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The overall objective of the EU-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four different terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.

The overall objective of the eu-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four different terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.

Objective: After a review of the existing practical solution available to the citizen to retrieve eHealth document, the paper describes an original specialized search engine WRAPIN. Method: WRAPIN uses advanced cross Lingual information retrieval technologies to check information quality by synthesizing medical concepts, conclusions and references contained in the health literature, to identify accurate, relevant sources. Thanks to MeSH terminology [1] (Medical Subject Headings from the U.S. National Library of Medicine) and advanced approaches such as conclusion extraction from structured document, reformulation of the query, WRAPIN offers to the user a privileged access to navigate through multilingual documents without Language or medical prerequisites. Results: The results of an evaluation conducted on the WRAPIN prototype show that results of the WRAPIN search engine are perceived as informative 65% (59% for a general-purpose search engine), reliable and trustworthy 72% (41% for the other engine) by users. But it leaves room for improvement such as the increase of database coverage, the explanation of the original functionalities and an audience adaptability. Conclusion: Thanks to evaluation outcomes, WRAPIN is now in exploitation on the HON web site (http://www.healthonnet.org), free of charge. Intended to the citizen it is a good alternative to general-purpose search engines when the user looks up trustworthy health and medical information or wants to check automatically a doubtful content of a Web page. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Constant assessment of the quality of health information on the Internet is an absolute necessity as peer review is often lacking in this media.To develop a simple and easy French Code of Ethics, which will enable medical students to judge quality of health information in teaching material available on the Internet.Three medical informaticians selected ten criteria from previously established codes of ethics from Europe and the USA. This instrument was tested on a sample of 30 health Internet teaching resources.For the panel of experts, chance corrected inter-observer agreement (kappa) for quality rating ranged from k = -0.19 and k = 0.33, demonstrating poor agreement among the raters.If negative results of this preliminary study are confirmed by further research, this finding may detrimentally affect projects in Europe to accredit or certify Internet health resources.

OBJECTIVES: To design and implement a medical web portal providing access to well qualified and high-quality information in the framework of universities and hospitals. METHOD: Based on the authors experience and the published literature, a model is proposed which describes the properties of documents in an object-oriented way. This model clearly separates from usual properties: the subject of a document as keywords, and information concerning its type, format, and location. RESULTS: An implementation has been done with an existing software that allows the capability to organize and index a web site according to the model. Experiments have been conducted which demonstrate the feasibility and the utility of such an approach. DISCUSSION: The benefits for the users, both designers and end users, of using such a portal are discussed. Forthcoming works are described.

The development of health care and hospital information systems has to meet users needs as well as requirements such as the tracking of all care activities and the support of quality improvement. The use of process-oriented analysis is of-value to provide analysts with: (i) a systematic description of activities; (ii) the elicitation of the useful data to perform and record care tasks; (iii) the selection of relevant decision-making support. But paper-based tools are not a very suitable way to manage and share the documentation produced during this step. The purpose of this work is to propose a method to implement the results of process analysis according to XML techniques (eXtensible Markup Language). It is based on the IDEF0 activity modeling language (Integration DEfinition for Function modeling). A hierarchical description of a process and its components has been defined through a flat XML file with a grammar of proper metadata tags. Perspectives of this method are discussed.

The Internet and the World Wide Web provide today end-users with capabilities to access universally to information in various and heterogeneous databases. The biomedical domain benefits from this new technology, specially for information retrieval by searching and browsing various sites. Nevertheless, end-users may be disoriented by specific ways to access information on different servers. In the framework of an Intranet design and development, we present a method for integrating information databases based on knowledge sources of the UMLS. The method provides designers of a Web site with facilities to implement an easy and homogeneous access to information. The pages are built dynamically and displayed according to a style sheet and their content stored in a database during the design phase. The database also describes the links between pages. Moreover, this organization provides administrators with powerful capabilities to manage Web sites.

The use of a taxonomy, such as the concept type lattice (CTL) of Conceptual Graphs, is a central structuring piece in a knowledge-based system. The knowledge it contains is constantly used by the system, and its structure provides a guide for the acquisition of other pieces of knowledge. We show how UMLS can be used as a knowledge resource to build a CTL and how the CTL can help the process of acquisition for other kinds of knowledge. We illustrate this method in the context of the MENELAS natural language understanding project.

INTRODUCTION Detection of clinical events from diverse electronic sources of information such as hospital discharge claims (HOSP), death registries (DEATH), laboratory values (LAB), and general practice databases (GP) may be useful for various epidemiological purposes. In particular, the EU-ADR project aims to detect adverse events deemed to be important in pharmacovigilance. Eight databases (DBs) from four countries, combining different sources of information, participate in the project. A common conceptual framework was lacking to describe harmoniously the algorithm by which each DB detected each event. OBJECTIVES Describe the algorithms that 8 different DBs used to identify 6 events: Acute myocardial infarction (AMI), Acute Renal Failure (ARF), Anaphylactic Shock (AS), Bullous Eruption (BE), Rhabdomyolysis (RHABD), Upper Gastrointestinal Bleeding (UGIB). Benchmark corresponding incidence rates (IRs). METHODS A list of medical concepts corresponding to each event of interest was provided and projected to the DSs different coding systems (ICD9, ICD10, READ, ICPC) and natural languages through the Unified Medical Language System (UMLS). Specific sources of information contained in each DB were classified in a common framework and DBs with similar structures were asked to search for concepts within the same sources. RESULTS Concepts were mainly searched for in GP diagnoses and primary diagnoses of HOSP, but for some events DEATH (AMI, ARF, AS) and LAB (RHABD) were independently used by DBs having them. Resulting age-adjusted IRs vary as follows across DBs: 1-2/1,000PY (AMI), 3-7/10,000PY (UGIB), 2-12/100,000PY (AS), 2-17/100,000PY (BE), 1-8/100,000PY (RHABD), 3-49/100,000PY (ARF). CONCLUSIONS It is possible to describe event extractions from heterogeneous DBs in a common conceptual framework. Residual differences in IRs may be due either to differences in the underlying populations or to differences in the characteristics (structure, coding system) of the DBs.

Background: Constant assessment of the quality of health information on the Internet is an absolute necessity as peer review is often lacking on this media. Objective: To develop a simple and easy French Code of Ethics which will enable medical students to judge quality of health information in teaching material available on the Internet. Design: Three medical scientists selected nine criteria from previously established codes of ethics from Europe and the USA. This instrument was tested on a sample of 24 health French-speaking Internet teaching resources. Results: For the panel of experts, we analyzed assessments with non parametric tests. This analysis demonstrated a strong agreement among the raters. Conclusion: It seems possible to produce an analysis summary to evaluate teaching material available on the Internet.

We describe in this paper, the implementation of a clinical practice guideline focused on breast cancer screening. Our aim in conceiving such a computerized guideline was first to help general practitioners in appreciating the risks their female patients might develop breast cancer and secondly to suggest them the screening measures adapted to each particular case. This implementation enables us to present our general methodology to elaborated and promulgate guidelines within the EsPeR project. This methodology aims at providing guidelines based on knowledge validated according to the EBM principles, that can be used in real time and updated according to current knowledge.

The compliance of physicians with the clinical practice guidelines (CPG) is insufficient and needs to be improved.To determine whether standalone computerized CPG within the PRESGUID project could improve compliance with the recommendations than the use of CPG in textual format.Comparative analyses of the responses made by two groups of resident physicians to a set of clinical cases. One group of residents had access to the CPG exclusively in textual format (paper document) while the second group had access to the CPG exclusively in computerized format within the PRESGUID software applications.The computable CPG are more efficient than the paper-based CPG regarding responses in compliance with the recommendations especially those judged to be relevant by an expert.These results should encourage the bodies responsible for diffusing CPG to promote the computable format and to facilitate the computerization process.

Context: The creation of the French Virtual Medical University, has been launched to share common resources and specific tools or developments in conjunction with the reform of medical studies in French Medical Schools. The project is aimed at using New Information and Communication Technology (NICT) to support New Education Technology (NET) in the health and medical Education field. This paper presents the task on video tools involving three Medical Schools for creating teaching resources. In this context, the ability of the medical informatics experts appears to be very useful in the field of medical e-learning because they can create an interface between teachers, students and the Medical Schools to support new pedagogical approaches. This paper presents the design and the specifications, which are defined to achieve these goals.

International audience; In order to develop an internet-based decision support system, making available for French general practitioners several prevention guidelines is was necessary to implement paper based guideline. We propose a framework allowing to transform paper based practice guideline into their electronic form. Three different problems were identified: computability (e.g. determinism of the eCPG), logic (e.g. ambiguities when combining Booleans operators) and external validity (i.e. stability of decision for variations around thresholds and proportion of subjects classified in the various terminal nodes). The last problem concerned documentation of evidence: the level of evidence was associated only with the terminal decision node and not with the pathway through the decision tree. We concluded that computerisation of guidelines is not possible without expertise or authors advice. To improve computability it is necessary to provide authors with a framework that checks ambiguities, and logical errors.

International audience; This paper is the description of a French Virtual Medical University based on the federation of existing or currently being developed resources in several Medical Schools in France. The objectives of the project is not only to share experiences across the country but also to integrate several resources using the New Information and Communication Technologies to support new pedagogical approaches for medical students and also for continuing medical education. The project includes: A virtual Medical Campus using secure access from several sites, The Integration of new interactive resources based on pedagogical methods, Implementation of new indexing and search engines based on medical vocabularies and ontologies, The definition of general and specific portals, the evaluation of the system for ergonomics and contents.

Most e-learning systems offer the same tools and resource materials to students who are different in terms of motivations, training backgrounds, technical skills and learning objectives. Adaptive systems development is a challenge intended to improve the efficiency of these systems. This communication presents the design and implementation of an adaptive medical e-learning environment. The authors describe the MEDIDACTE architecture developed in three levels namely, the educational resource, educational project and user level. Current MEDIDACTE implementation and integration in Marseille Medical University curriculum are presented.

International audience; Primary antibody deficiency (PAD) is characterized by a defective immunoglobulin production and recurrent infections, mostly involving respiratory and gastrointestinal tracts. Chronic or recurrent diarrhea is reported in up to 23%. Campylobacter infection is a common cause of infectious diarrhea, reported in 1.2% to 7.5% of patients with common variable immunodefi-ciency (CVID), the most frequent PAD. The aim of this study was to describe Campylobacter infection in patients with PAD included in a large nationwide study and analyze factors associ-ated with susceptibility to this pathogen. The DEFI (DEFicit Immunitaire) study is an ongoing large cross-sectional French multicentric study of adults with PAD, with retrospective collection of clinical data. All patients with a history of bacteriologically documented Campylobacter infection were identified, and clinical data were collected for each episode. Factors associated with recurrent infection were assessed as oddsratio (OR) and 95% confidence interval (CI), calculated by means of simple regression analysis. In patients with available material, strains of each episode were characterized using molecular analysis and compared (Table E1, available in this article’s Online Repository at www.jaci-inpractice.org). A com-parison of immunodeficiency-related characteristics of patients with and without Campylobacter infection was performed in the homogeneous group of patients with CVID. The control group included patients with CVID from DEFI centers who confirmed that patients did not develop Campylobacter infection after enrollment (Figure E1, available in this article’s Online Repository at www.jaci-inpractice.org). After correction for multiple comparisons, P

BACKGROUND Common variable immunodeficiency (CVID) is a primary immune deficiency defined by defective antibody production. In most series, a small proportion of patients present with opportunistic infections (OIs). METHODS The French DEFI study has enrolled patients with primary hypogammaglobulinemia and allows a detailed clinical and immunologic description of patients with previous OIs and/or at risk for OIs. RESULTS Among 313 patients with CVID, 28 patients (8.9%) presented with late-onset combined immune deficiency (LOCID), defined by the occurrence of an OI and/or a CD4(+) T cell count

OBJECTIVE: Data from electronic healthcare records (EHR) can be used to monitor drug safety, but in order to compare and pool data from different EHR databases, the extraction of potential adverse events must be harmonized. In this paper, we describe the procedure used for harmonizing the extraction from eight European EHR databases of five events of interest deemed to be important in pharmacovigilance: acute myocardial infarction (AMI); acute renal failure (ARF); anaphylactic shock (AS); bullous eruption (BE); and rhabdomyolysis (RHABD). DESIGN: The participating databases comprise general practitioners' medical records and claims for hospitalization and other healthcare services. Clinical information is collected using four different disease terminologies and free text in two different languages. The Unified Medical Language System was used to identify concepts and corresponding codes in each terminology. A common database model was used to share and pool data and verify the semantic basis of the event extraction queries. Feedback from the database holders was obtained at various stages to refine the extraction queries. MEASUREMENTS: Standardized and age specific incidence rates (IRs) were calculated to facilitate benchmarking and harmonization of event data extraction across the databases. This was an iterative process. RESULTS: The study population comprised overall 19 647 445 individuals with a follow-up of 59 929 690 person-years (PYs). Age adjusted IRs for the five events of interest across the databases were as follows: (1) AMI: 60-148/100 000 PYs; (2) ARF: 3-49/100 000 PYs; (3) AS: 2-12/100 000 PYs; (4) BE: 2-17/100 000 PYs; and (5) RHABD: 0.1-8/100 000 PYs. CONCLUSIONS: The iterative harmonization process enabled a more homogeneous identification of events across differently structured databases using different coding based algorithms. This workflow can facilitate transparent and reproducible event extractions and understanding of differences between databases.

The overall objective of the EU-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four different terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.

This paper reports the processes and initial outcomes of a pilot study which investigated a week long ‘virtual’ children’s ward experience for nursing students. Providing sufficient and meaningful experiences which enable students to quickly and effectively achieve competence in diverse areas of practice is often frustrated by the realities of available clinical experiences. Our response to this challenge was to more fully exploit and evaluate technologies which can be used to provide these learning experiences. Students experienced ‘real time’ scenario based work involving SIM-MAN; interactive information technology scenarios, critical incidents, master classes, video conferencing, and observational skill development exercises. Evaluation methodologies included observation of student performance, competence self rating scales; analysis of videotaped performance episodes and other data generated through the learning activities and lived experience accounts of participants. Initial findings indicate(1) statistically significant improvements in student competence measured through self reports; and (2) evidence of improvement gleaned from observed accounts, video analysis and qualitative evaluative comments. The final outcomes, including work with a control group, will be available for Conference.

This paper reports on a Virtual Interactive Practice (VIP) project that has the potential to revolutionise the educational delivery and learning of clinical skills complementing "real" practice. The focus is currently on nurse learning but the principles could equally be applied to multi and inter-professional learning and clinical decision-making. This project represents a new model to enhance clinical skill acquisition and clinical reasoning using a structured competency base. Integral to this is a strong partnership between education and practice utilising "real" live and recorded anonymised patient data from a critical care clinical information system (CIS) within a large district general hospital to structure scenarios fostering problem-based learning. This educational practice interface enables the synthesis of clinical data using virtual technology and sophisticated scenario-based simulation within a skills laboratory. The aim is to enhance the more ad hoc system of learning within conventional practice placements. Early findings suggest that VIP enhances practice providing a safe but challenging learning experience with the benefit of instant performance feedback to students.

The benefits of structured data are widely accepted within the nursing informatics community. However, despite the exis-tence of structured data in the form of well-established nurs-ing terminologies, computer-based nursing record systems are yet to achieve widespread adoption and few of the poten-tial benefits have yet to be realized. In this paper we argue the need for tools and techniques to support the entry of structured nursing data into computer-based systems. In the absence of a generally accepted solution, we build on preliminary work carried out at the 2002 Nursing Terminology Summit and analyze the results of other studies in order to identify a preliminary set of requirements or desiderata for such tools and techniques. These requirements are centered on: how structured data is presented to users for selection; how to mediate between a variety of conceptual structures -terminologies, information models, user interface models and models of the clinical process; and how to reduce the considerable modeling burden through re-use of modeling constructs. Further applied research is needed with the ultimate goal of developing a general solution that will benefit nurses, other professionals and ultimately their patients.

Summary The Danish Health IT strategy [Danish Ministry of Interior and Health, National Strategy for IT in the Health Sector 2003–2007, Copenhagen, 2003 (in Danish). http://www.im.dk/publikationer/itstrategi/itstrategi.pdf . [1] ] notes that integration between electronic health records (EHR) systems has a high priority. A prerequisite for real integration and semantic interoperability is agreement of the data content and the information models. The National Board of Health is working on a common model for EHR, and its adoption is now being promoted through pilot projects. At the same time, several development and implementation projects are taking place at a regional level. These EHRs are built on information models from different vendors and are based on different integration platforms. The Danish EHR observatory, which has been monitoring the development of EHRs in Denmark since 1998, has analysed the challenges of using different information models and integration platforms. This paper also maps the development in Denmark to the new paradigms in modelling techniques and integration technology.