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SGML document instance generated from the values entered on the data-entry form shown in Figure 2.
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Structured reporting systems use standardized data elements and predetermined data-entry formats to record observations. This article describes a system for structured data entry and reporting that generates reports encoded in the Standard Generalized Markup Language (SGML), an open, internationally accepted standard for document interchange. The s...
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... As above, a specialized class of CBD systems called Structured Entry systems allow users to document clinical care by selecting or modifying categorical concepts that are typically organized into templates. Structured entry systems are typically designed to capture structured and machine-readable data directly from the healthcare provider in real time, [63] to produce data that can facilitate automated reminders and alerts while providing an infrastructure for clinical other uses (e.g., automated billing, research, quality assur- ance). The following CBD systems have been implemented into the institution's clinical environment, from the least to the most structured and standardized. ...
Clinical notes summarize interactions that occur between patients and healthcare providers. With adoption of electronic health record (EHR) and computer-based documentation (CBD) systems, there is a growing emphasis on structuring clinical notes to support reusing data for subsequent tasks. However, clinical documentation remains one of the most challenging areas for EHR system development and adoption. The current manuscript describes the Vanderbilt experience with implementing clinical documentation with an EHR system. Based on their experience rolling out an EHR system that supports multiple methods for clinical documentation, the authors recommend that documentation method selection be made on the basis of clinical workflow, note content standards and usability considerations, rather than on a theoretical need for structured data.
... Even after a system is deployed, end users may have the need to adjust report formats and/or contents, and to create new reports due to the changes of business practices. Though the need of a flexible reporting method has existed for a long time, it has received little research attention [14,15]. This paper presents a configuration-based reporting method that can be used to develop flexible reporting solutions. ...
... Elements in reports cannot be added or changed without the modification of information systems [14]. Hampered by limited technologies, redesign and redevelopment are dominant approaches to deliver tailored reporting solutions for companies [15]. This usually leads to the long deployment cycle and high implementation cost of enterprise information systems. ...
Reports are significant and critical deliverables provided to end users by enterprise information systems, such as PLM and ERP. They provide structured and concise information for end users to effectively capture the status of resources, track the progress of jobs and analyse the profitability of products, etc. Reports are also key documents that help managers make decisions, perform planning activities and communicate with partners. At present, enterprise information systems are usually developed with fundamental reporting capabilities and require further design and development to provide customized reporting functions to individual customers at an implementation stage. The customization of reporting functions to a particular company is time-consuming and it is difficult to reuse the results for other companies. This paper proposes a configuration-based flexible reporting method. In this method, a complete reporting system consists of two parts: report configurations and computer programs. Reporting configurations contain instructions that instruct computer programs to generate reports. As computer programs work according to instructions in configurations rather than any hard-coded report generation logics and configurations can be represented in a neural format, report generation logics are loosely coupled with computer programs. As a result, such a reporting system can generate reports for different companies by providing different sets of configurations. Therefore, the proposed method enables to achieve a highly flexible reporting solution that can be easily tailored for different companies through reconfiguration with little redesign and redevelopment. In addition, the method also offers end users opportunities to reconfigure reporting functions according to their needs at a production stage. A prototype system has been developed to verify and demonstrate the method.
... We have chosen to use structured data entry to support the entry of good quality data by clinicians. Structured data entry in general is better developed than automated extraction using natural language processing, with other groups adopting this approach [13,14,15,16]. Our approach has the benefit of integrating completely into an ICD-9-CM based system (with the flexibility to move to ICD10 or any other coding system if required), using dynamically created screens (so new diseases can be easily added), and an extremely easy to user interface. ...
Routine databases containing large amounts of clinical data represent a tremendous opportunity for the evaluation of health care practices and outcomes. However, data collected for administrative purposes has limitations in content, accuracy and completeness. Routine entry of clinical information directly into clinical information systems by care providers is one strategy to address this problem. We developed a structured data entry method, the Clinical Data Framework (CDF), which has been used to support the capture of clinical information by clinicians in the normal process of care delivery. A study of the CDF over a two month period showed that it improved the accuracy of completeness of data collection over a coding method which was based on selection of ICD-9-CM codes.
... 2, tags locate a medication name, or a dose, or a frequency or a duration. Such documents are today used to make system-to-system communication [22,23], but cannot be realistically used to capture medical records: writing such documents is really time consuming, and we are sure no doctor or nurse could find time to write strongly-structured documents. ...
This article presents a global view of our proposal for a medical information system of the future. This information system focuses on patient medical records management. As most of the existing systems, it proposes to store information from patient records in a database. But records capture is different: we propose to use weakly-structured documents. Such documents contain paragraphs with some specific constraints represented by XML tags. The end-user writes new information under the form of weakly-structured documents. An internal system translates theses documents into new data for the internal database. Such a document-based user interface provides much more freedom to the end-user, and certainly reduces the distance between the physicians' way of working and the capture system.
... We sought to integrate existing Web-based systems for structured reporting (SPIDER) and probabilistic decision support (BANTER). Structured Reporting SPIDER (Structured Platform-Independent Data Entry and Reporting) uses open information standards to achieve platform-independent entry of structured reports [13,14]. SPIDER can accommodate a variety of reporting applications that contain hierarchically organized concepts [15]. ...
... From the data entered through the Web interface, SPIDER can create textual reports or XML documents. The XML documents include a report-specific DTD that defines the allowable data fields and values; the resulting report is thus both portable and self-defining [13,14]. SPIDER currently runs on a Sun Netra i5 Internet Server (Sun Microsystems, Palo Alto, CA) and the Netscape Enterprise Server 3.0 (Netscape Communications, Mountain View, CA). ...
The Extensible Markup Language (XML) is a newly adopted Internet protocol for data interchange designed to bring the key features of the Standard Generalized Markup Language (SGML; ISO 8879:1986)--extensibility, complex structures, and validation--to the World Wide Web. In this paper, we describe an architecture that uses XML to mediate between disparate client-server systems for structured reporting and decision support.
... [9], eDict[10], PointDx[11], PenRad[12], and SPIDER[13]. ...
This paper analyzes the use of structured radiology reports since 1997 at Midway Hospital Medical Center, which is a full-modality 150-bed community hospital located in Los Angeles, California. We describe the transition from a conventional transcription-based reporting system to one in which radiologists create reports for twelve radiology modalities directly through a structured reporting system. More than 160,000 structured radiology reports have been produced with the structured system. Compared to transcription, the structured reporting system has: (1) Improved the quality and consistency of reports. (2) Enabled instantaneous dissemination of reports to improve patient care and to decrease hospital stays. (3) Eliminated transcription costs. (4) Automated abstraction of reports with CPT and ICD-9 codes. The success of this system depends crucially on the completeness of structured report templates, as well as the ability to produce natural English sentences from structured input.
... Reporting) utiliza padrões de informação aberta para armazenar registros, independentes de plataforma, de relatórios estruturados [9]. O SPIDER pode acomodar uma variedade de aplicações relatórios, que contêm conceitos armazenados hierarquicamente [10]. ...
... Da entrada de dados, através da interface Web, o SPIDER pode criar relatórios textuais ou documentos XML. Os documentos XML incluem DTDs específicos, que definem os campos de dados e valores permitidos; o relatório fornecido é portável e possui autodefinição [9]. O SPIDER é executado, atualmente, um Netra i5 Sun Internet Server (Sun Microsystems, Palo Alto, CA) e no Netscape Enterprise Server 3.0 (Netscape Communications, Mountain View, CA). ...
Programa de Pós-graduação em Tecnologia em Saúde – PUCPR, Curitiba-PR, Brasil Resumo -Com o avanço da Web, a linguagem XML (eXtensible Markup Language) vem se tornando um padrão para armazenamento e interoperabilidade entre sistemas de informação. Esta tendência vem influenciando os Sistemas de Informação em Saúde, em projetos como: Synapses, SynEx, SPIDER, BANTER e MedLEE. Este artigo apresenta o papel do XML nestes projetos e o seu impacto na Informática em Saúde. Palavras-chave: XML, DTD, SGML, HTML, Sistema de Informação em Saúde, World Wide Web. Abstract – With Web growing, XML language (eXtensible Markup Language) is becoming a standard to storage and interoperability information systems. This tendency is affecting Health Information Systems, on projects like: Synapses, SynEx, SPIDER, BANTER and MedLEE. This article shows the XML function on these projects and his impact on Health Informatics.
Usually, physicians need radiology reports to diagnose their patients' illness. Radiology reports are mostly stored as unstructured text from which information retrieval is difficult. As a consequence, interpreting unstructured radiology reports automatically needs sophisticated text
mining algorithms. In this paper, we propose a new approach for structuring textual radiology reports. In the proposed approach radiology experts provide a set of patterns each of which consists of items with specific properties. Using the patterns as class labels, a radiology report is then
classified based on the items found in its sentences. In the proposed approach, the given radiology report is first classified by a Naïve Bayes classifier to support uncertainty. Then, a Boolean classifier is applied to the report which uses exact matching to achieve high precision. Finally,
a Case-Based Reasoning classifier is used to learn new patterns from the report if there is any. The experimental results show that the proposed approach can dynamically classify radiology reports with high precision.
The impact of freeze–thaw cycles on the physical stability of oil-in-water emulsions containing lecithin – coated and modified starch – coated droplets has been studied by combined dynamic light scattering (DLS) and differential scanning calorimetry (DSC) measurements. Emulsions prepared by high-pressure homogenization were within 200 nm size ranges. Lecithin-based emulsion systems were unstable to freeze–thaw cycles, which was attributed to extensive droplet aggregation induced by the ice formation during emulsion freezing process. Instead, modified starch systems were highly stable due to the formation of a thick layer of emulsifier which prevented the coalescence of nanoemulsions. The addition of ice nucleating protein lowered the freeze–thaw stability of lecithin-based emulsions, but had negligible effect on modified starch-based emulsions. In contrast, the addition of poly(ethylene glycol) improved the stability of lecithin-based emulsions but destabilized the modified starch-based emulsion systems.Graphical abstract
This paper analyzes an approach of using knowledge management mechanism as the foundation for structured reporting in a wide range of im-aging modalities. As background, this paper starts by describing a case study in which a 150-bed community hospital located in Los Angeles transitioned from a conventional transcription-based reporting system to one that allows radiologists to create reports for twelve radiology modalities directly through a structured reporting system. More than 200,000 structured radiology re-ports were produced with the structured system. When compared to tran-scription, the structured reporting system has: (1) improved the quality and consistency of reports, (2) enabled instantaneous dissemination of reports to improve patient care and to decrease hospital stays, and (3) eliminated tran-scription costs. Broad base acceptance of structured reporting systems for a wide range of modalities is still in doubt as other commercial structured re-porting systems target only niche modalities, such as ultrasound. The suc-cess of structured reporting for a wide range of modalities was first thought to be hinged on such factors as completeness of structured report templates, the ability to produce normal language sentences from structured input, as well as to the blending of free-form text input from speech recognition. Sub-sequent analysis reveals other important success factors.
