建立国家卫生与健康管理大数据平台的总体设想

在医疗卫生与健康领域,各类医疗机构、医疗信息平台、数字化医疗仪器、智能健康电子产品、可穿戴个人健康设备、健康信息平台会生成海量的健康医疗信息,形成健康医疗大数据.健康医疗大数据的发展与应用不仅可以完善我国医疗卫生服务体系,提升医疗服务质量和管理水平,而且可促进健康产业的发展,对国家经济发展具有现实的带动意义和长远的战略意义.对健康医疗大数据的基本特点进行了介绍,针对我国健康医疗大数据应用中存在的问题和挑战进行了分析.为提高我国健康管理的信息化水平和管理效率,提出一个能够融合医疗与健康信息的、覆盖我国国民的全方位、全周期的健康医疗数据平台——国家卫生与健康管理大数据平台,对建立该平台的总体设想进行了描述,并对该平台的建设方式、运营方式、数据来源及平台功能进行了介绍.     

An electronic menstrual cycle calendar: comparison of data quality with a paper version

OBJECTIVES: This pilot study compared a prototype electronic menstrual calendar on a handheld computer with a paper calendar for data quality and participants' perceptions. DESIGN: Twenty-three women completed identical information about menstrual bleeding and symptoms using paper and electronic calendars for 1 month each. RESULTS: Use of the paper calendar resulted in more missing data than the electronic calendar for bleeding characteristics (13% vs. 4%) and symptoms (35% vs. 4%). The electronic calendar's ability to log data entries revealed retrospective entry for 61% of the data. Total data entry and cleaning time was reduced by 81% with the electronic calendar. Overall, participants preferred the electronic (70%) to the paper (22%) calendar. CONCLUSIONS: Data quality with conventional paper calendars may be poorer than recognized. The data-logging feature, unique to the electronic calendar, is critical for assessing data quality. Electronic menstrual calendars can be useful data collection tools for research in women's health.     

Two complementary personal medication management applications developed on a common platform: case report

Background

Adverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs.

Objective

Our objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs (MyMediHealth), and one to assist older adults in care transitions (Colorado Care Tablet).

Methods

The applications were developed using a user-centered design approach. The two applications shared a common PHR platform based on a service-oriented architecture. MyMediHealth employed Web and mobile phone user interfaces. Colorado Care Tablet employed a Web interface customized for a tablet PC.

Results

We created complementary medication management applications tailored to the needs of distinctly different user groups using common components. Challenges were addressed in multiple areas, including how to encode medication identities, how to incorporate knowledge bases for medication images and consumer health information, how to include supplementary dosing information, how to simplify user interfaces for older adults, and how to support mobile devices for children.

Conclusions

These prototypes demonstrate the utility of abstracting PHR data and services (the PHR platform) from applications that can be tailored to meet the needs of diverse patients. Based on the challenges we faced, we provide recommendations on the structure of publicly available knowledge resources and the use of mobile messaging systems for PHR applications.     

Integration of a handheld based anaesthesia rounding system into an anaesthesia information management system

BACKGROUND: At the University Hospital Giessen, an anesthesia information management system (AIMS) is used for online record keeping of perioperative patient care, but preoperative anaesthesia assessments were still being recorded on paper and subsequently entered into the AIMS. Personal digital assistants (PDAs) seem to be useful instruments to establish a seamless digital anesthesiological documentation. OBJECTIVES: We decided to implement a solution for direct integration of data gathered during the preoperative assessment into the existing data management infrastructure. Parallel to the development of the system, we surveyed the future users to match their wishes and needs as far as possible. SYSTEM DESCRIPTION: A C program embedding the preoperative AIMS' data fields was developed. Data alignment with the Hospital information system (HIS) is controlled by a Java desktop software. The anaesthesiologist completes the available fields at the patient's bedside following the same algorithm and integrity check as the PC version. STATUS REPORT: Overall, 68% of the surveyed physicians supported the implementation of the system. The PDA solution has been available since May 2002. Data replication into the handheld and integration of mobile collected data into the AIMS generally work without problems. The HIS interconnection software converts the PDA file into the AIMS format for further processing. DISCUSSION: The preoperative anaesthetic assessment is a standardised task well suitable for conversion to an electronic data storage medium. Changing from redundant data entry in the OR to direct electronic recording at the patient's bedside seems simply logical. Handheld computers are inexpensive, flexible gadgets to realize this.     

Acceptance and cognitive load in a clinical setting of a novel device allowing natural real-time data acquisition

INTRODUCTION: This paper reports the findings of an evaluation study in the field of human-computer interaction about the use of a new data acquisition device, the digital pen. It focuses on specific aspects of the interaction between the users and the technology: the cognitive burden induced by the design of the tool in real conditions of use and its impact on user acceptance. METHODOLOGY: Human cognition is embedded in a complex sociocultural world. Therefore, we opted for ethnographically informed investigations reinforced by a satisfaction survey. The work context chosen for these investigations was the emergency room triage process. RESULTS: The technology meets a high acceptance (median 3 on a [-5,5] scale) shaded by unexpected additional cognitive burdens. These burdens originate in several technological and ergonomic flaws that have been discovered during the observations. These results have been used to improve the technology. CONCLUSION: We demonstrate the importance of this kind of field study to uncover unexpected possible sources of failure of acceptance of a new technology. Such kind of study should be held prior to the introduction of a new technology to lower the common failure rate encountered in the field of medical informatics.     

Interactive multidimensional display of magnetic resonance imaging data

Acquisition of multiparametric images in multiple planes often requires unacceptably long scanning times. The ability to display high quality planar cuts in arbitrary planes from single plane (eg, transaxial, coronal, or sagittal plane) images would alleviate the need to acquire images in multiple planes. The need to display data from three-dimensional volume acquisitions also poses a problem to the radiologist. We have developed an interactive multidimensional display tool for magnetic resonance data. The tool presents three orthogonal planes (such as transaxial, coronal, and sagittal) simultaneously and allows the user to interactively roam through the data set. The user can select any arbitrary oblique plane and obtain the corresponding reformations. Additionally the tool allows the correlated display of sets of differently acquired data. This tool offers an effective means for the display of isotropic data and reformatted planar data. The ability to interact directly with the data allows increased transference of information to the radiologist and referring physician.     

Evaluation of an architecture for intelligent query and exploration of time-oriented clinical data

OBJECTIVE: Evaluate KNAVE-II, a knowledge-based framework for visualization, interpretation, and exploration of longitudinal clinical data, clinical concepts and patterns. KNAVE-II mediates queries to a distributed temporal-abstraction architecture (IDAN), which uses a knowledge-based problem-solving method specializing in on-the-fly computation of clinical queries. METHODS: A two-phase, balanced cross-over study to compare efficiency and satisfaction of a group of clinicians when answering queries of variable complexity about time-oriented clinical data, typical for oncology protocols, using KNAVE-II, versus standard methods: both paper charts and a popular electronic spreadsheet (ESS) in Phase I; an ESS in Phase II. The measurements included the time required to answer and the correctness of answer for each query and each complexity category, and for all queries, assessed versus a predetermined gold standard set by a domain expert. User satisfaction was assessed by the Standard Usability Score (SUS) tool-specific questionnaire and by a "Usability of Tool Comparison" comparative questionnaire developed for this study. RESULTS: In both evaluations, subjects answered higher-complexity queries significantly faster using KNAVE-II than when using paper charts or an ESS up to a mean of 255 s difference per query versus the ESS for hard queries (p=0.0003) in the second evaluation. Average correctness scores when using KNAVE-II versus paper charts, in the first phase, and the ESS, in the second phase, were significantly higher over all queries. In the second evaluation, 91.6% (110/120) of all of the questions asked within queries of all levels produced correct answers using KNAVE-II, opposed to only 57.5% (69/120) using the ESS (p<0.0001). User satisfaction with KNAVE-II was significantly superior compared to using either a paper chart or the ESS (p=0.006). Clinicians ranked KNAVE-II superior to both paper and the ESS. CONCLUSIONS: An evaluation of the functionality and usability of KNAVE-II and its supporting knowledge-based temporal-mediation architecture has produced highly encouraging results regarding saving of physician time, enhancement of accuracy of clinical assessment, and user satisfaction.     

Mobilizing a health professional's workstation--results of an evaluation study

To evaluate the idea of a multifunctional mobile pen computer to support information processing tasks of health care professionals we carried out a field study. On a tablet-sized mobile pen computer we set up a health professional workstation, MEDIAS/WIN, with most of the application systems that are presently used by health professionals at Heidelberg University Medical Center. Our experiences during the study, involving 11 physicians, nine nurses and four computer scientists showed that it's not enough to make existing applications mobile most user interfaces have to be adapted for pen input. The presented system served as a valuable basis for study purposes but was not suitable for use in clinical routine. Patient data of the current clinical case and medical knowledge in the form of reference lists were found to be most important for mobile usage. Desirable functionality also included mobile access to electronic mail, electronic ordering of meals and some documentation tasks, e.g. the documentation of diagnoses and orders for diagnostic and therapy.     

EZ-Entry: a clinical data management system

In this paper, a new data management system named EZ-Entry is introduced. Five major functions are enclosed in this system: (1) user authentication; (2) database construction; (3) double data entry with instant alignment; (4) revision tracking; (5) query management. The practical application performed on two clinical trials indicates that EZ-Entry meets the requirements of clinical data management with high efficiency and security. This software is freely available on request from the authors for academic purposes.     

Building a robust, scalable and standards-driven infrastructure for secondary use of EHR data: the SHARPn project

The Strategic Health IT Advanced Research Projects (SHARP) Program, established by the Office of the National Coordinator for Health Information Technology in 2010 supports research findings that remove barriers for increased adoption of health IT. The improvements envisioned by the SHARP Area 4 Consortium (SHARPn) will enable the use of the electronic health record (EHR) for secondary purposes, such as care process and outcomes improvement, biomedical research and epidemiologic monitoring of the nation's health. One of the primary informatics problem areas in this endeavor is the standardization of disparate health data from the nation's many health care organizations and providers. The SHARPn team is developing open source services and components to support the ubiquitous exchange, sharing and reuse or 'liquidity' of operational clinical data stored in electronic health records. One year into the design and development of the SHARPn framework, we demonstrated end to end data flow and a prototype SHARPn platform, using thousands of patient electronic records sourced from two large healthcare organizations: Mayo Clinic and Intermountain Healthcare. The platform was deployed to (1) receive source EHR data in several formats, (2) generate structured data from EHR narrative text, and (3) normalize the EHR data using common detailed clinical models and Consolidated Health Informatics standard terminologies, which were (4) accessed by a phenotyping service using normalized data specifications. The architecture of this prototype SHARPn platform is presented. The EHR data throughput demonstration showed success in normalizing native EHR data, both structured and narrative, from two independent organizations and EHR systems. Based on the demonstration, observed challenges for standardization of EHR data for interoperable secondary use are discussed.     

Prospective,randomized evaluation of a personal digital assistant-based research tool in the emergency department

Background  

Personal digital assistants (PDA) offer putative advantages over paper for collecting research data. However, there are no data prospectively comparing PDA and paper in the emergency department. The aim of this study was to prospectively compare the performance of PDA and paper enrollment instruments with respect to time required and errors generated.     

A web-based data repository and review system for faculty evaluation and promotion.

The authors describe the development of MyInfoVault (MIV), a Web-based central data repository with a variety of integrated applications that generate a series of professional documents. These documents can be circulated and archived. MIV was developed and piloted over several years (2002-2006) at the University of California-Davis in response to a perceived need to improve management of faculty merit and promotion dossiers. This article focuses on the faculty advancement module (PacketOnline) of MIV. Additional applications for generating a personal curriculum vitae and NIH Biosketch are also briefly described.The authors report their experience with a two-year pilot program for PacketOnline, including an evaluation of its functionality derived from a user survey. Tasks for dossier preparation were rated fairly equivalently to the conventional method. Initial data entry was reported to be tedious, and there were frustrations with unanticipated glitches, typical of new systems. The largest improvements and benefits were seen in electronic review of dossiers, which was considered to be more efficient and effective than the conventional paper method. The authors found all users to be generally supportive of the new electronic system. The authors conclude that an electronic database with applications for faculty merit and promotion review is a worthwhile tool, and they suggest using a multidisciplinary team of users to achieve buy-in. Additional enhancements and monitors of performance of the MIV system are ongoing.     

Automatic radiologic reporting system using speech recognition

A radiograph report is usually made from an oral dictation by a radiologist, which is then typed. Typing Japanese is rather inconvenient and consumes many hours. In this paper we introduce a computer-assisted reporting system for radiologic images using speech recognition. The hardware of the reporting system consists of a speech recognizer DP-200(NEC) and a personal computer PC-8801 or PC-9801. The DP-200 has the capability of storing 500 different words spoken by a radiologist. At present, three application programs have been designed. These are for the interpretation of a liver scintigram, a bone scintigram and a chest radiograph. Data entry is done by the radiologist at a CRT display terminal in a conversational manner with predefined and predetermined branching. The time required to make a normal report using the liver or bone scintigram system was within one minute. The reporting time was several minutes in the case of an abnormality report. It is suggested that the system is useful for making an imaging report, for constructing the data base for the interpretation of medical images and for the picture archiving and communication system.     

User Evaluation of an Innovative Digital Reading Room

Reading room design can have a major impact on radiologists' health, productivity, and accuracy in reading. Several factors must be taken into account in order to optimize the work environment for radiologists. Further, with the advancement in imaging technology, clinicians now have the ability to view and see digital exams without having to interact with radiologists. However, it is important to design components that encourage and enhance interactions between clinicians and radiologists to increase patient safety, and to combine physician and radiologist expertise. The present study evaluates alternative workstations in a real-world testbed space, using qualitative data (users' perspectives) to measure satisfaction with the lighting, ergonomics, furniture, collaborative spaces, and radiologist workstations. In addition, we consider the impact of the added collaboration components of the future reading room design, by utilizing user evaluation surveys to devise baseline satisfaction data regarding the innovative reading room environment.     

Development and implementation of an EPR: how to encourage the user.

This paper reports on the role users played in the design and development of an electronic patient record. Two key users participated in the project team. All future users received questionnaires and a selection of them was interviewed. Before starting the development of the EPR, the attitude of users towards electronic record keeping, their satisfaction with the paper clinical records, their knowledge of computers, and their needs and expectations of computer applications in health care were measured by means of a questionnaire. The results of the questionnaire were supplemented with in-depth interviews. Users had a neutral attitude towards electronic record keeping. They were more positive about data entry of the paper records than data retrieval. During the development phase, but prior to the implementation of the EPR, a second questionnaire measured satisfaction with the paper records. Satisfaction appeared to be related to self-rated computer experience. Inexperienced computer users tended to be more positive about the paper records. In general, respondents did not have many expectations about electronic record keeping. A second series of interviews zoomed in on the expectations users had. Except for more concise reporting no beneficial effects of electronic record keeping were expected.     

A system for interactive film analysis.

An interactive, minicomputer system has been constructed for analyzing dynamic phenomena recorded on movie film in a developmental biology laboratory. The minicomputer interfaces a stop-motion, variable speed projector, a digitizing pen, and real-time graphics display equipment. An analyst uses the pen to digitize features in a film, e.g. by following a cell. A computer-generated animation portraying all data entered is superimposed on the film image and synchronized with it. Noteworthy system features include: image overlays on a large screen, data entry with the projector running, large data capacity, computer control of the projector, and convenient data entry tools.     

Information system design for a hospital emergency department: A usability analysis of software prototypes

Study objectiveThe purpose of this study is to evaluate the usability of emergency department (ED) software prototypes developed for Tablet personal computers (Tablet PCs) in order to keep electronic health records (EHRs) of patients errorless and accessible through mobile technologies. In order to serve this purpose, two alternative prototypes were developed for Tablet PCs: Mobile Emergency Department Software (MEDS) and Mobile Emergency Department Software Iconic (MEDSI) among which the user might choose the more appropriate one for ED operations based on a usability analysis involving the target users.MethodsThe study is based on a case study of 32 potential users of our prototypes at the ED of Kadikoy-AHG in Istanbul, Turkey. We examined usability of the prototypes for medical information systems by means of Nielsen’s heuristic evaluation and cognitive walkthrough methods relying on 7-point scales, and scenario completion success rate and average scenario completion time, respectively.ResultsThe implementation of MEDSI in our case study confirmed the view that the usability evaluation results of iconic GUIs were better than those of non-iconic GUIs in terms of Nielsen’s heuristic evaluation, effectiveness and user satisfaction. For the whole sample, paired t-test scores indicated that there was a significant difference (p < 0.01) between mean values of Nielsen’s usability scores toward MEDS and MEDSI indicating that MEDSI was evaluated more favorably than MEDS. As for effectiveness of the prototypes, significant differences (p < 0.01) were noted between MEDS and MEDSI in terms of both overall scenario completion success rate and average scenario completion time. Similarly, for the full sample of users independent sample t-test scores indicated that MEDSI was perceived significantly more favorable (p < 0.01) than MEDS in terms of overall user satisfaction.ConclusionThe study provides two important contributions to the extant literature. First, it addresses a topic and methodology that serves potentially interesting to the biomedical informatics community. Drawing on good background information and appropriate context, it involves various aspects of usability testing. Another contribution of the study lies in its examination of two different prototypes during the design phase involving the target users.     

Structured data entry for narrative data in a broad specialty: patient history and physical examination in pediatrics

Background  

Whereas an electronic medical record (EMR) system can partly address the limitations, of paper-based documentation, such as fragmentation of patient data, physical paper records missing and poor legibility, structured data entry (SDE, i.e. data entry based on selection of predefined medical concepts) is essential for uniformity of data, easier reporting, decision support, quality assessment, and patient-oriented clinical research. The aim of this project was to explore whether a previously developed generic (i.e. content independent) SDE application to support the structured documentation of narrative data (called OpenSDE) can be used to model data obtained at history taking and physical examination of a broad specialty.     

基于USB-4221数据采集卡的连续血压测量

针对现有连续无创血压测量系统测量结果离散程度高的问题,设计基于USB-4221数据采集卡的连续血压测量系统。通过AD8232心电传感器和指夹光电脉搏传感器同步获取心电-脉搏信号,设计心电-脉搏硬件调理电路。应用MIMIC数据库中心电-脉搏-血压信号计算脉搏传导时间,并进行回归分析,构建血压测量模型。同时,利用图形可视化工具GUI进行了用户平台的设计。系统采集了若干名志愿者的相关数据,测得的血压值与欧姆龙电子血压计HEM-8713的测量值进行对比,测量误差在±5 mmHg范围内,达到AAMI标准中对测量平均误差的要求。