Two RFID-based Solutions to Enhance Inpatient Medication Safety

Owing to the low cost and convenience of identifying an object without physical contact, Radio Frequency Identification (RFID) systems provide innovative, promising and efficient applications in many domains. An RFID grouping protocol is a protocol that allows an off-line verifier to collect and verify the evidence of two or more tags simultaneously present. Recently, Huang and Ku (J. Med. Syst, 2009) proposed an efficient grouping protocol to enhance medication safety for inpatients based on low-cost tags. However, the Huang–Ku scheme is not secure; an attacker can easily make up fake grouping records to cheat the verifier. This weakness would seriously endanger the safety of inpatient medication safety. This paper will show the weaknesses, and then propose two RFID-based solutions to enhance medication safety for two different scenarios. The proposed schemes are practical, secure and efficient for medication applications.     

Assessing the Relationship between Technology Readiness and Continuance Intention in an E-Appointment System: Relationship Quality as a Mediator

RFID technology is increasingly used in applications that require tracking, identification, and authentication. It attaches RFID-readable tags to objects for identification and execution of specific RFID-enabled applications. Recently, research has focused on the use of grouping-proofs for preserving privacy in RFID applications, wherein a proof of two or more tags must be simultaneously scanned. In 2010, a privacy-preserving grouping proof protocol for RFID based on ECC in public-key cryptosystem was proposed but was shown to be vulnerable to tracking attacks. A proposed enhancement protocol was also shown to have defects which prevented proper execution. In 2012, Lin et al. proposed a more efficient RFID ECC-based grouping proof protocol to promote inpatient medication safety. However, we found this protocol is also vulnerable to tracking and impersonation attacks. We then propose a secure privacy-preserving RFID grouping proof protocol for inpatient medication safety and demonstrate its resistance to such attacks.     

A RFID Grouping Proof Protocol for Medication Safety of Inpatient

In order to provide enhanced medication safety for inpatients, the medical mechanism which adopts the modified grouping proof protocol is proposed in this paper. By using the grouping proof protocol, the medical staffs could confirm the authentication and integrity of a group of Radio-Frequency Identification (RFID) tags which are embedded on inpatient bracelets and the containers of drugs. This mechanism is designed to be compatible with EPCglobal Class-1 Generation-2 standard which is the most popular specification of RFID tags. Due to the light-weight computational capacity of passive tags, only the pseudo-random number generator (PRNG) and cyclic redundancy code (CRC) are allowed to be used in the communication protocol. Furthermore, a practical scenario of using this proposed mechanism in hospital to examine the medication safety is also presented.     

A Hybrid Method Based on Fuzzy Clustering and Local Region-Based Level Set for Segmentation of Inhomogeneous Medical Images

Reliable sources report that errors in drug administration are increasing the number of harmed or killed inpatients, during healthcare. This development is in contradiction to patient safety norms. A correctly designed hospital-wide ubiquitous system, using advanced inpatient identification and matching techniques, should provide correct medicine and dosage at the right time. Researchers are still making grouping proof protocol proposals based on the EPC Global Class 1 Generation 2 ver. 1.2 standard tags, for drug administration. Analyses show that such protocols make medication unsecure and hence fail to guarantee inpatient safety. Thus, the original goal of patient safety still remains. In this paper, a very recent proposal (EKATE) upgraded by a cryptographic function is shown to fall short of expectations. Then, an alternative proposal IMS-NFC which uses a more suitable and newer technology; namely Near Field Communication (NFC), is described. The proposed protocol has the additional support of stronger security primitives and it is compliant to ISO communication and security standards. Unlike previous works, the proposal is a complete ubiquitous system that guarantees full patient safety; and it is based on off-the-shelf, new technology products available in every corner of the world. To prove the claims the performance, cost, security and scope of IMS-NFC are compared with previous proposals. Evaluation shows that the proposed system has stronger security, increased patient safety and equal efficiency, at little extra cost.     

住院病人欠费预测模型研究

针对住院病人欠费现象,以医院信息系统历年数据为基础建立数据仓库,对欠逃费病人数据进行多角度、多层次分析,采用Bayes算法和关联等规则,对欠逃费影响因素之间的关联关系进行量化分析,以欠逃费行为潜在的规律及其关键影响因素来建立数学预测模型;并以此预测和分析现有住院患者欠逃费的可能性,将分析结果提供给医院管理人员,加强关注欠逃费概率高的在院病人,以规避潜在欠逃费行为.同时,通过分析欠逃费病人发生的原因,指导医院对相关病种、科室的管理,提升医疗质量和管理水平,为医院科学管理和决策提供辅助支持.     

2004-2005年本院万古霉素的儿科用药分析

目的了解万古霉素在儿科患者的应用情况，以促进在儿科患者中更合理地使用万古霉素。方法采用回顾性调查分析2004-2005年本院儿科住院患者使用万古霉素的治疗过程。结果万古霉素治疗有效率68．2％，平均用药时间6．29d。结论严格用药指征，减少经验用药，采取特殊药物使用限制措施，有助于提高万古霉素的治疗效果与合理用药水平。     

How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis

ObjectiveTo conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS.Materials and MethodsWe searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed.ResultsThere was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18–8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72–0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence.Discussion and ConclusionDespite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.     

A Provably-Secure Transmission Scheme for Wireless Body Area Networks

Wireless body area network (WBANs) is composed of sensors that collect and transmit a person’s physiological data to health-care providers in real-time. In order to guarantee security of this data over open networks, a secure data transmission mechanism between WBAN and application provider’s servers is of necessity. Modified medical data does not provide a true reflection of an individuals state of health and its subsequent use for diagnosis could lead to an irreversible medical condition. In this paper, we propose a lightweight certificateless signcryption scheme for secure transmission of data between WBAN and servers. Our proposed scheme not only provides confidentiality of data and authentication in a single logical step, it is lightweight and resistant to key escrow attacks. We further provide security proof that our scheme provides indistinguishability against adaptive chosen ciphertext attack and unforgeability against adaptive chosen message attack in random oracle model. Compared with two other Diffie-Hellman based signcryption schemes proposed by Barbosa and Farshim (BF) and another by Yin and Liang (YL), our scheme consumes 46 % and 8 % less energy during signcryption than BF and YL scheme respectively.     

2009～2010年我院麻醉药品使用情况分析

目的分析我院麻醉药品使用情况,为临床合理使用麻醉药品提供参考。方法分别统计我院2009～2010年住院患者和门诊患者的麻醉药品的用药金额、用药剂量、用药天数、用药频率、日均费用、药物利用指数等,分析临床用药情况。结果2009～2010年我院麻醉药品在使用数量、消费金额及用药频度（DDDs）方面无明显变化;住院患者和门诊患者在使用麻醉药品方面存在明显差别;吗啡缓释片的用药频度在住院患者和门诊患者中均居前列,其药物利用指数（DUI）均〉1;吗啡控释片和羟考酮控释片（40mg）的药物利用指数只在住院患者中〉1。结论我院麻醉药品使用基本合理,但仍存在不合理现象,应进一步加强对麻醉药品使用的监督管理。     

Assessing the need for low secure care in Northern Ireland

Aims and method

To assess the need for the provision of low secure care in Northern Ireland. A survey of the providers of healthcare in Northern Ireland was conducted using a study tool based on Royal College of Psychiatrists Low Secure Network Standards admission criteria.

Results

A total of 105 patients were assessed as needing low secure care including 93 patients currently admitted to hospital in the region and 12 patients admitted to hospital outside of the region.

Clinical Implications

The results of this study are similar to previous estimates of need for the provision of low secure care in the UK. The results provide information likely to be of assistance in the commissioning of low secure services.

Declaration of Interest

NoneIt is self evident that what is needed in one part of a service will depend on the provision in other parts of the service. Mental Health Services in Northern Ireland have undergone substantial change in the past ten years through the implementation of the Bamford Review and Transforming Your Care.^{1, 2, 3} A significant consequence has been a change in the provision of inpatient care. A reduction in average available mental health beds by 35% over the past 5 years combined with high occupancy rates (90%) and a 19% reduced length of stay reflect a reduction in inpatient bed availability.⁴A regional network of forensic mental health services has been developing including the opening of the first medium secure unit, Shannon Clinic, in 2005, the development of community forensic mental health teams, and mental health services in prison.There are plans for the closure of long stay wards over the next few years.⁴ The Bamford Adult Implementation Group is chaired by commissioners and is tasked with planning the provision of low secure care. Low secure units provide rehabilitation for patients who need to be detained to hospital under mental health legislation. The criteria for detention to hospital are that the person suffers from a mental illness and failure to detain them would create a substantial risk of serious physical harm to self or others.The secure component of care consists of physical security, such as locked doors and fences, procedural security, such as control of various items coming into the ward, and relational security, which involves fostering therapeutic relationships through an in depth knowledge of the patient''s illness and behaviour. Low secure rehabilitation aims to reintegrate the patient back into society through multidisciplinary treatment of their illness and a reduction in the risk of harm that led to their detention.This survey aimed to assess the current need for the provision low secure services in the region. Unlike other parts of the UK, there is no private sector provision of secure mental healthcare in Northern Ireland.     

Medication Administration Discrepancies Persist Despite Electronic Ordering

Background

Up to 38% of inpatient medication errors occur at the administration stage. Although they reduce prescribing errors, computerized provider order entry (CPOE) systems do not prevent administration errors or timing discrepancies. This study determined the degree to which CPOE medication orders matched actual dose administration times.

Methods

At a 658-bed academic hospital with CPOE but lacking electronic medication administration charting, authors randomly selected adult patients with eligible medication orders from historical 1999–2003 CPOE log files. Retrospective manual chart audits compared expected (from CPOE) and actual timing of medication administrations. Outcomes included: dose omissions, median lag times between ordered and charted administrations, unauthorized doses, wrong dose errors, and the rate of nurses’ medication schedule shifting.

Results

Dose omissions occurred in 756 of 6019 (12.6%) audited administration opportunities; only 313 of the omissions (5.2% of opportunities) were unexplained. Wrong doses and unexpected doses occurred for 0.1% and 0.7% of opportunities, respectively. Median lag from expected first dose to actual charted administration time was 27 minutes (IQR 0-127). Nursing staff shifted from ordered to alternate administration schedules for 10.7% of regularly scheduled recurring medication orders. Chart review identified reasons for dose omissions, delays, and dose shifting.

Conclusion

Inpatient CPOE orders are legible and conveyed electronically to nurses and the pharmacy. Nonetheless, ward-based medication administrations do not consistently occur as ordered. Medication administration discrepancies are likely to persist even after implementing CPOE and bar-coded medication administration unless recommended interventions are made to address issues such as determining the true urgency of medication administration, avoiding overlapping duplicative medication orders, and developing a safe means for shifting dosing schedules.     

Randomized controlled trial of feedback on cost of hospital care among gastroenterology inpatients

Introduction

Spending on hospital inpatients comprises a major proportion of healthcare costs. This study assessed the impact of systematic feedback to gastroenterologists on the cost of care provided to inpatients on a gastrointestinal/hepatology (GIH) hospital service.

Methods

Patients with a GIH diagnosis were randomly assigned to be cared for by one of two hospital services. Over 3 months, teams were randomized to receive feedback (GIH A) or no feedback (GIH B, control group); feedback consisted of an email sent twice weekly to all physicians on the GIH A service detailing the length of stay (LOS) and real-time cost of care accrued by each inpatient.

Results

Over 3 months, care was provided to 56 (GIH A) and 47 (GIH B) inpatients with a GIH illness. Patient complexity level was similar for both services as demonstrated by mean relative value: 1.11 (GIH A) vs. 1.27 (GIH B), p = 0.2. Weighted LOS and weighted cost of care values were calculated to adjust for the respective RV of each patient. Mean weighted LOS (10.8 [GIH A] vs. 13.8 days/pt [GIH B], p = 0.02) and mean weighted cost of care (9,904 [GIH A] vs. 12,654 euros/pt [GIH B], p = 0.02) were significantly lower in the feedback group. Subsequent hospital readmission rates did not differ among both groups.

Conclusion

Systematic feedback on cost of care was associated with lower healthcare costs without compromising quality. Incorporating a running total of patient costs into computer software used to order patient tests may represent one approach to controlling healthcare expenses.     

湖南省直医保参保的恶性肿瘤住院患者自付费用现状及相关因素研究

目的：了解湖南省直城镇职工基本医疗保险参保恶性肿瘤住院患者的自付比例水平,分析其相关因素,以期为医保支付制度的完善提供信息。方法：采用随机分层抽样的方法抽取2011年1月至2014年12月有出院记录的参保恶性肿瘤患者10 527人次,在信息系统中收集一般社会人口学与费用等相关资料。计算自付比例与各部分费用的构成。采用多元线性回归分析自付比例的主要相关因素。结果：患者住院自付比例中位数为20.11%,在2011年至2014年保持平稳。患者住院自付比例主要相关因素包括年龄、是否公务员、是否退休、医院级别、住院费用、住院周数、药费构成比、一般医疗服务费构成比、治疗费构成比、检查化验费构成比及肿瘤类别。结论：恶性肿瘤住院患者的自付比例控制平稳,自付比例的差异能反映补偿政策的倾向,应以医院级别为主要着眼点进一步予以控制。     

Is Computerized Physician Order Entry Use Associated with a Decrease in Hospital Resource Utilization in Hospitals That Care for Children?

Despite large hospital costs for implementation and maintenance of Computerized Physician Order Entry (CPOE) for medication safety, little evidence exists to determine if predicted efficiency improvements translate into lower hospital resource utilization for inpatient pediatrics. The purpose of this study is to investigate the relationship between hospital CPOE use and resource utilization per case within children’s healthcare. The authors use a retrospective cross-sectional design with linear regression to assess relationships between hospital CPOE use and resource utilization per case. Despite large CPOE costs and financial barriers to adoption, we find that compared to those without CPOE, hospitals with CPOE did not have significantly lower cost per case. Because of the lack of evidence for financial benefit for CPOE use hospitals will likely need other motives to adopt CPOE. This emphasizes the importance of financial incentives for adoption of CPOE within children’s healthcare and represents important benchmark data for future comparison.     

山东省不同级别医院高血压患者住院费用及补偿分析

目的:山东省新农合政策实施后,分析高血压患者在不同级别医院住院费用及补偿情况,有针对性的提出改进措施。方法:选择山东省2005-2010年间3个县7,904名高血压患者住院病例为研究对象,对高血压患者在不同级别医院住院费用及补偿情况调查,并采用多元逐步回归模型对住院费用的影响因素进行分析。结果:高血压患者在县级医院住院费用呈负增长;县级医院和县级以上医院住院天数呈下降趋势;高血压患者在乡镇卫生院与县级医院自付费用差异逐年缩小;乡镇医院患者的实际补偿比例增长最多。结论:参合高血压患者在乡镇卫生院和县级医院住院费用和住院天数的差异逐渐缩小,新农合政策的实施逐步减轻了县级医院和乡镇卫生院高血压患者经济负担。     

3296例住院死亡患者死亡病因及死亡时间分析

目的:探讨我院十年来住院死亡病例的死因和死亡时间的规律,以及与年龄,性别的关系。方法:对3296例死亡患者进行统计学分析。结果:首位死因为恶性肿瘤,其次是消化系统疾病。前五种致死疾病男性均高于女性,死亡年龄高峰为60-69岁,各病种死亡高峰有明显的季节差异,死亡时间以农历朔,望期最多。结论:十年来,我院住院死亡患者前五位死因无变化,但有性别、年龄、时间差异。     

某医院2009年住院患者抗菌药物应用分析

[目的]对某医院2009年住院患者抗菌药物应用进行分析,为促进临床合理使用抗菌药物提供依据.[方法]随机抽取2009年住院患者病历2 080份,分析抗菌药物使用、病原学送检、联合应用、分级管理等情况.[结果l本院全年抗菌药物使用率为75.9％;病原学送检率为32.7％;非限制性应用率为77.1％;联用抗生素比例为28.0％.[结论]我院抗菌药物选择较合理,但使用率偏高.     

注射用泮托拉唑合理使用的影响因素分析

目的 探讨注射用泮托拉唑临床合理用药的影响因素。方法 采用简单随机抽样方法抽取蚌埠医学院第二附属医院住院患者2014年度至少使用一次注射用泮托拉唑的住院病历300例,分析其用药合理性,并对用药指征合理性的影响因素进行多因素logistic回归分析。结果 注射用泮托拉唑用药总不合理率为73.00%,logistic回归分析结果显示,合并使用皮质类固醇药物、禁食、内镜检查和用药指征不合理呈负相关,年龄段与用药指征不合理呈正相关（P<0.05）。结论 年龄段为注射用泮托拉唑用药指征合理性的独立危险因素,合并使用皮质类固醇药物、禁食和内镜检查为保护因素。     

急性心肌梗死病人住院费用分析

目的:本文通过探讨单病种病人住院费用的影响因素,以控制医疗费用的上涨.方法:以急性心肌梗死住院病人为例,对可能的影响因素进行统计分析.结果:影响急性心肌梗死病人住院费用的因素主要有性别、年龄、治疗方式.结论:针对不同的治疗方式,控制手术组病人的住院费用要从降低手术材料费用等入手;而非手术组病人的住院费用要以缩短住院时间,控制用药和合理用药为突破口,通过医疗保险制度的改革来解决.在以往的研究中,支付方式是一种主要的影响因素,但本文对急性心肌梗死病人的研究发现,不同支付方式的住院费用的差异无统计学意义.     

Evolution of an active psychogeriatric day hospital.

A geriatric day hospital was established as part of the psychogeriatric unit of the Royal Ottawa Hospital. While initially this day hospital was integrated with day hospital programs of other units, it became apparent that a separate facility was desirable. The activities and programs of the psychogeriatric day hospital, run by one registered nurse, were integrated with those of the geriatric inpatient unit. It was found to be advantageous for inpatients and day hospital patients to share the same physical facilities. The majority of day hospital patients came from the inpatient unit; almost all had affective disorders. The emphasis was on reintegration into the community. During the 1st year of operation there were 75 patients in the program; only 3 needed admission to the inpatient unit and 1 was readmitted after discharge.