A Learning Health System for Radiation Oncology

The proposed research aims to address the challenges faced by clinical data science researchers in radiation oncology accessing, integrating, and analyzing heterogeneous data from various sources. The research presents a scalable intelligent infrastructure, called the Health Information Gateway and Exchange (HINGE), which captures and structures data from multiple sources into a knowledge base with semantically interlinked entities. This infrastructure enables researchers to mine novel associations and gather relevant knowledge for personalized clinical outcomes. The dissertation discusses the design framework and implementation of HINGE, which abstracts structured data from treatment planning systems, treatment management systems, and electronic health records. It utilizes disease-specific smart templates for capturing clinical information in a discrete manner. HINGE performs data extraction, aggregation, and quality and outcome assessment functions automatically, connecting seamlessly with local IT/medical infrastructure. Furthermore, the research presents a knowledge graph-based approach to map radiotherapy data to an ontology-based data repository using FAIR (Findable, Accessible, Interoperable, Reusable) concepts. This approach ensures that the data is easily discoverable and accessible for clinical decision support systems. The dissertation explores the ETL (Extract, Transform, Load) process, data model frameworks, ontologies, and provides a real-world clinical use case for this data mapping. To improve the efficiency of retrieving information from large clinical datasets, a search engine based on ontology-based keyword searching and synonym-based term matching tool was developed. The hierarchical nature of ontologies is leveraged to retrieve patient records based on parent and children classes. Additionally, patient similarity analysis is conducted using vector embedding models (Word2Vec, Doc2Vec, GloVe, and FastText) to identify similar patients based on text corpus creation methods. Results from the analysis using these models are presented. The implementation of a learning health system for predicting radiation pneumonitis following stereotactic body radiotherapy is also discussed. 3D convolutional neural networks (CNNs) are utilized with radiographic and dosimetric datasets to predict the likelihood of radiation pneumonitis. DenseNet-121 and ResNet-50 models are employed for this study, along with integrated gradient techniques to identify salient regions within the input 3D image dataset. The predictive performance of the 3D CNN models is evaluated based on clinical outcomes. Overall, the proposed Learning Health System provides a comprehensive solution for capturing, integrating, and analyzing heterogeneous data in a knowledge base. It offers researchers the ability to extract valuable insights and associations from diverse sources, ultimately leading to improved clinical outcomes. This work can serve as a model for implementing LHS in other medical specialties, advancing personalized and data-driven medicine

Clinical innovation in pre-hospital care: An introduction to critical care paramedics in the UK

The aim of the project was to evaluate the development of ‘Critical Care Paramedics’ (CCPs) at South East Coast Ambulance NHS Trust (SECAmb) in the UK. SECAmb has developed a new CCP role in response to numerous national reports critical of sub-standard pre-hospital care for seriously ill and injured patients, and the need to save more lives. There is an ongoing debate on the use of doctors and paramedics in pre-hospital care and the evidence is mixed whether one is more effective than the other in reducing mortality rates. There are examples in other countries of increasing the involvement of paramedic staff, and of improved survival and treatment rates. This evaluation study used a financial and qualitative methodology to unravel the cost effectiveness of CCPs. Using this methodology rather than just a randomised population study, helped uncover the rich processes underlying the new capabilities rather than simply reporting statistically significant differences. In any case, the small CCP sample at the start of this evaluation would have made any statistical comparisons meaningless. The study is based on an extensive literature analysis, 60 interviews with key stakeholders, observations of CCPs in the field, attendance at meetings including developmental activities, and review of internal documentation

Evaluating information flow in medication management process in Australian acute care facilities: A multi-professional perspective

Over the years, various interventions have been introduced to improve the medication management process. While these interventions have addressed some aspects predisposing the process to inefficiencies, significant gaps are still prevalent across the process. Studies have suggested that the goal of optimal medication therapy is achievable when information flow integrates across the various medication management process phases, stakeholders and departments involved as the patient moves through the process. To provide a cross-sectional view of the process, this study utilised a systemic philosophy to evaluate the information flow integration across the process. The research approach adopted for this study takes a positivist paradigm, which is guided by the cause and effect (causality) belief. It explored numeric measures to evaluate the relationship between constructs that assessed information flow principles (accessibility, timeliness, granularity and transparency) within the medication process and the information integration. The research design was cross-sectional and analytical, and this ensures that findings are relevant to current situations across the Australian healthcare system. Data for this research was collected using an online self-administered survey and the data assessed information flow principles and technologies used in the medication management process. There were 88 participants in this study, including doctors, nurses and pharmacists. The questions and responses were coded for analysis and data analysis techniques used were frequency analysis, Pearson’s chi-square test and multivariate analysis. Findings from this study indicates that the constructs evaluating accessibility, transparency and granularity had moderate associations with the information integration in the medication management process. Further analysis highlighted accessibility as a significant principle in explaining an increase or decrease in information integration in the medication management process. The accessibility construct referring to information retrieval was significant across the two tests conducted. Accessibility is directly related to information sharing and the assessment and monitoring and evaluation phases in the medication management process were identified as having the highest challenges with information sharing. Furthermore, the hybrid (electronic and paper) channel was preferred to support information integration in the medication management process by the participants. Among the technologies evaluated for the medication process, computer-provider-order-entry was found to be statistically significant in explaining an increase in information integration. Overall, results from this study suggest that interventions for the medication management process in Australian acute care facilities should be directed towards improving accessibility, specifically information retrieval and the sharing of information with emphasis on the assessment and monitoring phases. Implementing strategies to address the gaps identified from this research can improve information integration across the process and thereby reducing medication errors, and improving patient care management. Furthermore, the technology adoption across the process highlights that technology adoption across participants’ facilities remains a challenge in Australia

A framework for the secure consumerisation of mobile, handheld devices in the healthcare institutional context

The advances in communication technologies have resulted in a significant shift in the workplace culture. Mobile computing devices are increasingly becoming an integral part of workplace culture. Mobility has several advantages to the organisation, one such example is the “always online” workforce resulting in increased productivity hours. As a result, organisations are increasingly providing mobile computing devices to the workforce to enable remote productivity at the organisations cost. A challenge associated with mobility is that these devices are likely to connect to a variety of networks, some which may insecure, and because of their smaller form factor and perceived value, are vulnerable to loss and theft amongst other information security challenges. Increased mobility has far reaching benefits for remote and rural communities, particularly in the healthcare domain where health workers are able to provide services to previously inaccessible populations. The adverse economic and infrastructure environment means institution provided devices make up the bulk of the mobile computing devices, and taking away the ownership, the usage patterns and the susceptibility of information to adversity are similar. It is for this reason that this study focuses on information security on institution provided devices in a rural healthcare setting. This study falls into the design science paradigm and is guided by the principles of design science proposed by Hevner et al. The research process incorporates literature reviews focusing on health information systems security and identifying theoretical constructs that support the low-resource based secure deployment of health information technologies. Thereafter, the artifact is developed and evaluated through an implementation case study and expert reviews. The outcomes from the feedback are integrated into the framework

Sex trafficking in Nepal: A qualitative study of process and context. Abstract.

Thousands of Nepalese girls are trafficked to India and other neighbouring countries every year, primarily for sex work and the majority return to Nepal after spending a years in sex trade. The sub‐group of Nepalese girls who become involved in sex work via trafficking are the focus of this paper. The aim of this study was to increase understanding regarding the context of sex trafficking, the methods and means of trafficking, living conditions in brothels and survival strategies among trafficked girls. We conducted 33 in‐depth interviews in early 2013 with returned trafficking survivors (n=14) and policy‐makers, people working in trafficking related NGOs/INGOs (n=19) in Nepal. All 14 trafficking survivors were recruited in Nepal through the NGO working on trafficking field. The young girls trafficked from Nepal to India in this study were typically unmarried, illiterate and very young (8 to 14 years at the time of trafficking). The key methods of trafficking were false marriage, fake job offer, and abduction. Among the 14 respondents, some had spent one month and others nearly 5 years in Indian brothels. Respondents were either rescued, escaped or released by brothel owners. Four out of 14 were HIV positive. Most policy makers mentioned that poverty, unemployment and illiteracy are the causes behind the trafficking of young girls. The anti‐trafficking interventions need to be considered at a) community level before movement has begun; b) urban centres which are both source and transitory centres for trafficking; c) trafficking level when girls are highly mobile and when they are in brothels; and d) return from trafficking as girls to m ove back into the community