Holographic patient tracking after bed movement for augmented reality neuronavigation using a head-mounted display

BACKGROUND

Holographic neuronavigation has several potential advantages compared to conventional neuronavigation systems. We present the first report of a holographic neuronavigation system with patient-to-image registration and patient tracking with a reference array using an augmented reality head-mounted display (AR-HMD).

METHODS

Three patients undergoing an intracranial neurosurgical procedure were included in this pilot study. The relevant anatomy was first segmented in 3D and then uploaded as holographic scene in our custom neuronavigation software. Registration was performed using point-based matching using anatomical landmarks. We measured the fiducial registration error (FRE) as the outcome measure for registration accuracy. A custom-made reference array with QR codes was integrated in the neurosurgical setup and used for patient tracking after bed movement.

RESULTS

Six registrations were performed with a mean FRE of 8.5 mm. Patient tracking was achieved with no visual difference between the registration before and after movement.

CONCLUSIONS

This first report shows a proof of principle of intraoperative patient tracking using a standalone holographic neuronavigation system. The navigation accuracy should be further optimized to be clinically applicable. However, it is likely that this technology will be incorporated in future neurosurgical workflows because the system improves spatial anatomical understanding for the surgeon.

COVID-19 CG enables SARS-CoV-2 mutation and lineage tracking by locations and dates of interest

COVID-19 CG (covidcg.org) is an open resource for tracking SARS-CoV-2 single-nucleotide variations (SNVs), lineages, and clades using the virus genomes on the GISAID database while filtering by location, date, gene, and mutation of interest. COVID-19 CG provides significant time, labor, and cost-saving utility to projects on SARS-CoV-2 transmission, evolution, diagnostics, therapeutics, vaccines, and intervention tracking. Here, we describe case studies in which users can interrogate (1) SNVs in the SARS-CoV-2 spike receptor binding domain (RBD) across different geographical regions to inform the design and testing of therapeutics, (2) SNVs that may impact the sensitivity of commonly used diagnostic primers, and (3) the emergence of a dominant lineage harboring an S477N RBD mutation in Australia in 2020. To accelerate COVID-19 efforts, COVID-19 CG will be upgraded with new features for users to rapidly pinpoint mutations as the virus evolves throughout the pandemic and in response to therapeutic and public health interventions.

Patient Identification Techniques - Approaches, Implications, and Findings

OBJECTIVES

To identify current patient identification techniques and approaches used worldwide in today's healthcare environment. To identify challenges associated with improper patient identification.

METHODS

A literature review of relevant peer-reviewed and grey literature published from January 2015 to October 2019 was conducted to inform the paper. The focus was on: 1) patient identification techniques and 2) unintended consequences and ramifications of unresolved patient identification issues.

RESULTS

The literature review showed six common patient identification techniques implemented worldwide ranging from unique patient identifiers, algorithmic approaches, referential matching software, biometrics, radio frequency identification device (RFID) systems, and hybrid models. The review revealed three themes associated with unresolved patient identification: 1) treatment, care delivery, and patient safety errors, 2) cost and resource considerations, and 3) data sharing and interoperability challenges.

CONCLUSIONS

Errors in patient identification have implications for patient care and safety, payment, as well as data sharing and interoperability. Different patient identification techniques ranging from unique patient identifiers and algorithms to hybrid models have been implemented worldwide. However, no current patient identification techniques have resulted in a 100% match rate. Optimizing algorithmic matching through data standardization and referential matching software should be studied further to identify opportunities to enhance patient identification techniques and approaches. Further efforts to improve patient identity management include adoption of patients' photos at registration, naming conventions, and standardized processes for recording patients' demographic data attributes.

MRLIHT: Mobile RFID-based Localization for Indoor Human Tracking

Radio Frequency Identification (RFID) technology has been widely used in indoor location tracking, especially serving human beings, due to its advantage of low cost, non-contact communication, resistance to hostile environments and so forth. Over the years, many indoor location tracking methods have been proposed. However, tracking mobile RFID readers in real-time has been a daunting task, especially for achieving high localization accuracy. In this paper, we propose a new Mobile RFID (M-RFID)-based Localization approach for Indoor Human Tracking, named MRLIHT. Based on the M-RFID model where RFID readers are equipped on the moving objects (human beings) and RFID tags are fixed deployed in the monitoring area, MRLIHT implements the real-time indoor location tracking effectively and economically. First, based on the readings of multiple tags detected by an RFID reader simultaneously, MRLIHT generates the response regions of tags to the reader. Next, MRLIHT determines the potential location region of the reader where two algorithms are devised. Finally, MRLIHT estimates the location of the reader by dividing the potential location region of the reader into finer-grained grids. The experimental results demonstrate that the proposed MRLIHT performs well in both accuracy and scalability.

Unique health identifiers for universal health coverage

Identifying everyone residing in a country, especially the poor, is an indispensable part of pursuing universal health coverage (UHC). Having information on an individuals' financial protection is also imperative for measuring the progress of UHC. This paper examines different ways of instituting a system of unique health identifiers that can lead toward achieving UHC, particularly in relation to utilizing universal civil registration and national unique identification number systems. Civil registration is a fundamental function of the government that establishes a legal identity for individuals and enables them to access essential public services. National unique identification numbers assigned at birth registration can further link their vital event information with data collected in different sectors, including in finance and health. Some countries use the national unique identification number as the unique health identifier, such as is done in South Korea and Thailand. In other countries, a unique health identifier is created in addition to the national unique identification number, but the two numbers are linked; Slovenia offers an example of this arrangement. The advantages and disadvantages of the system types are discussed in the paper. In either approach, linking the health system with the civil registration and national identity management systems contributed to advancing effective and efficient UHC programs in those countries.

The Relationship between Health Information Technology Laboratory Tracking Systems and Hospital Financial Performance and Quality

The objective of this study is to explore the relationship between hospitals Health Information Technology (HIT), and financial and quality performance. The study merged the 2017 Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System, American Hospital Association Annual Survey, and two CMS Hospital Compare datasets. A total of 3002 hospitals were analyzed using multivariate analysis. We found that hospitals with laboratory tracking systems reported better financial performance on five financial performance measures. Policymakers should consider developing policies that facilitate exploration and adoption of various hospital HIT capabilities that measurably improves hospital quality of care.

Improving patient identification in an ophthalmology clinic using name alerts

OBJECTIVE

To develop a standardized process for reviewing daily patient lists and identifying potential risks of misidentification. Our goal was to develop a proactive approach to identify and eliminate risks of patient misidentification.

METHODS

Assessment of current patient identification practices took place over a period of 4 weeks. Using a process map, a patient survey was developed to determine the encounter points when patient identification was confirmed. This information was used to develop a standardized protocol for review of daily appointment lists.

RESULTS

Review of daily appointment lists was completed to identify potential similar/same name risks. A standardized manual process of chart review, flagging, and tracking was developed.

CONCLUSIONS

The name alert process resulted in a simple manual process for identifying which patients have a higher name risk and allowed care providers to take preventative action to decrease potential risk of incorrect diagnostic testing, procedure, or medication administration.

The Development of an RFID Solution to Facilitate the Traceability of Patient and Pharmaceutical Data

One of the principal objectives of hospitals is to increase the quality of care of the patient. This is even more of a priority in Day Hospitals where certain medication requires special attention, from its preparation in the Pharmacy service to its delivery to the patient in the Day Hospital. In the case of expensive medicines, nursing staff have to comply with very detailed instructions in their administration to the patient (name of medicine, route, dosage, schedule, previous medication, conditions of conservation, etc.). This work focuses on the development of a multi-faceted hub application to facilitate the traceability of mixed intravenous medication from the beginning to the end of the process of prescription-validation-dosing-preparation-administration (PVD-PA) and be available to all health professionals involved: doctors, pharmacists, and the nursing staff of the Hospital Pharmacy and Day Hospital.

An Indoor Wayfinding System Based on Geometric Features Aided Graph SLAM for the Visually Impaired

This paper presents a 6-degree of freedom (DOF) pose estimation (PE) method and an indoor wayfinding system based on the method for the visually impaired. The PE method involves two-graph simultaneous localization and mapping (SLAM) processes to reduce the accumulative pose error of the device. In the first step, the floor plane is extracted from the 3-D camera's point cloud and added as a landmark node into the graph for 6-DOF SLAM to reduce roll, pitch, and Z errors. In the second step, the wall lines are extracted and incorporated into the graph for 3-DOF SLAM to reduce X , Y , and yaw errors. The method reduces the 6-DOF pose error and results in more accurate pose with less computational time than the state-of-the-art planar SLAM methods. Based on the PE method, a wayfinding system is developed for navigating a visually impaired person in an indoor environment. The system uses the estimated pose and floor plan to locate the device user in a building and guides the user by announcing the points of interest and navigational commands through a speech interface. Experimental results validate the effectiveness of the PE method and demonstrate that the system may substantially ease an indoor navigation task.

Patient identification and tube labelling - a call for harmonisation

Venous blood sampling (phlebotomy) is the most common invasive procedure performed in patient care. Guidelines on the correct practice of phlebotomy are available, including the H3-A6 guideline issued by the Clinical Laboratory Standards Institute (CLSI). As the quality of practices and procedures related to venous blood sample collection in European countries was unknown, the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase conducted an observational study in 12 European countries. The study demonstrated that the level of compliance of phlebotomy procedures with the CLSI H3-A6 guideline was unacceptably low, and that patient identification and tube labelling are amongst the most critical steps in need of immediate attention and improvement. The process of patient identification and tube labelling is an essential safety barrier to prevent patient identity mix-up. Therefore, the EFLM Working Group aims to encourage and support worldwide harmonisation of patient identification and tube labelling procedures in order to reduce the risk of preanalytical errors and improve patient safety. With this Position paper we wish to raise awareness and provide recommendations for proper patient and sample identification procedures.

Evaluation of a Tracking System for Patients and Mixed Intravenous Medication Based on RFID Technology

At present, one of the primary concerns of healthcare professionals is how to increase the safety and quality of the care that patients receive during their stay in hospital. This is particularly important in the administration of expensive and high-risk medicines with which it is fundamental to minimize the possibility of adverse events in the process of prescription-validation-preparation/dosage-dispensation-administration of intravenous mixes. This work is a detailed analysis of the evaluation, carried out by the health personnel involved in the Radiofrequency Identification (RFID) system developed in the Day Hospital and Pharmacy services of the Complejo Hospitalario Universitario A Coruña (CHUAC). The RFID system is evaluated by analyzing surveys completed by said health personnel, since their questions represent the key indicators of the patient care process (safety, cost, adequacy with the clinical practice). This work allows us to conclude, among other things, that the system tracks the patients satisfactorily and that its cost, though high, is justified in the context of the project context (use of dangerous and costly medication).

Detecting Bipolar Depression From Geographic Location Data

Objective

This paper aims to identify periods of depression using geolocation movements recorded from mobile phones in a prospective community study of individuals with bipolar disorder (BD).

Methods

Anonymized geographic location recordings from 22 BD participants and 14 healthy controls (HC) were collected over 3 months. Participants reported their depressive symptomatology using a weekly questionnaire (QIDS-SR₁₆). Recorded location data were preprocessed by detecting and removing imprecise data points and features were extracted to assess the level and regularity of geographic movements of the participant. A subset of features were selected using a wrapper feature selection method and presented to 1) a linear regression model and a quadratic generalized linear model with a logistic link function for questionnaire score estimation; and 2) a quadratic discriminant analysis classifier for depression detection in BD participants based on their questionnaire responses.

Results

HC participants did not report depressive symptoms and their features showed similar distributions to nondepressed BD participants. Questionnaire score estimation using geolocation-derived features from BD participants demonstrated an optimal mean absolute error rate of 3.73, while depression detection demonstrated an optimal (median ± IQR) F₁ score of 0.857 ± 0.022 using five features (classification accuracy: 0.849 ± 0.016; sensitivity: 0.839 ± 0.014; specificity: 0.872 ± 0.047).

Conclusion

These results demonstrate a strong link between geographic movements and depression in bipolar disorder.

Significance

To our knowledge, this is the first community study of passively recorded objective markers of depression in bipolar disorder of this scale. The techniques could help individuals monitor their depression and enable healthcare providers to detect those in need of care or treatment.

Getting It Right for Patient Safety: Specimen Collection Process Improvement From Operating Room to Pathology

OBJECTIVES

Specimen labeling defects within the perioperative environment are a known patient safety risk that carries the potential for adverse outcomes. These outcomes are a result of errors that occur when unsuspecting providers operate within poorly designed processes with little control over the specimen collection context. Many costly outcomes resulting from labeling errors may include patient harm, inappropriate treatments, lengthy investigations, corrective actions, and, at times, legal action.

METHODS

This improvement initiative to identify and reduce the risk of specimen labeling defects includes the application of a disciplined Lean problem-solving approach with the engagement of employees who actually perform the work.

RESULTS

By listening to the voice of our internal customers, we collectively redesigned the workflow by collaboratively linking work teams of the operating room and Pathology Department of Henry Ford Hospital, Detroit, over a 2-year period.

CONCLUSIONS

We illustrate successful interventions achieved by Lean process management by streamlining, standardizing, and mistake proofing the processes and eliminating waste and inefficiency through systematic problem solving.

Automatic Detection and Notification of “Wrong Patient—Wrong Location” Errors in the Operating Room

When procedures and processes to assure patient location based on human performance do not work as expected, patients are brought incrementally closer to a possible “wrong patient—wrong procedure” error. We developed a system for automated patient location monitoring and management. Realtime data from an active infrared/radio frequency identification tracking system provides patient location data that are robust and can be compared with an “expected process” model to automatically flag wrong-location events as soon as they occur. The system also generates messages that are automatically sent to process managers via the hospital paging system, thus creating an active alerting function to annunciate errors. We deployed the system to detect and annunciate “patientin-wrong-OR” events. The system detected all “ wrongoperating room (OR)” events, and all “wrong-OR” locations were correctly assigned within 0.50 ± 0.28 minutes (mean ± SD). This corresponded to the measured latency of the tracking system. All wrong-OR events were correctly annunciated via the paging function. This experiment demonstrates that current technology can automatically collect sufficient data to remotely monitor patient flow through a hospital, provide decision support based on predefined rules, and automatically notify stakeholders of errors.

Auto Identification Technology and Its Impact on Patient Safety in the Operating Room of the Future

Automatic identification technologies, such as bar coding and radio frequency identification, are ubiquitous in everyday life but virtually nonexistent in the operating room. User expectations, based on everyday experience with automatic identification technologies, have generated much anticipation that these systems will improve readiness, workflow, and safety in the operating room, with minimal training requirements. We report, in narrative form, a multi-year experience with various automatic identification technologies in the Operating Room of the Future Project at Massachusetts General Hospital. In each case, the additional human labor required to make these `labor-saving' technologies function in the medical environment has proved to be their undoing. We conclude that while automatic identification technologies show promise, significant barriers to realizing their potential still exist. Nevertheless, overcoming these obstacles is necessary if the vision of an operating room of the future in which all processes are monitored, controlled, and optimized is to be achieved.

Piloting the European Unified Patient Identity Management (EUPID) Concept to Facilitate Secondary Use of Neuroblastoma Data from Clinical Trials and Biobanking

Data from two contexts, i.e. the European Unresectable Neuroblastoma (EUNB) clinical trial and results from comparative genomic hybridisation (CGH) analyses from corresponding tumour samples shall be provided to existing repositories for secondary use. Utilizing the European Unified Patient IDentity Management (EUPID) as developed in the course of the ENCCA project, the following processes were applied to the data: standardization (providing interoperability), pseudonymization (generating distinct but linkable pseudonyms for both contexts), and linking both data sources. The applied procedures resulted in a joined dataset that did not contain any identifiers that would allow to backtrack the records to either data sources. This provided a high degree of privacy to the involved patients as required by data protection regulations, without preventing proper analysis.

Tracking the take - Using patient flow data to improve AMU performance and safety

AIMS

To create a system to co-ordinate the medical take, bed management and track patient flow. To use the system to continuously audit against Society for Acute Medicine Quality Indicators. To use the data to model patient flow and optimise working patterns to improve waiting times.

METHOD

An online whiteboard and underlying database system were designed, tested and implemented. Data from this system were used to audit against SAM Quality Indicators and then analysed to optimise both trainee and consultant working patterns.

RESULTS

The online whiteboard proved effective and popular as a working tool. Data collection improved using the electronic system. Optimising junior doctor working patterns to match demand led to a reduction of average waiting time to see a doctor from 190 minutes to 71 minutes (p < 0.0001), and a reduction in the proportion of patients waiting over 4 hours from 40% to 10% (p > 0.0001). Optimising consultant working patterns did not produced significant changes in waiting times.

CONCLUSIONS

The online whiteboard improved day-to-day working and data collection, when compared to the previous paper-based system. Better data facilitated analysis of working patterns leading to a significant improvement in patient waiting times.

Human factors engineering approaches to patient identification armband design

The task of patient identification is performed many times each day by nurses and other members of the care team. Armbands are used for both direct verification and barcode scanning during patient identification. Armbands and information layout are critical to reducing patient identification errors and dangerous workarounds. We report the effort at two large, integrated healthcare systems that employed human factors engineering approaches to the information layout design of new patient identification armbands. The different methods used illustrate potential pathways to obtain standardized armbands across healthcare systems that incorporate human factors principles. By extension, how the designs have been adopted provides examples of how to incorporate human factors engineering into key clinical processes.

Usefulness of biological fingerprint in magnetic resonance imaging for patient verification

The purpose of our study is to investigate the feasibility of automated patient verification using multi-planar reconstruction (MPR) images generated from three-dimensional magnetic resonance (MR) imaging of the brain. Several anatomy-related MPR images generated from three-dimensional fast scout scan of each MR examination were used as biological fingerprint images in this study. The database of this study consisted of 730 temporal pairs of MR examination of the brain. We calculated the correlation value between current and prior biological fingerprint images of the same patient and also all combinations of two images for different patients to evaluate the effectiveness of our method for patient verification. The best performance of our system were as follows: a half-total error rate of 1.59 % with a false acceptance rate of 0.023 % and a false rejection rate of 3.15 %, an equal error rate of 1.37 %, and a rank-one identification rate of 98.6 %. Our method makes it possible to verify the identity of the patient using only some existing medical images without the addition of incidental equipment. Also, our method will contribute to patient misidentification error management caused by human errors.

Ebola Tracker app

Developer Bryan Ratledge claims his Ebola Tracker app is the only up to date mapping application of the 2014 Ebola virus disease outbreak centred in West Africa. With this app, you track the Ebola outbreak just as you would track a hurricane, or the weather.

Application of Barcoding to Reduce Error of Patient Identification and to Increase Patient's Information Confidentiality of Test Tube Labelling in a Psychiatric Teaching Hospital

Learning from the experience of another medical center in Taiwan, Kaohsiung Municipal Kai-Suan Psychiatric Hospital has changed the nursing informatics system step by step in the past year and a half . We considered ethics in the original idea of implementing barcodes on the test tube labels to process the identification of the psychiatric patients. The main aims of this project are to maintain the confidential information and to transport the sample effectively. The primary nurses had been using different work sheets for this project to ensure the acceptance of the new barcode system. In the past two years the errors in the blood testing process were as high as 11,000 in 14,000 events per year, resulting in wastage of resources. The actions taken by the nurses and the new barcode system implementation can improve the clinical nursing care quality, safety of the patients, and efficiency, while decreasing the cost due to the human error.

Improving Quality and Safety through Positive Patient Identification

The World Health Organization recognizes that patient misidentification can contribute to medication, surgical and charting errors. Accreditation Canada has set national standards and the Joint Commission on Accreditation of Healthcare Organizations has listed patient identification as a national patient safety goal. A qualitative and observational evaluation of patient identification practices in the Pre-Admission Clinic, Admitting Department and the Perioperative Care Center uncovered confusion, with 90% (n = 55) of patient verification occurrences not matching current policies. These discrepancies identify an opportunity to reassess and standardize workflow, clarify what identification methods are acceptable and determine additional appropriate identification verification practices with ID bracelets and patient charts.

[Management directed at preventing misidentifications by introduction of the computed identification system and blood sampling by the transfusion unit; aim for good partnership between a transfusion unit and bedsides]

The initial step of blood transfusion therapy is blood type grouping. ABO-mismatch blood transfusion results in serious adverse effects. Several incidents in the process of blood sampling had been experienced in our hospital since 2006 to 2008. Therefore, we have introduced the computed identification system, and the transfusion unit has taken a part of blood sampling. Just after we introduced it in July 2010, only 7% of the doctors and the nurses used the system in blood sampling. Repeated training programs for doctors and nurses on blood sampling procedure improved the utilization to 95%. We realized the importance of our management in face of its introduction. We have to make continuous efforts on the safety of transfusion therapy, because new type of incidents can appear.

A hybrid localization technique for patient tracking

Nowadays numerous technologies are employed for tracking patients and assets in hospitals or nursing homes. Each of them has advantages and drawbacks. For example, WiFi localization has relatively good accuracy but cannot be used in case of power outage or in the areas with poor WiFi coverage. Magnetometer positioning or cellular network does not have such problems but they are not as accurate as localization with WiFi. This paper describes technique that simultaneously employs different localization technologies for enhancing stability and average accuracy of localization. The proposed algorithm is based on fingerprinting method paired with data fusion and prediction algorithms for estimating the object location. The core idea of the algorithm is technology fusion using error estimation methods. For testing accuracy and performance of the algorithm testing simulation environment has been implemented. Significant accuracy improvement was showed in practical scenarios.

Towards a global IT system for personalized medicine: the Medicine Safety Code initiative

The availability of pharmacogenomic data of individual patients can significantly improve physicians' prescribing behavior, lead to a reduced incidence of adverse drug events and an improvement of effectiveness of treatment. The Medicine Safety Code (MSC) initiative is an effort to improve the ability of clinicians and patients to share pharmacogenomic data and to use it at the point of care. The MSC is a standardized two-dimensional barcode that captures individual pharmacogenomic data. The system is backed by a web service that allows the decoding and interpretation of anonymous MSCs without requiring the installation of dedicated software. The system is based on a curated, ontology-based knowledge base representing pharmacogenomic definitions and clinical guidelines. The MSC system performed well in preliminary tests. To evaluate the system in realistic health care settings and to translate it into practical applications, the future participation of stakeholders in clinical institutions, medical researchers, pharmaceutical companies, genetic testing providers, health IT companies and health insurance organizations will be essential.

Framework for near-field-communication-based geo-localization and personalization for Android-based smartphones--application in hospital environments

Various applications using near field communication (NFC) have been developed for the medical sector. As a method of short-range wireless contact-driven data transfer, NFC is a useful tool in medicine. It can be used to transfer data such as blood pressure, control adherence to medication, or transmit in vivo data. The first proposed general framework uses NFC as a mechanism for indoor geo-localization in hospitals. NFC geo-localization is economical compared to classical concepts using indoor GPS or WLAN triangulation, and the granularity of location retrieval can be defined at a tag level. Using this framework, we facilitate the development of medical applications that require exact indoor geo-localization. Multi-user Android systems are addressed in the second framework. Using private NFC tags, users are able to carry on their personal settings for enabled applications. This eliminates the need for multiple user accounts on common Android devices, improves usability, and eases technical administration. Based on the prototypes presented here, we show a novel concept of using NFC-enabled Android devices in hospital environments.

The use of telemedicine in Italian Blood Banks: a nationwide survey

BACKGROUND

Telemedicine is defined as the use of electronic information and communication technologies to provide health care between distant people. Many activities in transfusion medicine could benefit from the application of telemedicine. To map the spread of the use of telemedicine in transfusion medicine in Italy, the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) performed a nationwide survey: the results are presented in this paper.

MATERIALS AND METHODS

A survey, dealing with different aspects of the use of telemedicine, was performed by sending a questionnaire to 280 Italian Blood Centres. The survey was designed to evaluate the diffusion of telemedicine and the features of the systems, with special attention to the systems' safety and legal adequacy. One section of the questionnaire was designed to identify the features of the systems considered essential by the respondents.

RESULTS

Out of 280 Blood Services contacted, 196 (70%) filled in at least one of the questions of the online questionnaire. Globally the use of some form of telemedicine was reported by 70% of the respondents. Telemedicine is used for remote validation of laboratory tests by 32% of the Centres that responded, for remote biological validation of blood units by 34% and for assignment of blood components by 29%. Less frequently, telemedicine is used to control electronic refrigerators, for electronic blood requests and for bed-side identification of patients.

DISCUSSION

The use of telemedicine is widespread in Italian Blood Services. There appears to be some heterogeneity between structures with regards to the evaluation of the systems' safety and their legal adequacy. No telemedicine system should be introduced into practice until it has proven to have the same standards of safety as the corresponding "on site" activity.

An improved algorithm to generate a Wi-Fi fingerprint database for indoor positioning

The major problem of Wi-Fi fingerprint-based positioning technology is the signal strength fingerprint database creation and maintenance. The significant temporal variation of received signal strength (RSS) is the main factor responsible for the positioning error. A probabilistic approach can be used, but the RSS distribution is required. The Gaussian distribution or an empirically-derived distribution (histogram) is typically used. However, these distributions are either not always correct or require a large amount of data for each reference point. Double peaks of the RSS distribution have been observed in experiments at some reference points. In this paper a new algorithm based on an improved double-peak Gaussian distribution is proposed. Kurtosis testing is used to decide if this new distribution, or the normal Gaussian distribution, should be applied. Test results show that the proposed algorithm can significantly improve the positioning accuracy, as well as reduce the workload of the off-line data training phase.

Capturing habitual, in-home gait parameter trends using an inexpensive depth camera

Results are presented for measuring the gait parameters of walking speed, stride time, and stride length of five older adults continuously, in their homes, over a four month period. The gait parameters were measured passively, using an inexpensive, environmentally mounted depth camera, the Microsoft Kinect. Research has indicated the importance of measuring a person's gait for a variety of purposes from fall risk assessment to early detection of health problems such as cognitive impairment. However, such assessments are often done infrequently and most current technologies are not suitable for continuous, long term use. For this work, a single Microsoft Kinect sensor was deployed in four apartments, containing a total of five residents. A methodology for generating trends in walking speed, stride time, and stride length based on data from identified walking sequences in the home is presented, along with trend estimates for the five participants who were monitored for this work.

[Measures to prevent patient identification errors in blood collection/physiological function testing utilizing a laboratory information system]

We constructed an integrated personal identification workflow chart using both bar code reading and an all in-one laboratory information system. The information system not only handles test data but also the information needed for patient guidance in the laboratory department. The reception terminals at the entrance, displays for patient guidance and patient identification tools at blood-sampling booths are all controlled by the information system. The number of patient identification errors was greatly reduced by the system. However, identification errors have not been abolished in the ultrasound department. After re-evaluation of the patient identification process in this department, we recognized that the major reason for the errors came from excessive identification workflow. Ordinarily, an ultrasound test requires patient identification 3 times, because 3 different systems are required during the entire test process, i.e. ultrasound modality system, laboratory information system and a system for producing reports. We are trying to connect the 3 different systems to develop a one-time identification workflow, but it is not a simple task and has not been completed yet. Utilization of the laboratory information system is effective, but is not yet perfect for patient identification. The most fundamental procedure for patient identification is to ask a person's name even today. Everyday checks in the ordinary workflow and everyone's participation in safety-management activity are important for the prevention of patient identification errors.

[Specimen misidentification in pathology laboratory: trends and measures]

Specimen misidentification in pathology laboratories may have serious consequences. Reports on the frequency of errors in pathology laboratories in Japan are rare. We reviewed near-miss and incident reports over 7 years in our laboratory, extracted those associated with misidentification, analyzed annual changes in numbers and content, and discussed the problems faced and measures taken to prevent misidentification. Of 113,447 pathological cases, 88 (0.078%) reports were associated with misidentification. Of these 88 misidentification cases, 19% occurred before and during accessioning, 16% during dissecting and sectioning, 30% during embedding, 13% during tissue cutting and slide mounting, 19% during slide submitting, and 3% during diagnosis. Two cases (2.3%) of misidentification were detected after diagnosis; however, misidentification did not appear to cause adverse effects in any patient. The frequency of events is similar to that reported in the literature; specimen misidentification was noted in 0.1-0.2% of cases in a modern pathology laboratory. Two-thirds of misidentification events occurred associated with gross specimens, similar to findings in other studies. With the introduction of new technologies that minimize the possibility of human errors (e.g., barcode reading, digital imaging of every specimen, and installation of a glass slide printer), education on medical safety, and the use of multiple safety nets (e.g., diagnosis cancelling and slide checking), errors have decreased, but have not been eliminated completely. Recording errors and reporting them to the hospital and social community, and maintaining a sustainable quality improvement system is very important to reduce errors in pathology.

Automated patient identity recognition by analysis of chest radiograph features

RATIONALE AND OBJECTIVES

The aim of this study was to develop a computerized scheme for automated identity recognition based on chest radiograph features.

MATERIALS AND METHODS

The proposed method was evaluated on a database consisting of 1000 pairs of posteroanterior chest radiographs. The method was based on six features: length of the lung field, size of the heart, area of the body, and widths of the upper, middle, and lower thoracic cage. The values for the six features were determined from a chest image, and absolute differences in feature values between the two images (feature errors) were used as indices of image similarity. The performance of the proposed method was evaluated by receiver operating characteristic (ROC) analysis. The discriminant performance was evaluated as the area Az under the ROC curve.

RESULTS

The discriminant performance Az of the feature errors for lung field length, heart size, body area, upper cage width, middle cage width, and lower cage width were 0.794 ± 0.005, 0.737 ± 0.007, 0.820 ± 0.008, 0.860 ± 0.005, 0.894 ± 0.006, and 0.873 ± 0.006, respectively. The combination of the six feature errors obtained an Az value of 0.963 ± 0.002.

CONCLUSION

The results indicate that combining the six features yields a high discriminant performance in recognizing patient identity. The method has potential usefulness for automated identity recognition to ensure that chest radiographs are associated with the correct patient.

A navigation system for the visually impaired an intelligent white cane

In this paper, we describe about a developed navigation system that supports the independent walking of the visually impaired in the indoor space. Our developed instrument consists of a navigation system and a map information system. These systems are installed on a white cane. Our navigation system can follow a colored navigation line that is set on the floor. In this system, a color sensor installed on the tip of a white cane, this sensor senses a color of navigation line and the system informs the visually impaired that he/she is walking along the navigation line by vibration. This color recognition system is controlled by a one-chip microprocessor. RFID tags and a receiver for these tags are used in the map information system. RFID tags are set on the colored navigation line. An antenna for RFID tags and a tag receiver are also installed on a white cane. The receiver receives the area information as a tag-number and notifies map information to the user by mp3 formatted pre-recorded voice. And now, we developed the direction identification technique. Using this technique, we can detect a user's walking direction. A triaxiality acceleration sensor is used in this system. Three normal subjects who were blindfolded with an eye mask were tested with our developed navigation system. All of them were able to walk along the navigation line perfectly. We think that the performance of the system is good. Therefore, our system will be extremely valuable in supporting the activities of the visually impaired.

Conformity between protocol eligibility criteria for electronic patient identification: a comparison of clinical trials

Clinical trial eligibility criteria define the target patient population for research studies. We assessed the eligibility criteria from 40 different protocols for Type II Diabetes Mellitus and depression (20 protocols each), to determine the extent to which protocol eligibility criteria were similar at three levels (test, test-value, and test-value-time clause). This was done to determine criteria that could be standardized to aid in identification of eligible patients from electronic health records. It was found that Type II Diabetes Mellitus had 36.9% similar and depression protocols had 53.1% similar at the test-value-clause level. This study demonstrates the need for more standardization of study protocol criteria as well as the associated query definitions to be run against the electronic healthcare data. Standardizing criteria based on the similar eligibility criteria between protocols will aid in patient recruitment by being able to reuse criteria and minimizing the time and money it takes to recruit patients.

Architecture and implementation for a system enabling smartphones to access smart card based healthcare records

The healthcare researchers', academics' and practitioners' interest concerning the development of Healthcare Information Systems has been on a steady rise for the last decades. Fueling this steady rise has been the healthcare professional need of quality information, in every healthcare provision incident, whenever and wherever this incident may take place. In order to address this need a truly mobile health care system is required, one that will be able to provide a healthcare provider with accurate patient-related information regardless of the time and place that healthcare is provided. In order to fulfill this role the present study proposes the architecture for a Healthcare Smartcard system, which provides authenticated healthcare professionals with remote mobile access to a Patient's Healthcare Record, through their Smartphone. Furthermore the research proceeds to develop a working prototype system.

An automated information system for families of patients in the operation room based on EMR data

When children undergo surgery, the parents waiting for them outside the room feel extreme anxiety. SNUH was a full EMR hospital. But nurses had to manually operate an electronic display board which provided information regarding the progresses of the operations. The parents had to be located in front of the board. It was a unilateral and passive system. Therefore, we were about to improve the system to provide efficient information satisfying both parents and nurses. This service, which connected to the EMR system to provide real time location of patients undergoing operations, provide information through an electronic display board outside the operating room and SMS messages. We could reduce uneasiness of patients' families, increase satisfactions, and further, not only contribute to establishing the improved service of SNUH but also lessening unnecessary duties of nurses.

Proposal of the patient location tracking and query (PLQ) of IHE integration profile for the better patient tracking

The Patient Location Tracking Query (PLQ) is the IHE integration profile in order to find the location of patient only in a hospital, not for cross-referencing between multiple hospitals. In Japan, it is common for elderly patients to consult multiple departments in one hospital visit. To find the location of patients quickly is very important for productivity and use of resources in a hospital. We analyzed the workflow of patients and defined three actors and two transactions for PLQ integration profile. In order to collect the location of patients, multiple systems must provide the location into central management system. We proposed PLQ for the better patient care in hospitals. We believe that by using this PLQ profile hospital staffs are able to utilize the resource more efficiently.

Radio Frequency Identification (RFID) in healthcare: a literature review

Creating and maintaining a safe and high-quality health care environment is of great importance for global community. New technologies and their applications can help us achieve this goal. Radio-Frequency Identification (RIFD) technology is considered one of those technologies and even today there are some interesting deployments in the health industry. As a result, this work aims to present the basic idea behind RFID solutions, problems that can be addressed with the adoption of RFID and the benefits of relative applications.

A mobile-health application to detect wandering patterns of elderly people in home environment

Wandering is a common and risky behavior in people with dementia (PWD). In this paper, we present a mobile healthcare application to detect wandering patterns in indoor settings. The application harnesses consumer electronics devices including WiFi access points and mobile phones and has been tested successfully in a home environment. Experimental results show that the mobile-health application is able to detect wandering patterns including lapping, pacing and random in real-time. Once wandering is detected, an alert message is sent using SMS (Short Message Service) to attending caregivers or physicians for further examination and timely interventions.