Electronic Health Record Architecture: A Systematic Review

Numerous advantages are derived from the electronic health record (EHR).Though achieving such advantages depends on its architecture, at present no unique understanding of the architecture dimensions and specifications is available. Therefore, the aim of the present study is a systematic review of architecture perception of the electronic health record. The authors searched the literature in Science Direct, Scopus, PubMed and Proudest Databases (2000 to Jun 2015).  Data extraction was done by 2 reviewers on content, structure, content/structure relationship, confidentiality and security of the EHR. Subsequent to refining the 87 retrieved studies, 25 studies were finally included in the study. In the studies and paradigms so far proposed for the EHR, a unique comprehensive architecture model from the viewpoint of research criteria has not been investigated and it has been considered only from some dimensions. Hence, we provide a new definition of the EHR architecture

Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

<p>Abstract</p> <p>Background</p> <p>The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS.</p> <p>Methods</p> <p>The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing.</p> <p>Results</p> <p>Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters.</p> <p>Conclusion</p> <p>It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability.</p

Voice controled electronic health record in dentistry

Název: Elektronický zubní kříž ovládaný hlasem Autor: MUDr. Radek Hippmann Pracoviště: Dětská stomatologická klinika FN Motol Školitel: Prof. MUDr. Taťjana Dostálová, DrSc., MBA E-mail školitele: [email protected] Tato dizertační práce se zabývá tvorbou komplexní elektronické zdravotnické dokumentace (EHR) pro oblast stomatologie. Tento vzniklý systém je navíc vylepšen o hlasové ovládání pomocí systému Automatic speech recognition (ASR) a o modul pro syntézu řeči Text-to-speech (TTS). První část práce je věnována úvodu do tématiky a jsou vymezeny jednotlivé oblasti, jejichž propojení je nutné pro vytvoření EHR systému pro tuto oblast. Jsou to především základním způsobem vymezené oblasti a pojmy ve stomatologii. Dále jsme se věnovali problematice temporomandibulárního kloubu (TMK), která je často opomíjena a jsou popsány i trendy v EHR a hlasových technologiích. V metodické části jsou popsány technologie při tvorbě EHR systému, hlasového rozpoznávání a klasifikace onemocnění TMK. V další části navazuje popis vlastních výsledků, které korespondují se znalostní bází stomatologie a TMK. Z nich vychází vlastní grafické uživatelské rozhranní Dentcross sloužící pro záznam stomatologických dat. Celá aplikace je ovladatelná hlasem a možné je i hlasové zpětné vyvolání informace pomocí modulu TTS....Title: Voice controlled electronic health record in dentistry Author: MUDr. Radek Hippmann Department: Department of paediatric stomatology, Faculty hospital Motol Supervisor: Prof. MUDr. Taťjana Dostalová, DrSc., MBA Supervisor's e-mail: [email protected] This PhD thesis is concerning with development of the complex electronic health record (EHR) for the field of dentistry. This system is also enhanced with voice control based on the Automatic speech recognition (ASR) system and module for speech synthesis Text-to- speech (TTS). In the first part of the thesis is described the whole issue and are defined particular areas, whose combination is essential for EHR system creation in this field. It is mainly basic delimiting of terms and areas in the dentistry. In the next step we are engaged in temporomandibular joint (TMJ) problematic, which is often ignored and trends in EHR and voice technologies are also described. In the methodological part are described delineated technologies used during the EHR system creation, voice recognition and TMJ disease classification. Following part incorporates results description, which are corresponding with the knowledge base in dentistry and TMJ. From this knowledge base originates the graphic user interface DentCross, which is serving for dental data...2. lékařská fakulta UKSecond Faculty of MedicineFirst Faculty of Medicine1. lékařská fakult

Inteligentní proxy pro mobilní uživatelská rozhraní elektronického zdravotního záznamu

V predloženej práci študujem možnosti využitia elektronického zdravotného záznamu, navrhnutého a implementovaného Josefom Špidlenom, na tzv. tenkých užívatelských klientoch, ako je napr. webový prehliadac na PC, vreckovom pocítaci alebo mobilnom telefóne. Úlohou práce jesprostredkovat užívatelovi (lekárovi, sestricke, záchrannej službe) informácie o jednotlivých pacientoch co najrýchlejšie a v prehladnej a užívatelsky prívetivej forme. Hlavným prínosom projektu je integrácia pacientových dát z rôznych zdrojov (databáz elektronického zdravotného záznamu MUDR), ktoré majú iba útržky znalostí o pacientovi, tak ako v reálnom živote jednotliví doktori alebo nemocnicné oddelenia. Proxy združuje dáta o pacientovi zo všetkých dostupných zdrojov a prezentuje ich ako jeden úplný a celistvý obraz pacienta. Takáto globálna integrácia dát je obrovská pomoc pre akúkolvek interakciu s pacientom s ohladom na jeho zdravotnú situáciu.In the present work we study possibilities of using the electronic healthcare record, created and implemented by Josef Špidlen, on thin user clients as web browser on PC, PDA or mobile phone. The task of this work is to present patient's medical informations to the users (physicians, nurses, emergency staff) in the fastest, well arranged and user-friendly form. The main benefit of this project is integration of patient's data from several sources (databases of electronic healthcare record MUDR), which every of them has only the fragment of knowledge about patient, as in real life separate physicians or hospitals. Proxy keeps the patient's data from all available sources and presents them as complete and compact image of the patient. This kind of global EHR data integration is a major help for every interaction with the patient with respect to his/her health condition.Katedra softwarového inženýrstvíDepartment of Software EngineeringFaculty of Mathematics and PhysicsMatematicko-fyzikální fakult

Telematic integration of health data: the INTESA project

Following an approach based on the methods of basic research, the INTESA project has developed a complete architecture of health information system, capable to guarantee a smart and safe storing of the essential information, an effective and personalized retrieval of data, and some innovative models to compare the results of clinical and medical activities of all the &#034;actors&#034; of the health care process. Together with other metropolitan repositories based on HL7 messages and applications able to examine the data stored, the developed archive will contribute to keep a check on every citizen&#039;s health history, clinical examinations and cure therapies, but, above all, it will allow to verify the efficacy and efficiency of the health care processes related to particular pathologies.Non present

User preferences for adaptive user interfaces in health information systems

An adaptive user interface requires identification of user requirements. Interface designers and engineers must understand end-user interaction with the system to improve user interface design. A combination of interviews and observations is applied for user requirement analysis in health information systems (HIS). Then, user preferences are categorized in this paper as either data entry, language and vocabulary, information presentation, or help, warning and feedback. The user preferences in these categories were evaluated using the focus group method. Focus group sessions with different types of HIS users comprising medical staff (with and without computer skills) and system administrators identified each user group’s preference for the initial adaptation of the HIS user interface. User needs and requirements must be identified to adapt the interface to users during data entry into the system. System designers must understand user interactions with the system to identify their needs and preferences. Without this, interface design cannot be adapted to users and users will not be comfortable using the system and eventually abandon its use

A denoising algorithm for surface EMG decomposition

The goal of the present thesis was to investigate a novel motor unit potential train (MUPT) editing routine, based on decreasing the variability in shape (variance ratio, VR) of the MUP ensemble. Decomposed sEMG data from 20 participants at 60% MVC of wrist flexion was used. There were two levels of denoising (relaxed and strict) criteria for removing discharge times associated with waveforms that did not decrease the VR and increase its signal-to-noise ratio (SNR) of the MUP ensemble. The peak-to-peak amplitude and the duration between the positive and negative peaks for the MUP template were dependent on the level of denoising (p’s 0.05). The same was true between denoising criteria (p>0.05). Editing the MUPT based on MUP shape resulted in significant differences in measures extracted from the MUP template, with trivial difference between the standard error of estimate for mean IDIs between the complete and denoised MUPTs

Využití tenchnologie GRID při zpracování medicínské informace

Práce se soustředí na vybrané oblasti biomedicínského výzkumu, které mohou profitovat ze současných výpočetních infrastruktur vybudovaných ve vědecké komunitě v evropském a světovém prostoru. Teorie výpočtu, paralelismu a distribuovaného počítání je stručně uvedena s ohledem na počítání v gridech a cloudech. Práce se zabývá oblastí výměny medicínských snímků a představuje propojení Gridového PACS systému s existujícími distribuovanými systémy pro sdílení DICOM snímků. Práce se dál zaměřuje na studium vědy týkající se lidského hlasu. Práce představuje vzdálený způsob přístupu k aplikaci pro analýzu hlasu v reálném čase pomocí úpravy protokolů pro vzdálenou plochu a pro přenos zvukových nahrávek. Tento dílčí výsledek ukazuje možnost využití stávajících aplikací na dálku specialisty na hlas. Oblast lidské fyziologie a patofyziologie byla studována pomocí přístupu tzv. systémové biologie. Práce přispívá v oblasti metodologie modelování lidské fyziologie pro tvorbu komplexních modelů založených na akauzálním a objektově orientovaném modelovacím přístupu. Metody pro studium parametrů byly představeny pomocí technologie počítání v gridech a v cloudech. Práce ukazuje, že proces identifikaci parametrů středně komplexních modelů kardiovasculárního systému a komplexního modelu lidské fyziologie lze významně zrychlit...This thesis focuses on selected areas of biomedical research in order to benefit from current computational infrastructures established in scientific community in european and global area. The theory of computation, parallelism and distributed computing, with focus on grid computing and cloud computing, is briefly introduced. Exchange of medical images was studied and a seamless integration of grid-based PACS system was established with the current distributed system in order to share DICOM medical images. Voice science was studied and access to real-time voice analysis application via remote desktop technology was introduced using customized protocol to transfer sound recording. This brings a possibility to access current legacy application remotely by voice specialists. The systems biology approach within domain of human physiology and pathophysiology was studied. Modeling methodology of human physiology was improved in order to build complex models based on acausal and object-oriented modeling techniques. Methods for conducting a parameter study (especially parameter estimation and parameter sweep) were introduced using grid computing and cloud computing technology. The identification of parameters gain substantial speedup by utilizing cloud computing deployment when performed on medium complex models of...nezařazení_neaktivníFirst Faculty of Medicine1. lékařská fakult

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

Revision of the electronic diabetic file at Clinic of Diabetology IKEM

Karta diabetika je elektronický medicínský záznam na Klinice diabetologie Institutu klinické a experimentální medicíny (IKEM). Jedná se o komplexní záznam o pacientovi, obsahující klinická a statistická data. Problémem karty diabetika je její obsáhlost a tedy i zdlouhavost vyplňování lékařskými pracovníky. Kvůli tomu klesá i její využitelnost. V práci je popsána tvorba programového modulu, který vede ke vzniku inovované karty diabetika vnořené do ambulantní zprávy a hlavně k novému uživatelskému rozhraní, pomocí něhož se zadávají do karty data. Dále jsou popsány další postupy mající za úkol podpořit implementaci do systému Zlatokop, nemocničního informačního systému v IKEM. Součástí je i zhodnocení přínosů této karty a přiblížení současného stavu tohoto projektu. Před popisem samotného řešení se práce věnuje ozřejmění základních oblastí týkajících se karty diabetika. Jedná se o obor elektronického zdravotnictví, speciálně potom v oblasti elektronického zdravotního záznamu, dále o oblast databází se zaměřením na Caché, databázi používanou v systému Zlatokop. Práce také podává základní informace o onemocnění diabetes mellitus a o základních principech uživatelského prožitku.Electronic diabetic record (EDR) is an electronic medical record used in Diabetology Clinics, Instittute for Clinical and Experimental Medicine (IKEM), Prague. EDR is complex record of patient statistical and clinical data. It´s complexity and large time demands on filling in all items make EDR not user friendly. Thus, benefits of electronic medical record are not fully utilized. The paper describes solution that leads to simpler user interface as component of outpatient message allowing easy entering data. The new interface has been designed and created in the form of program module. There are described other procedures to implement module into IKEM information system Zlatokop. At the end, there are discussed the advantages and shortcomings of this revised vision and current status of project of EDR. The first part of the work is about the basic concepts and problems regarding EDR. It is about e-health, specially about the electronic health record, databases, specially about Caché, which is used in Zlatokop, about diabetes mellitus and about user experience.