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  • 1.
    Gunnarsson, Svante
    et al.
    Linköping University, Department of Electrical Engineering, Automatic Control. Linköping University, Faculty of Science & Engineering.
    Herbertsson, Helena
    Linköping University, Department of Physics, Chemistry and Biology, Chemistry. Linköping University, Faculty of Science & Engineering.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Using Course and Program Matrices as Components in a Quality Assurance System2019In: The 15th International CDIO Conference: Proceedings – Full Papers / [ed] Jens Bennedsen, Aage Birkkjær Lauritsen, Kristina Edström, Natha Kuptasthien, Janne Roslöf & Robert Songer, Aarhus: Aarhus University , 2019, p. 110-119Conference paper (Refereed)
    Abstract [en]

    The CDIO framework is an integrated and important part of the new quality assurance system within the Faculty of Science and Engineering at Linköping University. Both the CDIO Syllabus and the CDIO Standards are used extensively in the system. First, the paper presents the development and use of the second generation of course matrices (previously denoted ITU-matrices) and program matrices, which build upon an adapted and extended version of the CDIO Syllabus. The extension is made to also include bachelor’s and master’s program in subjects outside the engineering field. Second, the paper presents how the CDIO Standards are used in the quality reports, which are vital parts of the quality assurance systems. As a result, the CDIO framework is used for the design, management, and quality assurance of all education programs ( approximately 60 programs) within the Faculty of Science and Engineering at Linköping University.

  • 2.
    Karlsson, Daniel
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Gøeg, Kirstine Rosenbeck
    Department of Health Science and Technology, Aalborg University.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Højen, Anne Randorff
    Department of Health Science and Technology, Aalborg University.
    Semantic Krippendorff’s α for measuring inter-rater agreement in SNOMED CT coding studies2014In: e-Health – For Continuity of Care / [ed] Christian Lovis, et al., Amsterdam, 2014, p. 151-155Conference paper (Refereed)
    Abstract [en]

    Semantic interoperability requires consistency in use of terminologies such as SNOMED CT. Inter-rater agreement measurement can be used to quantify this consistency among terminology users. Increasingly, studies of SNOMED CT include inter-rater agreement measures. However, published studies do not consider distance between concepts when calculating the inter-rater agreement measures. In this paper we propose a semantic inter-rater agreement measure for use with SNOMED CT encoded data. A semantic Krippendorff's α measure is implemented using a path-length based difference function. The measure is tested using three different datasets. Results show that the proposed semantic measure is sensitive to seriousness of coding differences whereas a nominal measure is not. The proposed measure reflects the intuition that distance matters when comparing uses of SNOMED CT.

  • 3.
    Nilsson, Gunnar
    et al.
    Family Medicine Stockholm, Karolinska Institute, Sweden.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, Lars-Erik
    Family Medicine Stockholm, Karolinska Institute, Sweden.
    Evaluation of three Swedish ICD-10 primary care versions: reliability and ease of use in diagnostic coding2000In: Methods of Information in Medicine, ISSN 0026-1270, Vol. 39, no 4-5, p. 325-331Article in journal (Refereed)
    Abstract [en]

    If computer-stored information is to be useful for purposes other than patient care, reliability of the data is of utmost importance. In primary healthcare settings, however, it has been found to be poor. This paper presents a study on the influence of coding tools on reliability and user acceptance. Six general practitioners coded 152 medical problems each by means of three versions of ICD-10, one with a compositional structure. At code level the reliability was poor and was almost identical when the three versions were compared. At aggregated level the reliability was good and somewhat better in the compositional structure. Ideas for improved user acceptance arose, and the study explored the need for several different tools to retrieve diagnostic codes.

  • 4.
    Nilsson, Gunnar
    et al.
    Karolinska Inst Stockholm.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, Lars-Erik
    Karolinska Inst Stockholm.
    Reliability in diagnostic coding: Evaluation of three Swedish ICD-10 primary care versions1999In: AMIA99,1999, Philadelphia: Harley & Belfus Inc , 1999, p. 1128-Conference paper (Refereed)
  • 5.
    Nilsson, Gunnar
    et al.
    Allmänmedicin Karolinska Institutet.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, L-E
    Allmänmedicin Karolinska Institutet.
    Evaluation of three Swedish ICD-10 primary care versions: reliability and ease of use in diagnostic codig2002In: Yearbook of Medical Informatics, p. 377-383Article in journal (Other academic)
  • 6.
    Nyström, Mikael
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Merkel, Magnus
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory.
    Ahrenberg, Lars
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory.
    Zweigenbaum, Pierre
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Creating a medical English-Swedish dictionary using interactive word alignment2006In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 6, no 35Article in journal (Refereed)
    Abstract [en]

    Background: This paper reports on a parallel collection of rubrics from the medical terminology systems ICD-10, ICF, MeSH, NCSP and KSH97-P and its use for semi-automatic creation of an English-Swedish dictionary of medical terminology. The methods presented are relevant for many other West European language pairs than English-Swedish. Methods: The medical terminology systems were collected in electronic format in both English and Swedish and the rubrics were extracted in parallel language pairs. Initially, interactive word alignment was used to create training data from a sample. Then the training data were utilised in automatic word alignment in order to generate candidate term pairs. The last step was manual verification of the term pair candidates. Results: A dictionary of 31,000 verified entries has been created in less than three man weeks, thus with considerably less time and effort needed compared to a manual approach, and without compromising quality. As a side effect of our work we found 40 different translation problems in the terminology systems and these results indicate the power of the method for finding inconsistencies in terminology translations. We also report on some factors that may contribute to making the process of dictionary creation with similar tools even more expedient. Finally, the contribution is discussed in relation to other ongoing efforts in constructing medical lexicons for non-English languages. Conclusion: In three man weeks we were able to produce a medical English-Swedish dictionary consisting of 31,000 entries and also found hidden translation errors in the utilized medical terminology systems. © 2006 Nyström et al, licensee BioMed Central Ltd.

  • 7.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Merkel, Magnus
    Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory. Linköping University, The Institute of Technology.
    Ahrenberg, Lars
    Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory. Linköping University, The Institute of Technology.
    Zweigenbaum, Pierre
    Assistance Publique-Hôpitaux de Paris, Inserm U729, Inalco CRIM.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Creating a medical English-Swedish dictionary using interactive word alignment2009In: Lexicography: The Changing Landscape / [ed] Salonee Priya, Hyderabad, India: The Icfai University Press , 2009, 1, p. 131-157Chapter in book (Other academic)
    Abstract [sv]

    Lexicography is a realm of growing academic specialization. Dictionaries map meaning onto use. We have innumerable dictionaries on different subjects and for different purposes which we keep referring to, time and again. Despite the frequency with which dictionaries are unquestioningly consulted, many have little idea of what actually goes into making them or how meanings are definitively ascertained. We have become so accustomed to using dictionaries that we fail to take notice of the effort and time spent in their making. Understanding the finer nuances of the art of dictionary-making will be of interest to everyone. With changing times and the penetration of technology, the bulkier forms of dictionaries have given way to softer forms. This book updates the reader to the changing notions of the lexicon and dictionary-making in the new realm of modern technology and newer electronic tools. The book introduces us to lexicography and leads us to dictionaries for general and specific purposes. It examines dictionary compilation and research and enables compilers, users, educators and publishers to look anew at the art of lexicography. It duly takes into account the fact that dictionaries are meant to fulfill the needs of specific user groups and reflects the same in the chapters devoted to various professional dictionaries, which have recently achieved widespread recognition in the lexicographical literature. A good read for students of linguistics, teachers and translators apart from general readers interested in knowing the intricate art of making a dictionary.

  • 8.
    Nyström, Mikael
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Merkel, Magnus
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Creating a medical dictionary using word alignment: The influence of sources and resources2007In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 7, no 37Article in journal (Refereed)
    Abstract [en]

    Background. Automatic word alignment of parallel texts with the same content in different languages is among other things used to generate dictionaries for new translations. The quality of the generated word alignment depends on the quality of the input resources. In this paper we report on automatic word alignment of the English and Swedish versions of the medical terminology systems ICD-10, ICF, NCSP, KSH97-P and parts of MeSH and how the terminology systems and type of resources influence the quality. Methods. We automatically word aligned the terminology systems using static resources, like dictionaries, statistical resources, like statistically derived dictionaries, and training resources, which were generated from manual word alignment. We varied which part of the terminology systems that we used to generate the resources, which parts that we word aligned and which types of resources we used in the alignment process to explore the influence the different terminology systems and resources have on the recall and precision. After the analysis, we used the best configuration of the automatic word alignment for generation of candidate term pairs. We then manually verified the candidate term pairs and included the correct pairs in an English-Swedish dictionary. Results. The results indicate that more resources and resource types give better results but the size of the parts used to generate the resources only partly affects the quality. The most generally useful resources were generated from ICD-10 and resources generated from MeSH were not as general as other resources. Systematic inter-language differences in the structure of the terminology system rubrics make the rubrics harder to align. Manually created training resources give nearly as good results as a union of static resources, statistical resources and training resources and noticeably better results than a union of static resources and statistical resources. The verified English-Swedish dictionary contains 24,000 term pairs in base forms. Conclusion. More resources give better results in the automatic word alignment, but some resources only give small improvements. The most important type of resource is training and the most general resources were generated from ICD-10. © 2007 Nyström et al, licensee BioMed Central Ltd.

  • 9.
    Nyström, Mikael
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Merkel, Magnus
    Linköping University, The Institute of Technology. Linköping University, Department of Computer and Information Science, NLPLAB - Natural Language Processing Laboratory.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Evaluating Bilingual Medical Terminologies with Word Alignment Methods2007In: Medinfo 2007: Proceedings of the 12th World Congress on Health (Medical) Informatics: Building Sustainable Health Systems / [ed] Kuhn, Klaus A; Warren, James R; Leong, Tze-Yun, Amsterdam: IOS Press, 2007, p. 244-Conference paper (Refereed)
  • 10.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Eneling, Martin
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Introduction to openEHR basic principles2008Conference paper (Refereed)
  • 11.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Örman, Håkan
    Åhlfeldt, Hans
    Data Needs for Patient Overviews: A Literature ReviewCompared with SNOMED CT and openEHRManuscript (preprint) (Other academic)
    Abstract [en]

    Patient overviews automatically generated fromelectronic healthcare data have different data needsdepending on their complexity. A literature reviewbased on a broad MEDLINE search found 16 suchoverviews for which the data needs were analyzedand compared with features provided bySNOMED CT and openEHR. Five systems used onlyinformation type, while five systems also presentedparticular values from its information entities. Sixsystems also aggregated or filtered the information.In addition to that, two systems provided referenceranges and three systems provided more advanceddecision support. The simple data needs can be metusing information entity markups based onSNOMED CT and SNOMED CT relationships. Morecomplex data needs can be satisfied using theopenEHR reference model and archetypes tostructure data and the archetype query language toretrieve individual data values. The most advancedoverviews also need additional methods foraggregation, filtering and connection to knowledgerepresentation.

  • 12.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Vikström, Anna
    Karolinska Institutet.
    Nilsson, Gunnar H
    Karolinska Institutet.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Enriching a primary health care version of ICD-10 using SNOMED CT mapping2010In: Journal of Biomedical Semantics, ISSN 2041-1480, Vol. 1, no 7Article in journal (Refereed)
    Abstract [en]

    Background: In order to satisfy different needs, medical terminology systems musthave richer structures. This study examines whether a Swedish primary health careversion of the mono-hierarchical ICD-10 (KSH97-P) may obtain a richer structureusing category and chapter mappings from KSH97-P to SNOMED CT and SNOMEDCT’s structure. Manually-built mappings from KSH97-P’s categories and chapters toSNOMED CT’s concepts are used as a starting point

    Results: The mappings are manually evaluated using computer-producedinformation and a small number of mappings are updated. A new and polyhierarchicalchapter division of KSH97-P’s categories has been created using thecategory and chapter mappings and SNOMED CT’s generic structure. In the newchapter division, most categories are included in their original chapters. Aconsiderable number of concepts are included in other chapters than their originalchapters. Most of these inclusions can be explained by ICD-10’s design. KSH97-P’scategories are also extended with attributes using the category mappings andSNOMED CT’s defining attribute relationships. About three-fourths of all conceptsreceive an attribute of type Finding site and about half of all concepts receive anattribute of type Associated morphology. Other types of attributes are less common.

    Conclusions: It is possible to use mappings from KSH97-P to SNOMED CT andSNOMED CT’s structure to enrich KSH97-P’s mono-hierarchical structure with a polyhierarchicalchapter division and attributes of type Finding site and Associatedmorphology. The final mappings are available as additional files for this paper.

  • 13.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Vikström, Anna
    Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet.
    Nilsson, Gunnar H
    Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Visualization of disease distribution with SNOMED CT and ICD-102010In: MEDINFO 2010 - Proceedings of the 13th World Congress on Medical Informatics / [ed] Safran, Charles; Reti, Shane; Marin, Heimar, Amsterdam: IOS Press, 2010, Vol. 160, p. 1100-1103Conference paper (Refereed)
    Abstract [en]

    Methods for presentation of disease and health problem distribution in a health care environment rely among other things on the inherent structure of the controlled terminology used for coding. In the present study, this aspect is explored with a focus on ICD-10 and SNOMED CT. The distribution of 2,5 million diagnostic codes from primary health care in the Stockholm region is presented and analyzed through the “lenses” of ICD-10 and SNOMED CT. The patient encounters, originally coded with a reduced set of ICD-10 codes used in primary health care in Sweden, were mapped to SNOMED CT concepts through a mapping table. The method used for utilizing the richer structure of SNOMED CT as compared to ICD-10 is presented, together with examples of produced disease distributions. Implications of the proposed method for enriching a traditional classification such as ICD-10 through mappings to SNOMED CT are discussed.

  • 14.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Shahsavar, Nosrat
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Det krävs en riktad satsning på e-hälsa2016In: Dagens medicin, ISSN 1104-7488, no 18, p. 22-Article in journal (Other (popular science, discussion, etc.))
  • 15.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    On information quality in primary health care registries2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Data compilation has a long history in the field of medicine, and domains for which data are pooled include, among others, epidemiological studies and quality assessment. Unfortunately, data may be of low quality with poor validity and reliability, and consequently, decisions based on statistics may be unreliable. The range of applications of information use and reuse is expected to extend from aggregation of information to retrieval of specific cases, which further emphasizes the importance of high quality data. The present thesis deals with aspects of information quality in Swedish primary health care registries. Such information is commonly encoded according to standardized coding systems.

    In order to improve coding quality, it is necessary to study the content, structure, and semantics of the coding systems, as well as the functionality of the tools used to access them. In particular, the thesis discusses the effect of the coding system structure - as an instrument for code retrieval as well as data aggregation - on the reliability of coding. In summary, the functionality of a tool that supports coding of medical problems must meet numerous requirements. Flexible structures for browsing the coding system and different types of lexical tools are needed, as are rules for guiding the correct choice of code with respect to a particular medical problem. As an instrument for data compilation, the structure of the coding system may support aggregation in ways that reflect dimension with low variability.

    The main contribution of this thesis is to increase understanding of the complexity of disease concepts and the coding systems used for representing them. In addition, it also encompasses the measurements of reliability in coded Swedish primary health care data that were carried out in both a smaller prospective and a larger retrospective study. Further, the thesis proposes a metric for retrospective reliability studies. Finally, the presented coding tool - the Classification Browser - is in itself a platform for further discussion and development in the domain of diagnostic coding.

  • 16.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Terminology support for diagnostic coding in primary health care2000Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Coding systems have a long history in the field of medicine, and domains for which data are pooled and coded include, among others, epidemiological studies, medical insurance registers, and quality assessment. Unfortunately, coded data may be of low quality with poor validity and reliability, and decisions based on statistics are consequently not reliable. The extensive and multi-faceted use of coded data demands high quality coding, and in order to improve the quality it is necessary to study the structure and the content of the coding systems as well as the tools used to access them.

    The present thesis deals with diagnostic coding in Swedish primary health care, and the objective is to analyze the role of computerized tools in diagnostic coding. In particular, the effect of the coding system structure-as a tool for code generation as well as data aggregation-an the reliability of coding is discussed. In summary, the functionality of a tool that supports coding of medical problems must meet numerous requirements. Flexible structures for browsing the coding system and different kinds of lexical tools are needed, as well as rules for guiding the correct choice of code with respect to a particular medical problem.

  • 17.
    Petersson, Håkan
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    A variance-based measure of inter-rater agreement in medical databases2002In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 35, no 5-6, p. 331-342Article in journal (Refereed)
    Abstract [en]

    The increasing use of encoded medical data requires flexible tools for data quality assessment. Existing methods are not always adequate, and this paper proposes a new metric for inter-rater agreement of aggregated diagnostic data. The metric, which is applicable in prospective as well as retrospective coding studies, quantifies the variability in the coding scheme, and the variation can be differentiated in categories and in coders. Five alternative definitions were compared in a set of simulated coding situations and in the context of mortality statistics. Two of them were more effective, and the choice between them must be made according to the situation. The metric is more powerful for larger numbers of coded cases, and Type I errors are frequent when coding situations include different numbers of cases. We also show that it is difficult to interpret the meaning of variation when the structures of the compared coding schemes differ.

  • 18.
    Petersson, Håkan
    et al.
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Improving inter-rater reliability by coding scheme reorganization: managing signs and symptomsManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this paper is to study the potential for improving inter-rater reliability in general practice registries through the use of a semantic terminology model that enables diagnostic labels to be separated into symptoms and diseases, i.e. into different levels of diagnostic precision. Cases coded as symptoms according to the ICD-based coding system currently in use in Swedish general practice were reclassified with the help of the model, and inter-rater variability was measured through divergences of observed coding distributions from expected distributions. 40 percent of the symptom cases were candidates for reclassification; half of these could actually be reclassified. This decreased inter-rater variability, but the difference was not statistically significant. Diagnostic categories with large variation in utilization rates were foWld, which calls for careful selection of topics for medical audit. Although reclassification of symptoms may improve reliability, no straightforward association was found between a chapter's diagnostic precision and its contribution to overall variability. Nor could differences in diagnostic precision explain all variation within a chapter. Further research on other dimensions of the coding system is needed before symptom reclassification can be recommended as a general reliability-improving tool.

  • 19.
    Petersson, Håkan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Gill, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Improving Inter-Rater Reliability through Coding Scheme Reorganization: Managing Signs and Symptoms2008In: The First Conference on Text and Data Mining of Clinical Documents Louhi08,2008, Turku: TUCS General Publications , 2008, p. 54-Conference paper (Refereed)
  • 20.
    Petersson, Håkan
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Gunnar
    Family Medicine Stockholm, Karolinska institutet, Stockholm.
    Stender, Lars-Erik
    Family Medicine Stockholm, Karolinska institutet, Stockholm.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    The connection between terms used in medical records and coding system: a study on Swedish primary health care data2001In: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 26, no 2, p. 87-99Article in journal (Refereed)
    Abstract [en]

    Implementation of problem lists and their relation to standardized coding systems have been approached and analysed in different ways. Most evaluations concern quantitative aspects such as content coverage in a specific domain. In order to reveal the qualitative aspects of diagnostic coding, medical record texts from primary health care encounters were compared with terms from a coding system that was used for describing them statistically. The records were coded by six general practitioners, and in some cases, an applied diagnostic term was found within the text, while other record text-coding system relationships were categorized as synonyms, alternative terms, and interpretations. Thus, the categories roughly corresponded to a measure of semantic distance between the terms in the record text and the rubrics of the coding system, and there was a correlation between semantic distance and inter-rater agreement. The subcategories of this scheme corresponded fairly well to recently published desiderata for clinical terminology servers, including functionality such as word normalization and spelling correction. However, not all problems could have been automatically coded by means of lexical methods, which can be partly explained by the fact that diagnostic coding also relies on clinical knowledge. In addition, proper automation relies on context representation within the records.

  • 21.
    Petersson, Håkan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Nilsson, Gunnar
    Stockholm County Council .
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Malmberg, Britt-Gerd
    Stockholm County Council .
    Wigertz, Ove
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Design and implementation of a world wide web accessible database for the Swedish ICD-10 primary care version using a concept system approach1997In: AMIA,1997, Philadelphia: Hanley & Belfus Inc , 1997, p. 885-Conference paper (Refereed)
  • 22.
    Petersson, Håkan
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Gunnar
    Centre of Medical Informatics in General Practice, Stockholm County Council, Sweden.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Malmberg, Britt-Gerd
    Centre of Medical Informatics in General Practice, Stockholm County Council, Sweden.
    Wigertz, Ove
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Semantic modeling of a traditional classification: results and implications1998In: Medinfo ‘98: Proceedings of the Ninth World Congress on Medical Informatics / [ed] Cesnik, B., McCray, A.T., Scherrer, J.-R., Australia: IOS Press , 1998, p. 613-617Conference paper (Refereed)
    Abstract [en]

    A primary health care version of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), together with a three-dimensional model for classification of diseases according to locations, origin, and type has been semantically represented. The resulting computer-based version is made available via the World Wide Web.

  • 23.
    Petersson, Håkan
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Terminology support for diagnostic coding in primary health care.2000In: AMIA,2000, Linköping: Department of Biomedical Engineering, Division of Medical Informatics, Linköpings universitet , 2000Conference paper (Refereed)
  • 24.
    Sundvall, Erik
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Forss, Mattias
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Chen, Rong
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Graphical Overview and Navigation of Electronic Health Records in a prototyping environment using Google Earth and openEHR Archetypes2007In: MEDINFO 2007 - Proceedings of the 12th World Congress on Health (Medical) Informatics – Building Sustainable Health Systems / [ed] Klaus A. Kuhn, James R. Warren, Tze-Yun Leong, IOS Press, 2007, p. 1043-1047Conference paper (Refereed)
    Abstract [en]

    This paper describes selected earlier approaches to graphically relating events to each other and to time; some new combinations are also suggested. These are then combined into a unified prototyping environment for visualization and navigation of electronic health records. Google Earth (GE) is used for handling display and interaction of clinical information stored using openEHR data structures and ‘archetypes’. The strength of the approach comes from GE's sophisticated handling of detail levels, from coarse overviews to fine-grained details that has been combined with linear, polar and region-based views of clinical events related to time. The system should be easy to learn since all the visualization styles can use the same navigation.

    The structured and multifaceted approach to handling time that is possible with archetyped openEHR data lends itself well to visualizing and integration with openEHR components is provided in the environment.

  • 25.
    Sundvall, Erik
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Eneling, Martin
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Chen, Rong
    Cambio Healthcare Systems.
    Örman, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Applying representational state transfer (REST) architecture to archetype-based electronic health record systems2013In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 13, no 57Article in journal (Refereed)
    Abstract [en]

    Background

    The openEHR project and the closely related ISO 13606 standard have defined structures supporting the content of Electronic Health Records (EHRs). However, there is not yet any finalized openEHR specification of a service interface to aid application developers in creating, accessing, and storing the EHR content.

    The aim of this paper is to explore how the Representational State Transfer (REST) architectural style can be used as a basis for a platform-independent, HTTP-based openEHR service interface. Associated benefits and tradeoffs of such a design are also explored.

    Results

    The main contribution is the formalization of the openEHR storage, retrieval, and version-handling semantics and related services into an implementable HTTP-based service interface. The modular design makes it possible to prototype, test, replicate, distribute, cache, and load-balance the system using ordinary web technology. Other contributions are approaches to query and retrieval of the EHR content that takes caching, logging, and distribution into account. Triggering on EHR change events is also explored.

    A final contribution is an open source openEHR implementation using the above-mentioned approaches to create LiU EEE, an educational EHR environment intended to help newcomers and developers experiment with and learn about the archetype-based EHR approach and enable rapid prototyping.

    Conclusions

    Using REST addressed many architectural concerns in a successful way, but an additional messaging component was needed to address some architectural aspects. Many of our approaches are likely of value to other archetype-based EHR implementations and may contribute to associated service model specifications.

  • 26.
    Sundvall, Erik
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Interactive Visualization and Navigation of Complex Terminology Systems, Exemplified by SNOMED CT2006In: Ubiquity: Technologies for Better Health in Aging Societies - Proceedings of MIE2006 / [ed] Arie Hasman, Reinhold Haux, Johan van der Lei, Etienne De Clercq, Francis Roger-France, IOS Press , 2006, p. 851-856Conference paper (Refereed)
    Abstract [en]

    Free-text queries are natural entries into the exploration of complex terminology systems. The way search results are presented has impact on the users ability to grasp the overall structure of the system. Complex hierarchies like the one used in SNOMED CT, where nodes have multiple parents (IS-A) and several other relationship types, makes visualization challenging. This paper presents a prototype, Term Viz, applying well known methods like "focus+context" and self-organizing layouts from the fields of Information Visualization and Graph Drawing to terminologies like SNOMED CT and ICD-10. The user can simultaneously focus on several nodes in the terminologies and then use interactive animated graph navigation and semantic zooming to further explore the terminology systems without loosing context. The prototype, based on Open Source Java components, demonstrates how a number of Information Visualisation methods can aid the exploration of medical terminologies with millions of elements and can serve as a base for further development.

  • 27.
    Sundvall, Erik
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Qamar, Rahil
    Dep of Computer Science University of Manchester, UK.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Forss, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Petersson, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Rector, Alan
    Dep of Computer Science University of Manchester, UK.
    Integration of Tools for Binding Archetypes to SNOMED CT2006Conference paper (Other academic)
    Abstract [en]

    The Archetype formalism and the associated Archetype Definition Language have been proposed as standard for specifying models of components of Electronic Healthcare Records as a means of achieving interoperability between clinical systems. This paper presents an archetype editor with support for manual or semi-automatic creation of bindings between archetypes and terminology systems. Lexical and semantic methods are applied in order to obtain automatic mapping suggestions. Information visualisation methods are also used to assist the user in exploration and selection of mappings.

    The methods and tools presented are general, but here only bindings between SNOMED CT and archetypes based on the openEHR reference model are presented in detail.

  • 28.
    Sundvall, Erik
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Qamar, Rahil
    Department of Computer Science University of Manchester, UK.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Forss, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Rector, Alan
    Department of Computer Science University of Manchester, UK.
    Integration of Tools for Binding Archetypes to SNOMED CT2008In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 8, no S7Article in journal (Refereed)
    Abstract [en]

    Background

    The Archetype formalism and the associated Archetype Definition Language have been proposed as an ISO standard for specifying models of components of electronic healthcare records as a means of achieving interoperability between clinical systems. This paper presents an archetype editor with support for manual or semi-automatic creation of bindings between archetypes and terminology systems.

    Methods

    Lexical and semantic methods are applied in order to obtain automatic mapping suggestions. Information visualisation methods are also used to assist the user in exploration and selection of mappings.

    Results

    An integrated tool for archetype authoring, semi-automatic SNOMED CT terminology binding assistance and terminology visualization was created and released as open source.

    Conclusion

    Finding the right terms to bind is a difficult task but the effort to achieve terminology bindings may be reduced with the help of the described approach. The methods and tools presented are general, but here only bindings between SNOMED CT and archetypes based on the openEHR reference model are presented in detail.

    Background

    The Archetype formalism and the associated Archetype Definition Language have been proposed as an ISO standard for specifying models of components of electronic healthcare records as a means of achieving interoperability between clinical systems. This paper presents an archetype editor with support for manual or semi-automatic creation of bindings between archetypes and terminology systems.

    Methods

    Lexical and semantic methods are applied in order to obtain automatic mapping suggestions. Information visualisation methods are also used to assist the user in exploration and selection of mappings.

    Results

    An integrated tool for archetype authoring, semi-automatic SNOMED CT terminology binding assistance and terminology visualization was created and released as open source.

    Conclusion

    Finding the right terms to bind is a difficult task but the effort to achieve terminology bindings may be reduced with the help of the described approach. The methods and tools presented are general, but here only bindings between SNOMED CT and archetypes based on the openEHR reference model are presented in detail.

  • 29.
    Sundvall, Erik
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Siivonen, Dominique
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Approaches to learning openEHR: a qualitative survey, observations, and suggestions2016In: Proceedings from the 14th Scandinavian Conference on Health Informatics 2016: Gothenburg, Sweden, April 6-7 2016 / [ed] Daniel Karlsson, Andrius Budrionis, Ann Bygholm, Mariann Fossum, Conceicao Granja, Gunnar Hartvigsen, Ole Hejlesen, Maria Hägglund, Monika Alise Johansen, Carl E Moe, Luis Marco-Ruiz, Vivian Vimarlund, Kassaye Y Yigzaw, Linköping: Linköping University Electronic Press, 2016, Vol. 122, p. 29-36Conference paper (Refereed)
    Abstract [en]

    Approaches such as ISO 13606 and openEHR aim to address data reusability by defining clinical data structures called archetypes and templates, based on a reference model. A problem with these approaches is that parts of them currently are rather difficult to learn. It can be hard to imagine what an archetype-based clinical system combined with modern terminology systems will look like and what consequences different modeling choices have, without seeing and experimenting with an operational system. This paper reports findings from a survey among openEHR learners and educators combined with observations of related openEHR mailing list discussions. The paper ends with an opinion piece, where we discuss potentially fruitful ways to learn, explore, and extend archetype-based EHR systems using visualization and examples.The findings highlight potential stumble blocks and solutions and should be of interest for both educators and self-learners.

  • 30.
    Åhlfeldt, Hans
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Petersson, Håkan
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Chen, Rong
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Nyström, Mikael
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Sundvall, Erik
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Advancement in the standardisation of the EHR2007In: 5th Scandinavian Conference on Health Informatics 2007, 2007Conference paper (Refereed)
1 - 30 of 30
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