Medical Informatics Europe '96

Human Facets in Information Technologies

Edited by

J. BrenderAalborg University, Aalborg, Denmark

J.P. ChristensenEuropean Commission DG XIII/C-5, Brussels, Belgium

J.-R. ScherrerUniversity Hospital Geneva, Geneva, Switzerland

P. McNairCopenhagen University Hospital, Hvidovre, Denmark

1996

IOSPress= = =

Ohnisha

/Amsterdam, Oxford, Tokyo, Washington, DC

Contents

Editorial xixMessage from the President of MIE 96 xxiMIE 96 Committees xxiiiKeynote Adresses xxvii

Scientific Presentations I: Networking and TelemedicineHuman Issues in the Development of Regional (National or Provincial) HealthInformation Systems and ServicesR. Neame 3Factors to Consider when Establishing a Europe-Wide Network for Exchange of HealthInformationT.M. Nielsen and H.D. Jergensen 8National Strategy for Implementation of a Health Care Network. The Human FacetsK. Bernstein, H. Bjerregaard Jensen, I. Johansen and T. Lehrmann 13Continuity and Coordination of Care by Implementation of a European Health CareNetworkK. Bernstein, H. Bjerregaard Jensen, I. Johansen and G. Orsi 18Ten Commandments for Implementation of Regional Health Care Networks. A CaseStory from a Large Scale Implementation/. Johansen, T. Lehrmann, H. Bjerregaard Jensen and K. Bernstein 23BlackSeaDiab: Project of an Informational Network Aiming at a Better Diabetes Care inthe Countries of the Black Sea RegionC. Ionescu-Tirgoviste, S. Bejan, E. Stanciu, G. Rachiteanu, T. Roman, S. Pruna andI. Mincu 27A Concept for a Regional Health Information Network (HIN) Based upon theExperiences with the Tyrolean HINW. Schoner, K.P. Pfeiffer, J Glasauer and^ G. Raudaschl 32Seamless Telematics across Regions - star . Evolution and Practical Approach of Open,Modular, Patient Based Health Care Telematic SolutionsB. Frandji and P. Cooper 36Danish Centre for Health TelematicsS. Mariboe, H. Bjerregaard Jensen, T. Lehrmann and K. Bernstein 41Computerized Monitoring of Dialysis Remote Sites and Follow-up of Chronic PatientsUsing Smart-PhonesE. Contini, G.P. Costantino, R. Harti, F. Quarello, G. Sancipriano and N.H. Selwood 44Teleradiology System MEDICUS: Software Architecture and First ExperiencesU. Engelmann, A. Schroter, U. Baur, A. Schroeder, O. Werner, K. Wolsiffer,H.-J. Baur, F. Saurbier, B. Goransson, E. Borah and H.-P. Meinzer 49IT Solutions in a Centrally Organised Mammography Screening in NorwayP.M. Ottestad 54

DIAB7e/: A Telemedicine Service for Diabetes CareE.J. Gomez, M.E. Hernando, F. del Pozo 58Remote Physiological Monitoring in the HomeP. Johnson and D.C. Andrews 63Economic Analysis of TelemedicineY.M. Chae, H.J. Lee, J. Jo and H.S. Choi 67GSM Enhances Teleambulance ServicesM. Adeyinka 72Medical Emergency Aid Through Telematics (MERMAID)G. Anogianakis, S. Maglavera and G.F.A. Harding 78Medical Teleconsultation and Emergency Aid Services to European Fishing VesselsG. Anogianakis and S. Maglavera 83Long Term Management of Diabetic Patients: A Distributed ArchitectureR. Bellazzi, A. Riva, M. Stefanelli and S. Fiocchi 88A WWW-Based Decision-Support System Using Medical Logic Modules and HypertextD. Karlsson, C. Ekdahl, N. Shahsavar, H. Gill, U. Forsum and O. Wigertz 93Provision of Healthcare Security Information Services Using the World-Wide WebS. Furnell, P. Sanders and M. Warren 98ELCANO: European and Latin-American Countries Associated for a Networked Databaseof Outstanding Guidelines in Unusual Clinical CasesJ.J. Sancho, N.C. Oliveri, G. Faba, M. Campos, F. Sanz and FT. De Dombal 103The European Health Telematics ObservatoryG. De Moor, M. Laires, M. McCurry and C. Thayer 108Interactive Access to Clinical and Epidemiological Cancer DataK. Adelhard, D. Holzel, A. Klammert and M. Schmidt 113INTERMED: A Telemedical Council on Rheumatic Diseases for Primary Health CareW. Swoboda, K. Adelhard and S. Schewe 118Integrating CSCW and Video-Conferencing in TelemedicineA. Barth, M. Eichelberg, S. Von Gehlen, A. Hewett and P. Jensch 123Synergy Between User Groups in EU ProjectsK. Bernstein, M. d'Angelantonio, A.J. Weser, C. Ceinos, L. Boydell and T. Reilly 128Regional Coordination of Referrals by Electronic Information SystemsT. Larsen and T. Lehrmann 133Test of EDI PrescriptionsS. Sorensen and S. Korsgaard 137Telematics in Community Pharmacies to Support Responsible Self-Medication. TheTESEMED ProjectF. Sanz, M.I. Loza, E.D. Ahlgrimm, P. Baetens, J. Cuypers, H. Cranz, M. Coronel,J.L. Fernandez-Lopez, A. De Mora and M. Sosa-Iudicissa 141

Scientific Presentations II: Medical Concepts and LanguageModelisation of a Criterion of Proximity: Application to Medical ThesauriD. Petiot, A. Bur gun and P. Le Beta 149Automated Extraction of Neurosurgical Procedure Expressions from Full Text Reports:The Multi-TALE ExperienceW. Ceusters, G. Deville and G. De Moor 154

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Medico-Economic Patient Encoding in the University Hospital of GenevaC. Lovis, P.-A. Michel, F. Borst, R. Baud, V. Griesser and J.-R. Scherrer 159Accessing to Knowledge Base Terms Using UMLS ConceptsB. Hardy, A. Burgun and P. Le Beux 164Medical Language Processing and Resources Reusability: A Case Study Applied toDutchP. Spyns 169The GALEN High Level OntologyA.L. Rector, J.E. Rogers and P. Pole 174Building a Terminology Server with a RDBMSJ. Stausberg, M. Laghmouch and C. Moraga 179LOINC - A Freely Available Coding Scheme for Clinical and Laboratory MeasurementsA. Thurin, C. McDonald, B. Bray, S. Huff, D. Bidgood, G. Abernathy, W. Tracy,L WidmanandS. Baker 184International Classification of Primary Care Converted to ICD-10: Extended DanishICPCE. Falko Lorentzen 188Conversion Table Between ICD-9 and ICD-10A. Zaiss, S. Schulz, B. Graubner and R. Klar 193Assigning SNOMED Codes to Natural Language Pathology ReportsL.M. de Bruijn, E. Verheijen, F.L. van Nes and J.W. Arends 198A Conceptual Model for a Terminological System for Healthcare in SwedenA. Junfors, S.-B. Wallin, A. Thurin and M. Carlsson 203Towards A New Generation of Terminologies and Coding SystemsA. Rossi Mori 208The Benefits of a Language of HealthJ.D. Read, H.F. Sanderson and Y.M. Sutton 213Supporting Health Care Telematics through Clinical ApplicationsL Alpay and H. Heathfleld 218The Danish National Health Classification System (DHCS). Nursing InterventionsClassification/. Madsen 223Overcoming Terminological Barriers in NursingN. Hardiker and J. Kirby 227Development of a Terminology Management System for the Swedish Healthcare SectorM. Carlsson, O. Wigertz, A. Junfors and S.-B. Wallin 232

Scientific Presentations HI: Infrastructure and StandardsHERMES - Telematic Healthcare - Remoteness and Mobility Factors in CommonEuropean Scenarios - CEC Project HC 1021J. Dripps, A. Lamb and K. Boddy 239'AORTICS', Advanced Open Resources Telematics in Critical Care SituationsP. Basagoiti, D. Borches, C. Zywietz, V. Mifsud, W. Friesdorf A. Gonzalez, C. Ernst,R. Ruiz and I. Trueba 243A Rigorous Approach to Assessing Medical Device Communication StandardsP. Curran, K. Norrie and M. Spicer 248

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Healthcare Message Standards - Who Benefits?T. Benson 253Development of a Standard for the Organisation of Medical Device NomenclaturesL. Rystrom and A. Rossi Mori 259The Middleware-Based Architectural Approach for Opening and Evolving HealthcareInformation SystemsF.M. Ferrara 264FACE: A GUI Integrated in an Existing, Large HIS, a Chain of Many LinksM.P. Hooymans, A. Osseyran and A.R. Bakker 271An Online Migration Strategy for a Large University Hospital ADT DatabaseA. Michel and J. Dudeck 276Significance of HL7 for the UserB.M. van Poppel, H. Lodder and A.R. Bakker 281Steps towards Integration of Knowledge Based Functions into a Hospital InformationSystemT. Btirkle, H.-U. Prokosch and J. Dudeck 286Aspects of Integrating a Disease Specific System into a Hospital InformationSystemU. Altmann, F. Katz, A. Tafazzoli, V. Haeberlin and J. Dudeck 291ITHACA Telematics for Integrated Client Centred CareL. Boydell 296FRAME: A Framework for the Development of GUI-Based Hospital InformationSystem ApplicationsL. Perinati, A. Tangenti, A. Di Cesare, L. Cagnoni and G.D. Pinna 301OOMM - Object-Oriented Matrix Modeling: A Framework for Hospital InformationSystem ModelingM. Cammarota, V. Huppes and S. Gaia 306Integration Architecture: the ISAR ProjectR. Beuscart, N. Souf, N. Blassel, C. Gourdin and B. Modjeddi 311Development and Implementation of a Hybrid Medical Information SystemX. Chen, R. Vaughan-Jones, M. Hawthorne, S. Kendal, I. Potts and P. Smith 316Focussing on the Medical Department: SAMMIEU. Hiibner, M. Staemmler, F.J. Schuier and J. Newell 321

Scientific Presentations IV: Quality and IT SystemsEvaluation of Clinical WorkstationsK. Hofmann, S. Graber and M. Flaig 329Setting and Evaluating an Inter-Hospital Network: a User's PerspectiveA.F. Fay, E. Fery-Lemonnier, E. Charpentier, P. David, C. Marsault andC. Viens-Bitker 334Cognitive Evaluation for the Assessment of Information Technology in HealthcareM.-C. Beuscart-Zephir, J. Brender, N. Souf and I. Menager-Depriester 339Evaluation of a Regional Electronic Health Care Network, Consequences for GeneralPracticeT. Jergensen, K. Bernstein, B. Danneskiold-Samsee and T. Lehrmann 344

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Standardized Evaluation of a Telepathology System between Boston (USA) and Dijon(France): Still Images on TV Screen Versus Glass SlidesF.A. Allaert, P. Dusserre, L. Dusserre, D. Weinberg, P.J. Yvon and P. Cotran 349Success through Evaluation - PROBET.A. Gronlund 354C.A.S.M. & C.A.S.T. Clinical Audit Structured Method & Clinical Audit StructuredToolsetNT. Ellis 359Assessing NHS Managers' IM&T CompetenceM.E. See ley and A. Mordue 364DADIVOX Integration of Medical Audit and an Electronic Patient Record for Use inDiabetes Mellitus Out-Patient Clinics in DenmarkN. Boye 369The Development of an Organisational Audit for Health Informatics in the NHSA. Mordue 374Monitoring the Quality of Care by Quality IndicatorsE. Nicolosi, F. Molino, G. Pandolfo and G. Molino 379Intelligent Control for Medical Quality AssuranceT. Gergely and M. Szdts 384Systems of Information Supply of Management Process in Medical Institutions/. Tchaklosh, M. Khobzay and B. Suvalo 389Considering the Human Facets in Innovation and Evaluation of a Primary Health CareSystemT. Jergensen and C. Christensen 392Test Center for Quality Assurance of Electronic Data Transmission in Primary HealthCareM.S. Christensen, J. Parker and J. Ravndam 397Identification of Empirically "Suspicious" Data Sets in Data Quality Assurance for aNew Hospital Financing System in AustriaK.P. Pfeiffer, E. Bechter, G. Embacher, K. Erhart, W. Fiirst, U. Gruber, L. Neuner,B. Pesec, M. Poll, M. Pregartbauer, R. Reindl and D. Wohlgenannt 401A Framework for Assessment of Information Technology and TelecommunicationsN. Koukoumas, G.M. Papadourakis and G.-M. Erimakis 405Towards a Knowledge Acquisition and Management System for ECG DiagnosisP. Bourlas, N.M. Sgouros, G. Papakonstantinou and P. Tsanakas 409Evaluation of the Scottish Clinical Audit Project Register, A Computerised DatabaseSystemK. Audish, S. Kinn and K. Gregson 413Evaluation of Technology in Health Care: the Case of Integrated Medical ImagingG.-M. Erimakis, G.M. Papadourakis, N. Koukoumas and S. Erimaki 416

Scientific Presentations V: Patient Data HandlingBuilding Healthcare Delivery Systems, Management, and Information around the HumanFacetsM.J. Rigby and S.C. Robins 425

The PEN&PAD Data Entry SystemJ. Kirby, N. Cope, A. De Souza, H. Fowler and R. Gain 430Design of a Patient Management Database System for Diabetes CentresK. Jaffri and B. Richards 435Electronic Medical Record in Gastrobase-II. Clinical and Educational AspectsP. Kocna 440Electronic Patient Record SCIRHK Tinggaard Nielsen, J. Agersten and F. Biering-Sorensen 443Use of Electronic Healthcare Records to Improve Primary Healthcare Services in theGreek IslandsA. Ginis, S. Deftereos and D. Sotiriou 448An Experiment towards a Document-Centered Hypertextual Computerised Patient RecordJ. Bouaud, B. Seroussi and P. Zweigenbaum 453MEDICA - 9 Years of Development and Use of a Clinical Information System in theUniversity Hospital of Endocrinology and Gerontology - SofiaD. Tcharaktchiev, A. Dimitrov, G. Dimov, P. Tzonov, B. Bajkushev, V. Kirov andB. Georgiev 458A Computer-Based Patient Record System to Promote Quality Care in Surgical PracticesH. Forssell and S. Chowdhury 463Computer Medical Record System for Brain Diseases and TraumasS.K. Gizatullin, A.K. Amirov and I.S. Osipov 466Knowledge-Based Electronic Medical Record (Matching Different Level KnowledgeHandling Technologies)L. Balkdnyi, K. Molndr, Z. Farkas, G. Umann, P. Szeredi, G. Surjdn and E. Kekes 470HVEPS - The Process of Installing and - Using an Electronic Healthcare Record Systemwithin a University Hospital, Organisational and Technical Observations from a PilotProjectS. Vingtoft, T. Almdal, U. Becker, J. Burgaard, P. Juhl, N. Koldso, L. Kristensen,H. Larsen, P. Loubjerg, B. Peitersen, H. Sigmund and H. Winkel 474The DIABCARD Feasibility StudyR. Engelbrecht, C. Hildebrand, M. Blecher, R. Corcoy, A. de Leiva 479Can Concepts and Terms in Existing Classifications Satisfy the Clinical Demands onElectronic Health Care Records?T. Olhede 484A Method to Define and Design Tools for Hypermedia Medical Reports ManagementF. Consorti, J. di Prospero, P. Merialdo and G. Sindoni 489The Electronic Diabetes Medical Record. Purpose Design of a Human-Computer InterfaceL.H. Nielsen, I.-V. Wagner, W. Schneider and C. Binder 494

Scientific Presentations VI: Knowledge and Information SystemsParticipative Design, Decision Trees, Automatic Learning and Medical Decision MakingP. Kokol, J. Zavrsnik, M. Zorman, I. Malcic and K. Kancler 501Simulation Applied to Medical Expert Systems Validation in Absence of Gold StandardM. Martin-Baranera, J.J. Sancho and F. Sanz 506

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Knowledge Representation and Clinical Practice Guidelines: The DILEMMA andPRESTIGE ProjectsC. Gordon, I. Herbert and P. Johnson 511PROforma: A Method and Language for Specifying Clinical Guidelines and ProtocolsJ. Fox, N. Johns, A. Rahmanzadeh and R. Thomson 516Using a Diabetes Advisory System to Evaluate a Patient-Led System of Semi-Quantitative Dietary AssessmentD.R. Meeking, O.K. Hejlesen, J. Metcalfe, S. Andreassen, R. Hovorka and D.A. Cavan 521On the Reliability of the Suggested Diagnosis of a Neural Network System in AcuteAbdominal PainE. Pesonen 528Current Research of Medical Knowledge-Based Systems in Germany, Results from aStudy Conducted in the Framework of MEDWISU. Kraut and G. Mann 532Rule-Based Medical Decision Making via Unification Procedure of InformationM.W. Kurzynski, J. Sas and A. Blinowska 537Integrative Database Analysis for the Detection of Inborn ErrorsG. Frauendienst-Egger, R. Hofestadt, T. Pfisterer, U. Mischke, F.K. Trefz andJ. Wieland 542Classification of Brainstem Auditory Evoked Potentials Using Artificial Neural NetworksP.J. McCullagh, G. King, H.G. McAllister and H.G. Houston 547Decision Support for Monitoring of Chronic Hepatitis C: Can Blood Laboratory TestsHelp?A. Babic, K. Hedin, U. Mathiesen, L. Franzen, A. Fryden, G. Bodemar and O. Wigertz 551Knowledge-Based Monitoring of Glaucoma Patients - a Connectionist's ApproachG. Zahlmann, M. Obermaier, C. Ritzke and M. Scherf 555Providing Decision Support for General Practitioners Using the Path.Finder System/. Buchan, H Heathfield, T. Kennedy and P. Bundred 560DBIRA: A Data Base Insulin Regimen AdvisorG. Gogou, V. Ambrosiadou, D. Goulis, N. Maglaveras and C. Pappas 565Abstraction of Data and Time for Prognoses of the Kidney Function in a Case-BasedReasoning SystemR. Schmidt, L. Gierl, B. Heindl and B. Pollwein 570Decision-Support System for Arterial Hypertension: Haemodynamic Monitoring andTreatmentF.T. Adilova, O. Tursunbaev andM. Paizieva 575Development of a Model for Knowledge-Based Monitoring of Patients with SystemicLupus ErythematosusG. Mann and K. Takabayashi 579Metabolic Emergencies: Informatic Management, Diagnosis and Treatment AssistanceC. Ionescu-Tirgoviste, E. Stanciu, S. Alecu, A. Necula, C. Dragomirescu, V. Mogos,I. Limbaseanu and I. Mincu 584AntibiosIS: An Information System Supporting Antibiotic PrescriptionG. Gogou, V. Ambrosiadou, D. Goulis, N. Maglaveras and C Pappas 589An Expert System for ITU TreatmentsR.A. Hollingsworth, B. Richards and B. Doran 594

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Decision Support of Nosocomial Infection TherapyM. Bohanec, M. Rems, S. Slavec and B. Urh 599Integrated System for Traditional Chinese Diagnosis and Treatment in AlternativeMedicineS. Alecu, A. Raclariu, M. Loghin, C. Ionescu-Tirgoviste, V. Patrugan, L. Serbu,A. Necula and E. Stanciu 604A Decision Support System for Biomedical Research EvaluationD. Hristovski, A. Rozic-Hristovski and S. Adamic 609A Heuristic Method for Diagnosing Multiple Diseases in Complex Medical DomainsModelled by Causal Probabilistic NetworksKG. Olesen and S. Andreassen 614Multi-Search - a Search Tool for Literature RetrievalH. Ahlfeldt, E. Lanhammar and O. Wigertz 619A Graphical User Interface for Biomedical Literature SearchF. Wiesman and A. Hasman 624Discovering Knowledge from Visual Field Data: Results in Optic Nerve DiseasesG. Cheng, X. Liu, J. Wu, B. Jones and R. Hitchings 629Comparison of Induction Algorithms in Routine Laboratory Diagnostics of ThyroidDysfunctionZ Sonicki, N. Masic, J. Kern, L. Lukinac and Z Kusic 634Anticipation by Learning of Image RetrievalD. Bandon, R. Kanz and C. Wehenkel 639Computer-Based System for Orientation of Treatment by Phytotherapy (FITOTER)C. Ionescu-Tirgoviste, V. Patrugan, N. Macovei, A. Bondarciuc, P. Chirila, L. Serbu,V. Dadarlat, G. Vladescu and M. Chirila 644On Extracting Relevant Information from Medical DataJ. Zvdrovd, M. Studeny and J. Preiss 649A New Version of the Programme ALGO for Clinical AlgorithmsH. Sitter, H. Prunte and W. Lorenz 654Conceptual Modelling of Breast Cancer Prognosis Using CommonKADSR. Sacile, C. Ruggiero and R. Dieng 658

Scientific Presentations VII: Health Information SystemsAn Information System for Community Nursing SupportO. Sustersic and V. Rajkovic 665A Comprehensive Blood Recipient Information System - From User Requirements toits FunctionsD. Qiu, G. Junghans, H. Kroll, A. Reisacher, A. Michel, K Marquardt, J. Dudeckand C. Mueller-Eckhardt 670Telematics for Anaesthesia and Intensive TherapyC.L. Bowes and J. Holland 675Extending an Integrated Hospital Information System beyond the HospitalT.S. Chen, CM. Chao and T.G. Gough 680Integration of Health Professional Workstations in Hospital Information SystemsA. Winter, A. Lagemann, B. Budig, W. Grothe, R. Haux, S. Herr, J. Pilz, R. Sawinskiand P. Schmucker 685

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EPIDO: A Surveillance Information System to Automatically Detect Notifiable DiseasesJ.M. Carbo, J.M. Bayas, M.T. Pi-Sunyer, F. Sanz, A. Vilella, J.J. Sancho, M. Martin,X. Nebot, G. Navarro, I Planas, A. Prat and L. Salleras 690Synapses - Federated Healthcare Record ServerJ. Grimson, W. Grimson, P. Hurlen, D. Ingram, J. Milan, A. Osseyran and M. Wilson 695Health Information Services Using VEMMI TechnologyA. Alcolea, E.J. Gomez, F. del Pozo and J.A. Quiles 700Evolution of an Integrated Hospital Information SystemA. Terazzi, A. Giordano and G. Minuco 705The Virtual Hospitalization: Towards an Information-Organisation System ArchitectureD. Luzi, F.L. Ricci, R. Maceratini and L.D. Serbanati 710Multimedia Telecollaboration for Second Opinion in EndoscopyB. Kraus, A. Tarhanjan, J. Keymling, T. Rabenstein, H.-D. Allescher, M. Classen,E.G. Hahn and A. Horsch 715A Hypermedia Information System for the Diffusion of Telemedicine ServicesP. Grifoni, C. Lalle, D. Luzi 719Dynamic Computer Analyser for 24-Hour ECG Holter RecordingsA. Mavromatis, N. Maglaveras, D. Koufoyiannis, A. Boufidou and C. Pappas 7243D Representation and Volume Determination of the Prostate from Ultrasound ImagesD. Crivianu-Gaita, F. Miclea, A. Gaspar, D. Mdrgineantu and S. Holban 729Comparative Evaluation of Lossless Image Compression Techniques on MammogramsG. Anastassopoulos, E. Karavatselou, D. Lymberopoulos and G. Panayotakis 734Modeling Using the Visible Human DatasetP. Gingins, P. Beylot, P. Kalra, N. Magnenat Thalmann, W. Maurel, D. Thalmann andJ. Fasel 739Parametric Methods of Dynamic Spectral Analysis of Non-Stationary Biological SignalsB. Schack, G. Griefibach, E. Bareshova, C. Anders, N.-P. Schumann and G. Florian 744Preliminary Research Using K-Mean Clustering for Auditory Brainstem ResponseDetectionT. Gronfors, J. Tian and M. Juhola 749An Original Method to Generate the Fourier Descriptors, Related with the BiologicalSignal Acquisition through its Essential PointsM. Tarata 753X-Ray Computed Transaxial Micro Tomography in Dental ResearchG. Thuesen, L. Bjorndal and T. Darvann 7583-D Analysis of Tooth Formation and Eruption in Patients with Craniofacial AnomaliesS. Kreiborg, P. Larsen, M. Bro-Nielsen and T. Darvann 763Medical Data Warehouse, an Investment for Better Medical CareJ. Niinimdki, G. Selen, M. Kailajdrvi, P. Gronroos, K. Irjala and J.J. Forsstrom 766Computational and Other Issues in Addressing the Concordance between Clinical andAdministrative Sources of Population-Based Health Care DataD.T. Gray, K.H. Baratz, DO. Hodge andL.C. Butterfield 771A Toxicology Post-Mortem Database SystemB. Richards, D. Killen, R.A. Hollingsworth and T. Richardson 111A Study of Behavioural Instability in Visual Function Self-TestingX. Liu, G. Cheng and J. Wu 778

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Exploring Cell Kinetic Models within an Integrated Simulation EnvironmentO. Werner, H.-J. Baur and H.-P. Meinzer 783Interactive Atlas of Congenital Craniofacial MalformationsP. Larsen, S. Kreiborg, F. Vinther, T. Darvann, T. Schiemann, U. Tiede andK.H. Hohne 788Research Using Neural Networks for Auditory Brainstem Response DetectionJ. Tian, T. Gronfors and M. Juhola 791

Scientific Presentations VIII: Education and TrainingThe Education of an Informatics Nurse. A Bachelor Program for Graduate Nurses inThe NetherlandsE. VanAalst 799Nursing Informatics Educational Issues: the NIGHTINGALE ProjectJ. Mantas 804A Hypermedia Computer-Aided Learning System for BronchoscopyA. Colman, B. Richards and R. Lewis 808A CAL System for Training and Treatment in an ITUR.A. Hollingsworth, B. Richards and B. Doran 813Dynamic Knowledge Networks and Intelligent TutoringU. Giani, R. Ascione, P. Martone and E. Giani 818The Teaching of Informatics to First-Year Students of Medicine and Nursing, throughan Interdisciplinary Innovative MethodologyM. Crudele, P. Binetti, A. Serio and D. Tartaglini 823The Development of Learning Materials for Medical Informatics Education in DutchProfessional Schools of Health CareA. Oostendorp, P. Buijnsters, V. Peeters, H van Lieshout and J. Aarts 828Health Informatics Education - Establishing a Faculty MindsetE.J.S. Hovenga 833Computer Curricula at Albert Szent-Gyorgyi Medical University: Programmes,Developments and InfrastructureJ. Karsai and Z. Hantos 838An Intelligent Tutoring System for Malaria Based on the Health-2000 Large-ScaleIntegrated Expert SystemS.F. Boyom, S.Y. Kwankam, I. Kouam, D.A. Asoh and F.G. Kouokam 843ONCOL2 Medical Education SystemJ. Stempczynska and E. Kacki 847

Scientific Presentations IX: Organisational Issues, Policies & Strategies andManagement of Healthcare ServicesComputer Supported Cooperative Work in Clinical PracticeJ. Bar dram and M. Solvkjcer 853An Asynchronous Cooperative Model for Coordinating Medical Unit ActivitiesF. Yousfi, R. Beuscart and N. Souf 858Nursing Schedule Quality in Theory and PracticeJ.H. Oldenkamp, M.S. Lettenga and J.L. Simons 863

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Nursing Informatics: A Delphi StudyH. Strachan 867Problems with Nursing Information Systems: are there Solutions?W.T.F. Goossen, P.J.M.M. Epping, I.L. Abraham, T.W.N. Dassen and A. Hasman 872Midwives and Information TechnologyT. Carroll, M. Philbin, M. Lavin, M. Williams, H. Young and M. Kelly 877Framework for the Co-ordination of Processes, Models and Technology SolutionsS. Bullas and D. Lloyd-Williams 882The PRESTIGE Project: Implementing Guidelines in HealthcareC. Gordon and M. Veloso 887National Programme of Health Informatics in Slovenia - its Development andPerspectivesT. Albreht, M. Rogac, D. Bozic, M. Macarol-Hiti, M. Markota, J. Misjak,D. Moravec-Berger, B. Potocnik and G. Raic 892Open Systems Frameworks for Health, a Cross-Sector Common Approach?D. Lloyd-Williams, R. Sitruk, J. Minter and T. Haynes 897The Challenge of Instructing Heads of Medical Departments in Israeli Hospitals inthe Use of Information SystemsO. Gilad, D. Bregman, M. Ronen and L. Levi 902IT to PATIENTS - What Else?K. Jessen 906Doctoral Level in Medical Informatics in RomaniaG.I. Mihalas 910Health Care Reform: The New Possibilities Offered by InformaticsT. Vdrhelyi 915Resource Management Constraints in Guideline-Based CareP. Barahona 920Telematics Support for the Shared Care Management of Coronary Artery Disease inthe PRESTIGE ProjectD. Pitty, P. Reeves, C. Gordon, Z. Ilic and T. Rickards 925An Ontology-Based Framework for Building Economic Evaluation Models inHealth CareS. Quaglini, L. Dazzi, S. Falasconi, M. Marchetti, M. Stefanelli and G. Barosi 930The Future is no Longer What it Used to be - Managing Cultural Diversity & HealthTelematics.M. Demeester and R. Beuscart 935Legal Liability Issues in Health Care TelematicsC. Laske 942An Actual Point of View of the Security of Medical Data: Slovenian PerspectiveG. Cerkvenik, M. Markota, S. Slavec, M. Rems, T. Azman and I. Podboj 946Development of a Coherent Policy of Security-Confidentiality in a HeterogeneousUniversity Hospital Environment in BelgiumC. Piret, F.H. Roger France and F. Pirard 951Tele-expertise: Users' and Suppliers' LiabilitiesF.A. Allaert and L. Dusserre 957

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Scientific Presentations X: Biomathematics, Simulation, Statistics andEpidemiologyOn the Irrelevant Feature Discarding in Neural Networks and its Applications inMedicineI. Ciuca and E.D. Hord 965Exploitation of Fuzzy Sets to Evaluation of the Concentration of Cholesterol inPersons Aged 18-65, Exemplified by the Population of a Big CityA. Gerstenkorn and J. Gerstenkorn 970Time-Variant Spectral Analysis of Laser Doppler Flow Signals on the Basis ofMultivariate Autoregressive ModellingM. Arnold, H. Witte, P. Leger, H. Boccalon, S. Bertuglia, A. Colantuoni and R. Bauer 972Extended Neural Networks for Signal Detection and Classification: An Approach forSimultaneous Optimization of Parameterized Preprocessing and Neural NetworksA. Doering and H. Witte 977Novel Kinetic Quantification of HIV-1 p24 Antigen with an Extended RangeM. Giacomini, C. Ruggiero, F. Lillo, J. McDermott and O.E. Varnier 982Use of Statistical Analysis in the Theses of Health Sciences Graduates of ShirazUniversity of Medical SciencesS.M.T. Ayatollahi 987Emergency Care Episode MethodologyC.R. Stein, S.A. Optenberg and P. Jacobs 988Optimal Method for Time Series Analysis of Mortality Rates and their Relations withOther FactorsN. Kocev, J. Marinkovic, H. Vlajinac and M. Milosavljevic . 993Notes on Computer Analysis of Signals of Vestibulo-Ocular Reflex Eye MovementsM. Juhola 998A System for the Management of Epidemiologic DataE. Pourabbas and M. Rafanelli 1002

System DemonstrationsNursing Records as a Key to Design of Electronical Medical Case RecordsK. Djurtoft 1009European Distributed Information Technology for Healthcare, Real Open HealthcareInformation Systems: Now a Reality in EuropeA. van der Werff, F.M. Ferrara and G. Mobilia 1014A Regional, Secure Cancer Documentation System for an Optimal "Shared Care" inOncologyB. Blobel 1019A Commercial Workstation for Laboratory HematologyL.W. Diamond, D.T. Nguyen, M. Lima, R. Simon and S.B. Aoutka 1027Gymnaste, A Solver for Nurse Scheduling Using Constraint Programming:A Technical and Sociological ChallengeG. Weil, K. Heus, P. Francois, P. Jacques and M. Poujade 1032Specifying Hospital Information Systems Using Business Process ModelingM. Amberg and S. Graber 1037

XVII

A New Approach for Hypermedia Medical Records ManagementF. Laforest, S. Frenot and A. Flory 1042Modeling X-Ray Imaging Procedures: A Tool for Generating Learning TasksL. Costaridou, C. Papanikolaou, C. Efstratiou, K. Hatzis, N. Pallikarakis andG. Panayiotakis 1047A Possible Concept for an Interactive 3D Visualization System for Training andPlanning of Liver SurgeryT. Darvann, M. Bro-Nielsen, K. Damgaard, A.B. Dobrzeniecki, U. Knigge, P. Larsen,S. Nasr and L.B. Svendsen 1052The PROMPT Electronic Health Care RecordP. Lagouarde, R. Thomson, J.-L. Renaud-Salis, P. Ferguson, S. Hajnal and P. Robles 1055Kommunedata's Electronic Patient RecordP. S. Olsen 1060MO-ON: A Neuro-Ophtalmology Computer Aided Learning ApplicationE.S. Bernad 1065Co-operative Health Information Networks "CHIN"A.J. Weser, L. Kleinholz, P.O. Soderstrom, P. Eklund, G. De Moor, H. Williams,G. Venters and B. Mahr 1068Communication Facilities in an Integrated HISH.C. Hejslet 1073Heilig Hart Ziekenhuis: A Case Study of the Healthcare NetworkJ.P. Desmet 1078The Diabetes Advisory System - an IT Approach to the Management of InsulinDependent DiabetesS. Andreassen, O.K. Hejlesen, R. Hovorka and D.A. Cavan 1079MEDIOZ: Personal Prototyping for Medical Workstations with Data Retrieval from anIntegrated HISH. Bruins Slot, C. de Vos, P. Arnou, M.P. Hooymans, C.J. Enning, L. van Gennip andA. Osseyran 1084Towards a New Generation of PACS-SystemsW. Benschop and R.A. van Geuns 1091

Workshops 1097

Industrial Presentations and Exhibitors 1105

Author Index 1109

Subject Index 1119