Showing papers in "Healthcare Informatics Research in 2012"

Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2)

Abstract: (ICTs) gave us new and innovative wave of communication life such as living in cyber space, instant messaging, and communications with whom anyone in anywhere. These are changing not only life-style, but also mode of business in every industry. Health care service industry is resource-intensive, processoriented, and doing business traditionally by method of confrontation between medical professionals and patients. ICTs have great potential to address some of the challenges faced by both developed and developing countries in providing accessible, cost-effective, high-quality health care services. Telemedicine uses ICTs to overcome geographical barriers, and increase access to health care services. These are particularly beneficial for rural and underserved communities in developing countries groups that traditionally suffered from lack of access to health care. In light of this potential, the World Health Organization (WHO) established the Global Observatory for eHealth (GOe) to review the benefits that ICTs can bring to health care and patients’ wellbeing. The Observatory is charged with determining the status of eHealth solutions, including telemedicine, at the national, regional, and global levels, and providing WHO’s Member States with reliable information and guidance on best practices, policies, and standards in eHealth. In 2005, following the formation of WHO’s eHealth strategy, the Observatory conducted a global eHealth survey to obtain general information about the state of eHealth among Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2)

Book Review: mHealth: New Horizons for Health through Mobile Technologies: Based on the Findings of the Second Global Survey on eHealth (Global Observatory for eHealth Series, Volume 3)

Abstract: with more intelligent and versatile connectivity and communication capabilities. The unprecedented spread of mobile technologies as well as advancements in their innovative capacity to address health priorities has evolved into a new field of eHealth known as mHealth (mobile health). By the end of 2010, there were nearly 5.3 billion mobile phone subscriptions in the world, with over 85% of the world’s population now within range of a commercial wireless signal [1]. There are 43.5 million Koreans, and 90% of the population had a mobile phone as of the year 2007 [2]. The World Health Organization’s (WHO) Global Observatory for eHealth defined mHealth as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices. mHealth involves the use of and capitalization on a mobile phone’s core utility of voice and short messaging service as well as more complex functionalities and applications, including a general packet radio service, thirdand fourth-generation mobile telecommunications (i.e., 3G and 4G systems), a global positioning system, and Bluetooth technology. The WHO Global Observatory for eHealth also surveyed the status of mHealth in 114 member states in 2009. The survey documented for analysis four aspects of mHealth: the adoption of initiatives, the types of initiatives, the status of evaluations, and barriers to implementation. Fourteen categories of mHealth services were surveyed: health call centres, emergency toll-free telephone services, managing emermHealth: New Horizons for Health through Mobile Technologies: Based on the Findings of the Second Global Survey on eHealth (Global Observatory for eHealth Series, Volume 3)

Computer and internet interventions for loneliness and depression in older adults: A meta-analysis

Abstract: OBJECTIVES This study conducted a meta-analysis to examine the effectiveness of computer and Internet training interventions intended to reduce loneliness and depression in older adults. METHODS Searches were performed to retrieve studies that had been published in peer-reviewed journals from January 2001 to July 2012 and written in English or Korean from PubMed, CINAHL, Scopus, the Cochrane Library, PsycINFO, KoreaMed, KMbase, KISS, MEDLIS, and RISS. We used combinations of the keywords for population, intervention, and psychosocial problems. A meta-analysis was employed to summarize the findings of studies on computer and Internet interventions for older adults. An overall mean weighted effect size for each outcome was calculated, and Q statistics were used to test the heterogeneity of variance in the effect sizes of the selected studies. RESULTS As the Q statistics revealed heterogeneity, random effects models were chosen for the meta-analysis. The overall mean weighted effect size for loneliness from five studies was statistically significant for decreased loneliness (Z = 2.085, p = 0.037). However, the overall mean weighted effect size for depression from five studies was not statistically significant (Z = 1.528, p = 0.126). CONCLUSIONS These results suggest that computer and Internet programs were effective in managing loneliness among older adults. Therefore, further computer-mediated social support should be considered to help manage loneliness in this population.

Looking Back, Looking Forward

Abstract: As 2012 draws to an end, we are excited by the fact that the busyness that we've seen here publishing this issue will soon be accompanied by a sense of deep joy. Not many have the privilege of knowing that the work they do can help and inspire those with similar passions, and we consider ourselves especially fortunate to contribute to a community of likeminded people. Finally, Issue 4 of Volume 18 is now officially published, ready to be read. Whether it be an academic journal or a novel, we all have different ways of approaching a text. Some start with the table of contents, while others jump straight ahead to the parts that interest them. I personally enjoy reading a text by reading the preface first. I have always felt that only when I read the preface do I get to see the big picture of the text-what the author is trying to do and how he or she is planning to go about doing it. In a journal like ours, the editorial works like the preface, so I feel obligated to give a short introduction to the articles presented here. This issue consists of eight articles-two reviews and six original research papers-that we hope will help you promote awareness of healthcare informatics as well as advance knowledge and application systems in healthcare fields. Two articles deal with clinical research support systems and what they have taught us about expert systems for diagnosis and sentence classifications. One article deals with bioinformatics, especially how to design and integrate a compact gene knowledge database. The remaining five, though touching upon a variety of topics in healthcare information systems, can be said to be articles on social factors, policies, and behavioral approaches; specifically, they concern topics such as the mobile environment, u-Health, organizational and individual barriers to information systems, user preference to monitors, and human factors in engineering. The collection of topics here is only one example of the gradual rise in interest in social factors, policy, and behavioral informatics. This trend is not only a consequence of recent focus on behavioral approaches (such as behavioral economics and behavioral politics) but is also an indicator of the growing importance of health attitude and behavior and environmental factors in one's health. Now more than ever, people across the disciplines are realizing that behavior is a key entity in problem solving. User behavior in healthcare informatics plays an important role in promoting the appropriate use of information technologies in order to improve health and healthcare. Clearly, there is a growing need for researchers who specialize in the use of technologies by patients and healthcare providers and in the design, implementation, and evaluation of behavior change interventions delivered through advanced technologies. We are glad to know that our journal is an attempt to address this need and its implications. This issue is yet another step in the right direction. It has been three years since we transformed the Journal of Korean Society of Medical Informatics (JKOSMI) into Healthcare Informatics Research (HIR), and a lot has happened since then. In its first year, 2010, it was indexed in the National Library of Medicine (NLM) Catalog; in its second year, in PubMed Central; and this year, we finished our application for SCOPUS. We're also happy to share that this year, HIR was recognized as the best academic journal in Korea by The Korean Federation of Science and Technology Societies. Now, our next goal is to apply for Science Citation Index (SCI) next year. We look back and feel pride in our growth in the last three years, and we look forward to growing even further in the next three. These achievements would not have been possible without you. As a reader and as a member of KOSMI, you are not a mere witness to this growth but a participant in it, and we hope that you feel as proud as we do in how far we've come. We also hope that you join us in our next step. To become an SCI journal, we need more high-quality articles and more diversity in our contributors. You can help by contributing your own work and helping us publicize at home and abroad. It is our hope that next year, when we look back on 2013, we can take joy not only in what we've achieved but also in how we achieved it together. May your 2013 be filled with joys for you and your family.

Medical image retrieval: past and present

Abstract: With the widespread dissemination of picture archiving and communication systems (PACSs) in hospitals, the amount of imaging data is rapidly increasing Effective image retrieval systems are required to manage these complex and large image databases The authors reviewed the past development and the present state of medical image retrieval systems including text-based and content-based systems In order to provide a more effective image retrieval service, the intelligent content-based retrieval systems combined with semantic systems are required

Seoul National University Bundang Hospital's Electronic System for Total Care

Abstract: Objectives Seoul National University Bundang Hospital, which is the first Stage 7 hospital outside of North America, has adopted and utilized an innovative and emerging information technology system to improve the efficiency and quality of patient care. The objective of this paper is to briefly introduce the major components of the SNUBH information system and to describe our progress toward a next-generation hospital information system (HIS).

Application of Stereo-Imaging Technology to Medical Field

Abstract: Objectives There has been continuous development in the area of stereoscopic medical imaging devices, and many stereoscopic imaging devices have been realized and applied in the medical field. In this article, we review past and current trends pertaining to the application stereo-imaging technologies in the medical field. Methods We describe the basic principles of stereo vision and visual issues related to it, including visual discomfort, binocular disparities, vergence-accommodation mismatch, and visual fatigue. We also present a brief history of medical applications of stereo-imaging techniques, examples of recently developed stereoscopic medical devices, and patent application trends as they pertain to stereo-imaging medical devices. Results Three-dimensional (3D) stereo-imaging technology can provide more realistic depth perception to the viewer than conventional two-dimensional imaging technology. Therefore, it allows for a more accurate understanding and analysis of the morphology of an object. Based on these advantages, the significance of stereoscopic imaging in the medical field increases in accordance with the increase in the number of laparoscopic surgeries, and stereo-imaging technology plays a key role in the diagnoses of the detailed morphologies of small biological specimens. Conclusions The application of 3D stereo-imaging technology to the medical field will help improve surgical accuracy, reduce operation times, and enhance patient safety. Therefore, it is important to develop more enhanced stereoscopic medical devices.

Wearable sensors in healthcare and sensor-enhanced health information systems: all our tomorrows?

Abstract: Wearable sensor systems which allow for remote or self-monitoring of health-related parameters are regarded as one means to alleviate the consequences of demographic change. This paper aims to summarize current research in wearable sensors as well as in sensor-enhanced health information systems. Wearable sensor technologies are already advanced in terms of their technical capabilities and are frequently used for cardio-vascular monitoring. Epidemiologic predictions suggest that neuropsychiatric diseases will have a growing impact on our health systems and thus should be addressed more intensively. Two current project examples demonstrate the benefit of wearable sensor technologies: long-term, objective measurement under daily-life, unsupervised conditions. Finally, up-to-date approaches for the implementation of sensor-enhanced health information systems are outlined. Wearable sensors are an integral part of future pervasive, ubiquitous and person-centered health care delivery. Future challenges include their integration into sensor-enhanced health information systems and sound evaluation studies involving measures of workload reduction and costs.

Barriers to the operation of patient safety incident reporting systems in korean general hospitals.

Abstract: Objectives This study aimed to explore the barriers to and factors facilitating the operation of patient safety incident reporting systems.

Health Insurance Claim Review Using Information Technologies

Abstract: Objectives: The objective of this paper is to describe the Health Insurance Review and Assessment Service (HIRA)’s payment request (PARE) system that plays the role of the gateway for all health insurance claims submitted to HIRA, and the claim review support (CRS) system that supports the work of claim review experts in South Korea. Methods: This study describes the two systems’ information technology (IT) infrastructures, their roles, and quantitative analysis of their work performance. It also reports the impact of these systems on claims processing by analyzing the health insurance claim data submitted to HIRA from April 1 to June 30, 2011. Results: The PARE system returned to healthcare providers 2.7% of all inpatient claims (97,930) and 0.1% of all outpatient claims (317,007) as un-reviewable claims. The return rate was the highest for the hospital group as 0.49% and the lowest rate was found in clinic group. The CRS system’s detection rate of the claims with multiple er rors in inpatient and outpatient areas was 23.1% and 2.9%, respectively. The highest rate of error detection occurred at guideline check-up stages in both inpatient and outpatient groups. Conclusions: The study found that HIRA’s two IT systems had a critical role in reducing heavy administrative workloads through automatic data processing. Although the return rate of the problematic claims to providers and the error detection rate by two systems was low, the actual count of the returned claims was large. The role of IT will become increasingly important in reducing the workload of health insurance claims review.

Geographical Information Systems and Health: Current State and Future Directions

Abstract: This paper provides an introduction to Geographical Information Systems (GIS) and how they can be used. It reviews the current state of GIS use in health care before identifying the barriers to more pervasive use of GIS in health. Finally, it makes recommendations for the direction of health GIS research over the next decade and concludes with a call to action to health informatics researchers to stop ignoring a tool and methodology that has such immense potential for improving the health of our communities.

A Study on User Satisfaction regarding the Clinical Decision Support System (CDSS) for Medication

Abstract: Objectives Many medication errors can occur when ordering and dispensing medicine in hospitals. The clinical decision support system (CDSS) is widely used in an effort to reduce medication errors. This study focused on the evaluation of user satisfaction with the CDSS for medication at a university hospital. Specifically, this study aimed to identify the factors influencing user satisfaction and to examine user requirements in order to further improve user satisfaction and drug safety.

Book Review: Social Networks and Health: Models, Methods, and Applications

Abstract: Health: Models, Methods, and Applications, is a Professor and Director of the Master of Public Health Program in the Department of Preventive Medicine, Keck School of Medicine, University of Southern California. He received his BS in Mathematics, MS in Mass Communication, and PhD in Communication. In addition, the author has published Evaluating Health Promotion Programs (Oxford University Press, 2002) and Network Models of the Diffusion of Innovations (Hampton Press, 1995); he has also published about 100 articles and chapters on social network analysis, health communication, health behavior change, and program evaluation, especially focusing on smoking cessation, substance abuse, family planning, HIV/STD, social support, etc. This book provides researchers in medical and public health with a useful introduction to social network analysis research. Although social network analysis has been employed in scientific research for over 70 years, the analysis methods have recently gained greater recognition and are currently widely used in research requiring interdisciplinary academic methods and advanced computing and statistics [1,2]. Social networks among, within, and between people and group are used to define their relationships and/or connections. Social networks are defined as a social structure connecting a set of actors such as people, organizations, political entities (states or nations), and/or other units [3]. Researchers in various fields have employed the methods of social network analysis to medical [4-6], epidemiology [7], and nursing [8] fields. This book is divided into three sections. Part I, “Models,” outlines fundamental knowledge and background information of social network analysis research. Chapter 1 provides Social Networks and Health: Models, Methods, and Applications

Human Factors Engineering in HI: So What? Who Cares? and What's in It for You?

Abstract: Objectives: Human factors engineering is a discipline that deals with computer and human systems and processes and provides a methodology for designing and evaluating systems as they interact with human beings. This review article reviews important current and past efforts in human factors engineering in health informatics in the context of the current trends in health informatics. Methods: The methodology of human factors engineering and usability testing in particular were reviewed in this article. Results: This methodology arises from the field of human factors engineering, which uses principles from cognitive science and applies them to implementations such as a computer-human interface and user-centered design. Conclusions: Patient safety and best practice of medicine requires a partnership between patients, clinicians and computer systems that serve to improve the quality and safety of patient care. People approach work and problems with their own knowledge base and set of past experiences and their ability to use systems properly and with low error rates are directly related to the usability as well as the utility of computer systems. Unusable systems have been responsible for medical error and patient harm and have even led to the death of patients and increased mortality rates. Electronic Health Record and Computerized Physician Order Entry systems like any medical device should come with a known safety profile that minimizes medical error and harm. This review article reviews important current and past efforts in human factors engineering in health informatics in the context of the current trends in health informatics.

Data Mining Application in Customer Relationship Management for Hospital Inpatients

Abstract: Objectives: This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. Methods: A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers’ medical services usage via a decision tree. Results: Patients were divided into two groups according to the variables of the RFM model and the group which had significantly high frequency of medical use and expenses was defined as loyal customers, a target market. As a result of the decision tree, the predictable factors of the loyal clients were; length of stay, certainty of selectable treatment, surgery, number of accompanying treatments, kind of patient room, and department from which they were discharged. Particularly, this research showed that when a patient within the internal medicine department who did not have surgery stayed for more than 13.5 days, their probability of being a classified as a loyal customer was 70.0%. Conclusions: To discover a hospital's loyal patients and model their medical usage patterns, the application of data-mining has been suggested. This paper suggests practical use of combining segmentation, targeting, positioning (STP) strategy and the RFM model with data-mining in CRM.

Ubiquitous health in Korea: progress, barriers, and prospects.

Abstract: Objectives Korea has one of the most advanced information technology (IT) infrastructures in the world, and the application of IT in health systems is rapidly progressing from computerization to information systems, ubiquitous systems, and smart systems. This study aims to analyze Korean environments in regards to the development of their u-Health industry and propose directions for u-Healthcare services based on this analysis.

Improving the Performance of Text Categorization Models used for the Selection of High Quality Articles.

Abstract: Objectives: Machine learning systems can considerably reduce the time and effort needed by experts to perform new systematic reviews (SRs). This study investigates categorization models, which are trained on a combination of included and commonly excluded articles, which can improve performance by identifying high quality articles for new procedures or drug SRs. Methods: Test collections were built using the annotated reference files from 19 procedure and 15 drug systematic reviews. The classification models, using a support vector machine, were trained by the combined even data of other topics, excepting the desired topic. This approach was compared to the combination of included and commonly excluded articles with the combination of included and excluded articles. Accuracy was used for the measure of comparison. Results: On average, the performance was improved by about 15% in the procedure topics and 11% in the drug topics when the classification models trained on the combination of articles included and commonly excluded, were used. The system using the combination of included and commonly excluded articles performed better than the combination of included and excluded articles in all of the procedure topics. Conclusions: Automatically rigorous article classification using machine learning can reduce the workload of experts when they perform systematic reviews when the topic-specific data are scarce. In particular, when the combination of included and commonly excluded articles is used, this system will be more effective.

Application of Social Network Analysis to Health Care Sectors

Abstract: Objectives: This study aimed to examine the feasibility of social network analysis as a valuable research tool for indicating a change in research topics in health care and medicine. Methods: Papers used in the analysis were collected from the PubMed database at the National Library of Medicine. After limiting the search to papers affiliated with the National Institutes of Health, 27,125 papers were selected for the analysis. From these papers, the top 100 non-duplicate and most studied Medical Subject Heading terms were extracted. NetMiner V.3 was used for analysis. Weighted degree centrality was applied to the analysis to compare the trends in the change of research topics. Changes in the core keywords were observed for the entire group and in three-year intervals. Results: The core keyword with the highest centrality value was “Risk Factor,” followed by “Molecular Sequence Data,” “Neoplasms,” “Signal Transduction,” “Brain,” and “Amino Acid Sequence.” Core keywords varied between time intervals, changing from “Molecular Sequence Data” to “Risk Factors” over time. “Risk Factors” was added as a new keyword and its social network was expanded. The slope of the keywords also varied over time: “Molecular Sequence Data,” with a high centrality value, had a decreasing slope at certain intervals, whereas “SNP,” with a low centrality value, had an increasing slope at certain intervals. Conclusions: The social network analysis method is useful for tracking changes in research topics over time. Further research should be conducted to confirm the usefulness of this method in health care and medicine.

Pitfalls and Security Measures for the Mobile EMR System in Medical Facilities

Abstract: Objectives The goal of this paper is to examine the security measures that should be reviewed by medical facilities that are trying to implement mobile Electronic Medical Record (EMR) systems designed for hospitals.

Design of activation functions for inference of fuzzy cognitive maps: application to clinical decision making in diagnosis of pulmonary infection.

Abstract: OBJECTIVES Fuzzy cognitive maps (FCMs) representing causal knowledge of relationships between medical concepts have been used as prediction tools for clinical decision making Activation functions used for inferences of FCMs are very important factors in helping physicians make correct decision Therefore, in order to increase the visibility of inference results, we propose a method for designing certain types of activation functions by considering the characteristics of FCMs METHODS The activation functions, such as the sinusoidal-type function and linear function, are designed by calculating the domain range of the functions to be reached during the inference process of FCMs Moreover, the designed activation functions were applied to the decision making process with the inference of an FCM model representing the causal knowledge of pulmonary infections RESULTS Even though sinusoidal-type functions oscillate and linear functions monotonously increase within the entire range of the domain, the designed activation functions make the inference stable because the proposed method notices where the function is used in the inference And, the designed functions provide more visible numeric results than do other functions CONCLUSIONS Comparing inference results derived using activation functions designed with the proposed method and results derived using activation functions designed with the existing method, we confirmed that the proposed method could be more appropriately used for designing activation functions for the inference process of an FCM for clinical decision making

Smart Information System for Gachon University Gil Hospital

Abstract: OBJECTIVES In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. METHODS This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. RESULTS The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. CONCLUSIONS Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future.

Clinical care improvement with use of health information technology focusing on evidence based medicine.

Abstract: OBJECTIVES Healthcare institutions need timely patient information from various sources at the point-of-care. Evidence-based medicine (EBM) is a tool for proper and efficient incorporation of the results of research in decision-making. Characteristics of medical treatment processes and practical experience concerning the effect of EBM in the clinical process are surveyed. METHODS A cross sectional survey conducted in Tehran hospitals in February-March 2012 among 51 clinical residents. The respondents were asked to apply EBM in clinical decision-making to answer questions about the effect of EBM in the clinical process. A valid and reliable questionnaire was used in this study. RESULTS EBM provides a framework for problem solving and improvement of processes. Most residents (76%) agreed that EBM could improve clinical decision making. Eighty one percent of the respondents believed that EBM resulted in quick updating of knowledge. They believed that EBM was more useful for diagnosis than for treatment. There was a significant association between out-patients and in-patients in using electronic EBM resources. CONCLUSIONS Research findings were useful in clinical practice and decision making. The computerized guidelines are important tools for improving clinical process quality. When learning how to use IT, methods of search and evaluation of evidence for diagnosis, treatment and medical education are necessary. Purposeful use of IT in clinical processes reduces workload and improves decision-making.

A Three-Year Autoregressive Cross-Lagged Panel Analysis on Nicotine Dependence and Average Smoking

Abstract: Objectives: Previous studies have been limited to the use of cross sectional data to identify the relationships between nicotine dependence and smoking. Therefore, it is difficult to determine a causal direction between the two variables. The purposes of this study were to 1) test whether nicotine dependence or average smoking was a more influential factor in smoking cessation; and 2) propose effective ways to quit smoking as determined by the causal relations identified. Methods: This study used a panel dataset from the central computerized management systems of community-based smoking cessation programs in Korea. Data were stored from July 16, 2005 to July 15, 2008. 711,862 smokers were registered and re-registered for the programs during the period. 860 of those who were retained in the programs for three years were finally included in the dataset. To measure nicotine dependence, this study used a revised Fagerstrom Test for Nicotine Dependence. To examine the relationship between nicotine dependence and average smoking, an autoregressive cross-lagged model was explored in the study. Results: The results indicate that 1) nicotine dependence and average smoking were stable over time; 2) the impact of nicotine dependence on average smoking was significant and vice versa; and 3) the impact of average smoking on nicotine dependence is greater than the impact of nicotine dependence on average smoking. Conclusions: These results support the existing data obtained from previous research. Collectively, reducing the amount of smoking in order to decrease nicotine dependence is important for evidence-based policy making for smoking cessation.

Comparison of Knowledge Levels Required for SNOMED CT Coding of Diagnosis and Operation Names in Clinical Records

Abstract: Objectives Coding Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT) with complex and polysemy clinical terms may ask coder to have a high level of knowledge of clinical domains, but with simpler clinical terms, coding may require only simpler knowledge. However, there are few studies quantitatively showing the relation between domain knowledge and coding ability. So, we tried to show the relationship between those two areas.

Implementation Issues of Virtual Desktop Infrastructure and Its Case Study for a Physician's Round at Seoul National University Bundang Hospital

Abstract: Objectives The cloud computing-based virtual desktop infrastructure (VDI) allows access to computing environments with no limitations in terms of time or place such that it can permit the rapid establishment of a mobile hospital environment. The objective of this study was to investigate the empirical issues to be considered when establishing a virtual mobile environment using VDI technology in a hospital setting and to examine the utility of the technology with an Apple iPad during a physician's rounds as a case study. Methods Empirical implementation issues were derived from a 910-bed tertiary national university hospital that recently launched a VDI system. During the physicians' rounds, we surveyed patient satisfaction levels with the VDI-based mobile consultation service with the iPad and the relationship between these levels of satisfaction and hospital revisits, hospital recommendations, and the hospital brand image. Thirty-five inpatients (including their next-of-kin) and seven physicians participated in the survey. Results Implementation issues pertaining to the VDI system arose with regard to the highly availability system architecture, wireless network infrastructure, and screen resolution of the system. Other issues were related to privacy and security, mobile device management, and user education. When the system was used in rounds, patients and their next-of-kin expressed high satisfaction levels, and a positive relationship was noted as regards patients' decisions to revisit the hospital and whether the use of the VDI system improved the brand image of the hospital. Conclusions Mobile hospital environments have the potential to benefit both physicians and patients. The issues related to the implementation of VDI system discussed here should be examined in advance for its successful adoption and implementation.

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.

Abstract: 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 ser vice to the clinical community.

Integration of Evidence into a Detailed Clinical Model-based Electronic Nursing Record System.

Abstract: OBJECTIVES The purpose of this study was to test the feasibility of an electronic nursing record system for perinatal care that is based on detailed clinical models and clinical practice guidelines in perinatal care. METHODS THIS STUDY WAS CARRIED OUT IN FIVE PHASES: 1) generating nursing statements using detailed clinical models; 2) identifying the relevant evidence; 3) linking nursing statements with the evidence; 4) developing a prototype electronic nursing record system based on detailed clinical models and clinical practice guidelines; and 5) evaluating the prototype system. RESULTS We first generated 799 nursing statements describing nursing assessments, diagnoses, interventions, and outcomes using entities, attributes, and value sets of detailed clinical models for perinatal care which we developed in a previous study. We then extracted 506 recommendations from nine clinical practice guidelines and created sets of nursing statements to be used for nursing documentation by grouping nursing statements according to these recommendations. Finally, we developed and evaluated a prototype electronic nursing record system that can provide nurses with recommendations for nursing practice and sets of nursing statements based on the recommendations for guiding nursing documentation. CONCLUSIONS The prototype system was found to be sufficiently complete, relevant, useful, and applicable in terms of content, and easy to use and useful in terms of system user interface. This study has revealed the feasibility of developing such an ENR system.

Development of Clinical Contents Model Markup Language for Electronic Health Records

Abstract: Objectives: To develop dedicated markup language for clinical contents models (CCM) to facilitate the active use of CCM in electronic health record systems. Methods: Based on analysis of the structure and characteristics of CCM in the clinical domain, we designed extensible markup language (XML) based CCM markup language (CCML) schema manually Results: CCML faithfully reflects CCM in both the syntactic and semantic aspects. As this language is based on XML, it can be expressed and processed in computer systems and can be used in a technology-neutral way. Conclusions: CCML has the following strengths: it is machine-readable and highly human-readable, it does not require a dedicated parser, and it can be applied for existing electronic health record systems.

Management Issues in Healthcare Information Technology

Abstract: Electronic medical record (EMR) and clinical decision support systems (CDSS) are being increasingly adopted by hospitals in Korea with the evolution of healthcare information technology (HIT). The adoption rate of EMR had greatly increased from 21.4% in 2005 to 77.3% in 2010. The adoption of CDSS had also greatly increased from almost 0% in 2005 to 27.3% in 2010 [1]. The benefits of these systems include a reduction of the report turnaround time, fewer medication errors, a reduction of adverse drug effects, and many others [2]. As these systems can have a profound impact on the quality of patient care and the efficiency of hospital administration, management issues such as their acceptance and use by physicians, nurses, and managers became crucial. Several theoretical models have been developed to explain user acceptance and other management issues in HIT. The most prominent model of user acceptance is the technology acceptance model [3]. This model states that a user's attitude towards a certain technology depends on the perceived usefulness of that technology and on its perceived ease of use. Attitude and perceived usefulness then jointly predict a user's intention to use that technology. Because physicians have a large degree of professional autonomy and are considered to make technology acceptance decisions independently, several studies have focused on physicians' acceptance of EMR [4], CDSS [5], and a picture archiving and communication system (PACS) [6]. Pynoo et al. [7] investigated physicians' PACS acceptance levels on three occasions (before, shortly after and one year after the introduction of PACS). They used the unified theory of acceptance and use of technology model [8], which extended the technology acceptance model by adding social influence and facilitating conditions as direct predictors of user acceptance. Social influence refers to perceived norms in the social environment concerning the use of a technology; and facilitating conditions refer to objective factors that facilitate the use of a technology, such as training, support and compatibility between the new and existing systems. Another related model for management issue is the information system (IS) success model by DeLone and McLean [9]. They included user satisfaction in addition to usage (including user acceptance) in their IS success model because user satisfaction is an alternative measure of system value in cases of obligatory use. They subdivided success measures of IS into six distinct categories: 1) system quality; 2) information quality; 3) usage; 4) user satisfaction; 5) individual impact; and 6) organizational impact. Within each category, several attributes could contribute to success. The information processing system itself is assessed with system quality attributes (e.g., usability, accessibility, ease of use). Information quality attributes (e.g., accuracy, completeness, legibility), concern the input and output of the system. Usage refers to system usage or information usage after user accepted the system. In their view, system quality and information quality individually and jointly affect usage and user satisfaction. Individual impact is a measure of the effect of the system or the information on users' behavior, and attributes can be information recall or the frequency of data retrieval or data entry. Organizational impact refers to the effects of the system on organizational performance. The IS success model has also been widely applied in HIT to identify the factors influencing user satisfaction in the areas of computerized physician entry system (CPOE) [10], clinical information systems (CIS) [11], enterprise resource planning (ERP) [12], hospital information systems [13], and CDSS [14]. DeLone and McLean [15] updated their success model by adding a service quality dimension. Service quality measure includes: up-to-date hardware and software, a dependable system, prompt user support, and user training. Since user support and user training are important factors for influencing physician acceptance, there is a need for more study on the updated IS success model for HIT. The most frequent format in the related literature on management issues is a one-shot approach, in which user acceptance or satisfaction is typically assessed only at one moment in time. However, Rogers [16] suggested that individual adoption is not an instantaneous act, but it is a process, which occurs over time. In his diffusion of innovation theory, individual adoption can be conceptualized as a five-stage process involving knowledge, persuasion, decision, implementation, and confirmation. The diffusion process is influenced by the individuals' perceptions of the innovation at the persuasion stage: relative advantage, compatibility, complexity, etc. When a new IT is introduced, user must first be aware that an innovation exists and must be persuaded that the new IT is beneficial. At the decision stage, the individual decides whether adopt or reject. After the implementation stage, the individual then confirms whether to continue to adopt or to discontinue. Because physicians' acceptance is so important to the success of CIS, the diffusion of innovation theory has been applied to assess the adoption process of physicians before and after the introduction of healthcare IS such as PACS [7], CIS [17], and IS for a public health center [18]. As new ITs are introduced, these management issues also changed. In an effort to effectively respond to rapidly changing IT, the Society for Information Management (SIM) in the United States have conducted surveys on management issue changes due to the development of new IT every three years from early 1980s [19,20]. Based on the SIM survey framework, Kim et al. [21] identified management issues of HIT in Korea using the Delphi method in two surveys and interviewed managers of hospital information systems in 1999. Kwak et al. [22] also surveyed the management issues of HIT in 2005 and compared their results with those of 1999. There are many benefits of such surveys in HIT management. IS managers can interpret trends in HIT and assess the impacts on their organization in the face of rapid changes in IT, such as u-health and mobile health technology. Researchers and educators can use the survey results to improve their understanding of critical managerial issues and to educate students in healthcare informatics. Accordingly, we encourage you to conduct such a survey on current managerial issues and submit the related research papers to HIR.

The Development of Medical Record Items: a User-centered, Bottom-up Approach.

Abstract: OBJECTIVES Clinical documents (CDs) have evolved from traditional paper documents containing narrative text information into the electronic record sheets composed of itemized records, where each record is expressed as an item with a specific value. We defined medical record (MR) items to be information entities with a specific value. These entities were then used to compile form-based clinical documents as part of an electronic health record system (EHR-s). METHODS We took a reusable bottom-up developmental approach for the MR items, which provided three things: efficient incorporation of the local needs and requirements of the medical professionals from various departments in the hospital, comprehensive inclusion of the essential concepts of the basic elements required in clinical documents, and the provision of a structured means for meaningful data entry and retrieval. This paper delineates our experiences in developing and managing medical records at a large tertiary university hospital in Korea. RESULTS We collected 63,232 MR items from paper records scanned into 962 CDs. The MR item database was constructed using 13,287 MR items after removing redundant items. During the first year of service users requested changes to be made to 235 (1.8%) attributes of the MR items and also requested the additional 9,572 new MR items. In the second year, the attributes of 70 (0.5%) of the existing MR items were changed and 3,704 new items were added. The number of registered MR items increased by 72.0% in the first year and 27.9% in the second year. CONCLUSIONS The MR item concept provides an easier and more structured means of data entry within an EHR-s. By using these MR items, various kinds of clinical documents can be easily constructed and allows for medical information to be reused and retrieved as data. The success of the use of MR items in a large tertiary university hospital system provides evidence that verifies our approach as being an efficient means of user-oriented and structured data entry, enabling the easy reuse of medical records.