Feasibility and acceptance of electronic quality of life assessment in general practice: an implementation study

Background Patients' health related quality of life (HRQoL) has rarely been systematically monitored in general practice. Electronic tools and practice training might facilitate the routine application of HRQoL questionnaires. Thorough piloting of innovative procedures is strongly recommended before the conduction of large-scale studies. Therefore, we aimed to assess i) the feasibility and acceptance of HRQoL assessment using tablet computers in general practice, ii) the perceived practical utility of HRQoL results and iii) to identify possible barriers hindering wider application of this approach. Methods Two HRQoL questionnaires (St. George's Respiratory Questionnaire SGRQ and EORTC QLQ-C30) were electronically presented on portable tablet computers. Wireless network (WLAN) integration into practice computer systems of 14 German general practices with varying infrastructure allowed automatic data exchange and the generation of a printout or a PDF file. General practitioners (GPs) and practice assistants were trained in a 1-hour course, after which they could invite patients with chronic diseases to fill in the electronic questionnaire during their waiting time. We surveyed patients, practice assistants and GPs regarding their acceptance of this tool in semi-structured telephone interviews. The number of assessments, HRQoL results and interview responses were analysed using quantitative and qualitative methods. Results Over the course of 1 year, 523 patients filled in the electronic questionnaires (1–5 times; 664 total assessments). On average, results showed specific HRQoL impairments, e.g. with respect to fatigue, pain and sleep disturbances. The number of electronic assessments varied substantially between practices. A total of 280 patients, 27 practice assistants and 17 GPs participated in the telephone interviews. Almost all GPs (16/17 = 94%; 95% CI = 73–99%), most practice assistants (19/27 = 70%; 95% CI = 50–86%) and the majority of patients (240/280 = 86%; 95% CI = 82–91%) indicated that they would welcome the use of electronic HRQoL questionnaires in the future. GPs mentioned availability of local health services (e.g. supportive, physiotherapy) (mean: 9.4 ± 1.0 SD; scale: 1 – 10), sufficient extra time (8.9 ± 1.5) and easy interpretation of HRQoL results (8.6 ± 1.6) as the most important prerequisites for their use. They believed HRQoL assessment facilitated both communication and follow up of patients' conditions. Practice assistants emphasised that this process demonstrated an extra commitment to patient centred care; patients viewed it as a tool, which contributed to the physicians' understanding of their personal condition and circumstances. Conclusion This pilot study indicates that electronic HRQoL assessment is technically feasible in general practices. It can provide clinically significant information, which can either be used in the consultation for routine care, or for research purposes. While GPs, practice assistants and patients were generally positive about the electronic procedure, several barriers (e.g. practices' lack of time and routine in HRQoL assessment) need to be overcome to enable broader application of electronic questionnaires in every day medical practice.

Cloud Computing in the EU Policy Sphere Interoperability, Vertical Integration and the Internal Market

Cloud computing is a new development that is based on the premise that data and applications are stored centrally and can be accessed through the Internet. Thisarticle sets up a broad analysis of how the emergence of clouds relates to European competition law, network regulation and electronic commerce regulation, which we relate to challenges for the further development of cloud services in Europe: interoperability and data portability between clouds; issues relating to vertical integration between clouds and Internet Service Providers; and potential problems for clouds to operate on the European Internal Market. We find that these issues are not adequately addressed across the legal frameworks that we analyse, and argue for further research into how to better facilitate innovative convergent services such as cloud computing through European policy – especially in light of the ambitious digital agenda that the European Commission has set out.

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

BACKGROUND Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. METHODS Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. RESULTS Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. CONCLUSION Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

Integration of embedded data processing algorithms inside PAMELA devices

PAMELA (Phased Array Monitoring for Enhanced Life Assessment) SHMTM System is an integrated embedded ultrasonic guided waves based system consisting of several electronic devices and one system manager controller. The data collected by all PAMELA devices in the system must be transmitted to the controller, who will be responsible for carrying out the advanced signal processing to obtain SHM maps. PAMELA devices consist of hardware based on a Virtex 5 FPGA with a PowerPC 440 running an embedded Linux distribution. Therefore, PAMELA devices, in addition to the capability of performing tests and transmitting the collected data to the controller, have the capability of perform local data processing or pre-processing (reduction, normalization, pattern recognition, feature extraction, etc.). Local data processing decreases the data traffic over the network and allows CPU load of the external computer to be reduced. Even it is possible that PAMELA devices are running autonomously performing scheduled tests, and only communicates with the controller in case of detection of structural damages or when programmed. Each PAMELA device integrates a software management application (SMA) that allows to the developer downloading his own algorithm code and adding the new data processing algorithm to the device. The development of the SMA is done in a virtual machine with an Ubuntu Linux distribution including all necessary software tools to perform the entire cycle of development. Eclipse IDE (Integrated Development Environment) is used to develop the SMA project and to write the code of each data processing algorithm. This paper presents the developed software architecture and describes the necessary steps to add new data processing algorithms to SMA in order to increase the processing capabilities of PAMELA devices.An example of basic damage index estimation using delay and sum algorithm is provided.

Paper-like electronic displays: Large-area rubber-stamped plastic sheets of electronics and microencapsulated electrophoretic inks

Electronic systems that use rugged lightweight plastics potentially offer attractive characteristics (low-cost processing, mechanical flexibility, large area coverage, etc.) that are not easily achieved with established silicon technologies. This paper summarizes work that demonstrates many of these characteristics in a realistic system: organic active matrix backplane circuits (256 transistors) for large (≈5 × 5-inch) mechanically flexible sheets of electronic paper, an emerging type of display. The success of this effort relies on new or improved processing techniques and materials for plastic electronics, including methods for (i) rubber stamping (microcontact printing) high-resolution (≈1 μm) circuits with low levels of defects and good registration over large areas, (ii) achieving low leakage with thin dielectrics deposited onto surfaces with relief, (iii) constructing high-performance organic transistors with bottom contact geometries, (iv) encapsulating these transistors, (v) depositing, in a repeatable way, organic semiconductors with uniform electrical characteristics over large areas, and (vi) low-temperature (≈100°C) annealing to increase the on/off ratios of the transistors and to improve the uniformity of their characteristics. The sophistication and flexibility of the patterning procedures, high level of integration on plastic substrates, large area coverage, and good performance of the transistors are all important features of this work. We successfully integrate these circuits with microencapsulated electrophoretic “inks” to form sheets of electronic paper.

Benefits of management systems integration: a literature review

The purpose of this paper is to identify the benefits of integrated management systems by comparing them with the benefits obtained through the individual implementation of ISO 9001 and ISO 14001 standards. The methodology used is a literature review based on an electronic search in the Web of Science, ScienceDirect, Scopus and Emerald databases. Findings show that although some benefits are common regardless the system management type, the benefits obtained with integration are greater than considering management systems separately because of the wider scope considered in integration. This is one of the first papers, to the best of our knowledge, to compare benefits from the two management systems standards when implemented separately and when integrated. In addition, some ideas are proposed for consideration in future research on the internalization of management systems and selection effect.

Approaches and Strategy for Cancer Research and Surveillance Data: Integration, Information Pipeline, Data Models, and Informatics Opportunities

Thesis (Ph.D.)--University of Washington, 2016-04

Investigating factors influencing local government decision makers while adopting integration technologies (IntTech)

The emergence of innovative and revolutionary Integration Technologies (IntTech) has highly influenced the local government authorities (LGAs) in their decision-making process. LGAs that plan to adopt such IntTech may consider this as a serious investment. Advocates, however, claim that such IntTech have emerged to overcome the integration problems at all levels (e.g. data, object and process). With the emergence of electronic government (e-Government), LGAs have turned to IntTech to fully automate and offer their services on-line and integrate their IT infrastructures. While earlier research on the adoption of IntTech has considered several factors (e.g. pressure, technological, support, and financial), inadequate attention and resources have been applied in systematically investigating the individual, decision and organisational context factors, influencing top management's decisions for adopting IntTech in LGAs. It is a highly considered phenomenon that the success of an organisation's operations relies heavily on understanding an individual's attitudes and behaviours, the surrounding context and the type of decisions taken. Based on empirical evidence gathered through two intensive case studies, this paper attempts to investigate the factors that influence decision makers while adopting IntTech. The findings illustrate two different doctrines - one inclined and receptive towards taking risky decisions, the other disinclined. Several underlying rationales can be attributed to such mind-sets in LGAs. The authors aim to contribute to the body of knowledge by exploring the factors influencing top management's decision-making process while adopting IntTech vital for facilitating LGAs' operational reforms.

Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods.

Segmental body composition determination through a bioelectrical very large scale integration (VLSI) system

The purpose of this investigation was to develop new techniques to generate segmental assessments of body composition based on Segmental Bioelectrical Impedance Analysis (SBIA). An equally important consideration was the design, simulation, development, and the software and hardware integration of the SBIA system. This integration was carried out with a Very Large Scale Integration (VLSI) Field Programmable Gate Array (FPGA) microcontroller that analyzed the measurements obtained from segments of the body, and provided full body and segmental Fat Free Mass (FFM) and Fat Mass (FM) percentages. Also, the issues related to the estimate of the body's composition in persons with spinal cord injury (SCI) were addressed and investigated. This investigation demonstrated that the SBIA methodology provided accurate segmental body composition measurements. Disabled individuals are expected to benefit from these SBIA evaluations, as they are non-invasive methods, suitable for paralyzed individuals. The SBIA VLSI system may replace bulky, non flexible electronic modules attached to human bodies. ^

Effects of academic integration on the persistence and achievement of under-prepared college students

The purpose of this dissertation was to examine the effect of academic integration, defined in terms of instructor/student contact, on the persistence of under-prepared college students and the achievement of those who persist. The overall design of this study compared instructor-initiated contact with conventional contact. The dependent variables were persistence, achievement, motivation and anxiety. Information was collected by administering the College-Level Mathematics Test (CLM), the Perceived Affective Contact Questionnaire (PAC), the expectancy and anxiety components of the Motivated Strategies for Learning Questionnaire (MSLQ), a departmental final examination, and by accessing university records. The sample consisted of 130 college algebra students at a large, public university with a Hispanic majority. The main analyses consisted of a 2x2x2 ANOVA (treatment by ethnicity by gender) to test for differences in achievement, t-tests to compare motivation, anxiety and perceived affective contact scores for the two groups, Chi-square tests to assess differences in persistence, and Pearson Product-Moment Correlation to determine the relationship between pretest scores and achievement variables. Results indicated that neither instructor-initiated contact, gender nor ethnicity is related to persistence, motivation or anxiety. A significant disordinal interaction of treatment and ethnicity was observed, with Hispanic experimental students scoring significantly higher on a test of algebra achievement than Hispanic control students. Academic integration, defined in terms of instructor/student contact, has a positive influence on the achievement of Hispanic students. This may imply their positive responsiveness to the relational aspect of contact due to traditional cultural values of interdependence, acquiescence to authority and physical closeness. Such interactive feedback is a means by which students with these values are recognized as members of the university academic community, prompting increased academic effort. Training in contact initiation to promote academic integration is implied, by the results of this study, for instructors dealing with first year students, especially instructors at institutions accommodating instructional methods to the needs of diverse groups.

Integration of Colombian refugees in Costa Rica : an ethnographic approach to the refugees' legal, economic, and social experiences

This qualitative study, based on interviews to 17 refugee families, attempts to identify the reasons behind the lack of integration of Colombian refugees in Costa Rica. The model of Immigrant Modes of Incorporation and the studies of Alejandro Portes and Julia Sensenbrenner about the sources of social capital on migrant communities provided the theoretical framework used to identify the roots of the integration challenges. The findings suggest that Costa Rican policies towards the reception and integration of Colombian refugees are exclusionary. The host labor market is marked by sentiments of xenophobia towards the sample population while reported cases of persecution in the country also inhibit this population's economic integration. The lack of social capital sources contributes to inhibit this community's development, despite their participation in informal networks. There were signs of collective action. Yet, the refugee community fails to come together, while it also seems alienated from the community of Colombian entrepreneurs in Costa Rica.

Integration and querying of heterogeneous, autonomous, distributed database systems

Today, databases have become an integral part of information systems. In the past two decades, we have seen different database systems being developed independently and used in different applications domains. Today's interconnected networks and advanced applications, such as data warehousing, data mining & knowledge discovery and intelligent data access to information on the Web, have created a need for integrated access to such heterogeneous, autonomous, distributed database systems. Heterogeneous/multidatabase research has focused on this issue resulting in many different approaches. However, a single, generally accepted methodology in academia or industry has not emerged providing ubiquitous intelligent data access from heterogeneous, autonomous, distributed information sources. This thesis describes a heterogeneous database system being developed at Highperformance Database Research Center (HPDRC). A major impediment to ubiquitous deployment of multidatabase technology is the difficulty in resolving semantic heterogeneity. That is, identifying related information sources for integration and querying purposes. Our approach considers the semantics of the meta-data constructs in resolving this issue. The major contributions of the thesis work include: (i.) providing a scalable, easy-to-implement architecture for developing a heterogeneous multidatabase system, utilizing Semantic Binary Object-oriented Data Model (Sem-ODM) and Semantic SQL query language to capture the semantics of the data sources being integrated and to provide an easy-to-use query facility; (ii.) a methodology for semantic heterogeneity resolution by investigating into the extents of the meta-data constructs of component schemas. This methodology is shown to be correct, complete and unambiguous; (iii.) a semi-automated technique for identifying semantic relations, which is the basis of semantic knowledge for integration and querying, using shared ontologies for context-mediation; (iv.) resolutions for schematic conflicts and a language for defining global views from a set of component Sem-ODM schemas; (v.) design of a knowledge base for storing and manipulating meta-data and knowledge acquired during the integration process. This knowledge base acts as the interface between integration and query processing modules; (vi.) techniques for Semantic SQL query processing and optimization based on semantic knowledge in a heterogeneous database environment; and (vii.) a framework for intelligent computing and communication on the Internet applying the concepts of our work.

Black children at integration demonstration in Canarsie

General note: Title and date provided by Bettye Lane.