Medical IT Research Articles

IT Outsourcing and Medical Secrecy

IT Outsourcing and Medical Secrecy Abstract. When medical practices outsource IT work, the requirements of data protection laws and professional secrecy in particular must be taken into account. In terms of data protection laws, outsourcing to third parties requires, among other things, that an agreement is concluded, and that the outsourcing provider only processes the data in the way that the doctor himself is permitted to do. Furthermore, outsourcing must not be prohibited by a legal or contractual obligation to maintain secrecy, such as medical professional secrecy. Professional secrecy has been widely discussed in recent years in connection with the outsourcing of services by physicians. Despite other restrictive positions, however, IT outsourcing should continue to be regarded as permissible if it can be justified on objective grounds, if it remains within the scope of what is customary and necessary for physicians and if appropriate measures are taken to avoid disclosure of personal data.

The Most Influential Scientists in the Development of Medical Informatics (25): Rolf Hansen (1931-1993).

Rolf Hansen (1931-1993) was one of pioneers of Medical informatics. He was an organized and pragmatic medical IT scientist who developed respected and pioneering health information systems at the Norwegian Institute of Public Health, Oslo, Norway (1-4).

1638. Tele-Infectious Disease Consultation Produces Equivalent Outcomes as In-Person Consultation

BackgroundTechnology can extend Infection Disease Consultants (IDCs) into resource limited small community US hospitals. We compared in-person infectious disease (ID) consults with Tele-ID consults to determine whether length of stay, antibiotic usage, drug cost, or readmission rates will remain the same between both groups over a 3-month period.MethodsUniversity of Maryland Harford Memorial Hospital (UM-HMH) is a 95-bed hospital including a 6-bed ICU. From May to August 2017 (study period) there was no IDC at UM-HMH. During study period, IDCs from a regional UM hospital provided formal Tele-ID consults through an HIPAA compliant secured Skype Business account. Patient history and wound examination were done by the IDC via video monitor while a bedside nurse assisted in performing the physical examination. Laboratory and radiological data were reviewed in real time as both hospitals shared the same electronic medical record and IT infrastructure (Meditech 6.15). A formal consultation was dictated and computer orders were entered by the IDC within 24 hours of the consult request. Daily Tele-ID follow-up rounds were conducted. IDCs had the authority to transfer a patient to the regional hospital for in-person care if deemed necessary. Study period was compared with a baseline period (May–August 2016) when IDCs were providing in-person consults at UM-HMH.ResultsBaseline period had 148 inpatient stays and study period had 148 inpatient stays. Despite similar case mix index in both groups, there was no statistical difference between the clinical outcomes. Results are shown in Table 1.Baseline PeriodStudy Period P valuePatients (n)148148–Average length of stay6.77.10.54Case mix index1.161.230.46Average days on antibiotics5.96.20.47Average drug cost$484$4960.85Readmission %22.217.80.38Deaths331ConclusionTele-ID at our hospitals was noninferior to in-person ID consults. An integrated computer system, nursing support, and daily follow-up are key components of a successful Tele-ID program.Disclosures All authors: No reported disclosures.

ON THE MACROSTRUCTURE OF ABSTRACTS IN MEDICAL AND ECONOMICS JOURNALS AND ITS LSP IMPLICATIONS

ON THE MACROSTRUCTURE OF ABSTRACTS IN MEDICAL AND ECONOMICS JOURNALS AND ITS LSP IMPLICATIONS

Structured workflow achieving interoperable smart energy systems

Interoperability is the key to Smart Grids and thereby to enable the energy transmission towards 100% renewable energy sources. The project Integrating the Energy System (IES) Austria adopted the holistic methodology to achieve interoperable systems, established in the medical IT and standardized in ISO DTR 28380–1, for the energy domain. The poster will outline the adopted process and the lessons learned when first trial Integration Profiles were specified and tested at the Connectathon Europe 2018, in The Hague, Netherlands. The methodology is found applicable to Smart Energy systems. Interoperability testing and profile integration validation were successfully implemented. The specification of new Integration Profiles, to be presented and tested at the Connectathon Energy 2019, is in progress.

Understanding Barriers to Cervical Screening Follow-Up and Treatment Compliance in Malaysia: A Qualitative Study of Provider Perspectives

Background: Cervical cancer is a leading cause of women mortality in Malaysia. In Malaysia, system of care remain fragmented despite the increased uptake of cervical screening. Thus, it is important to better understand factors that affect loss to follow-up and treatment along the care continuum. The ability of a patient to attend a cervical screening clinic, to return for possible treatment, and to return to clinic for follow-up evaluation (“the patient factor”) is a major component to the success of a screening program. Women diagnosed with early or local (stage 1) cervical cancer have a 92% chance of survival 5 years after diagnosis whereas survival rates decrease to 17% for women with late cancer diagnoses. Due to this, a better understanding of barriers to cervical cancer treatment can inform initiatives to address therapeutic delays, which is vitally important to providing optimal care. Aim: To explore, from the perspectives of healthcare professionals, the perceived barriers of cervical screening follow-up and treatment compliance in Malaysia. Methods: In-depth semistructured interviews with 45 government health clinic staffs comprise of clinicians, nurses, front desk staffs, medical laboratory technicians and IT support engineers were conducted from 5 government health clinics in Petaling District. Qualitative content analysis through an inductive approach was used to identify barriers of cervical cancer care continuum and treatment compliance in public health clinics settings. Results: Participants identified various potential barriers to seeking follow-up care and treatment after receiving a positive Pap test results or invalid test results at 2 levels: the structural level, and the patient level. Long waiting time, lack of transport to healthcare providers, fear of treatment, poor documentation, absence of cervical screening registry, as well as unsystematic referral or treatment procedures are some of the major reasons affecting follow-up and treatment compliance. Conclusion: The results highlight the need of structural and personal interventions that eliminate barriers to follow-up and treatment compliance along the care continuum.

Research IT maturity models for academic health centers: Early development and initial evaluation.

This paper proposes the creation and application of maturity models to guide institutional strategic investment in research informatics and information technology (research IT) and to provide the ability to measure readiness for clinical and research infrastructure as well as sustainability of expertise. Conducting effective and efficient research in health science increasingly relies upon robust research IT systems and capabilities. Academic health centers are increasing investments in health IT systems to address operational pressures, including rapidly growing data, technological advances, and increasing security and regulatory challenges associated with data access requirements. Current approaches for planning and investment in research IT infrastructure vary across institutions and lack comparable guidance for evaluating investments, resulting in inconsistent approaches to research IT implementation across peer academic health centers as well as uncertainty in linking research IT investments to institutional goals. Maturity models address these issues through coupling the assessment of current organizational state with readiness for deployment of potential research IT investment, which can inform leadership strategy. Pilot work in maturity model development has ranged from using them as a catalyst for engaging medical school IT leaders in planning at a single institution to developing initial maturity indices that have been applied and refined across peer medical schools.

Medical data mining in sentiment analysis based on optimized swarm search feature selection.

In this paper, we propose a novel technique termed as optimized swarm search-based feature selection (OS-FS), which is a swarm-type of searching function that selects an ideal subset of features for enhanced classification accuracy. In terms of gaining insights from unstructured medical based texts, sentiment prediction is becoming an increasingly crucial machine learning technique. In fact, due to its robustness and accuracy, it recently gained popularity in the medical industries. Medical text mining is well known as a fundamental data analytic for sentiment prediction. To form a high-dimensional sparse matrix, a popular preprocessing step in text mining is employed to transform medical text strings to word vectors. However, such a sparse matrix poses problems to the induction of accurate sentiment prediction model. The swarm search in our proposed OS-FS can be optimized by a new feature evaluation technique called clustering-by-coefficient-of-variation. In order to find a subset of features from all the original features from the sparse matrix, this type of feature selection has been a commonly utilized dimensionality reduction technique, and has the capability to improve accuracy of the prediction model. We implement this method based on a case scenario where 279 medical articles related to 'meaningful use functionalities on health care quality, safety, and efficiency' from a systematic review of previous medical IT literature. For this medical text mining, a multi-class of sentiments, positive, mixed-positive, neutral and negative is recognized from the document contents. Our experimental results demonstrate the superiority of OS-FS over traditional feature selection methods in literature.

Using the Asseco Medical Management Solutions Program to Monitor Patients After Kidney Transplantation

IntroductionIn Poland there is an average of 2.31 doctors per 1000 population (according to the Organization of Economic Cooperation and Development 2016), which is one of the lowest results in all of the European Union countries. With the persistent low number of specialists, the quantity of patients and their medical records keep increasing. In order to facilitate the work of doctors and to improve monitoring of the patients, most medical institutions decided to implement IT systems. At the Department of General and Transplant Surgery of Pomeranian Medical University in Szczecin, we have been using the Asseco Medical Management Solutions (AMMS) system for 5 years. The aim of this study was to evaluate the usefulness of the AMMS system in monitoring and early detection of disorders in renal transplant recipients. Materials and methodsThe retrospective study included 100 patients who underwent surgical treatments between 2012 and 2017. By analyzing the results of laboratory tests (ie, complete blood count), the concentration of creatinine and urea, potassium, and the doses of immunosuppressive drugs, we evaluated the usefulness of the AMMS system. ResultsThe clinical usefulness of the AMMS system related to the evaluation of predictors of early graft dysfunction has been confirmed. We have saved time in the analysis of medical records. ConclusionsThe AMMS system improved the management of medical records of patients after surgeries and allowed for the retrospective evaluation of the treatment and its immediate modification. The unification of medical IT systems in Poland would increase the availability of patients' data and support information transfer among all medical institutions. It would enable multifacility scientific meta-analysis.

Emergency Medical IT Services for Migrants Rescue Operations

This paper illustrates the research and development work done in the last 4 years in the frame of rescue operations of migrants who attempt to reach Italian coasts via sea journeys on Mediterranean routes. The context, characterized by humanitarian, social, and organizational issues, presents complex challenges that can only be tackled with a multidisciplinary, participatory, and internationalized approach. The ITHEALTH system and the results of its usability and user experience evaluations are presented. It takes inspiration from other projects developed for different purposes but acting in similar context and according to similar socio-technical dimensions.

Revising IEC 80001-1: Risk management of health information technology systems

IEC 80001-1 was published in 2010 and is now undergoing revision. Feedback gathered on the adoption of the standard has revealed a number of barriers that have impacted its adoption. The standard provides requirements related to the roles, responsibilities and activities that need to be performed for the risk management of medical IT networks. One reported barrier is a lack of drivers to motivate Top Management to implement the standard. In addition, there is a lack of alignment between IT and biomedical engineering departments within hospitals. Finally, the IEC 80001-1 standard was considered to be too complicated and complex to implement. This paper presents the barriers identified in the feedback and presents an approach to the revision of the standard as a process based standard following the structure outlined in ISO/IEC Directives Annex SL and aligned risk management standards as a means to overcome these barriers.

Risk Management Framework and Evaluation: Detail Site Study and Governance of Information Security Risk Management in Medical Information Technology Infrastructure in Hospitals

Objectives: This research has focused on exploring the risk factors involved in hospital medical IT infrastructure risk factor while carry out the software and hardware deployment (i.e. field study) and proposed a risk management framework and assessments for managing the risk. The main objective of the research is to propose an information security risk management framework for a hospital domain as part of use-case in this research. In this paper, we have identified possibilities of risk that might happen anytime, carried out risk analysis in university hospital, and provided risk contingency plans. Methods: Information security is very important for the organization, but very particular for hospital domain, due to patient information is involved and it is very sensitive. While delivering the information, need to be producing the right information at right time with the effective care. The availability of information is very important in medical systems where most of the providers are from cross-border healthcare domain. The methodology followed is a qualitative approach of interview, collecting data, analysis the data, evaluate and provide recommendations. Findings: The expected outcome from this work is a recommendation of risk managing framework for hospital domain on a global context. The risk assessment evaluates the IT plan reports for hospitals and the involved parties to identify the sensitivity, threats, vulnerabilities, and risks that surround the whole medical IT infrastructure. The identified risks are analysed, prioritized and mitigated by providing relevant control plan and recommendationswere provided toavoid or minimize the risk factors in the medical domain. Improvements: Based on field study and risk evaluation reports, IT infrastructure can be improved and risk factors would be forecasted in future and minimized with effective contingency plans. Keywords: Information Security, Medical Hospital, Risk Assessment, Risk Management, Risk Mitigation

A hybrid model of Internet of Things and cloud computing to manage big data in health services applications

Over the last decade, there has been an increasing interest in big data research, especially for health services applications. The adoption of the cloud computing and the Internet of Things (IoT) paradigm in the healthcare field can bring several opportunities to medical IT, and experts believe that it can significantly improve healthcare services and contribute to its continuous and systematic innovation in a big data environment such as Industry 4.0 applications. However, the required resources to manage such data in a cloud-IoT environment are still a big challenge. Accordingly, this paper proposes a new model to optimize virtual machines selection (VMs) in cloud-IoT health services applications to efficiently manage a big amount of data in integrated industry 4.0. Industry 4.0 applications require to process and analyze big data, which come from different sources such as sensor data, without human intervention. The proposed model aims to enhance the performance of the healthcare systems by reducing the stakeholders’ request execution time, optimizing the required storage of patients’ big data and providing a real-time data retrieval mechanism for those applications. The architecture of the proposed hybrid cloud-IoT consists of four main components: stakeholders’ devices, stakeholders’ requests (tasks), cloud broker and network administrator. To optimize the VMs selection, three different well-known optimizers (Genetic Algorithm (GA), Particle swarm optimizer (PSO) and Parallel Particle swarm optimization (PPSO) are used to build the proposed model. To calculate the execution time of stakeholders’ requests, the proposed fitness function is a composition of three important criteria which are CPU utilization, turn-around time and waiting time. A set of experiments were conducted to provide a comparative study between those three optimizers regarding the execution time, the data processing speed, and the system efficiency. The proposed model is tested against the state-of-the-art method to evaluate its effectiveness. The results show that the proposed model outperforms on the state-of-the-art models in total execution time the rate of 50%. Also, the system efficiency regarding real-time data retrieve is significantly improved by 5.2%.

Getting Digital Assets from Public-Private Partnership Research Projects through "The Valley of Death," and Making Them Sustainable.

Projects in public–private partnerships, such as the Innovative Medicines Initiative (IMI), produce data services and platforms (digital assets) to help support the use of medical research data and IT tools. Maintaining these assets beyond the funding period of a project can be a challenge. The reason for that is the need to develop a business model that integrates the perspectives of all different stakeholders involved in the project, and these digital assets might not necessarily be addressing a problem for which there is an addressable market of paying customers. In this manuscript, we review four IMI projects and the digital assets they produced as a means of illustrating the challenges in making digital assets sustainable and the lessons learned. To progress digital assets beyond proof-of-concept into widely adopted tools, there is a need for continuation of multi-stakeholder support tailored to these assets. This would be best done by implementing a structure similar to the accelerators that are in place to help transform startup businesses into growing and thriving businesses. The aim of this article is to highlight the risk of digital asset loss and to provoke discussion on the concept of developing an “accelerator” for digital assets from public–private partnership research projects to increase the chance that digital assets will be sustained and continue to add value long after a project has ended.

The impact of the hybrid platform of internet of things and cloud computing on healthcare systems: opportunities, challenges, and open problems

Cloud Computing (CC) and the Internet of Things (IoT) have emerged as new platforms in the ICT revolution of the twenty-first century. The adoption of the CloudIoT paradigm in the healthcare field can bring several opportunities to medical IT, and experts believe that it can significantly improve healthcare services and contribute to its continuous and systematic innovation. This paper presents a comprehensive review of the current literature on integration of CC and IoT to solving various problems in healthcare applications such as smart hospitals, medicine control, and remote medical services. Also, a brief introduction to cloud computing and internet of things with an application to health care is given. This paper presents a new concept of the integration of CC and IoT for healthcare applications, which is what we; call the CloudIoT-Health paradigm. The term CloudIoT-Health and some key integration issues are presented in this paper to offer a practical vision to integrate current components of CC and the IoT in healthcare applications. Also, this paper aims to present the state of the art and gap analysis of different levels of integration components, analyzing different existing proposals in CloudIoT-Health systems. Finally, related researches of CC and IoT integration for healthcare systems have been reviewed. Challenges to be addressed and future directions of research are identified, and an extensive bibliography is presented.

Potential of Medical IT in developing countries: Case study Mongolia

The field of medicine is difficult to compare between different countries, as the development and their focus are individual and faces unique problems. Possible solutions provided by the western world usually require higher financial expenses and intensive training of workers involved in the medical field. Experience gathered in Mongolia lead to the suggestion that the involvement of computer technology can create benefits for the healthcare sector without extensive costs and intensive training. The missing experience of medical workers can be covered with computed technology that is designed to support them in making correct decisions. At the same time these technologies will never be able to fully replace workers and therefore should not lead to dismissal in the healthcare sector.

Aktualny stan wiedzy na temat patomorfologii cyfrowej

In recent years, dynamic technological progress has been made, including the introduction of innovative solutions based on digital imaging in the field of pathomorphology. “Virtual microscopy” includes creating, viewing, managing, sharing, analyzing, and interpreting digital images of conventional microscope glass slides (WSI whole slide imaging). WSI systems, along with digital consulting platforms, are used in education, research, telepathology, teleconsultation, and routine diagnostics. Moreover, these systems provide user-friendly, fast and interactive sharing of digital images of microscopic specimens. Often, the development of the system allows integration with other medical IT systems. Applications that include image analysis and computer-assisted diagnosis facilitate the standardization of research results and support diagnostic accuracy. Virtual microscopy has many advantages, but it must be kept in mind that its limitations include high investment in equipment and infrastructure, the standardization of the quality of the digital images obtained, and the numerous concerns of pathomorphologists prior to its use in routine diagnostics.

OR.NET: multi-perspective qualitative evaluation of an integrated operating room based on IEEE 11073 SDC

Clinical working environments have become very complex imposing many different tasks in diagnosis, medical treatment, and care procedures. During the German flagship project OR.NET, more than 50 partners developed technologies for an open integration of medical devices and IT systems in the operating room. The aim of the present work was to evaluate a large set of the proposed concepts from the perspectives of various stakeholders. The demonstration OR is focused on interventions from the head and neck surgery and was developed in close cooperation with surgeons and numerous colleagues of the project partners. The demonstration OR was qualitatively evaluated including technical as well as clinical aspects. In the evaluation, a questionnaire was used to obtain feedback from hospital operators. The clinical implications were covered by structured interviews with surgeons, anesthesiologists and OR staff. In the present work, we qualitatively evaluate a subset of the proposed concepts from the perspectives of various stakeholders. The feedback of the clinicians indicates that there is a need for a flexible data and control integration. The hospital operators stress the need for tools to simplify risk management in openly integrated operating rooms. The implementation of openly integrated operating rooms will positively affect the surgeons, the anesthesiologists, the surgical nursing staff, as well as the technical personnel and the hospital operators. The evaluation demonstrated the need for OR integration technologies and identified the missing tools to support risk management and approval as the main barriers for future installments.

Medical IT – much progress in a short time

Medical IT – much progress in a short time

Mobile health (m-Health) for diabetes management

Diabetes is a major health challenge with a global impact regardless of age, country or economic condition. The increased prevalence of diabetes is reaching alarming levels. The necessity and urgency to find innovative care delivery solutions is becoming more important, particularly in the digital age. It is expected in the near future that more people with diabetes, especially the younger generations will be empowered by their smartphones and relevant mobile health (m-Health) innovations, to take more responsibility of their condition. Clinicians and healthcare providers are increasingly likely to assume the role of ‘navigators’ and ‘advisors’ rather than simply the medical gatekeeper for their patients. In this article, we describe the general architecture of current m-Health systems and applications for diabetes management. We also discuss the clinical evidence for impact from these important and innovative approaches to diabetes self-care and management and likely future trends in their usage. The latest statistics indicate that there are more than 1200 diabetes smartphone ‘apps’ and this area is growing exponentially in terms of ideas, technologies, devices and the associated industry. M-Health for diabetes care is now a major business stream for the medical device, mobile phone and IT telecommunication industries with high expectations arising from the potential benefits to be gained by both patients and healthcare providers. However, this potential has not yet been fully developed on the clinical side. This may be due to many factors including the reluctance of clinicians to engage with these technologies due to the lack of clinical evidence for their efficacy, poor adherence of people with diabetes to long-term use of these apps and the reluctance of healthcare funders to reimburse mobile diabetes.