Description

Journal of Medical Systems provides a forum for the presentation and discussion of the increasingly extensive applications of new systems techniques and methods in hospital clinic and physician's office administration; pathology radiology and pharmaceutical delivery systems; medical records storage and retrieval; and ancillary patient-support systems. The journal publishes informative articles essays and studies across the entire scale of medical systems from large hospital programs to novel small-scale medical services. Education is an integral part of this amalgamation of sciences and selected articles are published in this area. Since existing medical systems are constantly being modified to fit particular circumstances and to solve specific problems the journal includes a special section devoted to status reports on current installations.

Publisher details

Springer Verlag

Publications in this journal

• Using Machine Learning Classifiers to Assist Healthcare-Related Decisions: Classification of Electronic Patient Records.

  Authors: Juliana T Pollettini, Sylvia R G Panico, Julio C Daneluzzi, Renato Tinós, José A Baranauskas, Alessandra A Macedo

  Journal of medical systems.

  Surveillance Levels (SLs) are categories for medical patients (used in Brazil) that represent different types of medical recommendations. SLs are defined according to risk factors and the medical andSurveillance Levels (SLs) are categories for medical patients (used in Brazil) that represent different types of medical recommendations. SLs are defined according to risk factors and the medical and developmental history of patients. Each SL is associated with specific educational and clinical measures. The objective of the present paper was to verify computer-aided, automatic assignment of SLs. The present paper proposes a computer-aided approach for automatic recommendation of SLs. The approach is based on the classification of information from patient electronic records. For this purpose, a software architecture composed of three layers was developed. The architecture is formed by a classification layer that includes a linguistic module and machine learning classification modules. The classification layer allows for the use of different classification methods, including the use of preprocessed, normalized language data drawn from the linguistic module. We report the verification and validation of the software architecture in a Brazilian pediatric healthcare institution. The results indicate that selection of attributes can have a great effect on the performance of the system. Nonetheless, our automatic recommendation of surveillance level can still benefit from improvements in processing procedures when the linguistic module is applied prior to classification. Results from our efforts can be applied to different types of medical systems. The results of systems supported by the framework presented in this paper may be used by healthcare and governmental institutions to improve healthcare services in terms of establishing preventive measures and alerting authorities about the possibility of an epidemic.

• Secure Communication of Medical Information Using Mobile Agents.

  Authors: Morteza Nikooghadam, Ali Zakerolhosseini

  Journal of medical systems.

  Recently several efficient schemes are proposed to provide security of e-medicine systems. Almost all of these schemes have tried to achieve the highest security level in transmission of patients'Recently several efficient schemes are proposed to provide security of e-medicine systems. Almost all of these schemes have tried to achieve the highest security level in transmission of patients' medical information to medical institutions through a heterogeneous network like Internet. In this paper, we explain the insecurity of these schemes against "man-in-the-middle" attack. Furthermore, a dynamic mobile agent system based on hybrid cryptosystem is proposed that is both secure and also efficient in computation cost. Analyzing the security criteria confirms suitability of the proposed scheme for e-medicine systems.

• Creation of a RFID Based Real Time Tracking (R-RTT) System for Small Healthcare Clinics.

  Authors: Joseph C Chen, Thomas J Collins

  Journal of medical systems.

  A well-managed healthcare system improves the quality of the patient experience. However, many small healthcare clinics have suboptimal systems for scheduling and locating patients and medical staff,A well-managed healthcare system improves the quality of the patient experience. However, many small healthcare clinics have suboptimal systems for scheduling and locating patients and medical staff, delaying the relay of information and creating poor resource and room utilization. This paper proposes a Radio Frequency Identification (RFID)-based Real-Time Tracking (R-RTT) System for optimizing small healthcare facility operations, enabling further optimization of throughput time, room utilization, and patient flow. In the proposed scenario, RFID readers were equipped in strategic locations throughout the facility. Patients and medical staff were issued personalized RFID tags. When they pass through the reader's interrogation zone, it reads their RFID tag and sends the information to a central computer equipped with software capable of filtering the RFID data into useable information. A Visual Basic Application (VBA) program uses the information received from the ID tags to display the location of the patients and staff as they move throughout the facility. This increases their visibility within the facility by allowing medical staff to determine where their colleagues and patients are at all times. The VBA program was also able to record the data in order to track the time each stage of the appointment process takes to complete. The recorded time data can be broken into processes, making it easier to determine if it adds value. This data can then be transformed into a value stream map for further analysis and improvement.

• Evaluation of Computerized Physician Order Entry System-A Satisfaction Survey in Taiwan.

  Authors: Bey-Hwa Yui, Wai-Tim Jim, Marcelo Chen, Jong-Ming Hsu, Chieh-Yu Liu, Ting-Ting Lee

  Journal of medical systems.

  In the rapidly developing world of information technology, computers have been used in various settings for clinical medicine application. Studies have focused on computerized physician order entryIn the rapidly developing world of information technology, computers have been used in various settings for clinical medicine application. Studies have focused on computerized physician order entry (CPOE) system interface design and functional development to achieve a successful technology adoption process. Therefore, the purpose of this study was to evaluate physician satisfaction with the CPOE system. This survey included user attitude toward interface design, operation functions/usage effectiveness, interface usability, and user satisfaction. We used questionnaires for data collection from June to August 2008, and 225 valid questionnaires were returned with a response rate of 84.5 %. Canonical correlation was applied to explore the relationship of personal attributes and usability with user satisfaction. The results of the data analysis revealed that certain demographic groups showed higher acceptance and satisfaction levels, especially residents, those with less pressure when using computers or those with less experience with the CPOE systems. Additionally, computer use pressure and usability were the best predictors of user satisfaction. Based on the study results, it is suggested that future CPOE development should focus on interface design and content links, as well as providing educational training programs for the new users; since a learning curve period should be considered as an indespensible factor for CPOE adoption.

• Unified Performance Evaluation of Health Centers with Integrated Model of Data Envelopment Analysis and Bargaining Game.

  Authors: Mustafa Jahangoshai Rezaee, Alireza Moini, Fatema Haji-Ali Asgari

  Journal of medical systems.

  This paper introduces a new integrated approach to measure unified efficiency of the healthcare systems. Health centers as an important part of the healthcare systems are considered for evaluation.This paper introduces a new integrated approach to measure unified efficiency of the healthcare systems. Health centers as an important part of the healthcare systems are considered for evaluation. For this purpose, we define two categories of inputs to measure performance of health centers based on medical human resources and characteristics of spatial information by using geographic information system (GIS). Catching the balance in the spatial distribution of populations and services is one of the main problems in health centers evaluation. On the other hand, data envelopment analysis (DEA) is widely applied for measuring efficiency of the healthcare systems. But, the conventional DEA models may fail to integrated several categories of measures. In this paper, DEA and bargaining game model are integrated for evaluation of health centers. In other words, two categories of measures are used to measure unified efficiency for each health center in the competitive environment. Two models according to constant return to scale (CRS) and variable return to scale (VRS) assumptions are developed. The case study of health centers under supervising of Tehran university of medical sciences (TMUS) is presented to show the abilities of the proposed approach.

• Using Electronic Medical Record Systems for Admission Decisions in Emergency Departments: Examining the Crowdedness Effect.

  Authors: Ofir Ben-Assuli, Moshe Leshno, Itamar Shabtai

  Journal of medical systems.

  Many medical organizations have deployed electronic medical record (EMR) information systems (IS) to improve medical decision-making and increase efficiency. Despite their advantages, however, EMR ISMany medical organizations have deployed electronic medical record (EMR) information systems (IS) to improve medical decision-making and increase efficiency. Despite their advantages, however, EMR IS may make less of a contribution in the stressful environment of an emergency department (ED) that operates under tight time constraints. The high level of crowdedness in the EDs itself can cause physicians to make medical decisions resulting in more unnecessary admissions and fewer necessary admissions. Thus this study evaluated the contribution of an EMR IS to physicians by investigating whether EMR IS leads to improved medical outcomes in points of care in EDs under different levels of crowdedness. For this purpose a track log-file analysis of a database containing 3.2 million ED referrals in seven main hospitals in Israel (the whole population in these hospitals) was conducted. The findings suggest that viewing medical history via the EMR IS leads to better admission decisions, and reduces the number of possibly avoidable single-day admissions. Furthermore, although the ED can be very stressful especially on crowded days, physicians used EMR IS more on crowded days than on non-crowded days. These results have implications as regards the viability of EMR IS in complex, fast-paced environments.

• An Efficient Authentication Scheme for Telecare Medicine Information Systems.

  Authors: Zhian Zhu

  Journal of medical systems.

  To ensure patients' privacy, such as telephone number, medical record number, health information, etc., authentication schemes for telecare medicine information systems (TMIS) have been studiedTo ensure patients' privacy, such as telephone number, medical record number, health information, etc., authentication schemes for telecare medicine information systems (TMIS) have been studied widely. Recently, Wei et al. proposed an efficient authentication scheme for TMIS. They claimed their scheme could resist various attacks. However, in this paper, we will show their scheme is vulnerable to an off-line password guessing attack when user's smart card is lost. To improve the security, we propose a new authentication scheme for TMIS. The analysis shows our scheme could overcome the weaknesses in Wei et al.'s scheme and has better performance than their scheme.

• The Differing Privacy Concerns Regarding Exchanging Electronic Medical Records of Internet Users in Taiwan.

  Authors: Hsin-Ginn Hwang, Hwai-En Han, Kuang-Ming Kuo, Chung-Feng Liu

  Journal of medical systems.

  This study explores whether Internet users have different privacy concerns regarding the information contained in electronic medical records (EMRs) according to gender, age, occupation, education,This study explores whether Internet users have different privacy concerns regarding the information contained in electronic medical records (EMRs) according to gender, age, occupation, education, and EMR awareness. Based on the Concern for Information Privacy (CFIP) scale developed by Smith and colleagues in 1996, we conducted an online survey using 15 items in four dimensions, namely, collection, unauthorized access, secondary use, and errors, to investigate Internet users' concerns regarding the privacy of EMRs under health information exchanges (HIE). We retrieved 213 valid questionnaires. The results indicate that the respondents had substantial privacy concerns regarding EMRs and their educational level and EMR awareness significantly influenced their privacy concerns regarding unauthorized access and secondary use of EMRs. This study recommends that the Taiwanese government organizes a comprehensive EMR awareness campaign, emphasizing unauthorized access and secondary use of EMRs. Additionally, to cultivate the public's understanding of EMRs, the government should employ various media, especially Internet channels, to promote EMR awareness, thereby enabling the public to accept the concept and use of EMRs. People who are highly educated and have superior EMR awareness should be given a comprehensive explanation of how hospitals protect patients' EMRs from unauthorized access and secondary use to address their concerns. Thus, the public can comprehend, trust, and accept the use of EMRs, reducing their privacy concerns, which should facilitate the future implementation of HIE.

• Mitigating Error Vulnerability at the Transition of Care through the Use of Health IT Applications.

  Authors: Kendall Cortelyou-Ward, Ashley Swain, Tina Yeung

  Journal of medical systems.

  Adverse drug events are largely considered to be errors in which the severity of effects could be lessened or even prevented through more effective medication reconciliation practices. Transitions ofAdverse drug events are largely considered to be errors in which the severity of effects could be lessened or even prevented through more effective medication reconciliation practices. Transitions of care, particularly at the time of discharge from the hospital, represent a time of heightened error vulnerability that contributes to medication discrepancy occurrences. The observed vulnerability can be attributed to communication and care continuity gaps across health care settings and can often lead to preventable errors. Health IT tools developed through research can identify factors which increase the risk of medication discrepancies. Additionally, the implementations of optimized clinical workflow processes to form effective transitions of care are approaches to decreasing medication discrepancies which may lead to adverse drug events. While federal policies and certifying organizations have implemented quality initiatives to increase focus on medication reconciliation practices in the hospital and primary care settings, the same practices must be implemented after a patient is discharged to their homes or another health care facility in order to mitigate error vulnerabilities that occur at the transition of care. This paper provides an overview of health IT system capabilities and their applications within and across health care delivery settings to facilitate care coordination to ensure continuity of care.

• COSARA: Integrated Service Platform for Infection Surveillance and Antibiotic Management in the ICU.

  Authors: Kristof Steurbaut, Kirsten Colpaert, Bram Gadeyne, Pieter Depuydt, Peter Vosters, Christian Danneels, Dominique Benoit, Johan Decruyenaere, Filip De Turck

  Journal of medical systems.

  The Intensive Care Unit is a data intensive environment where large volumes of patient monitoring and observational data are daily generated. Today, there is a lack of an integrated clinical platformThe Intensive Care Unit is a data intensive environment where large volumes of patient monitoring and observational data are daily generated. Today, there is a lack of an integrated clinical platform for automated decision support and analysis. Despite the potential of electronic records for infection surveillance and antibiotic management, different parts of the clinical data are stored across databases in their own formats with specific parameters, making access to all data a complex and time-consuming challenge. Moreover, the motivation behind physicians' therapy decisions is currently not captured in existing information systems. The COSARA research project offers automated data integration and services for infection control and antibiotic management for Ghent University Hospital. The platform not only gathers and integrates all relevant data, it also presents the information visually at the point of care. In this paper, we describe the design and value of COSARA for clinical treatment and infectious diseases monitoring. On the one hand, this platform can facilitate daily bedside follow-up of infections, antibiotic therapies and clinical decisions for the individual patient, while on the other hand, the platform serves as management view for infection surveillance and care quality improvement within the complete ICU ward. It is shown that COSARA is valuable for registration, real-time presentation and management of infection-related and antibiotics data.

• Analysis of Cloud-Based Solutions on EHRs Systems in Different Scenarios.

  Authors: Gonzalo Fernández-Cardeñosa, Isabel de la Torre-Díez, Miguel López-Coronado, Joel J P C Rodrigues

  Journal of medical systems.

  Nowadays with the growing of the wireless connections people can access all the resources hosted in the Cloud almost everywhere. In this context, organisms can take advantage of this fact, in termsNowadays with the growing of the wireless connections people can access all the resources hosted in the Cloud almost everywhere. In this context, organisms can take advantage of this fact, in terms of e-Health, deploying Cloud-based solutions on e-Health services. In this paper two Cloud-based solutions for different scenarios of Electronic Health Records (EHRs) management system are proposed. We have researched articles published between the years 2005 and 2011 about the implementation of e-Health services based on the Cloud in Medline. In order to analyze the best scenario for the deployment of Cloud Computing two solutions for a large Hospital and a network of Primary Care Health centers have been studied. Economic estimation of the cost of the implementation for both scenarios has been done via the Amazon calculator tool. As a result of this analysis two solutions are suggested depending on the scenario: To deploy a Cloud solution for a large Hospital a typical Cloud solution in which are hired just the needed services has been assumed. On the other hand to work with several Primary Care Centers it's suggested the implementation of a network, which interconnects these centers with just one Cloud environment. Finally it's considered the fact of deploying a hybrid solution: in which EHRs with images will be hosted in the Hospital or Primary Care Centers and the rest of them will be migrated to the Cloud.

• Improved Particle Swarm Optimization Algorithm for Android Medical Care IOT using Modified Parameters.

  Authors: Wen-Tsai Sung, Yen-Chun Chiang

  Journal of medical systems.

  This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimizationThis study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services.

• The Differing Privacy Concerns Regarding Exchanging Electronic Medical Records of Internet Users in Taiwan

  Authors: Hwang, H. G. Han, H. E. Kuo, K. M. Liu, C. F

  Journal of Medical Systems.

• A Physician Order Category-Based Clinical Guideline Comparison System.

  Authors: Hwan-Jeu Yu, Chia-Ping Shen, Sarangerel Dorjgochoo, Chi-Huang Chen, Jin-Ming Wu, Mei-Shu Lai, Ching-Ting Tan, Chinburen Jigjidsuren, Erdenebaatar Altangerel, Hung-Chang Lee, Chih-Wen Hsueh, Yufang Chung, Feipei Lai

  Journal of medical systems.

  Today, in order to provide high-quality medical services and to extend resources and reduce costs, many large hospitals have adopted clinical guidelines as a structured way to manage medicalToday, in order to provide high-quality medical services and to extend resources and reduce costs, many large hospitals have adopted clinical guidelines as a structured way to manage medical activities. However, customization of clinical guidelines in order to treat a large number of patients is a major challenge. In this paper, we present a physician order category-based clinical guideline comparison system. The system uses a preprocessor software to convert the clinical guidelines from a Microsoft Word document into XML format, and it can also compare clinical guidelines over the conceptual view such as the physician order category. The system has already been used to compare the HCC surgical clinical guidelines of Taiwan and Mongolia-resulting in some differences being found, for which possible causes were discussed. Therefore, it can be seen that our research provides a practical and convenient way in which to compare clinical guidelines based on physician order category-thereby saving time and enabling physicians to quickly resolve discrepancies and make necessary adjustments to clinical guidelines.

• Security Analysis of Standards-Driven Communication Protocols for Healthcare Scenarios.

  Authors: Massimiliano Masi, Rosario Pugliese, Francesco Tiezzi

  Journal of medical systems.

  The importance of the Electronic Health Record (EHR), that stores all healthcare-related data belonging to a patient, has been recognised in recent years by governments, institutions and industry.The importance of the Electronic Health Record (EHR), that stores all healthcare-related data belonging to a patient, has been recognised in recent years by governments, institutions and industry. Initiatives like the Integrating the Healthcare Enterprise (IHE) have been developed for the definition of standard methodologies for secure and interoperable EHR exchanges among clinics and hospitals. Using the requisites specified by these initiatives, many large scale projects have been set up for enabling healthcare professionals to handle patients' EHRs. The success of applications developed in these contexts crucially depends on ensuring such security properties as confidentiality, authentication, and authorization. In this paper, we first propose a communication protocol, based on the IHE specifications, for authenticating healthcare professionals and assuring patients' safety. By means of a formal analysis carried out by using the specification language COWS: and the model checker CMC, we reveal a security flaw in the protocol thus demonstrating that to simply adopt the international standards does not guarantee the absence of such type of flaws. We then propose how to emend the IHE specifications and modify the protocol accordingly. Finally, we show how to tailor our protocol for application to more critical scenarios with no assumptions on the communication channels. To demonstrate feasibility and effectiveness of our protocols we have fully implemented them.

• An Approach for Building a Personal Health Information System Using Conceptual Domain Knowledge.

  Authors: Varadraj P Gurupur, Sang C Suh, Richard R Selvaggi, Pramukh R Karla, Jayalekshmi S Nair, Shilpa Ajit

  Journal of medical systems.

  In this paper we present the development of a Personal Health Information System (PHIS) by capturing the domain knowledge in the form of concept maps. The software architecture based on capturing theIn this paper we present the development of a Personal Health Information System (PHIS) by capturing the domain knowledge in the form of concept maps. The software architecture based on capturing the conceptual domain knowledge is demonstrated using a working prototype for patients suffering from diabetes mellitus. Cited current literature predicts that this user based information system has the potential to improve patient care, reduce medical errors, and lower health care costs.

• Monitoring, Control and Diagnostics using RFID Infrastructure.

  Authors: Anton Pleteršek, Miha Sok, Janez Trontelj

  Journal of medical systems.

  This work demonstrates the developed application for disinfection control by the sensing of chemical agents. The objective was to develop an Automatic Disinfectant Tracker (ADT) that would verify theThis work demonstrates the developed application for disinfection control by the sensing of chemical agents. The objective was to develop an Automatic Disinfectant Tracker (ADT) that would verify the disinfection of the hands of nurses, doctors, staff, patients, and visitors in hospitals within a required time frame. We have successfully investigated the development of hand disinfection control mechanisms and demonstrated two approaches, both based on the wireless Ultra-High-Frequency-based Radio-Frequency Identification (UHF-RFID) technology. The 100 % efficacy of detecting propanol and ethanol concentration was achieved by using the static disinfectant control (SDC-ADT) method. The time domain response provides an accurate determination of their performance in practice simply by measuring the applied disinfectant concentration and the duration of application. The present paper resulted from the measurements of a capacitive chemical sensor fabricated in the Laboratory for Microelectronics, (LMFE) and on measurements, based on a commercially available resistive type of sensor. A graphic user interface (IDS-GUI) is designed to successfully set the logger parameters and display the results.

• Process-Oriented Integration and Coordination of Healthcare Services across Organizational Boundaries.

  Authors: Edgar Tello-Leal, Omar Chiotti, Pablo David Villarreal

  Journal of medical systems.

  The paper presents a methodology that follows a top-down approach based on a Model-Driven Architecture for integrating and coordinating healthcare services through cross-organizational processes toThe paper presents a methodology that follows a top-down approach based on a Model-Driven Architecture for integrating and coordinating healthcare services through cross-organizational processes to enable organizations providing high quality healthcare services and continuous process improvements. The methodology provides a modeling language that enables organizations conceptualizing an integration agreement, and identifying and designing cross-organizational process models. These models are used for the automatic generation of: the private view of processes each organization should perform to fulfill its role in cross-organizational processes, and Colored Petri Net specifications to implement these processes. A multi-agent system platform provides agents able to interpret Colored Petri-Nets to enable the communication between the Healthcare Information Systems for executing the cross-organizational processes. Clinical documents are defined using the HL7 Clinical Document Architecture. This methodology guarantees that important requirements for healthcare services integration and coordination are fulfilled: interoperability between heterogeneous Healthcare Information Systems; ability to cope with changes in cross-organizational processes; guarantee of alignment between the integrated healthcare service solution defined at the organizational level and the solution defined at technological level; and the distributed execution of cross-organizational processes keeping the organizations autonomy.

• How to Measure the QoS of a Web-based EHRs System: Development of an Instrument.

  Authors: Isabel de la Torre-Díez, Miguel López-Coronado, Joel J P C Rodrigues

  Journal of medical systems.

  The quality of service (QoS) can be treated as a set of concepts whose satisfaction/dissatisfaction generates a global positive/negative vision about the service provided by any application. TheThe quality of service (QoS) can be treated as a set of concepts whose satisfaction/dissatisfaction generates a global positive/negative vision about the service provided by any application. The different nature of the services and its features require an analysis of the factors that have the greatest influence on the users' opinion and, therefore, measuring the quality of service in each application requires a specific instrument. This paper will introduce an instrument to measure the QoS offered to users by a general Web application for Electronic Health Records (EHRs). The collection of opinions from a pilot sample and the performance of an explanatory factor analysis will bring together the factors that best sum up the quality of an EHRs application. Subsequently, a confirmatory factor analysis will be performed to make the study reliable and, as its name suggests, to confirm that indeed the structure of the instrument developed measures the QoS in accordance with the requirements of the users.

• A Security and Privacy Preserving E-Prescription System Based on Smart Cards.

  Authors: Chien-Lung Hsu, Chung-Fu Lu

  Journal of medical systems.

  In 2002, Ateniese and Medeiros proposed an e-prescription system, in which the patient can store e-prescription and related information using smart card. Latter, Yang et al. proposed a novelIn 2002, Ateniese and Medeiros proposed an e-prescription system, in which the patient can store e-prescription and related information using smart card. Latter, Yang et al. proposed a novel smart-card based e-prescription system based on Ateniese and Medeiros's system in 2004. Yang et al. considered the privacy issues of prescription data and adopted the concept of a group signature to provide patient's privacy protection. To make the e-prescription system more realistic, they further applied a proxy signature to allow a patient to delegate his signing capability to other people. This paper proposed a novel security and privacy preserving e-prescription system model based on smart cards. A new role, chemist, is included in the system model for settling the medicine dispute. We further presented a concrete identity-based (ID-based) group signature scheme and an ID-based proxy signature scheme to realize the proposed model. Main property of an ID-based system is that public key is simple user's identity and can be verified without extra public key certificates. Our ID-based group signature scheme can allow doctors to sign e-prescription anonymously. In a case of a medical dispute, identities of the doctors can be identified. The proposed ID-based proxy signature scheme can improve signing delegation and allows a delegation chain. The proposed e-prescription system based on our proposed two cryptographic schemes is more practical and efficient than Yang et al.'s system in terms of security, communication overheads, computational costs, practical considerations.

• Family Physicians' Perceptions and Use of Electronic Clinical Decision Support During the First Year of Implementation.

  Authors: Annemie Heselmans, Bert Aertgeerts, Peter Donceel, Siegfried Geens, Stijn Van de Velde, Dirk Ramaekers

  Journal of medical systems.

  An electronic decision support system (the EBMeDS system) was integrated in one of the Electronic Medical Records (EMR) of Belgian family physicians (Feb 2010). User acceptance of the system isAn electronic decision support system (the EBMeDS system) was integrated in one of the Electronic Medical Records (EMR) of Belgian family physicians (Feb 2010). User acceptance of the system is considered as a necessary condition for the effective implementation of any IT project. Facilitators, barriers and issues of non-acceptance need to be understood in view of a successful implementation and to minimize unexpected adoption behavior. Objectives of the study were the assessment of users' perceptions towards the recently implemented EBMeDS system, the investigation of user-interactions with the system and possible relationships between perceptions and use. A mixed evaluation approach was performed consisting of a qualitative and a quantitative analysis. The technology acceptance model of UTAUT was used as a structural model for the development of our questionnaire to identify factors that may account for acceptance and use of the EBMeDS system (seven-point Likert scales). A quantitative analysis of computer-recorded user interactions with the system was performed for an evaluation period of 3 months to assess the actual use of the system. Qualitative and quantitative analysis were linked to each other. Thirty-nine family physicians (12 %) completed the survey. The majority of respondents (66 %) had a positive attitude towards the system in general. Mean intention to keep using the system was high (5,91 ± 1,33). Their perception of the ease of use of the system (mean 5,04 ± 1,41), usefulness (mean 4,69 ± 1,35) and facilitating conditions (4,43 ± 1,13) was in general positive. Only 0,35 % of reminders were requested on demand, the other 99,62 % of reminders displayed automatically. Detailed guidelines (long) were requested for 0,47 % of reminders automatically shown versus 16,17 % of reminders on request. The script behind the reminders was requested for 8,4 % of reminders automatically shown versus 13,6 % of reminders on request. The majority of respondents demonstrated a relatively high degree of acceptance towards the EBMeDS system. Although the majority of respondents was in general positive towards the ease of use of the system, usefulness and facilitating conditions, part of the statements gave rather mixed results and could be identified as important points of interest for future implementation initiatives and system improvements. It has to be stressed that our population consisted of a convenience sample of early adopters, willing to answer a questionnaire. The willingness to adopt the system depends on the willingness to use ICPC coding. As such, the quality of reminding partly depends on the quality of coding. There is a need to reach a larger population of physicians (including physicians who never used the system or stopped using the system) to validate the results of this survey.

• A Data Types Profile Suitable for Use with ISO EN 13606.

  Authors: Shanghua Sun, Tony Austin, Dipak Kalra

  Journal of medical systems.

  ISO EN 13606 is a five part International Standard specifying how Electronic Healthcare Record (EHR) information should be communicated between different EHR systems and repositories. Part 1 of theISO EN 13606 is a five part International Standard specifying how Electronic Healthcare Record (EHR) information should be communicated between different EHR systems and repositories. Part 1 of the standard defines an information model for representing the EHR information itself, including the representation of types of data value. A later International Standard, ISO 21090:2010, defines a comprehensive set of models for data types needed by all health IT systems. This latter standard is vast, and duplicates some of the functions already handled by ISO EN 13606 part 1. A profile (sub-set) of ISO 21090 would therefore be expected to provide EHR system vendors with a more specially tailored set of data types to implement and avoid the risk of providing more than one modelling option for representing the information properties. This paper describes the process and design decisions made for developing a data types profile for EHR interoperability.

• Creating Content Modules for Chinese EHR Documents and Their Trial Implementation in Wuwei City.

  Authors: Peng Yang, Feng Pan, Yongyong Xu, Danhong Liu, Ying Liang, Zhe Yang, Caihong Sun, Qing Ye

  Journal of medical systems.

  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 theseNumerous 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.

• An Authentication Scheme to Healthcare Security under Wireless Sensor Networks.

  Authors: Tsung-Chih Hsiao, Yu-Ting Liao, Jen-Yan Huang, Tzer-Shyong Chen, Gwo-Boa Horng

  Journal of medical systems.

  In recent years, Taiwan has been seeing an extension of the average life expectancy and a drop in overall fertility rate, initiating our country into an aged society. Due to this phenomenon, how toIn recent years, Taiwan has been seeing an extension of the average life expectancy and a drop in overall fertility rate, initiating our country into an aged society. Due to this phenomenon, how to provide the elderly and patients with chronic diseases a suitable healthcare environment has become a critical issue presently. Therefore, we propose a new scheme that integrates healthcare services with wireless sensor technology in which sensor nodes are employed to measure patients' vital signs. Data collected from these sensor nodes are then transmitted to mobile devices of the medical staff and system administrator, promptly enabling them to understand the patients' condition in real time, which will significantly improve patients' healthcare quality. As per the personal data protection act, patients' vital signs can only be accessed by authorized medical staff. In order to protect patients', the system administrator will verify the medical staff's identity through the mobile device using a smart card and password mechanism. Accordingly, only the verified medical staff can obtain patients' vital signs data such as their blood pressure, pulsation, and body temperature, etc.. Besides, the scheme includes a time-bounded characteristic that allows the verified staff access to data without having to have to re-authenticate and re-login into the system within a set period of time. Consequently, the time-bounded property also increases the work efficiency of the system administrator and user.

• An Improved Medical Decision Support System to Identify the Diabetic Retinopathy Using Fundus Images.

  Authors: S Jerald Jeba Kumar, M Madheswaran

  Journal of medical systems.

  An improved Computer Aided Clinical Decision Support System has been developed to classify the retinal images using Neural Network and presented in this paper. The Optic Disc Parameters, thickness ofAn improved Computer Aided Clinical Decision Support System has been developed to classify the retinal images using Neural Network and presented in this paper. The Optic Disc Parameters, thickness of the blood vessels, main vessel, and branch vessel and vein diameter have been extracted. Various types of Neural Network have been used for classification. The percentage of False Acceptance Rate and False Rejection Rate of the SVM classifier is found less than other classifiers. The accuracy of the proposed system has been verified and found to be 97.47%.

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