The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia

Autonomic care platform for optimizing query performance

Background: As the amount of information in electronic health care systems increases, data operations get more complicated and time-consuming. Intensive Care platforms require a timely processing of data retrievals to guarantee the continuous display of recent data of patients. Physicians and nurses rely on this data for their decision making. Manual optimization of query executions has become difficult to handle due to the increased amount of queries across multiple sources. Hence, a more automated management is necessary to increase the performance of database queries. The autonomic computing paradigm promises an approach in which the system adapts itself and acts as self-managing entity, thereby limiting human interventions and taking actions. Despite the usage of autonomic control loops in network and software systems, this approach has not been applied so far for health information systems. Methods: We extend the COSARA architecture, an infection surveillance and antibiotic management service platform for the Intensive Care Unit (ICU), with self-managed components to increase the performance of data retrievals. We used real-life ICU COSARA queries to analyse slow performance and measure the impact of optimizations. Each day more than 2 million COSARA queries are executed. Three control loops, which monitor the executions and take action, have been proposed: reactive, deliberative and reflective control loops. We focus on improvements of the execution time of microbiology queries directly related to the visual displays of patients' data on the bedside screens. Results: The results show that autonomic control loops are beneficial for the optimizations in the data executions in the ICU. The application of reactive control loop results in a reduction of 8.61% of the average execution time of microbiology results. The combined application of the reactive and deliberative control loop results in an average query time reduction of 10.92% and the combination of reactive, deliberative and reflective control loops provides a reduction of 13.04%. Conclusions: We found that by controlled reduction of queries' executions the performance for the end-user can be improved. The implementation of autonomic control loops in an existing health platform, COSARA, has a positive effect on the timely data visualization for the physician and nurse

Sistemas interativos e distribuídos para telemedicina

doutoramento Ciências da ComputaçãoDurante as últimas décadas, as organizações de saúde têm vindo a adotar continuadamente as tecnologias de informação para melhorar o funcionamento dos seus serviços. Recentemente, em parte devido à crise financeira, algumas reformas no sector de saúde incentivaram o aparecimento de novas soluções de telemedicina para otimizar a utilização de recursos humanos e de equipamentos. Algumas tecnologias como a computação em nuvem, a computação móvel e os sistemas Web, têm sido importantes para o sucesso destas novas aplicações de telemedicina. As funcionalidades emergentes de computação distribuída facilitam a ligação de comunidades médicas, promovem serviços de telemedicina e a colaboração em tempo real. Também são evidentes algumas vantagens que os dispositivos móveis podem introduzir, tais como facilitar o trabalho remoto a qualquer hora e em qualquer lugar. Por outro lado, muitas funcionalidades que se tornaram comuns nas redes sociais, tais como a partilha de dados, a troca de mensagens, os fóruns de discussão e a videoconferência, têm o potencial para promover a colaboração no sector da saúde. Esta tese teve como objetivo principal investigar soluções computacionais mais ágeis que permitam promover a partilha de dados clínicos e facilitar a criação de fluxos de trabalho colaborativos em radiologia. Através da exploração das atuais tecnologias Web e de computação móvel, concebemos uma solução ubíqua para a visualização de imagens médicas e desenvolvemos um sistema colaborativo para a área de radiologia, baseado na tecnologia da computação em nuvem. Neste percurso, foram investigadas metodologias de mineração de texto, de representação semântica e de recuperação de informação baseada no conteúdo da imagem. Para garantir a privacidade dos pacientes e agilizar o processo de partilha de dados em ambientes colaborativos, propomos ainda uma metodologia que usa aprendizagem automática para anonimizar as imagens médicasDuring the last decades, healthcare organizations have been increasingly relying on information technologies to improve their services. At the same time, the optimization of resources, both professionals and equipment, have promoted the emergence of telemedicine solutions. Some technologies including cloud computing, mobile computing, web systems and distributed computing can be used to facilitate the creation of medical communities, and the promotion of telemedicine services and real-time collaboration. On the other hand, many features that have become commonplace in social networks, such as data sharing, message exchange, discussion forums, and a videoconference, have also the potential to foster collaboration in the health sector. The main objective of this research work was to investigate computational solutions that allow us to promote the sharing of clinical data and to facilitate the creation of collaborative workflows in radiology. By exploring computing and mobile computing technologies, we have designed a solution for medical imaging visualization, and developed a collaborative system for radiology, based on cloud computing technology. To extract more information from data, we investigated several methodologies such as text mining, semantic representation, content-based information retrieval. Finally, to ensure patient privacy and to streamline the data sharing in collaborative environments, we propose a machine learning methodology to anonymize medical images

PACS for the Developing World

Digital imaging is now firmly ensconced in the developed world. Its widespread adoption has enabled instant access to images, remote viewing, remote consultation, and the end of lost or misplaced film. Unfortunately, the current paradigm of Picture Archiving and Communication System (PACS), with advanced technology inseparable from high complexity, high purchase costs, and high maintenance costs, is not suited for the low-income developing world. Like the simple, easy to repair, 1950’s American cars still running on the streets of Havana, the developing world requires a PACS (DW-PACS) that can perform basic functions and survive in a limited-resource environment. The purpose of this article is to more fully describe this concept and to present a blueprint for PACS tailored to the needs and resources of the developing world. This framework should assist both users looking for a vendor-supplied or open-source solutions and developers seeking to address the needs of this emerging market

Improvement of DHRA-DMDC Physical Access Software DBIDS Using Cloud Computing Technology: a Case Study

The U.S government has created and been executing an Identity and Management (IdM) vision to support a global, robust, trusted and interoperable identity management capability that provides the ability to correctly identify individuals and non-person entities in support of DoD mission operations. Many Directives and Instructions have been issued to standardize the process to design, re-designed new and old systems with latest available technologies to meet the visions requirements. In this thesis we introduce a cloud-based architecture for the Defense Biometric Identification System (DBIDS), along with a set of DBIDS Cloud Services that supports the proposed architecture. This cloud-based architecture will move DBIDS in the right direction to meet Dod IdM visions and goals by decoupling current DBIDS functions into DBIDS core services to create interoperability and flexibility to expand future DBIDS with new requirements. The thesis will show its readers how DBIDS Cloud Services will help Defense Manpower Data Center (DMDC) easily expanding DBIDS functionalities such as connecting to other DMDC services or federated services for vetting purposes. This thesis will also serve as a recommendation of a blue-print for DBIDS architecture to support new generation of DBIDS application. This is a step closer in moving DMDC Identity Enterprise Solution toward DoD IdM realizing vision and goals. The thesis also includes a discussion of how to utilize virtualized DBIDS workstations to address software-deployment and maintenance issues to resolve configuration and deployment issues which have been costly problems for DMDC over the years.http://archive.org/details/improvementofdhr109457379Civilian, Department of Defens

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

Future developments and trends in use of picture archiving and communication systems

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University London.Objectives: This study identifies modern information technologies that can improve the clinical practice of Picture Archiving and Communication Systems (PACS) and determines the approaches that are needed to improve the functionality of current PACS to provide better next generation PACS and to improve the future of radiology practices and workflow with future PACS generations. Method: A parallel mixed method approach was adopted including qualitative method (semi-structured interviews), quantitative method (questionnaire survey) and observation of online discussion groups on PACS. Five databases were searched to find salient literature, including Science Direct, Springer Link, Scopus, CINAHL Plus and Google Scholar. Six radiologists were interviewed and questionnaires were collected from 120 radiologists. Four online discussion groups related to PACS were monitored via LinkedIn. The data were analysed thematically using the thematic analysis method. Finally, a focus group was held with a separate group of radiologists to validate the findings. Results: Eight themes emerged from the thematic analysis of the data: (1) limitations of traditional PACS; (2) user needs and requirements that can increase PACS functionality; (3) Web based solutions of PACS; (4) PACS on mobile phones; (5) Vendor Neutral Archive (VNA); (6) full integration of voice recognition in PACS; (7) backup solutions for the system and (8) continuous training for PACS users. Discussion: With the development of healthcare information and communication technology (ICT) and with the increased demands of the radiologists to expand PACS usability, traditional PACS must be updated to follow the changes. Modern technologies can provide better solutions to enhance the functionality of current PACS. The next generation of PACS can fulfil the future requirements of users. This study considers the issues between the needs and requirements of the users of a PACS system in the future and the developing solutions in ICT and the PACS industry. Moreover, highly developed PACS systems with advanced features will have a direct impact in changing and improving radiology workflow. Accordingly, a model has been developed that proposes new features for the next generation PACS system, which may be applied to the next generation radiology practice. The model was validated with the focus group and, by using a separate group of radiologists in another country, was determined to be generalisable. Conclusion: It is widely recognised that traditional PACS must be updated to adopt recent advances in ICT. This research has identified themes that, when incorporated, will enhance the functionality of PACS and radiology workflow and provide better quality clinical practice. The findings from this empirical research can be used: as recommendations to vendors; for technology development; and by medical institutes to consider aspects when undertaking implementation of PACS and training future radiologists. Keywords: 'Picture archiving and communication system’, PACS, Future trends, next generation, Organisational efficiency, Productivity, Clinical practice, Ubiquitous.Ministry of Health, Government of Kuwai