Papers by Christian Lovis
Yearbook of Medical Informatics, 2007
SummaryElectronic patient record (EPR) systems are increasingly used and have matured sufficientl... more SummaryElectronic patient record (EPR) systems are increasingly used and have matured sufficiently so as to contribute to high quality care and efficient patient management. Our objective is to summarize current trends and major achievements in the field of EPR in the last year and to discuss their future prospects.Integrating health data from a variety of sources in a comprehensive EPR is a major prerequisite for e-health and eresearch. Current research continues to elaborate architectures, technologies and security concepts. To achieve semantic interoperability standards are developed on different levels, including basic data types, messages, services, architectures, terminologies, ontologies, scope and presentation of EPR content. Standards development organisations have started to harmonize their work to arrive at a consensus standard for EPR systems. Integrating the health care enterprise as a whole will optimize efficient use of resources, logistics and scheduling.The past few...
Current state of clinical information exchange in six countries
The objective of this panel is to describe the current state of clinical information exchange in ... more The objective of this panel is to describe the current state of clinical information exchange in patient care delivered today in England, the US, Switzerland, Scotland, India, and China. Each panel member will describe the level of EMR use and information exchange infrastructure and then will use two scenarios to illustrate how information exchange occurs today. Members will also discuss barriers to clinical information to exchange experienced in the country or overcome, and current examples of exchange of clinical information across national borders.
Journal of the American Medical Informatics Association : JAMIA
Advances in information technology (IT) enable a fundamental redesign of health care processes ba... more Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.
International Journal of Epidemiology, 1998
Background This study aimed to identify predictors of inappropriate hospital days in a department... more Background This study aimed to identify predictors of inappropriate hospital days in a department of internal medicine, as a basis for quality improvement interventions. Methods The appropriateness of 5665 hospital days contributed by 500 patients admitted to the Department of Internal Medicine, Geneva University Hospitals, Switzerland, was assessed by means of the Appropriateness Evaluation Protocol. Predictor variables included patient's age and sex, manner of admission and discharge, and characteristics of hospital days (weekend, holiday, sequence). Results Overall, 15% of hospital admissions and 28% of hospital days were rated as inappropriate. In multivariate models, inappropriate hospital days were more frequent among patients whose admission was inappropriate (odds ratio [OR] = 5.3, 95% CI : 3.1-8.4) and among older patients (80-95 years: OR = 3.6, 95% CI: 1.7-7.0, versus <50 years). The likelihood of inappropriateness also increased with each subsequent hospital day, culminating on the day of discharge, regardless of the total length of stay. Conclusions This study identified both the admission and the discharge processes as important sources of inappropriate hospital use in a department of internal medicine. The oldest patients were also at high risk of remaining in the hospital inappropriately. Surprisingly, long hospital stays did not generate a higher proportion of inappropriate days than short hospital stays. This information proved useful in developing interventions to improve the hospitalization process. Keywords Health services research, hospitalization, appropriateness of health care Accepted
European Journal of Epidemiology, 2013
In Switzerland, organ procurement is well organized at the national-level but transplant outcomes... more In Switzerland, organ procurement is well organized at the national-level but transplant outcomes have not been systematically monitored so far. Therefore, a novel project, the Swiss Transplant Cohort Study (STCS), was established. The STCS is a prospective multicentre study, designed as a dynamic cohort, which enrolls all solid organ recipients at the national level. The features of the STCS are a flexible patient-case system that allows capturing all transplant scenarios and collection of patientspecific and allograft-specific data. Beyond comprehensive clinical data, specific focus is directed at psychosocial and This study is conducted on behalf of all members of the Swiss Transplant Cohort Study.
Do Physicians Modify Their Prehospital Management of Patients in Response to a Public Campaign on Chest Pain?
The American Journal of Cardiology, 1998
The goals of this study were to analyze the impact of a public campaign on chest pain on physicia... more The goals of this study were to analyze the impact of a public campaign on chest pain on physicians involved in the prehospital care of patients with this symptom, in terms of physician delay, rates of immediate hospitalization, and of transportation by ambulance. Prehospital delays and decisions for all 866 patients with chest pain managed by the community and generalist physicians or by emergency physicians, who presented to the emergency department of a teaching hospital during the 12 months of the campaign, were compared with those of all 749 patients with similar presentations during the 12 months before it. When community and generalist physicians were involved, median (110 minutes) physician delay did not decrease during the campaign, whereas it decreased from 65 to 56 minutes (p &lt;0.003) when emergency physicians were involved. Rates of immediate hospitalization (73%) and of transportation by ambulance (47%) of patients managed by community and generalist physicians were unaffected by the campaign, whereas they increased from 96% and 89%, respectively, to 98% (p = 0.09) and 94% (p &lt;0.02) when emergency physicians were involved. Similar observations were made in patients with confirmed acute myocardial infarction and unstable angina and remained highly significant after adjustment for differences in clinical characteristics. Thus, community and generalist physicians did not significantly modify their prehospital management of patients with chest pain despite a public campaign. To be successful, guidelines on the matter have to be developed with the active participation of these physicians.
Studies in health technology and informatics, 2012
Reaching a good indoor geolocation without deploying extensive and expensive infrastructure is a ... more Reaching a good indoor geolocation without deploying extensive and expensive infrastructure is a challenge, because satellite positioning system is not available indoors. Geolocation could be of major use in healthcare facilities; to help care providers, visitors and patients to navigate, to improve movements and flows efficiency or to implement location-awareness systems. A system able to provide the location of a person in a hospital requires precision, multi-floors and obstacles management and should also perform in basements and outdoors. Such system needs also to be insensitive to environmental variations occurring in a hospital. These changes may be various kinds of obstacles. These can be the displacement of metallic objects, metallic machines, strong magnetic fields or simply human displacement. A system conforming to the above requirements can also answer various security questions, operational workflow management but also assist movement of people.
Studies in health technology and informatics, 1998
Automatic extraction of knowledge from large corpus of texts is an essential step toward linguist... more Automatic extraction of knowledge from large corpus of texts is an essential step toward linguistic knowledge acquisition in the medical domain. The current situation shows a lack of computer-readable large medical lexicons, with a partial exception for the English language. Moreover, multilingual lexicons with versatility for multiple languages applications are far from reach as long as only manual extraction is considered. Computer-assisted linguistic knowledge acquisition is a must. A multilingual lexicon differs from a monolingual one by the necessity to bridge the words in different languages. A kind of interlingua has to be built under the form of concepts to which the specific entries are attached. In the present approach, the authors have developed an intelligent rule-based tool in order to focus on a multilingual source of medical knowledge, like the International Classification of Disease (ICD) which contains a vocabulary of some 20,000 words, translated in numerous langua...
Swiss medical informatics, 2005
Image management, analysis, and retrieval are currently very active research fields mainly becaus... more Image management, analysis, and retrieval are currently very active research fields mainly because of the large amount of visual data being produced in modern hospitals, and the lack of applications dealing with these data. Most often, the goal is to aid the diagnostic process. Unfortunately, only very few medical image retrieval systems are currently used in clinical routine. One application domain with a high potential for automatic image retrieval is the analysis and retrieval of lung CTs. A first user study in the United States (Purdue University) shows that these systems allow improving the diagnostic quality significantly. This article describes an approach to an aid for lung CT diagnostics. The analysis incorporates several steps and the goal is to automate the process as much as possible for easy integration into clinical processes. Thus, several automatic steps are proposed from a selection of the most characteristic slices, to an automatic segmentation of the lung tissue a...
Swiss Medical Informatics, 2012
Studies in health technology and informatics, 2015
The interpretation of laboratory results is a critical part of the clinical decision making proce... more The interpretation of laboratory results is a critical part of the clinical decision making process. The proper understanding of many clinical conditions depends on the identification of evidences in the laboratory reports. If the classic tabular presentation of laboratory results has demonstrated its efficiency since many years, the increase number of potential results, the increased complexity of cases and the time shortage to analyses cases raise the question of finding more efficient ways of displaying these results to clinicians. The presentation layer becomes even more crucial when it comes to small-sized interactive displays. In this work, we discuss three alternative graphical representations of laboratory results adapted to handheld devices.
The Digital Pen and Paper
Methods of Information in Medicine, 2005
Summary Objectives: To evaluate the efficiency and acceptance of digital pen and paper technology... more Summary Objectives: To evaluate the efficiency and acceptance of digital pen and paper technology for real-time clinical data acquisition. Methods: A prospective interventional unblinded study involving consecutive patients in two clinical settings during a defined time-frame was proposed. The first trial was designed as a stress test to evaluate acceptance in a workload-intensive environment. Acceptance was assessed using observations and a satisfaction questionnaire. The second trial was intended to determine the reliability of data acquisition in a controlled environment. Reliability was assessed by comparing the performance of the digital pen against scanner analysis and a double human blinded acquisition. Results: Overall, users were satisfied with the use of the digital pen (median 3 on a Likert-scale (–5, 5)). Without any specific user training, successful data acquisition was greater than 80%. Use of this technology required less adaptation than standard computer devices, an...
Nursing care nomenclatures: Real implementation in the computerized patient care record
Studies in health technology and informatics
We report our experience in the conception and the use of a detailed nursing care documentation e... more We report our experience in the conception and the use of a detailed nursing care documentation electronic record. This nursing care record is completely nomenclature driven, including the user-interface. International nomenclatures or classifications such as NANDA are used. They have been translated to French and their language adopted to the local practice habits. This nursing CPR is used in nineteen wards in the five campuses of the University Hospitals of Geneva, covering a broad range of nursing care types, such as acute adult and paediatric care, surgery, general internal medicine, geriatrics, in- and outpatient psychiatry and long-term rehabilitation. This paper focuses on the problematic of the use of nomenclatures and classification in a nursing daily practice, particularly the social and behavioural challenges that had to be faced. The rationale behind the use of these nomenclatures is presented. We present some of the techniques that have been used to make a nomenclature-driven nursing CPR more attractive for nurses.
Comprehensive management of the access to a component-based healthcare information system
Medical Informatics Europe, 2006
to describe the key concepts and elements used to implement a comprehensive access management sys... more to describe the key concepts and elements used to implement a comprehensive access management system to a distributed, component-based healthcare information system. the a priori access is based on an institution-wide policy for access rights coupled to proximity process for the granting of such rights. Access rights are explicit and externalized from the information systems components. A posteriori control is based on a centralized, exhaustive journal of accesses to all components coupled to a decentralized verification process for suspicious accesses. the system has been operational for three years, initially used for the access to the computerized patient record components, and now extending to all the components of the hospital information system. The same architecture will be used for the development of the trans-institutional community health information network.
Studies in health technology and informatics, 2005
Terminologia Anatomica (TA) is the new standard in anatomical terminology. This terminology is av... more Terminologia Anatomica (TA) is the new standard in anatomical terminology. This terminology is available only in Latin and English and its worldwide adoption is subdued to the addition of terms from others languages. On the other hand Nomina Anatomica (NA), the previous standard, has been widely translated. Aim of this work was to append foreign terms to TA by using similarity matching algorithm between its Latin terms and those from NA. A semi-automatic matching of Latin terms from TA with those of NA was performed using a string-to-string distance algorithm and manual assessment. We used a French - Latin version of NA together with TA and we suggested French terms for TA. Coverage was evaluated by the number of exact and approximate matches. A target of 80% was set due to the superior number of terms in TA compared to NA. Relevance was estimated by manually comparing the meanings of the English and French terms related to the same Latin term. The question was whether they refer to...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2003
to evaluate the feasibility, potential and risks of an internet-based telemedicine network in dev... more to evaluate the feasibility, potential and risks of an internet-based telemedicine network in developing countries of Western Africa. a project for the development of a national telemedicine network in Mali was initiated in 2001, using internet-based technologies for distance learning and teleconsultations. the telemedicine network has been in productive use for 12 months and has enabled various collaboration channels, including North-South, South-South, and South-North distance learning and teleconsultations. It also unveiled a set of potential problems: a) limited pertinence of North-South collaborations when there are major differences in available resources or socio-cultural contexts between the collaborating parties; b) risk of induced digital divide if the periphery of the health system is not involved in the development of the network, and c) need for the development of local medical contents management skills. the identified risks must be taken into account when designing la...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2003
This paper presents how acquisition, storage and communication of clinical documents is implement... more This paper presents how acquisition, storage and communication of clinical documents is implemented at the University Hospitals of Geneva. Careful attention has been given to user-interfaces, in order to support complex layouts, spell checking, and templates management with automatic prefilling. A dual architecture has been developed for storage using an entity-attribute-value unified database and a consolidated, patient-centered, layout-respectful file-based storage, providing both representation power and speed of access. This architecture allows a great flexibility for storing a continuum of data types, ranging from simple typed values to complex clinical reports. Finally, communication is entirely based on HTTP-XML internally, and a HL-7 CDA interface V2 is currently studied for external communication. Some of the problems encountered, mostly related to the typology of documents and the ontology of clinical attributes are evoked.
PLoS ONE, 2013
Background: Antibiotic resistance is a major worldwide public health concern. In clinical setting... more Background: Antibiotic resistance is a major worldwide public health concern. In clinical settings, timely antibiotic resistance information is key for care providers as it allows appropriate targeted treatment or improved empirical treatment when the specific results of the patient are not yet available. Objective: To improve antibiotic resistance trend analysis algorithms by building a novel, fully data-driven forecasting method from the combination of trend extraction and machine learning models for enhanced biosurveillance systems. Methods: We investigate a robust model for extraction and forecasting of antibiotic resistance trends using a decade of microbiology data. Our method consists of breaking down the resistance time series into independent oscillatory components via the empirical mode decomposition technique. The resulting waveforms describing intrinsic resistance trends serve as the input for the forecasting algorithm. The algorithm applies the delay coordinate embedding theorem together with the k-nearest neighbor framework to project mappings from past events into the future dimension and estimate the resistance levels. Results: The algorithms that decompose the resistance time series and filter out high frequency components showed statistically significant performance improvements in comparison with a benchmark random walk model. We present further qualitative use-cases of antibiotic resistance trend extraction, where empirical mode decomposition was applied to highlight the specificities of the resistance trends. Conclusion: The decomposition of the raw signal was found not only to yield valuable insight into the resistance evolution, but also to produce novel models of resistance forecasters with boosted prediction performance, which could be utilized as a complementary method in the analysis of antibiotic resistance trends.
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Papers by Christian Lovis