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

Artificial Intelligence Agents and Knowledge Acquisition in Health Information System

This research work highlights the need for AI-powered applications and their usages for theoptimization of information flow processes in the medical sector, from the perspective of howAI-agents can impact human-machine interaction (HCI) for acquiring relevant and necessaryinformation in emergency department (ED). This study investigates how AI-agents can be applied to manage situations of patient related unexpected experiences, such as long waiting times,overcrowding issues, and high number of patients leaving without being diagnosed. For knowledge acquisition, we incorporated modelling workshop techniques for gathering domain information from the domain experts in the context of emergency department in Karolinska Hospi-tal, Solna, Stockholm, Sweden, and for designing the AI-agent utilizing NLP techniques. We dis-cuss how the proposed solution can be used as an assistant to healthcare practitioners and workers to improve medical assistance in various medical procedures to increase flow and to reduce workloads and anxiety levels. The implementation part of this work is based on the natural language processing (NLP) techniques that help to develop the intelligent behavior for information acquisition and itsretriev-al in a natural way to support patients/relatives’ communication with the healthcare organization efficiently and in a natural way

Using Informatics to Improve Autism Screening in a Pediatric Primary Care Practice

Background: According to the most recent report from the CDC (2018), autism spectrum disorder (ASD) affects approximately one in 59 children in the United States (U.S.). In 2007, the American Academy of Pediatrics (AAP) issued a strong recommendation for all primary care providers to screen children for autism, using a validated tool, at the 18 and 24-month well-child visits, in order to begin the referral process for more formal testing, and intervention, promptly. Despite the strong stance of the AAP and evidence supporting the importance of early intervention for children with ASD, not all primary care providers are screening for ASD or developmental delay. Purpose: To improve the percentage of eligible children, presenting for 18 and 24 month wellchild visits in a pediatric primary care office, who are screened for ASD, by integrating the Modified Checklist for Autism in Toddlers (M-CHAT) screening tool into the electronic medical record with tablets. The specific aims were to increase the percentage of children screened and improve the documentation of the screens performed. Methods: This quality improvement project utilized a before-after quantitative design to support the improvement. Reports were obtained for three months prior to the implementation of the tablets and process change, and again for three months following the implementation. Manual chart reviews were also performed to verify the data from the reports. The definition used for complete screening for this project included 1) presence of the completed screen in the medical record, 2) provider documentation of the result, interpretation, and plan if indicated, and 3) CPT code entry for charge capture completed in the electronic medical record. Results: The results of the project revealed improvements in overall percentages of eligible children screened for autism at D-H Nashua Pediatrics. The percentage of complete screening increased from 64.7% to 73.9% following the implementation of the project, a change which is statistically significant (t=31.6105, df=16,p=0.05). Each individual element was also tracked and those results showed that 1) the completeness of provider documentation related to the screening increased from 93.6% to 96% (t=41.3321, df=16, p=0.05) and 2) the M-CHAT screen was present in the electronic health record (EHR) 98.9% of the time, which was an increase from 84.6% (t=295.4084, df=16, p=0.05). The charge capture completion rate remained statistically unchanged at 76.5% (t=0.4664, df=16, p=0.05). Additionally, only one screening was noted to be missed altogether, out of 280 eligible children. Prior to the project, there were four missed screenings (out of 156 eligible children) captured by the chart reviews conducted over three months prior to the implementation of the project. Overall, the results show that the project resulted in an increase the percentage of M-CHAT screening, an increase in the presence of source documentation in the electronic health record (EHR), and more complete provider documentation related to the screening

Infectious diseases management framework for Saudi Arabia (SAIF)

A Thesis Submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Doctor of PhilosopyInfectious disease management system area is considered as an emerging field of modern healthcare in the Gulf region. Significant technical and clinical progress and advanced technologies can be utilized to enhance the performance and ubiquity of such systems. Effective infectious disease management (IDM) can be achieved by analysing the disease management issues from the perspectives of healthcare personnel and patients. Hence, it is necessary to identify the needs and requirements of both healthcare personnel and patients for managing the infectious disease. The basic idea behind the proposed mobile IDM system in this thesis is to improve the healthcare processes in managing infectious diseases more effectively. For this purpose, internet and mobile technologies are integrated with social networking, mapping and IDM applications to improve the processes efficiency. Hence, the patients submit their health related data through their devices remotely using our application to our system database (so-called SAIF). The main objective of this PhD project was the design and development of a novel web based architecture of next-generation infectious disease management system embedding the concept of social networking tailored for Saudi patients. Following a detailed literature review which identifies the current status and potential impact of using infectious diseases management system in KSA, this thesis conducts a feasibility user perspective study for identifying the needs and the requirements of healthcare personnel and the patients for managing infectious diseases. Moreover, this thesis proposes a design and development of a novel architecture of next-generation web based infectious disease management system tailored for Saudi patients (i.e., called SAIF – infectious diseases management framework for Saudi Arabia). Further, this thesis introduces a usability study for the SAIF system to validate the acceptability of using mobile technologies amongst infected patient in KSA and Gulf region. The preliminary results of the study indicated general acceptance of the patients in using the system with higher usability rating in high affected patients. In general, the study concluded that the concept of SAIF system is considered acceptable tool in particularly with infected patients

The Introduction of an Adult Sweat Test Clinic in an Acute Dublin Academic Teaching Hospital

Aim: The aim of this organisational development project was to introduce a sweat test clinic for adult patients’ in a large academic teaching hospital. Rationale: The sweat test is used in the diagnosis of cystic fibrosis. The introduction of Ivacaftor, trade name Kalydeco®, for a particular subset of cystic fibrosis patients and the recognition of milder phenotypes of cystic fibrosis in adults had resulted in an increased demand for an adult clinic. Prior to the introduction of the adult service 33 adults were awaiting sweat test appointments and unable to access a sweat test service. Change process: The Health Service Executive change model was used as a framework to guide the change process. A vision for the change was created and the introduction of the clinic was aligned to the mission of the organisation and that of the Health Service Executive, that patients’ will have access to high quality health care. Evaluation: The context, input, process and products model was used to evaluate the organizational development process. This involved evaluation each of the objectives of the project. A target of 8 weeks wait time for an appointment has been achieved. Results and conclusions: The adult sweat test service was implemented with two out of 14 patients’ having a chloride result indicative of cystic fibrosis. A further 19 patients are scheduled for appointment. Use of a structured change model guided successful implementation of the clinic. The target appointment wait time will require regular auditing by the Clinical Chemistry Department to ensure compliance. This will form part of the regular auditing of services as part of the overall laboratory quality management system. The service will be monitored for any increase or decrease in demand ensuring effective use of resources. This is report monthly at the Clinical Chemistry Operational Group meeting

The Potential for mHealth Interventions to Support Women with Breast Cancer after Active Treatment

Breast cancer is the most commonly diagnosed cancer among women worldwide. Chances of living one-year after diagnosis are high (~98%), and health self-management is essential to reduce risks of recurrence. Mobile health (mHealth) has emerged as a wide-reaching and cost-effective way of providing health information and support. Therefore, we conducted a narrative review of the currently available mHealth literature and synthesised the literature according to the impacts of mHealth interventions on patient outcomes, the potential mechanism for behaviour change and innovative approaches to developing future mHealth interventions. Results found a small amount of evidence for the value of mHealth interventions (text message programs, smartphone applications and activity trackers) for supporting women after breast cancer treatment. However, accessibility, cost and gender inequities may pose barriers to implementation. Developing consumer-led mHealth interventions based on lived-experiences will be essential to improving user outcomes. In conclusion, mHealth interventions are widely available and have the potential to support women after breast cancer treatment and further robust research will determine effectiveness in specific subgroups and populations

Washington University Record, September 3, 2009

https://digitalcommons.wustl.edu/record/2184/thumbnail.jp