A system for the provision of medical diagnostic and treatment advice in home care environment

Healthcare is an increasingly collaborative enterprise, involving broad range of healthcare services provided by many individuals and organizations. Apart from the provision of healthcare services to patients during hospitalization, the ability to assist people who have healthcare needs at their homes (e.g., the elderly) has become an increasingly critical issue. Provision of such personalized medical care services to patients requires readily access to integrated healthcare services ubiquitously. The integration of mobile and wireless devices with Grid technology can provide ubiquitous and pervasive access to Grid services. This article presents MASPortal, a Grid portal application for the assistance of people who are in need of medical advice at their homes. MASPortal is designed for use with wireless Personal Digital Assistants (PDAs) and provides remote access to an automated medical diagnostic and treatment advice system via an adaptive and easy to use interface. MASPortal has been implemented with a multi-layered security infrastructure in order to ensure secure access to healthcare processes and sensitive patient data.     

Through-Walls Communication for Medical Emergency Services

The authors present a model for bringing the coordination power of workflow management systems to outdoor wearable augmented reality (AR) systems. They portray how mobile equipment may be integrated with adaptive, context-aware work environments. A scenario of a medical emergency task is described to illustrate the functionality of this form of collaboration system. Appropriate information stickers are introduced to support data collection in medical emergency scenarios in a sophisticated form through a hands-free user interface for medical personnel. They propose the use of new user interface technology, including multimedia, AR information stickers, and the allocation of patient medical records to identified locations of the human body. A key feature is the access to relevant information for users in the mobile environment as well as for those in the advanced control room. An additional advantage is the automatic recording of on-site data, which helps to build the medical record of a patient without interfering with the work of the emergency team.     

Virtual Nursing Using Deep Belief Networks for Elderly People (DBN-EP)

The demand for better health services has resulted in the advancement of remote monitoring health, i.e., virtual nursing systems, to watch and support the elderly with innovative concepts such as being patient-centric, easier to use, and having smarter interactions and more accurate conclusions. While virtual nursing services attempt to provide consumers and medical practitioners with continuous medical and health monitoring services, access to allied healthcare experts such as nurses remains a challenge. In this research, we present Virtual Nursing Using Deep Belief Networks for Elderly People (DBN-EP), a new framework that provides a virtual nurse agent deployed on a senior citizen’s home, workplace, or care centre to help manage their health condition on a continuous basis. Using this method, healthcare providers can assign various jobs to nurses by utilizing a general task definition mechanism, in which a task is defined as a combination of medical workflow, operational guidelines, and data gathered from a remotely monitored virtual nursing system. Practitioners are in charge of DBN-EP and make treatment decisions for patients. This allows a DBN-EP to act as a personalized full-time nurse for a client by carrying out practitioner support activities based on information gathered about the client’s health. An electronic Personal Health Record (ePHR) system, such as a specialized web portal and mobile apps, could provide such patient information to elderly person family members and care centres. We created a prototype system using a DBN-EP system that allows traditional client applications and healthcare provider systems to collaborate. Finally, we demonstrate how this system may benefit the elderly through a result and debate.     

Personal Digital Assistants in medical education and practice

Abstract This paper reports on a current project, KNOWMOBILE, that explores how wireless and mobile technologies, in this case how Personal Digital Assistants (PDAs) may be useful in medical education and clinical practice, particularly to access net‐based information. KNOWMOBILE is a research collaboration involving academic and industrial partners which aims to support Problem‐Based Learning (PBL) and the integration of Evidence‐Based Medicine (EBM) in medical education reform in Norway. What does ‘just‐in‐time’ access to information mean in clinical settings? How can health professionals be helped with access to the most up‐to‐date medical information? From a preliminary analysis of the problems of Personal Digital Assistants in use — and nonuse — problems regarding information and communication infrastructure discussed that require work from a social historical interpretation of ‘infrastructures’ in order to enhance design perspectives and directions for future research. It is concluded that the PDAs should not be regarded as Personal Digital Assistants, but rather as gateways in complicated webs of interdependent technical and social networks.     

RFID Positioning and Physiological Signals for Remote Medical Care

The safety of patients and the quality of medical care provided to them are vital for their wellbeing. This study establishes a set of RFID (Radio Frequency Identification)-based systems of patient care based on physiological signals in the pursuit of a remote medical care system. The RFID-based positioning system allows medical staff to continuously observe the patient's health and location. The staff can thus respond to medical emergencies in time and appropriately care for the patient. When the COVID-19 pandemic broke out, the proposed system was used to provide timely information on the location and body temperature of patients who had been screened for the disease. The results of experiments and comparative analyses show that the proposed system is superior to competing systems in use. The use of remote monitoring technology makes user interface easier to provide high-quality medical services to remote areas with sparse populations, and enables better care of the elderly and patients with mobility issues. It can be found from the experiments of this research that the accuracy of the position sensor and the ability of package delivery are the best among the other related studies. The presentation of the graphical interface is also the most cordial among human-computer interaction and the operation is simple and clear.     

Ubiquitous spatial-information services using cell phones

Conventional thinking about mobile methods for accessing the Internet is rapidly changing. The processing power of cell phones is steadily improving, and the wireless network's communication speed is increasing. Once these changes are in place, most mobile applications will give way to a third-generation (3G) cell-phone-based infrastructure. In particular, using 3G cell phones instead of conventional PCs or personal digital assistants (PDAs) will make possible ubiquitous spatial information services. These services let you use a cell phone to easily find nearby hospitals, restaurants, banks, stores, and so on. Moreover, pedestrians will be able to use cell phones to receive navigational guidance services similar to those delivered by vehicle navigation systems. In this article, we introduce real system implementations and field trials to demonstrate the potential of this integrated spatial-information services approach.     

Mobile architecture for the Wishard Memorial Hospital Ambulatory Service

The introduction of portable computers into existing database systems requires traditional transaction mechanisms to be adapted to meet the needs of the mobile user. These mobile users utilise hand-held and laptop computers called mobile hosts, that can access the database from any location at any time. In this paper, we describe a mobile architecture that places mobile on the ambulances of the Wishard Memorial Hospital Ambulatory Service. This mobile architecture is designed to support transactions created by a mobile host that may be disconnected from the network during the execution of these transactions. The environment for this mobile architecture is the Indianapolis Network for Patient Care and Research (INPCR) of Marion County, Indianapolis, Indiana. The INPCR, which was developed to provide patient care by presenting clinical data in a clear and efficient manner, utilises the distributed medical patient database of the Regenstrief Medical Record System (RMRS) as a data repository. The medical personnel of the ambulatory service are able to submit transactions to the patient database of the RMRS to access vital patient information. The transactions in this environment use the forward recovery of sagas to minimise the amount of recovery needed during transaction failure. By allowing the medical personnel (hospital emergency room staff and the emergency medical technicians of the Wishard Memorial Hospital Ambulance Service) the ability to store, retrieve, create, and evaluate the medical records of their patients, they can provide high-quality care in a time and cost effective manner.     

Dependable and secure computing in medical information systems

Medical information systems facilitate ambulatory patient care, and increase safer and more intelligent diagnostic and therapeutic capabilities through automated interoperability among distributed medical devices. In modern medical information systems, dependability is one of the most important factors for patient safety in the presence of delayed or lost system alarm and data streams due to the intermittent medical device network connection or failure. In addition, since the medical information need to be frequently audited by many human operators as well as the automated medical devices, secure access control is another pivotal factor for patient privacy and data confidentiality against inside or outside adversaries. In this study, we propose a dependable and secure access policy enforcement scheme for disruption-tolerant medical information systems. The proposed scheme exploits the external storage node operated by the device controller, which enables reliable communications between medical devices. Fine-grained data access control is also achieved, while the key escrow problem is resolved such that any curious device controller or key generation center cannot decrypt the private medical data of patients. The proposed scheme allows the device controller to partially decrypt the encrypted medical information for the authorized receivers with their corresponding attributes without leaking any confidential information to it. Thus, computational efficiency at the medical devices is also enhanced by enabling the medical devices to delegate most laborious tasks of decryption to the device controller.     

Integrating medical expert systems, patient data-bases and user interfaces

Expert system applications in the clinical domain have not been very popular for lack of an adequate integration with other applications used in clinical environments. In the last few years, there is a growing trend towards the introduction of knowledge based systems as systems embedded in conventional applications. In this paper we propose an integration strategy of an expert system in oncology therapy with a clinical history data base and a user interface adapted to the needs of the medical environment. Our objective has been to design a system that is easy to use and provides all functions needed by the medical staff. The final system has consisted in first integrating three development tools and then using them in order to construct the complete application. The result is a global tool for the development of clinical information systems with embedded intelligent modules.     

Develop a multi-detection security system using multi-sensor fusion algorithms

The paper develops the multi-detection system using multi-level surveillance structure. The system contains active detection modules, passive detection modules, a supervised computer, an image system and an intelligent home. The passive detection modules contain wire/wireless detection modules and appliance control modules, and decide the event to be true or not using fusion algorithms, and transmit detection signals to the supervised computer via wire/wireless interface. Mobile robots are active detection modules and carry various sensors to search dangerous events. Each mobile robot transmits the real-time event signal to the supervised computer and the other mobile robots via wireless RF interface. The image system detects fire source using Otsu algorithm. The system integrates wire/wireless passive detection modules, mobile robots and image system to detect fire source using weighted average method. If the fire event occurs, the supervised computer calculates the dangerous grade using logical filter method according to the signals of detection modules in the first step, and transmits the position of the fire event to the other mobile robots. The assigned mobile robots move to the event location for double check autonomously, and transmit the detection results to the supervised computer. The supervised computer gives the final decision according to the feedback signals in the second step. Finally, we present some experimental scenarios using passive detection modules, active detection modules and image system for the fire detection in the intelligent home.     

Secure Integration of Distributed Medical Data Using Mobile Agents

This article is part of a special issue on Intelligent Agents in Healthcare. This article proposes a secure medical-information-gathering system based on mobile agents that overcomes traditional systems' data availability issues. Information availability is a major concern when the provision of care is at stake. Physicians make their decisions based on available information. Virtual electronic patient records (VEPRs) provide the necessary means for intra-institution data integration, enabling a single view of all patients' clinical information. Nevertheless, patients are mobile entities visiting multiple institutions during their life, leaving a trail of scattered information. This proposal is based on a mobile-agent system that provides IEEE-FIPA standardized interinstitution data discovery, transport, and integration for medical information. It combines traditional security schemes for protecting information with advanced agent-driven self-protection mechanisms and role-based access control. The system interacts with remote legacy applications, thus facilitating integration of clinical documents. Highly sensitive medical information can be brought where needed.     

基于HIS的移动护士终端的设计

移动护士终端是基于医院信息系统HIS（HospitalInformationSystem）的一个手持终端执行系统,主要用来协助护士对住院患者完成日常护理及病区管理等工作。设计采用ARMll系列的$3C6410嵌入式芯片、WindowsCE6．0操作系统及RFID读卡器等技术,具有成本低、体积小、便携式、操作简单、界面友好等特点。实际运行表明,系统运行稳定,能够代替医院传统的纸质医嘱,优化了工作流程,提高了护理工作的质量和效率,实现了HIS向病房的扩展与延伸。     

The evaluation of an information system for intensive care

This paper describes the application of humancomputer interaction (HCI) research methods in critical care medicine. An evaluation of an information system for the support of cardiological intensive care (The Aachen Information System for Intensive Care- AISIC) is outlined. AISIC supports the capturing of diagnostic and therapeutic patient data by nursing staff, the requesting of external diagnostic reports, and the retrieval of information for treatment planning performed by physicians (Popp 1994). It was hypothesized that use of the information system would result in quicker task completion times and a reduction in error-making, when compared to the existing paper-based record-keeping system. The evaluation was carried out using eight different forms of data capture, ranging from interview and questionnaire to automatic keystroke logging. The results of the evaluation revealed problems in the prescribing and recording of medication dosage and administration. The resultant redesign of the medication option is discussed, along with implications for improved patient care through the cognitive engineering of medical information systems. The problems encountered in conducting this type of work in a critical care environment are also discussed.     

Development of a computerized infectious disease monitor (CIDM)

At the LDS Hospital in Salt Lake City, an interface was developed between the microbiology laboratory computer system and the HELP integrated central hospital computer system. The HELP system includes medical information from most clinical care support areas. The microbiology data are translated from the laboratory computer file structure to a hierarchical data structure on the HELP system. A knowledge base was created with the help of infectious disease experts, and became part of a Computerized Infectious Disease Monitoring system (CIDM). The knowledge base is automatically activated when specific microbiology data are entered into a patient's computer file (data driven), thus decisions are made automatically with no additional effort required of medical personnel. The CIDM was designed to inform infectious disease personnel when a patient has one of the following conditions: a hospital-acquired infection, an infection at a normally sterile body site, an infection due to a bacteria with an unusual antibiotic sensitivity pattern, an infection for which the patient is not receiving an antibiotic to which the offending bacteria is sensitive, an infection that could be treated with a less expensive antibiotic, an infection which is required by law to be reported to state and national health authorities, and those patients receiving prophylactic antibiotics longer than is medically indicated. All of the microbiology data are now extensively reviewed by nurses and physicians from terminals at nursing stations or intensive care units. The CIDM is currently being used for hospital-acquired infection surveillance at LDS Hospital.     

Mobility management for m-commerce requests in wireless cellular networks

Increasing number of sophisticated services provided by the current wireless communication systems have caused a significant transition from E-commerce to M-commerce. Enterprises have provided considerable new opportunities to promote their businesses accessible from small mobile devices such as personal digital assistant (PDA) or mobiles phones. These facilities are envisioned as the most convenient way of using M-commerce. Using such services from mobile phones or PDAs equipped with GSM/GPRS involve effective mobility management mechanisms in cellular networks—a popular architecture for wireless networks. Success of such systems will largely depend on the reliable connection for the roaming users. Consequently, Quality of Service (QoS) provision is one of the most challenging issues in the heterogeneous wireless network-based m-commerce systems. Such m-commerce systems enable users to roam between different wireless networks operators and geographical areas while providing interactive broadband services and seamless connectivity. This paper presents an analytical framework to model scarce channels in any cell for maximizing channel utilization and efficient handling of handover requests. Typical numerical experiments are presented to validate the analytical solution against simulation to study the effect of bursty traffic upon the performance of the cell in any cellular networks.     

Case studies of IT sophistication in nursing homes: A mixed method approach to examine communication strategies about pressure ulcer prevention practices

Most nursing homes lack information technology (IT) for supporting clinical work in spite of its potential to improve the safety, quality, and efficiency of nursing home care in the United States. Increased attention to medical error and concern for patient safety have prompted general recommendations to develop sophisticated technologies to support clinical decision making at the point of care, to promote data standards in electronic records, and to develop systems that communicate with each other. However, little is known about what IT applications best support communication and risk assessment practices to improve resident outcomes in nursing homes. Thus, the overall aim of this study was to evaluate how differences in IT sophistication in nursing homes impact communication and use of technology related to skin care and pressure ulcers. We used a mixed method approach to conduct case studies on two nursing homes – one with high IT sophistication and one with low IT sophistication. Observational analysis and social network analysis were used to identify patterns in communication types and locations; also, focus groups were conducted to explore communication strategies used by Certified Nursing Assistants (CNAs) to support pressure ulcer prevention practices. Overall, results from social network analysis of observational data indicate that direct interactions between CNAs and registered nurses (RNs) or licensed practical nurses (LPNs) were more frequent in the low IT sophistication home and occurred in more centralized locations (e.g. the nursing station) compared to the high IT sophistication home. Moreover, these findings are supported by focus group results, which indicate that the high IT sophistication home had more robust and integrated communication strategies (both IT and non IT) that may allow for interactions throughout the facility and require less frequent face to face interactions between CNAs and RNs or LPNs to verify orders or report patient status. Results from this study provide insight into the design and assessment of different forms of communication to support clinical work in NHs.Relevance to industryNurses bear great burdens for nursing home care; yet, issues persist with poor quality, variable performance of caregiving, and lack of implementation of proven care interventions. One new hope for improvement in nursing home care is the introduction of IT to improve communication, clinical decision-making, and quality of care.     

A preliminary study on the use of clinical care classification in nursing documentation data sets

This study analyzed and organized the content coverage of the clinical care classification (CCC) system to represent nursing record data in a medical center in Taiwan. The nursing care plan was analyzed using the process of knowledge discovery in the data set. The nursing documentation was mapped based on the full list of nursing diagnoses and interventions available using the CCC system. The result showed that 75.45% of the documented diagnosis terms can be mapped using the CCC system. A total of 21 established nursing diagnoses were recommended for inclusion in the CCC system. The results also showed that 30.72% of assessment/monitor tasks and 31.16% of care/perform tasks were provided by nursing professionals, whereas manage/refer actions accounted for 15.36% of the tasks involved in nursing care. The results showed that the CCC system is a suitable clinical information system for the majority of nursing care documentation, and is useful for determining the patterns in nursing practices.     

Evaluating Bar Coding‐Aided Medication Administration through Identification of Nursing Work Deficiencies

Health care information technology (IT) systems manage administrative and clinical processes more accurately and efficiently. However, their effects on clinical work flow are still not fully understood. In this article, we investigate the bar‐coded medication administration (BCMA) system for its effect on nurses working in inpatient departments. Evaluation is applied by examining work deficiencies before and after the IT system implementation based on a proposed nursing work model. A list of nurse‐perceived risks of work deficiencies related to the current BCMA system has been identified. Results show five main deficiencies that are mainly related to aspects of the IT environment and work schedule/process, including increased workload, IT systems downtime, unclear orders/task schedules, reduced time for patient‐care tasks, and redundant documentation. This study emphasizes the importance of understanding the reciprocal relationship between IT implementation and health care work system. © 2012 Wiley Periodicals, Inc.     

Web-enabled smart card for ubiquitous access of patient's medical record

The combined benefits of smart card to support mobility in a pocket coupled with the ubiquitous access of Web technology, present a new paradigm for medical information access systems. The paper describes the framework of Java Card Web Servlet (JCWS) that is being developed to provide seamless access interface between a Web browser and a Java-enabled smart card. Importantly, the smart card is viewed as a mobile repository of Web objects comprised of HTML pages, medical data objects, and record browsing and updating applet. As the patient moves between hospitals, clinics and countries, the mobility of the smart-card database dynamically binds to the JCWS framework to facilitate a truly ubiquitous access and updating of medical information via a standard Web-browser interface.     

Balancing documentation and direct patient care activities: A study of a mature electronic health record system

US hospitals now fully embrace electronic documentation systems as a way to reduce medical errors and improve patient safety outcomes. Whether spending time on electronic documentation detracts from the time available for direct patient care, however, is still unresolved. There is no knowledge on the permanent effects of documenting electronically and whether it takes away significant time from patient care when the healthcare information system is mature. To understand the time spent on documentation, direct patient care tasks, and other clinical tasks in a mature information system, we conducted an observational and interview study in a midwestern academic hospital. The hospital implemented an electronic medical record system 11 years ago. We observed 22 health care workers across intensive care units, inpatient floors, and an outpatient clinic in the hospital. Results show that healthcare workers spend more time on documentation activities compared to patient care activities. Clinical roles have no influence on the time spent on documentation. This paper describes results on the time spent between documentation and patient care tasks, and discusses implications for future practice.Relevance to industryThe study applies to healthcare industry that faces immense challenges in balancing documentation activities and patient care activities.