Providing User Security Guarantees in Public Infrastructure Clouds

The infrastructure cloud (IaaS) service model offers improved resource flexibility and availability, where tenants - insulated from the minutiae of hardware maintenance - rent computing resources to deploy and operate complex systems. Large-scale services running on IaaS platforms demonstrate the viability of this model; nevertheless, many organizations operating on sensitive data avoid migrating operations to IaaS platforms due to security concerns. In this paper, we describe a framework for data and operation security in IaaS, consisting of protocols for a trusted launch of virtual machines and domain-based storage protection. We continue with an extensive theoretical analysis with proofs about protocol resistance against attacks in the defined threat model. The protocols allow trust to be established by remotely attesting host platform configuration prior to launching guest virtual machines and ensure confidentiality of data in remote storage, with encryption keys maintained outside of the IaaS domain. Presented experimental results demonstrate the validity and efficiency of the proposed protocols. The framework prototype was implemented on a test bed operating a public electronic health record system, showing that the proposed protocols can be integrated into existing cloud environments.

Improving the use of the nursing process: the impact of charting methodology developed from King's conceptual framework on the use of the nursing process

The purpose of this study was to assess the effects of changing a nursing documentation system, developed from King's Conceptual Framework, on the use of the nursing process. The null hypothesis was that there would be no significant increase in the reflection of the use of the nursing process on the nursing care plan or nurses' notes, as a result of using a nursing documentation system developed using King's Conceptual Framework (1981). The design involved the development of a questionnaire that was used to review health records pre and post implementation of a documentation system developed based on King's Conceptual Framework and Theory of Goal Attainment (1981). A Record Completeness Score was obtained from some of the questions. The null hypothesis was rejected. The results of the study have implications for nursing administration and the evaluation of nursing practice. If the use of a documentation system developed from a conceptual framework increases the reflection of the nursing process on the patient's health record, nursing will have the means to measure patient outcomes/goal attainment. All health care organizations and levels of government are focusing on methods to monitor and control the health-care dollar. In order for nursing to clearly determine the costs associated with nursing care, measurement of patient outcomes/goal attainment will need to be possible. In order to measure patient outcomes/goals attainment nurses will need to be able to collect data on their practice. It will be critical that nursing have a documentation system in place which facilitates the reflection of the nursing process within a theoretical framework.

Analyse de la logique d’intervention d’une adaptation québécoise d’un modèle de soins centré sur le patient appuyé par un dossier médical personnel dans les suivis pédiatriques au sein d’un groupe de médecine de famille

Dans l'optique d'améliorer la performance des services de santé en première ligne, un projet d'implantation d'une adaptation québécoise d'un modèle de soins centré sur le patient appuyé par un dossier médical personnel (DMP) a été mis sur pied au sein d'un groupe de médecine familiale (GMF) de la région de Montréal. Ainsi, ce mémoire constitue une analyse comparative entre la logique de l'intervention telle qu'elle est décrite dans les données probantes concernant les modèles de soins centrés sur le patient et le dossier médical personnel ainsi que la logique de l'intervention issue de nos résultats obtenus dans le cadre de ce projet au sein d'un GMF. L'analyse organisationnelle se situe durant la phase de pré-déploiement de l'intervention. Les principaux résultats sont que la logique d'intervention appliquée dans le cadre du projet est relativement éloignée de ce qui se fait de mieux dans la littérature sur le sujet. Ceci est en partie explicable par les différentes résistances en provenance des acteurs du projet (ex. médecins, infirmières, fournisseur technologique) dans le projet, mais aussi par l'absence de l'interopérabilité entre le DMP et le dossier médical électronique (DME). Par ailleurs, les principaux effets attendus par les acteurs impliqués sont l'amélioration de la continuité informationnelle, de l’efficacité-service, de la globalité et de la productivité. En outre, l’implantation d’un modèle centré sur le patient appuyé par un DMP impliquerait la mise en œuvre d’importantes transformations structurelles comme une révision du cadre législatif (ex. responsabilité médicale) et des modes de rémunérations des professionnels de la santé, sans quoi, les effets significatifs sur les dimensions de la performance comme l’accessibilité, la qualité, la continuité, la globalité, la productivité, l’efficacité et la réactivité pourraient être limités. Ces aménagements structuraux devraient favoriser la collaboration interprofessionnelle, l'interopérabilité des systèmes, l’amélioration de la communication multidirectionnelle (patient-professionnel de la santé) ainsi qu'une autogestion de la santé supportée (ex. éducation, prévention, transparence) par les professionnels de la santé.

HealthConnect and the duty of care: a dilemma for medical practitioners

This article asks whether medical practitioners' duty of care to their patients will encompass participation in the HealthConnect shared electronic records initiative. Medico-legal aspects of the HeathConnect scheme relating to the nature of shared electronic health record summaries (SEHRS) are examined, focusing on their function as an element of patient care and their ultimate purpose. The analysis is based on the premise that an incomplete and hence inaccurate shared electronic health record summary is clinically and legally more perilous than no record at all.

Cartão de residente municipal: instrumento para aprimoramento da gestão no município: o caso de Louveira, SP

Para implementar políticas públicas nos municípios, um dos problemas é a ausência de dados que informem a realidade da situação local, o que evidencia o benefício e a necessidade dos instrumentos de tecnologia de informação para maior eficiência e eficácia na gestão pública. No município de Louveira, analisou-se o caso específico da implantação de uma ferramenta da tecnologia de informação que é utilizado por toda a prefeitura, denominado no local como Cartão Cidadão, que visa documentar o acesso e utilização dos serviços públicos municipais, porém no estudo do caso foi realizado um corte para averiguar o instrumento como estratégia de gestão para aprimorar o planejamento no município, mais precisamente na área da saúde. A gestão do sistema do Cartão Cidadão aliado aos registros em prontuário eletrônico de saúde deram maior confiabilidade ao banco de dados da saúde municipal, possibilitando averiguar e traçar estratégia definida para a gestão do Sistema Único de Saúde (SUS) local, assim como permitiu melhor averiguação dos desvios do sistema. Finalmente, apresentamos questionamentos sobre o sistema SUS frente a municipalização e ainda sobre e a questões do pacto de saúde e do próprio pacto federativo brasileiro.

RP97-362 File It Easy, Find It Fast: A Home Filing System

A home filing system makes important papers readily available when needed. If managed properly, the filing system can get older papers out of the way, making needed records more accessible. A well-organized filing system for your household can pay big dividends when it comes time to find an important paper you need NOW. There is no one best filing system for everyone; what works for you could be a disaster for someone else. Once set up, a filing system helps you to be a more effective and efficient financial manager and decision maker.

Interoperabilità tra frammenti E.H.R. e coordinamento semantico

La tesi si propone di esaminare le tematiche della rappresentazione della conoscenza in termini di Electronic Health Record (EHR), della loro interoperabilità nei sistemi di e-Health, e del ruolo del coordinamento semantico nella costruzione di sistemi di e-Health basati su EHR.

Il fascicolo sanitario elettronico tra Semantic Web e diritto alla privacy

Principale obiettivo della ricerca è quello di ricostruire lo stato dell’arte in materia di sanità elettronica e Fascicolo Sanitario Elettronico, con una precipua attenzione ai temi della protezione dei dati personali e dell’interoperabilità. A tal fine sono stati esaminati i documenti, vincolanti e non, dell’Unione europea nonché selezionati progetti europei e nazionali (come “Smart Open Services for European Patients” (EU); “Elektronische Gesundheitsakte” (Austria); “MedCom” (Danimarca); “Infrastruttura tecnologica del Fascicolo Sanitario Elettronico”, “OpenInFSE: Realizzazione di un’infrastruttura operativa a supporto dell’interoperabilità delle soluzioni territoriali di fascicolo sanitario elettronico nel contesto del sistema pubblico di connettività”, “Evoluzione e interoperabilità tecnologica del Fascicolo Sanitario Elettronico”, “IPSE - Sperimentazione di un sistema per l’interoperabilità europea e nazionale delle soluzioni di Fascicolo Sanitario Elettronico: componenti Patient Summary e ePrescription” (Italia)). Le analisi giuridiche e tecniche mostrano il bisogno urgente di definire modelli che incoraggino l’utilizzo di dati sanitari ed implementino strategie effettive per l’utilizzo con finalità secondarie di dati sanitari digitali , come Open Data e Linked Open Data. L’armonizzazione giuridica e tecnologica è vista come aspetto strategico per ridurre i conflitti in materia di protezione di dati personali esistenti nei Paesi membri nonché la mancanza di interoperabilità tra i sistemi informativi europei sui Fascicoli Sanitari Elettronici. A questo scopo sono state individuate tre linee guida: (1) armonizzazione normativa, (2) armonizzazione delle regole, (3) armonizzazione del design dei sistemi informativi. I principi della Privacy by Design (“prottivi” e “win-win”), così come gli standard del Semantic Web, sono considerate chiavi risolutive per il suddetto cambiamento.

DEVELOPING A METHOD FOR IDENTIFYING AND REDUCING FUNCTIONAL DISCREPANCIES OF INFORMATION SYSTEMS

Currently more than half of Electronic Health Record (EHR) projects fail. Most of these failures are not due to flawed technology, but rather due to the lack of systematic considerations of human issues. Among the barriers for EHR adoption, function mismatching among users, activities, and systems is a major area that has not been systematically addressed from a human-centered perspective. A theoretical framework called Functional Framework was developed for identifying and reducing functional discrepancies among users, activities, and systems. The Functional Framework is composed of three models – the User Model, the Designer Model, and the Activity Model. The User Model was developed by conducting a survey (N = 32) that identified the functions needed and desired from the user’s perspective. The Designer Model was developed by conducting a systemic review of an Electronic Dental Record (EDR) and its functions. The Activity Model was developed using an ethnographic method called shadowing where EDR users (5 dentists, 5 dental assistants, 5 administrative personnel) were followed quietly and observed for their activities. These three models were combined to form a unified model. From the unified model the work domain ontology was developed by asking users to rate the functions (a total of 190 functions) in the unified model along the dimensions of frequency and criticality in a survey. The functional discrepancies, as indicated by the regions of the Venn diagrams formed by the three models, were consistent with the survey results, especially with user satisfaction. The survey for the Functional Framework indicated the preference of one system over the other (R=0.895). The results of this project showed that the Functional Framework provides a systematic method for identifying, evaluating, and reducing functional discrepancies among users, systems, and activities. Limitations and generalizability of the Functional Framework were discussed.

Clinical decision support capabilities of commercially-available clinical information systems.

BACKGROUND: The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized provider order entry (CPOE) systems. Purpose The goal of this project was to describe and quantify the results of a study of decision support capabilities in Certification Commission for Health Information Technology (CCHIT) certified electronic health record systems. METHODS: The authors conducted a series of interviews with representatives of nine commercially available clinical information systems, evaluating their capabilities against 42 different clinical decision support features. RESULTS: Six of the nine reviewed systems offered all the applicable event-driven, action-oriented, real-time clinical decision support triggers required for initiating clinical decision support interventions. Five of the nine systems could access all the patient-specific data items identified as necessary. Six of the nine systems supported all the intervention types identified as necessary to allow clinical information systems to tailor their interventions based on the severity of the clinical situation and the user's workflow. Only one system supported all the offered choices identified as key to allowing physicians to take action directly from within the alert. Discussion The principal finding relates to system-by-system variability. The best system in our analysis had only a single missing feature (from 42 total) while the worst had eighteen.This dramatic variability in CDS capability among commercially available systems was unexpected and is a cause for concern. CONCLUSIONS: These findings have implications for four distinct constituencies: purchasers of clinical information systems, developers of clinical decision support, vendors of clinical information systems and certification bodies.

Patient-centered medical home technology effects on hypertension and diabetes control

Background: Hypertension and Diabetes is a public health and economic concern in the United States. The utilization of medical home concepts increases the receipt of preventive services, however, do they also increase adherence to treatments? This study examined the effect of patient-centered medical home technologies such as the electronic health record, clinical support system, and web-based care management in improving health outcomes related to hypertension and diabetes. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question " Do patient-centered medical home technologies have an effect of diabetes and hypertension treatment?" This was followed by an evaluation of specific examples of the technologies utilized such as computer-assisted recommendations and web-based care management provided by the patient's electronic health record. Ebsco host, Ovid host, and Google Scholar were the databases used to conduct the literature search. Results: The initial search identified over 25 studies based on content and quality that implemented technology interventions to improve communication between provider and patient. After further assessing the articles for risk of bias and study design, 13 randomized controlled studies were chosen. All of the studies chosen were conducted in various primary care settings in both private practices and hospitals between the years 2000 and 2007. The sample sizes of the studies ranged from 42 to 2924 participants. The mean age for all of the studies ranged from 56 to 71 years. The percent women in the studies ranged from one to 78 percent. Over one-third of the studies did not provide the racial composition of the participants. For the seven studies that did provide information about the ethnic composition, 64% of the intervention participants were White. All of the studies utilized some type of web-based or computer-based communication to manage hypertension or diabetes care. Findings on outcomes were mixed, with nine out of 13 studies showing no significant effect on outcomes examined, and four of the studies showing significant and positive impact on health outcomes related to hypertension or diabetes Conclusion: Although the technologies improved patient and provider satisfaction, the outcomes measures such as blood pressure control and glucose control were inconclusive. Further research is needed with diverse ethnic and SES population to investigate the role of patient-centered technologies on hypertension and diabetes control. Also, further research is needed to investigate the effects of innovative medical home technologies that can be used by both patients and providers to increase quality of communication concerning adherence to treatments.^

Diseño e implementación de un algoritmo para la detección de la negación de textos clínicos en español

Vivimos en una época en la que cada vez existe una mayor cantidad de información. En el dominio de la salud la historia clínica digital ha permitido digitalizar toda la información de los pacientes. Estas historias clínicas digitales contienen una gran cantidad de información valiosa escrita en forma narrativa que sólo podremos extraer recurriendo a técnicas de procesado de lenguaje natural. No obstante, si se quiere realizar búsquedas sobre estos textos es importante analizar que la información relativa a síntomas, enfermedades, tratamientos etc. se puede refererir al propio paciente o a sus antecentes familiares, y que ciertos términos pueden aparecer negados o ser hipotéticos. A pesar de que el español ocupa la segunda posición en el listado de idiomas más hablados con más de 500 millones de hispano hablantes, hasta donde tenemos de detección de la negación, probabilidad e histórico en textos clínicos en español. Por tanto, este Trabajo Fin de Grado presenta una implementación basada en el algoritmo ConText para la detección de la negación, probabilidad e histórico en textos clínicos escritos en español. El algoritmo se ha validado con 454 oraciones que incluían un total de 1897 disparadores obteniendo unos resultado de 83.5 %, 96.1 %, 96.9 %, 99.7% y 93.4% de exactitud con condiciones afirmados, negados, probable, probable negado e histórico respectivamente. ---ABSTRACT---We live in an era in which there is a huge amount of information. In the domain of health, the electronic health record has allowed to digitize all the information of the patients. These electronic health records contain valuable information written in narrative form that can only be extracted using techniques of natural language processing. However, if you want to search on these texts is important to analyze if the relative information about symptoms, diseases, treatments, etc. are referred to the patient or family casework, and that certain terms may appear negated or be hypothesis. Although Spanish is the second spoken language with more than 500 million speakers, there seems to be no method of detection of negation, hypothesis or historical in medical texts written in Spanish. Thus, this bachelor’s final degree presents an implementation based on the ConText algorithm for the detection of negation, hypothesis and historical in medical texts written in Spanish. The algorithm has been validated with 454 sentences that included a total of 1897 triggers getting a result of 83.5 %, 96.1 %, 96.9 %, 99.7% and 93.4% accuracy with affirmed, negated, hypothesis, negated hypothesis and historical respectively.

Clinical Phenotyping in the Prediction of Pediatric Acute Kidney Injury

Thesis (Master's)--University of Washington, 2016-06

Exploiting sensitivity of nonorthogonal joint diagonalisation as a security mechanism in steganography

We have recently proposed the framework of independent blind source separation as an advantageous approach to steganography. Amongst the several characteristics noted was a sensitivity to message reconstruction due to small perturbations in the sources. This characteristic is not common in most other approaches to steganography. In this paper we discuss how this sensitivity relates the joint diagonalisation inside the independent component approach, and reliance on exact knowledge of secret information, and how it can be used as an additional and inherent security mechanism against malicious attack to discovery of the hidden messages. The paper therefore provides an enhanced mechanism that can be used for e-document forensic analysis and can be applied to different dimensionality digital data media. In this paper we use a low dimensional example of biomedical time series as might occur in the electronic patient health record, where protection of the private patient information is paramount.

Mobile case-based decision support for intelligent patient knowledge management

Hospitals everywhere are integrating health data using electronic health record (EHR) systems, and disparate and multimedia patient data can be input by different caregivers at different locations as encapsulated patient profiles. Healthcare institutions are also using the flexibility and speed of wireless computing to improve quality and reduce costs. We are developing a mobile application that allows doctors to efficiently record and access complete and accurate real-time patient information. The system integrates medical imagery with textual patient profiles as well as expert interactions by healthcare personnel using knowledge management and case-based reasoning techniques. The application can assist other caregivers in searching large repositories of previous patient cases. Patients' symptoms can be input to a portable device and the application can quickly retrieve similar profiles which can be used to support effective diagnoses and prognoses by comparing symptoms, treatments, diagnosis, test results and other patient information. © 2007 Sage Publications.