Design and implementation of a federated health record server

This paper describes the practical implementation of a federated health record serverbased on a generic and comprehensive public domain architecture and deployed in alive clinical setting.The authors, working at the Centre for Health Informatics and MultiprofessionalEducation (University College London), have built up over a decade of experiencewithin Europe on the requirements and information models that are needed to underpincomprehensive multi-professional electronic health records. This work has involvedcollaboration with a wide range of healthcare and informatics organisations and partnersin the healthcare computing industry across Europe though the EU Health Telematicsprojects GEHR, Synapses, EHCR-SupA, SynEx and Medicate. The resultingarchitecture models have influenced recent European standards in this area, such asCEN TC/251 ENV 13606. UCL has now designed and built a federated health recordserver based on these models which is now running in the Department ofCardiovascular Medicine at the Whittington Hospital in north London. A new EC FifthFramework project, 6WINIT, is enabling new and innovative IPv6 and wirelesstechnology solutions to be added to this work.The north London clinical demonstrator site has provided the solid basis from which toestablish "proof of concept" verification of the design approach, and a valuableopportunity to install, test and evaluate the results of the component engineeringundertaken during the EC funded projects

London SynEx Demonstrator Site: Impact Assessment Report

The key ingredients of the SynEx-UCL software components are: 1. A comprehensive and federated electronic healthcare record that can be used to reference or to store all of the necessary healthcare information acquired from a diverse range of clinical databases and patient-held devices. 2. A directory service component to provide a core persons demographic database to search for and authenticate staff users of the system and to anchor patient identification and connection to their federated healthcare record. 3. A clinical record schema management tool (Object Dictionary Client) that enables clinicians or engineers to define and export the data sets mapping to individual feeder systems. 4. An expansible set of clinical management algorithms that provide prompts to the patient or clinician to assist in the management of patient care. CHIME has built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multiprofessional electronic healthcare records. The resulting architecture models have influenced new European standards in this area, and CHIME has designed and built prototype EHCR components based on these models. The demonstrator systems described here utilise a directory service and object-oriented engineering approach, and support the secure, mobile and distributed access to federated healthcare records via web-based services. The design and implementation of these software components has been founded on a thorough analysis of the clinical, technical and ethico-legal requirements for comprehensive EHCR systems, published through previous project deliverables and in future planned papers. The clinical demonstrator site described in this report has provided the solid basis from which to establish "proof of concept" verification of the design approach, and a valuable opportunity to install, test and evaluate the results of the component engineering undertaken during the EC funded project. Inevitably, a number of practical implementation and deployment obstacles have been overcome through this journey, each of those having contributed to the time taken to deliver the components but also to the richness of the end products. UCL is fortunate that the Whittington Hospital, and the department of cardiovascular medicine in particular, is committed to a long-term vision built around this work. That vision, outlined within this report, is shared by the Camden and Islington Health Authority and by many other purchaser and provider organisations in the area, and by a number of industrial parties. They are collectively determined to support the Demonstrator Site as an ongoing project well beyond the life of the EC SynEx Project. This report, although a final report as far as the EC project is concerned, is really a description of the first phase in establishing a centre of healthcare excellence. New EC Fifth Framework project funding has already been approved to enable new and innovative technology solutions to be added to the work already established in north London

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

Kinetic Monte Carlo simulations inspired by epitaxial graphene growth

Graphene, a flat monolayer of carbon atoms packed tightly into a two dimensional hexagonal lattice, has unusual electronic properties which have many promising nanoelectronic applications. Recent Low Energy Electron Microscopy (LEEM) experiments show that the step edge velocity of epitaxially grown 2D graphene islands on Ru(0001) varies with the fifth power of the supersaturation of carbon adatoms. This suggests that graphene islands grow by the addition of clusters of five atoms rather than by the usual mechanism of single adatom attachment. We have carried out Kinetic Monte Carlo (KMC) simulations in order to further investigate the general scenario of epitaxial growth by the attachment of mobile clusters of atoms. We did not seek to directly replicate the Gr/Ru(0001) system but instead considered a model involving mobile tetramers of atoms on a square lattice. Our results show that the energy barrier for tetramer break up and the number of tetramers that must collide in order to nucleate an immobile island are the important parameters for determining whether, as in the Gr/Ru(0001) system, the adatom density at the onset of island nucleation is an increasing function of temperature. A relatively large energy barrier for adatom attachment to islands is required in order for our model to produce an equilibrium adatom density that is a large fraction of the nucleation density. A large energy barrier for tetramer attachment to islands is also needed for the island density to dramatically decrease with increasing temperature. We show that islands grow with a velocity that varies with the fourth power of the supersaturation of adatoms when tetramer attachment is the dominant process for island growth

A study of the kinematics and binary-induced shaping of the planetary nebula HaTr 4

We present the first detailed spatio-kinematical analysis and modelling of the planetary nebula HaTr 4, one of few known to contain a post-common-envelope central star system. Common envelope evolution is believed to play an important role in the shaping of planetary nebulae, but the exact nature of this role is yet to be understood. High spatial- and spectral- resolution spectroscopy of the [OIII]5007 nebular line obtained with VLT-UVES are presented alongside deep narrowband Ha+[NII]6584 imagery obtained using EMMI-NTT, and together the two are used to derive the three-dimensional morphology of HaTr 4. The nebula is found to display an extended ovoid morphology with an enhanced equatorial region consistent with a toroidal waist - a feature believed to be typical amongst planetary nebulae with post-common-envelope central stars. The nebular symmetry axis is found to lie perpendicular to the orbital plane of the central binary, concordant with the idea that the formation and evolution of HaTr 4 has been strongly influenced by its central binary.Comment: 9 pages, 5 figures, accepted for publication in MNRA