17 research outputs found
Evaluation of A Prototype of Computerized Health Knowledge Summaries
Physicians raise two questions in every three patients they see and around 50% of those questions are not even pursued due to various reasons. These unanswered questions represent huge knowledge gap and could result in less than desirable treatment outcomes. The situation becomes even worse with the emergence of internet technologies which brought explosively increasing information and knowledge into everybody's lives. To make medical information more readily available and to facilitate physicians' decision making process, we designed and developed a medical knowledge summary system that automatically extract and synthesize relevant medical evidence from major resources including UpToDate and PubMed. We performed a pilot usability study to evaluate the effectiveness of the system and used the feedback from physicians to further the development effort. Physicians in general found our system intuitive to use and information delivered very valuable in filling in their knowledge gaps.Master of Science in Information Scienc
A standards-based ICT framework to enable a service-oriented approach to clinical decision support
This research provides evidence that standards based Clinical Decision Support (CDS)
at the point of care is an essential ingredient of electronic healthcare service delivery. A
Service Oriented Architecture (SOA) based solution is explored, that serves as a task
management system to coordinate complex distributed and disparate IT systems,
processes and resources (human and computer) to provide standards based CDS.
This research offers a solution to the challenges in implementing computerised CDS such
as integration with heterogeneous legacy systems. Reuse of components and services to
reduce costs and save time. The benefits of a sharable CDS service that can be reused by
different healthcare practitioners to provide collaborative patient care is demonstrated.
This solution provides orchestration among different services by extracting data from
sources like patient databases, clinical knowledge bases and evidence-based clinical
guidelines (CGs) in order to facilitate multiple CDS requests coming from different
healthcare settings. This architecture aims to aid users at different levels of Healthcare
Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and
managing services, thus enabling transparency.
The research employs the Design Science research methodology (DSRM) combined with
The Open Group Architecture Framework (TOGAF), an open source group initiative for
Enterprise Architecture Framework (EAF). DSRM’s iterative capability addresses the
rapidly evolving nature of workflows in healthcare. This SOA based solution uses
standards-based open source technologies and platforms, the latest healthcare standards
by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service
(RLUS) standard. Combining business process management (BPM) technologies,
business rules with SOA ensures the HCO’s capability to manage its processes. This
architectural solution is evaluated by successfully implementing evidence based CGs at
the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent
Referral (Lung Cancer), c) Genome testing and integration with CDS in screening
(Lynch’s syndrome). In addition to medical care, the CDS solution can benefit
organizational processes for collaborative care delivery by connecting patients,
physicians and other associated members. This framework facilitates integration of
different types of CDS ideal for the different healthcare processes, enabling sharable CDS
capabilities within and across organizations
Utilization of automated location tracking for clinical workflow analytics and visualization
abstract: The analysis of clinical workflow offers many challenges to clinical stakeholders and researchers, especially in environments characterized by dynamic and concurrent processes. Workflow analysis in such environments is essential for monitoring performance and finding bottlenecks and sources of error. Clinical workflow analysis has been enhanced with the inclusion of modern technologies. One such intervention is automated location tracking which is a system that detects the movement of clinicians and equipment. Utilizing the data produced from automated location tracking technologies can lead to the development of novel workflow analytics that can be used to complement more traditional approaches such as ethnography and grounded-theory based qualitative methods. The goals of this research are to: (i) develop a series of analytic techniques to derive deeper workflow-related insight in an emergency department setting, (ii) overlay data from disparate sources (quantitative and qualitative) to develop strategies that facilitate workflow redesign, and (iii) incorporate visual analytics methods to improve the targeted visual feedback received by providers based on the findings. The overarching purpose is to create a framework to demonstrate the utility of automated location tracking data used in conjunction with clinical data like EHR logs and its vital role in the future of clinical workflow analysis/analytics. This document is categorized based on two primary aims of the research. The first aim deals with the use of automated location tracking data to develop a novel methodological/exploratory framework for clinical workflow. The second aim is to overlay the quantitative data generated from the previous aim on data from qualitative observation and shadowing studies (mixed methods) to develop a deeper view of clinical workflow that can be used to facilitate workflow redesign. The final sections of the document speculate on the direction of this work where the potential of this research in the creation of fully integrated clinical environments i.e. environments with state-of-the-art location tracking and other data collection mechanisms, is discussed. The main purpose of this research is to demonstrate ways by which clinical processes can be continuously monitored allowing for proactive adaptations in the face of technological and process changes to minimize any negative impact on the quality of patient care and provider satisfaction.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201
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
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Optimizing the Collection and Use of Patient-Generated Health Data
This dissertation aims to examine the collection and use of digital patient-generated health data (PGHD) in real-world settings, including existing barriers from the perspectives of patients and healthcare providers, and possible approaches to optimizing the process. In Chapter One, the potential of PGHD to improve health and wellness, particularly for individuals with chronic conditions, as well as known barriers to PGHD collection and use, are described. One chronic condition in particular, atrial fibrillation (AF), is then introduced as a use case for PGHD. Chapter Two contains an integrative review synthesizing findings from eleven studies reporting patients’ and providers’ needs when collecting and using PGHD, and identifying convergence and divergence between needs. Chapter Three contains a quantitative evaluation of sustained engagement, currently a major barrier to collection of PGHD, in a group of adults self-monitoring AF, as well as predictors and moderators of engagement that come from an adapted version of the Unified Theory of Acceptance and Use of Technology (UTAUT). These individuals were previously enrolled in the randomized, controlled trial, the iPhone® Helping Evaluate Atrial Fibrillation Rhythm through Technology (iHEART). In Chapter Four, the adapted UTAUT model is explored in more detail through a qualitative investigation of sustained engagement with patients, healthcare providers, and research coordinators involved in the iHEART trial. Chapter Five summarizes the findings of this dissertation, including strengths and limitations, and elicits implications for the intersection of health policy and clinical practice, design, nursing, and future research from the findings
Medical Informatics
Information technology has been revolutionizing the everyday life of the common man, while medical science has been making rapid strides in understanding disease mechanisms, developing diagnostic techniques and effecting successful treatment regimen, even for those cases which would have been classified as a poor prognosis a decade earlier. The confluence of information technology and biomedicine has brought into its ambit additional dimensions of computerized databases for patient conditions, revolutionizing the way health care and patient information is recorded, processed, interpreted and utilized for improving the quality of life. This book consists of seven chapters dealing with the three primary issues of medical information acquisition from a patient's and health care professional's perspective, translational approaches from a researcher's point of view, and finally the application potential as required by the clinicians/physician. The book covers modern issues in Information Technology, Bioinformatics Methods and Clinical Applications. The chapters describe the basic process of acquisition of information in a health system, recent technological developments in biomedicine and the realistic evaluation of medical informatics