Description and Experience of the Clinical Testbeds

This deliverable describes the up-to-date technical environment at three clinical testbed demonstrator sites of the 6WINIT Project, including the adapted clinical applications, project components and network transition technologies in use at these sites after 18 months of the Project. It also provides an interim description of early experiences with deployment and usage of these applications, components and technologies, and their clinical service impact

Supporting Special-Purpose Health Care Models via Web Interfaces

The potential of the Web, via both the Internet and intranets, to facilitate development of clinical information systems has been evident for some time. Most Web-based clinical workstations interfaces, however, provide merely a loose collection of access channels. There are numerous examples of systems for access to either patient data or clinical guidelines, but only isolated cases where clinical decision support is presented integrally with the process of patient care, in particular, in the form of active alerts and reminders based on patient data. Moreover, pressures in the health industry are increasing the need for doctors to practice in accordance with ¿best practice¿ guidelines and often to operate under novel health-care arrangements. We present the Care Plan On-Line (CPOL) system, which provides intranet-based support for the SA HealthPlus Coordinated Care model for chronic disease management. We describe the interface design rationale of CPOL and its implementation framework, which is flexible and broadly applicable to support new health care models over intranets or the Internet

Mobile consultant: Evaluation of additional services

As the need for mobility in the medical world increases, newer systems and applications came to light; many of them based on wireless and mobile networks. PDA based systems were presented in the past, capable of videoconferencing and transmitting high quality images between a roaming consultant and a fixed point in the hospital. These systems not only had desirable characteristics but also incorporated additional services that were found of value: paging, Voice over IP calling, Internet, email, intranet, patient record update, etc. This paper presents an engineering and clinical evaluation of those additional services based on both objective and subjective criteria. It concludes that such complementary services can be desirable as they increase personnel mobility, utilize the hospital resources more efficiently while at the same time increase productivity and decrease the cost of hardware and communications

An Integrated Approach for Evaluating Students' Achievement of Clinical Objectives

During the clinical phase of undergraduate medical education (UME) students are often geographically dispersed and assigned to preceptors throughout the community. Monitoring, documenting, and evaluating their clinical experiences and achievement of clinical objectives in this venue becomes a challenge, especially for large UME programs. The purpose of this manuscript is to discuss a method for developing and implementing a school-wide evaluation system for the clinical phase of UME. This type of evaluation system links students' clinical experiential data with the objectives of a clerkship, using technological advances, such as the Personal Digital Assistant (PDA), Internet, and intranet. Clerkship directors are provided real-time reports on student's progress toward achieving clerkship objectives and are able to monitor the clinical activities of the clerkship. Students on the other hand, will be empowered to take more control of their educational experiences by monitoring their own progress

Fuzzy Logic in Clinical Practice Decision Support Systems

Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. This paper discusses sources of fuzziness in clinical practice guidelines. We consider how fuzzy logic can be applied and give a set of heuristics for the clinical guideline knowledge engineer for addressing uncertainty in practice guidelines. We describe the specific applicability of fuzzy logic to the decision support behavior of Care Plan On-Line, an intranet-based chronic care planning system for General Practitioners

Providing secure remote access to legacy applications

While the widespread adoption of Internet and Intranet technology has been one of the exciting developments of recent years, many hospitals are finding that their data and legacy applications do not naturally fit into the new methods of dissemination. Existing applications often rely on isolation or trusted networks for their access control or security, whereas untrusted wide area networks pay little attention to the authenticity, integrity or confidentiality of the data they transport. Many hospitals do not have the resources to develop new ''network-ready'' versions of existing centralised applications. In this paper, we examine the issues that must be considered when providing network access to an existing health care application, and we describe how we have implemented the proposed solution in one healthcare application namely the diabetic register at Hope Hospital. We describe the architecture that allows remote access to the legacy application, providing it with encrypted communications and strongly authenticated access control but without requiring any modifications to the underlying application. As well as comparing alternative ways of implementing such a system, we also consider issues relating to usability and manageability, such as password management

The Identity Project: in-depth case studies of Identity Management - UCL institutional audit. Final report

This report presents the results of an audit of identity management practices at UCL, as part of Work Package 2 of The Identity Project (http://www.identity-project.info), a study funded under the JISC e-infrastructure programme, to address the current practice and future needs of UK academic institutions in Identity Management. After an introduction to the organisational context and a description of the audit methodology, the results of fifteen interviews are presented thematicall