Using electronic health records to support clinical trials: a report on stakeholder engagement for EHR4CR

Background. The conduct of clinical trials is increasingly challenging due to greater complexity and governance requirements as well as difficulties with recruitment and retention. Electronic Health Records for Clinical Research (EHR4CR) aims at improving the conduct of trials by using existing routinely collected data, but little is known about stakeholder views on data availability, information governance, and acceptable working practices. Methods. Senior figures in healthcare organisations across Europe were provided with a description of the project and structured interviews were subsequently conducted to elicit their views. Results. 37 structured interviewees in Germany, UK, Switzerland, and France indicated strong support for the proposed EHR4CR platform. All interviewees reported that using the platform for assessing feasibility would enhance the conduct of clinical trials and the majority also felt it would reduce workloads. Interviewees felt the platform could enhance trial recruitment and adverse event reporting but also felt it could raise either ethical or information governance concerns in their country. Conclusions. There was clear support for EHR4CR and a belief that it could reduce workloads and improve the conduct and quality of trials. However data security, privacy, and information governance issues would need to be carefully managed in the development of the platform

An electronic healthcare record server implemented in PostgreSQL

This paper describes the implementation of an Electronic Healthcare Record server inside a PostgreSQL relational database without dependency on any further middleware infrastructure. The five-part international standard for communicating healthcare records (ISO EN 13606) is used as the information basis for the design of the server. We describe some of the features that this standard demands that are provided by the server, and other areas where assumptions about the durability of communications or the presence of middleware lead to a poor fit. Finally, we discuss the use of the server in two real-world scenarios including a commercial application

Blockchain technologies in healthcare institutions : focus on security and effective cooperation with the government

Purpose: This article considers the relevance of healthcare modernization processes in Russia in terms of marketing activities activation, public-private partnerships intensification. Design/Methodology/Approach: The problem of ensuring security when government and healthcare institutions interact by means of blockchain technologies is under-explored and requires further research and investigation. Therefore, methods of induction, deduction, problem, system and logical analysis along with the economic process and system modelling method combined with the formalization method are used in this article. Findings: A mechanism for effective ensuring the safety of interaction between the government and healthcare institutions using blockchain technologies in the course of conducting financial flows and operational information exchange in modern Russia is proposed. Practical Implications: The proposed mechanism for effective ensuring of security in terms of interaction between the government and the healthcare institution by means of blockchain technologies in modern Russia effectively ensures the security of interaction between the government and healthcare institutions . Originality/Value: Authors’ findings could be introduced into the healthcare industry.peer-reviewe

Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Towards A Well-Secured Electronic Health Record in the Health Cloud

The major concerns for most cloud implementers particularly in the health care industry have remained data security and privacy. A prominent and major threat that constitutes a hurdle for practitioners within the health industry from exploiting and benefiting from the gains of cloud computing is the fear of theft of patients health data in the cloud. Investigations and surveys have revealed that most practitioners in the health care industry are concerned about the risk of health data mix-up amongst the various cloud providers, hacking to comprise the cloud platform and theft of vital patients’ health data.An overview of the diverse issues relating to health data privacy and overall security in the cloud are presented in this technical report. Based on identifed secure access requirements, an encryption-based eHR security model for securing and enforcing authorised access to electronic health data (records), eHR is also presented. It highlights three core functionalities for managing issues relating to health data privacy and security of eHR in health care cloud

Beyond Volume: The Impact of Complex Healthcare Data on the Machine Learning Pipeline

From medical charts to national census, healthcare has traditionally operated under a paper-based paradigm. However, the past decade has marked a long and arduous transformation bringing healthcare into the digital age. Ranging from electronic health records, to digitized imaging and laboratory reports, to public health datasets, today, healthcare now generates an incredible amount of digital information. Such a wealth of data presents an exciting opportunity for integrated machine learning solutions to address problems across multiple facets of healthcare practice and administration. Unfortunately, the ability to derive accurate and informative insights requires more than the ability to execute machine learning models. Rather, a deeper understanding of the data on which the models are run is imperative for their success. While a significant effort has been undertaken to develop models able to process the volume of data obtained during the analysis of millions of digitalized patient records, it is important to remember that volume represents only one aspect of the data. In fact, drawing on data from an increasingly diverse set of sources, healthcare data presents an incredibly complex set of attributes that must be accounted for throughout the machine learning pipeline. This chapter focuses on highlighting such challenges, and is broken down into three distinct components, each representing a phase of the pipeline. We begin with attributes of the data accounted for during preprocessing, then move to considerations during model building, and end with challenges to the interpretation of model output. For each component, we present a discussion around data as it relates to the healthcare domain and offer insight into the challenges each may impose on the efficiency of machine learning techniques.Comment: Healthcare Informatics, Machine Learning, Knowledge Discovery: 20 Pages, 1 Figur

The Vasco da Gama Movement : reflections and experiences of an exchange programme

The Vasco da Gama Movement (VdGM) defines itself as the Network for Young and Future Family Doctors of the European Regional Branch of the World Organisation of Family Doctors (WONCA Europe). The early beginnings of this movement date back to 2002 during preparations for the Junior Doctor Programme initiated by Dr Alphonse Sips, a dedicated Dutch family doctor, as part of the 2003 WONCA Europe Amsterdam Conference. Together with a group of enthusiastic trainees from the Netherlands and support from the European Academy of Teachers in General Practice/Family Medicine (EURACT), Dr Sips went on to develop the first pre-conference meeting for six international groups, each involving trainees and EURACT teachers to serve as guides. This laid the foundations for the development of the VdGM (Vasco Da Gama Movement, 2012; Sloane, 2016)). The ideals of the movement were set out in 2005 during a meeting that took place in Lisbon, the home of Vasco da Gama, from where he set out on a similar voyage of discovery and thus the name was born. Successful pre-conferences preceding the WONCA Europe Conference have been held annually since. Furthermore, VdGM has continued to grow and expand from then on to include a vast range of other events and activities, all with the aim of improving general practitioner (GP) empowerment, connection and support.peer-reviewe

General practice organisation and healthcare reform : what do Maltese general practitioners think?

In Malta, two-thirds of primary healthcare is delivered by private general practitioners (GPs), mostly working single-handed without supporting staff. The combined lack of patient registration and transferable medical records lead to fragmentation of care, duplication of resources and suboptimal disease prevention and management. In 2009, the government proposed a reform to encourage partnerships which was shelved. The aim of this article is to explore the opinions of GPs about how practice organisation might influence them and their patients and to seek GPs’ views about possible healthcare reform initiatives. A postal cross-sectional survey of all specialists in family medicine resident in Malta. An instrument was designed, piloted and validated. SPSS® (v. 20) was used for analysis. One hundred and fifty (44%) questionnaires were returned. Respondents were representative of the sample as regards demographic and employment characteristics. Only 26% of GPs are female, but most work in partnerships or the public service. Seventy-seven per cent of private GPs work single-handed. Group practitioners are more likely to utilise electronic medical records and appointments, and to employ secretaries. Doctors acknowledge that although patients prefer one GP, partnerships can deliver better patient care. GPs believe that partnerships are beneficial for themselves, and would consider joining one. Females and young doctors favour partnerships. Respondents, particularly young doctors, favour patient registration and reform. Public doctors who work part-time privately oppose reform. Most GPs favour group practices and health reform, especially females and young doctors (whose proportions are increasing). Primary care should be urgently reformed and patient registration introduced. Public-private agreements would stimulate partnership formation. Public group practices could cater for means-tested citizens.peer-reviewe

Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan.

Objective  To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services. Method  A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic. Results  There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10-20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations. Conclusion  Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases

Information systems and healthcare XXIV: Factors affecting the EAI adoption in the healthcare sector

Recent developments in the field of integration technologies like Enterprise Application Integration (EAI) have emerged to support organizations towards improving the quality of services and reducing integration costs. Despite the importance of EAI, there is limited empirical research reported on its adoption in the healthcare sector. Khoumbati et al. [2006] developed a model for the evaluation of EAI in healthcare organizations. In doing so, the causal interrelationship of EAI adoption factors was identified by using fuzzy cognitive mapping. This paper is a progression of previous work in the area and seeks to contribute by validating the model through a different case environment. Thus, this paper contributes by deriving and proposing the MAESTRO model for EAI adoption. MAESTRO identifies a set of factors that influence EAI adoption and it is evaluated through a real-life case study. It provides an understanding of the EAI adoption process through its grounding on empirical data. In doing so, the MAESTRO model supports the management of healthcare organizations during the decision-making process for EAI adoption