DACTyL:towards providing the missing link between clinical and telehealth data

This document conveys the findings of the Data Analytics, Clinical, Telehealth, Link (DACTyL) project. This nine-month project started at January 2013 and was conducted at Philips Research in the Care Management Solution group and as part of the Data Analysis for Home Healthcare (DA4HH) project. The DA4HH charter is to perform and support retrospective analyses of data from Home Healthcare products, such as Motiva telehealth. These studies will provide valid insights in actual clinical aspects, usage and behavior of installed products and services. The insights will help to improve service offerings, create clinical algorithms for better outcome, and validate and substantiate claims on efficacy and cost-effectiveness. The current DACTyL project aims at developing and implementing an architecture and infrastructure to meet the most demanding need from Motiva telehealth customers on return on investment (ROI). These customers are hospitals that offer Motiva telehealth to their patients. In order to provide the Motiva service cost-effectively, they need to have insight into the actual cost, benefit and resource utilization when it comes to Motiva deployment compared to their usual routine care. Additional stakeholders for these ROI-related data are Motiva customer consultants and research scientists from Philips for strengthening their messaging and service deliveries to arrive at better patient care

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

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

Archetype based intelligent system for healthcare interoperability

Tese doutoramento - Programa Doutoral em Engenharia BiomédicaThe healthcare arena configures an environment of both complexity and cooperation, in which numerous and distinct information systems must exchange information in a expedite and consolidated manner. Where healthcare interoperability is concerned several techniques, methodologies, architectures and standards exist. However subjects such as service distribution, fault tolerance, standards, communication flavoring and tightly-bound systems still are a major issue of concern. This work studies and researches the best methodologies to imbue intelligent behaviours combined with ontology and moral awareness into multi-agents system applied to healthcare environments. Its core objective is to propose, develop, implement and evaluate an archetype for an interoperability platform oriented towards the healthcare environment. This archetype was validated in several implementation in different major healthcare institutions. It is based in an agent framework named JADE and is adapted and oriented towards the healthcare environment. Henceforth the resulting archetype addresses the existing limitations in past and present solutions regarding healthcare interoperability. It explores the limits of intelligent behaviours in multi-agent systems applied to interoperation procedures in healthcare, towards the improvement of the reliability and quality of information exchanged.A área da saúde configura um ambiente de grande complexidade e cooperação onde inúmeros e distintos sistemas de informação têm que trocar informação entre si de uma forma expedita e consolidada. No âmbito da interoperabilidade hospitalar existem várias técnicas, metodologias, arquiteturas e standards. No entanto, temas como distribuição de serviços, tolerância à falha, standards, flavouring de comunicações e sistemas fortemente acoplados, continuam a ser um importante fonte de preocupação. Este trabalho estuda e pesquiza as melhores metodologias de embeber comportamentos inteligentes combinados com ontologias e noções morais em sistemas multi-agentes aplicados a ambientes hospitalares. O seu objectivo principal é propor, desenvolver, implementar e avaliar um arquétipo para uma plataforma de interoperabilidade orientada para o ambiente hospitalar. Este arquétipo foi validado em diferentes implementações em instituições de saúde portuguesas de grande dimensão. Esta plataforma é baseada numa framework de agentes denominada JADE e foi adaptada e orientada para o ambiente hospitalar.. Desta forma o arquétipo resultante é orientado para resolver as limitações existentes nas soluções atuais de interoperabilidade hospitalar. Este explora os limites dos comportamentos inteligentes em sistemas multi-agente quando aplicados em procedimentos de interoperabilidade na área da saúde para melhorar a fiabilidade e qualidade da informação trocada entre estes sistemas

Plataforma para visualização de dados clínicos baseada em software open source

Healthcare providers are faced with the challenge of going through large amounts of data in search of answers to complex questions. On top of that, medical sta typically don't have database knowledge, and so, it is necessary to provide them with tools that allows the visualization of reports, charts and dashboards, without having to interact or even see query languages, ideally on the same platforms where data is generated. Embedding Business Intelligence (BI) has emerged as a possible solution to this issue, providing end-user with tools that enables them to explore data in a simpli ed way. Thus, the application where the solution was embedded not only is enhanced, but the necessity for data analysis stand-alone tools is eliminated. This thesis starts by analyzing if integrating a BI solution into medical platforms is plausible, by presenting the main characteristics of clinical data, followed by an overview of the state of the art on open-source Business Intelligence software. Then, a solution proposal is presented where the development of an embedded solution is pragmatically addressed. Finally, case studies where the integration of the work developed was integrated will be presented, in order to evaluate its applicability and integrability.Os profissionais de saúde enfrentam constantemente o desafio de analisar grandes quantidades de dados médicos na procura de respostas para questões complexas. Além disso, estes profissionais não têm conhecimentos de linguagens para consultas de bases de dados. Portanto, é necessário providenciar aos profissionais de saúde ferramentas que lhes permitam visualizar relatórios, gráficos e dashboards, sem que seja necessário interagir com linguagens de consulta, idealmente nas plataformas onde os dados são gerados. Integrar soluções de Business Intelligence (BI) em aplicações já existentes surge como uma possível solução para este problema, providenciando recursos aos utilizadores finais que lhes permitam explorar dados de uma forma simplificada. Deste modo, não só é valorizada a aplicação onde ocorre a integração, como é eliminada a necessidade de plataformas destacadas para análise de dados. Esta dissertação começa por analisar se a integração de soluções BI na área da saúde é viável, apresentando as principais caracteristicas de dados clínicos, bem como um estado de arte das soluções Business Intelligence existentes. De seguida, é apresentada uma proposta de solução, onde o desenvolvimento de uma solução integrável é detalhadamente descrito. Por fim, serão apresentados casos de estudo onde a integração do trabalho desenvolvido ocorreu, de forma a avaliar a sua aplicabilidade e integrabilidade.Mestrado em Engenharia Informátic

Identity Management and Authorization Infrastructure in Secure Mobile Access to Electronic Health Records

We live in an age of the mobile paradigm of anytime/anywhere access, as the mobile device is the most ubiquitous device that people now hold. Due to their portability, availability, easy of use, communication, access and sharing of information within various domains and areas of our daily lives, the acceptance and adoption of these devices is still growing. However, due to their potential and raising numbers, mobile devices are a growing target for attackers and, like other technologies, mobile applications are still vulnerable. Health information systems are composed with tools and software to collect, manage, analyze and process medical information (such as electronic health records and personal health records). Therefore, such systems can empower the performance and maintenance of health services, promoting availability, readability, accessibility and data sharing of vital information about a patients overall medical history, between geographic fragmented health services. Quick access to information presents a great importance in the health sector, as it accelerates work processes, resulting in better time utilization. Additionally, it may increase the quality of care. However health information systems store and manage highly sensitive data, which raises serious concerns regarding patients privacy and safety, and may explain the still increasing number of malicious incidents reports within the health domain. Data related to health information systems are highly sensitive and subject to severe legal and regulatory restrictions, that aim to protect the individual rights and privacy of patients. Along side with these legislations, security requirements must be analyzed and measures implemented. Within the necessary security requirements to access health data, secure authentication, identity management and access control are essential to provide adequate means to protect data from unauthorized accesses. However, besides the use of simple authentication models, traditional access control models are commonly based on predefined access policies and roles, and are inflexible. This results in uniform access control decisions through people, different type of devices, environments and situational conditions, and across enterprises, location and time. Although already existent models allow to ensure the needs of the health care systems, they still lack components for dynamicity and privacy protection, which leads to not have desire levels of security and to the patient not to have a full and easy control of his privacy. Within this master thesis, after a deep research and review of the stat of art, was published a novel dynamic access control model, Socio-Technical Risk-Adaptable Access Control modEl (SoTRAACE), which can model the inherent differences and security requirements that are present in this thesis. To do this, SoTRAACE aggregates attributes from various domains to help performing a risk assessment at the moment of the request. The assessment of the risk factors identified in this work is based in a Delphi Study. A set of security experts from various domains were selected, to classify the impact in the risk assessment of each attribute that SoTRAACE aggregates. SoTRAACE was integrated in an architecture with requirements well-founded, and based in the best recommendations and standards (OWASP, NIST 800-53, NIST 800-57), as well based in deep review of the state-of-art. The architecture is further targeted with the essential security analysis and the threat model. As proof of concept, the proposed access control model was implemented within the user-centric architecture, with two mobile prototypes for several types of accesses by patients and healthcare professionals, as well the web servers that handles the access requests, authentication and identity management. The proof of concept shows that the model works as expected, with transparency, assuring privacy and data control to the user without impact for user experience and interaction. It is clear that the model can be extended to other industry domains, and new levels of risks or attributes can be added because it is modular. The architecture also works as expected, assuring secure authentication with multifactor, and secure data share/access based in SoTRAACE decisions. The communication channel that SoTRAACE uses was also protected with a digital certificate. At last, the architecture was tested within different Android versions, tested with static and dynamic analysis and with tests with security tools. Future work includes the integration of health data standards and evaluating the proposed system by collecting users’ opinion after releasing the system to real world.Hoje em dia vivemos em um paradigma móvel de acesso em qualquer lugar/hora, sendo que os dispositivos móveis são a tecnologia mais presente no dia a dia da sociedade. Devido à sua portabilidade, disponibilidade, fácil manuseamento, poder de comunicação, acesso e partilha de informação referentes a várias áreas e domínios das nossas vidas, a aceitação e integração destes dispositivos é cada vez maior. No entanto, devido ao seu potencial e aumento do número de utilizadores, os dispositivos móveis são cada vez mais alvos de ataques, e tal como outras tecnologias, aplicações móveis continuam a ser vulneráveis. Sistemas de informação de saúde são compostos por ferramentas e softwares que permitem recolher, administrar, analisar e processar informação médica (tais como documentos de saúde eletrónicos). Portanto, tais sistemas podem potencializar a performance e a manutenção dos serviços de saúde, promovendo assim a disponibilidade, acessibilidade e a partilha de dados vitais referentes ao registro médico geral dos pacientes, entre serviços e instituições que estão geograficamente fragmentadas. O rápido acesso a informações médicas apresenta uma grande importância para o setor da saúde, dado que acelera os processos de trabalho, resultando assim numa melhor eficiência na utilização do tempo e recursos. Consequentemente haverá uma melhor qualidade de tratamento. Porém os sistemas de informação de saúde armazenam e manuseiam dados bastantes sensíveis, o que levanta sérias preocupações referentes à privacidade e segurança do paciente. Assim se explica o aumento de incidentes maliciosos dentro do domínio da saúde. Os dados de saúde são altamente sensíveis e são sujeitos a severas leis e restrições regulamentares, que pretendem assegurar a proteção dos direitos e privacidade dos pacientes, salvaguardando os seus dados de saúde. Juntamente com estas legislações, requerimentos de segurança devem ser analisados e medidas implementadas. Dentro dos requerimentos necessários para aceder aos dados de saúde, uma autenticação segura, gestão de identidade e controlos de acesso são essenciais para fornecer meios adequados para a proteção de dados contra acessos não autorizados. No entanto, além do uso de modelos simples de autenticação, os modelos tradicionais de controlo de acesso são normalmente baseados em políticas de acesso e cargos pré-definidos, e são inflexíveis. Isto resulta em decisões de controlo de acesso uniformes para diferentes pessoas, tipos de dispositivo, ambientes e condições situacionais, empresas, localizações e diferentes alturas no tempo. Apesar dos modelos existentes permitirem assegurar algumas necessidades dos sistemas de saúde, ainda há escassez de componentes para accesso dinâmico e proteção de privacidade , o que resultam em níveis de segurança não satisfatórios e em o paciente não ter controlo directo e total sobre a sua privacidade e documentos de saúde. Dentro desta tese de mestrado, depois da investigação e revisão intensiva do estado da arte, foi publicado um modelo inovador de controlo de acesso, chamado SoTRAACE, que molda as diferenças de acesso inerentes e requerimentos de segurança presentes nesta tese. Para isto, o SoTRAACE agrega atributos de vários ambientes e domínios que ajudam a executar uma avaliação de riscos, no momento em que os dados são requisitados. A avaliação dos fatores de risco identificados neste trabalho são baseados num estudo de Delphi. Um conjunto de peritos de segurança de vários domínios industriais foram selecionados, para classificar o impacto de cada atributo que o SoTRAACE agrega. O SoTRAACE foi integrado numa arquitectura para acesso a dados médicos, com requerimentos bem fundados, baseados nas melhores normas e recomendações (OWASP, NIST 800-53, NIST 800-57), e em revisões intensivas do estado da arte. Esta arquitectura é posteriormente alvo de uma análise de segurança e modelos de ataque. Como prova deste conceito, o modelo de controlo de acesso proposto é implementado juntamente com uma arquitetura focada no utilizador, com dois protótipos para aplicações móveis, que providênciam vários tipos de acesso de pacientes e profissionais de saúde. A arquitetura é constituída também por servidores web que tratam da gestão de dados, controlo de acesso e autenticação e gestão de identidade. O resultado final mostra que o modelo funciona como esperado, com transparência, assegurando a privacidade e o controlo de dados para o utilizador, sem ter impacto na sua interação e experiência. Consequentemente este modelo pode-se extender para outros setores industriais, e novos níveis de risco ou atributos podem ser adicionados a este mesmo, por ser modular. A arquitetura também funciona como esperado, assegurando uma autenticação segura com multi-fator, acesso e partilha de dados segura baseado em decisões do SoTRAACE. O canal de comunicação que o SoTRAACE usa foi também protegido com um certificado digital. A arquitectura foi testada em diferentes versões de Android, e foi alvo de análise estática, dinâmica e testes com ferramentas de segurança. Para trabalho futuro está planeado a integração de normas de dados de saúde e a avaliação do sistema proposto, através da recolha de opiniões de utilizadores no mundo real

Digital Transformation in Healthcare

This book presents a collection of papers revealing the impact of advanced computation and instrumentation on healthcare. It highlights the increasing global trend driving innovation for a new era of multifunctional technologies for personalized digital healthcare. Moreover, it highlights that contemporary research on healthcare is performed on a multidisciplinary basis comprising computational engineering, biomedicine, biomedical engineering, electronic engineering, and automation engineering, among other areas