Indiana University-Purdue University Indianapolis (IUPUI) / Clinical Decision Support is one of the only aspects of health information technology that has demonstrated decreased costs and increased quality in healthcare delivery, yet it is extremely expensive and time-consuming to create, maintain, and localize. Consequently, a majority of health care systems do not utilize it, and even when it is available it is frequently incorrect. Therefore it is important to look beyond traditional guideline-based decision support to more readily available resources in order to bring this technology into widespread use. This study proposes that the wisdom of physicians within a practice is a rich, untapped knowledge source that can be harnessed for this purpose. I hypothesize and demonstrate that this wisdom is reflected by order entry data well enough to partially reconstruct the knowledge behind treatment decisions. Automated reconstruction of such knowledge is used to produce dynamic, situation-specific treatment suggestions, in a similar vein to Amazon.com shopping recommendations. This approach is appealing because: it is local (so it reflects local standards); it fits into workflow more readily than the traditional local-wisdom approach (viz. the curbside consult); and, it is free (the data are already being captured). This work develops several new machine-learning algorithms and novel applications of existing algorithms, focusing on an approach called Bayesian network structure learning. I develop: an approach to produce dynamic, rank-ordered situation-specific treatment menus from treatment data; statistical machinery to evaluate their accuracy using retrospective simulation; a novel algorithm which is an order of magnitude faster than existing algorithms; a principled approach to choosing smaller, more optimal, domain-specific subsystems; and a new method to discover temporal relationships in the data. The result is a comprehensive approach for extracting knowledge from order-entry data to produce situation-specific treatment menus, which is applied to order-entry data at Wishard Hospital in Indianapolis. Retrospective simulations find that, in a large variety of clinical situations, a short menu will contain the clinicians' desired next actions. A prospective survey additionally finds that such menus aid physicians in writing order sets (in completeness and speed). This study demonstrates that clinical knowledge can be successfully extracted from treatment data for decision support.

En la actualidad, la medicina no puede entenderse sin el apoyo de la tecnología. Las nuevas tecnologías forman parte del día a día de los profesionales de la salud y, cada vez más, de los usuarios de servicios médicos. Los avances en las tecnologías de la información y la comunicación (TICS) permiten una mayor interacción del personal médico con sus pacientes. El término e-Health se refiere a la aplicación de las TICS en el sector sanitario. Éstas permiten un fácil acceso a la información sobre salud, la posibilidad de interaccionar con otros pacientes y formar grupos de apoyo, la comunicación con profesionales de la salud y la utilización como herramienta en el seguimiento de patologías crónicas. El cáncer de mama es el tumor maligno femenino más frecuente. En España, una de cada ocho mujeres padecerá cáncer de mama en algún momento de su vida. Además, es una de las enfermedades más mediáticas y conocidas, con campañas de difusión sobre la prevención y el tratamiento del cáncer de mama en los distintos medios de comunicación. Todo esto lo convierte en un problema socio-sanitario importante. La fase diagnóstica de una lesión mamaria puede llegar a durar varias semanas, lo que influye en el bienestar psicológico de las mujeres que esperan el resultado definitivo de sus pruebas. La falta de información sobre los distintos pasos a seguir y el motivo de realización de los mismos aumentan la ansiedad en las pacientes, que tratan de indagar sobre su enfermedad por otros medios, siendo Internet la herramienta más utilizada en los últimos años. El objetivo principal de nuestro estudio es comprobar si la información y el seguimiento conjunto durante el proceso diagnóstico disminuye el nivel de ansiedad en mujeres con una lesión mamaria sospechosa. Para ello hemos creado una aplicación web con acceso personalizado, donde se dará información detallada de la patología de la paciente y de los distintos procesos diagnósticos que precisa cada una de forma individual. Como base del proyecto hemos desarrollado un proceso utilizando Bussines Process Management Notation (BPMN) con la aplicación BonitaBPM Community, que describe todas las fases del diagnóstico de una lesión mamaria y las distintas intervenciones de las partes implicadas para que la información se integre de manera eficaz a través de la web específicamente diseñada para nuestro proyecto. Diseñamos una aplicación web Isencilla, llamada “BreasTrack”, con acceso identificado personal, bilingüe (español/inglés), que incluye información general sobre patología mamaria, así como la información específica del proceso diagnóstico individual de cada paciente. Debido a una serie de problemas técnicos y de mantenimiento, finalmente utilizamos para este estudio una versión adaptada de “BreasTrack” a través de la plataforma MOODLE. La población elegida para la investigación son mujeres pertenecientes al Hospital de Torrevieja que presenten una lesión mamaria sospechosa que precisa la realización de una biopsia para su confirmación diagnóstica. Dividimos a las mujeres en dos grupos: un grupo control, que sólo debe completar el test de ansiedad de Spielberg (STAI) al inicio y al final del proceso diagnóstico, y un grupo de estudio, que además realizará el seguimiento de su proceso a través de la web. En una primera fase del estudio, analizamos y comparamos los niveles de ansiedad de cada grupo y las características socio-demográficas de las pacientes que presentan mayor nivel de ansiedad y en qué momento del proceso diagnóstico es más elevada. Por otra parte, evaluamos la usabilidad de nuestra aplicación web, tanto desde el punto de vista de las usuarias como de otros profesionales de la salud. Presentamos los resultados de una prueba de concepto con 29 participantes, 14 en el grupo web y 15 en el grupo control. La edad media de las pacientes fue de 59 años (36-75). La duración de la fase diagnóstica fue de 15,4 días (7-34). En global, todas las mujeres presentan un elevado nivel de ansiedad al inicio del proceso diagnóstico (72,17±4,34), que llega casi a normalizarse en el test final (56,24±4,34). No hay diferencias significativas entre el grupo web y el control, aunque el descenso en el nivel de ansiedad final es más importante en las mujeres que utilizaron la web, de un 78,57±6,25 en el test inicial hasta un 58,57±6,25 en el STAI final. Las participantes que presentaron el mayor nivel de ansiedad inicial en función de los factores socio-demográficos estudiados fueron: las mujeres menores de 45 años (92,16±9,55), las españolas por encima del resto de europeas (79,08±6,75), las viudas (93,5±16,53) y las separadas (74,66±13,5), las mujeres sin estudios (93,5±16,53), las mujeres con hijos (74,65±4,87) y las que practican algún deporte o técnica de relajación (74,2±5,23). Pocas diferencias en relación con el apoyo social o los antecedentes de cáncer de mama. En cuanto al tipo de tumor diagnosticado, las mujeres más ansiosas fueron el grupo de resultado benigno, pero de potencial maligno incierto, tanto al inicio (82±10,46) como al final del período diagnóstico (74,2±10,46). Entre las mujeres que utilizaron la web, la disminución de la ansiedad al final del proceso fue más evidente en mujeres de edad media (52,38±8,27), europeas (55,28±8,84), mujeres con estudios superiores (44±11,69), casadas (58,55±7,79), con apoyo social (52,28±6,75), sin antecedentes oncológicos (51±8,84) y las que practican deporte o técnicas de relajación (49,63±7,05). En comparación con el grupo control, no hubo grandes diferencias en ninguno de los factores estudiados, ya que en este grupo el nivel de ansiedad final también se mantiene o disminuye en muchos de los subgrupos, aunque en menor medida que en el grupo web. A pesar de estos resultados, la mayoría de las mujeres consideraron la web muy útil (57,14%) o útil (21,43%) durante la fase diagnóstica de una lesión mamaria. La valoración de la usabilidad por parte de profesionales de la salud concluye que “BreasTrack” es una aplicación w página web sencilla, intuitiva y útil, que cubre las necesidades del usuario. La adaptación en MOODLE no fue considerada tan fácil de utilizar al principio ni tan intuitiva, aunque si útil para las pacientes. Desde un punto de vista técnico se consultó con ingenieros aspectos sobre el desarrollo y el mantenimiento de la aplicación, concluyendo que el desarrollo de la aplicación web era más complejo que la adaptación (incluida la instalación) del MOODLE igual que su mantenimiento. En conclusión, “BreasTrack” es una herramienta web que ayuda a reducir el elevado nivel de ansiedad que presentan las mujeres durante la fase diagnóstica de una lesión mamaria sospechosa, independientemente de los factores socio-demográficos analizados en esta tesis. Es una web usable, útil y cubre las expectativas para las que fue diseñada. La implementación de la web original en un estudio con un mayor número de participantes permitirá una valoración más real del impacto de las TICS en la salud psicológica de nuestras pacientes.

Medical records are rapidly being digitized to electronic medical records. Although Electronic Medical Records (EMRs) improve administration, billing, and logistics, an open research problem remains as to how doctors can leverage EMRs to enhance patient care. This thesis describes a system that analyzes a patient's evolving EMR in context with available biomedical knowledge and the accumulated experience recorded in various text sources including the EMRs of other patients. The aim of the Clinician Decision Support (CDS) Dashboard is to provide interactive, automated, actionable EMR text-mining tools that help improve both the patient and clinical care staff experience. The CDS Dashboard, in a secure network, helps physicians find de-identified electronic medical records similar to their patient's medical record thereby aiding them in diagnosis, treatment, prognosis and outcomes. It is of particular value in cases involving complex disorders, and also allows physicians to explore relevant medical literature, recent research findings, clinical trials and medical cases. A pilot study done with medical students at the Virginia Tech Carilion School of Medicine and Research Institute (VTC) showed that 89% of them found the CDS Dashboard to be useful in aiding patient care for doctors and 81% of them found it useful for aiding medical students pedagogically. Additionally, over 81% of the medical students found the tool user friendly. The CDS Dashboard is constructed using a multidisciplinary approach including: computer science, medicine, biomedical research, and human-machine interfacing. Our multidisciplinary approach combined with the high usability scores obtained from VTC indicated the CDS Dashboard has a high potential value to clinicians and medical students. / Master of Science

The purpose of this project was to develop a document imaging application. By scanning the documents into an electronic repository, medical staff will be able to more easily store and locate these records. To make the application user friendly and facilitate staff access to patient medical records, the application is wed-based and uses the Oracle Application Server to implement a multitiered model.

Research report submitted to the School of Economic and Business Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Commerce (Information Systems) by coursework and research, 2 November 2017 / Mobile health applications are fast becoming an influential source of information for pregnant women. Studies have shown that pregnant women download 3 such apps on average on their cellphones. These mobile technologies have been shown to help women monitor their progress during their pregnancy and personalise healthcare to suit their needs. To date, llimited research has been directed towards understanding usage behaviours with these apps. Various authors have argued that there is a need to expand the scope of research from simple usage behaviour to deeper levels as technology becomes more sophisticated and easily available. M-health technologies are increasingly becoming more varied and sophisticated and as such this study aims to explore post-adoption usage specifically of mobile health pregnancy applications in the South African context. This study specifically looked at post adoption usage behaviours and used Hsieh and Zmud’s (2006) framework as a basis of understanding these behaviours. The potential influences on these behaviours were sourced from various studies done on pregnant women usage of ICT in general. These influences were then investigated to see whether they were relevant in the context of m-health pregnancy support applications. The primary method of data collection was open ended semi structured interviews with twelve pregnant women. Data analysis was done using the iterative model for qualitative data analysis proposed by Miles and Huberman (1994). The findings revealed that pregnant women displayed post adoption usage behaviours of routine use and IS continuance. With regards to the infusion stage, the study found that pregnant women engaged in the first set of post adoption usage behaviours i.e. extended usage and deep usage. They did not engage in second stage behaviours namely emergent use, feature extension or intention to explore behaviours. The influences identified in the literature were found to be relevant in the context of m-health applications and additional influences such as cost of seeing gynaecologist, number of features on the app and social structures were found to have an influence on usage of the apps. This study provides unique insights into the views of pregnant women’s experiences with m-health apps. Specifically, by using interpretive research it uncovers the subjective meanings around post adoption usage behaviours, understanding how pregnant women engage in these behaviours and subsequently how these behaviours are sustained during their pregnancy. The study recognises m-health pregnancy support apps as important tools in the pregnancy journey. It highlights how pregnant women value these apps and view them as huge information sources, reassurance and comfort during their pregnancy. It is argued that medical professionals cannot distance themselves away from these apps and need to work in conjunction with them to provide robust maternity care to their patients. 5 Theoretically, this study adds to our understanding of post adoption usage behaviours specifically in the context of m-health pregnancy apps. Limited studies have been done in this field specifically in the South African context and the study provides a foundation for further research. Further research can be done to understand how these apps are changing the relationship between pregnant women and medical professionals and furthermore, whether the information received from these apps is reliable and credible. / GR2018

A Dissertation in fulfillment of the requirements for the Degree of Master of Commerce by Research in Information Systems / Electronic Medical Records (EMR) systems aim to provide an integrated solution to a number of hospital processes, including supporting administrative functions such as patient billing, providing clinical guidelines, and allowing clinicians to order and view lab reports. Yet with all these possible benefits, like many other types of information systems and technologies, their impact on hospital performance has been a key area of interest and a source of debate. This study examines the extent to which EMR systems are available across South African hospitals as well as how well they have been integrated into the processes of the said hospitals. The diffusion of EMR systems means they are available in the relevant clinical units whilst their infusion suggests they are comprehensively embedded into the processes that they are meant to support. The most important question answered in this study was whether the diffusion and infusion of these systems had any impact on the performance of hospitals. Answering this question would aid decision makers on whether more effort is indeed needed to ensure their availability across units and their embedding into hospital processes. The study collected data from a number of hospitals in the private and public sector with multiple informants providing data on diffusion and infusion of these systems as well as on hospital performance. Performance measures included the hospitals’ economic efficiency, their clinical effectiveness, patient safety, and patient satisfaction. Key findings were that while there are performance benefits in the diffusion of EMR systems across units, the impacts are not always positive for some hospitals. Large hospitals were less likely to benefit from the diffusion of these systems. However the comprehensive use of these systems provided benefits for all types of hospitals, suggesting that while availability may be important, it is the comprehensive embedding of the EMR system into the hospital’s processes that is more beneficial to all types of hospitals. These results present further opportunity for research into why the impact of EMR systems is not always positive for some hospitals. / MT2017

In order to improve the quality of care, there is urgent need to involve patients in their own healthcare. So to make patient centered health care system Personal Health Records are proposed as viable solution. This research discusses the importance of a Patient Centric Health Record system. Such systems can empower patients to participate in improving health care quality. It would also provide an economically viable solution to the need for better healthcare without escalating costs by avoiding duplication. The proposed system is Web-based; therefore it has high accessibility and availability. The cloud computing based architecture is used which will allow consumers to address the challenge of sharing medical data. PHR would provide a complete and accurate summary of the health and medical history of an individual by gathering data from many sources. This would make information accessible online to anyone who has the necessary electronic credentials to view the information. / by Vishesh Ved. / Thesis (M.S.C.S.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

Mining the human genome for therapeutic target(s) discovery promises novel outcome. Over half of the proteins in the human genome however, remain uncharacterized. These proteins offer a potential for new target(s) discovery for diverse diseases. Additional targets for cancer diagnosis and therapy are urgently needed to help move away from the cytotoxic era to a targeted therapy approach. Bioinformatics and proteomics approaches can be used to characterize novel sequences in the genome database to infer putative function. The hypothesis that the amino acid motifs and proteins domains of the uncharacterized proteins can be used as a starting point to predict putative function of these proteins provided the framework for the research discussed in this dissertation. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

O presente estudo consiste em descrever e analisar a evolução da Telemedicina no Brasil, abrangendo as experiências efetivamente implantadas até dezembro de 2000. Várias instituições no país têm adotado programas de telemedicina, tais como hospitais, laboratórios de análises clínicas, clínicas especializadas em realização de eletrocardiogramas à distância, universidades, o Exército e o próprio Governo. Cada uma das experiências tem diferentes objetivos e não há nenhuma integração entre elas. As aplicações estudadas variam desde aquelas que requerem uma estrutura tecnológica simples como a realização de eletrocardiogramas à distância, até outras mais sofisticadas tecnologicamente como a realização de teleconferências com transmissão de imagens clínicas para segunda opinião médica e monitoração remota de leitos. Para a realização do estudo foram feitas entrevistas com os responsáveis pelos programas e um levantamento de dados em publicações especializadas. As conclusões apontam para a falta de coordenação entre os modelos adotados, para a resistência cultural relativa à informática médica e à telemedicina e para o papel tímido do Governo no fomento da telemedicina. / The present study consists in describing and analyzing the evolution of Telemedicine in Brazil, comprehending the experiences established until December 2000. Several institutions in the country use telemedicine programs, as hospitals, pathology analysis clinics, remote electrocardiograms clinics, universities, the Brazilian Army and the federal Government. Each experience has its own goals and there is no integration among them. The telemedicine programs comprehend a wide range of applications: while some require a plain technological structure as remote electrocardiograms, others demand more sophisticated resources as teleconferences with clinical images transmission and remote bedside monitoring. To accomplish this study it was necessary to conduct interviews with the leaders of the projects and also data mining in specialized publications. The conclusions indicate that there is lack of coordination among the experiences, that there is a cultural resistence both to medical informatics and telemedicine, and the faint Goverment role in stimulating telemedicine.

Pacientes críticos tratados em uma UTI comumente apresentam quadros severos de hiperglicemia. Estudos mostram que o controle da glicemia a níveis restritos leva à melhoria no prognóstico de tais pacientes. O controle glicêmico é feito através da medição freqüente da glicemia através de um exame de \"ponta de dedo\", aliada à infusão de insulina, numa atividade bastante trabalhosa para a equipe de enfermagem. Nos últimos anos, surgiram os primeiros sistemas comerciais de monitoramento contínuo de glicose para uso ambulatorial. Entretanto, há uma série de limitações que dificultam seu uso em uma UTI. No presente trabalho, foi desenvolvido um sistema de monitoramento contínuo de glicose para pacientes críticos hiperglicêmicos, batizado de vMonGluco. Esse sistema utiliza um monitor contínuo de glicose, disponível comercialmente, conectado a um palmtop, de forma a obter leituras de glicose em tempo real. Os dados coletados são enviados a um servidor seguindo a norma Health Level Seven (HL7). O servidor redireciona os dados a um monitor de beira de leito, disponibilizando as leituras de maneira prática. As informações também são armazenadas em um sistema de Prontuário Eletrônico do Paciente. Testes realizados em pacientes comprovaram a validade das leituras obtidas. Assim, com o presente trabalho, espera-se trazer uma contribuição prática e significativa no tratamento de pacientes críticos hiperglicêmicos. / Critical patients in an ICU usually experience severe hyperglycemia. Studies show that the control of glycemia to restricted levels can increase the prognosis of these patients. This control is usually done through the frequent reading of glycemia using a fingerstick test, together with the infusion of insulin, in a troublesome activity for the nursery team. In the last few years, the first commercial glucose monitoring systems for ambulatory use have been created. However, several difficulties limit its use in an ICU. In the present work, a continuous glucose monitoring system, named as vMonGluco, was developed. The system uses a commercially available continuous glucose monitor connected to a palmtop, in order to get glucose readings in real time. The collected data are sent to a server using the Health Level Seven (HL7) standard. The server redirects the data to a bedside monitor, so the readings can be accessed in practical way. The information is also stored in an Electronic Health Record system. Tests applied to patients showed the validity of the obtained readings. This way, with the present work, it is expected to bring a practical and significant contribution to the treatment of critical hyperglycemic patients.