Improving usefulness of eHealth systems through Information Accountability

With the implementation of the Personally Controlled eHealth Records system (PCEHR) in Australia, shared Electronic Health Records (EHR) are now a reality. However, the characteristic implicit in the PCEHR that puts the consumer (i.e. patient) in control of managing his or her health information within the PCEHR prevents healthcare professionals (HCPs) from utilising it as a one-stop-shop for information at point of care decision making as they cannot trust that a complete record of the consumer's health history is available to them through it. As a result, whilst reaching a major milestone in Australia's eHealth journey, the PCEHR does not reap the full benefits that such a shared EHR system can offer.

eHealth and the modern society

The integration of Information and Communication Technologies (ICT) into healthcare processes “eHealth” is driving enormous change in healthcare delivery and productivity. The transformations empower patients and present opportunities for new synergies between healthcare professionals, clinical decision makers, policy makers and educators. Technologies that are directly driving changes include Tele-medicine, Electronic health records (EHR), Standards to ensure computer systems inter-operate, Decision support systems, Data mining and easy access to medical information. This workshop provides an introduction to key informatics initiatives in eHealth using real examples and suggests how applications can be applied to modern society.

Sharing of clinical data in a maternity setting: How do paper hand-held records and electronic health records compare for completeness?

Background Historically, the paper hand-held record (PHR) has been used for sharing information between hospital clinicians, general practitioners and pregnant women in a maternity shared-care environment. Recently in alignment with a National e-health agenda, an electronic health record (EHR) was introduced at an Australian tertiary maternity service to replace the PHR for collection and transfer of data. The aim of this study was to examine and compare the completeness of clinical data collected in a PHR and an EHR. Methods We undertook a comparative cohort design study to determine differences in completeness between data collected from maternity records in two phases. Phase 1 data were collected from the PHR and Phase 2 data from the EHR. Records were compared for completeness of best practice variables collected The primary outcome was the presence of best practice variables and the secondary outcomes were the differences in individual variables between the records. Results Ninety-four percent of paper medical charts were available in Phase 1 and 100% of records from an obstetric database in Phase 2. No PHR or EHR had a complete dataset of best practice variables. The variables with significant improvement in completeness of data documented in the EHR, compared with the PHR, were urine culture, glucose tolerance test, nuchal screening, morphology scans, folic acid advice, tobacco smoking, illicit drug assessment and domestic violence assessment (p = 0.001). Additionally the documentation of immunisations (pertussis, hepatitis B, varicella, fluvax) were markedly improved in the EHR (p = 0.001). The variables of blood pressure, proteinuria, blood group, antibody, rubella and syphilis status, showed no significant differences in completeness of recording. Conclusion This is the first paper to report on the comparison of clinical data collected on a PHR and EHR in a maternity shared-care setting. The use of an EHR demonstrated significant improvements to the collection of best practice variables. Additionally, the data in an EHR were more available to relevant clinical staff with the appropriate log-in and more easily retrieved than from the PHR. This study contributes to an under-researched area of determining data quality collected in patient records.

Data driven and practice-based evidence : design and development of efficient and effective clinical decision support system

Decision-making is such an integral aspect in health care routine that the ability to make the right decisions at crucial moments can lead to patient health improvements. Evidence-based practice, the paradigm used to make those informed decisions, relies on the use of current best evidence from systematic research such as randomized controlled trials. Limitations of the outcomes from randomized controlled trials (RCT), such as “quantity” and “quality” of evidence generated, has lowered healthcare professionals’ confidence in using EBP. An alternate paradigm of Practice-Based Evidence has evolved with the key being evidence drawn from practice settings. Through the use of health information technology, electronic health records (EHR) capture relevant clinical practice “evidence”. A data-driven approach is proposed to capitalize on the benefits of EHR. The issues of data privacy, security and integrity are diminished by an information accountability concept. Data warehouse architecture completes the data-driven approach by integrating health data from multi-source systems, unique within the healthcare environment.

Paper and electronic antenatal records: What do women and health care providers tell us about their use?

The antenatal paper hand-held record (PHR) has been used extensively in general practice (GP) shared-care management of pregnant women, but recently the antenatal electronic health record (EHR) was introduced. This study aimed to examine the experiences of women and health care providers who use the PHR and the EHR, and find out the relative role of these records in the integration of care. Purposive homogenous samples of women and health care providers were interviewed as users of the PHR in phase 1 and the EHR in phase 2 of the study. Qualitative data were collected via interview with women and GPs and focus groups held with hospital health care providers. Interviews were coded manually and analysed using qualitative content analysis. Fifteen women participated in phase 1 and 12 in phase 2. Seventeen GPs participated in phase 1 and 15 in phase 2. Five focus groups with hospital health care providers were conducted in each phase. Results were categorised into four themes: 1. Record purpose; 2. Perception of the record; 3. Content of the record, and; 4. Sharing information in the record. Both women and health care providers were familiar with the PHR, but identified that some information was missing or not utilised well, and reported underuse of the EHR. The study identified continued widespread use of the PHR and several issues concerning the use of the EHR. An improvement in the strategic implementation of the EHR is suggested as a mechanism to facilitate its wider adoption.

Quality of information for quality of life: Healthcare big data analytics

Big data analysis in healthcare sector is still in its early stages when comparing with that of other business sectors due to numerous reasons. Accommodating the volume, velocity and variety of healthcare data Identifying platforms that examine data from multiple sources, such as clinical records, genomic data, financial systems, and administrative systems Electronic Health Record (EHR) is a key information resource for big data analysis and is also composed of varied co-created values. Successful integration and crossing of different subfields of healthcare data such as biomedical informatics and health informatics could lead to huge improvement for the end users of the health care system, i.e. the patients.

Information Accountability of Healthcare Big Data

Huge amount of data are generated from a variety of information sources in healthcare while the data sources originate from a veracity of clinical information systems and corporate data warehouses. The data derived from the above data sources are used for analysis and trending purposes thus playing an influential role as a real time decision-making tool. The unstructured, narrative data provided by these data sources qualify as healthcare big-data and researchers argue that the application of big-data in healthcare might enable the accountability and efficiency.

Adopting healthcare big data in Sri Lankan healthcare sector

The concept of big data has already outperformed traditional data management efforts in almost all industries. Other instances it has succeeded in obtaining promising results that provide value from large-scale integration and analysis of heterogeneous data sources for example Genomic and proteomic information. Big data analytics have become increasingly important in describing the data sets and analytical techniques in software applications that are so large and complex due to its significant advantages including better business decisions, cost reduction and delivery of new product and services [1]. In a similar context, the health community has experienced not only more complex and large data content, but also information systems that contain a large number of data sources with interrelated and interconnected data attributes. That have resulted in challenging, and highly dynamic environments leading to creation of big data with its enumerate complexities, for instant sharing of information with the expected security requirements of stakeholders. When comparing big data analysis with other sectors, the health sector is still in its early stages. Key challenges include accommodating the volume, velocity and variety of healthcare data with the current deluge of exponential growth. Given the complexity of big data, it is understood that while data storage and accessibility are technically manageable, the implementation of Information Accountability measures to healthcare big data might be a practical solution in support of information security, privacy and traceability measures. Transparency is one important measure that can demonstrate integrity which is a vital factor in the healthcare service. Clarity about performance expectations is considered to be another Information Accountability measure which is necessary to avoid data ambiguity and controversy about interpretation and finally, liability [2]. According to current studies [3] Electronic Health Records (EHR) are key information resources for big data analysis and is also composed of varied co-created values [3]. Common healthcare information originates from and is used by different actors and groups that facilitate understanding of the relationship for other data sources. Consequently, healthcare services often serve as an integrated service bundle. Although a critical requirement in healthcare services and analytics, it is difficult to find a comprehensive set of guidelines to adopt EHR to fulfil the big data analysis requirements. Therefore as a remedy, this research work focus on a systematic approach containing comprehensive guidelines with the accurate data that must be provided to apply and evaluate big data analysis until the necessary decision making requirements are fulfilled to improve quality of healthcare services. Hence, we believe that this approach would subsequently improve quality of life.

Managing and sharing health data through information accountability protocols

Concerns over the security and privacy of patient information are one of the biggest hindrances to sharing health information and the wide adoption of eHealth systems. At present, there are competing requirements between healthcare consumers' (i.e. patients) requirements and healthcare professionals' (HCP) requirements. While consumers want control over their information, healthcare professionals want access to as much information as required in order to make well-informed decisions and provide quality care. In order to balance these requirements, the use of an Information Accountability Framework devised for eHealth systems has been proposed. In this paper, we take a step closer to the adoption of the Information Accountability protocols and demonstrate their functionality through an implementation in FluxMED, a customisable EHR system.

Empowering the consumer through Accountable-eHealth (AeH) systems

Allowing consumers to designate preferred healthcare professionals; Accountable-eHealth systems create a transparent and accountable eHealth environment for better healthcare delivery.

An information accountability perspective to eHealth security and privacy

Rigid security boundaries hinder the proliferation of eHealth. Through active audit logs, accountable-eHealth systems alleviate privacy concerns and enhance information availability.

Modelagem do padrão TISS por meio do enfoque dual da Fundação openEHR

Em 2005, a Agência Nacional de Saúde Suplementar (ANS) estabelece o padrão TISS (Troca de Informação na Saúde Suplementar), intercâmbio eletrônico obrigatório entre as operadoras de planos de saúde (cerca de 1500 registradas na ANS) e prestadores de serviços (cerca de 200 mil) sobre os eventos de assistência prestados aos beneficiários. O padrão TISS foi desenvolvido seguindo a estrutura do Comitê ISO/TC215 de padrões para informática em saúde e se divide em quatro partes: conteúdo e estrutura, que compreende a estrutura das guias em papel; representação de conceitos em saúde, que se refere às tabelas de domínio e vocabulários em saúde; comunicação, que contempla as mensagens eletrônicas; e segurança e privacidade, seguindo recomendação do Conselho Federal de Medicina (CFM). Para aprimorar sua metodologia de evolução, essa presente tese analisou o grau de interoperabilidade do padrão TISS segundo a norma ISO 20514 (ISO 20514, 2005) e a luz do modelo dual da Fundação openEHR, que propõe padrões abertos para arquitetura e estrutura do Registro Eletrônico de Saúde (RES). O modelo dual da Fundação openEHR é composto, no primeiro nível, por um modelo de referência genérico e, no segundo, por um modelo de arquétipos, onde se detalham os conceitos e atributos. Dois estudos foram realizados: o primeiro se refere a um conjunto de arquétipos demográficos elaborados como proposta de representação da informação demográfica em saúde, baseado no modelo de referência da Fundação openEHR. O segundo estudo propõe um modelo de referência genérico, como aprimoramento das especificações da Fundação openEHR, para representar o conceito de submissão de autorização e contas na saúde, assim como um conjunto de arquétipos. Por fim, uma nova arquitetura para construção do padrão TISS é proposta, tendo como base o modelo dual da Fundação openEHR e como horizonte a evolução para o RES centrado no paciente

金环蛇毒心脏毒对S180,EAC腹水癌细胞的细胞毒性作用

目的: 探讨金环蛇毒心脏毒对S180, EAC 腹水癌细胞的细胞毒作用。方法: 采用小白鼠腹腔和皮下接种S180, EAC 腹 水癌细胞造成小白鼠腹水模型后腹腔注射金环蛇毒心脏毒。结果: 腹腔注射金环蛇毒心脏毒, 能抑制肿瘤细胞的生长, 降低接 种率。但不能完全控制腹水和癌细胞的生长。体外试验表明有明显的细胞毒作用。台酚蓝染色镜检可见死细胞显著增加, 腹 水图片检查, 给药后细胞膜破裂, 纤维化坏死明显。结论: 能延长小白鼠存活时间。

金环蛇蛇毒对S180, EAC 腹水癌细胞的细胞毒性作用

　目的　探讨金环蛇毒对S180, EAC 腹水癌细胞的细胞毒性作用。　方法　采用小白鼠腹腔和皮下 接种S180, EAC 腹水癌细胞造成小白鼠腹水模型后腹腔注射金环蛇毒。　结果　腹腔注射金环蛇毒, 能 抑制肿瘤细胞的生长, 降低接种率。但不能完全控制腹水和癌细胞的生长。体外试验表明有明显的细胞毒 作用。台酚蓝染色镜检可见死细胞显著增加, 腹水图片检查给药后细胞膜破裂, 纤维化坏死明显。　结论 　能延长小白鼠存活时间。

The vertical microdistribution of cyanobacteria and green algae within desert crusts and the development of the algal crusts

Substantial amounts of algal crusts were collected from five different desert experimental sites aged 42, 34, 17, 8 and 4 years, respectively, at Shapotou ( China) and analyzed at a 0.1 mm microscale of depth. It was found that the vertical distribution of cyanobacteria and microalgae in the crusts was distinctly laminated into an inorganic-layer (ca. 0.00 - 0.02 mm, with few algae), an algae-dense-layer ( ca. 0.02 - 1.0 mm) and an algae-sparse-layer ( ca. 1.0 - 5.0 mm). It was interesting to note that in all crusts Scytonema javanicum Born et Flah ( or Nostoc sp., cyanobacterium), Desmococcus olivaceus (Pers ex Ach., green alga) Laundon and Microcoleus vaginatus Gom. ( cyanobacterium) dominated at the depth of 0.02 - 0.05, 0.05 - 0.1 and 0.1 - 1.0 mm, respectively, from the surface. Phormidium tenue Gom. ( or Lyngbya cryptovaginatus Schk., cyanobacterium) and Navicula cryptocephala Kutz.( or Hantzschia amphioxys (Ehr.) Grun. and N. cryptocephala together, diatom) dominated at the depth of 1.0 - 3.0 and 3.5 - 4.0 mm, respectively, of the crusts from the 42 and 34 year old sites. It was apparent that in more developed crusts there were more green algae and the niches of Nostoc sp., Chlorella vulgaris Beij., M. vaginatus, N. cryptocephala and fungi were nearer to the surface. If lichens and mosses accounted for less than 41.5% of the crust surface, algal biovolume was bigger when the crust was older, but the opposite was true when the cryptogams other than algae covered more than 70%. In addition to detailed species composition and biovolume, analyses of soil physicochemical properties, micromorphologies and mineral components were also performed. It was found that the concentration of organic matter and nutrients, electric conductivity, silt, clay, secondary minerals were higher and there were more micro-beddings in the older crusts than the less developed ones. Possible mechanisms for the algal vertical microdistribtion at different stages and the impact of soil topography on crust development are discussed. It is concluded that biomethods ( such as fine species distribution and biovolume) were more precise than mineralogical approaches in judging algal crust development and thus could be a better means to measure the potentiality of algal crusts in desert amelioration.