Interoperability--a key infrastructure requirement for personalised health services

Functional and semantic interoperability requirements for ubiquitous personalised health services reach beyond current concepts of health information integration among professional stakeholders and related Electronic Patient Records ("eHealth"): Future health telematics infrastructures have particularly to maintain semantic interoperability among systems using different coding schemes and terminologies and to include home, personal and mobile systems.

Biomedical informatics research network: building a national collaboratory to hasten the derivation of new understanding and treatment of disease

Through support from the National Institutes of Health's National Center for Research Resources, the Biomedical Informatics Research Network (BIRN) is pioneering the use of advanced cyberinfrastructure for medical research. By synchronizing developments in advanced wide area networking, distributed computing, distributed database federation, and other emerging capabilities of e-science, the BIRN has created a collaborative environment that is paving the way for biomedical research and clinical information management. The BIRN Coordinating Center (BIRN-CC) is orchestrating the development and deployment of key infrastructure components for immediate and long-range support of biomedical and clinical research being pursued by domain scientists in three neuroimaging test beds.

Grid-enabled biosensor networks for pervasive healthcare

Current advances in biosensor technology allow multiple miniaturized or textile sensors to record continuously biosignals, such as blood pressure or heart rate, and transmit the information of interest to clinical sites. New applications are emerging, based on such systems, towards pervasive healthcare. This paper describes an architecture enabling biosensors, forming a Body Area Network (BAN), to be integrated in a Grid infrastructure. The Grid services proposed, such as access to recorded data, are offered via the BAN console, an enhanced wearable computer, where the recordings of multiple biosensors are integrated. Medical Grid-enabled Nodes can have access to biosensor measurements upon demand, or can agree to get notifications and alerts. Thus, in such a distributed environment, data and computational resources are independent, yet cooperating unobtrusively, contributing to the notion of pervasive healthcare.

A grid architecture for medical applications

Grid technology can provide medical organisations with powerful tools through which they can gain coordinated access to computational resources that hitherto where inaccessible to them. This paper discusses how several classes of medical applications could benefit from the use of Grid technology. We concentrate on applications that were put forward by partners in the Dutch VL-e project. After describing the difficulties related to the realization of such applications without making use of the Grid, we describe an architecture that allows the applications to use Grid resources. We demonstrate how this architecture can be integrated into existing systems to provide flexible and transparent access to Grid services and show performance results of a test case.

Grid-based onto-technologies provide an effective instrument for biomedical research

New experimental technologies have rapidly transformed biomedical research into a data-intensive discipline. Being grafted onto Grid environment ontologies deliver an effective "onto-technology" to explore wide variety of different sorts of links in heterogeneous distributed data sources as well as to define new facts and represent new relationships between data sets.

ProGenGrid: a grid-enabled platform for bioinformatics

In this paper we describe the ProGenGrid (Proteomics and Genomics Grid) system, developed at the CACT/ISUFI of the University of Lecce which aims at providing a virtual laboratory where e-scientists can simulate biological experiments, composing existing analysis and visualization tools, monitoring their execution, storing the intermediate and final output and finally, if needed, saving the model of the experiment for updating or reproducing it. The tools that we are considering are software components wrapped as Web Services and composed through a workflow. Since bioinformatics applications need to use high performance machines or a high number of workstations to reduce the computational time, we are exploiting a Grid infrastructure for interconnecting wide-spread tools and hardware resources. As an example, we are considering some algorithms and tools needed for drug design, providing them as services, through easy to use interfaces such as the Web and Web service interfaces built using the open source gSOAP Toolkit, whereas as Grid middleware we are using the Globus Toolkit 3.2, exploiting some protocols such as GSI and GridFTP.

Supporting clinical practice at the bedside using wireless technology

OBJECTIVES

Despite studies that show improvements in both standards of care and outcomes with the judicious application of clinical practice guidelines (CPGs), their clinical utilization remains low. This randomized controlled trial examined the use of a wirelessly networked mobile computer (MC) by physicians at the bedside with access to an emergency department information system, decision support tools (DSTs), and other software options.

METHODS

Each of ten volunteer emergency physicians was randomized using a matched-pair design to work five shifts in standard fashion (desktop computer [DC] access) and five shifts with a wirelessly networked MC. Work pattern issues and electronic CPG/DST use were compared using end-of-shift satisfaction questionnaires and review of a CPG/DST database. Repeated-measures analysis of variance was used to examine between-shift differences.

RESULTS

A total of 100 eight-hour shifts were evaluated; 99% compliance with postshift questionnaires was achieved. Using a seven-point Likert scale (MC values first), MCs were rated as being as fast (5.04 vs. 4.54; p=0.13) and convenient (5.08 vs. 4.14; p=0.07) as DCs. Overall, physicians rated MCs to be less efficient (3.18 vs. 4.30; p=0.02) but encouraged more frequent use of DSTs (4.10 vs. 3.47; p=0.03) without impacting doctor-patient communication (2.78 vs. 2.96; p=0.51). During the study period, physician use of an intranet Web application (eCPG) was more frequent during shifts assigned to the MC when compared with the DC (eCPG uses/shift, 3.6 vs. 2.0; p=0.033).

CONCLUSIONS

The MC technology permitted physicians to access information at the bedside and increased the use of CPG/DST tools. According to physicians, patients appeared to accept their use of information technology to assist in decision making. Development of improved computer technology may address the major limitation of MC portability.

Adverse health-care events: Part 2. Incident reporting systems

This paper, the second in a series of four on adverse health events, outlines the process for reporting, investigating and learning from clinical incidents. It outlines the nursing contribution and nurses' responsibility with regards to effective clinical risk management in order to achieve a major cornerstone of clinical governance--making the NHS safer for patients.

Everybody's doing it. With the U.S. economy limping along, the unlikeliest marketers are trying to claim a niche in healthcare

The hospital outlook might seem bleak to some investors, but a bevy of diverse companies are seeking the financial cure they believe the healthcare industry can provide. Everyone from carpet companies to trucking firms has been drawn to healthcare because of its seemingly endless consumer demand. Jeannine Rossignol, left, senior marketing manager at Xerox Corp., demonstrates a product at the recent VHA Leadership Conference in Boston.

MFDTool: a software program for designing optimal multifunction displays

This paper describes a software program called MFDTool. MFDTool is used to design multifunction displays (MFDs), which enable people to interact with computer information systems. MFDTool characterizes the problem of MFD design as the identification of how people interact with the system and what types of constraints should be imposed by the designer to shape the properties of the MFD. Once this information is provided, MFDTool uses an optimization procedure to build a variety of candidate MFD designs and to identify the MFD design that best satisfies the constraints. An example of MFD design is discussed.

IT doesn't matter

As information technology has grown in power and ubiquity, companies have come to view it as ever more critical to their success; their heavy spending on hardware and software clearly reflects that assumption. Chief executives routinely talk about information technology's strategic value, about how they can use IT to gain a competitive edge. But scarcity, not ubiquity, makes a business resource truly strategic--and allows companies to use it for a sustained competitive advantage. You only gain an edge over rivals by doing something that they can't. IT is the latest in a series of broadly adopted technologies--think of the railroad or the electric generator--that have reshaped industry over the past two centuries. For a brief time, as they were being built into the infrastructure of commerce, these technologies created powerful opportunities for forward-looking companies. But as their availability increased and their costs decreased, they became commodity inputs. From a strategic standpoint, they became invisible; they no longer mattered. that's exactly what's happening to IT, and the implications are profound. In this article, HBR's editor-at-large Nicholas Carr suggests that IT management should, frankly, become boring. It should focus on reducing risks, not increasing opportunities. For example, companies need to pay more attention to ensuring network and data security. Even more important, they need to manage IT costs more aggressively. IT may not help you gain a strategic advantage, but it could easily put you at a cost disadvantage. If, like many executives, you've begun to take a more defensive posture toward IT, spending more frugally and thinking more pragmatically, you're already on the right course. The challenge will be to maintain that discipline when the business cycle strengthens.

Virtual prototyping and testing of in-vehicle interfaces

Electronic innovations that are slowly but surely changing the very nature of driving need to be tested before being introduced to the market. To meet this need a system for integrated virtual prototyping and testing has been developed. Functional virtual prototypes of various traffic systems, such as driver assistance, driver information, and multimedia systems can now be easily tested in a driving simulator by a rapid prototyping approach. The system has been applied in recent R&D projects.

Tool command language automation of the modular ion cyclotron data acquisition system (MIDAS) for data-dependent tandem Fourier transform ion cyclotron resonance mass spectrometry

This manuscript describes the addition of data-dependent automation to the modular ion cyclotron resonance data acquisition system (MIDAS). The automation is made possible by developments and incorporation of a tool command language (Tcl) interpreter for automated acquisition. To accomplish the automation, real-time generation of excitation waveforms and scriptable data post-processing has been implemented into the MIDAS source code. In addition a new excitation event has also been added to allow for run-time generation of a single notch stored waveform inverse Fourier transform (SWIFT) excitation event. Examples of these new features and discussion of their enhancement to the existing data station are presented.

Using GIS and historical records to reconstruct residential exposure to large-scale pesticide application

Investigation of pesticide impacts on human health depends on good measures of exposure. Historical exposure data are needed to study health outcomes, such as cancer, that involve long latency periods, and other outcomes that are a function of the timing of exposure. Environmental or biological samples collected at the time of epidemiologic study may not represent historical exposure levels. To study the relationship between residential exposure to pesticides and breast cancer on Cape Cod, Massachusetts, historical records of pesticide use were integrated into a geographic information system (GIS) to estimate exposures from large-scale pesticide applications between 1948 and 1995. Information on pesticide use for gypsy moth and other tree/vegetative pest control, cranberry bog cultivation, other agriculture, mosquito control, recreational turf management, and rights-of-way maintenance is included in the database. Residents living within or near pesticide use areas may be exposed through inhalation due to drift and volatilization and through dermal contact and ingestion at the time of application or in later years from pesticides that deposit on soil, accumulate in crops, or migrate to groundwater. Procedures were developed to use the GIS to estimate the relative intensity of past exposures at each study subject's Cape Cod addresses over the past 40 years, taking into account local meteorological data, distance and direction from a residence to a pesticide use source area, size of the source area, application by ground-based or aerial methods, and persistent or nonpersistent character of the pesticide applied. The resulting individual-level estimates of relative exposure intensity can be used in conjunction with interview data to obtain more complete exposure assessment in an epidemiologic study. While the database can improve environmental epidemiological studies involving pesticides, it simultaneously illustrates important data gaps that cannot be filled. Studies such as this one have the potential to identify preventable causes of disease and guide public policies.

Information architecture for a federated health record server

This paper describes the information models that have been used to implement a federated health record server and to deploy it in a live clinical setting. The authors, working at the Centre for Health Informatics and Multiprofessional Education (University College London), have built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multi-professional electronic health records. This work has involved collaboration with a wide range of health care and informatics organisations and partners in the healthcare computing industry across Europe though the EU Health Telematics projects GEHR, Synapses, EHCR-SupA, SynEx and Medicate. The resulting architecture models have fed into recent European standardisation work in this area, such as CEN TC/251 ENV 13606. UCL has implemented a federated health record server based on these models which is now running in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. The information models described in this paper reflect a refinement based on this implementation experience.