[show abstract][hide abstract] ABSTRACT: Organizations that have limited resources need to conduct clinical studies in a cost-effective, but secure way. Clinical data residing in various individual databases need to be easily accessed and secured. Although widely available, digital certification, encryption, and secure web server, have not been implemented as widely, partly due to a lack of understanding of needs and concerns over issues such as cost and difficulty in implementation.
The objective of this study was to test the possibility of centralizing various databases and to demonstrate ways of offering an alternative to a large-scale comprehensive and costly commercial product, especially for simple phase I and II trials, with reasonable convenience and security.
We report a working procedure to transform and develop a standalone Access database into a secure Web-based secure information system.
For data collection and reporting purposes, we centralized several individual databases; developed, and tested a web-based secure server using self-issued digital certificates.
The system lacks audit trails. The cost of development and maintenance may hinder its wide application.
The clinical trial databases scattered in various departments of an institution could be centralized into a web-enabled secure information system. The limitations such as the lack of a calendar and audit trail can be partially addressed with additional programming. The centralized Web system may provide an alternative to a comprehensive clinical trial management system.
[show abstract][hide abstract] ABSTRACT: The eMonitor is a component of the ePatient system; a prototype system used by emergency medical services (EMS) personnel in the field to record and transmits electronic patient care report (ePCR) information interactively. The eMonitor component allows each Mobile Data Terminal (MDT) on an unreliable Cisco MobileIP wireless network to securely send and received XML messages used to update patient information to and from the MDT before, during and after the transport of a patient.
[show abstract][hide abstract] ABSTRACT: Feedback Expert System for Emergency Medical Services (EMS) Documentation (FEED) has a rule-based knowledge base (KB) that was verified against specifications in a focus group consisting of six experts. The focus group suggested changes in almost all rules discussed, indicating that the KB did not meet specifications at that stage of development. However, enough information was gathered to address these issues in the next iteration of development.
[show abstract][hide abstract] ABSTRACT: The traditional communication infrastructure of the pre-hospital Emergency Medical System (EMS) is limited to voice communication using radio or cell phone technologies. With the emergence of 3rd Generation wireless networks (3G) and enhanced mobile devices capable of data communication (e.g., mobile tablets, PDAs with cell phones, or cell phones with PDA capabilities), the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication. However, video requires substantially more bandwidth which 4th Generation (4G) systems are promising. However, their availability is limited. We present an infrastructure that allows dynamic selection of the best data transport mode in the pre-hospital EMS environment.
[show abstract][hide abstract] ABSTRACT: The knowledge base (KB) for E-CAD (Enhanced Computer-Aided Dispatch), a triage decision support system for Emergency Medical Dispatch (EMD) of medical resources in trauma cases, is being evaluated. We aim to achieve expert consensus for validation and refinement of the E-CAD KB using the modified Delphi technique. Evidence-based, expert-validated and refined KB will provide improved EMD practice guidelines and may facilitate acceptance of the E-CAD by state-wide professionals.
[show abstract][hide abstract] ABSTRACT: To assess information needs of Emergency Medical Services (EMS) personnel and the potential of electronic decision support tools, we surveyed 39 paramedic students and practicing EMS personnel. We found frequent use of paper-based tools, with imperfect accessibility and ease of use. Potential electronic decision support tools were rated as helpful, but some alerts were rated low. The results may be helpful in design, implementation and research of electronic decision support tools for EMS.
[show abstract][hide abstract] ABSTRACT: Chest pain is a unique symptom in medical narration because the underlying cause can vary from mild acidity to massive Acute Myocardial Infarction also known as heart attack. Medical dispatching today is geared towards patient safety however too many Advanced Life Support (ALS) responses are made due to protocol of following every chest pain call. These ALS responses lead to inefficient use of community resources. Computerized dispatch protocol integrated with the dispatch station can achieve same level of patient safety with better utilization of Emergency Medical System (EMS) resources.
[show abstract][hide abstract] ABSTRACT: Based on the Alabama Patient Care Report we developed a basic Electronic Patient Care Report (ePCR) to collect data in an EMS environment. The ePCR GUI is now enhanced using speech recognition to provide speech-based command and control mechanisms to input structured data and initiate processes. This voice-enabled ePCR (vePCR) is used to evaluate the feasibility of handling EMS test cases and to get user feedback about the speech recognition functionality and usefulness.
[show abstract][hide abstract] ABSTRACT: Response times for pre-hospital emergency care may be improved with the use of algorithms that analyzes historical patterns in incident location and suggests optimal places for pre-positioning of emergency response units. We will develop such an algorithm based on cluster analysis and test whether it leads to significant improvement in mileage when compared to actual historical data of dispatching based on fixed stations.
[show abstract][hide abstract] ABSTRACT: Timely pre-hospital management of snake bite and poisoning cases is hindered by the lack of information about availability of antidotes in hospitals. We aim to build a regional antidote database by collecting real-time antidote stock information from hospital pharmacy inventory systems and make this information available to the emergency medical technicians (EMTs). This would save valuable time, leading to improved outcomes for the patients.
[show abstract][hide abstract] ABSTRACT: The rapid growth of online publications such as the Medline and other sources raises the questions how to get the relevant information efficiently. It is important, for a bench scientist, e.g., to monitor related publications constantly. It is also important, for a clinician, e.g., to access the patient records anywhere and anytime. Although time-consuming, this kind of searching procedure is usually similar and simple. Likely, it involves a search engine and a visualization interface. Different words or combination reflects different research topics. The objective of this study is to automate this tedious procedure by recording those words/terms in a database and online sources, and use the information for an automated search and retrieval. The retrieved information will be available anytime and anywhere through a secure web server.
We developed such a database that stored searching terms, journals and et al., and implement a piece of software for searching the medical subject heading-indexed sources such as the Medline and other online sources automatically. The returned information were stored locally, as is, on a server and visible through a Web-based interface. The search was performed daily or otherwise scheduled and the users logon to the website anytime without typing any words. The system has potentials to retrieve similarly from non-medical subject heading-indexed literature or a privileged information source such as a clinical information system. The issues such as security, presentation and visualization of the retrieved information were thus addressed. One of the presentation issues such as wireless access was also experimented. A user survey showed that the personalized online searches saved time and increased and relevancy. Handheld devices could also be used to access the stored information but less satisfactory.
The Web-searching software or similar system has potential to be an efficient tool for both bench scientists and clinicians for their daily information needs.
BMC Medical Informatics and Decision Making 02/2005; 5:6. · 1.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: Data gathering processes in pre-hospital care have been poorly studied. This study aims to compare an electronic PCR with the current paper standard. EMTs will hear a case narrative and enter this information in paper PCR, ePCR or ePCR pre-filled with historical patient data pulled from a database. Time taken, accuracy and completeness will be measured for each encounter. This study will provide better insight into data entry at the point of care.
[show abstract][hide abstract] ABSTRACT: The pre-hospital emergency medical and public safety information environment is nearing a threshold of significant change. The change is driven in part by several emerging technologies such as secure, high-speed wireless communication in the local and wide area networks (wLAN, 3G), Geographic Information Systems (GIS), Global Positioning Systems (GPS), and powerful handheld computing and communication services, that are of sufficient utility to be more widely adopted. We propose a conceptual model to enable improved clinical decision making in the pre-hospital environment using these change agents.
[show abstract][hide abstract] ABSTRACT: Wireless local area networks (WLANs) are considered the next generation of clinical data network. They open the possibility for capturing clinical data in a prehospital setting (e.g., a patient's home) using various devices, such as personal digital assistants, laptops, digital electrocardiogram (EKG) machines, and even cellular phones, and transmitting the captured data to a physician or hospital. The transmission rate is crucial to the applicability of the technology in the prehospital setting.
We created two separate WLANs to simulate a virtual local are network environment such as in a patient's home or an emergency room (ER). The effects of different methods of data transmission, number of clients, and roaming among different access points on the file transfer rate were determined.
The present results suggest that it is feasible to transfer small files such as patient demographics and EKG data from the patient's home to the ER at a reasonable speed. Encryption, user control, and access control were implemented and results discussed.
Implementing a WLAN in a centrally managed and multiple-layer-controlled access control server is the key to ensuring its security and accessibility. Future studies should focus on product capacity, speed, compatibility, interoperability, and security management.
BMC Medical Informatics and Decision Making 09/2004; 4:12. · 1.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: The explosive growth of online biological and medical information presents a real time challenge to the strategy and methods currently used in information acquisition. One of these challenges is how to retrieve the relevant information in a timely manner. Agent technology and various filtering systems have been employed in order to enhance the relevancy. Integration of the two into a user-friendly interface will further reduce the time spent in the process. In addition, personalization will provide extra relevancy to the retrieved information. Starting from a personalized PubMed search, we propose to apply the bottom-up strategy in our development of agents that are linked to a Personalized Domain-Specific Vocabulary (PDSV), which consists of major terms, sources and techniques by which a Molecular Oncologist search for the relevant information. The successful application of PDSV in online information retrieval (IR) in one research area will lay a foundation for future expansion into other health care research areas.
[show abstract][hide abstract] ABSTRACT: The creation of an electronic version of the Patient Care Report (ePCR) during the ambulance run remains a challenge for the pre-hospital environment. Current ePCR systems follow a "one-size-fits-all" approach. In this context, system components such as user interfaces and business models are developed without taking into account the specifics for different categories of patients or information needs of EMS agencies. These customizations involve extensive alteration of user interfaces, business objects and the data layer requiring significant investment of resources such as time and programming expertise. This paper describes an investigation into a model-driven approach to automate the generation of business objects and data layer classes for context-specific ePCRs. The workflow involves design of the metamodel, creation of domain models and generation of business classes based on the Component Based Scalable Logical Architecture (CSLA) framework.