croquant, Dalillama, Danim, Daveswagon, Deuceniner, Dl2000, Dulciana,
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of Reading, KCMain, Lesgura, LogicalFinance33, Lrogers0711, Lucifero4, Mattruby, MedHead, MedicusMagnificus, MelanieN, Michael Devore, Michael Hardy, Mmsrinivasan, Mootros,
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Man, Vlc2009, Wakasmaka, Wapiti, WarthogDemon, West Side Intellectual, Wikfr, Zereshk, 157 anonymous edits
Da Vinci Surgical System Source: https://en.wikipedia.org/w/index.php?oldid=572649769 Contributors: 2602:306:CD20:8D80:4DD4:ADAB:DC86:E066, Andersenz2, AxelBoldt, Barek,
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Queerbubbles, Rl, Ro ra 6, Roberta F., SJFriedl, Scottalter, Seaphoto, Shaded0, Smalljim, Smiloid, Staffel, The Thing That Should Not Be, Thinkinger, Vanished user vjhsduheuiui4t5hjri, Widr,
Ytic nam, 74 anonymous edits
NeuroArm Source: https://en.wikipedia.org/w/index.php?oldid=551281967 Contributors: Babygirl2010, Brownh2o, Chaosdruid, Clicketyclack, Danim, Fgegypt, Gene Nygaard, Glloq, Ilatour,
K ideas, Keensdesign, Mychoi, QCRI, Simeon, Skysmith, Thane, Utcursch, 27 anonymous edits
Laboratory Unit for Computer Assisted Surgery Source: https://en.wikipedia.org/w/index.php?oldid=558427906 Contributors: Akamelfg, CommonsDelinker, Horia Ionescu, Iridescent,
J04n, Jeff3000, Llorenzi, Obiwankenobi, Rdiger Marmulla, 2 anonymous edits
Health Insurance Portability and Accountability Act Source: https://en.wikipedia.org/w/index.php?oldid=572647540 Contributors: 10metreh, 2620:72:0:639:A8A4:B871:40EC:130A,
28bytes, Ahoerstemeier, Airproofing, Akradecki, Alansohn, Alexius08, Allsaints23, Andrewhahn47, Aoso0ck, Argon233, Avernet, Bart133, Beachdude2k, Bearian, Beland, Benbest, Bevo,
Bikeable, Brainy J, BrianOfRugby, BrianWo, Brim, C01dphu510n, Calmer Waters, Casshart, Chaitanyakadiyala, Checkmate000, Chris the speller, Chuck607, Classicnovels, Cntras,
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Galemarieharris, Galoubet, Garga2, Gdk11411, Ginsuloft, GiveItSomeThought, GoldRingChip, Gregwtmtno, Gz33, Hantanplan, Hooperbloob, Howcheng, ISTJonathan, IlyaHaykinson, Int21h,
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Article Sources and Contributors
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Tnspartan, Tom Morris, Tonynovak, Travisk, Trice2432, Vancem, Varunvnair, Vastardly, W guice, Widr, Wknight94, Wtmitchell, Yhelothur, Yossin, 452 anonymous edits
Certification Commission for Healthcare Information Technology Source: https://en.wikipedia.org/w/index.php?oldid=561443723 Contributors: Aspooner, Awillmore, Bearcat, Chronulator,
Chzz, Dawnseeker2000, Glenmarshall, Hongooi, Hu12, JennyRad, Keeper76, MarcoTolo, Medsync, Mikeblas, MisysHC, Mojo Hand, Mootros, Mr pand, Perspectoff, R'n'B, Rjwilmsi,
Rsabbatini, Ryanjo, Sabathecat, ShelleyAdams, Struway, Trumpetfire, Turoczy, Twirligig, 100 anonymous edits
Medical software Source: https://en.wikipedia.org/w/index.php?oldid=572270317 Contributors: Brian Geppert, Calltech, Crazysane, DerBorg, Edward, Harrygouvas, Hmains, JHunterJ,
Jabraham mw, JonHarder, Kku, Krishna1234, Lowesteve, Mark Arsten, MarmotteNZ, MatthiasG, Mckeond, Mean as custard, Mootros, Nancysandhu, Neutrality, NimbleToad, Obiwankenobi,
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Dental software Source: https://en.wikipedia.org/w/index.php?oldid=569838473 Contributors: AK456, Arpingstone, Asjensen, AxexDental, Bcartolo, Bgwhite, Brainy J, Chris the speller,
Danail Angelov, David Gerard, DeTandarts, DoctorKubla, Edward, Eeekster, EoGuy, Garmaa, GoingBatty, I am One of Many, John of Reading, Katharineamy, Kirti t, Kont 200, Logical
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Stefanomione, Vegaswikian, Welsh, WereSpielChequers, William Avery, 50 anonymous edits
List of freeware health software Source: https://en.wikipedia.org/w/index.php?oldid=561851763 Contributors: Bigweeboy, Jselanikio, Ksaravanakumar, Kumar245, Malcolma, Medflagman,
Metadiego, MohammadLafi, Navis78, Obiwankenobi, Olga Vovk, Ph.eyes, RTG, Ronz, Tedickey, 20 anonymous edits
List of open source healthcare software Source: https://en.wikipedia.org/w/index.php?oldid=465793443 Contributors: 1w1k1wr1ter, Alvinmarcelo, Anilverma3, Anoopjohn, Arcadian,
Asargent, Ashishof77, Astif, Babis d, Barryallard, Bastula, Bender235, Boilermanc, Bthuman, Buffbills7701, Burlywood, Calliopejen1, Cameron.walsh, Cander0000, Caultonpos, Ceefour,
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SystemOneCo, Tajdink, Tatiana AlChueyr, Tdoune, Themfromspace, Theo177, Theserialcomma, Tim.churches, Titodutta, Tommy2010, Tony1, Tradimus, Tuneful440, Twcook, Ugm6hr,
Umls04aa, Vela1606, Versageek, Vidwiki, WDavis1911, WRK, Wdr3, Wiki Raja, Willbennett2007, Wknight94, Wocky, Xueshengyao, Yanokwa, Yushkevich, 367 anonymous edits
List of neuroimaging software Source: https://en.wikipedia.org/w/index.php?oldid=573321973 Contributors: Alark1, BenediktS, Cecilyen, Clicketyclack, Darkdigger, Dawynn, Dicklyon,
Dylancwood, Emal35, Epsilon22, Fmri.bergen, Gcastellanos, GyroMagician, Janviermichelle, Josief, Jstorrs, Karjaho, Kpmiyapuram, Krajcsi, Kslays, Mterrill, N.vanstrien, Olga Vovk, Peaceful
horizon, Qradua, Rwwww, Sorbiers93, Tassedethe, Wandell, Welsh, Winkler, 30 anonymous edits
Mirth Source: https://en.wikipedia.org/w/index.php?oldid=488530425 Contributors: Barbaar, Brian a lee, CommonsDelinker, DarkFrog, DrZaius, Gbortis, Level1-9, Obiwankenobi,
Perspectoff, Prolog, Shaggyjacobs, Zeno McDohl, 10 anonymous edits
Mpro Source: https://en.wikipedia.org/w/index.php?oldid=553727893 Contributors: Dcirovic, Drcdw67, Edcolins, Edgar181, Gbmav, Nyttend, Trivialist, VQuakr, Vzc635ae, 7 anonymous
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Open Dental Source: https://en.wikipedia.org/w/index.php?oldid=569663161 Contributors: AlistairMcMillan, Allstarecho, Angrytoast, Bobamnertiopsis, Brian0918, Cander0000, Cokoli,
DeTandarts, Djmckee1, Ebyabe, Edward, Frap, Free Software Knight, Gdbanks, Hu12, Iridescent, JLaTondre, Jason Quinn, Jordansparks, Lightmouse, Longhair, Meegs, Michael Hardy, Mild
Bill Hiccup, Nate.sparks, Neutrality, Polisher of Cobwebs, Princeboy, R'n'B, Rjwilmsi, Rwwww, SarekOfVulcan, SchuminWeb, Surv1v4l1st, Uncle G, Wolfehhgg, Xldent, YUL89YYZ, 61
anonymous edits
Personal Health Application Source: https://en.wikipedia.org/w/index.php?oldid=495133686 Contributors: Auntof6, Bearcat, Fabrictramp, Freeerasure, JanEnEm, Magioladitis, Medicine man,
Obiwankenobi, Ronz, Santryl, ShelleyAdams, Warrior4321, Woohookitty, 8 anonymous edits
Texas Medication Algorithm Project Source: https://en.wikipedia.org/w/index.php?oldid=573744820 Contributors: Ahoerstemeier, Alison, Andrew73, Antaeus Feldspar, Aspro, Chris the
speller, ClockworkSoul, FiachraByrne, Fram, Fvasconcellos, Haemo, Hmains, Hyperion35, Lawikitejana, LouI, Martial Law, MaryTormey, Midgley, Nabla, Ombudsman, PCock,
PhysiciansDeskReference, Psychiatrykills, RXPhd, Rl, Rogerd, Scootercatter, SimonP, Standardname, TenOfAllTrades, TrevMrgn, Unara, Vegaswikian, 16 anonymous edits
MUMPS Source: https://en.wikipedia.org/w/index.php?oldid=573380816 Contributors: 205.180.71.xxx, 21n, 80N, A5b, A930913, AHMartin, AbuAmir, Abuyakl, AlistairMcMillan, Alvo,
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Charles Matthews, Chester Markel, Chowbok, Chris Roy, ClockworkTroll, Cmdrjameson, Connel MacKenzie, Conversion script, Cryptic-wiki, Cybercobra, DCrazy, DNewhall, Damian Yerrick,
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Sputnik23, Stevietheman, Talktokunal, Tedickey, Tesscass, That Guy, From That Show!, The Wild Falcon, Thumperward, Tim Ivorson, Tlesher, Tlwiechmann, ToastieIL, Toresbe, Vald,
Versus22, Vrenator, W Nowicki, Wavelength, Wbm1058, Wdr3, Wernher, Who, Wikiborg, Wikiklrsc, Wikky Horse, Ww, Yuckfoo, Zabdiel, Zeno Gantner, 322 anonymous edits
Bing Health Source: https://en.wikipedia.org/w/index.php?oldid=565829079 Contributors: Damaster98, Danifronter, LilHelpa, Tuanese, Typhoon87, Wkriebel, 6 anonymous edits
Dossia Source: https://en.wikipedia.org/w/index.php?oldid=571930624 Contributors: Bigmantonyd, D6, Ftrotter, Gekhap, Giraffedata, Ikjadoon, Kimun, MMsharpie30, Magioladitis, Malcolma,
Manscher, Obiwankenobi, P motch, Rich Farmbrough, Rjwilmsi, Rsabbatini, ShelleyAdams, T@nn, Whoisjohngalt, Woohookitty, 25 anonymous edits
E-Patient Source: https://en.wikipedia.org/w/index.php?oldid=495063990 Contributors: Drscarlat, ErikNilsson, Hordaland, JakobSteenberg, Jane023, Jonl, KBrainbridge, Kmasters0,
Kosherfrog, Lfstevens, LincolnSt, Minnaert, Mytcsy, Obiwankenobi, RDBrown, Rachelellaway, Rich Farmbrough, Rjwilmsi, Rsabbatini, Sevk Tzevnerig, ShelleyAdams, Tony1,
UseTheCommandLine, Versageek, WOSlinker, WhatamIdoing, 17 anonymous edits
Google Health Source: https://en.wikipedia.org/w/index.php?oldid=570865962 Contributors: Abangerter, AbdiViklas, Azertus, Bluerasberry, Braincricket, Bsadowski1, Chris Paton,
Clarificationgiven, Clueless, Compfreak7, Cosmo7, Daniel Lawrence, Derekleungtszhei, FayssalF, Frap, Frozen Wind, Gobonobo, GoingBatty, Jack Bauer00, Jamalystic, JbTruthiness, Jcarroll,
JonathanCross, KarenViceroy, Killuminator, Koavf, Kosovohp, Liangent, Logical Cowboy, Luk, MamboJambo, Mato, Mobilereflex, N5iln, Natkeeran, Noodles25, Obiwankenobi, Ohnoitsjamie,
Pipedreamergrey, Privatechef, Reddyb2, Rich Farmbrough, Rjwilmsi, Rongdenhp, Ronz, Ross Fraser, Rouenpucelle, Rsabbatini, Sandstein, Senimazarine, Sethdillon, Sfan00 IMG, Syp,
WereSpielChequers, Whoisjohngalt, , 60 anonymous edits
IMedicor Source: https://en.wikipedia.org/w/index.php?oldid=562817390 Contributors: Asod123123, Eastmain, Jauerback, Lyjusinski, Mojo Hand, Obiwankenobi, Polly, Ramaksoud2000,
Rick295, Rsabbatini, Shmaarts, TheAMmollusc, 2 anonymous edits
Microsoft Amalga Source: https://en.wikipedia.org/w/index.php?oldid=544479069 Contributors: Algray1977, Bazonka, Chesshydra, Chowbok, Davidmack, Dfxdeimos, Eptin, Frank Perbet,
Frecklefoot, Gary King, Good Olfactory, Gscshoyru, HDow, InverseHypercube, Jed 20012, Kgwikipedian, KuduIO, Kurieeto, Millermk, NawlinWiki, Obiwankenobi, Ph.eyes, Rahilns,
Rsabbatini, Ryanjo, Sedmic, Urda, Vanished user ikijeirw34iuaeolaseriffic, Vincej, Wintermute314, 24 anonymous edits
Microsoft HealthVault Source: https://en.wikipedia.org/w/index.php?oldid=565377661 Contributors: 2001:4898:18:3:CCD3:72B3:EC07:30F1, Aspects, Canfood, Coffee, Danielkivatinos,
Digifiend, Eezip, Eric.Gunnerson, Fluffernutter, Good Olfactory, Grawity, Jenniferpost, Johnspencer, JonoPowell, Kgwikipedian, Kirkaiya, Obiwankenobi, PhilKnight, Retired user 0001,
Rsabbatini, SeanAhern, Shadowjams, Smoth 007, Soumyasch, Terrycostantino, Tide rolls, Trmartin13, Wickorama, ZeiP, ZimZalaBim, Zipswich, 35 anonymous edits
Article Sources and Contributors
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Patient portal Source: https://en.wikipedia.org/w/index.php?oldid=567825675 Contributors: AAAVVV333, Aaron-carlock, Abecedare, Agilestyle, Beetstra, Dennis Bratland, Dialectric,
Ean5533, Echikitsa, Felix Folio Secundus, FieldsTom, Jdeutsch, John of Reading, Kilopi, Klmartin9, Mandi.coker, Mike V, Mreddy08, MrsBasto, Msundaresh, Oddharmonic, Ohnoitsjamie,
Reedts, Ronz, Rsabbatini, Sabreshark, Synahelp, Tabletop, Thuvan Dihn, TracyGeo, WhatamIdoing, YUL89YYZ, 42 anonymous edits
Virtual patient Source: https://en.wikipedia.org/w/index.php?oldid=565586496 Contributors: Adilkhan1234, Anschaefer, Auntof6, Barticus88, Bocasurf, Britot, ChrisGualtieri, Cornellrockey,
Crystallina, Drscarlat, Gene Hobbs, Jsfouche, Kc8ukw, Kittiseth, LilHelpa, Lockley, Manuelpaul, Micru, Nick Number, Pearle, Ph.eyes, Propaniac, Rachelellaway, Rsabbatini, SJP, Salad Days,
Sianclaireowen, Sturm br, That Guy, From That Show!, Topps, TrojanDoc, Versageek, Virtualpatient, WhatamIdoing, Woohookitty, Yegg13, 16 anonymous edits
Translational research informatics Source: https://en.wikipedia.org/w/index.php?oldid=506770537 Contributors: Biochemza, Duffbeerforme, Infomd, Jdegreef, Jonkerz, Magioladitis,
Mr.moyal, Obiwankenobi, Prpayne, R'n'B, RHaworth, 4 anonymous edits
Clinical data management system Source: https://en.wikipedia.org/w/index.php?oldid=560865707 Contributors: Avantika789, Belovedfreak, Biowizardvinoth, Brainhome, Bsklais, Bwong2k,
Capricorn42, Clinnovo, Cquan, Drscarlat, Edcolins, EoGuy, Gobbleswoggler, Gustav III, Hreynerson, Hydrargyrum, Iauixpr, Jafib, Kamalakhtar1, LlamaAl, Manop, Markanderson33, Michael
Slone, Nidhi Ralli, PhilMoggridge, Pvosta, Qwfp, R000t, RHaworth, Riteshmandal, Tassedethe, TheAMmollusc, UseTheCommandLine, V.harter, Vamanachar, Versageek, Wikieditor1952, 38
anonymous edits
Case report form Source: https://en.wikipedia.org/w/index.php?oldid=544546834 Contributors: Abhijeet Safai, Brian the Editor, Dmiller001, Edcolins, Feureau, Ilyushka88, Jesse V., Mailer
diablo, MastCell, Ph.eyes, Pvosta, Rich Farmbrough, Sofia Roberts, Targethealth, Vianello, Wagino 20100516, Xris0, 9 anonymous edits
Clinical coder Source: https://en.wikipedia.org/w/index.php?oldid=573520461 Contributors: Alanvoss, Archananup, Beeswaxcandle, Briancrouch, Butseriouslyfolks, Camw, CliffC, Deb,
Dshun, Gary King, Guptan99, Harbir123, Herosomc, Jarble, JeepdaySock, Jesanj, Kilopi, Little pob, Manu18, Onkar195, Pigman, RDBrown, Rjwilmsi, Rworsnop, Tedder, Thinking of England,
Treehousedweller, Twirligig, Versageek, Xnike315x, 23 anonymous edits
Clinical data acquisition Source: https://en.wikipedia.org/w/index.php?oldid=530517483 Contributors: Abhijeet Safai, Andrewman327, Brian the Editor, Chrispounds, Edcolins, Esowteric,
Geordieredhead, Jeekc, MastCell, Mr. Lefty, Orpheus, Pvosta, R5gordini, Santtus, ScottRaw, VQuakr, Xris0, Zeary, 6 anonymous edits
Data clarification form Source: https://en.wikipedia.org/w/index.php?oldid=518109981 Contributors: Abhijeet Safai, Devourer09, Edcolins, Feureau, Pvosta, 2 anonymous edits
Patient-reported outcome Source: https://en.wikipedia.org/w/index.php?oldid=573132136 Contributors: Brucecharlesworth, Burntsauce, Chowbok, Closedmouth, Drhays, Edcolins, Edgar181,
Eleven11d, Erikcambria, Femto, Feureau, FiveColourMap, G716, GR-Manchester, Gbmav, Giraffedata, Jmvalderas, Khazar2, Kognos, Lifesciences, Lwdiener, Mapiede, Marips, Meadowsk,
Ncahill, Niceguyedc, Nick Number, NielsenGW, Oxford Outcomes, Pattigustafson, PaulWicks, Potionism, Pvosta, Rjwilmsi, Robocoder, Savoyard1217, Sharkli, Wavelength, WikHead, Wirthrj,
14 anonymous edits
Diagnosis codes Source: https://en.wikipedia.org/w/index.php?oldid=554559831 Contributors: Alanvoss, Arcadian, Beeswaxcandle, ChrisCork, Correogsk, Davidruben, Deb, Ftaute, Guptan99,
Hordaland, Jsfouche, Kafziel, Khazar, Mikeo, PHUIII, Punkinhed, Pvosta, Rjwilmsi, SchreiberBike, Ske2, Tedder, Tygrus, Wireless friend, 12 anonymous edits
Procedure codes Source: https://en.wikipedia.org/w/index.php?oldid=554560001 Contributors: Alanvoss, Arcadian, Davidruben, Deb, Jtheb69, Kafziel, Little pob, Mifter, Oanabay04, Pvosta,
Rwalker, Ske2, Tedder, 8 anonymous edits
Bar Code Medication Administration Source: https://en.wikipedia.org/w/index.php?oldid=546049499 Contributors: AirBa, Barcoder24, IGsheppard, JHunterJ, Joanneyswong, Jsfouche,
KDStennett, Obiwankenobi, YUL89YYZ, 4 anonymous edits
Bidirectional Health Information Exchange Source: https://en.wikipedia.org/w/index.php?oldid=334951032 Contributors: Arcadian, Bobergj, Chris the speller, Dekart, Funandtrvl,
Jamesdcarroll, Jonkerz, Obiwankenobi, Physadvoc, Pklinker, Rjwilmsi, Rwwww, 2 anonymous edits
Classification Commune des Actes Mdicaux Source: https://en.wikipedia.org/w/index.php?oldid=544250398 Contributors: Arcadian, JHunterJ, John of Reading, NickelShoe, Sadads, 2
anonymous edits
Classification of Pharmaco-Therapeutic Referrals Source: https://en.wikipedia.org/w/index.php?oldid=563985788 Contributors: AK456, Anypodetos, BD2412, Bazonka, Belovedfreak,
Colonies Chris, CommonsDelinker, Don4of4, EagleFan, Guptan99, Magioladitis, Michael Hardy, Muhammad Tabish, Nick Number, Nono64, Obiwankenobi, R'n'B, Raimundo Pastor,
Redrose64, Rjwilmsi, SRaemiA, SchreiberBike, Woohookitty,
Clinical Context Object Workgroup Source: https://en.wikipedia.org/w/index.php?oldid=334951348 Contributors: A purple wikiuser, Argon233, Egombrich, John of Reading, KVeil, Lep47,
Lexi Marie, Obiwankenobi, Owen, Pugetbill, Raboof, Tom Ngo, Whitepaw, Xdxfp, 16 anonymous edits
Clinical Data Interchange Standards Consortium Source: https://en.wikipedia.org/w/index.php?oldid=573686089 Contributors: 786b6364, 790, Angusmca, Avadakin, BD2412, Btrinczek,
Bunnyhop11, Cander0000, ClaretAsh, Cmdrjameson, Crystallina, DocGizmo, Dougdp, Dthomsen8, Edcolins, Emersoni, Formedix, G716, Iramidi, Isheden, Jareha, Jones1901, MZMcBride,
Mandarax, Melcombe, Mild Bill Hiccup, Obiwankenobi, Pvosta, Ronz, Sakaton, Saurabh0410, SebastianHellmann, Simonhalsey, Teferi, Thuja, Troy.smyrnios, Wiggyboo, 39 anonymous edits
Clinical Document Architecture Source: https://en.wikipedia.org/w/index.php?oldid=569984513 Contributors: Alexandru.chircu, BD2412, Cander0000, ChristofG, Dclunie, Doughorner,
Drscarlat, GreyCat, Lep47, Linforest, Lingmac, Obiwankenobi, PigFlu Oink, Pvosta, Shaggyjacobs, Sstrader, Tom Morris, Versageek, Wrennj9, 12 anonymous edits
Continuity of Care Document Source: https://en.wikipedia.org/w/index.php?oldid=549514621 Contributors: Arthena, Cander0000, Cyndijoan, Davidkibbe, Drscarlat, Gschadow, Jddamore,
JimVC3, Jsfouche, Mr. IP, Nealmcb, Obiwankenobi, Rhdolin, ShelleyAdams, Techman224, 16 anonymous edits
Clinical Document Architecture Source: https://en.wikipedia.org/w/index.php?oldid=569984513 Contributors: Alexandru.chircu, BD2412, Cander0000, ChristofG, Dclunie, Doughorner,
Drscarlat, GreyCat, Lep47, Linforest, Lingmac, Obiwankenobi, PigFlu Oink, Pvosta, Shaggyjacobs, Sstrader, Tom Morris, Versageek, Wrennj9, 12 anonymous edits
Continuity of Care Record Source: https://en.wikipedia.org/w/index.php?oldid=559522413 Contributors: CCRadvocate, Cander0000, Charles Matthews, Davidkibbe, Delonnette, Donama,
Drscarlat, GMcGath, Hiberniantears, Hugh2414, Jfdwolff, Johanvs, Jwollaston, Lenin1991, LincolnSt, Lizwillock, Manscher, Mercenario97, Niceguyedc, Obiwankenobi, PhilHibbs, Pnm, Pvosta,
Sanjiv swarup, TessVague, ThaddeusB, Versageek, Wrennj9, 48 anonymous edits
COSTART Source: https://en.wikipedia.org/w/index.php?oldid=307408430 Contributors: Eastlaw, Pvosta, 1 anonymous edits
Current Procedural Terminology Source: https://en.wikipedia.org/w/index.php?oldid=573700637 Contributors: AdjustablePliers, Alanvoss, Alkaline19, Alpha Quadrant, Arcadian, Argon233,
BD2412, BWP2007, Barticus88, BigK HeX, Bobo192, Brainy J, Carlosx911, Chowbok, Daveatglendora, Deb, Elukenich, Eprof1984, Georgcantor666, James.davis@pmicmail.com, Jamesdavis,
Jason64, Jesanj, Joshunger, Kafziel, Linforest, Linguisticgeek, Mbwallace, Mercury McKinnon, Michaelbeebe, Millsiv, Minna Sora no Shita, MoogleDan, Niceguyedc, Ninja247, NotWith,
Oanabay04, Ohnoitsjamie, R'n'B, SchreiberBike, Ske2, Slavlin, Spiff666, Susvolans, Tedder, Tide rolls, Topbanana, Zzuuzz, 94 anonymous edits
Diagnosis-related group Source: https://en.wikipedia.org/w/index.php?oldid=555408041 Contributors: 2620:72:0:222:D862:4735:F382:5BAE, Anaxial, Argon233, Beeswaxcandle,
Bernhardtgl, Bradjayhan, CaliforniaDreaming, CheshireKatz, Clarkcameron, Cmcnicoll, Denimadept, Dmoss, Duckysmokton, Gurch, Hugh2414, James.davis@pmicmail.com, JeffreyBillings,
Jesanj, Joe Danger Stox, Kafziel, Klosetkarbuff, MER-C, Mac, MargaretRutherford, Mentifisto, Mfranck, Michael Hardy, Minesweeper, Minimac, Mkmcconn, Molly-in-md, Mons0122,
MrDolomite, Pagrashtak, Pmiconline, Pvosta, RHaworth, Radagast83, Ramaksoud2000, Redjar, Rlavely, Ronhjones, SchreiberBike, Telfordbuck, Thuvan Dihn, TimothyChenAllen,
Vegaswikian, 73 anonymous edits
Digital Imaging and Communications in Medicine Source: https://en.wikipedia.org/w/index.php?oldid=422132294 Contributors: 4 spaces, Abdull, Af1523, Aipetri, Alex.tan, Alphachimp,
Amdescombes, Amelio Vzquez, Andreala, Arcadian, Avernet, Beevee, Bgwhite, Blakecaldwell, Boivie, Brian310207, Brighterorange, Bwr54, Ceejayoz, Charlesb, Chengyanliang, Chris
Capoccia, Chruck, Ciscoperin, CommonsDelinker, Cuthbert8, DMacks, DavidMCEddy, Dclunie, Dfoxvog, Dfwiley, Dglane001, Dicomprogrammer, Dineshkoka, Dqmillar, DrAdamInCA,
EscapingLife, Frap, Freedomworks, Ganesha Freya, GargoyleMT, Giraffedata, Gleb, Glider87, Harry, IXICOexpert, Imran qau, Intellijean, JHKrueger, Jfdwolff, John of Reading, Johnkmetha,
JungleRob, KellyCoinGuy, Khalid hassani, Khanafer, KissL, Kku, Kolmigabrouil, Kolmodin, Kr-val, Ksaravanakumar, Kubanczyk, Kvng, Kweeket, Lambiam, Lancetfluke, Lovecreak,
Margin1522, Mark Asread, Markaud, Mathieu, Mco44, Medconn, Metadiego, Movses, MrOllie, MrSerif, MrSincere, Mrjackiebooboo, Mwarf, Ncouture, Nereocystis, Obiwankenobi, Okelm,
Onorem, Oxymoron83, Pacsman, Phatom87, Pmg, RCGodward, Rbardwell, Rhcoe, Rich Farmbrough, Rinkle gorge, Rlee0001, Ronz, Rsabbatini, S.jodogne, Sanesto, SeanAhern, Sebo.PL,
Simeon antonov, Skim, Smelnikov, Soundray, Stephan Leeds, Supten, Surv1v4l1st, TIITEIES L645, TRosenbaum, TastyPoutine, Tenbergen, Test21, Threexk, Thumperward, Tuqui, Umls04aa,
Undermyumbrella, W Nowicki, WLU, Whatcanidonow, Wheelie, Wikid77, X22yang, Xxdude200xX, Zabdiel, Zoicon5, mer Cengiz elebi, , 252 anonymous edits
Article Sources and Contributors
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DOCLE Source: https://en.wikipedia.org/w/index.php?oldid=567889846 Contributors: Brainy J, Chowbok, Diannaa, Editor2020, LincolnSt, Obiwankenobi, R'n'B, Yiiman, 5 anonymous edits
Electronic Common Technical Document Source: https://en.wikipedia.org/w/index.php?oldid=527129659 Contributors: Alfie66, Anetode, Breno, Calhobbes, Carrasco, Clonan03, Clopscotch,
Dancter, Diamondit, Drscarlat, ECMgirl, Ectdexpert, Edcolins, Flowanda, Ianrhys, James.buzzard, JamesErrico, Kbouldin, Krmar, Kvanluvanee, Leridant, Lknoch, Mariolina, Mmgarrett,
MrOllie, Mvulpe, Nikhilwason, ObfuscatePenguin, Obiwankenobi, Pmh35, Pnm, Pvosta, Samarind, Sarjensystems, Tony1, Versageek, Welsh, XMLman, Yintan, 117 anonymous edits
EUDRANET Source: https://en.wikipedia.org/w/index.php?oldid=525866801 Contributors: Boson, Linas, Lotje, Pvosta, Tim!, 1 anonymous edits
General Data Format for Biomedical Signals Source: https://en.wikipedia.org/w/index.php?oldid=549982774 Contributors: Anna Frodesiak, DoctorKubla, Edward, Icairns, Jackindia000,
Jfdwolff, Lexor, Obiwankenobi, Sun Creator, TheParanoidOne, Theo177, 9 anonymous edits
Health Level 7 Source: https://en.wikipedia.org/w/index.php?oldid=574228139 Contributors: 2620:72:0:B36:B891:9FB9:3E47:A9BB, AED, Abtract, Akkarael, Amccaf1, Anas.sal,
Ansiansiansi, Argon233, Arthena, Arx Fortis, Avernet, BD2412, Borgmike, Charliemccay, ChristofG, Christopherlin, Cnilep, Csoma, Cyrius, Deltaseeker, Donama, Drkhalidmunir, Dungodung,
ESkog, Ebeisher, Erich gasboy, Erkan Yilmaz, Esaintpierre, Ewascent, Excirial, Freyr, Friedi87, G716, Gemmy&gemmy, Glenmarshall, GregWooledge, Gschadow, Hl7developer, Hl7stan,
Hmains, Ifware, IlyaHaykinson, Interoperable, Ipahophead, Jareer, Jeffthewhitegoose, Joinarnold, Jsfouche, KHeitmann, KVeil, Kate.woodcroft, Katey Harris, Kku, Koshatul, Krubinmd,
KyleBatty, Lingmac, Lostraven, Luna Santin, Lyverbe, Manscher, MastCell, Mazi, Mentifisto, Merlin-geezer, Mild Bill Hiccup, Mindmatrix, Msormune, MusikAnimal, Mwarf, N-Man,
Nealmcb, Neotool, Niemeyerstein en, Novangelis, OCampbell, Obankston, Obiwankenobi, Ohnoitsjamie, P.gibellini, Perspectoff, Peruvianllama, Pjacobi, Pmh35, Pvosta, RJaguar3, Randyest,
Ravisivapriya, Rich Farmbrough, Rick Block, Roger.e.miller@gmail.com, Roniza, Ross Fraser, Rrburke, RredCat, S.K., SaintlyVoice, Sanfranman59, Seandsi, ShabbatSam, Sjorford, Slambo,
Socalblue, Supten, TRosenbaum, Temporaluser, ThatWasThen, TonyJulian, Touchwiki, Tuntable, Unittester123, Usefulspirit, Vincej, Vtran2, Wikidemon, Xdxfp, Yeng-Wang-Yeh, 286
anonymous edits
Healthcare Common Procedure Coding System Source: https://en.wikipedia.org/w/index.php?oldid=567993945 Contributors: Alanvoss, Alkaline19, Amhlaw, Arcadian, Argon233,
Bluemoose, CapitalR, Evanh2008, Hu12, James.davis@pmicmail.com, JeepdaySock, Joaquin Murietta, Leffel, Mufka, Oanabay04, Pagrashtak, PaulHanson, PrevMedFellow, Richard D. LeCour,
S. Neuman, Ske2, SpaghettiOnSnails, Steinsky, Tabletop, Tedder, TimothyChenAllen, Topbanana, WhatamIdoing, Widr, YUL89YYZ, 29 anonymous edits
Healthcare Information Technology Standards Panel Source: https://en.wikipedia.org/w/index.php?oldid=487405592 Contributors: Cander0000, Fang Aili, Hebrides, Obiwankenobi,
Random user 39849958, Rmartinmd, 6 anonymous edits
Health Informatics Service Architecture Source: https://en.wikipedia.org/w/index.php?oldid=563104616 Contributors: Drscarlat, Jamesmcmahon0, Jeodesic, Kintetsubuffalo, Magioladitis,
Meno25, Obiwankenobi, Phaedrus86, Pvosta, Radagast83, Sharna Smith, StoptheDatabaseState, Tagtool, ThaddeusB, Versageek, 5 anonymous edits
Healthcare Services Specification Project Source: https://en.wikipedia.org/w/index.php?oldid=487405430 Contributors: Cander0000, Chris the speller, Edward, Krubinmd, Lep47,
Obiwankenobi, 3 anonymous edits
International Statistical Classification of Diseases and Related Health Problems Source: https://en.wikipedia.org/w/index.php?oldid=574145148 Contributors: 102orion, 213.253.39.xxx,
2620:72:0:D02:645B:225B:23D1:3DCC, A.macleay, AbinoamJr, Ahoerstemeier, Alanvoss, Alkaline19, Anonymous6494, Arcadian, Argon233, Arisa, Ary29, Asystole, AxelBoldt, BWP2007,
Beeswaxcandle, Beland, Ben-Zin, Bender235, Benzi455, Bfinn, BlaF, Bluerasberry, BookSquirrel, Borgx, Brainmachine, Briaboru, CaliforniaDreaming, Camw, Canley, Canuckle, Carlos Porto,
CaseInPoint, Ccarrington86, Celain, Cholerashot, Claus Diff, Clavicule, Closedmouth, Colin, Conversion script, Corpx, Correogsk, Cybercobra, DARTH SIDIOUS 2, Danielkivatinos,
Davidberky, Davidruben, Dcattell, Deb, Dgilperez, Dglockler, Dmeranda, Doczilla, Dpv, Dr.Bastedo, Drgarden, Drift chambers, DuncanHill, Eastlaw, Ecarman, Edwy, Elm, Elockid, Elukenich,
EverSince, Fabioli2010, Farside, Felix116, Fgongolo ars fvg, Flyer22, Frank, Ftaute, Gamaliel, Gauss, Ge0nk, Ghaly, Graffoe, GregWooledge, Guptan99, HappyDog, HectorMoffet, Herosomc,
Hooperbloob, Hordaland, Hu12, Hugh2414, Ibbn, Icdmaat, Inaaaa, J04n, James.davis@pmicmail.com, Jamesdavis, Jarble, Jason64, Jdgraaf, Jeepday, JeepdaySock, Jfernandezvalencia, Jirka6,
Jmarchn, Jusdafax, Kafziel, Kainaw, Kilopi, Kiran Gopi, Koavf, Krinndnz, Krisguy, LadyofShalott, LeadSongDog, Lfstevens.us, Lightmouse, LilHelpa, LordK, Lugia2453, MC MasterChef,
Mac, Mack2, Mani1, MartinHarper, MastCell, Matthias M., Mattisse, McSly, Mccajor, Mccready, Medzk, Melcombe, Metju, Michael Hardy, Mikemee, Miquonranger03, Moonriddengirl, Moshe
Constantine Hassan Al-Silverburg, MrArifnajafov, MrDolomite, MrOllie, MyInvestment, NCurse, Nabla, Niceguyedc, Nightstallion, Ninja247, NuclearWarfare, O'Dea, Obiwankenobi,
Ohnoitsjamie, Olivier, Pagrashtak, Petersam, Philip Trueman, Philipstalleygordon, PitchStoneHealth, PlayerapX, Pmiconline, Psychiatrick, Pursh2002, Pvosta, Quantumobserver, Raimundo
Pastor, Regetch, RichardF, Rjwilmsi, Robert1947, Robertminard, Rossj81, Rrburke, Ryaninuk, SHCarter, Salvidrim!, Sam Weller, Scs, Seandsi, Shantavira, SimonP, Sirmelle, Ske2, Slashme,
Snalwibma, Specialistu, Stalik, Steve2011, Suidafrikaan, Sun Creator, SuperJumbo, Tabledhote, Tedder, The Transhumanist (AWB), ThisGregM, ThomasPusch, Tide rolls, TimCod, Timwi,
Tinton5, Tmooto, ToNToNi, Tomcloyd, Tomi, Tomical, Toms2866, Udo Altmann, Uncle Milty, UnitedStatesian, Ustunb, Utuado, Vanished User 1004, WLU, Wandering perfect fool, Wdfarmer,
Welsh, Wsm3t, Xfze, Yk Yk Yk, Yuya Tamai, Ziphon, Zorro CX, Zvika, Zzuuzz, 250 anonymous edits
ICD-10 Source: https://en.wikipedia.org/w/index.php?oldid=573796390 Contributors: 5 albert square, Alanvoss, AlexanderJohnGrant, Amitrana1984, Andyjsmith, Arcadian, Biosthmors,
Bjankuloski06en, Bobianite, Brainy J, Bwpach, CanadianLinuxUser, Carleas, Ched, Conversion script, Csigabi, DENker, Danny, Director.daaq, Discospinster, Docsufi, Drgarden, Dront,
ENeville, Estrva, Flyer22, Frye0031, Ftaute, Gobbleswoggler, Gregh11, Guptan99, Halosean, Hcobb, HoCkEy PUCK, Hordaland, Hudson Stern, Icdmaat, Int21h, Javiersorribes, Jeepday,
JeepdaySock, Jjchawla, Jncraton, JonathanDavidArndt, Jppanja, Kacser, Kelson, Keoormsby, KerryMartin, Klmartin9, Kuru, Kwiki, LeadSongDog, Ljberg, Lroomberg, Malamute5, Martarius,
Matchups, Matje1987, Maxxicum, Niceguyedc, Nightscream, Nightstallion, Penbat, Pol098, QuasarTE, Quasirandom, Raimundo Pastor, Reaper Eternal, Rich Farmbrough, Robek, SadanYagci,
SandyGeorgia, SarekOfVulcan, Scottalter, Shawnlhood, Sheeana, SummerWithMorons, Surturz, T@Di, Tedder, Tgoldst5, Theopolisme, TimCod, Tocant, Triple5, Tyweb, Usefulspirit, Ward20,
Whywhenwhohow, WikHead, Wikid77, WinterPlatypus, Witchkraut, X22yang, Xanzzibar, Xmilanz, 127 anonymous edits
ICD-10 Procedure Coding System Source: https://en.wikipedia.org/w/index.php?oldid=556620938 Contributors: Arcadian, Ashleyleia, CanisRufus, Davidberky, Deb, GTBacchus, Gilderien,
JaGa, JeepdaySock, Kafziel, Maria Sieglinda von Nudeldorf, Nono64, NotWith, RobDe68, Rwalker, Ske2, Skysmith, WhatamIdoing, 12 anonymous edits
International Classification of Diseases for Oncology Source: https://en.wikipedia.org/w/index.php?oldid=554560975 Contributors: Ahering@cogeco.ca, Arcadian, Auntof6, BD2412,
Cobaltcigs, Davidkinnen, Deb, Drewivan, Eleassar, Icdmaat, J04n, Johnacle, Kafziel, Leolaursen, Mdonken, NapoliRoma, Open2universe, R'n'B, Ske2, Skinny McGee, Suidafrikaan, Tedernst,
Twinsday, Uploadvirus, Woohookitty, 6 anonymous edits
International Classification of Functioning, Disability and Health Source: https://en.wikipedia.org/w/index.php?oldid=560504566 Contributors: -1g, Ahtcan, Binesh230, Dodger67, Eastlaw,
Erencexor, EverSince, Evrcan, Fgongolo ars fvg, Gensdevoyage, Guptan99, Jonkerz, Kafziel, Kikodawgzzz, M4gnum0n, MrOllie, Ny cs2, OTWashU, Obiwankenobi, Patrick, Petersam, Ph.eyes,
Romanc19s, SandyGeorgia, Solar-Wind, Viriditas, Wcam, 30 anonymous edits
International Classification of Health Interventions Source: https://en.wikipedia.org/w/index.php?oldid=555555725 Contributors: Arcadian, Auric, Deb, Herosomc, Kafziel, Kilopi, Maria
Sieglinda von Nudeldorf, Ske2, ThomasPusch, Wireless friend, 1 anonymous edits
International Classification of Primary Care Source: https://en.wikipedia.org/w/index.php?oldid=551552252 Contributors: Arcadian, Danieljllpinto, Guptan99, Hmains, Kafziel, Leah L
Marino, Obiwankenobi, PaulHanson, Pvosta, Raimundo Pastor, Redrose64, Rjwilmsi, SchreiberBike, Tortillovsky, Tygrus, WereSpielChequers, WhatamIdoing, 3 anonymous edits
International Healthcare Terminology Standards Development Organisation Source: https://en.wikipedia.org/w/index.php?oldid=362858235 Contributors: Andthu, Beeswaxcandle,
Crystallina, David Markwell, DragonflySixtyseven, Dthomsen8, Fadesga, Fuzziebrain, MilkTheImp, Misarxist, Pimvolkert, Steschu, Taojun545, Zarcadia, 13 anonymous edits
ICPC-2 PLUS Source: https://en.wikipedia.org/w/index.php?oldid=503391781 Contributors: Guptan99, Kafziel, Obiwankenobi, Pegship, Pvosta, Raimundo Pastor, Tygrus
ISO 27799 Source: https://en.wikipedia.org/w/index.php?oldid=561530053 Contributors: GregorB, Iridescent, Nasa-verve, Nzjoe, Veridion, 5 anonymous edits
ISO/IEEE 11073 Source: https://en.wikipedia.org/w/index.php?oldid=573410304 Contributors: A12n, Acutetech, Ancm, Arjayay, BD2412, Bartekg 1985, Bernd.rottmann, Castlewalk,
Chowbok, Hongooi, John of Reading, Kmacdowe, Lmatt, MelvinReynolds, Mild Bill Hiccup, Nasa-verve, Obiwankenobi, Obrienmi8, Pjacobi, Tagulnic, The Thing That Should Not Be, W
Nowicki, Wiki559, 40 anonymous edits
ISO/TC 215 Source: https://en.wikipedia.org/w/index.php?oldid=535531810 Contributors: DavidCary, Endorf, Ezhiki, Glenmarshall, Goldenrowley, GreenGourd, Juliancolton, KVeil, Lmatt,
Obiwankenobi, Pegship, Pvosta, Ross Fraser, Secretary12, TScabbard, TheParanoidOne, Tobias Conradi, Topbanana, 7 anonymous edits
LOINC Source: https://en.wikipedia.org/w/index.php?oldid=572192112 Contributors: Akkarael, Arcadian, Arthena, Bluerasberry, Chowbok, ChristofG, Ckelker, Dfoxvog, Donama, Gaius
Cornelius, Grv87, Heli doc, Index1, J.delanoy, JeepdaySock, Jfdwolff, Jfernandezvalencia, Jfinnert, Jsfouche, Lep47, Libzz, Linforest, Obiwankenobi, Pol098, Pvosta, RoySoltoff, Sakaton, Ske2,
Slucas, Woohookitty, 35 anonymous edits
MEDCIN Source: https://en.wikipedia.org/w/index.php?oldid=573761930 Contributors: Amerpwr, AnemoneProjectors, Arthena, Aspooner, Ben Ben, Chicagorob1, Discospinster, Dwhsoh,
Enric Naval, Greghayes79, N8allan, RoySoltoff, Styles01, WhatamIdoing, 17 anonymous edits
Article Sources and Contributors
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MedDRA Source: https://en.wikipedia.org/w/index.php?oldid=566609946 Contributors: Aranel, Arcadian, Blueoceancruiser, ChildofMidnight, Dictlibrarian, Digger65, DropDeadGorgias,
Jackol, Joneske laf, Karan n 87, Klemen Kocjancic, Kolmigabrouil, Kwamikagami, Mailer diablo, MichaK, NemoT, Obiwankenobi, Pvosta, Rm1271, Scott182, Sergeymk, Strubin, WAS 4.250,
44 anonymous edits
Medical Subject Headings Source: https://en.wikipedia.org/w/index.php?oldid=573426359 Contributors: A. B., Achaemenes, AlainV, Aldaron, Arcadian, Arthur A C Treuherz, Asfreeas,
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Hordaland, J04n, Jakob Suckale, Jfdwolff, Jlittlet, Katcher, Kotniski, Lalvers, Loopback007, MD Syria, Magioladitis, Marcelo1229, Marudubshinki, Medzk, Mentifisto, Mike Dillon, Nichtich,
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PHONE?, TestPilot, Thatotherperson, TiCPU, Tono-bungay, Tony1, Torf, Tregoweth, Udo Altmann, Vrenator, Ward20, Was a bee, Wavelength, ZayZayEM, Zigger, 22 anonymous edits
Minimum Data Set Source: https://en.wikipedia.org/w/index.php?oldid=547114462 Contributors: Argon233, Jsfouche, THB, Theredhouse7, Wrennj9, 11 anonymous edits
Multiscale Electrophysiology Format Source: https://en.wikipedia.org/w/index.php?oldid=557171504 Contributors: Benbrinkmann, BrianY, Cwmhiraeth, Diannaa, FiachraByrne, Michael
Hardy, Obiwankenobi, Rd232, Ttonyb1
NANDA Source: https://en.wikipedia.org/w/index.php?oldid=567269799 Contributors: Arcadian, BD2412, Bgwhite, Cmdrjameson, Dawynn, Dylan Lake, Eluv22, FrisoRaemaekers, Jsfouche,
Lavinma, Lquilter, MattKingston, Mons0122, NANDAExecDir, Rich Farmbrough, Rmosler2100, Rwalker, SchreiberBike, Shenme, Sidiade, Ske2, Station1, Syrthiss, THB, Thherdman,
Tradimus, 19 anonymous edits
Nursing Interventions Classification Source: https://en.wikipedia.org/w/index.php?oldid=557834409 Contributors: Amicon, Arcadian, BD2412, Eluv22, Felixboy, FrisoRaemaekers,
GreggEdwards, GregorB, Jsfouche, LilHelpa, Mons0122, Pvosta, RoySoltoff, Thherdman, Woohookitty, 8 anonymous edits
Nursing Minimum Data Set Source: https://en.wikipedia.org/w/index.php?oldid=570137218 Contributors: Doughorner, Jsfouche, Mons0122, Pvosta, Woohookitty, 1 anonymous edits
Nursing Outcomes Classification Source: https://en.wikipedia.org/w/index.php?oldid=543372892 Contributors: D6, FrisoRaemaekers, Jsfouche, Manomohan, Mons0122, PigFlu Oink, Pvosta,
RoySoltoff, Woohookitty
OpenGALEN Source: https://en.wikipedia.org/w/index.php?oldid=556380660 Contributors: Bender235, Duncan.Hull, Egbert J. van der Haring, Free Software Knight, Julian Mendez, Libzz,
Linforest, NickelShoe, Pieter E Zanstra, Richhoncho, 6 anonymous edits
SNOMED Source: https://en.wikipedia.org/w/index.php?oldid=26800760 Contributors: AKappa, Anypodetos, Arcadian, Arthena, Brighterorange, CDN99, CanisRufus, Deb, Debresser,
Eastlaw, Gbonline, GregorB, Hawk-, Ihtsdo dma, J. Spencer, J04n, Jdrumgoole, Jlittlet, John of Reading, MilkTheImp, NielsenGW, Obiwankenobi, Only, PhilKnight, Pvosta, Ske2, Suidafrikaan,
TheNewNormal, Was a bee, Wikid77, Winterschlaefer, Wireless friend, Woohookitty, Yves.lussier, 26 anonymous edits
SNOMED CT Source: https://en.wikipedia.org/w/index.php?oldid=574163626 Contributors: Abelardy, Andthu, Arthena, BD2412, BDennis IHC, Bachrach44, Beata Steinberg, Beckje01,
Bender235, Biosthmors, Bluerasberry, Brossow, Chowbok, Chris Capoccia, Cyndijoan, DanConnolly, David Markwell, DavidMarkwell, Davidruben, Deltaseeker, Domte, Egbert J. van der
Haring, Farblizer, GlassFET, Hawk-, High-tech, Ihtsdo dma, IndizenTechnologies, Isaacshi, Jfernandezvalencia, Jni, Jsfouche, Kafziel, Kainaw, Libzz, LilHelpa, LindsayH, Linforest,
LouiseDobbs, MacTed, Magioladitis, Mike Gleason, MilkTheImp, Mons0122, Mrawahi, Obiwankenobi, Orangemike, Oski Jr, Paul Millsom, Pizzaman, Pop1corn, Pvosta, R'n'B, Raimundo
Pastor, Rorydavidson, RoySoltoff, Ryulong, Scopecreep, Steschu, Tuntable, Veterinarian, W guice, Wardblonde, Was a bee, WikHead, Wntwff, Yiiman, Yves.lussier, 89 anonymous edits
Standard for Exchange of Non-clinical Data Source: https://en.wikipedia.org/w/index.php?oldid=552745954 Contributors: Addison2008, Dougdp, G716, Ground Zero, Malcolma,
Obiwankenobi, Rsabbatini, Troy.smyrnios
TC 251 Source: https://en.wikipedia.org/w/index.php?oldid=469399558 Contributors: KVeil, Lmatt, Obiwankenobi, Oughnic, Pvosta, Rastegwee, ThaddeusB, Varrialpo, 2 anonymous edits
WHOART Source: https://en.wikipedia.org/w/index.php?oldid=307408922 Contributors: Cg2p0B0u8m, Eastlaw, Pvosta
Nosology Source: https://en.wikipedia.org/w/index.php?oldid=560613758 Contributors: APH, Aleksd, Alessandro f2001, Alexmorgan, Andreas Erick, Andrewneely, Andy85719, Andycjp,
Beeswaxcandle, Beland, Caspiax, Dawynn, EagleFan, Eequor, Guptan99, Gkhan, Jagged 85, Jfdwolff, Jon Awbrey, Jondel, Kafziel, Kpjas, Krsont, Lindsay658, Lorem Ip, Macedonian, Mr
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Viriditas, Wikiisdangerousfortermpapers, William Longland, Yamara, 15 anonymous edits
Archetype Source: https://en.wikipedia.org/w/index.php?oldid=556280369 Contributors: 1ForTheMoney, BVerhees, Donama, Dummy6277, Gilliam, Lancepickens, Leszek Jaczuk, Ligulem,
Martarius, Neo139, Pvosta, Rich Farmbrough, ThaddeusB, - -, 4 anonymous edits
OBO Foundry Source: https://en.wikipedia.org/w/index.php?oldid=564842284 Contributors: Chris the speller, Cmungall, Duncan.Hull, Elshawkestrel, Linas, Obiwankenobi, Phismith,
Rsabbatini, Sarpaneva, Sintniklaas, WAvegetarian, 22 anonymous edits
Ontology for Biomedical Investigations Source: https://en.wikipedia.org/w/index.php?oldid=386417340 Contributors: Elshawkestrel, Mcourtot, Modify, Rojoxiii, Scott Martin,
SteveChervitzTrutane, 12 anonymous edits
Open Biomedical Ontologies Source: https://en.wikipedia.org/w/index.php?oldid=573210462 Contributors: 0dimensional, Aa2-2004, Amkilpatrick, Ceyockey, Dan Bolser, Duncan.Hull,
Dusty777, Erick.Antezana, Fernercc, Hamidtirmizi, Khalid hassani, Phismith, Plantontology, Rror, Sgt Pinback, Spark202, SteveChervitzTrutane, Two Bananas, Venullian, Weaddon, 13
anonymous edits
TIME-ITEM Source: https://en.wikipedia.org/w/index.php?oldid=527498885 Contributors: Arcadian, BD2412, Felix Folio Secundus, Hordaland, J04n, Twillett, Woohookitty, 7 anonymous
edits
American Association for Medical Systems and Informatics Source: https://en.wikipedia.org/w/index.php?oldid=573674831 Contributors: Bearcat, NLM Archives and Manuscripts,
Obiwankenobi, Pragmatic Idealist, Psu256, Senator2029, Stemonitis, 1 anonymous edits
American College of Medical Informatics Source: https://en.wikipedia.org/w/index.php?oldid=461719551 Contributors: A. Carty, GioCM, Ipeirotis, Katharineamy, Lquilter, Mheart,
Obiwankenobi, Ricardo Carneiro Pires, Sirkad, Yves.lussier, 1 anonymous edits
American Health Information Management Association Source: https://en.wikipedia.org/w/index.php?oldid=549403178 Contributors: Amr.rs, Awillmore, Bhadani, Careful Cowboy,
Fabrictramp, Funandtrvl, JaGa, Katharineamy, Mandarax, Nikkimaria, Obiwankenobi, Page54, Pdmanske, Pmanske, Richhoncho, Solowiki23, Synergy, X!, 20 anonymous edits
American Telemedicine Association Source: https://en.wikipedia.org/w/index.php?oldid=565813806 Contributors: Barkchip, Bryanrutherford0, Cgingold, Eagle4000, Eastmain, EhJJ,
ElinorD, GRIFFEY366, Harryzilber, Leontios, Obiwankenobi, Piotrus, Rsabbatini, Shyamdash, Tim!, 5 anonymous edits
Belgian Health Telematics Commission Source: https://en.wikipedia.org/w/index.php?oldid=514348466 Contributors: Funandtrvl, Nicolas Barbier, Pvosta, Rjwilmsi, Rsabbatini
Brazilian Society of Health Informatics Source: https://en.wikipedia.org/w/index.php?oldid=543859832 Contributors: Atama, Bgwhite, CommonsDelinker, EagleFan, Gaius Cornelius,
JPG-GR, Kungfuadam, Lamoura br, Luan, Michael Hardy, Naraht, Obiwankenobi, Ottawahitech, Project FMF, R'n'B, Rich Farmbrough, Rsabbatini, Upsala, Welsh, 9 anonymous edits
Brazilian Congress on Health Informatics Source: https://en.wikipedia.org/w/index.php?oldid=336667120 Contributors: Atama, Bgwhite, CommonsDelinker, EagleFan, Gaius Cornelius,
JPG-GR, Kungfuadam, Lamoura br, Luan, Michael Hardy, Naraht, Obiwankenobi, Ottawahitech, Project FMF, R'n'B, Rich Farmbrough, Rsabbatini, Upsala, Welsh, 9 anonymous edits
Center for Telehealth and E-Health Law Source: https://en.wikipedia.org/w/index.php?oldid=448292432 Contributors: Asav, JDDC1, Jncraton, Malcolma, Postcard Cathy, Rjwilmsi,
Rsabbatini, 1 anonymous edits
European Federation for Medical Informatics Source: https://en.wikipedia.org/w/index.php?oldid=544623816 Contributors: Acroterion, Biruitorul, Btrinczek, Discospinster, Engelbaer,
Fram, Hughthemann, Leolaursen, LibStar, Obiwankenobi, Pvosta, Start florin, 3 anonymous edits
European Health Telematics Association Source: https://en.wikipedia.org/w/index.php?oldid=487402910 Contributors: Funandtrvl, Lanmlanm, Mean as custard, Obiwankenobi, Pvosta,
Rsabbatini
Article Sources and Contributors
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European Health Telematics Observatory Source: https://en.wikipedia.org/w/index.php?oldid=506863005 Contributors: Magioladitis, Pvosta, R'n'B, Rsabbatini
European Institute for Health Records Source: https://en.wikipedia.org/w/index.php?oldid=568220572 Contributors: Bondegezou, Edward, Khazar2, Nicolas Barbier, Obiwankenobi,
Phaedrus86, Phillip Tao, Pvosta, ThaddeusB, Txuspe, 3 anonymous edits
Health On the Net Foundation Source: https://en.wikipedia.org/w/index.php?oldid=565747471 Contributors: Axl, BullRangifer, Djln, Encephalon, Eysen, Fasten, Grook Da Oger, Jmh649,
Jose Ramos, Khazar2, Kpjas, LeadSongDog, Levineps, Mandarax, Mayla21, Megapixie, Michael Hardy, Mikael Hggstrm, Nsaa, Ph.eyes, Phe, Robofish, Rsabbatini, SandyGeorgia, The
Anome, Vicki Rosenzweig, Wjjessen, WulfTheSaxon, Zollerriia, 17 anonymous edits
HISA Source: https://en.wikipedia.org/w/index.php?oldid=393045798 Contributors: Drscarlat, Jamesmcmahon0, Jeodesic, Kintetsubuffalo, Magioladitis, Meno25, Obiwankenobi, Phaedrus86,
Pvosta, Radagast83, Sharna Smith, StoptheDatabaseState, Tagtool, ThaddeusB, Versageek, 5 anonymous edits
Indian Association for Medical Informatics Source: https://en.wikipedia.org/w/index.php?oldid=571354460 Contributors: Darkwind, Docsridhar, Edward, Fram, Gogia7, Hamman Samuel,
John Vandenberg, Obiwankenobi, Rich Farmbrough, Sbbhattacharyya, Shyamsunder, Sukhi, Supten, TimBentley, Vinaitheerthan, Vsri, Yamla, 9 anonymous edits
International Medical Informatics Association Source: https://en.wikipedia.org/w/index.php?oldid=553284945 Contributors: AED, Ahoerstemeier, Astavrou, Bamyers99, Ciscogiii, Donama,
EagleFan, Edward, EncycloPetey, Fram, Gentgeen, Godcast, Kerowyn, Khoikhoi, Khwolf, Loop 9, LukasPietsch, MBisanz, Michael Hardy, Obiwankenobi, Pak21, Pvosta, Rentaferret, Rodw,
SJK, SimonP, SteinbDJ, Supten, Synergy, TastyPoutine, Vojtech Huser, Wegely, Woman+man, ZayZayEM, 19 anonymous edits
Medinfo Source: https://en.wikipedia.org/w/index.php?oldid=494979489 Contributors: Darkwind, Jonducrou, Kenb215, Nancy Lorenzi, Obiwankenobi, Vojtech Huser, 5 anonymous edits
National Resource Center for Health Information Technology Source: https://en.wikipedia.org/w/index.php?oldid=505857349 Contributors: 4EverGone, Bubbaq401, Dmeranda, Donama,
Dpugrad01, Ewulp, Kawanazii, Netsnipe, Pvosta, Spotharaju, 6 anonymous edits
Open Source Health Care Alliance Source: https://en.wikipedia.org/w/index.php?oldid=334953345 Contributors: Aizatto, Blauerflummi, Cander0000, Frap, Iridescent, Jonkerz, Midgley,
N5iln, Obiwankenobi, Twcook, 2 anonymous edits
The Continua Health Alliance Source: https://en.wikipedia.org/w/index.php?oldid=567171350 Contributors: Acutetech, AppForCalPERSMCII, Asmithmd1, BD2412, BuffaloConspiracy,
Castlewalk, Chelsicontinua, Chowbok, Chris the speller, Continua, Ferritecore, Flowanda, FlyHigh, G825e3, Giraffedata, Interoperable, JHunterJ, Jim.henderson, Kirkewing, Maelwys,
Malcolma, MrOllie, Rsabbatini, Rwwww, The Rambling Man, Vegaswikian, VirtualizationGuru, W Nowicki, Wayne Miller, WikHead, Wireless friend, Wtshymanski, 9 anonymous edits
UNESCO Chair in Telemedicine Source: https://en.wikipedia.org/w/index.php?oldid=563694498 Contributors: Catai2008, Comatmebro, DoctorKubla, Gary King, Leolaursen, Mandarax,
Niaz, Obiwankenobi, Rsabbatini, Sms1sms1, Starcheerspeaksnewslostwars, Tim!, Tobyflanderson24, 1 anonymous edits
World Health Imaging, Telemedicine, and Informatics Alliance Source: https://en.wikipedia.org/w/index.php?oldid=552809825 Contributors: CliffC, CommonsDelinker, Drbreznjev,
GoingBatty, L Kensington, Mechanistic, Mhoaglin, Obiwankenobi, Rsabbatini, TexasAndroid, TreasuryTag, 4 anonymous edits
List of medical and health informatics journals Source: https://en.wikipedia.org/w/index.php?oldid=566580069 Contributors: D6, Dawnseeker2000, Enric Naval, Fences and windows,
Fransanlag, Gadget850, Guillaume2303, Headbomb, Jaydenm, John Vandenberg, Khwolf, Mootros, Obiwankenobi, Rich jj, Sepsep3, TanveerBeg, The Grumpy Hacker, Wp.contributor2001, ,
14 anonymous edits
Journal of Information Professionals in Health Source: https://en.wikipedia.org/w/index.php?oldid=334966030 Contributors: Cewvero, Danelo, FrancisTyers, Guillaume2303, Jwillbur,
Kathleen.wright5, Rich Farmbrough, Rjwilmsi, Zleitzen
Journal of Medical Internet Research Source: https://en.wikipedia.org/w/index.php?oldid=560977132 Contributors: Anil1956, Bigredbrain, Bondegezou, Daniel Mietchen, Edcolins, Eysen,
Furorimpius, Guillaume2303, John Vandenberg, Jonemerson, Qui1che, RDBrown, Randykitty, Rich Farmbrough, Robofish, Stevenfruitsmaak, 16 anonymous edits
BeHealth Source: https://en.wikipedia.org/w/index.php?oldid=525547925 Contributors: Adavidb, Nicolas Barbier, Obiwankenobi, Pvosta, 1 anonymous edits
Canada Health Infoway Source: https://en.wikipedia.org/w/index.php?oldid=495720875 Contributors: Awsomistic, Bearcat, BillgTO, Chris the speller, Deetdeet, Donama, Lightmouse,
Obiwankenobi, PKT, Plastikspork, Pvosta, Rakerman, Rsabbatini, Sjschen, Webchick40, Wikieditor47, Zollerriia, 6 anonymous edits
Distance Learning and Telemedicine Grant and Loan Program Source: https://en.wikipedia.org/w/index.php?oldid=499164972 Contributors: Agradman, Bearcat, MrRadioGuy, Neutrality,
Rsabbatini, Trevor MacInnis
EHealth Ontario Source: https://en.wikipedia.org/w/index.php?oldid=545710354 Contributors: Amchow78, Andrewpmk, Blowfish, Cantons-de-l'Est, Hollomis, Hugo999, Kevlar67, Logan,
Mr.richard.james, NorthernThunder, Plasma east, Prowsej, Richard.james.henry, Rjwilmsi, Ross Fraser, Ruralpaths, Spencerk, Zvn, 9 anonymous edits
HealthConnect Source: https://en.wikipedia.org/w/index.php?oldid=563138700 Contributors: BD2412, Chowbok, Donama, Meetkmt, MoondyneAWB, Shiftchange, Sun Creator, Sylvanelite, 3
anonymous edits
Health Information Systems Programme Source: https://en.wikipedia.org/w/index.php?oldid=558306894 Contributors: Boothy443, Callmederek, Gjs238, Grutness, Hyacinth, Lastorset,
MariusStrom, Obiwankenobi, Petter.nielsen, Red Slash, Saga City, Stephenchou0722, Thine Antique Pen, Tlambo, TracyRenee, Vincej, WikiLeon, , 8 anonymous edits
District Health Information System Source: https://en.wikipedia.org/w/index.php?oldid=188341866 Contributors: Bob Pond, Chris the speller, Frap, GregRowles, Jeswinicv, Kenb215,
Lastorset, LincolnSt, Margrsto, Obiwankenobi, Palosirkka, Petter.nielsen, Phil Boswell, Prashanthns, Questra wp, 11 anonymous edits
FLOW Source: https://en.wikipedia.org/w/index.php?oldid=487327385 Contributors: Mild Bill Hiccup, Nicolas Barbier, Pvosta
Health informatics in China Source: https://en.wikipedia.org/w/index.php?oldid=527895603 Contributors: Black Falcon, BrownHairedGirl, Iridescent, Jheung, John of Reading, Jsfouche,
LilHelpa, Loop 9, Obiwankenobi, R'n'B, Rjwilmsi, Sillyfolkboy, Sun Creator, ThaddeusB, Timrollpickering, Twirligig, Visik, 1 anonymous edits
NHS Direct Source: https://en.wikipedia.org/w/index.php?oldid=573299236 Contributors: 28421u2232nfenfcenc, Adambisset, AxG, Briantist, Camw, Can't sleep, clown will eat me, Chase me
ladies, I'm the Cavalry, Clawed, Cloudbound, Cms2005, Coren, Corington, DominoyesMaybe, DoorsAjar, Doryfish, EoGuy, Erasmuspd, Gailann21, Iboov, Iridescent, Kungfuadam,
LarkinToad2010, MBRZ48, Mais oui!, Melaen, Mereda, Mikey678uk, Mj wood, Mpclark, Nick C, Owain.davies, PMJ, Reviewer26, Rich Farmbrough, Road Wizard, Saxsux, Smerus, Stifle,
Thunderwing, Timrollpickering, Tshallett, Versageek, Welshman10, Wimt, Wine Guy, Zarcadia, 94 anonymous edits
NHS National Programme for IT Source: https://en.wikipedia.org/w/index.php?oldid=375627517 Contributors: Benstitch, Betts2006, Bondegezou, Bubblenut, Bunnyhop11,
CaliforniaAliBaba, Cloudbound, Davidruben, Dcirovic, DoHID, Eeekster, Engi08, Grap10, H2g2bob, Heakins, Heron, Hugo999, JamesBWatson, Jeremy112233, Keith D, Kittybrewster, Little
pob, Mais oui!, Mattl, Midgley, Millstream3, Netha Hussain, Regregex, Rich Farmbrough, Rillian, Smowton, Surreyuser, Technical 13, Woohookitty, 24 anonymous edits
Ontario Telemedicine Network Source: https://en.wikipedia.org/w/index.php?oldid=487431958 Contributors: Alan Liefting, Andrew McIntosh, Connormah, Dtolj, GregorB, Harryzilber,
Mean as custard, Mfawal, NorthernThunder, Obiwankenobi, Rmlahey, Rsabbatini, Tim!, 5 anonymous edits
Public Health Information Network Source: https://en.wikipedia.org/w/index.php?oldid=502806173 Contributors: Bearcat, Beaumont, Bspratt80, Cgoffena, Chris.rider81, Dawhitfield,
Elomis, Hfan507, Kurieeto, Lmbarreto, Mholder718, NACCHOWEB, Nishkid64, Roleplayer, Vtheel, WDavis1911, 8 anonymous edits
SAPPHIRE Source: https://en.wikipedia.org/w/index.php?oldid=498791645 Contributors: Crism, Headbomb, John of Reading, Michaelenandry, Obiwankenobi, Pmirhaji, Rjwilmsi, Rsabbatini,
Shiva Evolved, 1 anonymous edits
SmartCare Source: https://en.wikipedia.org/w/index.php?oldid=489416365 Contributors: Addshore, Corypedia, Dancter, Ebyabe, Gmcressman, Grievous Angel, Ipvjsp, LilHelpa, LincolnSt,
Mervyn, Obiwankenobi, Perspectoff, SaraKennedy, Tassedethe, Tbdevries, Tchubs, 10 anonymous edits
Building Europe-Africa Collaborative Network for Applying IST in Health Care Sector Source: https://en.wikipedia.org/w/index.php?oldid=334950647 Contributors: Brainy J, I Like
Cheeseburgers, Jra, Lastorset, 6 anonymous edits
Article Sources and Contributors
793
Global Infectious Disease Epidemiology Network Source: https://en.wikipedia.org/w/index.php?oldid=543978406 Contributors: Altenmann, Artfog, Guillaume2303, Hbdragon88, J04n, JIP,
JonHarder, Lunawisp, Melcombe, MithrandirMage, Nono64, SteinbDJ, Useknowledge, 16 anonymous edits
Integrating the Healthcare Enterprise Source: https://en.wikipedia.org/w/index.php?oldid=567895202 Contributors: Apgolota, CALR, DJ Clayworth, Glenmarshall, Interoperable, Ipheige,
Jfdwolff, Jgoldman, KVeil, Ketiltrout, KevinPODonnell, Khanafer, Michaelzeng7, Novangelis, Obiwankenobi, P.gibellini, RHaworth, The Whispering Wind, Tikuko, Vsm01, W Nowicki, 33
anonymous edits
GIS and Public Health Source: https://en.wikipedia.org/w/index.php?oldid=469704497 Contributors: Aetarrell, Andresswift, Funandtrvl, Postcard Cathy, Stucklog, Tony1, Vegaswikian,
Yellowfinjp, 5 anonymous edits
Neuroinformatics Source: https://en.wikipedia.org/w/index.php?oldid=571570124 Contributors: Ambertk, Betacommand, Blaxthos, Br4in, CopperKettle, DadaNeem, Dancter, Datadreamer,
Dave noise, David Eppstein, Download, Drleavsy, Ds13, Edran, Enquire, Fnielsen, Frap, Genesis12, Georg Stillfried, Good Olfactory, Hans Dunkelberg, Huon, Janis incf, Jay8g, Jgrethe, Jweis,
Kokapellimt, LeslieSSmith, LittleHow, Lizia7, LizzardKitty, LondonTime, Looie496, Mange01, Maurice Carbonaro, Meduz, Mrh30, Mtdearing, Ngoddard, Nkf31, Obiwankenobi, Orenburg1,
Ospalh, Pascal.Tesson, Pillai ajay, Rjlabs, Rjwilmsi, Rohrkemper, Seijihyouronka, Skittleys, Slarson, Stevekoslow, Themfromspace, Tremilux, Typically, Unidesigner, Vanished 1850,
Vegaswikian, Virtualerian, Waithought, WhatamIdoing, WikHead, Wingman4l7, Woohookitty, Yves.lussier, 61 anonymous edits
Healthcare Effectiveness Data and Information Set Source: https://en.wikipedia.org/w/index.php?oldid=554568218 Contributors: Argon233, Barticus88, Chowbok, ChrisGualtieri,
CultureDrone, Davisjohn, IsabelDalhousie, Jbryan2000, Kpqos, MrMarmite, Pagrashtak, PaulHanson, PrevMedFellow, R-vcarlson, THB, The Anonymouse, TheJJJunk, Thumperward, Trud the
Borg, Zzuuzz, 23 anonymous edits
E-epidemiology Source: https://en.wikipedia.org/w/index.php?oldid=545432311 Contributors: Atomscolor1, Az1568, D-rew, Dawynn, Fredrick day, Janlit, JzG, Kotepho, Litton, Ombudsman,
Ph.eyes, RDBrown, 13 anonymous edits
Epi Info Source: https://en.wikipedia.org/w/index.php?oldid=540932038 Contributors: Arcadian, Biohazard530, Cdckms, Chris the speller, DNitch, Den fjttrade ankan, Ettrig, Frap, Free
Software Knight, Jack Bauer00, JeffreyN, Jesse V., Kathleen.wright5, Masgatotkaca, Melcombe, Mild Bill Hiccup, Obiwankenobi, Onorem, Palosirkka, Ph.eyes, Pnm, Prashanthns, Qwfp,
Raymond Feilner, Rjwilmsi, StatisticalSoftware, Tabletop, Yworo, 23 anonymous edits
OpenEpi Source: https://en.wikipedia.org/w/index.php?oldid=544834201 Contributors: Arcadian, ArglebargleIV, BD2412, Carmen56, Cdckms, Chopperdave55, Cybercobra, Dekimasu,
Iridescent, JLaTondre, Jesse V., Mange01, Masgatotkaca, Melcombe, NeMeSiS, Oleg Alexandrov, Pagrashtak, Qwfp, Rich257, Tedickey, 59 anonymous edits
Living Human Project Source: https://en.wikipedia.org/w/index.php?oldid=548782981 Contributors: ChrisGualtieri, Editor437, ErkDemon, Logan, Mild Bill Hiccup, Misarxist, Nurg,
Viceconti
Stereolithography Source: https://en.wikipedia.org/w/index.php?oldid=568830705 Contributors: Horia Ionescu, Jeff3000, Mild Bill Hiccup, Mogism, Rjbibb, Rsabbatini, Squids and Chips,
Thumperward, Will Beback Auto, 3 anonymous edits
Virtual Physiological Human Source: https://en.wikipedia.org/w/index.php?oldid=572892867 Contributors: AdRock, Alexdebarna, Anrnusna, Beardda, Braincricket, Dendodge, ErkDemon,
Greenonions23, High-tech, Holger Stenzhorn, Magioladitis, Mdd, Michael Hardy, Msermesant, Number 57, Nurg, Pvosta, Rcorredorj, Rjwilmsi, Rockonomics, Rror, Snie007, Udirock,
VanishedUserABC, Viceconti, Vphnoe, WikHead, Wilchett, 18 anonymous edits
Visible Human Project Source: https://en.wikipedia.org/w/index.php?oldid=574142485 Contributors: Andy Smith, Arthena, AxelBoldt, BD2412, Chriszuma, Danielbates, Danim, ErkDemon,
Flyguy649, GUllman, Gargaj, Graham87, HandsomeFella, Historyinaction, Infrapatellar, JHKrueger, Jeffrey O. Gustafson, JoBaWik, Julesd, Kerowyn, Kevin Rector, Kieranbrowne,
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RupertMillard, Satarnion, Tmac174, Uanfala, Vittala, Was a bee, 52 anonymous edits
Edward H. Shortliffe Source: https://en.wikipedia.org/w/index.php?oldid=559252848 Contributors: Amlai, Bender235, Bobo192, Carlosguitar, Fisherjs, Getonyourfeet, Guillaume2303,
Johnpacklambert, KConWiki, Legoktm, Mootros, Obiwankenobi, Piano non troppo, Raryel, Shortliffe, Tabletop, Tassedethe, Tcaruso2, Thore Husfeldt, W Nowicki, Waacstats, Ysen,
Yves.lussier, 20 anonymous edits
Don E. Detmer Source: https://en.wikipedia.org/w/index.php?oldid=545046178 Contributors: DonEDetmer, Dondetmer, Epbr123, Jivecat, Mandarax, Obiwankenobi, Rich Farmbrough, 2
anonymous edits
Homer R. Warner Source: https://en.wikipedia.org/w/index.php?oldid=560986118 Contributors: Betacommand, C.Fred, Donama, Elkinpl, Emeraude, Enric Naval, Epbr123, Gabal, Harry
Canyon, Ihwk, Iridescent, Johnpacklambert, Malcolma, Obiwankenobi, Pgestela, Racklever, Richard Arthur Norton (1958- ), Shaggyjacobs, Vkutah, Waacstats, 7 anonymous edits
Robert Ledley Source: https://en.wikipedia.org/w/index.php?oldid=557308666 Contributors: A wild Rattata, ATX-NL, Bodhi-Baum, Christopedia, Cspenser, Dawnseeker2000, Eastfrisian,
Hqb, Janggeom, Jovember, Jrcla2, Khazar2, Magioladitis, Mdy66, Obiwankenobi, Plindenbaum, Rjwilmsi, Robert K S, Shinryuu, T@nn, Thorwald, Waacstats, 9 anonymous edits
Vimla L. Patel Source: https://en.wikipedia.org/w/index.php?oldid=526517883 Contributors: Asurite, Clicketyclack, Drmies, Dsp13, Johnpacklambert, Obiwankenobi, Postcard Cathy,
Sahitimyneni, Tassedethe, XLerate, Ysen, Yves.lussier, 7 anonymous edits
Image Sources, Licenses and Contributors
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