London SynEx Demonstrator Site: Impact Assessment Report

The key ingredients of the SynEx-UCL software components are: 1. A comprehensive and federated electronic healthcare record that can be used to reference or to store all of the necessary healthcare information acquired from a diverse range of clinical databases and patient-held devices. 2. A directory service component to provide a core persons demographic database to search for and authenticate staff users of the system and to anchor patient identification and connection to their federated healthcare record. 3. A clinical record schema management tool (Object Dictionary Client) that enables clinicians or engineers to define and export the data sets mapping to individual feeder systems. 4. An expansible set of clinical management algorithms that provide prompts to the patient or clinician to assist in the management of patient care. CHIME has built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multiprofessional electronic healthcare records. The resulting architecture models have influenced new European standards in this area, and CHIME has designed and built prototype EHCR components based on these models. The demonstrator systems described here utilise a directory service and object-oriented engineering approach, and support the secure, mobile and distributed access to federated healthcare records via web-based services. The design and implementation of these software components has been founded on a thorough analysis of the clinical, technical and ethico-legal requirements for comprehensive EHCR systems, published through previous project deliverables and in future planned papers. The clinical demonstrator site described in this report has provided the solid basis from which to establish "proof of concept" verification of the design approach, and a valuable opportunity to install, test and evaluate the results of the component engineering undertaken during the EC funded project. Inevitably, a number of practical implementation and deployment obstacles have been overcome through this journey, each of those having contributed to the time taken to deliver the components but also to the richness of the end products. UCL is fortunate that the Whittington Hospital, and the department of cardiovascular medicine in particular, is committed to a long-term vision built around this work. That vision, outlined within this report, is shared by the Camden and Islington Health Authority and by many other purchaser and provider organisations in the area, and by a number of industrial parties. They are collectively determined to support the Demonstrator Site as an ongoing project well beyond the life of the EC SynEx Project. This report, although a final report as far as the EC project is concerned, is really a description of the first phase in establishing a centre of healthcare excellence. New EC Fifth Framework project funding has already been approved to enable new and innovative technology solutions to be added to the work already established in north London

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

Information Systems and Healthcare XX: Toward Seamless Healthcare with Software Agents

Healthcare processes are frequently fragmented and often badly supported with IT. Inter- and intra-organizational communication and media frictions complicate the continuous provision of information according to the principle of information logistics. Based on extensive literature review, we present the vision of seamless healthcare with horizontally and vertically integrated healthcare processes enabled by seamless IT support. Its implementation requires the establishment of a communication infrastructure and the deployment of adequate standards in healthcare. There are already comprehensive approaches for dealing with integrating heterogeneous information systems. However, they lack a common communication infrastructure and do not support proactivity and flexibility which are dominant characteristics in healthcare. We propose a software agent-based approach for realizing the vision of seamless healthcare. We present a corresponding implementation for integrating heterogeneous information systems in the context of the German Health Telematics Infrastructure. Based on the concept and the implementation, we show that the modular approach is capable of supporting a wide range of different applications. We furthermore outline which facets of an agent-based solution could be implemented in an operative real-world environment. In closing we derive implications for IT decision makers in healthcare and show directions for future approaches for reducing information logistics related deficits in healthcare

Specification and Needs of the Clinical Testbeds

This deliverable describes the three clinical testbed demonstrator sites of the 6WINIT Project. These sites provide a means of validating the technical 6WINIT solutions and of the potential benefits of using wireless IPv6 services. In this deliverable each site has provided a description of the healthcare setting, the clinical challenges to be addressed and the clinical applications that will be used to profile 6WINIT. The deliverable also includes an initial outline view of the technical strategy for implementing the 6WINIT solutions and considers any relevant networking and security issues

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

The Interactive Medical Emergency Department (iMED): Architectural Integration of Digital Systems into the Emergency Care Environment

In healthcare, the architectural response to the development of information technologies has largely been relegated to a reactive role, essentially waiting for systems to develop and simply accommodating them with appropriately sized spaces. Designing IT systems independently from, rather than integrally with, their environment impedes them from reaching their full potential as vital components in the delivery of care by creating a lack of flexibility, decelerating performance, and degrading the healing environment. The flexibility of the environment is compromised by fixed position, single user data systems which prevent it from actively adapting to changing conditions, especially during volumetric surges associated with mass casualty events. Additionally, the delivery of care is hindered by traditional data entry points which minimize the caregiver\u27s ability to utilize information effectively by increasing distances to, and wait times for, available platforms. Furthermore, the overall quality of the healing environment is degraded by the increasing amount of technological clutter which can be difficult to sanitize, intimidating to patients, and unsafe by frustrating care. Dissolving the disconnect between architectural environments and information technology can be achieved by devising architectural elements and treatment protocols which would fuse both entities together, creating a more holistic, digitally integrated setting in which to deliver care. Utilizing advances such as integrated wall interfaces and environmental sensor systems would improve the delivery of care by empowering users and architectural settings with the ability to effectively adapt to changing conditions, increase accessibility to information, and streamline care for improved patient outcomes. Replacing fixed position, single user data entry systems with environmentally integrated surface interfaces would improve flexibility and performance by creating a multitude of localized points to access data, as well as streamline and simplify the environment by eliminating technological clutter. The process in which to derive an architectural response to the thesis statement was initiated by performing a series of interviews with nationally prominent professionals in the fields of healthcare architecture and information technology, attending international design conferences, interning in health facilities, assembling a cross-disciplinary thesis committee, and conducting a thorough literature review. The thesis research phase began by studying the historical progression and significance of information technology in healthcare environments in order to discern the architectural role in the implementation of these systems. The research focus was then shifted to all areas of architecture, identifying applicable precedent studies in which the environmental integration of information technology had enhanced the quality of the setting, highlighting characteristics that would improve flexibility, performance, and outcomes in the field of healthcare. From this exploration, a series of typological selection criteria were developed in order to determine which area within the healthcare spectrum would best demonstrate the potentials of this union. The emergency care environment was selected as an appropriate vessel to implement the thesis, due to its need for flexibility in order to accommodate ever changing demographic needs, significant volumetric shifts, fast paced care delivery which is dependent on the rapid utilization of information, and high patient turnover rate requiring an efficient throughput processes. Specific problems relevant to contemporary emergency departments were then identified, including overcrowding, staffing issues, and inability to accommodate for volumetric surges, all of which stem from inadequate throughput methodologies. The thesis then explored how the fusion of digital modalities with architectural elements in the emergency care environment would remediate these problems by improving the throughput of the facility. To ensure the final design holistically satisfies the goal of improving the quality and effectiveness of emergency care through the environmental integration of information technology, a series of design principles were developed to serve as its basis. In order to optimize data flow, access to input areas must be maximized by conceiving the building as an interface, where spatial boundaries become digital connections. If integrated data systems are to be accessible from a universal architectural interface and respond in a safe and controlled manner, digital scanning technologies such as biometrics and RFID tagging must be fused with physical threshold conditions in order to enable the digital system\u27s recognition of its inhabitants. In an additional effort to maintain safety, maximize workability, and ensure a level of sterility in sensitive environments, the facility needs to be designed into layers of penetration, regulating access to only those users who meet proper security clearances. Furthermore, the facility needs to act like a sponge, easily expanding and contracting the layers of penetration in an effort to accommodate unpredictable volumetric increases during mass casualty events. In addition to increasing its capacity, the facility should also be prepared to appropriate adjacent, existing infrastructure for overflow shelter and staging operations during such events. The programmatic typology of a freestanding medical emergency department, in which there is no connection to an existing facility, was selected with the intention of deriving a pure condition which eliminated extraneous influences from diluting the focus of this thesis on the relationship between information technology and architecture. Although rare in the US, freestanding emergency care facilities are a viable option for expanding healthcare provider\u27s coverage, capturing areas with growing populations, and improving the regional capability to respond effectively during mass casualty events. The base program was derived from the Swedish Medical Issaquah Campus Freestanding Emergency Department in Seattle, Washington, and then modified to function as a Point of Distribution (POD) site during mass casualty events. A series of potential mass casualty event scenarios were then developed in order to effectively prepare conceptual simulations to test possible responses from the facility\u27s program. The thesis proposal consists of a freestanding, 40,000+ square foot Interactive Medical Emergency Department (iMED) located in Charleston, SC. The proposal is guided by an established set of design principles, aiming to improve the delivery of emergency care during daily operations and mass casualty surge events through the architectural integration of information technology. In order to provide a range of possible disaster response situations, the building was located in the densely populated peninsula area of Charleston, South Carolina, within a region which is susceptible to an assortment of mass casualty events (including hurricanes, earthquakes, and terrorist attacks). The final site within the urban context adheres to a set of established criteria, including placement on open, stable, elevated land adjacent to the major access arterials of I-26, Hwy 17, and Meeting Street. Additionally, the site was located within a rapidly expanding, non-historical sector of the city which is not part of an existing healthcare complex. By meeting regional and urban conditions defined in the criteria, the site\u27s location strengthens the facility\u27s ability to deliver care during both daily and surge conditions substantially

A mobility enabled inpatient monitoring system using a ZigBee medical sensor network

This paper presents a ZigBee In-Patient Monitoring system embedded with a new ZigBee mobility management solution. The system enables ZigBee device mobility in a fixed ZigBee network. The usage, the architecture and the mobility framework are discussed in details in the paper. The evaluation shows that the new algorithm offers a good efficiency, resulting in a low management cost. In addition, the system can save lives by providing a panic button and can be used as a location tracking service. A case study focused on the Princes of Wales Hospital in Hong Kong is presented and findings are given. This investigation reveals that the developed mobile solutions offer promising value-added services for many potential ZigBee applications

From a simple EHR to the market lead: what technologies to add

Electronic health records (EHRs) can store, capture, and present patient data in an organized way that improves physicians’ workflow and patient care. This makes EHRs key to addressing many of today’s health care challenges. An interdisciplinary review and qualitative study of artificial intelligence, machine learning, natural language processing, and real-time location services in health care was conducted. The results show that in an industry where digitization is key, several recommendations can be made to leverage these technologies in ways that can improve current systems and help EHR vendors become the market lead

Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background: The variability in physicians’ attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway. Objective: This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed. Methods: We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results. Results: Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care’s dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues. Conclusions: Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research