Composite and comprehensive multimedia electronic health care records

Merged with duplicate record 10026.1/845 on 03.04.2017 by CS (TIS)The thesis considers the issue of multimedia data utilisation within modem health care delivery and the consequent need for an appropriate patient records system. The discussions centre upon the deployment and utilisation of IT systems, and paper-based patient records within health care establishments (HCEs), and the resultant problems, such as data duplication, inconsistency, unavailability and loss. Electronic Health Care Records (EHCRs) are put forward as a means of obviating the problems defined, and effectively supporting the future development of care provision in a coherent manner. The thesis identifies the barriers to further development of EHCRs with respect to clinical data entry, clinical terminiologies, record security and the integration of other information sources. Equally, a number of EHCR developments are reviewed. This shows that, although elements of EHCRs (such as electronic prescribing) have been achieved, significant further developments are required to produce composite and comprehensive EHCRs, capable of capturing and maintaining all patient data (especially multimedia data, which is being increasingly utilised within care provision). The thesis defines a new comprehensive and composite Multimedia Electronic Health Care Record (MEHCR) system to facilitate the following: • delivery and management of all patient care; • creation/recording/support and maintenance of patient data (including multimedia data) to give composite and comprehensive multimedia patient records. The assistance of a local HCE was utilised throughout the project, enabling a suitable reference environment to be established and utilised, so that the process of care provision could be defined. The thesis describes how the requirements of the new MEHCR were identified (via examination of the care provision process defined), and thus how an appropriate conceptual design was formulated. This describes the form and capabilities of the required system. The resulting MEHCR is effectively a comprehensive care provision tool, which aids both process of care delivery and that of data generation and recording. Thus, the MEHCR concept facilitates patient care provision whilst aiding the seamless creation and maintenance of multimedia patient records. To achieve the conceptual design, a design environment was defined to give an intermediate means of enabling the MEHCR's implementation and further development. Thus, the MEHCR can be achieved, or implemented, using either a revolutionary or evolutionary approach. Equally, it is a means for enabling the MEHCR's continued evolution (e.g. the incorporation of new clinical systems etc.), so that it remains composite and comprehensive over time as care provision changes. The thesis also describes an evaluation of the ideas defined, based upon the development of a prototype system simulating the form and operations of the MEHCR conceptual design. The prototype system was demonstrated to a number of parties and an evaluation conducted. The results obtained were very positive as to the nature, structure and capabilities of the system as given by the conceptual design. The design environment was also commended as both a practical means of achieving the MEHCR (especially as it enables retaining of existing system where appropriate), and for its future development as care provision advances.Plymouth Hospitals NHS Trus

Telemedicine for improving access to health care in resource-constrained areas : from individual diagnosis to strengthening health systems

In many developing countries there is an acute shortage of trained medical specialists. This does not only hamper individual patients’ access to medical diagnostics but furthermore limits the development of health systems because a major role of the specialists is the provision of continuous medical education of health care personnel. The rapid development of information and communication technologies has enabled radically new forms of virtual collaboration at a distance. So-called telemedicine enables us today to transmit knowledge to the patient rather than to only transport patients to the centres where the knowledge is available; this has promising implications in particular for remote and under-served areas. Initiated by a request from a Swiss surgeon from Solomon Islands, a project for supporting the hospital in Honiara, capital of Solomon Islands, with pathology diagnoses was started between Honiara and the Department of Pathology in Basel in 2001. After a successful start this pilot project found broad interest, and the Internet platform that had been developed was soon utilised by projects from other countries and medical disciplines. Thus, questions arose about the diagnostic accuracy of such remote diagnoses as well as about their acceptance and impact on the local health care system. The work presented here was initiated on this background. It analyses the applicability of telemedicine in the context of resource-constrained areas and in particular the possibilities to extend its impact from improving individual diagnosis towards strengthening health care systems. A central part of this project was the development of iPath, an Internet- and email-based telemedicine platform, which facilitates medical consultations, knowledge exchange and continuous education on a global scale. A particular emphasis was put on the applicability and accessibility for users from developing countries with limited infrastructure and network connectivity. The complete software was released under an open-source licence in order to allow unrestricted reuse for other institutions. The diagnostic accuracy of this form of telemedicine was studied in two projects from the field of pathology. A retrospective review of over 200 glass slides from each project revealed complete diagnostic concordance between the telemedical diagnosis and review diagnosis in 69% and 85% respectively. Clinically relevant discrepancies were found in 8% and 3.3% of all examinations. Selection of images by the non-expert and communication were found to have the greatest impact on diagnostic accuracy. Both factors can be addressed by training and organisation of workflow. In comparison to submitting material for pathological examination by courier, the turn-around time could be reduced from weeks to days or hours. Besides the more rapid availability of diagnosis, telemedicine enabled a direct dialogue between the surgeon and the pathologist and thus facilitated an implicit permanent medical education. The educational aspects of telemedicine were studied within the scope of a tele-dermatology project in South Africa. Distance collaboration with a dermatologist empowered a general practitioner based in a rural area to diagnose and treat a majority of patients with dermatological problems. Besides the direct benefit of saving the patients the cost of transportation to visit the dermatologist, the general practitioner could strengthen his own diagnostic skills under direct guidance and quality control of a specialist. As a consequence he will be able to treat more patients locally, close to their homes and families. The whole project was implemented within the local health system in order to facilitate a future inclusion of other primary care facilities. Regional telemedicine networks play a major role to ensure relevance and acceptability of consultative and educational telemedicine. Within the scope of the Ukrainian Swiss Perinatal Health Program a telemedicine component was included, and it was found that the use of regional language as well as inclusion of the regional specialists are important for the acceptance of telemedicine and should not be neglected in a era of globalisation. The presented results demonstrate that save and reliable telemedicine can be implemented with limited resources. Telemedicine is suitable in particular to strengthen existing international collaborations and to support professionally isolated medical specialists. Regional collaboration and inclusion of regional specialists are desirable if telemedicine shall help to strengthen health care systems. The application of telemedicine should not only focus on providing care to individual patients, but should explicitly incorporate skills development and capacity building of primary care staff. Organisation of work flow and communication have been found to be the most challenging task for the implementation of telemedicine networks. Resources must be invested not only in technology but more importantly in training and organisation. Utilisation of existing technological infrastructure is advisable wherever possible and greatly reduces the complexity of providing support and maintenance. The presented telemedicine platform provides an efficient tool for the organisation of interdisciplinary, regional and international telemedicine networks. We hope that the unrestricted availability of the software developed during this project will enable other institutions to utilise it for their own purpose and that they will thus be able to allocate resources on the organisation of workflow rather than technology

The VPS ReplaySuite: development and evaluation of a novel, Internet based telepathology tool

The ReplaySuite is a web-based telepathology tool that replicates the doubleheaded microscope environment online, enabling a reviewing pathologist to ‘replay’ an archived virtual slide examination. Examination-tracking data obtained by the Virtual Pathology Slide (VPS) virtual slide viewer is exploited, allowing a remote pathologist to review an examination conducted at a different time and location. This removes temporal and spatial issues associated with double-headed microscopy. In order to conduct a preliminary evaluation of the technology, 9 pathologists used the ReplaySuite to review examination replays and diagnostic data from archived examinations of 10 needlecore breast biopsies. Diagnostically difficult cases were most frequently evaluated, either via diagnostic concordance graphs or examination replays, and all 3 participants who replayed more than 10 examinations stated the ReplaySuite to be of some or great benefit in pathology training and quality assurance. Of those who replayed an examination by another pathologist, 83% (5/6) agreed that replays provided an insight into the examining pathologists diagnosis, and 33% (2/6) reconsidered their own diagnosis for at least one case. Of those who reconsidered their original diagnosis, all reclassified either concordant with group consensus or original glass slide diagnosis. This study demonstrated that the ReplaySuite was of potential benefit in pathology education, however the technology required evaluation in a setting that would facilitate its impact on diagnostic performance. Accordingly, a redeveloped VPS and ReplaySuite were incorporated into the EQUALIS External Quality Assurance (EQA) study in chronic hepatitis staging and grading. During the study, 9 Swedish pathology departments examined and scored digital representations of liver needlecore biopsies during two sessions, with 10 cases per session and two digital slides per case. Between scoring sessions, participants were provided with access to two supplementary electronic resources: the ReplaySuite, and a library of pre-selected reference images. Comparison of concordance with gold standard (KVAST group) scoring before and after electronic resource use facilitated the elucidation of impact on diagnostic performance. Between scoring sessions, participant concordance with KVAST staging increased by 18% (49%-67%), while concordance with KVAST grading increased by 20% (34%-54%). Mean staging un-weighted kappa improved from 0.347 to 0.554 (+0.207), or from ‘fair’ to ‘moderate’ exact agreement with KVAST staging. Linear weighted staging kappa improved from 0.603 to 0.688 (+0.085), indicating close agreement in both sessions. Mean grading unweighted kappa increased from 0.132 to 0.412 (+0.280), or from a ‘poor’ to ‘moderate’ level o f exact agreement with KVAST, while linear weighted kappa improved from 0.328 to 0.624 (+0.295), or from ‘fair’ to ‘good’ level of approximate agreement with KVAST. Subsequent to the EQA scheme, an expert liver pathologist used the ReplaySuite to evaluate study examinations, assessing examination technique and identifying sources of error. Examinations scoring concordant with KVAST were observed to exhibit acceptable examination technique more frequently than discordantly scoring examinations. When grading, 28% (46% - 18%) more concordant than discordant examinations were considered to have viewed sufficient tissue, and at the appropriate magnification. A similar disparity of 24% (59% - 35%) was observed in staging, suggesting that examination technique was important both when determining the degree of necroinflammation within a biopsy, and when ascertaining the extent of fibrosis. In assessing sources of error, the expert pathologist identified a potential source in 50% of grading examinations, with misinterpretation of observed pathology cited in 19%, and missed pathology (oversight) cited in 31% of grading examinations. Of the 41% of staging examinations in which a source was identified, misinterpretation of observed pathology was cited in 20% of examinations, and missed pathology (oversight) in 21% of examinations. This study demonstrated that the use of supplementary electronic resources could result in improvements in diagnostic performance. It also illustrated the significant ‘add on’ value that could be provided by the ReplaySuite in EQA, by providing means to assess not only diagnostic concordance, but also diagnostic technique and identify sources of error. In order to assess Irish trainee pathologist’s perceptions of computer-assisted learning (CAL), a number of commercial systems were utilised to incorporate digital slides into a postgraduate seminar series, and provide subsequent access to seminar digital slides, diagnoses and expert annotations online. All surveyed trainees considered the use of digital slides and expert annotations of benefit in pathology training, and considered the potential implementation of expert examination replays, online self-assessment and the capability to search online for material by organ, diagnosis or pathological feature of benefit. The work described herein illustrates that both expert and trainee pathologists alike consider the use of supplementary electronic resources of benefit in pathology education, and demonstrates that their use can improve diagnostic performance. The ability to evaluate participation in EQA studies via the ReplaySuite provides significant additional value to education schemes, providing a depth of assessment not possible with conventional microscopy

Consolidated List of Requirements

This document is a consolidated catalogue of requirements for the Electronic Health Care Record (EHCR) and Electronic Health Care Record Architecture (EHCRA), gleaned largely from work done in the EU Framework III and IV programmes and CEN, but also including input from other sources including world-wide standardisation initiatives. The document brings together the relevant work done into a classified inventory of requirements to inform the on-going standardisation process as well as act as a guide to future implementation of EHCRA-based systems. It is meant as a contribution both to understanding of the standard and to the work that is being considered to improve the standard. Major features include the classification into issues affecting the Health Care Record, the EHCR, EHCR processing, EHCR interchange and the sharing of health care information and EHCR systems. The principal information sources are described briefly. It is offered as documentation that is complementary to the four documents of the ENV 13606 Parts I-IV produced by CEN Pts 26,27,28,29. The requirements identified and classified in this deliverable are referenced in other deliverables

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

Developing an integrated MDT service model for the management of patients with lung cancer

The motivation for this research was the publication in 1995 of the Calman-Hine report. This provided a strategic framework for the delivery of cancer care by creating a network of cancer care centres in England and Wales to enable patients to receive a uniformly high standard of care. The report acknowledged the fact that although the evidence on optimal cancer care used to prepare the report was based on two key sources (i) medical literature and (ii) audit data provided by UK cancer registries, they did not lend themselves to controlled experiments as most information came from retrospective analyses; hence they were subject to a number of possible flaws and biases. Yet the report recommended some key structural changes to be implemented. The focus of the research described in this thesis was centred on the recommendation of a multidisciplinary team (MDT) review of patients prior to a treatment decision, both in general cancer units as well as in specialised cancer centres. Given the mandate to implement these recommendations, the research questions addressed were “can the current configuration support this recommendation?”, “what evidence was there to support the effectiveness of the MDT?” and “was there a model of care to support the service delivery of cancer care?” A literature review established that there was no existing template upon which MDT services could be set up. This research therefore set out to develop an MDT model to support operational delivery of care in the setting of a cancer centre. The clinical specialty in which this research was undertaken was that of lung cancer. The research successfully developed a conceptual model. However, in the process, a number of operational and practical constraints were identified within the revised service configuration designed to deliver high quality cancer care through the incorporation of the MDT service, and this ultimately limited the extent to which the model could be deployed in the particular clinical setting. Nevertheless, the modelling process did enable a range of core issues to be identified, enabling design solutions to be formulated and tested, thereby confirming the effectiveness of the MDT model. In particular, the adoption of a soft modelling approach was shown to be beneficial in addressing operational problems. By engaging clinical and other end-users right from the start in the modelling process, the models did become operationally accepted, allowing resistance to change to be overcome and the solution to be integrated into the business process. MDT services are now well established, both in cancer units and cancer centres and published data on their effectiveness in the treatment of lung cancer, although not conclusive; demonstrate an increase in resection rates. However, assessing the long-term impact of MDTs on lung cancer outcomes remains a topic for future research

The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence

Introduction: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. Methods: A selective review of the credible literature during the past decade (2005?2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. Findings: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140295/1/tmj.2016.0149.pd

Computer deployment in the health services of developed and developing countries : a comparative case study of the UK and Oman

Organisations are increasingly deploying and using computer technology in various ways, involving the allocation of large amounts of capital and human resources. However, in many cases, computer deployment has been accompanied by failure, particularly in health care services. Therefore, information technology has raised grave questions, misunderstanding, fears, and hostility.This study emphasises the importance of computer deployment and development in developed and developing countries' health care services with examples from advanced and less advanced nations. It describes strategy development for IT/ISs using information system methodologies and explores the development of ISs strategy in the NHS in the light of fundholding and the internal market. A number of problems that commonly influence the success or failure of computer deployment and development are identified. These issues are explained through two case studies: the Omani health system and General Practices (GPRs) in the UK, which have introduced computers.The research focuses on five main sets of issues related to computer deployment and utilisation in health care: strategic planning; computer utilisation; computer fears; computer impact; and computer technical problems and performance. Users' overall satisfaction with systems in use is also considered.Data collection was carried out using two surveys. One survey was conducted in GPRs in Humberside and the other conducted in Royal Hospital and Sultan Qaboos University Hospital in Oman. Data sources included observations, review of relevant documents, such as reports, research papers and manuals, structured and non-structured interviews with selected users and a questionnaire.A number of conclusions can been drawn from this study: firstly, computer deployment, utilisation and development still faces problems in both the systems studied, more especially the Omani system. Secondly, GPRs have carried out strategic planning for computer deployment and utilisation and are prepared to use information system methodology for IT/IS strategy and there is a plan to use this for competitive advantage but Omani hospitals did not set a constructive strategic plan for their systems. Thirdly, the main problems of computer failure are related to human issues rather technical issues. The most important of these human issues are the style of the leadership planning, poor utilisation of computer applications, lack of skills and poor training. Finally, the results of the survey suggested that though the respondents were aware of the potential of computer technology, the problems of computer fears, training and lack of skills were experienced, and often, few individuals possessed computingknowledge.The author suggests several points to be considered: 1) that any thinking about computer deployment and development should employ appropriate information system development methodologies; 2) the decisions on computer deployment, use and development should be made by a special committee that has expertise in IT matters; 3) good strategic planning for computer deployment, use and development; should be connected to the organisation's overall strategy and 4) there is a need of mandate review for such development and planning. With these points in mind the researcher presents a diagram to help improving strategic planning and development of IT/IS methods with particular emphasis on the Omani environment

Mobile application to assist cancer patients access healthcare and funding in Kenya

Thesis submitted in partial fulfillment of the requirements for the Degree of Master of Science in Information Technology (MSIT) at Strathmore UniversityCancer has posed to be a killer disease over time. Most patients die of cancer due to lack of access to early screening and effective treatment and lack of medical funds. Cancer treatment is deemed expensive thus most patients would need a health insurance fund or donor to offset the hospital bill. Cancer patients also need information on where they can access quality health service. There are several stakeholders who have joined forces to overcome the cancer burden. The government of Kenya has spearheaded the initiative by introduction of NHIF cover, covering cancer treatment. Cancer patients can be treated at NHIF approved hospitals using the capped cover amount. There are also Non-governmental organizations and cancer fund drives that have been organized to assist in the cancer burden in Kenya. Data was collected using questionnaires, the data collected was used to find out the challenges faced when accessing health care and funding. Data was analyzed using Google analytics tools and results obtained were used to guide the researcher in the design of the mobile and web application. Agile software methodology was used to develop the application. A mobile and web application was developed to assist cancer patients to access health care and funding. Users of the system are required to register their details that consist of their bio data as well as their NHIF number. The details of the user are sent to the donor to assist in paying the monthly contribution as well as the deficit amount to cover the full cancer treatment. Users are also referred to an oncologist and Hospital facility upon appointment request