Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Guideline based structured documentation: the final goal?

Thomas Bürkle1, Thomas Ganslandt, Dirk Tübergen

  • 1Department of Medical Informatics and Biomathematics, Domagkstr 9, 48149 Münster, Germany.

Studies in Health Technology and Informatics
|October 6, 2004
PubMed
Summary
This summary is machine-generated.

Related Concept Videos

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

Evaluation of Predictive Models of Inpatient Nursing Workloads.

Studies in health technology and informatics·2026
Same author

Quality Assessment in Paediatric Cardiology: Experiences from Leveraging a Clinical Data Warehouse.

Life (Basel, Switzerland)·2026
Same author

A Molecular "Thermometer" for Measuring Effective Non-Local Exchange.

Journal of computational chemistry·2026
Same author

Uncovering sex patterns in BPSD among home-care patients: longitudinal findings from a population-based registry - digital dementia registry Bavaria.

Frontiers in psychiatry·2026
Same author

Secondary Data for Clinical Pharmacists' Decision Support: Evaluating 'Triple Whammy' Interactions Within INTERPOLAR.

Studies in health technology and informatics·2026
Same author

Expert Evaluation of an AI Governance and Ethics Framework Implemented at a University Hospital.

Studies in health technology and informatics·2026
Same journal

A GenAI Pipeline for Violinist Kinematic Data Management.

Studies in health technology and informatics·2026
Same journal

AMAL-For-Qatar: A Comprehensive AI Ecosystem for Fetal Ultrasound Analysis - Project Overview and Achievements.

Studies in health technology and informatics·2026
Same journal

Longitudinal Treatment-Aware Multimodal AI for Dermatology: A Scoping Review.

Studies in health technology and informatics·2026
Same journal

Predicting Postpartum Depression Using Imbalance-Aware Machine Learning.

Studies in health technology and informatics·2026
Same journal

Validation of Deep-Learning Models for Autosegmentation of Brain Metastases.

Studies in health technology and informatics·2026
Same journal

Delay-Dependent Gating in Modular RNNs.

Studies in health technology and informatics·2026
See all related articles

Structured documentation for endoscopy reports improves information retrieval and patient care. Guideline-based documentation offers benefits but may not suit all cases.

Area of Science:

  • Medical Informatics
  • Clinical Documentation

Background:

  • Traditional medical documents are largely unstructured narrative text.
  • Structured documentation can enhance information retrieval for research, therapy, and patient care.

Purpose of the Study:

  • To present an integrated application for endoscopy documentation with varying degrees of structure.
  • To evaluate the advantages of structured reporting for clinical information systems.

Main Methods:

  • Development and routine use of an endoscopy documentation application since 2000.
  • Implementation of unstructured free text, indexed terms, and fully structured, guideline-based documentation.
  • Integration into a comprehensive clinical information system.

Main Results:

Related Experiment Videos

  • Early versions allowed free text reports with images and indexed terms, improving patient retrieval.
  • Current version supports guideline-based documentation, automatically generating codes and reports.
  • Demonstrated practical advantages of structured data for clinical information systems.

Conclusions:

  • Structured documentation in endoscopy offers significant benefits for information management.
  • Guideline-based documentation is advantageous but may not be universally applicable to all endoscopy procedures.