Electronic medical records concepts and data management

Healthcare information (Clinical Data) is associated with every individual, young or old, rich or poor, belonging to any country. Clinical data is very extensive. Everyday some new diseases and new symptoms are being seen and the human race is struggling to find cures. There are many diseases whose diagnosis, symptoms, and possible treatment are known but unfortunately that rare knowledge is not available to every individual in the world. This initiates all the vision behind presenting a paper on EMR/ EHR and its Data Management. The thesis reviews the concept of EMR/ EHR thus explaining its concepts, importance, market need etc. Thesis will also explain privacy and security related to clinical data in electronic format which is a very important as any electronic data is prone to hacks and data loss. To manage and utilize such amount of data, there is need of extensive data management and so the thesis explains the concepts of Datawarehouse, its importance, ETL, Schemas etc. As part of explaining these concepts a mini EMR/EHR Datawarehouse is designed which explains various subject areas possible in any EMR Datawarehouse. Last but not the least, the thesis comments on the Future of EMR/ EHR and the World Vision on this revolutionary change

Content diffusion in ALERT clinical applications

Estágio realizado na ALERT e orientado pelo Eng.º Tiago SilvaTese de mestrado integrado. Engenharia Informática e Computação. Faculdade de Engenharia. Universidade do Porto. 200

Syndromic surveillance: reports from a national conference, 2003

Overview of Syndromic Surveillance -- What is Syndromic Surveillance? -- Linking Better Surveillance to Better Outcomes -- Review of the 2003 National Syndromic Surveillance Conference - Lessons Learned and Questions To Be Answered -- -- System Descriptions -- New York City Syndromic Surveillance Systems -- Syndrome and Outbreak Detection Using Chief-Complaint Data - Experience of the Real-Time Outbreak and Disease Surveillance Project -- Removing a Barrier to Computer-Based Outbreak and Disease Surveillance - The RODS Open Source Project -- National Retail Data Monitor for Public Health Surveillance -- National Bioterrorism Syndromic Surveillance Demonstration Program -- Daily Emergency Department Surveillance System - Bergen County, New Jersey -- Hospital Admissions Syndromic Surveillance - Connecticut, September 2001-November 2003 -- BioSense - A National Initiative for Early Detection and Quantification of Public Health Emergencies -- Syndromic Surveillance at Hospital Emergency Departments - Southeastern Virginia -- -- Research Methods -- Bivariate Method for Spatio-Temporal Syndromic Surveillance -- Role of Data Aggregation in Biosurveillance Detection Strategies with Applications from ESSENCE -- Scan Statistics for Temporal Surveillance for Biologic Terrorism -- Approaches to Syndromic Surveillance When Data Consist of Small Regional Counts -- Algorithm for Statistical Detection of Peaks - Syndromic Surveillance System for the Athens 2004 Olympic Games -- Taming Variability in Free Text: Application to Health Surveillance -- Comparison of Two Major Emergency Department-Based Free-Text Chief-Complaint Coding Systems -- How Many Illnesses Does One Emergency Department Visit Represent? Using a Population-Based Telephone Survey To Estimate the Syndromic Multiplier -- Comparison of Office Visit and Nurse Advice Hotline Data for Syndromic Surveillance - Baltimore-Washington, D.C., Metropolitan Area, 2002 -- Progress in Understanding and Using Over-the-Counter Pharmaceuticals for Syndromic Surveillance -- -- Evaluation -- Evaluation Challenges for Syndromic Surveillance - Making Incremental Progress -- Measuring Outbreak-Detection Performance By Using Controlled Feature Set Simulations -- Evaluation of Syndromic Surveillance Systems - Design of an Epidemic Simulation Model -- Benchmark Data and Power Calculations for Evaluating Disease Outbreak Detection Methods -- Bio-ALIRT Biosurveillance Detection Algorithm Evaluation -- ESSENCE II and the Framework for Evaluating Syndromic Surveillance Systems -- Conducting Population Behavioral Health Surveillance by Using Automated Diagnostic and Pharmacy Data Systems -- Evaluation of an Electronic General-Practitioner-Based Syndromic Surveillance System -- National Symptom Surveillance Using Calls to a Telephone Health Advice Service - United Kingdom, December 2001-February 2003 -- Field Investigations of Emergency Department Syndromic Surveillance Signals - New York City -- Should We Be Worried? Investigation of Signals Generated by an Electronic Syndromic Surveillance System - Westchester County, New York -- -- Public Health Practice -- Public Health Information Network - Improving Early Detection by Using a Standards-Based Approach to Connecting Public Health and Clinical Medicine -- Information System Architectures for Syndromic Surveillance -- Perspective of an Emergency Physician Group as a Data Provider for Syndromic Surveillance -- SARS Surveillance Project - Internet-Enabled Multiregion Surveillance for Rapidly Emerging Disease -- Health Information Privacy and Syndromic Surveillance SystemsPapers from the second annual National Syndromic Surveillance Conference convened by the New York City Department of Health and Mental Hygiene, the New York Academy of Medicine, and the CDC in New York City during Oct. 23-24, 2003. Published as the September 24, 2004 supplement to vol. 53 of MMWR. Morbidity and mortality weekly report.1571461

Can routinely collected electronic health data be used to develop novel healthcare associated infection surveillance tools?

Background: Healthcare associated infections (HCAI) pose a significant burden to health systems both within the UK and internationally. Surveillance is an essential component to any infection control programme, however traditional surveillance systems are time consuming and costly. Large amounts of electronic routine data are collected within the English NHS, yet these are not currently exploited for HCAI surveillance. Aim: To investigate whether routinely collected electronic hospital data can be exploited for HCAI surveillance within the NHS. Methods: This thesis made use of local linked electronic health data from Imperial College Healthcare NHS Trust, including information on patient admissions, discharges, diagnoses, procedures, laboratory tests, diagnostic imaging requests and traditional infection surveillance data. To establish the evidence base on surveillance and risks of HCAI, two literature reviews were carried out. Based on these, three types of innovative surveillance tools were generated and assessed for their utility and applicability. Results: The key findings were firstly the emerging importance of automated and syndromic surveillance in infection surveillance, but the lack of investigation and application of these tools within the NHS. Syndromic surveillance of surgical site infections was successful in coronary artery bypass graft patients; however it was an inappropriate methodology for caesarean section patients. Automated case detection of healthcare associated urinary tract infections, based on electronic microbiology data, demonstrated similar rates of infection to those recorded during a point prevalence survey. Routine administrative data demonstrated mixed utility in the creation of simplified risk scores or infection, with poorly performing risk models of surgical site infections but reasonable model fit for HCA UTI. Conclusion: Whilst in principle routine administrative data can be used to generate novel surveillance tools for healthcare associated infections; in reality it is not yet practical within the IT infrastructure of the NHS

Developing effective hospital management information systems: A technology ecosystem perspective

This thesis presents the results of the program of research performed in the completion of a Doctor of Philosophy (Business) entitled: Developing Effective Hospital Management Information Systems: A Technology Ecosystem Perspective. The central contention of this thesis is that the current ecosystem models in the information technology (IT) and information systems (IS) literature can be extended and improved. In turn they can be better applied to the field of IS and the development and implementation of information systems. This research seeks to highlight an example of how these models can be extended, through an analysis of the specific context of the hospital management information system environment, using the technology ecosystems model (TEM) of Adomavicius et al (Adomavicius et al., 2005). The environment in which hospital managers operate is characterised by high demand pressures, strong public service expectations, and an ever diminishing income stream (in relative terms) with which to provide services. Even in private hospital care, many of these pressures still apply, as well as a pressure to maintain profit margins. The agenda context here is a complex one, particularly when one considers the role of hospitals in this context. Hospitals have multiple competing priorities when viewed from a management perspective. This is despite the fact that the core mission of the hospital is to provide timely, safe care within available human and financial resources, to patients who present for care. This care can be across multiple care settings inside the hospital including the inpatient space, the operating theatres, the intensive care unit, and the emergency department; and in outreach settings. Hospitals however, have been described as a series of cottage industries each loosely coupled with a common objective of supplying care to patients. All of these factors combine to mean that managing a hospital with the above-mentioned aim in mind, is a very difficult task. Nakagawa et al (Nakagawa et al., 2011) talk specifically to this difficulty. In this research I undertake this examination through 2 core exercises. Firstly I examine the literature – both the information related and health care literature, for insights into the questions at hand. Secondly I examine the lessons learned from five Case Studies (CSs). The first four of these are based in physical hospital facilities across three Australian states. The final one is a “virtual CS” in which the views of multiple parties, not centred on any given physical institution, are sought and examined in relation to these questions. Based on the data collected in both the literature review and the CS’, and through a process of triangulation and research model validation, I conclude that a hospital management technology ecosystem (a HOME) can be described. Its existence thus validates the core TEM, and in fact the findings support some meaningful extensions to the TEM. The HOME is predominantly characterised by the presence of strong drivers of change that arise from outside the immediate hospital environment. Examples include changes in the labour market, and the skill sets of workers; changes in the broader development and availability of technology (for example – think of the effects of the rise of smart phones), and changes in government policies and funding arrangements. In the majority of cases these broader influencing forces (Environment Shaping Forces – ESF’s) can be seen to act on the local management environment and the role of technology in that environment, through describable intermediaries. A very obvious example of this is the effect of a global financial downturn - eventually this wide reaching force could be expected to affect hospitals (be they private or public) through struggling performance of a parent company, or state government funding cutbacks. In turn this could easily lead to reduced spending on IT in a given hospital. These findings, along with those around services provided by the ecosystem, and the measurement of ecosystem success or failure, add substantially to the IS knowledge base in this area. This research thus acts as a sound basis for further research in this new direction, but also provides a usable conceptual and practical framework within which stakeholders – managers, clinicians, beauracrats and the software development community - can view the management of hospitals and the technologies in support of that management