Design and development of EMR supporting medical process management

Constructing a diversified online neurology teaching model under the COVID-19

Purpose

To construct a diversified and comprehensive network teaching model to provide highly qualified medical teaching in neurology under COVID-19 pandemic.

Materials and methods

Published studies on medical education were systematically reviewed and summarized. Based on previous studies and our experience, we constructed a novel online neurology teaching model and applied it to real scene. Students taking traditional in class lessons and online lessons were asked to finish the test, respectively, to compare the efficiency of learning. Questionnaires were designed and assigned to get the feedback from students.

Results

The average test score of students who take online class (84.27 ± 4.64) was significantly higher than those who take in class lessons (82.08 ± 6.17) (P < 0.01). According to the feedbacks from students, online classes were more attractive to students than the conventional one.

Conclusion

Traditional single-mode teaching can no longer meet the needs of current medical education, especially under the rampant epidemic. This novel teaching mode, which orchestrates high-tech tools, diverse teaching methods and traditional teaching concepts, provides the solution to the challenge faced by traditional medical education. We believe that this novel online teaching mode will boost neurology education and inspire educators in other fields during this tough period.

Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review

Background: China has been encouraged to learn from international innovations in the organization and management of health service delivery to achieve the national health reform objectives. However, the success and effectiveness of implementing innovations is affected by the interactions of innovations with the Chinese context. Our aim is to synthesize evidence on factors influencing the implementation of non-Chinese innovations in organization and management of health service delivery in mainland China. Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched seven databases for peer-reviewed articles published between 2009 and 2020. Data were analyzed and combined to generate a list of factors influencing the implementation of foreign innovations in China. The factors were classified in the categories context, system, organization, innovation, users, resources, and implementation process. Results: The 110 studies meeting the inclusion criteria revealed 33 factors. Most supported by evidence is the factor integration in organizational policies, followed by the factors motivation & incentives and human resources. Some factors (e.g., governmental policies & regulations) were mentioned in multiple studies with little or no evidence. Conclusion: Evidence on factors influencing the implementation of foreign innovations in organization and management of health service delivery is scarce and of limited quality. Although many factors identified in this review have also been reported in reviews primarily considering Western literature, this review suggests that extrinsic motivation, financial incentives, governmental and organizational policies & regulations are more important while decentralization was found to be less important in China compare to Western countries. In addition, introducing innovations in rural China seems more challenging than in urban China, because of a lack of human resources and the more traditional rural culture.

An ontology-based approach to patient follow-up assessment for continuous and personalized chronic disease management

OBJECTIVE

Chronic diseases are complex and persistent clinical conditions that require close collaboration among patients and health care providers in the implementation of long-term and integrated care programs. However, current solutions focus partially on intensive interventions at hospitals rather than on continuous and personalized chronic disease management. This study aims to fill this gap by providing computerized clinical decision support during follow-up assessments of chronically ill patients at home.

METHODS

We proposed an ontology-based framework to integrate patient data, medical domain knowledge, and patient assessment criteria for chronic disease patient follow-up assessments. A clinical decision support system was developed to implement this framework for automatic selection and adaptation of standard assessment protocols to suit patient personal conditions. We evaluated our method in the case study of type 2 diabetic patient follow-up assessments.

RESULTS

The proposed framework was instantiated using real data from 115,477 follow-up assessment records of 36,162 type 2 diabetic patients. Standard evaluation criteria were automatically selected and adapted to the particularities of each patient. Assessment results were generated as a general typing of patient overall condition and detailed scoring for each criterion, providing important indicators to the case manager about possible inappropriate judgments, in addition to raising patient awareness of their disease control outcomes. Using historical data as the gold standard, our system achieved a rate of accuracy of 99.93% and completeness of 95.00%.

CONCLUSIONS

This study contributes to improving the accessibility, efficiency and quality of current patient follow-up services. It also provides a generic approach to knowledge sharing and reuse for patient-centered chronic disease management.

Research and Development of Semantics-based Sharable Clinical Pathway Systems

The clinical pathway (CP) as a novel medical management schema is beneficial for reducing the length of stay, decreasing heath care costs, standardizing clinical activities, and improving medical quality. However, the practicability of CPs is limited by the complexity and expense of adding the standard functions of electronic CPs to existing electronic medical record (EMR) systems. The purpose of this study was to design and develop an independent clinical pathway (ICP) system that is sharable with different EMR systems. An innovative knowledge base pattern was designed with separate namespaces for global knowledge, local knowledge, and real-time instances. Semantic web technologies were introduced to support knowledge sharing and intelligent reasoning. The proposed system, which was developed in a Java integrated development environment, achieved standard functions of electronic CPs without modifying existing EMR systems and integration environments in hospitals. The interaction solution between the pathway system and the EMR system simplifies the integration procedures with other hospital information systems. Five categories of transmission information were summarized to ensure the interaction process. Detailed procedures for the application of CPs to patients and managing exceptional alerts are presented by explicit data flow analysis. Compared to embedded pathway systems, independent pathway systems feature greater feasibility and practicability and are more advantageous for achieving the normalized management of standard CPs.

An electronic medical record system with treatment recommendations based on patient similarity

As the core of health information technology (HIT), electronic medical record (EMR) systems have been changing to meet health care demands. To construct a new-generation EMR system framework with the capability of self-learning and real-time feedback, thus adding intelligence to the EMR system itself, this paper proposed a novel EMR system framework by constructing a direct pathway between the EMR workflow and EMR data. A prototype of this framework was implemented based on patient similarity learning. Patient diagnoses, demographic data, vital signs and structured lab test results were considered for similarity calculations. Real hospitalization data from 12,818 patients were substituted, and Precision @ Position measurements were used to validate self-learning performance. Our EMR system changed the way in which orders are placed by establishing recommendation order menu and shortcut applications. Two learning modes (EASY MODE and COMPLEX MODE) were provided, and the precision values @ position 5 of both modes were 0.7458 and 0.8792, respectively. The precision performance of COMPLEX MODE was better than that of EASY MODE (tested using a paired Wilcoxon-Mann-Whitney test, p < 0.001). Applying the proposed framework, the EMR data value was directly demonstrated in the clinical workflow, and intelligence was added to the EMR system, which could improve system usability, reliability and the physician's work efficiency. This self-learning mechanism is based on dynamic learning models and is not limited to a specific disease or clinical scenario, thus decreasing maintenance costs in real world applications and increasing its adaptability.

Effect of targeted health education in patients receiving painless gastroscopy

AIM: To assess the effect of targeted health education in patients receiving painless gastroscopy.

METHODS: Eighty-four patients receiving painless gastroscopic examination at our hospital from June 2011 to June 2014 were randomly assigned into either an observation group or a control group. The control group received routine health education, and the observation group received targeted health education. The changes in blood pressure and pulse, self-rating anxiety scale (SAS) score, examination time and respiratory depression rate were compared between the two groups.

RESULTS: The changes in blood pressure and pulse were significantly less in the observation group than in the control group (2.24 mmHg ± 0.42 mmHg vs 6.69 mmHg ± 2.17 mmHg, 1.26 times/min ± 0.22 times/min vs 8.54 times/min ± 4.31 times/min, P < 0.05). Before nursing care, SAS scores were similar between the two groups (P > 0.05); after nursing care, SAS score was significantly lower in the observation group than in the control group (40.08 ± 4.31 vs 47.33 ± 10.64, P < 0.05). The examination time was significantly shorter in the observation group (P < 0.05), and the number of patients with respiratory depression was significantly less in the observation group (3 vs 9, P < 0.05).

CONCLUSION: Targeted health education can lower the tension and anxiety before examination, stabilize the pulse and blood pressure, shorten the examniation time and reduce the rate of respiratory depression in patients receiving painless gastroscopy.

Effect of Plan-Do-Check-Act cycle in relieving anxiety in patients undergoing emergency gastroscopy

AIM: To investigate the effect of Plan-Do-Check-Act (PDCA) cycle in relieving anxiety among patients undergoing emergency gastroscopy.

METHODS: Ninety-six patients receiving emergency gastroscopy were divided randomly into either a control group (n = 46) or an experimental group (n = 50). The control group underwent traditional nursing care, and the experiment group received PDCA before gastroscopy. The changes in heart rate, respiration, and blood pressure were monitored, and anxiety levels were compared between the two groups using the self-rating anxiety scale (SAS).

RESULTS: SAS score, heart rate, respiration, and blood pressure were not significantly different between the experiment and control groups before intervention (all P > 0.05). After treatment, SAS score and the levels of heart rate, respiration rate, and blood pressure in the experiment group were significantly lower than those before treatment and those in the control group (pre- and post-treatment: SAS score 53.71 ± 9.29 vs 40.75 ± 2.66, P < 0.01; heart rate 96.23/min ± 0.04/min vs 81.25/min ± 1.22/min, P < 0.01; respiration rate 16.77/min ± 2.38/min vs 12.33/min ± 2.36/min, P < 0.05; systolic pressure 126.23 mmHg ± 15.14 mmHg vs 112.25 mmHg ± 8.55 mmHg, P < 0.05; diastolic pressure 72.29 mmHg ± 7.11 mmHg vs 62.74 mmHg ± 9.32 mmHg, P < 0.05). The effective rate was significantly higher in the experiment group than in the control group (80% vs 67.3%, P < 0.05).

CONCLUSION: PDCA cycle can reduce the degree of preoperative anxiety in patients undergoing emergency gastroscopy.

Privacy preserving index for encrypted electronic medical records

With the development of electronic systems, privacy has become an important security issue in real-life. In medical systems, privacy of patients' electronic medical records (EMRs) must be fully protected. However, to combine the efficiency and privacy, privacy preserving index is introduced to preserve the privacy, where the EMR can be efficiently accessed by this patient or specific doctor. In the literature, Goh first proposed a secure index scheme with keyword search over encrypted data based on a well-known primitive, Bloom filter. In this paper, we propose a new privacy preserving index scheme, called position index (P-index), with keyword search over the encrypted data. The proposed index scheme is semantically secure against the adaptive chosen keyword attack, and it also provides flexible space, lower false positive rate, and search privacy. Moreover, it does not rely on pairing, a complicate computation, and thus can search over encrypted electronic medical records from the cloud server efficiently.

Creating personalised clinical pathways by semantic interoperability with electronic health records

OBJECTIVE

There is a growing realisation that clinical pathways (CPs) are vital for improving the treatment quality of healthcare organisations. However, treatment personalisation is one of the main challenges when implementing CPs, and the inadequate dynamic adaptability restricts the practicality of CPs. The purpose of this study is to improve the practicality of CPs using semantic interoperability between knowledge-based CPs and semantic electronic health records (EHRs).

METHODS

Simple protocol and resource description framework query language is used to gather patient information from semantic EHRs. The gathered patient information is entered into the CP ontology represented by web ontology language. Then, after reasoning over rules described by semantic web rule language in the Jena semantic framework, we adjust the standardised CPs to meet different patients' practical needs.

RESULTS

A CP for acute appendicitis is used as an example to illustrate how to achieve CP customisation based on the semantic interoperability between knowledge-based CPs and semantic EHRs. A personalised care plan is generated by comprehensively analysing the patient's personal allergy history and past medical history, which are stored in semantic EHRs. Additionally, by monitoring the patient's clinical information, an exception is recorded and handled during CP execution. According to execution results of the actual example, the solutions we present are shown to be technically feasible.

CONCLUSION

This study contributes towards improving the clinical personalised practicality of standardised CPs. In addition, this study establishes the foundation for future work on the research and development of an independent CP system.

Creating content modules for Chinese EHR documents and their trial implementation in Wuwei City

Numerous and diverse paper-based health record documents are currently used in China, which are not only different from each other but are also inconsistent with national regulations. If these documents are made to be structured and electronically available, the health records information can be processed by computers to promote a shareable electronic health record (EHR) across organizations. As such, this work was intended to develop a set of content modules to be employed as reusable building blocks for converting the paper-based health records to structured EHR documents. Therefore, in this study, we developed 77 content modules based on the documents of national specifications and implemented them to Wuwei City as a trial. According to the EHR requirements of Wuwei, we added two new content modules in addition to the 77 existing content modules. We then successfully established an EHR system based on the new content modules in combination with the original content modules. This paper could contribute to the construction of structured Chinese EHR documents and provide some experiences as a reference for building EHR systems.

Operational problems of Haniwa net as a form of social capital: interdependence between human networks of physicians and information networks

In August 2009, Miyazaki Health and Welfare Network (Haniwa Net, hereafter referred to as "the Net"), centrally led by University of Miyazaki Hospital (UMH), adopted a center hospital-based system offering a unilateral linkage that enables the viewing of UMH's medical records through a web-based browser (electronic medical records (EMR)). By the end of December 2010, the network had developed into a system of 79 collaborating physicians from within the prefecture. Beginning in August 2010, physicians in 12 medical institutions were visited and asked to speak freely on the operational issues concerning the Net. Recordings and written accounts were coded using the text analysis software MAXQDA 10 to understand the actual state of operations. Analysis of calculations of Kendall's rank correlation confirmed that the interdependency between human networks and information networks is significant. At the same time, while the negative opinions concerning the functions of the Net were somewhat conspicuous, the results showed a correlation between requests and proposals for operational improvements of the Net, clearly indicating the need for a more user-friendly system and a better viewer.

RFID-enabled healthcare applications, issues and benefits: an archival analysis (1997-2011)

In this paper, a comprehensive review of articles published between 1997 and 2011 in the Journal of Medical Systems (JMS) on RFID technology is presented. A total of 22 papers are analyzed using a classification framework that has three dimensions: RFID-enabled healthcare applications, RFID-enabled healthcare issues, and RFID-enabled healthcare benefits. In addition, an invitation sent to all authors of the papers accepted for the special issue on RFID for the JMS allows them to position their various papers within the classification framework. Finally, a list of future research directions is presented.

Ontology-based clinical pathways with semantic rules

Clinical Pathways (CP) enhance the quality of patient care, and are thus important in health management. However, there is a need to address the challenge of adaptation of treatment procedures in CP-that is, the treatment schemes must be re-modified once the clinical status and other care conditions of patients in the healthcare setting change, which happen frequently. In addition, the widespread and frequent use of Electronic Medical Records (EMR) implies an increasing need to combine CP with other healthcare information systems, especially EMR, in order to greatly improve healthcare quality and efficiency. This study proposed an ontology-based method to model CP: ontology was used to model CP domain terms; Semantic Web Rule language was used to model domain rules. In this way, the CP could reason over the rules, knowledge, and information collected, and provides automated error checking for the next steps of the treatment in runtime, which is adaptive to treatment procedures. To evaluate our method, we built a Lobectomia Pulmonalis CP and realized it based on an EMR system.