Performance Analysis of a Medical Record Exchanges Model(SCI)

[[abstract]]Electronic medical record exchange among hospitals can provide more information for physician diagnosis and reduce costs from duplicate examinations. In this paper, we proposed and implemented a medical record exchange model. According to our study, exchange interface servers (EISs) are designed for hospitals to manage the information communication through the intra and interhospital networks linked with a medical records database. An index service center can be given responsibility for managing the EIS and publishing the addresses and public keys. The prototype system has been implemented to generate, parse, and transfer the health level seven query messages. Moreover, the system can encrypt and decrypt a message using the public-key encryption algorithm. The queuing theory is applied to evaluate the performance of our proposed model. We estimated the service time for each queue of the CPU, database, and network, and measured the response time and possible bottlenecks of the model. The capacity of the model is estimated to process the medical records of about 4000 patients/h in the 1-MB network backbone environments, which comprises about the 4% of the total outpatients in Taiwan. Performance Analysis of a Medical Record Exchanges Model (PDF Download Available). Available from: https://www.researchgate.net/publication/51375541_Performance_Analysis_of_a_Medical_Record_Exchanges_Model [accessed Jan 15, 2016]

[[alternative]]應用電子照護改善偏遠地區健康服務之研究－以台灣東部某山地部落為例

[[abstract]]改善偏鄉醫療照護，一直都是政府施政的重要目標。台灣為多山地區，醫療資源分布不平均，大型醫院全都集中在幾個主要的市區，偏鄉地區的民眾就醫非常不便。近年來，已經開始發展遠距電子照護服務，但大部分仍然只在大型醫院附近試辦。由於偏遠地區普遍存在著數位落差的問題，實務應用上也較為困難，但是如果能夠發展成功，相信其效益也將遠大於都市地區。本研究準備為台灣東部山區某原住民部落，建置一套電子照護系統，目前已在當地安裝電腦及簡易生醫訊號量測儀器設備，透過網路連接健康管理系統伺服器，並且為當地居民及學童進行衛教訓練，本篇論文探討偏遠地區實施電子照護遭遇到的困難，並分享實作的經驗。[[abstract]]To improve people’s healthcare quality is an important objective of a government. However, large hospitals are often located in urban areas, and the distribution of medical resources is unequality. Most of the mountain areas in Taiwan are difficult to travel. It is usually inconvenient for people in rural areas to visit a hospital. There have been many projects in developing remote electronic healthcare in recent years, but most of them are only implemented in urban areas. Because of the digital divide issues in rural areas, it is difficult to apply electronic healthcare in practice. We believe that electronic healthcare benefits more to a rural area than to an urban area. In this study, we have developed a remote healthcare management system for an aboriginal village in the mountain area of eastern Taiwan. A vital-sign device for measuring the blood pressure and glucose level is integrated to a computer system. The system may connect to a healthcare management server through the Internet. We have also offered courses of health education for local residents and students. In this paper, we will discuss and share our experience in implementation such an electronic healthcare system

Design and Implementation of an Innovation Epidemic Information Exchange Platform

[[abstract]]疾病管制署負責疫情監控，為了能夠迅速收集和分析醫院間通報的相關資訊，在2007年就開始建立防疫資訊交換平台，以分散式系統架構，在各醫療院所端安裝一部個人電腦作為閘道器，負責將各醫院的資料轉換成健康資訊交換第七層協定（HL7）的標準訊息，再傳送到疾病管制署的主機分析處理。近年來，政府積極推動以臨床文件架構（CDA）作為跨機構間電子病歷交換的標準文件，另外，資訊及通訊科技也有很大的進步，防疫資訊交換平台將有很大的改善空間。本研究以專家訪談的方式，了解現有防疫資訊交換平台運作情形及新的需求，規劃新的資料交換格式及防疫資訊系統的架構，提出以雲端運算架構及簡化的CDA交換格式的改善建議，並以實作系統雛形的方式，開發設計和分析實際應用的可行性，醫院資訊系統的資料，可以透過程式創新的服務系統進行編碼、解碼及驗證，並且轉換成為CDA或是Green CDA的標準格式。未來準備配合國家防疫雲計畫實際推廣應用，相信對於防疫資訊交換及疫情防治會有所幫助。 The Center for Disease Control (CDC) constantly controls and monitors the infectious diseases. In order to quickly collect and analyze epidemic information among hospitals, The CDC has built an epidemic information exchange platform since 2007. The platform is a distributed architecture with a personal computer installed in each hospital as data exchange gateway that may transfer relevant information into HL7 standard messages and then send it to the server in the CDC for further processing. In recent years, the government encourages different institutions to exchange electronic medical records in Clinical Document Architecture (CDA) as a standard format to replace the traditional HL7 messages. In addition, the information and communication technologies progress rapidly and the hardware in each hospital is quickly outdated. The epidemic information exchange platform has a large room for improvement.In this study, we visited domain experts to understand the operation situation and new requirements of the epidemic information exchange platform. We also made recommendations of applying cloud computing architecture and using the simplified CDA as data exchange format for improvement. We have implemented a prototyping system to analyze the feasibility of practical applications. The reporting data of hospital information system can be encoded, decoded and validated through this innovation services system and transferred into CDA or Green-CDA standard format. We hope that the research results can be widely promoted in epidemic reporting environment, and believe that the quality and efficiency of epidemic prevention and control will be greatly improved

A Review of Information and Communication Technologies for Long Term Care Applications

[[abstract]]資訊與通訊科技日新月異，在國內外各領域都有很好的應用，臺灣面對著高齡及少子女化的影響，積極發展遠距電子照護服務，近年來已經有許多經驗及成功的案例。本文探討資訊與通訊在長期照護領域應用的相關中英文文獻40餘篇，依照資訊系統的開發流程，區分為資訊系統需求分析、資訊系統架構及資訊系統評估三部分探討，了解目前國內遠距照護發展的現況，並且彙整了包括重視個人化及人性化設計、維護個案隱私及資訊系統安全、採用醫療資訊交換標準、行動通訊設備的應用、透過藍芽及Wi-Fi無線傳輸資料、建立雲端運算服務、建立遠距照護的商業營運模式及跨資訊及照護領域的人才培育等八個議題，作為開發未來長期照護服務統發展的努力方向。 Information and communication technologies progress rapidly and find useful applications in numerous fields all over the world. Facing to the impact of an aging population and a low birth rate in Taiwan, we need to develop Tele-healthcare services actively. There have been many successful cases and experiences in recent years. In this study, we are going to review the literatures relevant to the Information and communication applications in the field of long term care. As an effort to suggest a long term care service system, we will also investigate the following 8 important issues, including paying attention to the personnel and individualized designing, maintaining the cases privacy and information system security, use medical information exchange standards, apply mobile communication devices, transferring data through wireless, performing cloud architecture services, building business model and cultivating cross multidisciplinary experts

Trends in quality of end-of-life care for Taiwanese cancer patients who died in 2000-2006

[[abstract]]BACKGROUND: Quality of end-of-life care received by cancer patients has never been explored in an entire Asian country for all ages and cancer groups. PATIENTS AND METHODS: Retrospective cohort study to examine trends in quality of end-of-life care among a cohort of 242 530 Taiwanese cancer patients who died in 2000-2006. RESULTS: In the last month of life, cancer care tended to become increasingly aggressive as shown by (i) intensive use of chemotherapy (15.45%-17.28%), (ii) frequent emergency room visits (15.69%-20.99%) and >14-day hospital stays (41.48%-46.20%), (iii) admissions to intensive care units (10.04%-12.41%), and (iv) hospital deaths (59.11%-65.40%). Use of cardiopulmonary resuscitation (13.09%-8.41%), intubation (26.01%-21.07%), and mechanical ventilation (27.46%-27.05%) decreased, whereas use of hospice services increased considerably (7.34%-16.83%). Among those receiving hospice services, rates of referrals to hospice services in the last 3 days of life decreased from 17.88% to 17.13% but remained steady after adjusting for selected covariates. CONCLUSIONS: The quality of end-of-life care for Taiwanese cancer decedents was substantially inferior to that previously reported and to that recommended as benchmarks for not providing overly aggressive care near the end of life

Generating Standardized Clinical Documents for Medical Information Exchanges

[[abstract]]The author mentions that in order to facilitate the exchange of medical information, Taiwan's Department of Health supported a project to standardize electronic medical records. Part of this project involved developing a system that automatically generates samples for the 108 different types of standard documents. The paper discusses the efforts to create a comprehensive specification system to help hospital staffs create EMRs that conform to the HL7 CDA. The guidelines comprise online documents and formats, categorized according to the various paper forms used in different hospitals. For ease of use, the Standardization Clinical Document Generation System was also developed. The system generates sample documents automatically, thereby maintaining consistency and reducing human errors

2010, Propensity For Home Death Among Taiwanese Cancer Decedents, 2001-2006 Determined By Services Received At End Of Life

[[abstract]]CONTEXT: The discrepancy between patients' preferred and actual place of death highlights the dilemma inherent in achieving their preferences for home death. Research on determinants of home death has been limited largely by focusing on individual-level factors and somewhat on health care resources at the primary hospital and regional levels. OBJECTIVES: To investigate factors associated with home death, specifically, services received by cancer patients at the end of life (EOL). METHODS: This was a retrospective cohort study using administrative data from 201,201 Taiwanese cancer decedents in the period 2001-2006. RESULTS: Rates of home death decreased significantly over time (from 35.67% to 32.39%). Dying at home was associated with patient demographics (gender, age, and marital status) and disease characteristics (cancer type, metastatic status, postdiagnosis survival time, and comorbidity level). Taiwanese cancer patients were less likely to die at home if they received care from a medical oncologist and in hospitals or regions with abundant health care resources. Furthermore, Taiwanese cancer patients were less likely to die at home if they used life-sustaining treatments (intensive care unit care, cardiopulmonary resuscitation, intubation, and mechanical ventilation) in the last month of life. However, multiple emergency room visits in the last month of life and receiving hospice care increased Taiwanese cancer patients' propensity to die at home. CONCLUSION: Despite the causal ambiguity in interpreting our research findings, they indicate that using life-sustaining treatments at EOL not only exacts a substantial toll from patients, family members, and society, but also decreases the likelihood of dying at home

Impact of age on end-of-life care for adult Taiwanese cancer decedents, 2001–2006

[[abstract]]Background: With increasing patient age in Western countries, evidence indicates a pervasive pattern of decreasing healthcare expenditures and less aggressive medical care, including end-of-life (EOL) care. However, the impact of age on EOL care for Asian cancer patients has not been investigated.Purpose: To explore how healthcare use at EOL varies by age among adult Taiwanese cancer patients.Methods: Retrospective cohort study using administrative data among 203,743 Taiwanese cancer decedents, 2001–2006. Age was categorized as 18–64, 65–74, 75–84, and ≥85 years.Results: Elderly (≥65 years) Taiwanese cancer patients were significantly less likely than those 18–64 years to receive aggressive treatment in their last month of life, including chemotherapy, >1 emergency room visits, >1 hospital admissions, >14 days of hospitalization, hospital death, intensive care unit admission, cardiopulmonary resuscitation, intubation, and mechanical ventilation. However, they were significantly more likely to receive hospice care in their last year of life.Conclusion: Elderly Taiwanese cancer patients at EOL received less chemotherapy, less aggressive management of health crises associated with the dying process, and fewer life-extending treatments, but they were more likely to receive hospice care in their last year and to achieve the culturally highly valued goal of dying at home

Development of a Deterministic XML Schema by Resolving Structure Ambiguity of HL7 Messages

[[abstract]]Health level 7 (HL7) is a standard for medical information exchange. It defines data transfers for the application systems in the healthcare environment. Alternatively, the extensible markup language (XML) is a standard for data exchange using the Internet. If exchange messages follow the content and the sequence defined by HL7 and are expressed in the XML format, the system may benefit from the advantages of both standards. In creating the XML schema, we found ambiguities in HL7 message structures that cause the XML schema to be non-deterministic. These ambiguous expressions are summarized within 12 structures and can be replaced with equivalent or similar unambiguous structures. The finite state automata are used to verify expression equivalence. Applying this schema, an XML document may eliminate redundant segment group definitions and make the structure simple and easy to reproduce. In this paper, we discuss the methods and our experience in resolving ambiguous problems in HL7 messages to generate a deterministic XML schema

[[alternative]]A Study of the System Architecture of HL7 Query Messages for Medical Record Exchanges

[[abstract]]由於電腦科技的進步，各醫療院所的病歷電腦化已經非常普遍，跨醫院交換電子病歷的需求也越來越高。在衛生署的支持下，近年來已經有多位專家學者投入電子病歷交換的研究，雖然已有部分的研究成果，但在實務應用上仍不普遍。本篇論文將探討近年來國內電子病歷交換的發展，並且提出了一個以健康第七層通訊協定（HL7）查詢訊息為主的電子病歷交換系統的架構，在系統雛形中為醫院端建立一個電子病歷交換主機，可以透過網路連結醫院的病歷資料庫系統並且交換HL7訊息；各醫院的病歷交換主機向病歷交換中心註冊，由一部索引伺服器來管理各個交換主機的網址及加解密金鑰。我們已經完成一個簡單的病歷交換系統，實際模擬HL7查詢訊息的編碼、解碼、加密、解密的功能，可以迅速安全的傳送電子病歷。[[abstract]]Because of the rapid improvements in computers and communication technologies during the last few years, electronic medical records have been used extensively in hospitals. Moreover, pressure is growing to regulate data exchange among healthcare organizations. Although the government has allocated funding for numerous projects and studies in this field for several years already, and has achieved some important goals, complete implementation of medical records exchange across all hospitals is still difficult. This study discusses existing implementations of medical record exchange in the domestic health environment and a new record-exchange architecture employing Health Level Seven (HL7) query messages. The exchange interface servers are established for hospitals to manage the information communication through the intra- and inter-hospital network linked with a medical records database. An index service center can be given responsibility for managing the exchange interface servers and publishing the addresses and public keys. The prototype machine has been implemented in this study to generate, parse and transfer the HL7 query messages. Moreover, the system can also encrypt and decrypt a message using the public key encryption algorithm and can quickly and securely transmit medical records