Ebook: Advances in Information Technology and Communication in Health

In March 1986, a Canadian colloquium with an international flavor was convened to discuss the impact of information technology on community health. It was sponsored by the School of Health Information Science at the University of Victoria and the British Columbia Ministry of Health. Notable speakers were Salah Mandil, the Director of Information Systems Service at the World Health Organization, and Stan Dubas, the Deputy Minister of Health for British Columbia. This small, successful gathering was the predecessor of the Information Technology in Community Health (ITCH) conferences that followed in 1987, 1988, 1990, 1992, 1994, 1996, 1998 and 2000.

In 2007, after a brief hiatus, the conference was held again but this time it had expanded its scope. It was known as Information Technology and Communications in Health (ITCH) 2007; with the same acronym but with a different meaning as demanded by its international appeal and wider choice of subject areas. The conference in 2007 was an unmatched success and now, as 2009 approaches, we prepare for an even more eventful convention, which encourages experts to demonstrate and share their experiences and knowledge. The theme for the ITCH 2009 conference is “Revolutionizing Health Care with Informatics: From Research to Practice.”

The Organizing Committee feels honoured to promote this event and, thereby, to contribute to the advancement of informatics in health and health care. Many people have volunteered their time and financial sponsorship; we sincerely thank them. We wish, however, to give specific recognition to those who are serving on the Steering Committee and the Scientific Program Committee.

James G. McDaniel, Editor

School of Health Information Science

University of Victoria,

Victoria, British Columbia, Canada

December 15, 2008

This paper presents a novel method for the detection of the fovea center in color fundus images. The method was evaluated using a set of 89 images from the DIARETDB1 project, which contains images presenting normal and pathological situations. Using the Mean Absolute Distance (MAD) as a metric, we report 7.37±8.89 (mean ± standard deviation) detection performance for the fovea center which represents an improvement in comparison to other state-of-the-art methods in the literature.

Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory – Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

Anemia is a common disease affecting about 3.5 million people in the United States. In present day clinical practice, a clinician makes a diagnosis of anemia based on low hemoglobin levels discovered during a complete blood count (CBC) test. If the etiology of the anemia is not readily apparent, the clinician orders additional testing to discover the cause of the anemia. Which tests are ordered, in what order these tests are run, and how the information gathered from the tests is used is based primarily on the individual physician's knowledge and expertise. Using this system to determine the cause of anemia is not only labor and resource intensive but it carries a potential for morbidity and an occasional mortality. Utilizing previously published data, we created an algorithmic approach to analyze the cause of anemia in the majority of cases. The algorithm accepts as input three parameters from a CBC test: (1) mean corpuscular volume, (2) red cell distribution width, and (3) reticulocyte count. With these three parameters, the algorithm generates a probable etiology of the anemia. Additionally, the algorithm will automatically order reflex tests needed to confirm the diagnosis. These reflex tests can be modified depending on the policies of the institution using the algorithm, as different institutions may order different tests based on availability and costs. This is a simple algorithm that could be integrated into the CBC test output. When a low hemoglobin level is found, the algorithm suggests the probable etiology and orders reflex tests if they are desired. Such an approach would not only provide cost efficiency and time savings but would also elevate the level of every clinician ordering a CBC to that of an expert hematologist.

We present the case of an ambulatory clinic in which an operational review was conducted to identify opportunities for efficiency in appointment scheduling and capacity allocation. We required process data to compare that which was planned to that which actually happened and to develop advanced analytical models. Similar to other health care studies, these data proved to be limited or non-existent. Consequently we had to conduct a time-consuming collection of operational metrics. We make recommendations for the perpetual collection of process data for modeling and simulation.

Operations research (OR) is playing an increasing role in the support of many health care initiatives. However one of the main challenges facing OR practitioners is the availability and the integrity of operations data. Hospital information systems (HIS) are often designed with a clinical or accounting focus and may lack the data necessary for operational studies. In this paper, we illustrate the data processing methods and data challenges faced by our team during a study of surgical scheduling practices at the Vancouver Island Health Authority. We also provide some general recommendations to improve HIS from an operations perspective. In general, more integration between operations researchers and HIS specialists are required to support ongoing operational improvements in the health care sector.

Adverse Drug Events (ADE) due to medication errors and human factors are a major public health issue. They endanger patient safety and cause considerable extra healthcare costs. The European project PSIP (Patient Safety through Intelligent Procedures in medication) aims to identify and prevent ADE. Data mining of the structured hospital data bases will give a list of observed ADE with frequencies and probabilities, thereby giving a better understanding of potential risks. The main objective of the project is to develop innovative knowledge based on the mining results and to deliver to professionals and patients, in the form of alerts and decision support functions, a contextualized knowledge fitting the local risk parameters.

Providing knowledge at the point of care offers the possibility for reducing error and improving patient outcomes. However, the vast majority of the physician's information needs are not met in a timely fashion. The research presented in this paper characterizes an expert librarian's search strategies as it pertains to the selection and use of various electronic information resources. The 10 searches conducted by the librarian to address the physician's information needs varied in terms of complexity and question type. The librarian employed a total of 10 resources and used as many as 7 in a single search. The longer term objective is to model the sequential process in sufficient detail as to be able to contribute to the development of intelligent automated search agents.

One key to revolutionizing health care with informatics is the ability of decision-makers to access and analyze relevant data in a timely and efficient manner. Inspired by the demand for timely access to hospitalization data in Canada, CIHI Portal is an innovative web-based analytical tool which combines leading technology and data for decision support analysis. Hospitals, regional health authorities and ministries of health can use CIHI Portal to access comparable, pan-Canadian healthcare data for health data analysis, collaboration and dissemination. The goal of CIHI Portal is to support health care decision-makers in their local and regional health care planning and to answer service delivery questions.

The Capital Health region in Alberta used Resource Intensity Weights (RIW) to investigate claims that patients within their region were getting sicker over the past few years and that additional resources would be required in the future. Using the CIHI Portal, Capital Health conducted an analysis on historical trends in the average RIWs

Average Resource Intensity Weight is calculated as the total Resource Intensity Weight (RIW) divided by the total number of inpatient separations.

Use of Electronic Health Record (EHR) systems is increasing globally. However, adoption rates of Health Information Systems (HISs) continue to remain poor. To improve adoption rates, there is need to provide greater HIS experience to health professionals and informaticians in health and biomedicine during their undergraduate and graduate education. A recent review of the health professional educational curricula (i.e., medicine, nursing, allied health and health/biomedical informatics) revealed that they provide only limited exposure to EHRs. In response to this educational need, the authors have developed the University of Victoria Interdisciplinary Electronic Health Record Educational Portal (UVicIED-EHR Portal). This unique, web-based portal allows students of the health professions and practicing professionals to access and interact with a set of representative EHR HIS solutions using the web. The portal, which links to several EMRs, EPRs and PHRs, has been used by several health professional educational programs in medicine, nursing and health informatics. It provides practicing health and health/biomedical informatics professionals, for example, managers and directors, with opportunities to access and review EHR systems. The portal has been used successfully in the classroom, laboratory and with distance education to give hands-on experience with a variety of HISs and their components.

At the University of Technology, Sydney (UTS), Australia, a pilot study was conducted to introduce and integrate mobile point-of-care technologies into the clinical laboratory experiences of students in the Bachelor of Midwifery program. The pilot study was a collaborative project between Intel Healthcare and the Faculty of Nursing Midwifery and Health at UTS and was conducted using Intel's mobile clinical assistants (MCA). Through role playing, students were exposed to a number of case scenarios drawn from authentic midwifery practice. The MCA was used to gain information such as test results, clinical practice protocols, and best evidence guidelines. The students were expected to discuss the information with the woman. Following the activity, students completed an online survey to identify the impact of the MCA on the role-playing situations. They also participated in a focus group where they could discuss the use of the point-of-care technology in relation to preparation for practice. Results from these evaluations indicated that the students were positive about using the MCA in simulation sessions and they also considered that this technology would be helpful in their practice. It is hoped that the use of such point-of-care technology will be integrated across the Faculty's pre-registration midwifery and nursing programs to provide students with access to the most recent information technology innovations in health care.

It is generally accepted that Information Technology (IT) is a highly desirable and a very necessary ingredient of modern health care. Review of available literature reveals a paucity of medical informatics and information technology courses in undergraduate medical curricula and a lack of research to assess the effectiveness of medical informatics in undergraduate medical education. The need for such initiatives is discussed and a pilot project is described that evaluated the effectiveness of education in the use of Electronic Medical Record (EMR) applications. Educational activities, for example, could be medical students conducting virtual medical encounters or interacting with EMR applications. An EMR application, which was used in several related projects, has been adapted to the educational environment: standardized patient records can be created and cloned so that individual students can interact with a “standard” patient and alter the patient's data.

This paper describes the Engineering 4 Health (E4H) Challenge, an interdisciplinary and intercultural initiative that, on the one hand, seeks to improve health education of children in under-serviced communities and, on the other, seeks to attract students in British Columbia to professions in engineering and health. The E4H Challenge engages high school and university students in BC to cooperatively design and develop health information and communication technology (ICT) to educate children living in under-serviced communities. The E4H Challenge works with the One Laptop Per Child (OLPC) program to integrate applications for health awareness into the school programs of communities in developing countries. Although applications developed by the E4H Challenge use the low-cost, innovative XO laptop (the “$100 laptop” developed by the OLPC foundation) the software can also be used with other inexpensive hardware.

We describe an innovative educational program that provides an easily-accessible introduction to Applied Health Informatics (AHI) in an effort to attract new trainees to this discipline. We call this program the AHI Bootcamp. It includes an intense, interactive, but brief on-site program, with the majority of its content delivered in approximately 80 hours of on-line presentations. The AHI Bootcamp introduces individuals, who have a broad spectrum of backgrounds but little or no knowledge of Health Informatics (HI), to the nature, concepts, methods, tools and applications of HI to address information-based challenges in health maintenance and health care delivery. AHI is the discipline that is concerned with the planning, procurement, deployment, implementation, management, effective use, and evaluation of informatics solutions in the health space. This program targets the high profile areas of AHI, orienting participants to the pursuit of broader and deeper explorations in the field.

The information management system of Department of Critical Care Medicine in Calgary Health Region was modeled using a departmental information management framework. The clinical, administrative, research and educational, decision-making and quality improvement information needs of the department are served by the system.

There is an increasing requirement for interdisciplinary teams to share patient data to ensure optimal care. Healthcare providers in all settings from Emergency Medicine to long-term care management need access to patient information. In the UK, developments to address the need for information sharing have uncovered issues that the Canadian eHealth establishment would do well to heed when undertaking its own initiatives.

In this paper technical and architectural issues are described in deploying electronic health records (EHRs) over the WWW. The project described involved deployment of EHRs that have been designed to serve in the education of health professionals and health/biomedical informaticians. In order to allow for ubiquitous access to a range of EHRs remotely an architecture was designed with three layers: (a) the “Internet” or remote user access layer (2) the “Perimeter Network”, or middle firewall security and authentication layer (3) the “HINF EHR Network”, consisting of the internal servers hosting EHR applications and databases. The approaches allow for a large number of remote users running a range of operating systems to access the educational EHRs from any location remotely. Virtual machine (VM) technology is employed to allow multiple versions and platforms of operating systems to be installed side-by-side on a single server. Security, technical and budgetary considerations are described as well as past and current applications of the architecture for a number of projects for the education of health professionals in the area of electronic health records.

The electronic Child Health Network (eCHN) is an advanced implementation of an electronic health record (EHR). This is a case study of the building of an integrated and shared EHR from multiple systems at multiple sites for the benefit of patients and clinicians. Optimal patient care requires that information about a person's overall health and interactions with the health care system be available to the appropriate providers when and where it is needed. eCHN is a pioneering response to the need for such shared records. A key to its success is that it is a flexible, scalable, open, multi-vendor solution designed to work with existing hospital systems and other networks. As Canada's largest functioning integrated EHR, eCHN is serving three million people and transforming the quality of health record keeping and clinical decision-making. eCHN enables health care providers across Ontario to share accurate patient data – in real time.

This paper utilizes three frameworks described in the literature to better understand the reasons why Canada lags other OECD countries in EMR implementation. First, we use an EMR policy framework to evaluate three provincial EMR implementation programs across Canada. Second, we use an EMR implementation multi-theoretical framework that is predictive of EMR success to evaluate those same programs. Finally, we use a cost-benefit framework developed in the USA to compare the cost-benefits of EMR implementations in Canada compared to those in the USA. We draw conclusions and make recommendations based on our findings.

The increasing use of clinical decision support systems (CDSS) to assist clinicians in decision-making is pushing the limits of information technology. The emergence of Electronic Health Records (EHR) coupled with enriched health information standards such as HL7 CDA, SNOMED, ICD-10 and LOINC have provided a rich environment for massive data collection and analysis by healthcare providers. This immense increase in data collection has also provided a gateway for the application of various data mining techniques on clinical datasets so as to measure health status (i.e. function, comfort and likelihood of dying) of patients. In measuring health status, many clinicians have opted to use CDSS to assist in decision-making and enhance clinical experience. However, even as the use of CDSS in clinicians' office continues to grow, the question that remains in the minds of many patients and the general public is whether it is appropriate, or ethical, for researchers to use health data collected for the purpose of direct patient care to develop computerized predictive decision support tool. In this paper, a systematic review is used to highlight the relevant technical barriers and ethical issues surrounding the secondary use of health data in developing CDSS.

A national health information management/information technology (IM/IT) strategy is crucially important for a country in planning and implementing healthcare priorities. However, little comparative research has been performed in this area, especially in Asian countries. This paper reviews, assesses and compares the healthcare systems, as well as the national health IM/IT initiatives and strategies in Hong Kong, Taiwan and Singapore. Although the proportion of public and private health services, IT infrastructure development, and government involvement in these three jurisdictions are different, they experience similar challenges with limited resources. By outlining the approaches being taken in the three Asian jurisdictions, this paper provides comparison, evaluation and insights that may be useful to other jurisdictions.