Will mHealth Revolutionize Health and Clinical Management and Open up New Horizons for Mental Health?

OBJECTIVES

To summarize recent research and emerging trends in the field of Health and Clinical management and propose a selection of best papers for year 2015.

METHODS

A literature review has been conducted by the two section editors and computerized provider order entry systems from bibliographic databases regards to health clinical management. As a result, a list of 15 candidate papers has been elaborated and a peer-reviewed has been performed by external reviewers. A consensus meeting has been organized between the two section editors and the editorial board to conclude the selection of the 3 best papers.

RESULTS

Starting with 1803 papers published in 2015, the full selection process ended with three papers from international peer-reviewed journals for the Health and Clinical Management section.

CONCLUSION

IoT and Cloudification have a direct impact on health and clinical management this year. Telepsychiatry benefits directly from this development and take advantages of the improvement of smart homes and of the generalization of mHealth solutions. Social networks are starting to be integrated as valuable source of information that are complementary to clinical data for reasoning-based solutions.

A 2015 Medical Informatics Perspective on Health and Clinical Management: Will Cloud and Prioritization Solutions Be the Future of Health Data Management?

OBJECTIVES

Summarize current excellent research and trends in the field of Health and Clinical management.

METHODS

Synopsis of the articles selected for the IMIA Yearbook 2015 RESULTS: Three papers from international peer-reviewed journals have been selected for the Health and Clinical Management section.

CONCLUSION

Telemedicine is still very active in Health and clinical management, but the new tendencies on which we focus this year were firstly the introduction of cloud for health data management, with some specific security problems, and secondly an emerging expectation of prioritization tools in health care Management.

Trends on integrating framework of applications or data. Findings from the section on health and clinical management

OBJECTIVE

To summarize current excellent research and trends in the field of Health and Clinical management.

METHODS

Synopsis of the articles selected for the IMIA Yearbook 21014 RESULTS: A comprehensive review of papers published in 2013 was performed by querying PubMed. 1079 were reviewed as papers without authors, without abstract or smaller than 4 pages were excluded from the selection. The editors reviewed all papers and 15 papers selected and provided to to international reviewers. Four papers from international peer-reviewed journals were finally selected for the Health and Clinical Management section.

CONCLUSION

Many telemedicine applications are tested nowadays in medical situation, but the challenges emphasized by the best papers selection focus on the ability of proposing integrative frameworks for applications or data in order to handle efficiency of health and clinical management.

Trends on Integrating Technologies for Mobile and Personalized Care

Objectives: Summarize current excellent research and trends in the field of Health and Clinical Management.

Method: Synopsis of the articles selected for the IMIA Yearbook 2013.

Results: Five papers from international peer-reviewed journals have been selected for the section of Health and Clinical Management.

Conclusions: The selected articles illustrate current research regarding the Health and Clinical Management and showed that it is impacted by the importance of personalizing the care and integrating the use of mobile and connected technologies.

Trends on integrating technologies for mobile and personalized care. Findings from the section on health and clinical management

OBJECTIVES

Summarize current excellent research and trends in the field of Health and Clinical Management.

METHOD

Synopsis of the articles selected for the IMIA Yearbook 2013.

RESULTS

Five papers from international peer-reviewed journals have been selected for the section of Health and Clinical Management.

CONCLUSIONS

The selected articles illustrate current research regarding the Health and Clinical Management and showed that it is impacted by the importance of personalizing the care and integrating the use of mobile and connected technologies.

Augmented notebooks for pervasive learning in medical practice

Medical e-learning can benefit from the new technologies, and pervasive learning resources and tools worth to be introduced in the medical context. Micro-learning seems to be an interesting way for pervasive learning. But it is still difficult to propose pedagogical resources that are built by learners, from meaningful experiments. We conducted an analysis of the exchanges performed by Health care professionals in the hospital in order to understand where and when educational exchanges appear. We analyzed the type of documents exchanged. The residents' paper notebooks caught our attention first because it answers some clinician-needs and second because the computerization of such a notebook could add a collaborative dimension to the pedagogical resources. We propose a model of an augmented resident's notebook and we briefly describe an implementation using Content Management System and WIKI, before setting the discussion and the conclusion sections.

Characterizing consumer health terminology in the breast cancer field

Despite the large availability of medical information on the Internet, health consumers still encounter problems to find, interpret and understand this information. These problems are mainly due to their lack in medical knowledge and the difference between their language and the language of health professionals. In order to propose information retrieval services more adapted to health consumers language and knowledge, we have developed techniques to collect, identify and analyze the terms and the expressions used by lay persons to talk about breast cancer. The study of health consumers' language is a relatively recent research field. Many studies have been conducted to analyze and characterize the vocabulary used by health consumers to talk about medical subjects in English. We have conducted the same study for the French language in the breast cancer field. We have gathered a corpus of texts to identify terms and expressions used by health consumers who talk about breast cancer in French. The terms have been organized in a concept-based terminology. This terminology has been analyzed on several levels: concept level, term level, term-concept level and finally relation level.

Group Decision Support System applied to the medical pluri-disciplinary decision group: usability and efficacy

OBJECTIVES

This paper aims to study whether the application of a Group Decision Support System to medical collective decision committees is possible and to determine which GDSS specifications are convenient.

BACKGROUND

We introduce the common knowledge about GDSS and define the process of the collective medical decision.

METHODS

An experimental GDSS has been tested in an actual medical collective decision committee. A usability analysis has been performed to precise usability and acceptability of the system and to highlight pro and cons of the various functionalities of the GDSS.

RESULTS

Information sharing was conveniently supported by the GDSS. All the documents were available for the support of the discussion. But, the introduction of a GDSS in the decision committee added new constraints such as the necessity of an excellent preparation phase. Limits of the system have been revealed: lack of feedback on decision actors, lack of support to obtain the consensus and lack of memorisation. According to these results, we have proposed new GDSS features to improve the decision.

DISCUSSION-CONCLUSION

Using a GDSS supporting the medical collective decision is realistic and may support the process of the consensual decision.

Informal notes to support the asynchronous collaborative activities

BACKGROUND

Health care professionals' collaboration is highly important for the medical practice. Efficient exchange of information improves good cooperation, but remains complex, due to the diversity of the medical activities. Currently, the health record is mainly used to manage structured medical information. On the one hand, such structure supports treatment that requires the documented information. On the other hand, however, the structure also imposes constraints on narrative and conversational practices of health care professionals. They use other collaboration means through phone, mail, annotations and free texts for informal strategies of communication. We focussed on informal written documents. Two different studies provided us some materials: home care charts in the context of home care and annotations in the context of the hospital health records.

PURPOSES

We wanted to design a model of the Communication Notes to computerize the written notes so as to improve the communication and the coordination of the practitioners.

METHODS

We compared the results of the two studies about the various writing strategies used by the health care professionals to keep traces of their exchanges and of their acts. The first study deals with the information mentioned by the nurses in a chart during home care situations. We analysed the distribution of cooperation activities in action and in planning. The second study deals with the annotations which are written by all the practitioners to complete the documents of the health record in a paediatric ward. We analysed how annotations take part in their collaborations.

RESULTS

We found some invariable items in these two situations and we proposed a model for these Communication Notes which can be used to describe and to index them according to different points of view. Some indications on the way such descriptions are used in current computerized systems are also reported. The originality of this model comes from the way it takes into account a collaborative perspective which is not often used in the electronic medical settings.

CONCLUSIONS

With our model of Communication Notes, we now dispose of a promising setting for managing all the informal and unforeseeable information produced by the health care professionals during care.

Integrating descriptive, functional and cooperative aspects in a domain ontology to computerize home care charts

To coordinate themselves, home care (HC) professionals use artifacts to keep a mutual understanding on their common activity: lightly structured charts written in natural language. Instead of trying to define a record to capture them, we want to focus on efficient indexing of this information. The use of a Domain Ontology was proposed. This paper explains how we built and implemented it. Three complementary aspects of the HC charts were analyzed (i) functional aspects performed with precise analyses of actual charts; (ii) interoperability aspects with the use of some HL7-RIM standardized descriptions; and (iii) cooperative aspects, with the integration of a cooperation model. We proposed a Domain Ontology to represent the concepts and the relations used in the charts. The implementation was done with Protégé; the ontology was built in OWL-DL. The IAnnotate application helps us to index the HC chart with the domain ontology. The next step of the work will use the ontology to reason about the different items of information contained in the charts so that contextual use of them should be envisaged.

Context awareness in health care: a review

BACKGROUND

Health care systems will integrate new computing paradigms in the coming years. Context-awareness computing is a research field which often refers to health care as an interesting and rich area of application.

AIM

Through a survey of the research literature, we intended to derive an objective view of the actual dynamism of context awareness in health care, and to identify strengths and weaknesses in this field.

METHODS

After discussing definitions of context, we proposed a simple framework to analyse and characterize the use of context through three main axes. We then focused on context-awareness computing and reported on the main teams working in this area. We described some of the context-awareness projects in health care. A deeper analysis of the hospital-based projects demonstrated the gap between recommendations expressed for modelling context awareness and the actual use in a prototype. Finally, we identified pitfalls encountered in this area of research.

RESULTS

A number of opportunities remain for this evolving field of research. We found relatively few groups with such a specific focus. As yet there is no consensus as to the most appropriate models or attributes to include in context awareness. We conclude that a greater understanding of which aspects of context are important in a health care setting is required; the inherent sociotechnical nature of context-aware applications in health care; and the need to draw on a number of disciplines to conduct this research.

A study of the communication notes for two asynchronous collaborative activities

INTRODUCTION

To build relevant tools for Health Care Professionals, we must study and understand their practices. This paper discusses the way they leave traces in the Patient Record to help asynchronous collaboration, elaborating new documents or adding annotations.

METHODS

We compared the results of two studies about the various writing strategies used by the Health Care Professionals to capture knowledge in the Patient Records. The first study deals with the information written by the nurses in a textbook during homecare situations. The second one deals with the annotations left by all the practitioners to complete the documents of the patient record in a hospital ward.

RESULTS

We have found some invariants in these two situations. An interpretation model based on four levels: Communication Context, Communication Object, Value of Communication and Value of Cooperation, is proposed in order to describe and to index the characteristics of the Communication Notes.

A distributed coordination platform for home care: analysis, framework and prototype

Good cooperation between health care (HC) professionals, patient, and family is indispensable during homecare as mentioned in reports and analyses from different countries. In a French National project named coordination for the quality of care (COQUAS), we aimed to address the problem of improving such cooperation with current tools and techniques. We hypothesized that, as in some other domains, a better integration of use and users in informatics systems could improve the usefulness of the cooperative tool. The first part of this paper is devoted to the cognitive analysis of the homecare process and highlights the requirements which should be met according to this analysis. We describe some specific features of asynchronous cooperation and some communication issues in the cooperation of HC workers. We then detail the analysis of the homecare process: methodology, description of the processes, cognitive activity analyses, and of the requirements which flow from this analysis. The second part of this paper proposes a framework and then describes a modular system prototype, designed to take into account these requirements, including aspects of both cooperation and interoperability. It uses a meta-description of actions and information derived from a cognitive study to build dynamically the interface settings; it respects the current trend in distributed architecture and uses XML communication of messages, manages complex coordination with a workflow and allows mobile work. The last part of the paper presents the evaluation which has been done with the implemented prototype, with actual homecare users.

Integration of the cognitive knowledge of activity in a service oriented architecture in the home care context

The complex nature of a home care (HC) situation induces an important need for cooperation between the health care professionals. But even if this need is sometimes evocated in reports on HC issues, it is more difficult to get precise knowledge on this cooperative activity, and, consequently, propositions for computerized HC organization and management systems. We did some researches on this topic area. Previous phases of work let us highlight the actual need for cooperation, and obtain precise information on the HC activity processes and data. In this paper, we focused on the integration of this cognitive knowledge on the design of a HC cooperation architecture. Different levels of requirements for the cooperative system are mentioned: coordination, communication of information, delegation of activity, integration of services and personal access to the tasks to perform. A description of the usefulness and use of the cognitive knowledge is proposed, the architecture design, modular, distributed, and able to integrate external services is presented, and the results of a validation test of the implemented prototype, performed with actual HC professionals in an evaluation laboratory are presented.

Homecare: the need for cooperative information systems

Assuming responsibility of patients at home (Homecare) is organized around a complex cooperation of partners: health care actors, relatives and helpers, all of whom intervene in the patient's home and who spark off the setting up of cooperative information systems. We present our work relating to such systems within the context of home care. Such activity is based on the collaboration of multiple mobile actors, obtaining information in a multimodal fashion, while taking the job profiles and professional grades of the users into account. Information is obtained from heterogeneous systems. The quality of management of the activity of the various health care actors and of the feedback on information handled at the time of the homecare process will determine how easy it may be to set up homecare as well as the quality of care. In this paper we outline the main stages of our work: grasping the context of homecare and studying co-operative activity from a fundamental point of view but also as applied to homecare. We describe the system proposed for accessing distributed information and for organizing the supervision of the 2 fundamental processes: (1) the LOGISTICAL process (to manage the organization), (2) and the CARE Process (to follow-up the medical or nursing status of the patient), and then we enhance the contribution of mobile technologies in this context.

Communication of information in the homecare context

Organizing the Homecare with new information technologies is nowadays an important challenge. Indeed, some medical evolutions as the improvement of the duration of life, the number of chronic diseases and some social evolutions, such as the quality of patient life, or economic evolutions, such as the reduction of hospitalisation costs, could benefit from homecare. In this paper, we present the problem of the communication of information in the homecare context. Some main phases have been described that compose the two homecare processes: a logistic process and a care process. The communication of information during homecare depends on the concerned phases: first, some exchanges of information from existing Information System to the Homecare Information System; then, some exchanges between the homecare system and the mobile health care actors; and then, some mails during the outcome phase. Coordination architecture is briefly described, and two different implementations for the communication of information during homecare are presented: one is using XML messages to exchange information between Information Systems; the other is using mobile tools for communicating with mobile actors.

Information and logistics for homecare

TELECOS is a regional project whose ambition is to use new cooperation tools, in the context of homecare, in order to facilitate the coordinated cooperative work of health actors. Homecare can improve the quality of life for the patient and reduce costs but it also induces a lot of difficulties during organisation and care. We aim at knowing more about the activity of cooperation in the homecare context and proposing a cooperation platform which answers to the specific needs generated during homecare and which integrates new applications. In this paper, we present the results of our study of homecare. The activity analysis leads us to determine two specific processes: one concerns the implementation of human and material resources and design of the homecare protocol (the logistics process) and the other concerns the coordination of the healthcare actors during effective homecare (the care process). The first process is composed of five main phases during which an healthcare professional is required as coordinator. We then present the Worklow model used to represent the cooperation activity in homecare. We describe the activity: the tasks and subtasks are represented in a declarative way. We then briefly present our prototype, devoted to homecare management, implementing the different phases of the information process, developed in JAVA.

A simulation of dynamic tasks routing to improve cooperation in intensive care units

Cooperation between Health Care Professionals is essential for the quality of care. Workflow systems could improve the transfer of informations and responsibilities within Health Care Actors. We have proposed a conversation-based Workflow in order to modelize the therapeutics plan in the ICU. In such a complex field, the flexibility of the workflow system is essential for the system to be usable. We have introduced some dynamicity by adding roles in the model. With the use of roles, the dynamicity of the workflow is assumed by the routing process. We need to use simulation to be able to study the impact of routing algorythms on the efficiency of the coordination.

A modelization of the task allocation problem for prescribing activity in an ICU

The improvement of coordination between Health Care Professionals belonging different specialities and who are extremely mobile, is a crucial problem in Medicine. A workflow System is one example of the new informatics tools which facilitate the transfer of information and responsibility between health care providers. Medical informatics systems in particular should be reactive enough to cope with the flexibility of real work situations: in this paper, we present the task allocation problem. We distinguish between the workflow control process and the notifying process, which concerns the sharing out of the tasks between the actors concerned. We focus on the impact of strategies of notification on the progress of coordinated work. We propose a simulator to model and study the different ways of sharing tasks between actors in an Intensive Care Unit's activity of prescription.

Dynamic workflow model for complex activity in intensive care unit

Cooperation is very important in Medical care, especially in the Intensive Care Unit (ICU) where the difficulties increase which is due to the urgency of the work. Workflow systems are considered as well adapted to modelize productive work in business process. We aim at introducing this approach in the Health Care domain. We have proposed a conversation-based Workflow in order to modelize the therapeutics plan in the ICU [1]. But in such a complex field, the flexibility of the workflow system is essential for the system to be usable. In this paper, we focus on the main points used to increase the dynamicity. We report on affecting roles, highlighting information, and controlling the system We propose some solutions and describe our prototype in the ICU.

Dynamic workflow model for complex activity in intensive care unit

Co-operation is very important in Medical care, especially in the Intensive Care Unit (ICU) where the difficulties increase which is due to the urgency of the work. Workflow systems are considered as well adapted to modelize productive work in business process. We aim at introducing this approach in the Health Care domain. We have proposed a conversation-based workflow in order to modelize the therapeutics plan in the ICU [1]. But in such a complex field, the flexibility of the workflow system is essential for the system to be usable. We have concentrated on three main points usually proposed in the workflow models, suffering from a lack of dynamicity: static links between roles and actors, global notification of information changes, lack of human control on the system. In this paper, we focus on the main points used to increase the dynamicity. We report on affecting roles, highlighting information, and controlling the system. We propose some solutions and describe our prototype in the ICU.

An asynchronous co-operative model for co-ordinating medical unit activities

CSCW is devoted to the analysis of interactions among human beings when performing their work together (Ellis et al., Commun. ACM 1 (34) (1991) 38-58). The main fields of application are work organisation, healthcare, education and training. Our main goal is to study the co-operative models allowing task co-ordination and conflict management between actors within a distributed environment, particularly in medical units. We do not aim to produce a practical system suitable for near-term deployment in the intensive care units (ICU), but rather an experimental system that performs and co-ordinates a range of intelligent planning tasks in ICU activities. The emphasis will be put especially on asynchronous co-operation. We apply the Workflow approach to ICU organisation through the analysis and the proposal of a co-operative model.

Telemedicine for AIDS patients accommodations

People suffering from AIDS are subject to frequent hospitalisations. In some cases, they cannot go back home after hospitalisations, due to severe illness, family or sociologic problems. This is the reason why some therapeutic flats are at their disposal to make easier their medical follow-up after the hospital's discharge. In these Therapy Accommodation, they are treated by trained GP who often suffer from lack of information and lack of expertise in difficult cases. For this purpose we included these flats in the regional Telemedicine AIDS network to give these physicians free access to the computerised multimedia medical record of their patients and to provide them with synchronous co-operation facilities.