I dagens samhälle är det vanligt att patienter söker vård hos olika vårdgivare, vilket resulterar i att vårdinformationen blir splittrad och allt högre krav ställs på de datoriserade journalsystemen. Till exempel ska de stödja ett processorienterat arbetssätt för att samla information från samma vårdprocess. Vårdinformationen måste därför vara tillgänglig över organisationsgränser och olika journalsystem måste kunna kommunicera med varandra, där en ökad tillgänglighet ställer högre krav på informationssäkerhet och behörighetskontroll. Journalsystemen bör, för att uppfylla dessa krav, utvecklas enligt standarder och riktlinjer. Det finns ett flertal nationella och internationella organisationer som arbetar med att ta fram standarder och riktlinjer för hur journalsystem bör utvecklas. Problemet är att dessa arbeten sker på olika nivåer och gäller olika delar av journalsystemen. Det är därmed en stor utmaning för journalleverantörer att förhålla sig till dessa arbeten. Syftet med det här examensarbetet har varit att utreda hur utvalda, svenska och europeiska, standardiseringsarbeten förhåller sig till varandra samt att avgöra på vilket sätt de är av relevans för journalleverantörer. Dessutom har syftet varit att framställa en prototyp av ett IT-stöd för processorienterad vårddokumentation. En kvalitativ litteraturstudie har i det här examensarbetet resulterat i en sammanställning av de utvalda standardiseringsarbetena. Arbetena hanterar främst områden som kan användas för att ena vårdprocessen, exempel på dessa är behörighetskontroll och standardiserad kommunikation med informationsspecifikationer eller arketyper. SAMBA har tagit fram en processmodell som beskriver vårdprocessen. Baserat på denna modell och krav från standardiseringsarbetena har vi framställt ett förslag på ett IT-stöd för processorienterad vårddokumentation.

Technology of today makes it possible to change the way traditional healthcare is conducted. As the population grows older, and the elderly is becoming an increasing part of the whole population, the need for cost efficient and personalised care increases. By implementing home healthcare IT projects, it is possible for more patients to be treated at home with sustained quality of care. This thesis documents the work of a master’s degree project carried out during the autumn of 2005. The project is part of a research project within the Department of Biomedical Engineering at Linköping University. The project aims at developing a data model for storing medical data. The model should be general and easy to expand. This model is intended to be used within a larger system allowing a patient to measure medical data from a remote location.

Today Image acquisition equipment produces huge amounts of data that needs to be processed. Often the data describes signals with a dimensionality higher then 2, as with ordinary images. This introduce a problem when it comes to process this high dimensional data since ordinary signal processing tools are no longer suitable. New faster and more efficient tools need to be developed to fully exploit the advantages with e. g. a 3D CT-scan. One such tool is filternets, a layered networklike structure, which the signal propagates through. A filternet has three fundamental advantages which will decrease the filtering time. The network structure allows complex filter to be decomposed into simpler ones, intermediate result may be reused and filters may be implemented with very few nonzero coefficients (sparse filters). The aim of this study has been to create an implementation for filternets and optimize it with respect to execution time. Specially the possibility to use filternets that approximates a harmonic filterset for estimating orientation in 3D signals is investigated. Tests show that this method is up to about 30 times faster than a full filterset consisting of dense filters. They also show a slightly larger error in the estimated orientation compared with the dense filters, this error should however not limit the usability of the method.

<p>I hälso- och sjukvården i Sverige används ett flertal medicintekniska apparater och IT-system. Ofta läser man av en skärm på den medicintekniska apparaten och noterar informationen på papper för att sedan manuellt mata in dessa uppgifter i IT-systemen. Detta manuella mellanled finns det önskemål och förhoppningar om att slippa. Man vill kunna överföra information automatiskt mellan den medicintekniska apparaten och IT-systemet, med andra ord vill man integrera dem. För att åstadkomma detta måste ett antal grund-läggande förutsättningar uppfyllas. Bland annat ställs vissa krav på tekniken hos den medicintekniska apparaten, kommunikationskanalen och IT-systemet. Dessutom är det nödvändigt att uppfylla gällande lagar och regler. Utöver detta finns det faktorer som kan underlätta, till exempel användandet av erkända standarder för kommunikationen. Syftet med detta examensarbete har varit att belysa och utreda dessa bakomliggande faktorer för att få integration av nyss beskrivet slag att fungera. Arbetet är en bakgrundsstudie på detta område.</p>

Thesis (Ph. D.)--University of Florida, 1993. / Typescript. Vita. Includes bibliographical references (leaves 150-158).

Despite considerable effort considerable cost in both time and money, as many as two out of three persons with type 1 diabetes are not in control of their disease. As a result, 40% of these individuals will go on to develop at least one serious complication including retinopathy, nephropathy, neuropathy and cardiomyopathy. It is further estimated that as much as $4 billion could be saved annually if all persons with type 1 diabetes in the US were properly controlled. Adequate treatment of type 1 diabetes is predicated on the estimation of three clinical insulin therapy parameters: the basal dose, the insulin sensitivity factor and the insulin-to-carbohydrate ratio. Currently, these therapy parameters are determined by iterative titration procedures based on expert opinion. Unfortunately, there is evidence suggesting that for the majority of individuals, these titration protocols do not provide good results. In this work we develop an alternative to traditional insulin titration protocols that allows clinical insulin therapy parameters to be estimated directly from a set of easily acquired measurements. First, a simple model of type 1 diabetes is used to derive a series of equations connecting the model's parameters to the clinically important insulin therapy parameters of insulin sensitivity factor, insulin-to-carbohydrate ratio and basal insulin dose. The simplifying assumptions used to derive these equations are tested and shown to be valid and the Fisher Information Matrix is used to demonstrate parameter identifiability. Parameter estimation is then performed on two cohorts of virtual subjects, as well as two segments of real continuous glucose monitoring data from a person with type 1 diabetes. Identification of the true insulin therapy parameters is successful under most conditions for both cohorts of virtual subjects. Parameter estimation for one of the two segments of real continuous glucose monitoring data is also successful. Finally, because continuous glucose monitors are instrumental to successful implementation of our insulin therapy framework, the physiological environment in which continuous glucose monitoring takes place is modeled and a fundamental limitation on measurement precision is shown to exist. An examination of physiological variability in the parameters indicates that many of the challenges observed in real world continuous glucose monitoring may have a relationship to changes in capillary bed perfusion. A rationale for anecdotally reported sensor faults is also proposed based on the physical mechanisms explored. / text

Study methods: Mixed-method study design was used to investigate feasibility of implementing a mobile-phone based behavioural intervention to reduce CVD risk factors among the Chinese population. Patients, who were 45-79 years old, fair English literacy, had access to a JAVA enabled mobile phone and had no mental health problems, cognitive impairment or severe illness, were eligible to the study. Intervention: Patients recruited from three settings (1 GP, 1 specialist and 1 public clinics) had the study software installed to their phone. The software enabled patients to access their CVD risk profiles (including weight, BP, HbA1c, and lipoprotein profile), 10-year CVD risk prediction (based on Framingham Cardiac Risk Score), and pre-set behavioural recommendations. Patients’ CVD risk profiles were updated at 1-month and 3-month follow-up when their test results were available. Patients were alerted with healthy behaviours recommendations. Outcomes: Outcomes were measured at baseline and 3-month follow-up. Clinical outcomes included Cardiac Risk Factor Score and its components (BMI, Systolic & Diastolic BP, total cholesterol, HDL and HbA1c). Two sets of questionnaires were used to measure knowledge, risk reduction behaviour and attitude toward usefulness of medical records (pre-intervention) and perceived ease of use, usefulness, satisfaction and utilisation of the software (post-intervention). Results and Discussion: 19 patients were recruited at baseline. 75% (14) aged 45-55 years, 58% (11) were male, 79% (15) had secondary or lower education, 63% (12) were married, and 95% (18) never smoked. Patients’ understanding about CVD risk factors and risk reduction behaviour was moderate. Patients’ attitude toward electronic medical record was positive. Overall patients’ perception of usefulness, ease of use and satisfaction with the software was satisfactory. Post-intervention, a decreasing trend was observed in patients’ CVD risk profiles i.e. weight, BMI, SBP&DBP, HbA1c and Lipoprotein profile. Focus group discussions revealed that there was a mismatch between physicians and patients perspectives about the use of mobile phone in a behavioural intervention. Physicians tended to express their concern about the quality of records, security of technology, and patients’ actual benefit, while patients showed little concern about security and great excitement about further use of mobile phone technology in assisting their disease self-management. The public sector physicians admitted that their patients were passive in term of seeking information about their health. Patients were willing to use this software for future care if it could provide more real-time data, tailored recommendations for behavioural change, and an interactive communication tool with their physicians. Physicians would like to try the software if it could ease patient-management process, especially enhance patient-physician communication, and be a decision support system to help them keep track with changes that their patients made. Conclusion: This pilot study has provided preliminary evidence of the feasibility, acceptability, and utility of an e-platform in primary interventions for CVD in Hong Kong. / published_or_final_version / Community Medicine / Master / Master of Philosophy

Medical imaging informatics is one of the important research areas in radiology that studies how information available on medical images is retrieved, analyzed, and enhanced. Recent development in medical imaging informatics has resulted in improvement of diagnostic accuracy based on imaging examinations, as well as efficiency in clinical workflow. Computer aided diagnosis (CAD) and electronic patient record system (ePR) are both topics in medical imaging informatics that have matured from research concepts into commercially available computerized systems in clinical environment. The current challenges are to further broaden their scope of applications. In this thesis project, I developed a CAD system for interpreting PET/CT examinations and an ePR system for patient data integration in neurosurgery suites. Specifically, the CAD system in this project was designed to automatically diagnose nasopharyngeal carcinoma (NPC) on Positron emission tomography/computed tomography (PET/CT) examinations, which aimed to detect and classify both the primary NPC and its nodal metastasis. The regions of interests (ROIs) were segmented from the PET images and registered onto the CT in order to combine the imaging features from both modalities and the a priori anatomical knowledge of the suspicious lesion. These combined features were then classified by a support vector machine (SVM) to generate the final diagnosis result. The system was validated with 25 PET/CT examinations from 10 patients suffering from NPC, and the result produced by the system was compared to the gold standard of lesions manually contoured by experienced radiologists. The results confirmed that the system successfully distinguished all 53 genuine lesions from the mimickers due to normal physiological uptake and artifacts that also produced potentially confusing signals. The second part of the project involved development of an electronic patient record system (ePR) that integrated all the myriad of images and different types of clinical information before, during, and after neurosurgery operations, in order to enhance efficiency of work flow in this unique clinical environment. The system comprises of pre-, intra-, and post-operation modules which correspond to the different stages of the neurosurgery. The pre-op module was developed to store and categorize all images and data before the procedure to assist the surgeons in planning operation. The intra-op module integrates all the input signals, waveforms, images and videos that are produced by different imaging and physiological monitoring devices in the operation room during the surgery, and displays all the relevant information in a single large screen in real time to ease monitoring of the procedure. The post-op module helps surgeons to review all the data acquired from all the prior stages for follow-up of the treatment outcome. One-tumor case was utilized to test the pre-op module, and the signals and waveforms simulators were used to evaluate the performance of the intra-op module. In summary, two different medical informatics systems, a CAD and an ePR system were developed. Both showed promising results in laboratory tests. Future work would involve performance enhancement and feedback of the systems, and ultimately evaluation of these systems in the clinical environment. / published_or_final_version / Diagnostic Radiology / Master / Master of Philosophy

M. Tech. Business Information Systems / The acceptance of E-health in South African Hospitals and other developing countries is slow and confusing. Healthcare professionals must be fully engaged in the E-health decision making since they are the main users of E-health systems. It is important to note that using E-health to support the daily work of healthcare professionals can improve healthcare provision and so improve citizens' health. However, investing in affordable E-health applications that can help in realising the benefits of technology and minimizing health costs is not easy. Literature shows that much as there are several studies that have been conducted in respect of technology acceptance, adoption and use, little attention has been given to E-health acceptance in South Africa. Therefore, this study sought to design a model for E-health acceptance for South African hospitals.

M. Tech. Business Information Systems / The purpose of the study was to develop a framework that could be used to assess e-health readiness for rural South Africa. Data for the study was collected from Moses Kotane Municipality in the North West Province of South Africa. One state hospital and ten clinics were used for data collection. From related literature, six constructs of; core readiness, structural readiness, engagement readiness, societal readiness, performance and effort expectance were used as pillars for e-health readiness assessment. The attributes that were identified in the literature were validated by healthcare administrators at the regional office of the Northwest province.