On-site customer analytics and reporting (OSCAR):a portable clinical data warehouse for the in-house linking of hospital and telehealth data

This document conveys the results of the On-Site Customer Analytics and Reporting (OSCAR) project. This nine-month project started on January 2014 and was conducted at Philips Research in the Chronic Disease Management group as part of the H2H Analytics Project. Philips has access to telehealth data from their Philips Motiva tele-monitoring and other services. Previous projects within Philips Re-search provided a data warehouse for Motiva data and a proof-of-concept (DACTyL) solution that demonstrated the linking of hospital and Motiva data and subsequent reporting. Severe limitations with the DACTyL solution resulted in the initiation of OSCAR. A very important one was the unwillingness of hospitals to share personal patient data outside their premises due to stringent privacy policies, while at the same time patient personal data is required in order to link the hospital data with the Motiva data. Equally important is the fact that DACTyL considered the use of only Motiva as a telehealth source and only a single input interface for the hospitals. OSCAR was initiated to propose a suitable architecture and develop a prototype solution, in contrast to the proof-of-concept DACTyL, with the twofold aim to overcome the limitations of DACTyL in order to be deployed in a real-life hospital environment and to expand the scope to an extensible solution that can be used in the future for multiple telehealth services and multiple hospital environments. In the course of the project, a software solution was designed and consequently deployed in the form of a virtual machine. The solution implements a data warehouse that links and hosts the collected hospital and telehealth data. Hospital data are collected with the use of a modular service oriented data collection component by exposing web services described in WSDL that accept configurable XML data messages. ETL processes propagate the data, link, and load it on the OS-CAR data warehouse. Automated reporting is achieved using dash-boards that provide insight into the data stored in the data warehouse. Furthermore, the linked data is available for export to Philips Re-search in de-identified format

A Home E-Health System for Dependent People Based on OSGI

This chapter presents a e-health system for dependent people installed in a home environment. After reviewing the state of art in e-health applications and technologies several limitations have been detected because many solutions are proprietary and lack interoperability. The developed home e-health system provides an architecture capable to integrate different telecare services in a smart home gateway hardware independent from the application layer. We propose a rule system to define users’ behavior and monitor relevant events. Two example systems have been implemented to monitor patients. A data model for the e-health platform is described as well.Ministerio de Educación y Ciencia TSI2006-13390-C02-0

An Interoperable Clinical Cardiology Electronic Health Record System - a standards based approach for Clinical Practice and Research with Data Reuse

Currently in hospitals, several information systems manage, very often autonomously, the patient’s personal, clinical and diagnostic data. This originates a clinical information management system consisting of a myriad of independent subsystems which, although efficient in their specific purpose, make the integration of the whole system very difficult and limit the use of clinical data, especially as regards the reuse of these data for research purposes. Mainly for these reasons, the management of the Genoese ASL3 decided to commission the University of Genoa to set up a medical record system that could be easily integrated with the rest of the information system already present, but which offered solid interoperability features, and which could support the research skills of hospital health workers. My PhD work aimed to develop an electronic health record system for a cardiology ward, obtaining a prototype which is functional and usable in a hospital ward. The choice of cardiology was due to the wide availability of the staff of the cardiology department to support me in the development and in the test phase. The resulting medical record system has been designed “ab initio” to be fully integrated into the hospital information system and to exchange data with the regional health information infrastructure. In order to achieve interoperability the system is based on the Health Level Seven standards for exchanging information between medical information systems. These standards are widely deployed and allow for the exchange of information in several functional domains. Specific decision support sections for particular aspects of the clinical life were also included. The data collected by this system were the basis for examples of secondary use for the development of two models based on machine learning algorithms. The first model allows to predict mortality in patients with heart failure within 6 months from their admission, and the second is focused on the discrimination between heart failure versus chronic ischemic heart disease in the elderly population, which is the widest population section served by the cardiological ward

Computer-supported cooperative work in tele home care : architecture design, implementation and evaluation

With the development of healthcare service and computer networks, the healthcare providers are focusing on how to implant new technologies into health sections. These instant messaging techniques can lead healthcare service more efficienct than before. It is necessary to design and construct a cooperative work platform for patients and healthcare providers. They are able to communicate with each other, share information or documents and access into health records. This project will concentrate on the system design, implementation and evaluation to achieve a better performance platform. The underlying data repository will encompass distributed system aspects and data warehousing approach to promote the functions of this healthcare system. This platform will be deployed to the tele home care service and in-depth study on the healthcare services. Some of the innovations will be included in system design. The target of this project is to design the architecture of collaborative workspace for healthcare personnel and implement a prototype with useful functions. The evaluation will be conducted to validate the efficiency of proposed distributed database for patient records. In addition, it will be more flexible and less data redundant. Meanwhile, a demo system will be deployed in order to show and define the implemented functions

Biomedical research in a digital health framework

This article describes a Digital Health Framework (DHF), benefitting from the lessons learnt during the three-year life span of the FP7 Synergy-COPD project. The DHF aims to embrace the emerging requirements--data and tools--of applying systems medicine into healthcare with a three-tier strategy articulating formal healthcare, informal care and biomedical research. Accordingly, it has been constructed based on three key building blocks, namely, novel integrated care services with the support of information and communication technologies, a personal health folder (PHF) and a biomedical research environment (DHF-research). Details on the functional requirements and necessary components of the DHF-research are extensively presented. Finally, the specifics of the building blocks strategy for deployment of the DHF, as well as the steps toward adoption are analyzed. The proposed architectural solutions and implementation steps constitute a pivotal strategy to foster and enable 4P medicine (Predictive, Preventive, Personalized and Participatory) in practice and should provide a head start to any community and institution currently considering to implement a biomedical research platform

eHealth Conversations : using information management, dialogue, and knowledge exchange to move toward universal

The publication of eHealth Conversations, developed with the support of the Spanish Agency for International Development Cooperation (AECID), represents a major step forward for the PAHO/WHO Strategy, since it explores ways of implementing regional mechanisms with free and equitable access to information and knowledge sharing. These initiatives aim to advance the goals of more informed, equitable, competitive, and democratic societies, where access to health information is considered a basic right. This publication is one of the instruments used by PAHO/WHO to develop the initiatives outlined in the Strategy, which coincides with the global eHealth strategy. One of the fundamental needs for the improvement of eHealth is the dissemination of information, and PAHO/WHO is assuming a leading role in this effort. The development of this new electronic publication is a key step in disseminating information that will be useful for decision makers on applying these technologies for the health of the Americas. This electronic book is one of the products of PAHO/WHO’s project: “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health.” Participants in these conversations included experts on electronic health and other specialties. Through virtual dialogues, the experts contributed with knowledge and reflections on the present and the future of eHealth in the Americas, analyzed the situation, and made recommendations for the implementation of electronic health initiatives. These recommendations are not only intended for PAHO/ WHO, but also for governments and the private sector. The aim of the project is to guarantee the convergence of local, national, and regional initiatives regarding the adoption and application of ICTs for public health, with special attention on critical issues in this field. It also intends to strengthen individual and collective capacities of health workers and institutions, connecting them in a network of on-line health networks, as well as to reinforce the PAHO/WHO eHealth program.Acknowledge the Spanish Agency for International Development Cooperation (AECID) for its financial support in preparing this publication and developing the project titled “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health;

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

Conceptual Framework for Semantic Interoperability in Sensor-enhanced Health Information Systems (SIOp4Se-HIS)

Transducer integration into different accessories such as eyeglasses, wristbands, vest, wristwatches, among others, has brought myriads of physiological data that could be of help in making patients health monitoring easier. However, this myriad of data are generated from different devices with different formats and uncoordinated data types which ultimately compromises the data integrity and renders it medically less importance. Furthermore, several wearables do operate as data island as they cannot incorporate their captured data into the Health Information Systems (HIS) for easy accessibility by the health-care professionals for further processing, interpretation and actions on the patients’ health. Therefore, to enable the flow of data that will be useful to both patient and health-care professional, the existing HIS should be transducer enhanced / enabled, and they should operate at the same semantic interoperability level to allow for exchange of meaningful data from transducers to HIS. In bid to achieve this, several attempts have been made using standards, and archetypes, which goes a long way in providing interoperability at the technical and syntactic level. However, repositories of heterogeneous transducer data as provided by health monitoring systems, requires actionable knowledge of context (environment) from which the data is collected for it to be medically useful and interoperate at the semantic level with the HIS. There are three approaches: the model-driven; standard based and archetype approach but only the ontology driven guarantees making the applications smarter, or make the data smarter. The study propose the latter option using a dual model approach to leverage semantic technologies in order to provide and apply more meaningful health monitoring data representation between transducers and HIS. We approached this study using the design science research methodology and developed a hybrid methodology by combining two methods to develop our ontologies that are based on standards in the domains, with this unique method we achieved a novel approach to solve the obstacle of semantic interoperability through our proposed framework for Semantic Interoperability for Sensor-enhanced Health Information Systems (se-HIS) and bridged the gaps in systems’ interoperability between monitoring units and HIS. The outcome is a robust, explicit conceptual framework for sensor-enhanced health information systems Interoperability (IOp) at the semantic level. This semantically enabled our HIS, to interoperate with Transducers that are compliant with the Institute of Electrical and Electronics Engineers (IEEE) 21451 family of standards, and it provides the ability to query high-level knowledge of the data context as well as low-level raw data accessibility in a multi-transducer enable HIS