Healthcare IT Systems Research Articles

300. Computed tomography use in a large italian region: Trend analysis 2004–2014 of emergency and outpatient CT examinations in children and adults

Purpose To analyse Computed Tomography (CT) use in recent years in a high population density area in Italy (approximately 10 million inhabitants, including 1 million children), focusing on the developing age. Methods and materials Retrospective analysis of records from the Health Care IT System, covering more than 400 hospitals and clinics. Description of CT use between 2004 and 2014 in emergency and outpatient care and assessment of the radiation exposure trend. Results Over 9 million scans were performed. Emergency procedures showed a global increase of 230%, which mainly consisted of Head exams. In the global outpatient setting, the annual number of CT scans per person increased approximately 19%. A moderate increase in CT exams was observed in the developing age population, while a remarkable increase in Dental, Chest and Abdominal procedures occurred within the 10–30-year age range. The increase in the mean annual dose per caput in the global patient pool was approximately 42%, increasing from 0.72 mSv to 1.03 mSv. The population rate that received an annual radiation dose per caput from CT higher than 1 mSv tripled in the 11-year interval, increasing from 16 to 48%. Conclusion The outcomes raise a special concern for teenagers and young adults, taking into account that the widespread use of CT represents probably the single most important achievement in diagnostic radiology. The increase in CT use and in the CT-derived radiation dose in the population is occurring in spite of the evidence of the substantially improved carcinogenic potential of low doses of X-ray radiation, particularly for children. In contrast with several published investigations, which underline the radiation risk for paediatric age, the level of detail of the data processed in this study highlights a remarkable increase in the irradiation of teenagers and young adults, whose risk tends to be underestimated.

An effective cloud based personal emergency response system by providing privacy protection for the medical data

Timely access to the emergency medical services is challenging tasks due to the increasing percentage of population. Especially prehospital emergency situations are neglected for quite a long time. The agglomeration of medical gadgets and other system applications that bridges the gap to healthcare IT systems through Internet or computer networks is placed under the domain (IoMT) Internet Of Medical Things . In this project an efficient medical data monitoring and an emergency response system has been developed. IoT in healthcare is made to bridge the gap by providing the connectivity through internet making sure that the information is secured and available on the timely access. The wireless monitoring device collects data from various sensors, which is shared into the database using ZigBee cc2530 Transmitter Receiver through UART communication. The wireless device is embedded with sensors like Pulse oximeter (senses the heart beat rate and blood oxygen concentration)and temperature sensor. This data is monitored regularly and if there is any abnormality in the values then an alert is sent to the doctor to intimate the condition of the patient. This paper provides an interaction of the patient with the doctors. The interaction is enabled using public and private chat application where any number of patients can interact with a doctor. It is challenging task to personalize specific healthcare data i.e. medical records for various application users in an appropriate and secured fashion. Thus, the patient’s health records i.e. prescription, scan reports, etc. are uploaded by the patient which can be viewed by the doctor. These files are encrypted using an encryption algorithm before uploading it into the cloud. Similarly it is decrypted while downloaded by the doctor for reference. The data collected is used for the prediction of diseases like heart attack and the report is sent to the doctor. Hence the project’s aim is, when the recorded value exceeds the threshold range, an automatic intimation with the patient’s collected data is sent to the concerned doctor.

Lääkärit ja hoitajat parempien tietojärjestelmien kehittämistyössä: kyvykkäät ja innokkaat käyttäjät alihyödynnettyinä

Loppukäyttäjien osallistuminen potilastietojärjestelmien kehittämiseen on keskeistä, jotta järjestelmiä voidaan kehittää heidän tarpeitaan vastaaviksi ja työtehtäviin sopiviksi. Sairaanhoitajien ja lääkärien osallistumista käyttämiensä tietojärjestelmien kehittämistyöhön selvitettiin valtakunnallisten kyselytutkimusten avulla. Sairaanhoitajien aineisto kerättiin keväällä 2017. Lääkärien kyselytutkimus toteutettiin samoin keväällä 2017 ja lisäksi vuosina 2014 ja 2010, tosin vuonna 2017 lääkäreiltä ei kysytty kehittämiseen osallistumisen tavoista.
 Kyselyyn vastanneista sairaanhoitajista 46 % ja lääkäreistä 49 % kertoi osallistuneensa tietojärjestelmien kehittämistyöhön. Sairaanhoitajista 21 % oli valmiita osallistumaan kehittämisryhmiin ja vain 20 % ei ollut lainkaan kiinnostuneita osallistumaan; vuoden 2014 kyselyssä lääkäreillä vastaavat osuudet olivat 18 % ja 16 %. Ohjelmistotoimittajien ei koettu olevan kiinnostuneita loppukäyttäjien näkemyksistä eikä kehittämisehdotuksia toteutettu toivotulla tavalla eikä ripeydellä. Verrattuna vuosiin 2010 ja 2014 lääkärien arviot eivät olleet muuttuneet positiivisemmiksi.
 Loppukäyttäjistä suuri osa olisi halukkaita osallistumaan kehittämistyöhön jollakin tavalla, mutta ohjelmistokehitys ei ole toistaiseksi löytänyt parhaita tapoja heidän osallistumisensa mahdollistamiseen. On ilmeistä, että loppukäyttäjät eivät koe pystyvänsä vaikuttamaan ohjelmistokehitykseen toivotulla tavalla. Osallistamisen on myös oltava mahdollista osana jokapäiväistä työtä. Terveydenhuollon organisaatioiden on tunnistettava kehittämistyöhön osallistumisen merkitys ja mahdollistettava esimerkiksi tietojärjestelmälääkärien ja -hoitajien urapolut. Tärkeää on, että tietojärjestelmiä kehittävien lääkäreiden ja sairaanhoitajien kliininen työ jatkuu tietojärjestelmien kehittämisen rinnalla, jotta näkemys työhön, missä järjestelmiä käytetään, säilyy.

Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults.

To analyse CT use in recent years in a high-density Italian area (±10 million inhabitants, including 1 million children), focusing on developing age. Retrospective analysis of records from HealthCare IT System, covering >400 hospitals and clinics. Description of CT use between 2004-2014 in emergency and outpatient care and assessment of radiation exposure trend. Over 9 million scans were performed. Emergency procedures showed a global increase of 230 %, mainly head examinations. In the global outpatient setting, the annual number of CT scans/person increased ±19 %. A moderate increase in CT examinations was observed in the developing age population, while a remarkable increase in dental, chest and abdominal procedures occurred for the 10- to 30-year age range. The increase in mean annual dose/capita in the global patient pool was approximately 42 %, increasing from 0.72-1.03 mSv. The population rate receiving an annual CT radiation dose/capita higher than 1 mSv tripled in the 11-year interval, increasing from 16-48 %. The remarkable increase in radiation exposure raises a special concern for teenagers and young adults, whose risk tends to be underestimated. The fivefold increase in dental CTs in the younger age groups requires further investigations. • Literature highlights a remarkable increase in CT use over the last decades. • The paediatric age had higher exposure to X-ray risk. • A detailed retrospective analysis of more than 9 million scans was performed. • Dental, chest, abdominal procedures increased remarkably in 10- to 30-year age range. • This study raises concern about exposure for teenagers and young adults.

SMART on FHIR: a standards-based, interoperable apps platform for electronic health records.

Objective In early 2010, Harvard Medical School and Boston Children’s Hospital began an interoperability project with the distinctive goal of developing a platform to enable medical applications to be written once and run unmodified across different healthcare IT systems. The project was called Substitutable Medical Applications and Reusable Technologies (SMART).Methods We adopted contemporary web standards for application programming interface transport, authorization, and user interface, and standard medical terminologies for coded data. In our initial design, we created our own openly licensed clinical data models to enforce consistency and simplicity. During the second half of 2013, we updated SMART to take advantage of the clinical data models and the application-programming interface described in a new, openly licensed Health Level Seven draft standard called Fast Health Interoperability Resources (FHIR). Signaling our adoption of the emerging FHIR standard, we called the new platform SMART on FHIR.Results We introduced the SMART on FHIR platform with a demonstration that included several commercial healthcare IT vendors and app developers showcasing prototypes at the Health Information Management Systems Society conference in February 2014. This established the feasibility of SMART on FHIR, while highlighting the need for commonly accepted pragmatic constraints on the base FHIR specification.Conclusion In this paper, we describe the creation of SMART on FHIR, relate the experience of the vendors and developers who built SMART on FHIR prototypes, and discuss some challenges in going from early industry prototyping to industry-wide production use.

IPhone Independent Real Time Localization System Research and Its Healthcare Application

This project studied several popular localization algorithms on iPhone and, according to the demands, specifically designed it to improve healthcare IT system in hospitals. The challenge of this project was to realize the different localization systems on iPhone and to make balance between its response time and localization accuracy. We implemented three popular localization algorithms, namely nearest neighbor (NN), K-nearest neighbor (KNN), and probability phase, and we compared their performance on iPhone. Furthermore, we also implemented a real-time localization system using the ZigBee technology on iPhone. Thus, the whole system could realize not only self-localization but also others-localization. To fulfill the healthcare needs, we developed an application, which can be used to improve the hospital IT, system. The whole project included three phases. The first phase was to localize iPhone’s position using the received WiFi signal by iPhone, compare and optimize their performances. During the second phase, we implemented a ZigBee RFID localization system and combined it with the WiFi system. Finally, we combined new features of the system with a healthcare IT system. We believe that this application on iPhone can be a useful and advanced application in hospitals.

The use of standardization in IT systems in health care

Standardization is one of the important tools for the implementation of EU policies to ensure the competitiveness of enterprises and the elimination of barriers to trade within the EU. The European Commission “e-Health Action Plan” (2004) recognized the interoperability of information systems in health care as one of its priorities. Standardization, in turn, is a prerequisite to ensure interoperability. The authors examined the extent to which standardization is reflectead in the key acts on the informatization of health care: The Directives for Informatization “eHealth Poland” for 2011-2015, approved by the management of the Ministry of Health, Act of 28 April 2011 on the information system in health care (Journal of Laws of 2011, No. 113, item. 657, as amended). Lack of effective comprehensive legal solutions in the field of standardization, especially at the statutory level has been confirmed. This complicates the process of informatization in terms of interoperability. According to the authors this lack meant that in most of the implemented systems generally no valid standardization solutions were implemented and thus the interoperability. The standardization initiative under the responsibility of the Polish Committee for Standardization was not used either.

Information revolution – from healthcare to i-care

Information revolution – from healthcare to i-care

Medical Informatics in China: Healthcare IT Trends, Academic and Research Developments

Describing the challenges and advances in medical informatics in China from the perspectives of hospital information systems, workforce, and academic, and research advances. The paper summarizes information from the CMIA (China Medical Informatics Association and findings reported by CHIMA (China Hospital Information Management Association), including a White Paper on China Hospital Information Systems. Biomedical and Health Informatics has grown considerably during the past decade in China, and is an important component of proposed government planning that includes development of healthcare cards, clinical workflow path rules, and rural medicine. CMIA has strengthened as an organization promoting education, research and academic activities, while CHIMA has sponsored many hospital-based activities, including workshops on technical and workforce IT priorities related to proposed reforms of China's healthcare system. China's challenges and opportunities in biomedical informatics and healthcare IT are considerable, with the former requiring greater promotion of academic research and educational opportunities through CMIA to support the burgeoning development of healthcare IT systems throughout the country. National and international collaboration and exchanges could lead to very useful comparative studies, Recommendations by CHIMA to the national government and academia focus on organizational and workforce standards, roles, and defining career paths for HIT professionals as well as CME education in healthcare informatics at the graduate university.

Assessment and adoption of web-based health information systems

The Personal Health Record (PHR) is an emerging web-based healthcare IT system, which is a hot topic of discussion among healthcare professionals and many other people. It is a very new concept and many companies are now offering PHR services to their customers. The PHR is created and kept up to date by the user, healthcare providers or insurance companies. Users can enter their information and manage their PHR. The PHR can include everything from medical histories to test results, physician's notes, prescriptions and information from their pharmacies and insurance companies. Hence PHR empowers the patients and gives them full access to their healthcare data. Many employers, insurance companies, hospitals and physicians are offering PHR services to their consumers. There are also many websites from where consumers can sign up for free PHR services. Due to the many benefits associated with PHR services, consumers find it very attractive to use. But there are also many concerns hindering the adoption of PHR. In this paper we shall review the factors affecting adoption of PHR systems using the Technology Acceptance Model (TAM) and formulate hypotheses for PHR adoption.

The quality of evidence in health informatics: How did the quality of healthcare IT evaluation publications develop from 1982 to 2005?

Objective To obtain an overview of study designs and study methods used in research evaluating IT in health care, to present a list of quality criteria by which all kinds of reported evaluation studies on IT systems in health care can be assessed, and to assess the quality of reported evaluation studies on IT in health care and its development over time (1982–2005). Methods A generic 10-item list of quality indicators was developed based on existing literature on quality of medical and medical informatics publications. It is applicable to all kind of IT evaluation papers and not restricted to randomized controlled trials. One hundred and twenty explanatory papers evaluating the effects of an IT system in health care published between 1982 and 2005 were randomly selected from PubMed, the study designs and study methods were extracted, and the quality indicators were used to assess the quality of each paper by two independent raters. Results The inter-rater variability of scoring the 10 quality indicators as assessed by a pre-test with nine papers was good ( K = 0.87). There was a trend towards more multi-centre studies and authors coming more frequently from various departments. About 70% of the studies used a design other than a randomized controlled trial (RCT). Forty percent of the studies combined at least two different data acquisition methods. The quality of IT evaluation papers, as defined by the quality indicators, was only slightly improving in time (Spearman correlation coefficient [ r s] = 0.19). The quality of RCTs publications was significantly higher than the quality of non-RCT studies ( p < 0.001). Conclusion The continuous and dominant number of non-RCT studies reflects the various approaches applicable to evaluate IT systems in health care. Despite the increasing discussion on evidence-based health informatics, the quality of published evaluation studies on IT interventions in health care is still insufficient in some aspects. Journal editors and referees should take care that reports of evaluation on IT systems contain all aspects needed for a sufficient understanding and reproducibility of a paper. Publication guidelines should be developed to support more complete and better publications of IT evaluation papers.

Data mining for improved cardiac care

Cardiovascular Disease (CVD) is the single largest killer in the world. Although, several CVD treatment guidelines have been developed to improve quality of care and reduce healthcare costs, for a number of reasons, adherence to these guidelines remains poor. Further, due to the extremely poor quality of data in medical patient records, most of today's healthcare IT systems cannot provide significant support to improve the quality of CVD care (particularly in chronic CVD situations which contribute to the majority of costs).We present REMIND, a Probabilistic framework for Reliable Extraction and Meaningful Inference from Nonstructured Data. REMIND integrates the structured and unstructured clinical data in patient records to automatically create high-quality structured clinical data. There are two principal factors that enable REMIND to overcome the barriers associated with inference from medical records. First, patient data is highly redundant -- exploiting this redundancy allows us to deal with the inherent errors in the data. Second, REMIND performs inference based on external medical domain knowledge to combine data from multiple sources and to enforce consistency between different medical conclusions drawn from the data -- via a probabilistic reasoning framework that overcomes the incomplete, inconsistent, and incorrect nature of data in medical patient records.This high-quality structuring allows existing patient records to be mined to support guideline compliance and to improve patient care. However, once REMIND is configured for an institution's data repository, many other important clinical applications are also enabled, including: quality assurance; therapy selection for individual patients; automated patient identification for clinical trials; data extraction for research studies; and to relate financial and clinical factors. REMIND provides value across the continuum of healthcare, ranging from small physician practice databases to the most complex hospital IT systems, from acute cardiac care to chronic CVD management, and to experimental research studies. REMIND is currently deployed across multiple disease areas over a total of 5,000,000 patients across the US.

Hiding in plain sight: What Koppel et al. tell us about healthcare IT

We agree with the point that Dr. Koppel and coauthors make in their JAMA paper ‘‘The Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors.’’ There really is a problem with healthcare IT and the problem is not an artifact of the particular system that the paper s research covered. It is intriguing that this is considered news. Heeks et al. [1] have contended that ‘‘many—even most—health care information systems are failures.’’ Moll van Charante et al. [2] pointed out similar issues 12 years ago. The research that our lab has conducted over the past decade indicates that this is the way healthcare IT systems work. With no changes to how IT systems are developed, this is the way they will continue to work in the future. That a problem exists is not an issue. What the problem is and why it exists beg more discussion. Safety culture attitude surveys are currently popular, but produce only shifting sands that offer little traction when it comes to making progress in patient safety. The Koppel et al. article offers a firm foothold. But where do we take the next step? The problem is not ‘‘human error.’’ If it exists, error is a consequence of interaction with IT systems rather than a cause of adverse outcomes [3]. The core issue is to understand healthcare work and workers. On the surface, healthcare work seems to flow smoothly. That is because the clinicians who provide healthcare service make it so. Just beneath the apparently smooth-running operations is a complex, poorly bounded, conflicted, highly variable, uncertain, and high-tempo work domain. The technical work [4] that clinicians perform resolves these complex and conflicting elements into a productive work domain. Occa-

IHE “Integrating the Healthcare Enterprise”—an update for Information Technology Infrastructure for 2005

The Integrating the Healthcare Enterprise initiative addresses issues of information technology interoperability in healthcare, including issues of cross-departmental and cross-enterprise IT infrastructure. A number of new integration profiles have been developed in this field in 2004. Personnel White Pages allow to set-up a central database of human workforce members including user identity management. Audit Trail and Node Authentication provides basic IT security infrastructure. Patient Demographics Queries allow quick access to patient demographics based on a central patient information server. Cross-enterprise Document Sharing is a first step towards an inter-institutional “longitudinal” electronic healthcare record. The use of IHE terminology and information structures allows for an easy and fully interoperable installation of even complex IT systems in healthcare. Therefore, an inclusion of IHE integration profiles into requests for tenders is recommended by the German Foundation for Research for better clarification of the systems to be installed.

Demand-driven Evolution of IT Systems in Healthcare

To analyze and to optimize interdisciplinary clinical processes, to introduce an IT-supported model for demand-driven system evolution in healthcare, and to demonstrate the feasibility of the approach for a clinical example and to present an evaluation. System evolution and change management are viewed as two sides of the same coin, thus formal methods for process analysis and IT system evolution were embedded into a goal-oriented change management model. Based on a process model, a Failure Mode and Effects Analysis (FMEA) and a computer simulation were performed. A tool for rapid application development (RAD) was used to incrementally improve the healthcare information system according to newly arising needs. Each of the formal methods used contributed to the successful reorganization of the interdisciplinary clinical process. An evaluation demonstrated significant improvements. An integrated IT application was implemented to support the optimized process. Process improvement is feasible and effective when formal methods for process analysis and requirements specification are used in a reasonable and goal-oriented way. It might be necessary to trade off costs and benefits or simplify a given method in the context of a particular project. As the same information is utilized in different tools, it is supposed that the efforts for process analysis, documentation and implementation of adapted applications could be reduced if different tools were integrated and based on a single coherent reference model for description of clinical processes.

Health care IT system failures: Risks, prevention and recovery

Health care IT system failures: Risks, prevention and recovery

Cryptographic protection of health information: cost and benefit

Medical, legal, and economic reasons inevitably force health care establishments to apply more and more open distributed IT systems rather than the less flexible and more expensive mainframes. Managing, for example, electronic patient records by various users at different locations by means of large scale client-server systems requires new security provisions for storing, archiving and communicating those data. Using an analogy, data processing is being changed from railroads to highways. Formerly, only one engine-driver was responsible for the security of a whole train, whereas now the car-drivers themselves are responsible each for his own car. Unless the cars are equipped with suitable security mechanisms like breaks and safety belts this change endangers individuals within and outside the cars. Cryptography provides many of the relevant security mechanisms for open distributed health care IT systems. Indeed, suitable cost effective cryptographic products are available but are rarely found in health care IT systems. The reason is more political than economic: diverging national security interests in the EU have prevented strong security in public telecommunication infrastructures arguing that, e.g. criminals would profit, too. The resulting uncertainty of investments delays the development, standardisation and installation of cryptographic solutions.