Designing and evaluating the children's developmental motor disorders system: an experience from a developing country

BACKGROUND

Developmental disorders are a prevalent problem in the health sector of low- and middle-income countries (LMICs), and children in these countries are at greater risk. A registry system is helpful and vital to monitoring and managing this disease.

OBJECTIVE

The present study aims to develop an electronic registry system for children's developmental motor disorders.

METHODS

The study was conducted between 2019 and 2020 in three phases. First, the requirements of the system were identified. Second, UML diagrams were first drawn using Microsoft Visio software. Then, the system was designed using the ASP.NET framework in Visual Studio 2018, and the C# programming language was used in the NET 4.5 technology platform. In the third phase, system usability was evaluated from the users' viewpoint.

RESULTS

The findings of this research included system requirements, a conceptual model, and a web-based system. The client and system server connection was established through the IP/TCP communication protocol in a university physical network. End users approved the system with an agreement rate of 87.14%.

CONCLUSION

The study's results can be used as a model for designing and developing systems related to children's developmental movement disorders in other countries. It is also suggested as a valuable platform for research and improving the management of this disease.

ETL Processes for Integrating Healthcare Data - Tools and Architecture Patterns

Improving the interoperability of healthcare information systems is a crucial clinical care issue involving disparate but coexisting information systems. However, healthcare organizations are also facing the dilemma of choosing the right ETL tool and architecture pattern as data warehouse enterprises. This article gives an overview of current ETL tools for healthcare data integration. In addition, we demonstrate three ETL processes for clinical data integration using different ETL tools and architecture patterns, which map data from various data sources (e.g. MEONA and ORBIS) to diverse standards (e.g. FHIR and openEHR). Depending on the project's technical requirements, we choose our ETL tool and software architecture pattern to boost team efficiency.

User-centred design for machine learning in health care: a case study from care management

OBJECTIVES

Few machine learning (ML) models are successfully deployed in clinical practice. One of the common pitfalls across the field is inappropriate problem formulation: designing ML to fit the data rather than to address a real-world clinical pain point.

METHODS

We introduce a practical toolkit for user-centred design consisting of four questions covering: (1) solvable pain points, (2) the unique value of ML (eg, automation and augmentation), (3) the actionability pathway and (4) the model's reward function. This toolkit was implemented in a series of six participatory design workshops with care managers in an academic medical centre.

RESULTS

Pain points amenable to ML solutions included outpatient risk stratification and risk factor identification. The endpoint definitions, triggering frequency and evaluation metrics of the proposed risk scoring model were directly influenced by care manager workflows and real-world constraints.

CONCLUSIONS

Integrating user-centred design early in the ML life cycle is key for configuring models in a clinically actionable way. This toolkit can guide problem selection and influence choices about the technical setup of the ML problem.

Design Recommendations for Presenting Clinical Guidelines on Mobile Devices

Some areas of clinical practice are still required to access and utilise clinical information that is inefficient or restrictive. Therefore, mobile device information delivery is becoming a key factor. However, recommendations on presenting clinical information on mobile devices are limited or not optimised for modern mobile design. Results from user-centred design studies inform the creation of a set of recommendations to assist in creating and delivering clinical guidelines on mobile devices.

Designing a Patient-Centered Notification System into a PHR

Personal health records could help patients overcome the anxiety related to gaps on health related information. The objective of this research was to explore what type of information was perceived by patients as useful to receive as a notification on their PHR as a framework for the design of a patient-centered notification system. We applied a qualitative approach followed by usability tests. From interviews to patients, we obtained main categories of notifications to include according to its perceived usefulness while, from iterative usability tests, we obtained a final version of prototypes developed according to patient-interface interaction experiences. This research helped us to understand patients needs and behavior to design an efficient notification system and also represents the first step for the development of clinical decision support systems for patients into the PHR with the potential to improve clinical outcomes and healthcare delivery.

The role of smartphone applications in clinical practice: a review

OBJECTIVE

The number of medical mobile phone applications continues to grow. Although otorhinolaryngology-specific applications represent a small proportion, there are exciting innovations emerging for the specialty. This article will assess the number of applications available and review how they may be used in clinical practice.

METHOD

The application stores of the two most popular mobile phone platforms, Apple and android, were searched using multiple search terms.

RESULTS

A total of 107 ENT applications were identified and categorised according to intended use. Eight applications were reviewed in more detail and assessed on whether a doctor or allied health professional was involved in their design and if they were evidence-based.

CONCLUSION

There are a number of ENT-specific smartphone applications currently available. As the technology progresses, their scope has extended beyond being purely for reference. Nevertheless, it remains difficult to assess the validity and security of these applications.

User-Centered Design of a Pediatric Vaccination Module for Patients

Immunization information systems and registries are essential for vaccine programs to succeed. Personal Health Record should improve decision making of healthcare providers and consumer outcomes. This article aims to describe the software development of an immunization module using a user-centered design, starting from the analysis of potential users' needs. The design was made through cycles of iterations, adjustments were made validating real scenarios and taking into account the user needs. The main features identified through interviews were: vaccination schedule, further information on vaccines' usefulness, notification, downloadable patient vaccination status and other vaccines outside the official calendar. The final scope is to create a simple, efficient and safe platform for patient immunization management.

Demand Analysis and Function Design of Health Decision Support System in China

In order to improve the level of health decision-making, based on health information resources and decision support function types, this study summarized five core functions of health decision support system: information support, monitoring and early warning, analysis and evaluation, trend prediction, comprehensive optimization; And from the perspective of business functions, business processes and business activities of business domains, the demand of Health Decision Support System is refined in to six parts, such as public health, medical care, drug management, medical insurance, comprehensive management, grass-roots health. On this basis, the overall design of the system is carried out.

Model-Driven Architecture Based Software Development for Epidemiological Surveillance Systems

Epidemiological surveillance systems enable collection, analysis and dissemination of information on the monitored disease to different stakeholders. It may be done manually or using a software. Given the poor performances of manual systems, the software approach is generally adopted. Epidemiological surveillance systems are based on existing softwares, softwares developed from scratch given the specifications or softwares provided by a vendor. These solutions are not always suitable because epidemiological surveillance systems evolve quickly (new drugs, new treatment protocols, etc.), leading to software updates, which can take time (while waiting for a new version) and be expensive. In this article, we present the use of the Model-Driven Architecture (MDA) approach to model and generate epidemiological surveillance systems. The result is a complete MDA based methodology and tool to develop epidemiological surveillance systems. The tool was used to model and generate softwares that are now used for epidemiological surveillance of tuberculosis in Cameroon.

The Opportunities and Challenges of Pragmatic Randomized Trials Using a Specialized Software: CloudTrials Project

Pragmatic randomized trials are essential to improve knowledge of real world clinical practice. Pragmatic trials design reflect routine clinical care, which have advantages to initiate and conduct, compared to classical clinical trials. Trials help to: engage bedside clinicians, increase efficiency of patient recruitment and follow up, minimize loss to follow up and include technological patient reported outcomes. The objective is to describe the opportunities and challenges designing a specialized software to administrate pragmatic randomized trials.

An agent based architecture for high-risk neonate management at neonatal intensive care unit

Background

In recent years, the use of new tools and technologies has decreased the neonatal mortality rate. Despite the positive effect of using these technologies, the decisions are complex and uncertain in critical conditions when the neonate is preterm or has a low birth weight or malformations. There is a need to automate the high-risk neonate management process by creating real-time and more precise decision support tools.

Objective

To create a collaborative and real-time environment to manage neonates with critical conditions at the NICU (Neonatal Intensive Care Unit) and to overcome high-risk neonate management weaknesses by applying a multi agent based analysis and design methodology as a new solution for NICU management.

Methods

This study was a basic research for medical informatics method development that was carried out in 2017. The requirement analysis was done by reviewing articles on NICU Decision Support Systems. PubMed, Science Direct, and IEEE databases were searched. Only English articles published after 1990 were included; also, a needs assessment was done by reviewing the extracted features and current processes at the NICU environment where the research was conducted. We analyzed the requirements and identified the main system roles (agents) and interactions by a comparative study of existing NICU decision support systems. The Universal Multi Agent Platform (UMAP) was applied to implement a prototype of our multi agent based high-risk neonate management architecture.

Results

Local environment agents interacted inside a container and each container interacted with external resources, including other NICU systems and consultation centers. In the NICU container, the main identified agents were reception, monitoring, NICU registry, and outcome prediction, which interacted with human agents including nurses and physicians.

Conclusion

Managing patients at the NICU units requires online data collection, real-time collaboration, and management of many components. Multi agent systems are applied as a well-known solution for management, coordination, modeling, and control of NICU processes. We are currently working on an outcome prediction module using artificial intelligence techniques for neonatal mortality risk prediction. The full implementation of the proposed architecture and evaluation is considered the future work.

User-Centered Design Improves the Usability of Drug-Drug Interaction Alerts: A Validation Study in the Real Scenario

Decision support systems can alert physicians to the existence of drug interactions. The Hospital Italiano de Buenos Aires, Argentina, has an in-house electronic health record with computerized physician order entry and clinical decision support. It includes a drug-drug interaction alert system, initially developed under traditional engineering techniques. As we detected a high alert override rate, we rebuilt the knowledge database and redesigned the alert interface with User-Centered Design techniques. A laboratory crossover study using clinical vignettes showed that new alerts were more usable than traditional ones.This paper aimed to validate these results through a controlled and randomized experimental study with two branches (old vs. new design) in a real setting. We analyzed, quantitatively, every fired alert between April 2015 and September 2016. Finally, we performed user surveys and qualitative interviews to inquire about their satisfaction and perceptions.In real scenarios, user-centered design alerts were more usable, being more effective and satisfactory, but less efficient than traditional alerts. "Safe omission", as a new concept, emerged from our stratified analyses and interviews.

Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity

BACKGROUND

Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine.

OBJECTIVE

The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The measurement model was adapted and modified for the healthcare domain.

METHODS

Three clinical infectious disease teams were observed, audio-recorded and transcribed. Each team included an infectious diseases expert, one infectious diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding processes and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen's kappa.

RESULTS

The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions.

CONCLUSION

The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.

Designing an electronic personal health record for professional Iranian athletes

Background:

By providing sports organizations with electronic records and instruments that can be accessed at any time or place, specialized care can be offered to athletes regardless of injury location, and this makes the follow-up from first aid through to full recovery more efficient.

Objectives:

The aim of this study was to develop an electronic personal health record for professional Iranian athletes.

Patients and Methods:

First, a comparative study was carried out on the types of professional athletes’existing handheld and electronic health information management systems currently being used in Iran and leading countries in the field of sports medicine including; Australia, Canada and the United States. Then a checklist was developed containing a minimum dataset of professional athletes’ personal health records and distributed to the people involved, who consisted of 50 specialists in sports medicine and health information management, using the Delphi method. Through the use of data obtained from this survey, a basic paper model of professional athletes' personal health record was constructed and then an electronic model was created accordingly.

Results:

Access to information in the electronic record was through a web-based, portal system. The capabilities of this system included: access to information at any time and location, increased interaction between the medical team, comprehensive reporting and effective management of injuries, flexibility and interaction with financial, radiology and laboratory information systems.

Conclusions:

It is suggested that a framework should be created to promote athletes’ medical knowledge and provide the education necessary to manage their information. This would lead to improved data quality and ultimately promote the health of community athletes.

Expert System Shells for Rapid Clinical Decision Support Module Development: An ESTA Demonstration of a Simple Rule-Based System for the Diagnosis of Vaginal Discharge

Objectives

This study demonstrates the feasibility of using expert system shells for rapid clinical decision support module development.

Methods

A readily available expert system shell was used to build a simple rule-based system for the crude diagnosis of vaginal discharge. Pictures and 'canned text explanations' are extensively used throughout the program to enhance its intuitiveness and educational dimension. All the steps involved in developing the system are documented.

Results

The system runs under Microsoft Windows and is available as a free download at http://healthcybermap.org/vagdisch.zip (the distribution archive includes both the program's executable and the commented knowledge base source as a text document). The limitations of the demonstration system, such as the lack of provisions for assessing uncertainty or various degrees of severity of a sign or symptom, are discussed in detail. Ways of improving the system, such as porting it to the Web and packaging it as an app for smartphones and tablets, are also presented.

Conclusions

An easy-to-use expert system shell enables clinicians to rapidly become their own 'knowledge engineers' and develop concise evidence-based decision support modules of simple to moderate complexity, targeting clinical practitioners, medical and nursing students, as well as patients, their lay carers and the general public (where appropriate). In the spirit of the social Web, it is hoped that an online repository can be created to peer review, share and re-use knowledge base modules covering various clinical problems and algorithms, as a service to the clinical community.

The Development of a Graphical User Interface Engine for the Convenient Use of the HL7 Version 2.x Interface Engine

OBJECTIVES

The Health Level Seven Interface Engine (HL7 IE), developed by Kyungpook National University, has been employed in health information systems, however users without a background in programming have reported difficulties in using it. Therefore, we developed a graphical user interface (GUI) engine to make the use of the HL7 IE more convenient.

METHODS

The GUI engine was directly connected with the HL7 IE to handle the HL7 version 2.x messages. Furthermore, the information exchange rules (called the mapping data), represented by a conceptual graph in the GUI engine, were transformed into program objects that were made available to the HL7 IE; the mapping data were stored as binary files for reuse. The usefulness of the GUI engine was examined through information exchange tests between an HL7 version 2.x message and a health information database system.

RESULTS

Users could easily create HL7 version 2.x messages by creating a conceptual graph through the GUI engine without requiring assistance from programmers. In addition, time could be saved when creating new information exchange rules by reusing the stored mapping data.

CONCLUSIONS

The GUI engine was not able to incorporate information types (e.g., extensible markup language, XML) other than the HL7 version 2.x messages and the database, because it was designed exclusively for the HL7 IE protocol. However, in future work, by including additional parsers to manage XML-based information such as Continuity of Care Documents (CCD) and Continuity of Care Records (CCR), we plan to ensure that the GUI engine will be more widely accessible for the health field.