Abstract
Clinical record integration and visualisation is one of the most important abilities of modern health information systems (HIS). Its use on clinical encounters plays a relevant role in the efficacy and efficiency of health care. One solution is to consider a virtual patient record (VPR), created by integrating all clinical records, which must collect documents from distributed departmental HIS. However, the amount of data currently being produced, stored and used in these settings is stressing information technology infrastructure: integrated VPR of central hospitals may gather millions of clinical documents, so accessing data becomes an issue. Our vision is that, making clinical reports to be stored either in primary (fast) or secondary (slower) storage devices according to their likelihood of visualisation can help manage the workload of these systems. The aim of this work was to develop a model that predicts the probability of visualisation, within 24h after production, of each clinical report in the VPR, so that reports less likely to be visualised in the following 24 hours can be stored in secondary devices. We studied log data from an existing virtual patient record (n=4975 reports) with information on report creation and report first-time visualisation dates, along with contextual information. Bayesian network classifiers were built and compared with logistic regression, revealing high discriminating power (AUC around 90%) and accuracy in predicting whether a report is going to be accessed in the 24 hours after creation.

Abstract
In pharmacovigilance, reported cases are considered suspected adverse drug reactions (ADR). Health authorities have thus adopted structured causality assessment methods, allowing the evaluation of the likelihood that a medicine was the causal agent of an adverse reaction. The aim of this work was to develop and validate a new causality assessment support system used in a regional pharmacovigilance centre. A Bayesian network was developed, for which the structure was defined by an expert, aiming at implementing the current guidelines for causality assessment, while the parameters were learnt from 593 completely-filled ADR reports evaluated by the Portuguese Northern Pharmacovigilance Centre expert between 2000 and 2012. Precision, recall and time to causality assessment (TTA) was evaluated, according to the WHO causality assessment guidelines, in a retrospective cohort of 466 reports (April to September 2014) and a prospective cohort of 1041 reports (January to December 2015). Results show that the network was able to easily identify the higher levels of causality (recall above 80%), although strugling to assess reports with a lower level of causality. Nonetheless, the median (Q1:Q3) TTA was 4 (2:8) days using the network and 8 (5:14) days using global introspection, meaning the network allowed a faster time to assessment, which has a procedural deadline of 30 days, improving daily activities in the centre.

Abstract
Background and study aims Efficacy and adverse events probabilities influence decisions regarding the best options to manage patients with gastric superficial lesions. We aimed at developing a Bayesian model to individualize the prediction of outcomes after gastric endoscopic submucosal dissection (ESD). Patients and methods Data from 245 gastric ESD were collected, including patient and lesion factors. The two endpoints were curative resection and post-procedural bleeding (PPB). Logistic regression and Bayesian networks were built for each outcome; their predictive value was evaluated in-sample and validated through leave-one-out and cross-validation. Clinical decision support was enhanced by the definition of risk matrices, direct use of Bayesian inference software and by a developed online platform. Results ESD was curative in 85.3% and PPB occurred in 7.7% of patients. In univariate analysis, male sex, ASA status, carcinoma histology, polypoid or depressed morphology, and lesion size >= 20mm were associated with non-curative resection, while ASA status, antithrombotics and lesion size >= 20mm were associated with PPB. Naive Bayesian models presented AUROCs of similar to 80% in the derivation cohort and >= 74% in cross-validation for both outcomes. Risk matrices were computed, showing that lesions with cancer at biopsies, >= 20mm, proximal or in the middle third, and polypoid are more prone to non-curative resection. PPB risk was <5% in lesions <20mm in the absence of antithrombotics. Conclusions The derived Bayesian model presented good discriminative power in the prediction of ESD outcomes and can be used to predict individualized probabilities, improving patient information and supporting clinical and management decisions.

Abstract
Crohn's disease is one type of inflammatory bowel disease whose incidence is currently increasing, and may affect any part of both the small and large intestine, possibly irritating deeper layers of the organs. Being a chronic disease, neither treatment nor surgery actually heals the patients. Thus, focus has been given to identifying good prognostic models based on clinical factors since they are more easily included in daily practice. The aim of this work is to provide an initial study on the adequacy of a Bayesian network model to enhance the prognosis prediction for patients with Crohn's disease. Multicentric study data of patients with surgery or immunosuppression in the six month after diagnosis was used to derive a Bayesian network, focusing on the prognosis and the analysis of factors interaction, including clinical features, disease course, treatment, follow-up plan, and adverse events. Two models were evaluated (naive Bayes and Tree-Augmented Naive Bayes) and also compared with logistic regression, using cross-validation and ROC curve analysis. Preliminary results showed competitive accuracy (above 75%) and discriminative power (above 70%). The generated models presented interesting insights on factor interaction and predictive ability for the prognosis, supporting their use in future clinical decision support systems.

Abstract
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Abstract
Background: Audit Trails (AT) are fundamental to information security in order to guarantee access traceability but can also be used to improve Health information System's (HIS) quality namely to assess how they are used or misused. This paper aims at analysing the existence and quality of AT, describing scenarios in hospitals and making some recommendations to improve the quality of information. Methods: The responsibles of HIS for eight Portuguese hospitals were contacted in order to arrange an interview about the importance of AT and to collect audit trail data from their HIS. Five institutions agreed to participate in this study; four of them accepted to be interviewed, and four sent AT data. The interviews were performed in 2011 and audit trail data sent in 2011 and 2012. Each AT was evaluated and compared in relation to data quality standards, namely for completeness, comprehensibility, traceability among others. Only one of the AT had enough information for us to apply a consistency evaluation by modelling user behaviour. Results: The interviewees in these hospitals only knew a few AT (average of 1 AT per hospital in an estimate of 21 existing HIS), although they all recognize some advantages of analysing AT. Four hospitals sent a total of 7 AT - 2 from Radiology Information System (RIS), 2 from Picture Archiving and Communication System (PACS), 3 from Patient Records. Three of the AT were understandable and three of the AT were complete. The AT from the patient records are better structured and more complete than the RIS/PACS. Conclusions: Existing AT do not have enough quality to guarantee traceability or be used in HIS improvement. Its quality reflects the importance given to them by the CIO of healthcare institutions. Existing standards (e.g. ASTM: E2147, ISO/TS 18308: 2004, ISO/IEC 27001: 2006) are still not broadly used in Portugal.