User-centered visual analysis using a hybrid reasoning architecture for intensive care units

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care

Information Technologies for the Healthcare Delivery System

That modern healthcare requires information technology to be efficient and fully effective is evident if one spends any time observing the delivery of institutional health care. Consider the observation of a practitioner of the discipline, David M. Eddy, MD, PhD, voiced in Clinical Decision Making, JAMA 263:1265-75, 1990, . . .All confirm what would be expected from common sense: The complexity of modern medicine exceeds the inherent limitations of the unaided human mind. The goal of this thesis is to identify the technological factors that are required to enable a fully sufficient application of information technology (IT) to the modern institutional practice of medicine. Perhaps the epitome of healthcare IT is the fully integrated, fully electronic patient medical record. Although, in 1991 the Institute of Medicine called for such a record to be standard technology by 2001, it has still not materialized. The author will argue that some of the technology and standards that are pre-requisite for this achievement have now arrived, while others are still evolving to fully sufficient levels. The paper will concentrate primarily on the health care system in the United States, although much of what is contained is applicable to a large degree, around the world. The paper will illustrate certain of these pre-requisite IT factors by discussing the actual installation of a major health care computer system at the University of Rochester Medical Center (URMC) in Rochester, New York. This system is a Picture Archiving and Communications System (PACS). As the name implies, PACS is a system of capturing health care images in digital format, storing them and communicating them to users throughout the enterprise

Patent Registry Database

The purpose of the study is twofold. First, to demonstrate the ability of a database to handle a large number of patients and accompanying medical information to allow the clinician to diagnose and treat them with greater efficiency and rapidity. Secondly, to create a patient registry database for children with growth problems (St. Joseph\u27s Hospital group study). Computing trends indicate that over the next few years, computer stored medical records will become technically and economically feasible on a broad scale. Many clinical databases are already becoming available for doctors and hospitals to use. The benefits of computer-based medical records out-weigh the paper records. The main benefits are (1) improved logistics and organization of medical records to speed care and improve doctor\u27s efficiency, (2) automatic computer review of the medical record to limit errors and control costs, and (3) systemic analysis of previous clinical experience to guide future practices and policies. Paper reports may often be out of date in hospitals or in medical clinics where the patient\u27s status can change rapidly. Furthermore, unlike terminals, turnaround paper documents cannot provide reminders or error checks as data is recorded on them. The database that is chosen for this project is called Paradox for IBM PC computers. Computer stored medical records associated with each patient is best managed under a unified database structure. Of the available non-medical databases, Paradox has been proven to be cheaper, easier to learn, and maintain. Since it is a relational database, the tables are interlinked to produce the desired results. This database should help the clinician in adding new patient data and, in updating the previous patient\u27s information by using less time. In conclusion, the Paradox database has been shown to be an effective management tool for doctors to perform fast entry and easy storage of medical records, updating files simultaneously and instantaneously with the added assurance of data accuracy and efficient memory utilization

Database modeling and .NET Web services in the context of a distributed Web-based hospital information system

Thesis (M.Eng.)--Massachusetts Institute of Technology, Dept. of Civil and Environmental Engineering, 2002.Includes bibliographical references (p. 84).by Glorimar Ripoll.M.Eng

A formal architecture-centric and model driven approach for the engineering of science gateways

From n-Tier client/server applications, to more complex academic Grids, or even the most recent and promising industrial Clouds, the last decade has witnessed significant developments in distributed computing. In spite of this conceptual heterogeneity, Service-Oriented Architecture (SOA) seems to have emerged as the common and underlying abstraction paradigm, even though different standards and technologies are applied across application domains. Suitable access to data and algorithms resident in SOAs via so-called ‘Science Gateways’ has thus become a pressing need in order to realize the benefits of distributed computing infrastructures.In an attempt to inform service-oriented systems design and developments in Grid-based biomedical research infrastructures, the applicant has consolidated work from three complementary experiences in European projects, which have developed and deployed large-scale production quality infrastructures and more recently Science Gateways to support research in breast cancer, pediatric diseases and neurodegenerative pathologies respectively. In analyzing the requirements from these biomedical applications the applicant was able to elaborate on commonly faced issues in Grid development and deployment, while proposing an adapted and extensible engineering framework. Grids implement a number of protocols, applications, standards and attempt to virtualize and harmonize accesses to them. Most Grid implementations therefore are instantiated as superposed software layers, often resulting in a low quality of services and quality of applications, thus making design and development increasingly complex, and rendering classical software engineering approaches unsuitable for Grid developments.The applicant proposes the application of a formal Model-Driven Engineering (MDE) approach to service-oriented developments, making it possible to define Grid-based architectures and Science Gateways that satisfy quality of service requirements, execution platform and distribution criteria at design time. An novel investigation is thus presented on the applicability of the resulting grid MDE (gMDE) to specific examples and conclusions are drawn on the benefits of this approach and its possible application to other areas, in particular that of Distributed Computing Infrastructures (DCI) interoperability, Science Gateways and Cloud architectures developments

MS

thesisHealth information systems are networks of computers employed by health care enterprises to facilitate the delivery of their health care product. Computers originally entered the medical domain solely as tools aimed at the business functions of the hospital. Having demonstrated their utility in this area, computers were perceived by certain innovators to have usefulness in the clinical domain. As clinical computer applications were successfully developed and implemented, they have over time been merged together into systems offering multiple areas of functionality directly impacting the clinical aspects of health care delivery. Such health information systems have now assumed major importance in the provision of health care in a complex medical environment. Although the focus of substantial investment for development and implementation, relatively little work has been done to assess the value of such health information systems. The business information technology literature and the medical informatics literature each include only a small number of published reports examining the value question in an incomplete manner. No generally accepted valuation strategy has been developed for information systems in either the business or health care domains. Several valuation methods with potential applicability to health information systems have evolved: cost-effectiveness / cost- benefit analysis, return on investment, information economics, measurement systems, the Strassmann approach, the Japanese approach, and the strategic value approach. None of these valuation strategies is clearly superior; each has different strengths and weaknesses. A matrix comparing these strategies on the bases of explicitness and ease of implementation is proposed. Intermountain Health Care (IHC) has been instrumental in the development of health information systems and a leader in the application of such technology in clinical health care delivery. IHC's HELP system has played a seminal role as a catalyst to the development of the health information system industry. Although both historically and functionally important, detailed financial information regarding HELP'S origins and implementation no longer exists. Current IHC budget information demonstrates the major financial commitment underway within this health care enterprise totaling approximately $157 million over the last decade and with additional expenditures of$47 to $61 million projected annually through fiscal year 2004. The complex budgetary relationships between HELP and the other health information systems at LDS Hospital further obscure the magnitude of the information technology investment within this institution. Benefits of health information systems are potentially most substantial within the domain of clinical integration. IHC has not implemented any formal valuation strategy for its health information systems, but the ad hoc measurement systems valuation approach applied to date is practical, flexible, and the most appropriate of the available systems. Adequate valuation of health information systems cannot readily be achieved given the existing traditional hierarchical accounting structure; an alternative accounting framework patterned after a relational database is proposed

International Telemedicine/Disaster Medicine Conference: Papers and Presentations

The first International Telemedicine/Disaster Medicine Conference was held in Dec. 1991. The overall purpose was to convene an international, multidisciplinary gathering of experts to discuss the emerging field of telemedicine and assess its future directions; principally the application of space technology to disaster response and management, but also to clinical medicine, remote health care, public health, and other needs. This collection is intended to acquaint the reader with recent landmark efforts in telemedicine as applied to disaster management and remote health care, the technical requirements of telemedicine systems, the application of telemedicine and telehealth in the U.S. space program, and the social and humanitarian dimensions of this area of medicine

Master of Science

thesisThere is increasing competition in the field of community pharmacy practice from chain pharmacies and other providers. There is also a lack of available studies which examine pharmacists' attitudes toward marketing and the actual use of marketing in a pharmacy; there is however, literature on "how" to market. It is first necessary to examine the current practices of pharmacists with regard to marketing before the "how" can be implemented. A questionnaire was mailed to 154 independent community pharmacies in the state of Utah. Of these pharmacies, 110 responded; however, only 83 questionnaires (53.9%) were determined to be complete for analysis. The pharmacy managers were asked to provide personal information regarding their education, number of years at present position, and their self-perception of their marketing knowledge. The pharmacy managers were also asked for specific information on the pharmacies in which they work such as professional services offered and marketed, the perceived competition, prescription volume as percent of total sales and the average menthe expenditure on marketing. The pharmacists were also asked about their attitude toward different marketing tools and the frequency of use of these tools for marketing their pharmacy and professional services. Also examined were the possible effects of factors such as attitudes, perceived competition, and volume of business in a pharmacy on the extent of marketing. On the average almost 22% of the respondents perceived the various marketing tools as being "extremely effective" and another 47% felt that these tools were "effective." However, these marketing tools were used by a much lower proportion of pharmacist who thought that they were effective. Exceptions to the rule were word-of-mouth which was used by a large percentage (95.2%) and billboard advertising which was perceived as being effective by a low percentage (19.3%). The yellow pages were perceived as being "ineffective," but were used by a relatively large percentage (92.8%) of the respondents. The average monthly marketing expenditure was $181.7 ±$186.7. This skew to the left is primarily due to the fact that 30% of the pharmacist spent less than $50.00 per month on marketing. Results indicate that the attitudes of pharmacists toward marketing and perceived competition have very little apparent influence on average monthly marketing expenditures and the frequency of use of different marketing tools. Few pharmacists reported using competition surveys and analysis of pharmacy strengths and weaknesses relative to the average number of prescriptions dispensed per day and the extent of marketing. The variables examined in this study suggest that there may be very little influence on the extent of marketing from pharmacists' attitudes towards marketing, perceived competition, and volume of prescription as a percent of total sales. To better understand the marketing decisions of pharmacists in an independent computing pharmacy, factors such as cost of marketing, time required for marketing activities, the perception for the need to market, and differentiation between pharmacies based on geographical location may also be necessary

A FRAMEWORK FOR BIOPROFILE ANALYSIS OVER GRID

An important trend in modern medicine is towards individualisation of healthcare to tailor care to the needs of the individual. This makes it possible, for example, to personalise diagnosis and treatment to improve outcome. However, the benefits of this can only be fully realised if healthcare and ICT resources are exploited (e.g. to provide access to relevant data, analysis algorithms, knowledge and expertise). Potentially, grid can play an important role in this by allowing sharing of resources and expertise to improve the quality of care. The integration of grid and the new concept of bioprofile represents a new topic in the healthgrid for individualisation of healthcare. A bioprofile represents a personal dynamic "fingerprint" that fuses together a person's current and past bio-history, biopatterns and prognosis. It combines not just data, but also analysis and predictions of future or likely susceptibility to disease, such as brain diseases and cancer. The creation and use of bioprofile require the support of a number of healthcare and ICT technologies and techniques, such as medical imaging and electrophysiology and related facilities, analysis tools, data storage and computation clusters. The need to share clinical data, storage and computation resources between different bioprofile centres creates not only local problems, but also global problems. Existing ICT technologies are inappropriate for bioprofiling because of the difficulties in the use and management of heterogeneous IT resources at different bioprofile centres. Grid as an emerging resource sharing concept fulfils the needs of bioprofile in several aspects, including discovery, access, monitoring and allocation of distributed bioprofile databases, computation resoiuces, bioprofile knowledge bases, etc. However, the challenge of how to integrate the grid and bioprofile technologies together in order to offer an advanced distributed bioprofile environment to support individualized healthcare remains. The aim of this project is to develop a framework for one of the key meta-level bioprofile applications: bioprofile analysis over grid to support individualised healthcare. Bioprofile analysis is a critical part of bioprofiling (i.e. the creation, use and update of bioprofiles). Analysis makes it possible, for example, to extract markers from data for diagnosis and to assess individual's health status. The framework provides a basis for a "grid-based" solution to the challenge of "distributed bioprofile analysis" in bioprofiling. The main contributions of the thesis are fourfold: A. An architecture for bioprofile analysis over grid. The design of a suitable aichitecture is fundamental to the development of any ICT systems. The architecture creates a meaiis for categorisation, determination and organisation of core grid components to support the development and use of grid for bioprofile analysis; B. A service model for bioprofile analysis over grid. The service model proposes a service design principle, a service architecture for bioprofile analysis over grid, and a distributed EEG analysis service model. The service design principle addresses the main service design considerations behind the service model, in the aspects of usability, flexibility, extensibility, reusability, etc. The service architecture identifies the main categories of services and outlines an approach in organising services to realise certain functionalities required by distributed bioprofile analysis applications. The EEG analysis service model demonstrates the utilisation and development of services to enable bioprofile analysis over grid; C. Two grid test-beds and a practical implementation of EEG analysis over grid. The two grid test-beds: the BIOPATTERN grid and PlymGRID are built based on existing grid middleware tools. They provide essential experimental platforms for research in bioprofiling over grid. The work here demonstrates how resources, grid middleware and services can be utilised, organised and implemented to support distributed EEG analysis for early detection of dementia. The distributed Electroencephalography (EEG) analysis environment can be used to support a variety of research activities in EEG analysis; D. A scheme for organising multiple (heterogeneous) descriptions of individual grid entities for knowledge representation of grid. The scheme solves the compatibility and adaptability problems in managing heterogeneous descriptions (i.e. descriptions using different languages and schemas/ontologies) for collaborated representation of a grid environment in different scales. It underpins the concept of bioprofile analysis over grid in the aspect of knowledge-based global coordination between components of bioprofile analysis over grid