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Zhang H, Lyu T, Yin P, Bost S, He X, Guo Y, Prosperi M, Hogan WR, Bian J. A scoping review of semantic integration of health data and information. Int J Med Inform 2022; 165:104834. [PMID: 35863206 DOI: 10.1016/j.ijmedinf.2022.104834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We summarized a decade of new research focusing on semantic data integration (SDI) since 2009, and we aim to: (1) summarize the state-of-art approaches on integrating health data and information; and (2) identify the main gaps and challenges of integrating health data and information from multiple levels and domains. MATERIALS AND METHODS We used PubMed as our focus is applications of SDI in biomedical domains and followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) to search and report for relevant studies published between January 1, 2009 and December 31, 2021. We used Covidence-a systematic review management system-to carry out this scoping review. RESULTS The initial search from PubMed resulted in 5,326 articles using the two sets of keywords. We then removed 44 duplicates and 5,282 articles were retained for abstract screening. After abstract screening, we included 246 articles for full-text screening, among which 87 articles were deemed eligible for full-text extraction. We summarized the 87 articles from four aspects: (1) methods for the global schema; (2) data integration strategies (i.e., federated system vs. data warehousing); (3) the sources of the data; and (4) downstream applications. CONCLUSION SDI approach can effectively resolve the semantic heterogeneities across different data sources. We identified two key gaps and challenges in existing SDI studies that (1) many of the existing SDI studies used data from only single-level data sources (e.g., integrating individual-level patient records from different hospital systems), and (2) documentation of the data integration processes is sparse, threatening the reproducibility of SDI studies.
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Affiliation(s)
- Hansi Zhang
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Tianchen Lyu
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Pengfei Yin
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Sarah Bost
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Xing He
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yi Guo
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Mattia Prosperi
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Willian R Hogan
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jiang Bian
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States.
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Chatterjee A, Pahari N, Prinz A. HL7 FHIR with SNOMED-CT to Achieve Semantic and Structural Interoperability in Personal Health Data: A Proof-of-Concept Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:3756. [PMID: 35632165 PMCID: PMC9147872 DOI: 10.3390/s22103756] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023]
Abstract
Heterogeneity is a problem in storing and exchanging data in a digital health information system (HIS) following semantic and structural integrity. The existing literature shows different methods to overcome this problem. Fast healthcare interoperable resources (FHIR) as a structural standard may explain other information models, (e.g., personal, physiological, and behavioral data from heterogeneous sources, such as activity sensors, questionnaires, and interviews) with semantic vocabularies, (e.g., Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT)) to connect personal health data to an electronic health record (EHR). We design and develop an intuitive health coaching (eCoach) smartphone application to prove the concept. We combine HL7 FHIR and SNOMED-CT vocabularies to exchange personal health data in JavaScript object notion (JSON). This study explores and analyzes our attempt to design and implement a structurally and logically compatible tethered personal health record (PHR) that allows bidirectional communication with an EHR. Our eCoach prototype implements most PHR-S FM functions as an interoperability quality standard. Its end-to-end (E2E) data are protected with a TSD (Services for Sensitive Data) security mechanism. We achieve 0% data loss and 0% unreliable performances during data transfer between PHR and EHR. Furthermore, this experimental study shows the effectiveness of FHIR modular resources toward flexible management of data components in the PHR (eCoach) prototype.
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Affiliation(s)
- Ayan Chatterjee
- Department of Information and Communication Technology, Center for eHealth, University of Agder, 4630 Kristiansand, Norway;
| | - Nibedita Pahari
- Department of Software Development, Knowit As, 4836 Arendal, Norway;
| | - Andreas Prinz
- Department of Information and Communication Technology, Center for eHealth, University of Agder, 4630 Kristiansand, Norway;
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Park HS, Kim KI, Chung HY, Jeong S, Soh JY, Hyun YH, Kim HS. A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study. JMIR Med Inform 2021; 9:e29184. [PMID: 34346894 PMCID: PMC8374662 DOI: 10.2196/29184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022] Open
Abstract
Background Personal health record (PHR) technology can be used to support workplace health promotion, and prevent social and economic losses related to workers’ health management. PHR services can not only ensure interoperability, security, privacy, and data quality, but also consider the user’s perspective in their design. Objective Using Fast Healthcare Interoperability Resources (FHIR) and national health care data sets, this study aimed to design and develop an app for providing worker-centered, interconnected PHR services. Methods This study considered the user’s perspective, using the human-centered design (HCD) methodology, to develop a PHR app suitable for occupational health. We developed a prototype after analyzing quantitative and qualitative data collected from workers and a health care professional group, after which we performed a usability evaluation. We structured workers’ PHR items based on the analyzed data, and ensured structural and semantic interoperability using FHIR, Systematized Nomenclature of Medicine–Clinical Terms (SNOMED-CT), and Logical Observation Identifiers Names and Codes (LOINC). This study integrated workers’ health information scattered across different Korean institutions through an interface method, and workers’ PHRs were managed through a cloud server, using Azure API for FHIR. Results In total, 562 workers from industrial parks participated in the quantitative study. The preferred data items for PHR were medication, number of steps walked, diet, blood pressure, weight, and blood glucose. The preferred features were ability to access medical checkup results, health information content provision, consultation record inquiry, and teleconsultation. The worker-centered PHR app collected data on, among others, life logs, vital signs, and medical checkup results; offered health care services such as reservation and teleconsultation; and provided occupational safety and health information through material safety data sheet search and health questionnaires. The app reflected improvements in user convenience and app usability proposed by 19 participants (7 health care professionals and 12 end users) in the usability evaluation. The After-Scenario Questionnaire (ASQ) was evaluated with a mean score of 5.90 (SD 0.34) out of 7, and the System Usability Scale (SUS) was evaluated a mean score of 88.7 (SD 4.83) out of 100. Conclusions The worker-centered PHR app integrates workers’ health information from different institutions and provides a variety of health care services from linked institutions through workers’ shared PHR. This app is expected to increase workers’ autonomy over their health information and support medical personnel’s decision making regarding workers’ health in the workplace. Particularly, the app will provide solutions for current major PHR challenges, and its design, which considers the user’s perspective, satisfies the prerequisites for its utilization in occupational health.
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Affiliation(s)
- Hyun Sang Park
- Digital Healthcare Department, BIT Computer Co. Ltd., Seoul, Republic of Korea.,Department of Medical Informatics, Kyungpook National University, Daegu, Republic of Korea
| | - Kwang Il Kim
- Finance Programs Department, Korea Occupational Safety and Health Agency, Ulsan, Republic of Korea
| | - Ho-Young Chung
- Department of Medical Informatics, Kyungpook National University, Daegu, Republic of Korea
| | - Sungmoon Jeong
- Department of Medical Informatics, Kyungpook National University, Daegu, Republic of Korea
| | - Jae Young Soh
- Digital Healthcare Department, BIT Computer Co. Ltd., Seoul, Republic of Korea
| | - Young Ho Hyun
- Digital Healthcare Department, BIT Computer Co. Ltd., Seoul, Republic of Korea
| | - Hwa Sun Kim
- Elecmarvels Co. Ltd., Daegu, Republic of Korea
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García-Berná JA, Fernández-Alemán JL, Carrillo de Gea JM, Toval A, Mancebo J, Calero C, García F. Energy efficiency in software: A case study on sustainability in personal health records. JOURNAL OF CLEANER PRODUCTION 2021; 282:124262. [PMID: 32982077 PMCID: PMC7508020 DOI: 10.1016/j.jclepro.2020.124262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 08/30/2020] [Accepted: 09/13/2020] [Indexed: 06/11/2023]
Abstract
A personal health record is an eHealth technology in which users can observe their progress over time for a given condition. A research gap was identified in the literature concerning the study of the amount of energy that these systems need for their operation, and the energy efficiency that may be attained depending on their design. After the selection of five representative personal health records, a total of 20 tasks commonly done, and based on previous work, were performed with regard to two proposed scenarios, namely patient use and health personnel usage. The power consumption of the main components of a host machine was measured during the performance of the proposed duties. To that end, a hardware tool called the Energy Efficiency Tester was employed. The data collected were analyzed statistically, and significant differences were found in the respective consumption of the display (χ2 (4) = 23.782, p = 0.000), the processor (χ2 (4) = 29.018, p = 0.000) and the whole PC (χ2 (4) = 28.582, p = 0.000). For all of these components, NoMoreClipBoard was the personal health record that required the least energy (57.699 W for the display, 3.162 W for the processor and 181.113 W for the whole PC). A total of two strong correlations were found in the energy consumption between the hard disk and the graphics card (r = 0.791, p < 0.001), and the processor and the PC (r = 0.950, p < 0.001). Some features generated special amounts of power consumption, such as the news wall found on PatientsLikeMe, or the use of load icons that had an impact on most PC components. In addition, an in-depth analysis of the user interfaces was performed. A discussion was carried out on the design of the user interfaces, also taking into account recommendations drawn from the literature, checking for their implementation in the personal health records selected. With the aim of promoting sustainability among software developers, a best practice guideline on sustainable software design was proposed. Basic sustainability recommendations were collected for professionals to consider when developing a software system in general, and a personal health record in particular.
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Affiliation(s)
- José A García-Berná
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Spain
| | - José L Fernández-Alemán
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Spain
| | - Juan M Carrillo de Gea
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Spain
| | - Ambrosio Toval
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Spain
| | - Javier Mancebo
- Department of Information Technologies and Systems, Faculty of Computer Science, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Coral Calero
- Department of Information Technologies and Systems, Faculty of Computer Science, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Félix García
- Department of Information Technologies and Systems, Faculty of Computer Science, University of Castilla-La Mancha, Ciudad Real, Spain
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Pellison FC, Rijo RPCL, Lima VC, Crepaldi NY, Bernardi FA, Galliez RM, Kritski A, Abhishek K, Alves D. Data Integration in the Brazilian Public Health System for Tuberculosis: Use of the Semantic Web to Establish Interoperability. JMIR Med Inform 2020; 8:e17176. [PMID: 32628611 PMCID: PMC7381074 DOI: 10.2196/17176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/17/2020] [Accepted: 03/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background Interoperability of health information systems is a challenge due to the heterogeneity of existing systems at both the technological and semantic levels of their data. The lack of existing data about interoperability disrupts intra-unit and inter-unit medical operations as well as creates challenges in conducting studies on existing data. The goal is to exchange data while providing the same meaning for data from different sources. Objective To find ways to solve this challenge, this research paper proposes an interoperability solution for the tuberculosis treatment and follow-up scenario in Brazil using Semantic Web technology supported by an ontology. Methods The entities of the ontology were allocated under the definitions of Basic Formal Ontology. Brazilian tuberculosis applications were tagged with entities from the resulting ontology. Results An interoperability layer was developed to retrieve data with the same meaning and in a structured way enabling semantic and functional interoperability. Conclusions Health professionals could use the data gathered from several data sources to enhance the effectiveness of their actions and decisions, as shown in a practical use case to integrate tuberculosis data in the State of São Paulo.
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Affiliation(s)
- Felipe Carvalho Pellison
- Bioengineering Postgraduate Program of the São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil
| | - Rui Pedro Charters Lopes Rijo
- Polytechnic Institute of Leiria, Leiria, Portugal.,Institute for Systems and Computers Engineering at Coimbra, Coimbra, Portugal.,Center for Health Technology and Services Research, Porto, Portugal.,Department of Social Medicine of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Vinicius Costa Lima
- Bioengineering Postgraduate Program of the São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil
| | | | - Filipe Andrade Bernardi
- Bioengineering Postgraduate Program of the São Carlos School of Engineering, University of São Paulo, São Carlos, Brazil
| | - Rafael Mello Galliez
- Academic Tuberculosis Program, Medical School of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Afrânio Kritski
- Academic Tuberculosis Program, Medical School of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kumar Abhishek
- Department of Computer Science and Engineering, National Institute of Technology, Patna, India
| | - Domingos Alves
- Department of Social Medicine of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Saripalle R, Runyan C, Russell M. Using HL7 FHIR to achieve interoperability in patient health record. J Biomed Inform 2019; 94:103188. [DOI: 10.1016/j.jbi.2019.103188] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/09/2019] [Accepted: 04/22/2019] [Indexed: 11/16/2022]
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Mavrogiorgou A, Kiourtis A, Perakis K, Pitsios S, Kyriazis D. IoT in Healthcare: Achieving Interoperability of High-Quality Data Acquired by IoT Medical Devices. SENSORS 2019; 19:s19091978. [PMID: 31035612 PMCID: PMC6539021 DOI: 10.3390/s19091978] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
It is an undeniable fact that Internet of Things (IoT) technologies have become a milestone advancement in the digital healthcare domain, since the number of IoT medical devices is grown exponentially, and it is now anticipated that by 2020 there will be over 161 million of them connected worldwide. Therefore, in an era of continuous growth, IoT healthcare faces various challenges, such as the collection, the quality estimation, as well as the interpretation and the harmonization of the data that derive from the existing huge amounts of heterogeneous IoT medical devices. Even though various approaches have been developed so far for solving each one of these challenges, none of these proposes a holistic approach for successfully achieving data interoperability between high-quality data that derive from heterogeneous devices. For that reason, in this manuscript a mechanism is produced for effectively addressing the intersection of these challenges. Through this mechanism, initially, the collection of the different devices’ datasets occurs, followed by the cleaning of them. In sequel, the produced cleaning results are used in order to capture the levels of the overall data quality of each dataset, in combination with the measurements of the availability of each device that produced each dataset, and the reliability of it. Consequently, only the high-quality data is kept and translated into a common format, being able to be used for further utilization. The proposed mechanism is evaluated through a specific scenario, producing reliable results, achieving data interoperability of 100% accuracy, and data quality of more than 90% accuracy.
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Affiliation(s)
- Argyro Mavrogiorgou
- Department of Digital Systems, University of Piraeus, M. Karaoli & A. Dimitriou 80, 18534 Piraeus, Greece.
| | - Athanasios Kiourtis
- Department of Digital Systems, University of Piraeus, M. Karaoli & A. Dimitriou 80, 18534 Piraeus, Greece.
| | | | - Stamatios Pitsios
- Singular Logic EU Projects Department, Achaias 3, 14564 Kifisia, Greece.
| | - Dimosthenis Kyriazis
- Department of Digital Systems, University of Piraeus, M. Karaoli & A. Dimitriou 80, 18534 Piraeus, Greece.
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Structurally Mapping Healthcare Data to HL7 FHIR through Ontology Alignment. J Med Syst 2019; 43:62. [PMID: 30721349 DOI: 10.1007/s10916-019-1183-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
Current healthcare services promise improved life-quality and care. Nevertheless, most of these entities operate independently due to the ingested data' diversity, volume, and distribution, maximizing the challenge of data processing and exchange. Multi-site clinical healthcare organizations today, request for healthcare data to be transformed into a common format and through standardized terminologies to enable data exchange. Consequently, interoperability constraints highlight the need of a holistic solution, as current techniques are tailored to specific scenarios, without meeting the corresponding standards' requirements. This manuscript focuses on a data transformation mechanism that can take full advantage of a data intensive environment without losing the realistic complexity of health, confronting the challenges of heterogeneous data. The developed mechanism involves running ontology alignment and transformation operations in healthcare datasets, stored into a triple-based data store, and restructuring it according to specified criteria, discovering the correspondence and possible transformations between the ingested data and specific Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) through semantic and ontology alignment techniques. The evaluation of this mechanism results into the fact that it should be used in scenarios where real-time healthcare data streams emerge, and thus their exploitation is critical in real-time, since it performs better and more efficient in comparison with a different data transformation mechanism.
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Plastiras P, O'Sullivan D. Exchanging personal health data with electronic health records: A standardized information model for patient generated health data and observations of daily living. Int J Med Inform 2018; 120:116-125. [PMID: 30409336 DOI: 10.1016/j.ijmedinf.2018.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/19/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The development of a middleware information model to facilitate better interoperability between Personal and Electronic Health Record systems in order to allow exchange of Patient Generated Health Data and Observations of Daily Leaving between patients and providers in order to encourage patient self-management. MATERIALS AND METHODS An information model based on HL7 standards for interoperability has been extended to support PGHD and ODL data types. The new information models uses HL7 CDA to represent data, is instantiated as a Protégé ontology and uses a set of mapping rules to transfer data between Personal and Electronic Health Record systems. RESULTS The information model was evaluated by executing a set of use case scenarios containing data exported from three consumer health apps, transformed to CDA according to developed mapping rules and validated against a CDA schema. This allowed various challenges to emerge as well as revealed gaps in current standards in use and the information model has been refined accordingly. DISCUSSION AND CONCLUSION Our proposed middleware solution offers a number of advantages. When modifications are made to either a Personal or Health Electronic Health Record system or any integrated consumer app, they can be incorporated by altering only the instantiation of the information model. Our proposition uses current standards in use such as CDA. The solution is applicable to any EHR system with HL7 CDA support.
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Affiliation(s)
- Panagiotis Plastiras
- Department of Computer Science, City University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - Dympna O'Sullivan
- Department of Computer Science, City University of London, Northampton Square, London EC1V 0HB, United Kingdom; School of Computing, National College of Ireland, Mayor Street, North Dock, Dublin 1, D01 Y300, Ireland
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Hackl WO, Hoerbst A. On the Way to Close the Loop in Information Logistics: Data from the Patient - Value for the Patient. Yearb Med Inform 2018; 27:91-97. [PMID: 30157511 PMCID: PMC6115236 DOI: 10.1055/s-0038-1667076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To summarize recent research and to propose a selection of best papers published in 2017 in the field of Clinical Information Systems (CIS). METHOD Each year a systematic process is carried out to retrieve articles and to select a set of best papers for the CIS section of the International Medical Informatics Association (IMIA) Yearbook of Medical Informatics. The query aiming at identifying relevant publications in the field of CIS was refined by the section editors during the last years. For three years now, the query is stable. It comprises search terms from the Medical Subject Headings (MeSH) thesaurus as well as additional free text search terms from PubMed and Web of Science®. The retrieved articles were categorized in a multi-pass review carried out by the two section editors. The final selection of candidate papers was then peer-reviewed by Yearbook editors and external reviewers. Based on the review results, the best papers were then selected by the IMIA Yearbook editorial board. Text mining, and term co-occurrence mapping techniques were used to get an overview on the content of the retrieved articles. RESULTS The query was carried out in mid-January 2018, yielding a consolidated result set of 2,255 articles which had been published in 939 different journals. Out of them, 15 papers were nominated as candidate best papers and four of them were finally selected as best papers in the CIS section. Again, the content analysis of the articles revealed the broad spectrum of topics which is covered by CIS research. CONCLUSIONS Modern clinical information systems serve as backbone for a very complex, trans-institutional information logistics process. Data that is produced by, documented in, shared via, organized in, presented by, and stored within clinical information systems is more and more reused for multiple purposes. We found a lot of examples showing the benefits of such data reuse with various novel approaches implemented to tackle the challenges of this process. We also found that the patient moves in the focus of interest of CIS research. So the loop of information logistics begins to close: data from the patients is used to produce value for the patients.
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Affiliation(s)
- Werner O Hackl
- Institute of Medical Informatics, UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Alexander Hoerbst
- eHealth Research and Innovation Unit, UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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