Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606

Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain

An Integrated and Distributed Framework for a Malaysian Telemedicine System (MyTel)

The overall aim of the research was to produce a validated framework for a Malaysian integrated and distributed telemedicine system. The framework was constructed so that it was capable of being useful in retrieving and storing a patient's lifetime health record continuously and seamlessly during the downtime of the computer system and the unavailability of a landline telecommunication network. The research methodology suitable for this research was identified including the verification and validation strategies. A case study approach was selected for facilitating the processes and development of this research. The empirical data regarding the Malaysian health system and telemedicine context were gathered through a case study carried out at the Ministry of Health Malaysia (MOHM). The telemedicine approach in other countries was also analysed through a literature review and was compared and contrasted with that in the Malaysian context. A critical appraisal of the collated data resulted in the development of the proposed framework (MyTel) a flexible telemedicine framework for the continuous upkeep o f patients' lifetime health records. Further data were collected through another case study (by way of a structured interview in the outpatient clinics/departments of MOHM) for developing and proposing a lifetime health record (LHR) dataset for supporting the implementation of the MyTel framework. The LHR dataset was developed after having conducted a critical analysis of the findings of the clinical consultation workflow and the usage o f patients' demographic and clinical records in the outpatient clinics. At the end of the analysis, the LHR components, LHR structures and LHR messages were created and proposed. A common LHR dataset may assist in making the proposed framework more flexible and interoperable. The first draft of the framework was validated in the three divisions of MOHM that were involved directly in the development of the National Health JCT project. The division includes the Telehealth Division, Public and Family Health Division and Planning and Development Division. The three divisions are directly involved in managing and developing the telehealth application, the teleprimary care application and the total hospital information system respectively. The feedback and responses from the validation process were analysed. The observations and suggestions made and experiences gained advocated that some modifications were essential for making the MyTel framework more functional, resulting in a revised/ final framework. The proposed framework may assist in achieving continual access to a patient's lifetime health record and for the provision of seamless and continuous care. The lifetime health record, which correlates each episode of care of an individual into a continuous health record, is the central key to delivery of the Malaysian integrated telehealth application. The important consideration, however, is that the lifetime health record should contain not only longitudinal health summary information but also the possibility of on-line retrieval of all of the patient's health history whenever required, even during the computer system's downtime and the unavailability of the landline telecommunication network

Registered Nurses\u27 Intention To Use Electronic Documentation Systems: A Mixed Methods Study

BACKGROUND: Home care in Ontario has become the fastest growing sector and cornerstone of the healthcare system. As a result of the increased shift to the home care sector in Ontario, there have been several health information technology (HIT) initiatives to improve the quality and delivery of health care services to patients. This is exemplified with the province-wide development and implementation of electronic documentation systems (EDS). Electronic documentation systems have the potential to ensure timely, up-to-date and comprehensive patient health and care-related information is available and accessible to healthcare providers such as registered nurses regardless of their physical location. Access to patient health and care-related information supports high-quality nursing care, decision-making, and care delivery processes. Despite the benefits of EDS (i.e., improved workflow, reduced diagnostic and laboratory tests and adverse drug events), low intention by registered nurses to use these systems is well documented. Existing evidence suggests that an expressed intention to use HIT such as EDS is a direct predictor and antecedent of behavioural usage. Despite the growing efforts to understand registered nurses’ perceptions and overall intention to use EDS in practice, there is limited knowledge about registered nurses’ intention to use EDS in the context of home care practice. AIMS: The purpose of this study was to understand and examine factors that influence nurses’ intention and overall perception of using EDS in their home care practice. The conceptual model framing this study was adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT) to delineate the relationships among factors that influence registered nurses’ intention to use EDS in home care practice. METHOD: A sequential, explanatory mixed methods design, using a sample of nurses from Ontario who are currently practicing within the home care sector were recruited to address the study’s objectives. Data were collected using both quantitative (online survey) and qualitative (semi-structured individual telephone interviews) methods. Quantitative data were analyzed with descriptive statistics and hierarchical multiple regression analysis and qualitative data were analyzed with content and inductive thematic analysis. RESULTS: Individual, technological and organizational / environmental characteristics were found to influence nurses’ intention, level of comfort and experience with EDS usage in home care practice. Additional factors found to influence home care nurses’ experience with EDS usage included: the development and employment of workarounds, the influence of nurse-patient interaction amidst system usage, and the ability to provide input towards the system design. CONCLUSION: Nurses play a significant role in the delivery of home health care services to Ontarians. The findings highlight the importance for: a) further exploration of the most appropriate model and / or adaptation of a model identifying a range of factors influencing nurses’ intention to use EDS in different healthcare contexts; b) continued integration of nursing informatics competencies within nursing curricula; c) an organizational culture that supports the use of EDS in nurses’ home practice (i.e., enlisting user champions and providing adequate training and IT support); and d) having representation of nurses in the EDS design and / or implementation processes through a user-centered design approach

Quality framework for semantic interoperability in health informatics: definition and implementation

Aligned with the increased adoption of Electronic Health Record (EHR) systems, it is recognized that semantic interoperability provides benefits for promoting patient safety and continuity of care. This thesis proposes a framework of quality metrics and recommendations for developing semantic interoperability resources specially focused on clinical information models, which are defined as formal specifications of structure and semantics for representing EHR information for a specific domain or use case. This research started with an exploratory stage that performed a systematic literature review with an international survey about the clinical information modelling best practice and barriers. The results obtained were used to define a set of quality models that were validated through Delphi study methodologies and end user survey, and also compared with related quality standards in those areas that standardization bodies had a related work programme. According to the obtained research results, the defined framework is based in the following models: Development process quality model: evaluates the alignment with the best practice in clinical information modelling and defines metrics for evaluating the tools applied as part of this process. Product quality model: evaluates the semantic interoperability capabilities of clinical information models based on the defined meta-data, data elements and terminology bindings. Quality in use model: evaluates the suitability of adopting semantic interoperability resources by end users in their local projects and organisations. Finally, the quality in use model was implemented within the European Interoperability Asset register developed by the EXPAND project with the aim of applying this quality model in a broader scope to contain any relevant material for guiding the definition, development and implementation of interoperable eHealth systems in our continent. Several European projects already expressed interest in using the register, which will now be sustained by the European Institute for Innovation through Health Data

A novel platform incorporating multiple forms of communication to support applications in a mobile environment

This thesis discusses the creation of a novel platform that incorporates multiple communication methods, including SMS, email and web-based technologies, for interacting with users of mobile communication devices. The platform utilises people in a mobile environment to solve a range of different application problems, where each problem is a separate and distinct scenario type with unique objectives. There are existing applications available that interact with users of mobile communication devices to provide a service, such as regular weather updates to the users. Other applications have been designed to manage and coordinate the users to perform tasks within a mobile environment, such as performing field studies for scientific purposes. However, the existing applications are designed for only one specific scenario, with the design and implementation solely focused on solving the objectives of that scenario. Each component of these applications needs to be developed from scratch in order to cater for the application s requirements. There is currently no integrated communications platform that offers a framework for supporting a range of different scenario types. The new platform, entitled the Connected-Mobile Platform, aims to support the rapid development and implementation of new scenarios. This platform is composed of a framework of generic components that enable the active running of multiple scenarios concurrently, with the ability to tailor to the requirements of new scenarios as they arise via a structured process. The platform facilitates a means to coordinate its users in order to tackle the objectives of a scenario. The thesis investigates several system architectures to determine an appropriate architectural design for constructing the proposed platform. The platform has a generic framework, based on a client-server architecture, to facilitate the inclusion of a multitude of scenarios. A scenario represents a problem or an event, whereby the platform can utilise and interact with users of mobile communication devices to attempt to solve the objectives of the scenario. Three mobile communication methods are supported; the Short Message Service, electronic mail and web-forms via the mobile internet. Users are able to select and switch between the different methods. The thesis describes the platform s tailored communication structure for scenarios and autonomous analysis of messages. The thesis discusses case studies of two different scenarios to evaluate the platform s facilities for rapid scenario development. The Diet Diary scenario, which is for individual users, aims to manage a user s daily calorie intake to help them reach their desired weight goal. The focus is on the platform s functionality for analysing and responding to messages autonomously. The Missing Persons scenario, which utilises multiple users, involves tracking and locating people who have been reported missing. The focus is on the platform s functionality for coordinating the multiple users, through the creation of assignments, in order to distribute the scenario objectives. The thesis concludes by highlighting the novel features of the platform and identifying opportunities for future work

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Near Field Communication Applications

Near Field Communication (NFC) is a short-range, low power contactless communication between NFC-enabled devices that are held in the closed proximity to each other. NFC technology has been moving rapidly from its initial application areas of mobile payment services and contactless ticketing to the diversity of new areas. Three specific NFC tags highlighted in the thesis have different structures in terms of memory, security and usage in different applications. NFC information tags exploit the data exchange format NDEF standardized by NFC Forum. NFC applications are rapidly stepping into novel and diverse application areas. Often they are deployed in combination with different devices and systems through their integrability and adaptability features. The diverse application areas where NFC tags and cards are used cover smart posters, contactless ticketing, keys and access control, library services, entertainment services, social network services, education, location based services, work force and retail management and healthcare. In designing different NFC applications, it is necessary to take into consideration different design issues such as to choosing the NFC tools and devices according to the technical requirements of the application, considering especially the memory, security and price factors as well as their relation to the purpose and usage of the final product. The security aspect of the NFC tags is remarkably important in selecting the proper NFC device. The race between hackers attacking and breaking the security systems of programmable high level products and manufacturers to produce reliable secure systems and products seems to never end. This has proven to be case, for example, for trying MIFARE Ultralight and DESFire MF3ICD40 tags. An important consideration of studying the different applications of NFC tags and cards during the thesis work was to understand the ubiquitous character of NFC technology.Lähitunnistus yhteys tekniikka (NFC) on lyhyen tähtäimen, pienitehoinen, kontaktiton yhteydenpito NFC yhteensopivien laitteiden välillä, jossa laitteet pidetään toistensä välittömässä läheisyydessä tiedon siirtämiseksi niiden välillä. NFC-teknologia on siirtynyt nopeasti sen alkuperäisiltä toimialueilta eli mobiili maksupalvelujen ja kontaktittomien lippujen sovellusalueilta moninaisille uusille alueille. Kolmella NFC tagillä, joita on käsitelty tässä tutkielmassa, on muistin, turvallisuuden ja käytön kannalta erilaisiä rakenteita, joita käytetään eri sovelluksissa. NFC-tagit käyttävät tiedonvälityksessä NFC Forumin standardoimaa NDEF-tiedonvaihtoformaattia. NFC sovellukset esiintyvät yhä enenevässä määrin nopeasti kehyttyvillä, uudenlaisilla ja monipuolisilla sovellusalueilla, usein yhdessä eri laitteiden ja järjestelmien kanssa. NFC on käytettävissä erinäisten laitteiden kanssa erilaisissa järjestelmäympäristöissä. Monipuoliset sovellusalueet, joissa muun muassa NFC-tagejä ja -kortteja käytetään sisältävät seuraavanlaisia sovelluksia: älykkäät julisteet, kontaktittomat liput, avaimet ja pääsynvalvonta, kirjastopalvelut, viihdepalvelut, sosiaalisen verkoston palvelut, kasvatukseen ja koulutukseen liittyvät palvelut, sijaintiperustaiset palvelut, työvoiman ja vähittäiskaupan hallinto-palvelut ja terveyspalvelut. Erilaisten NFC-sovelluksien suunnittelussa on väistämätöntä ottaa erilaisia suunnitteluasioita huomioon kuten valita NFC-työkalut ja laitteet sovelluksen teknisten vaatimusten mukaan. Erilaiset tärkeät tekijät kuten muisti, tietoturvallisuusominaisuudet ja hinta ja niiden kaikkien toimivuus lopputuotteen kannalta on otettava huomioon. Tietoturvallisuusnäkökohta on erityisen tärkeä oikean NFC laitteen valitsemisessa, sillä käynnissä on loputon kilpajuoksu hakkerien, jotka yrittävät rikkoa ohjelmoitavien korkeatasoisten laitteiden ja tuotteiden tietoturvajärjestelmiä, ja valmistajien, jotka pyrkivät tuottamaan luotettavia varmoja järjestelmiä, välillä. Tietoturvariskiin liittyviä ongelmia on löydetty esimerkiksi MIFARE Ultralight ja DESFire MF3ICD40 tageista. Tärkeä havainto, joka saatiin erilaisten NFC sovelluksien tutkimisesta, oli oivaltaa NFCteknologian potentiaalinen kaikkialle ulottuva, yleiskäyttöinen luonne