Medical Information Management Research Articles

The Study on Health Information Characteristics and Privacy

Because health information has some different properties from other general data, it is important to understand 'information subject,' 'subject of information generation,' 'subject of information management' according to the characteristics of each medical information. It makes it possible to develop the appropriate security technology under the current legal regulations. In this paper, we identify some incorrect uses in existing papers, we show that "Patient-Participated on Electronic Health Record Systems" is more appropriate expression rather than "Patient-Controlled on Electronic Health Record Systems." We discuss three key factors (information subject, subject of information generation, subject of information management) of medical information and 'personal information self-determination.' As a solution for privacy, we suggest the 'Secure and dynamic consent system' and 'Personally-controlled health record on PHR (Personal Health Records)' should be developed under the current law and the current (or future) integrated medical information system.

The Study on Health Information Characteristics and Privacy

Because health information has some different properties from other general data, it is important to understand 'information subject,' 'subject of information generation,' 'subject of information management' according to the characteristics of each medical information. It makes it possible to develop the appropriate security technology under the current legal regulations. In this paper, we identify some incorrect uses in existing papers, we show that "Patient-Participated on Electronic Health Record Systems" is more appropriate expression rather than "Patient-Controlled on Electronic Health Record Systems." We discuss three key factors (information subject, subject of information generation, subject of information management) of medical information and 'personal information self-determination.' As a solution for privacy, we suggest the 'Secure and dynamic consent system' and 'Personally-controlled health record on PHR (Personal Health Records)' should be developed under the current law and the current (or future) integrated medical information system.

Cross-cultural validation of the patient-practitioner orientation scale among primary care professionals in Spain.

BackgroundIn recent decades, many self‐report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person‐centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient‐Practitioner Orientation Scale (PPOS) using a sample of primary care health‐care professionals in Spain.MethodsBaseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item‐to‐scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2‐factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA).ResultsLow inter‐item correlations were observed, and the CFA 2‐factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10‐item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3‐factor structure. Participants showed a patient‐oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing.ConclusionAlthough the 2‐factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health‐care professionals overall show a patient‐oriented attitude, although less marked in issues such as patients’ need for and management of medical information.

Improving clinical records: their role in decision-making and healthcare management – COVID-19 perspectives

ABSTRACT Background: The ability of healthcare system to face the COVID-19 pandemic requires a professional competency in maintaining medical records to increase information and healthcare services quality. This study analyses the competency influence to medical record and health information management on planning and decision-making of healthcare services. A case study was conducted to explore this phenomenon. The COVID-19 has impacted to the clinical records is also discussed. Methods: The study uses a quantitative method to analyse correlation between medical record professional competencies, the quality and decision-making of healthcare services. Data analysis was used the structural equation model. The data were collected through purposive sampling of 49 respondents in case study hospital in Padang, Indonesia. Results: The medical record competency construct has a less significant effect on the decision-making construct, although the latter is positively related to competency. The quality construct is positively related to and has a significant effect on the decision-making construct. Conclusion: In the case study hospital revealed the competent medical record professional had a small influence on decision-making. In the COVID-19 pandemic situation, the new tools or systems such as telehealth or telemedicine might be an alternative by the healthcare service provider to improve their clinical record management information systems.

Investigating the satisfaction level of physicians in regards to implementing medical Picture Archiving and Communication System (PACS)

BackgroundUser satisfaction with PACS is considered as one of the important criteria for assessing success in using PACS. The objective of this study was to determine the level of user satisfaction with PACS and to compare its functional features with traditional film-based systems.MethodsThis study was conducted in 2017. Residents at three large university hospitals in Kerman filled-out a self-administered questionnaire consisting of three parts: demographic information of participants, user satisfaction with PACS, comparing features of the two digital and traditional imaging systems. The validity of this questionnaire was approved by five medical informatics, radiology, and health information management specialists and its reliability was confirmed by Cronbach’s alpha (86%). Data were analyzed using descriptive statistics and the Spearman, Mann Whitney U and Kruskal-Wallis statistical tests.ResultsThe mean of the participants’ ages was 31.4 (±4.4) years and 59% of the participants were females. The mean of physicians’ satisfaction with PACS’ had no significant relationship with their age (P = 0.611), experience of using PACS (P = 0.301), specialty (P = 0.093), and percent of interpretation of images with PACS (P = 0.762). It had a significant relationship with the participants’ computer skills (P = 0.022).ConclusionsThe mean of physicians’ satisfaction with PACS was at a moderate to a high level, yet there are still problems in the successful implementation of these systems and establishing interoperability between them. PACS has not fully met all the demands of physicians and has not achieved its predetermined objectives, such as all-access from different locations.

Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 - National Poison Data System, United States, January 1, 2020-March 31, 2020.

On January 19, 2020, the state of Washington reported the first U.S. laboratory-confirmed case of coronavirus disease 2019 (COVID-19) caused by infection with SARS-CoV-2 (1). As of April 19, a total of 720,630 COVID-19 cases and 37,202 associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3). To assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System (NPDS), CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January-March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. Call data from poison centers are uploaded in near real-time to NPDS. During January-March 2020, poison centers received 45,550 exposure calls related to cleaners (28,158) and disinfectants (17,392), representing overall increases of 20.4% and 16.4% from January-March 2019 (37,822) and January-March 2018 (39,122), respectively. Although NPDS data do not provide information showing a definite link between exposures and COVID-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products.

A Survey of Blockchain-Based Strategies for Healthcare

Blockchain technology has been gaining visibility owing to its ability to enhance the security, reliability, and robustness of distributed systems. Several areas have benefited from research based on this technology, such as finance, remote sensing, data analysis, and healthcare. Data immutability, privacy, transparency, decentralization, and distributed ledgers are the main features that make blockchain an attractive technology. However, healthcare records that contain confidential patient data make this system very complicated because there is a risk of a privacy breach. This study aims to address research into the applications of the blockchain healthcare area. It sets out by discussing the management of medical information, as well as the sharing of medical records, image sharing, and log management. We also discuss papers that intersect with other areas, such as the Internet of Things, the management of information, tracking of drugs along their supply chain, and aspects of security and privacy. As we are aware that there are other surveys of blockchain in healthcare, we analyze and compare both the positive and negative aspects of their papers. Finally, we seek to examine the concepts of blockchain in the medical area, by assessing their benefits and drawbacks and thus giving guidance to other researchers in the area. Additionally, we summarize the methods used in healthcare per application area and show their pros and cons.

THE IMPACT OF MEETING ACCREDITATION STANDARDS ON THE QUALITY OF THE ELECTRONIC HEALTH RECORDS

Objective: Electronic health records (EHRs) are considered a way to make the management of patient information easier, improve efficiency, and decrease costs related to medical information management. Compliance with requirements from accreditation bodies on quality of documentation ensures the complete and accurate patient information in the EHR. The purpose of this study is to measure the effect of quality accreditation on the quality of documentation in the EHR.
 Methods: A simple random sample of 18% of patient records was manually selected each month during the entire study period from the population of discharged patients. The auditing process included 18 months starting from January 2014 until June 2015. The data collection was performed by a quality management unit using a modified medical record completeness checklist adapted from Joint Commission International (JCI) criteria.
 Results: The results of the study show the improvement in compliance with complete medical records’ documentation after the JCI accreditation. However, after the accreditation, the compliance suffers a dramatic fall which could be referred to the post-accreditation slump. The compliance then improved again to reach higher levels of compliance. Using paired t-test, the mean of total compliance with complete and accurate medical records in October 2014 was less than in May 2015.
 Conclusion: This study highlighted the performance of one process before and after the first accreditation of the organization showing the real difference between the performance before and after the accreditation and explaining the drop that happened just after the accreditation.

Electronic health system implementation as a component of public health management: world experience

The article analyses foreign and domestic scientific and practical investigations on the e-Health system in countries with developed and developing Healthcare system. Different approaches to term «e-Нealth» are considered starting from the instruments, which make availability of medical care easier for a patient up to the system of medical information management and wider abilities of public management of healthcare. The level of trust and public perception of different elements of e-Health in different countries is determined. E-Health implementation risks are analyzed. Ways to implement e-Health in public health management in Ukraine are suggested. Today, more and more healthcare providers, healthcare professionals, and health care providers are using Internet technologies to engage in healthcare communication. The main advantages are the speed and convenience of communication activities using e-Health. Healthcare professionals receive accurate and unbiased clinical and statistical data. That made possible to influence public health management, the effectiveness of which depends on the use of modern forms of communication for physicians, population, patients and public management and administration bodies. A wide range of communications with the public, patients, business, politicians, researchers, as well as the implementation of financial and administrative models in health care depend on this system.

Wavelet packet transform-based medical image multiple watermarking with independent component analysis extraction

Rapid growth of internet in all aspects of life has led to the easy availability of the digital data to everyone. E-commerce, telemedicine, etc., are among the many applications of internet. Telemedicine is a crucial field where internet finds application. Healthcare professionals use internet to transmit and receive medical data. Thus the medical images can be shared, processed and transmitted through computer networks. All patient records, linked to the medical secrecy, must be confidential. Because of the importance of the security issues in the management of medical information, there is a need to develop watermarking techniques for protecting medical images. In this paper, colour medical image watermarking methods rely on wavelet packet transform (WPT) and extraction using independent component analysis (ICA). For watermark extraction, Pearson ICA is applied as it attains the new trait is that it not entail the renovation procedure in watermark extraction. The grades show that projected method is vigorous beside attacks such as Gaussian noise, salt and pepper noise, rotation and translation. The performance measures like PSNR, similarity measure and normalised correlation are assessed to confirm the robustness of the scheme.

Wavelet packet transform-based medical image multiple watermarking with independent component analysis extraction

Rapid growth of internet in all aspects of life has led to the easy availability of the digital data to everyone. E-commerce, telemedicine, etc., are among the many applications of internet. Telemedicine is a crucial field where internet finds application. Healthcare professionals use internet to transmit and receive medical data. Thus the medical images can be shared, processed and transmitted through computer networks. All patient records, linked to the medical secrecy, must be confidential. Because of the importance of the security issues in the management of medical information, there is a need to develop watermarking techniques for protecting medical images. In this paper, colour medical image watermarking methods rely on wavelet packet transform (WPT) and extraction using independent component analysis (ICA). For watermark extraction, Pearson ICA is applied as it attains the new trait is that it not entail the renovation procedure in watermark extraction. The grades show that projected method is vigorous beside attacks such as Gaussian noise, salt and pepper noise, rotation and translation. The performance measures like PSNR, similarity measure and normalised correlation are assessed to confirm the robustness of the scheme.

The role of medical informatics in the management of medical information.

With progress in information and communication technology, medical information has been converted to digital formats and stored and managed using computer systems. The construction, management, and operation of medical information systems and regional medical liaison systems are the main components of the clinical tasks of medical informatics departments. Research using medical information accumulated in these systems is also a task for medical informatics department. Recently, medical real-world data (RWD) accumulated in medical information systems has become a focus not only for primary use but also for secondary uses of medical information. However, there are many problems, such as standardization, collection, cleaning, and analysis of them. The internet of things and artificial intelligence are also being applied in the collection and analysis of RWD and in resolving the above problems. Using these new technologies, progress in medical care and clinical research is about to enter a new era. J. Med. Invest. 67 : 27-29, February, 2020.

Imaging Examination and Quantitative Detection and Analysis of Gastrointestinal Diseases Based on Data Mining Technology.

The medical image storage and transmission system completes the collection, storage, management, diagnosis and information processing of digital medical image information generated from digital medical devices, accumulates a large amount of data resources, and uses these valuable data resources to extract corresponding diseases. Diagnostic rules that help improve the accuracy of clinical disease diagnosis have always been the subject of medical research and management. Gastrointestinal diseases are common high-risk digestive diseases. This paper studies the imaging detection and quantitative detection and analysis of gastrointestinal diseases based on data mining, aiming to improve the accuracy of doctors' clinical diagnosis, reduce the misdiagnosis and misdiagnosis of patients' diseases, and reduce the burden on patients. With the high computing speed and computational accuracy of the computer, combined with the flexible analysis and judgment ability of the human body, the doctor can help the semi-structured and unstructured diagnosis problems. Experiments demonstrate the effectiveness and robustness of the proposed method.

Attitudes Toward Blockchain Technology in Managing Medical Information: Survey Study.

BackgroundThe recently developed blockchain technology uses a peer-to-peer network to distribute data to all participants for storage. This method enhances data safety, reliability, integrity, and transparency. To successfully introduce blockchain technology to medical data management, it is essential to obtain consent from medical doctors and patients.ObjectiveThe aim of this study was to examine medical doctors’ and patients’ attitudes toward the use of blockchain technology and interpret the findings within the framework of expectancy theory.MethodsIn this questionnaire survey, we examined medical doctors’ (n=90) and patients’ (n=90) attitudes toward the use of blockchain technology in the management and distribution of medical information. The questionnaire comprised 8 questions that assessed attitudes toward new means of managing and distributing medical information using blockchain technology. Responses were rated on a scale that ranged from 1 (very negative) to 7 (very positive).ResultsMedical doctors (mean 3.7-5.0) reported significantly more negative attitudes than patients (mean 6.3-6.8). Furthermore, self-employed doctors reported more negative attitudes than employed doctors and university professors.ConclusionsTo successfully introduce blockchain technology to medical data management, it is necessary to promote positive attitudes toward this technology among medical doctors, especially self-employed doctors.

A systematic and comprehensive review of internet use in cancer patients: Psychological factors.

AbstractObjectivesOnline resources are changing patient‐professional relationship and care delivery by empowering patients to engage in decisions in order to cope with their illness and modify behaviors. This review analyses the psychological factors associated with spontaneous and health professional–guided internet use in cancer patients.MethodsSearches were performed in the PubMed (MEDLINE), PsycINFO, and Scopus databases. Studies were included if they involved cancer patients or focused on the relationship between cancer patients and health professionals, describing either patients' spontaneous use of interne or a guided‐structured eHealth psychosocial intervention.ResultsSeventy‐seven scientific papers were finally included. Results described emotional and behavioral outcomes in cancer patients who accessed online information. Internet has long been used spontaneously not only as a source of medical information or symptom management but also for decision making or emotional and social support. Health professionals can guide internet use, providing specific web‐based recommendations and developing intervention programs to better meet patients' needs, such as educational or information programs.ConclusionOnline access is a complementary form of care that physicians can provide. Patients benefit from online resources, especially when both they and their health professionals increase their engagement with online interventions such as integrated systems or online communities.

Rich Text Formatted EHR Narratives: A Hidden and Ignored Trove.

This study presents an approach for mining structured information from clinical narratives in Electronic Health Records (EHRs) by using Rich Text Formatted (RTF) records. RTF is adopted by many medical information management systems. There is rich structural information in these files which can be extracted and interpreted, yet such information is largely ignored. We investigate multiple types of EHR narratives in the Enterprise Data Warehouse from a multisite large healthcare chain consisting of both, an academic medical center and community hospitals. We focus on the RTF constructs related to tables and sections that are not available in plain text EHR narratives. We show how to parse these RTF constructs, analyze their prevalence and characteristics in the context of multiple types of EHR narratives. Our case study demonstrates the additional utility of the features derived from RTF constructs over plain text oriented NLP.

Availability and Quality of Information Used by Nurses While Admitting Patients to a Rural Home Health Care Agency.

Home health care admission nurses need high quality patient information but that information is not uniformly available. Despite this challenge, these nurses must make four critical decisions at patient admission to construct the plan of care: (1) patient problems to address in the home health care episode; (2) patient medication management; (3) services in addition to skilled nursing; and (4) skilled nursing visit pattern. We observed 12 in-home admissions at a rural home health care agency and interviewed nurses before and after about these decisions. We analyzed content and quality of documents. To evaluate quality, for each decision we assessed concordance between documents. Interview responses provided context in the analysis. Across all admissions, documents and their contents were not uniformly present. Nurses rarely received visit pattern or medication management information. There was discordance in the number of patient problems among and between available documents and the plan of care. Electronic health record design recommendations include interoperability and structured, consistent, actionable information.

RETRACTED ARTICLE: Staganography-based healthcare model for safe handling of multimedia health care information using VR

Due to the development of the Internet of Things (IoT) in the medical field, special medical equipment such as CT and MRI, which are used in medical institutions, can be used for digital healthcare services by medical staff using VR. However, the integrity and confidentiality of multimedia health care information handled through special medical equipment using VR is still one of the major issues that cause many problems in the application sector of medical services. This paper proposes a steganography-based digital healthcare model to ensure the integrity of user multimedia image information processed through special medical equipment using VR. The proposed model aims to prevent illegal use by the medical team through VR of multimedia image information collected through special medical equipment without the consent of the user. The proposed model uses the user’s signature and credentials in a hybrid cipher for multimedia health care information. The proposed model has features that ensure the integrity and confidentiality of the user’s medical image information without disturbing the user’s multimedia image quality filmed through special medical equipment. In addition, multimedia medical information viewed through VR is not exploited without the consent of users because the user’s signature information was encrypted using steganography-based cryptography-based ciphering techniques. In particular, the proposed model provides real-time guidance related to users’ health conditions and first-aid care in connection with the hospital health service to improve the management of medical image information for users in hospitals. As a result of the performance evaluation, the proposed model averaged 12.5% improvement in the management of the user’s medical image information compared to the existing technique, and the user’s accuracy in extracting medical image information was averaged 10.4% higher than that of the existing technique.

Digital Health Care and the Fourth Industrial Revolution.

We live in a world where big medical data are being compiled. Many people make use of biometric information gathered by a variety of health care devices linked to smartphones, such as Fitbit devices. In addition, the development of medical information management schemes and the introduction of health information systems have greatly increased the possibility of using medical records stored in medical institutions. With the development of sensor technology and analytical capabilities, we have gained new knowledge through big data, stemming from the collection of data that was not important in the current medical area. Digital health care is moving toward creating value while creating utility as well based on data collected beyond the level of those collected by sensors. Only organizations that have quickly entered the market and accumulated data and have already developed advanced algorithms based on the data can be competitive. However, digital health care companies that survive in the market will lead the change and will reorganize the health care sector. In addition, a big data-based health care platform can help increase the number of e-patients through patient participation.

Moving away from the boilerplate: Real-world evidence for clinical trial laboratory criteria.

e14581 Background: There is a need to enable as many suitable patients onto clinical trials in oncology, that are also representative of patients seen in clinical practice. Currently, oncology trials often require patients to have minimum laboratory tests for hematology and liver function amongst others. We compared the real-world laboratory results and clinical information in TransMed’s patient repository against the requirements of a set of clinical trials to assess patient eligibility retrospectively. Methods: Industry-sponsored clinical trials for follicular lymphoma which started in 2018 were retrieved from the U.S. National Library of Medicine’s clinical trials website. We aimed to find the most common set of diagnosis inclusion criteria and the range of platelet requirements to those observed from real-world data. TransMed’s patient data was collected from its consortium of 205 clinical sites, which includes a variety of source systems at each site, such as electronic medical record systems and laboratory information management systems among others. Results: There were 16 trials which matched our criteria. The most common trial inclusion criteria were for grades 1-3a, progression after at least one line of therapy, and a platelet count > 75 x10-9/L. We found 53 retrospectively-eligible patients who would have met the trial’s main criteria when the patient was between therapies in 2018. At some point within 90 days before starting another therapy, 9% (5/53) of patients failed the requirement for platelet count. Among those, 40% (2/5) were within a 10% drop in the required threshold. Conclusions: We have presented an exemplar combination of cancer diagnosis with a single laboratory test and found patients who could be considered for trials though are deemed ineligible due to a narrowly-missed requirement. Many such tests vary over time, by cancer type, prior treatment, comorbidities and should be considered in the context of other test results. By using real-world evidence at the time of trial design, clinical trials can be optimized to allow improved patient recruitment and expanded availability to patients while ensuring clinical suitability.