Supporting the clinical trial recruitment process through the grid

Patient recruitment for clinical trials and studies is a large-scale task. To test a given drug for example, it is desirable that as large a pool of suitable candidates is used as possible to support reliable assessment of often moderate effects of the drugs. To make such a recruitment campaign successful, it is necessary to efficiently target the petitioning of these potential subjects. Because of the necessarily large numbers involved in such campaigns, this is a problem that naturally lends itself to the paradigm of Grid technology. However the accumulation and linkage of data sets across clinical domain boundaries poses challenges due to the sensitivity of the data involved that are atypical of other Grid domains. This includes handling the privacy and integrity of data, and importantly the process by which data can be collected and used, and ensuring for example that patient involvement and consent is dealt with appropriately throughout the clinical trials process. This paper describes a Grid infrastructure developed as part of the MRC funded VOTES project (Virtual Organisations for Trials and Epidemiological Studies) at the National e-Science Centre in Glasgow that supports these processes and the different security requirements specific to this domain

Information architecture for a federated health record server

This paper describes the information models that have been used to implement a federated health record server and to deploy it in a live clinical setting. The authors, working at the Centre for Health Informatics and Multiprofessional Education (University College London), have built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multi-professional electronic health records. This work has involved collaboration with a wide range of health care and informatics organisations and partners in the healthcare computing industry across Europe though the EU Health Telematics projects GEHR, Synapses, EHCR-SupA, SynEx and Medicate. The resulting architecture models have fed into recent European standardisation work in this area, such as CEN TC/251 ENV 13606. UCL has implemented a federated health record server based on these models which is now running in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. The information models described in this paper reflect a refinement based on this implementation experience

Telehealth and Mobile Health Applied To IntegratedBehavioral Care: OpportunitiesFor Progress In New Hampshire

This paper is an accompanying document to a webinar delivered on May 16, 2017, for the New Hampshire Citizens Health Initiative (Initiative). As integrated behavioral health efforts in New Hampshire gain traction, clinicians, administrators, payers, and policy makers are looking for additional efficiencies in delivering high quality healthcare. Telehealth and mobile health (mHealth) have the opportunity to help achieve this while delivering a robust, empowered patient experience. The promise of video-based technology was first made in 1964 as Bell Telephone shared its Picturephone® with the world. This was the first device with audio and video delivered in an integrated technology platform. Fast-forward to today with Skype, FaceTime, and webinar tools being ubiquitous in our personal and business lives, but often slow to be adopted in the delivery of medicine. Combining technology-savvy consumers with New Hampshire’s high rate of electronic health record (EHR) technology adoption, a fairly robust telecommunications infrastructure, and a predominately rural setting, there is strong foundation for telehealth and mHealth expansion in New Hampshire’s integrated health continuum

Joining up health and bioinformatics: e-science meets e-health

CLEF (Co-operative Clinical e-Science Framework) is an MRC sponsored project in the e-Science programme that aims to establish methodologies and a technical infrastructure forthe next generation of integrated clinical and bioscience research. It is developing methodsfor managing and using pseudonymised repositories of the long-term patient histories whichcan be linked to genetic, genomic information or used to support patient care. CLEF concentrateson removing key barriers to managing such repositories ? ethical issues, informationcapture, integration of disparate sources into coherent ?chronicles? of events, userorientedmechanisms for querying and displaying the information, and compiling the requiredknowledge resources. This paper describes the overall information flow and technicalapproach designed to meet these aims within a Grid framework

A standard-driven communication protocol for disconnected clinics in rural areas

The importance of the Electronic Health Record (EHR), which stores all healthcare-related data belonging to a patient, has been recognized in recent years by governments, institutions, and industry. Initiatives like Integrating the Healthcare Enterprise (IHE) have been developed for the definition of standard methodologies for secure and interoperable EHR exchanges among clinics and hospitals. Using the requisites specified by these initiatives, many large-scale projects have been set up to enable healthcare professionals to handle patients' EHRs. Applications deployed in these settings are often considered safety-critical, thus ensuring such security properties as confidentiality, authentication, and authorization is crucial for their success. In this paper, we propose a communication protocol, based on the IHE specifications, for authenticating healthcare professionals and assuring patients' safety in settings where no network connection is available, such as in rural areas of some developing countries. We define a specific threat model, driven by the experience of use cases covered by international projects, and prove that an intruder cannot cause damages to the safety of patients and their data by performing any of the attacks falling within this threat model. To demonstrate the feasibility and effectiveness of our protocol, we have fully implemented it

Supporting security-oriented, inter-disciplinary research: crossing the social, clinical and geospatial domains

How many people have had a chronic disease for longer than 5-years in Scotland? How has this impacted upon their choices of employment? Are there any geographical clusters in Scotland where a high-incidence of patients with such long-term illness can be found? How does the life expectancy of such individuals compare with the national averages? Such questions are important to understand the health of nations and the best ways in which health care should be delivered and measured for their impact and success. In tackling such research questions, e-Infrastructures need to provide tailored, secure access to an extensible range of distributed resources including primary and secondary e-Health clinical data; social science data, and geospatial data sets amongst numerous others. In this paper we describe the security models underlying these e-Infrastructures and demonstrate their implementation in supporting secure, federated access to a variety of distributed and heterogeneous data sets exploiting the results of a variety of projects at the National e-Science Centre (NeSC) at the University of Glasgow