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PubMed1995

National Patient Master Index in Singapore.

It has been the practice of hospitals and medical institutions to keep their patients' medical records. Access to such valuable information will be confined within the respective health institutions if there is no proper infrastructure to facilitate sharing of the information. On the other hand, it has been the wish of medical professionals, as well as patients who frequent hospitals and medical institutions that patients' medical records, especially essential medical conditions, are readily available, whenever required, regardless of the health institution by which the patient is being attended to. In response, the National Patient Master Index (NPMI) system was conceived and implemented by the Singapore Ministry of Health in 1994. The NPMI system aims at providing a patient database at national level that allows authorised users faster access to a patient's essential medical data thereby facilitating patient management. This paper describes the implementation of the NPMI system, its data elements, system functionality and access control to address data confidentiality and privacy.

Computer Security↗
PubMed1994

TANIT AIM project (A2036): Telematics for ANaesthesia and Intensive Therapy.

On-going work relating to the development of advanced telematics systems for Critical Care environments is described. This work is in part sponsored by the Commission of European Communities under the AIM TANIT project. Two example departments have been selected for piloting in the project: Intensive Care and Anaesthesia. The objective of this paper is to outline the complex issues that need to be addressed when developing such systems.

Anesthesia Department, Hospital↗
PubMed1993

Current issues in choosing personal computers.

This paper offers a discussion of the main considerations that nurse educators need to make when choosing a personal computer for their own use. Whilst the issues under discussion are targeted at the home user, those same issues are also relevant to the corporate buyer or the manager who is budgeting for a department or college. The paper highlights issues concerning Central Processing Units (CPUs), keyboards and monitors and identifies some of the software applications that are available.

Choice Behavior↗
PubMed1991

There are viruses and viruses.....

Life has its problems. To succeed it has to survive: to survive it has to sacrifice its identity. And viruses have their fingers in the essence of it all. Consider the situation. There are useful genes. Such genes promote the survival of the individuals which house them. It is not unreasonable, therefore, to expect that an enterprising life-form would seek to gain advantage from the existence of such useful genes by distributing them around the life forms which are not so blessed. This achieves two effects. It justifies the existence of a class of organisms which serve as gene transporters (vectors) and it provides the recipient with benefit (a situation from which the transporter can also gain). Of course, the system can have its teething troubles as in the case of the transporter that provides a package which does damage and thereby decreases the survival of both the recipient and its invader. Yet, over a billion or so years, organisms of increasing complexity have emerged owing not a little to the processes of whole gene transfer by vector systems.

Biological Evolution↗
PubMed2006

Prevention of missing data in clinical research studies.

Missing data is a problem that is ubiquitous to all clinical studies and a source of multiple problems from an analytic point of view (reduced statistical power, increased the type I error, bias) Statistical approaches have been developed to analyze data collected from trials with missing data. Understanding and implementing the appropriate statistical technique is essential but should be differentiated from preventive approaches that are designed to reduce rates of missing data In this article, we draw attention to these preventive efforts. Seven steps to minimizing the amount of missing data are defined as documentation, training, monitoring reports, patient contact, data entry and management, pilot studies, and communication. Although the implementation of these approaches is time consuming and costly, the overall quality of the study is increased. Despite efforts devoted to areas, no study is without missing data. Once the study is completed, it is essential to assess the pattern of missing data and apply the appropriate statistical analysis.

Bias↗
PubMed2006

Informatics tools to improve clinical research study implementation.

BACKGROUND: There are numerous potential sources of problems when performing complex clinical research trials. These issues are compounded when studies are multi-site and multiple personnel from different sites are responsible for varying actions from case report form design to primary data collection and data entry. METHODS: We describe an approach that emphasizes the use of a variety of informatics tools that can facilitate study coordination, training, data checks and early identification and correction of faulty procedures and data problems. The paper focuses on informatics tools that can help in case report form design, procedures and training and data management. CONCLUSION: Informatics tools can be used to facilitate study coordination and implementation of clinical research trials.

Clinical Trials as Topic↗
PubMed2005

Efficient storage of healthcare data in XML-based smart cards.

In this paper we present storage structures for efficiently processing XML path queries on healthcare data stored in smart cards using XML format. In the design of the storage structures that we present, properties of healthcare data and fundamental types of queries on the healthcare data are taken into account as well as the constraints of the smart cards. We compare the space and time efficiency of the proposed storage structures for various types of queries.

Algorithms↗
PubMed2005

Teleradiology: threat or opportunity?

The rapid advances in information technology and communication bandwidth have spawned an equally rapid development of clinical teleradiology. Current computer technology and communication capability allow easy transfer of diagnostic images, of any complexity, to any location in the world. This provides the opportunity to acquire swift primary and secondary diagnostic opinions from the remotest of locations, often at economically attractive rates, with the potential for easing the burden on hard-pressed departments of radiology. However, this comes at the potential cost of distancing the clinical radiologist from the patient, with consequent impact upon direct clinical care. As this technology advances across the world, it is vital that UK radiologists are familiar with the clinical implications, the medicolegal framework within which the field operates and the associated governance issues. This paper reviews current practice and discusses the associated risks.

Computer Security↗
PubMed2006

The Public-Key-Infrastructure of the Radiological Society of Germany.

Pretty Good Privacy (PGP) encoding is based on the Public-Key-Procedure and permits the safe transmission of medical data. Furthermore it allows the use of an electronic signature provided that keys used belong to the key owner and that the key owner's identity is guaranteed by a trusted third party. Under the auspices of the Radiological Society of Germany (Deutsche Röntgengesellschaft, DRG) its IT-Working Group (Arbeitsgemeinschaft für Informationstechnik, @GIT) built up an appropriate Certification Authority including the required Public-Key-Infrastructure. These @GIT certified PGP keys allow the legal use of telemedicine in Germany. Digital signatures based to those certified keys correspond to the advanced signature according to the German Signature Law.

Algorithms↗
PubMed2006

An e-consent-based shared EHR system architecture for integrated healthcare networks.

OBJECTIVES: Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model. METHODS: A literature survey summarizes considerations of current architectural approaches. Complemented by a methodical analysis in two regional settings, a formal architecture model was specified and implemented. RESULTS: Results presented in this paper are a survey of architectural approaches for shared health records and an architecture model for a virtual shared EHR, which combines a patient-centred integration policy with provider-oriented document management. An electronic consent system assures, that access to the shared record remains under control of the patient. A corresponding system prototype has been developed and is currently being introduced and evaluated in a regional setting. CONCLUSION: The proposed architecture is capable of partly replacing message-based communications. Operating highly available provider repositories for the virtual shared EHR requires advanced technology and probably means additional costs for care providers. Acceptance of the proposed architecture depends on transparently embedding document validation and digital signature into the work processes. The paradigm shift from paper-based messaging to a "pull model" needs further evaluation.

Computer Communication Networks↗
PubMed2006

e-Records in health--preserving our future.

INTRODUCTION: Papyrus manuscripts nearly 2000 years old, can still be read, but documents composed on a Wang or other word processor just 30 years ago are gone forever. Standards and formats used for storing and accessing information are constantly changing, and the required hardware or software will likely be obsolete or no longer exist in the near future. PURPOSE: To understand how to urgently address the data preservation issue as we migrate to greater use of e-records, in particular 'lifetime' electronic health records (EHR's), as our primary, perhaps sole, e-record. In principle, these dynamic and critical health data must be preserved and capable of real-time access on a 7/24/365 basis for perhaps 125 years. Without forethought, only a small fraction of the data currently stored within any healthcare jurisdiction will survive for more than a decade or so, or be exchangeable between jurisdictions. The situation will only be compounded as EHR's become ubiquitous. APPROACH: The literature was reviewed to identify data preservation issues and potential solutions, and guide development of policy recommendations to minimise the impact of this potentially catastrophic system failure. These recommendations are directed at the practice, program, and decision-making levels, and in both the public and private sectors. CONCLUSION: Data preservation poses a critical barrier to e-health and future healthcare systems. At this time broad awareness of data preservation issues is poor. This paper offers policy recommendations to stimulate debate and development of suitable strategies.

Access to Information↗
PubMed2006

The need to know the history of the use of digital patient data, in particular the EHR.

The purpose of this article is to explore the need for the possibility to reconstruct electronic medical data, in particular the electronic health record (EHR) as they have been or could have been presented to a specified health care professional at a specified moment in the past. The approach taken is that first the need for such functionality is discussed with attention to the differences between electronic records and paper records in this respect. Next the architectural and technical consequences of the implementation of the functionality are considered. The article concludes that such functionality is needed for medical audit, self assessment and handling of complaints. It further concludes that it is far from easy to implement the functionality. If the health care community underwrites the need for such functionality this will have a significant impact on the architecture of medical information systems and the (distributed) EHR. It is recommended that the professional associations and the governments, in collaboration with WHO, take a position on the need to be able to reconstruct the contents of the EHR. IMIA could take the lead in that process.

Access to Information↗
PubMed2006

Comprehensive management of the access to the electronic patient record: towards trans-institutional networks.

BACKGROUND: A system ensuring tight control access is used since 5 years at the University Geneva Hospitals (HUG) over a four campuses health care system with ambulatory care settings behaving like a small community care network. Access to identified clinical information is limited to care providers that have a therapeutic relationship with the patient and to those data needed for that relation. The same policy applies to administrative or scientific research accesses. This paper presents how the HUG met the challenging goal of protecting patient privacy within regulatory limits while keeping the system operational in terms of use and management. SOLUTION: The main characteristics of the system are: (a) an institution-wide policy for access rights to the computerized patient record; (b) an institutional management of the contracts of the collaborators; (c) access profiles based on application-independent, fine-grained access rights; (d) a decentralized attribution of profession-specific access profiles; (e) a complete, centralized log of all accesses to the clinical information system; and (f) a decentralized verification of the accesses. Many of these characteristics can be maintained when evolving towards a trans-institutional computerized patient record, but new constraints need to be taken into account.

Access to Information↗