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

On the Use of XML in Medical Imaging Web-Based Applications

The rapid growth of digital technology in medical fields over recent years has increased the need for applications able to manage patient medical records, imaging data, and chart information. Web-based applications are implemented with the purpose to link digital databases, storage and transmission protocols, management of large volumes of data and security concepts, allowing the possibility to read, analyze, and even diagnose remotely from the medical center where the information was acquired. The objective of this paper is to analyze the use of the Extensible Markup Language (XML) language in web-based applications that aid in diagnosis or treatment of patients, considering how this protocol allows indexing and exchanging the huge amount of information associated with each medical case. The purpose of this paper is to point out the main advantages and drawbacks of the XML technology in order to provide key ideas for future web-based applicationsPeer ReviewedPostprint (author's final draft

An Architecture for Provenance Systems

This document covers the logical and process architectures of provenance systems. The logical architecture identifies key roles and their interactions, whereas the process architecture discusses distribution and security. A fundamental aspect of our presentation is its technology-independent nature, which makes it reusable: the principles that are exposed in this document may be applied to different technologies

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

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

Authorization schema for electronic health-care records: for Uganda

This thesis discusses how to design an authorization schema focused on ensuring each patient's data privacy within a hospital information system

Noninvasive methods for children\u27s cholesterol level determination

Today, there is a controversy about the role of cholesterol in infants and the measurement and management of blood cholesterol in children. Several scientific evidences are supporting relationship between elevated blood cholesterol in children and high cholesterol in adults and development of adult arteriosclerotic diseases such as cardiovascular and cerebrovascular disease. Therefore controlling the level of blood cholesterol in children is very important for the health of the whole population. Non-invasive methods are much more convenient for the children because of their anxieties about blood examinations. In this paper we will present a new try to find non-invasive methods for determining the level of blood cholesterol in children with the use of intelligent system

Surface EMG decomposition using a novel approach for blind source separation

We introduce a new method to perform a blind deconvolution of the surface electromyogram (EMG) signals generated by isometric muscle contractions. The method extracts the information from the raw EMG signals detected only on the skin surface, enabling longtime noninvasive monitoring of the electromuscular properties. Its preliminary results show that surface EMG signals can be used to determine the number of active motor units, the motor unit firing rate and the shape of the average action potential in each motor unit

Medical informatics : the generic interchange of comprehensive health data

The objective of this project was to study the area of generic transfer of comprehensive medical data.The work presented in this thesis had as its main premise the belief that generic transfer of comprehensive medical data will help towards the goal of better healthcare particularly in an environment of shared care. It studied the main methods of data transfer available at present, and as a result carried out an in depth review of one such method adopted by the National Health Service (NHS). Criticism of this method was made. These criticisms lead on to the development of an alternative method of generic data transfer based on an emerging European standard for the storage of medical data. This in turn led on to the consideration of data in legacy systems. Finally, an evaluation of the developed method was undertaken