Streamlining patient consultations for sleep disorders with a knowledge-based CDSS

ObjectivesThis paper examines the workflow of sleep physicians during a patient consultation and how an innovative clinical decision support system (CDSS) provides efficiency and effectiveness gains.MethodsThe CDSS tools consisted of two input applications for patient data, with a knowledge based decision support system developed participatively with physicians and an international panel. An argument tree approach was used to produce diagnostic explanations and an evidence-based report for the physician using medically correct and shared terminology. A usability evaluation using a qualitative approach was carried out to ensure that the CDSS met the physicians׳ information needs, as well as the wider needs of a Sleep Investigation Unit.ResultsThe physicians found the CDSS both useful and usable with clear applications in triage and diagnostic decision-making, and in patient education.ConclusionThe CDSS both reduces the time and number of visits needed for consultations, and helps focus consultation on better individual patient care through informed explanation of diagnostic and treatment decisions.     

Clinical decision support system in medical knowledge literature review

The current study involved methodology and content analyses of abstracts of 30 clinical decision support system (CDSS) related studies with high impact factors. The main aim of the current work was to identify the performance and efficiency of CDSS, and enhance the understanding of CDSS for a better health management among the physicians and the patients. To add structure to the current study, major research areas were categorized based on a multidimensional unfolding analysis. In this regard, eight studies were conducted based on theoretical research, ten studies were related to the system and performance of CDSS, and 12 studies verified the efficacy through analysis and evaluation of CDSS. The results indicated that the above-mentioned studies on improvement in systematic performance. Then, based on the improvement, effectively used evaluations were conducted comparably. Moreover, 14 studies analyzed patients’ data and assessed decision support system (DSS). The related findings denoted that DSS has been mainly used for patient management and a large number of studies have verified its effectiveness, using several data to ensure its accuracy and reliability. In addition, the analyzed results of the abstracts and the titles were compared to find whether the titles of the literature articles reveal their content. Using these methodological studies, the academic outlook of medical informatics could be forecasted and the academic quality could be improved by resolving the problems, arising out of system development and realization processes. Such problems can be solved through analyses and interpretation of multilateral parameters, such as the trend in academic development, research direction, topics and methods.     

The Office of the Future: Integrating Information in the Care System

Healthcare's shift in focus, demand and expectations presents medical practices with opportunities to effect change in office operations and patient services. Developing strategies to incorporate technology among staff and physicians is a high priority for practice administrators today. A computerized medical record is a significant change in the daily activities of physicians, clinical support staff, and patients. A multi-manufacturer, integrated information system that routes data from a patient's body through a point-of-care device and straight into a patient management system - all without keyboard entry - is the Office of the Future.     

A computer-based outpatient medical record for a teaching hospital.

We developed a computer-based outpatient medical record system to facilitate direct physician interaction with the clinical computing system at the Beth Israel Hospital in Boston. During the 2 years since the medical record system was installed, 20 staff physicians, 5 fellows, 64 residents, and 11 nurse practitioners have entered 15,121 active problems and 1996 inactive problems for 3524 patients, as well as 12,651 active medications and 1894 discontinued medications for 3430 patients. Another 20,321 items were entered on health-promotion and disease-prevention screening sheets, and with the help of automatic updating by the computer, an additional 21,897 entries on screening sheets were made for 8686 patients. Clinicians wrote 10.9 +/- 12.8 (mean +/- SD) words per problem when they were working at the computer, as compared with 4.3 +/- 2.5 words per problem when they were writing in the paper medical record. We conclude that physicians will readily enter data directly into a computing system when they are given appropriate tools, and that they consider the computer-based problem list to be a valuable improvement over its paper counterpart. Use of a computer-based medical record system has obvious benefits for data management and patient care.     

RFID Positioning and Physiological Signals for Remote Medical Care

The safety of patients and the quality of medical care provided to them are vital for their wellbeing. This study establishes a set of RFID (Radio Frequency Identification)-based systems of patient care based on physiological signals in the pursuit of a remote medical care system. The RFID-based positioning system allows medical staff to continuously observe the patient's health and location. The staff can thus respond to medical emergencies in time and appropriately care for the patient. When the COVID-19 pandemic broke out, the proposed system was used to provide timely information on the location and body temperature of patients who had been screened for the disease. The results of experiments and comparative analyses show that the proposed system is superior to competing systems in use. The use of remote monitoring technology makes user interface easier to provide high-quality medical services to remote areas with sparse populations, and enables better care of the elderly and patients with mobility issues. It can be found from the experiments of this research that the accuracy of the position sensor and the ability of package delivery are the best among the other related studies. The presentation of the graphical interface is also the most cordial among human-computer interaction and the operation is simple and clear.     

Secure information authentication protocol between patients and medical staff in a hospital environment

Recently, it has become possible for the hospital environment to provide medical services to patients anywhere by integrating IT technology in medical devices. However, medical services in the current environment face a problem in that identifiable patient information cannot be safely transferred to the medical staff when the patient is receiving medical services. In this paper, we propose a mandate-based signature authentication protocol that can safely deliver the personal information of patients to the medical personnel providing the medical services. In the proposed protocol, the patient information being delivered is encrypted with a signature key and random-generated number in order to avoid exposure to a third party capable of identifying the information of the patient. In addition, the proposed protocol maintains the synchronization between patients and staff based on the rating of the medical personnel in order to prevent the illegal abuse of patient information from a third party. In particular, the proposed protocol ensures access only to staff members who have received a mandate from the hospital to care for the patient. The performance and security of the proposed protocol are evaluated separately. In the performance evaluation, the proposed protocol‘s authentication latency showed an average improvement of 6.5% over the previous protocol. Throughtput was 8% higher than the previous protocol, and the authentication overhead improved by an average of 5.3%.     

Construction of patient service system based on QFD in internet of things

In recent years, as the basic medical science is improved, the prevention and treatment of bedsore have made great progress. However, from the incidence rate of bedsore worldwide, its downward trend is extremely weak, so the nursing of a bedsore is still a major problem in the medical field. To explore the construction of patient service system based on quality function deployment (QFD) in the Internet of Things (IoT) environment, in this study, with the support of IoT technology, deep learning algorithm and QFD method are used to build patient service model to achieve the detection and nursing reminder of patients' physical condition. The basic framework of patient service system is constructed, and the system performance is simulated and analyzed in the simulation environment. The results show that when the data collection and analysis of health monitoring, functional analysis and the functional architecture of IoT are further carried out, it is found that the service system built in this study is more standardized, and it can monitor the physiological data of patients who are bedridden for a long time and cannot turn over in real time, so as to have a preliminary understanding of the patients' physical condition. Through the results of the service system, patients can get personalized care that varies from person to person, thus reducing the pressure of medical staff, and doctors can have a clearer real-time understanding of patients' physical condition. Therefore, in this study, the patient service system constructed has a timely avoidance effect on bedsore and achieves the expected demand, to provide an experimental basis for the service treatment of patients in the later medical industry.

     

Artificial intelligence hospital hardware system and clinical observation of molecular heparin sodium in hemodialysis patients

Mobile technology is changing the way the patient is undergoing medical treatment. The patient is integrated to manage their health, smartphone, and tablet. The mobile device, such as a patient monitoring system, provides easy-to-doctor real-time patient information. It is easier to communicate with patients and doctors. Mobile health care offers several advantages; however, there are also disadvantages to using these mobile technologies. Necessary to solve privacy is one of the few problems. The patient will not pay more attention. It will focus on mobile medical privacy issues. Based on the mobile medical privacy protection laws, will show how to protect the patient of intelligence Privacy-Preserving Approach for Mobile Healthcare (PAMH). Based on the smartphone's application and access control mechanism, the solution is designed to allow patients to develop their privacy settings, the disclosure of confidential medical information. Various aspects of solution are to use the proposed method; it is defined by whether the patient's privacy policy is shown in the actual scenario. Low Molecular Weight Heparin (LMWH) has been extensively studied; it has become the preferred treatment for several indications, including pulmonary embolism. Effectiveness of their blood dialysis, but is believed to be similar to that of Unfractionated Heparin (UFH), there is a discussion that the risk of their safety is still renal disorder in a patient bio-enrichment. Compared to unfractionated heparin for Extracorporeal Circulation (ECC) anticoagulant, Sodium has been introduced as a viable diagnostic tool for assessing the Na + content of the tissue in kidney disease patients.     

Trust in medical technology by patients and healthcare providers in obstetric work systems

Multiple types of users (i.e. patients and care providers) have experiences with the same technologies in healthcare environments and may have different processes for developing trust in those technologies. The objective of this study was to assess how patients and care providers make decisions about the trustworthiness of mutually used medical technology in an obstetric work system. Using a grounded theory methodology, we conducted semi-structured interviews with 25 patients who had recently given birth and 12 obstetric healthcare providers to examine the decision-making process for developing trust in technologies used in an obstetric work system. We expected the two user groups to have similar criteria for developing trust in the technologies, though we found patients and physicians differed in processes for developing trust. Trust in care providers, the technologies' characteristics and how care providers used technology were all related to trust in medical technology for the patient participant group. Trustworthiness of the system and trust in self were related to trust in medical technology for the physician participant group. Our findings show that users with different perspectives of the system have different criteria for developing trust in medical technologies.     

The evaluation of an information system for intensive care

This paper describes the application of humancomputer interaction (HCI) research methods in critical care medicine. An evaluation of an information system for the support of cardiological intensive care (The Aachen Information System for Intensive Care- AISIC) is outlined. AISIC supports the capturing of diagnostic and therapeutic patient data by nursing staff, the requesting of external diagnostic reports, and the retrieval of information for treatment planning performed by physicians (Popp 1994). It was hypothesized that use of the information system would result in quicker task completion times and a reduction in error-making, when compared to the existing paper-based record-keeping system. The evaluation was carried out using eight different forms of data capture, ranging from interview and questionnaire to automatic keystroke logging. The results of the evaluation revealed problems in the prescribing and recording of medication dosage and administration. The resultant redesign of the medication option is discussed, along with implications for improved patient care through the cognitive engineering of medical information systems. The problems encountered in conducting this type of work in a critical care environment are also discussed.     

Patient safety in outpatient surgery: the viewpoint of the healthcare providers

The objective of this study is to understand the viewpoint of healthcare providers with regard to patient safety in outpatient surgery settings. Two methods were used to gather data from the healthcare providers: (1) questionnaire with open-ended questions about six predefined stages of the patient care process; (2) survey with closed questions. With the first method, the main quality and safety of care issues concerned communication to patients, coordination of reports and forms, patient and staff time pressures and standards of care. The first two stages of the outpatient surgery process, i.e. patient work-up prior to day of surgery and patient admission and preparation on the day of surgery, yielded many more comments than the other four stages. The results of the structured questionnaire show that, overall, the healthcare providers report high quality of care provided by themselves (98%) and their surgery centre (96%). With regard to patient safety (i.e. cancellations of surgeries, patient safety problems and serious mistakes), there was a clear difference in perceptions reported by the physicians vs. the nurses and other staff. Nurses and other staff were more likely to report patient safety problems than physicians. The combination of qualitative data from the initial questionnaire and the quantitative data from the structured questionnaire provides a rather complete view of the outpatient surgery staff perceptions of quality and safety of care. This research highlights the importance of getting input from the healthcare providers regarding the quality and safety of care rather than relying only on traditional measures about patient outcomes.     

A bio-statistical mining approach for classifying multivariate clinical time series data observed at irregular intervals

In medical information system, the data that describe patient health records are often time stamped. These data are liable to complexities such as missing data, observations at irregular time intervals and large attribute set. Due to these complexities, mining in clinical time-series data, remains a challenging area of research. This paper proposes a bio-statistical mining framework, named statistical tolerance rough set induced decision tree (STRiD), which handles these complexities and builds an effective classification model. The constructed model is used in developing a clinical decision support system (CDSS) to assist the physician in clinical diagnosis. The STRiD framework provides the following functionalities namely temporal pre-processing, attribute selection and classification. In temporal pre-processing, an enhanced fuzzy-inference based double exponential smoothing method is presented to impute the missing values and to derive the temporal patterns for each attribute. In attribute selection, relevant attributes are selected using the tolerance rough set. A classification model is constructed with the selected attributes using temporal pattern induced decision tree classifier. For experimentation, this work uses clinical time series datasets of hepatitis and thrombosis patients. The constructed classification model has proven the effectiveness of the proposed framework with a classification accuracy of 91.5% for hepatitis and 90.65% for thrombosis.     

Using tablets in medical consultations: Single loop and double loop learning processes

ObjectiveThis paper investigates the influence of using tablet in waiting rooms and medical examinations on how physicians give information and how patients learn. It further assesses the factors that impact patient satisfaction.MethodsPatients and physicians in a primary care clinic were given a tablet device to search for health information in the waiting room, and when interacting with the physician, while physicians used the tablet device to share information with patients during the medical consultation. 82 patients completed a ‘pre’ survey on using tablets to search for health related information and a ‘post’ survey after their visit. Structural equation modeling was employed to analyze patient's perceptions.ResultsTablet use during consultation has a negative effect on patients' perceptions of physician information giving, but using the tablet in the waiting room has a positive impact on patient learning, perceptions of physicians' information giving and patient satisfaction.ConclusionsThis study indicates the importance of tablet use in ensuring information giving and patient learning. It further highlights the potential for tablets to promote single-loop learning in the medical encounter by better preparing patients for the physician's information giving. Tablets also enable double-loop learning, which leads to greater patient satisfaction.     

Inpatient diabetes care: complexity,resilience and quality of care

It is estimated that 10–15 % of UK hospital inpatients have diabetes. Poor glycemic control is a care quality problem that has been linked to organizational factors such as inadequate training, inadequate protocols, problems with communication and teamwork, and difficulty coordinating mealtimes. Interventions using specialist diabetes teams have been effective in addressing some of these problems and have led to increased staff and patient self-efficacy and reduced length of stay. The aim of this study was to investigate how inpatient diabetes care is delivered and how resilience is created and/or breaks down, and to identify the implications for quality improvement. In-depth interviews (n = 32) with diabetes specialist and non-specialist staff were conducted in an acute medical admissions environment in an 850-bed teaching hospital. The Critical Decision Method, a content-orientated knowledge elicitation technique, was adapted to guide interview schedules, which explored key decisions, gaps and discontinuities in care and strategies for work system improvement. Care is delivered through the coordination of a multilayered team of different professionals. Specialists provide expertise and problem solving through case-based reasoning using problem-solving skills acquired through past experience. Ward staff focus on processes and immediate patient needs and are more reliant on decision protocols. Gaps in care can occur and result in delays in referring to specialists and clinical inertia. Specialists are a key source of resilience in the system and bridge gaps by acting reactively to problems, proactively monitoring and anticipating problems, providing staff education, and patient support and education. Opportunities for supporting clinicians to bridge gaps in care were identified.     

Telemedicine as a tool for intensive management of diabetes: the DIABTel experience

This paper presents the current features of the DIABTel telemedicine system and the evaluation outcomes of its use in clinical routine. This telemedicine system is designed to complement the daily care and intensive management of diabetic patients through telemonitoring and telecare services. The system comprises a patient unit (PU) used by patients in their day-to-day activities and a Medical Workstation used by physicians and nurses at hospitals. Both applications offer tools to collect, manage, view and interpret data and to exchange data and messages. The system was evaluated for usability, telemedical protocols, metabolic control and quality of life. This evaluation consisted in a 6-month cross-over pilot study with ten Type I diabetic patients. The results of the evaluation allowed assessment of the telemedicine protocols in terms of the number of communications/patient (21.6+/-7.7); days between communications (5.4+/-2.66); messages sent by physicians (118 text messages); and data and messages transmitted by patients (3524 blood glucose readings, 1649 day-to-day insulin adjustments, 24 exercise reports, ten diet modifications and 63 text messages). Physicians performed more therapeutic changes during the DIABTel period than in the control period. There was a trend towards HbA1c improvement during DIABTel use with no incidence in the number of hypoglycaemias. This pilot study demonstrates the feasibility of the DIABTel system in clinical routine use and its potential benefits for diabetes care: improving the availability of information necessary for therapy adjustments; offering new physician-patient communication tools; increasing patient empowerment and education; and showing a positive trend towards improving the metabolic control of patients. Further studies are needed to validate these findings and to promote telemedicine as an opportunity to better diabetes care.     

A hybrid SCA–VNS meta-heuristic based on Iterated Hungarian algorithm for physicians and medical staff scheduling problem in outpatient department of large hospitals with multiple branches

This paper investigates the scheduling problem of physicians and medical staff in outpatient department of large hospitals with multi-branch. The large hospital has several branches and each branch has its own medical staff, while the physicians need to serve in all the branches affiliated to the hospital. In order to improve the working efficiency of physicians, each physician would be equipped with a medical staff during his working hours. The working time of physicians and medical staff have several requirements considering the satisfaction of them. The paper takes into account the demand and the available resources of the hospital, the workload of physicians and medical staff, etc. as the constraints, and the purpose is to minimize the dissatisfaction of physicians, the cost of physicians and the deviation of the frequency of physicians at work in different clinics. Then, a hybrid meta-heuristic algorithm SCA–VNS combining a Sine Cosine Algorithm (SCA) and variable neighborhood search (VNS) based on Iterated Hungarian algorithm, which is incorporated to solve the physicians and medical staff assignment, is proposed to solve this problem. Through computational experiments that available physicians and medical staff scheduling have been generated and perform better than other compared algorithms.     

Computer-aided system for diabetes care in Berlin, G.D.R

In the Centre of Diabetes and Metabolic Disorders of Berlin, G.D.R., a computer-aided care system has been used since 1974, aiming at relieving physicians and medical staff from routine tasks and rendering possible epidemiological research on an unselected diabetes population of a defined area. The basis of the system is the data bank on diabetics (DB), where at present data from approximately 55,000 patients are stored. DB is used as a diabetes register of Berlin. On the basis of standardised criteria of diagnosis and therapy of diabetes mellitus in our dispensary care system, DB facilitates representative epidemiological analyses of the diabetic population, e.g. prevalence, incidence, duration of diabetes, and modes of treatment. The availability of general data on the population or the selection of specified groups of patients serves the management of the care system. Also, it supports the computer-aided recall of type II diabetics, treated either with diet alone or with diet and oral drugs. In this way, the standardised evaluation of treatment strategies in large populations of diabetics is possible on the basis of uniform metabolic criteria (blood glucose plus urinary glucose). The system consists of a main computer in the data processing unit and of personal computers in the diabetes centre which can be used either individually or as terminals to the main computer. During 14 years of experience, the computer-aided out-patient care of type II diabetics has proved efficient in a big-city area with a large population.     

Involving users in the design and usability evaluation of a clinical decision support system

AIM: To design and evaluate a clinical decision support system (CDSS) to support cardiovascular risk prevention in type 2 diabetes. METHODS: A preliminary requirements specification and three prototype CDSS interface designs were developed. Seven patients and seven clinicians conducted 'usability tests' on five different task scenarios with the CDSS prototypes to test its effectiveness, efficiency and 'user-friendliness'. Structured, qualitative questions explored their preferences for the different designs and overall impressions of clinical usefulness. RESULTS: Patients and clinicians were enthusiastic about the CDSS and used it confidently after a short learning period. Some patients had difficulty interpreting clinical data, but most were keen to see the CDSS used to help them understand their diabetes, provided a clinician explained their results. Clinicians' main concern was that the CDSS would increase consultation times. Changes suggested by users were incorporated into the final interface design. CONCLUSION: We have successfully incorporated patients' and clinicians' views into the design of a CDSS, but it was an arduous process.     

Improving physicians' performance with a stroke CDSS: A cognitive fit design approach

A large body of evidence over many years suggests that clinical decision support systems (CDSSs) can be helpful in improving both clinical outcomes and adherence to evidence-based guidelines. CDSSs have however failed to show their effectiveness due to poor ease of use and integration within clinical workflows. This research therefore emphasizes a cognitive fit design approach to developing an effective CDSS to solve those issues. According to the cognitive fit theory CDSS should align with the problem and task representation in order to match the physician's mental model to reduce cognitive effort. Several guidelines based on the cognitive fit design are proposed. A stroke CDSS prototype following the design guidelines is developed to demonstrate its feasibility. The system usability test results showed that the developed stroke CDSS was acceptably accurate, able to lessen the cognitive effort as desired, and preferable for use due to the significant reduction in cognitive load. The developed artifact has shown the potential to benefit physicians. Finally, implications and conclusions are discussed.