NHS Direct Wales (NHSDW) is a nurse-led 24-hour health advice and information line. This study estimated the effect of deprivation on the demand for, and outcome of, direct calls to NHSDW after controlling for potentially confounding factors. The author analysed anonymous data from NHSDW on 410,000 calls over 2.5 years, including patient characteristics (age, gender, relationship to caller, ward of residence) and call characteristics (whether for triage or information, day of call). To each call she added ward data including: the corresponding Welsh Index of Multiple Deprivation score; population density; and distance from nearest Emergency Department (ED). She used multiple linear regression to model the relationship between deprivation and demand and binary logistic regression to model the relationship between deprivation and outcome. Confounding variables explained 33.0% of variation in advice call rates; and 27.5% of that in information call rates (both significant at 0.1% level). Deprivation was not a statistically significant predictor of these rates (significance levels 0.158 and 0.244 respectively). Deprivation had more effect on outcomes: an increase in deprivation from one fifth to the next fifth increased by 13% the probability of receiving advice to call 999 emergency care within triage calls [Odds ratio (OR) 1.127; 95% confidence interval (Cl) from 1.113 to 1.143]; and that of receiving advice to seek care face to face rather than self care by 5% (OR 1.049; Cl from 1.041 to 1.058) for triage calls and by 3% (OR 1.034; Cl from 1.022 to 1.047) for information calls. In short, deprivation had no detectable effect on demand for calls, but a positive effect on the outcome of the call. While it is possible that the data underestimated the ‘need’ of deprived patients for healthcare, they yield no evidence that NHSDW should seek to improve access from those patients.

Shared electronic health record (EHR) systems constitute an important Telemedicine and e-Health application. Successful implementation of shared health records calls for a satisfactory level of security. This is invariably achieved through applying and enforcing strict, and often quite complicated, rules and procedures in the access process. For this reason, information security strategy for EHR systems is needed to be in place. This research reviewed the definition of different terms that related to electronically stored and shared health records and delineated related information security terms leading to a definition of an information security strategy. This research also made a contribution to understanding information security strategy as a significant need in EHR systems. A major case study of the National Programme for IT (NPfIT) in England is used to be the container of other two sub-case studies in two different Acute Trusts. Different research methods used: participant observation and networking, semi-structured interviews, and documentary analysis. This research aimed to provide a comprehensive understanding to the information security strategy of England’s EHR system by presenting its different information security issues such as consent mechanisms, access control, sharing level, and related legal and regulatory documents. Six factors that influence the building of an information security strategy in EHR systems, were identified in this research, political, social, financial, technical, clinical and legal. Those factors are considered to be driving the strategy directly or indirectly. EHR systems are technical-clinical systems, but having other factors (than technical and clinical) that drive this technical-clinical system is a big concern. This research makes a significant contribution by identifying these factors, and in addition, this research shows not only how these factors can influence building the information security strategy, but also how they can influence each other. The study of the mutual influence among the six factors led to the argument that the most powerful factor is the political factor, as it directly or indirectly influences the remaining five factors. Finally, this research proposes guidelines for building an information security strategy in EHR systems. These guidelines are presented and discussed in the form of a framework. This framework was designed after literature analysis and after completing the whole research journey. It provides a tool to help putting the strategy in line by minimising the influence of various factors that may steer the strategy to undesirable directions.

In this thesis, a novel graphene (GN) based electrocardiogram (ECG) sensor is designed, constructed and tested to validate the concept of coating GN, which is a highly electrically conductive material, on Ag substrates of conventional electrodes. The background theory, design, experiments and results for the proposed GN-based ECG sensor are also presented. Due to the attractive electrical and physical characteristics of graphene, a new ECG sensor was investigated by coating GN onto itself. The main focus of this project was to examine the effect of GN on ECG monitoring and to compare its performance with conventional methods. A thorough investigation into GN synthesis on Ag substrate was conducted, which was accompanied by extensive simulation and experimentation. A GN-enabled ECG electrode was characterised by Raman spectroscopy, scanning electron microscopy along with electrical resistivity and conductivity measurements. The results obtained from the GN characteristic experimentation on Raman spectroscopy, detected a 2D peak in the GN-coated electrode, which was not observed with the conventional Ag/AgCl electrode. SEM characterisation also revealed that a GN coating smooths the surface of the electrode and hence, improves the skin-to-electrode contact. Furthermore, a comparison regarding the electrical conductivity calculation was made between the proposed GN-coated electrodes and conventional Ag/AgCl ones. The resistance values obtained were 212.4 Ω and 28.3 Ω for bare and GN-coated electrodes, respectively. That indicates that the electrical conductivity of GN-based electrodes is superior and hence, it is concluded that skin-electrode contact impedance can be lowered by their usage. Additional COMSOL simulation was carried out to observe the effect of an electrical field and surface charge density using GN-coated and conventional Ag/AgCl electrodes on a simplified human skin model. The results demonstrated the effectiveness of the addition of electrical field and surface charge capabilities and hence, coating GN on Ag substrates was validated through this simulation. This novel ECG electrode was tested with various types of electrodes on ten different subjects in order to analyse the obtained ECG signals. The experimental results clearly showed that the proposed GN-based electrode exhibits the best performance in terms of ECG signal quality, detection of critical waves of ECG morphology (P-wave, QRS complex and T-wave), signal-to-noise ratio (SNR) with 27.0 dB and skin-electrode contact impedance (65.82 kΩ at 20 Hz) when compared to those obtained by conventional a Ag/AgCl electrode. Moreover, this proposed GN-based ECG sensor was integrated with core body temperature (CBT) sensor in an ear-based device, which was designed and printed using 3D technology. Subsequently, a finger clipped photoplethysmography (PPG) sensor was integrated with the two-sensors in an Arduino based data acquisition system, which was placed on the subject's arm to enable a wearable multiple physiological measurement system. The physiological information of ECG and CBT was obtained from the ear of the subject, whilst the PPG signal was acquired from the finger. Furthermore, this multiple physiological signal was wirelessly transmitted to the smartphone to achieve continuous and real-time monitoring of physiological signals (ECG, CBT and PPG) on a dedicated app developed using the Java programming language. The proposed system has plenty of room for performance improvement and future development will make it adaptabadaptable, hence being more convenient for the users to implement other applications than at present.

<p>The Sub-Saharan Africa (SSA) region is faced with limited medical personnel and healthcare services to address the many healthcare problems of the region. Poor health indicators reflect the overall decline in socio-economic development. Shortages of access to health services in the region is further complicated by the concentration of health services in urban areas, the region’s multiple medical problems (over 70% of HIV/AIDS cases in the world); and the brain drain phenomenon – it is estimated one-third of African physicians emigrate to North America and Europe. The result is that the SSA region is left with about 10 physicians, and 20 beds, per 100,000 patients. Telemedicine has been found to offer socio-economic benefits, reduce costs, and improve access to healthcare service providers by patients, but previous attempts to move various information technologies from developers in the industrial world to the developing world have failed because of a clear neglect of infrastructural and cultural factors that influence such transfers. The objective of this study is to address key factors that challenge the introduction of telemedicine technology into the health sector in SSA in particular, and by extension, other developing countries with similar socio-economic structures.</p><p>This research offers a distinctive perspective, focusing on visually-based clinical applications in the SSA region, and considerable attention to the national infrastructure and cultural impact of telemedicine transfer (social and value) outcomes. Two research models and its associated hypotheses are proposed and empirically tested using quantitative data collected from SSA physicians and other health professionals. The study also contributes to the ongoing debate on the potential of telemedicine in improving access and reducing costs. This research can help to understand the socio-economic impact of telemedicine outcomes in a comprehensive way. The finding from the survey shows the rapid advances in telemedicine technology specifically, visual clinical applications may become an essential healthcare tool in the near future within SSA countries.</p>

The Sub-Saharan Africa (SSA) region is faced with limited medical personnel and healthcare services to address the many healthcare problems of the region. Poor health indicators reflect the overall decline in socio-economic development. Shortages of access to health services in the region is further complicated by the concentration of health services in urban areas, the region’s multiple medical problems (over 70% of HIV/AIDS cases in the world); and the brain drain phenomenon – it is estimated one-third of African physicians emigrate to North America and Europe. The result is that the SSA region is left with about 10 physicians, and 20 beds, per 100,000 patients. Telemedicine has been found to offer socio-economic benefits, reduce costs, and improve access to healthcare service providers by patients, but previous attempts to move various information technologies from developers in the industrial world to the developing world have failed because of a clear neglect of infrastructural and cultural factors that influence such transfers. The objective of this study is to address key factors that challenge the introduction of telemedicine technology into the health sector in SSA in particular, and by extension, other developing countries with similar socio-economic structures. This research offers a distinctive perspective, focusing on visually-based clinical applications in the SSA region, and considerable attention to the national infrastructure and cultural impact of telemedicine transfer (social and value) outcomes. Two research models and its associated hypotheses are proposed and empirically tested using quantitative data collected from SSA physicians and other health professionals. The study also contributes to the ongoing debate on the potential of telemedicine in improving access and reducing costs. This research can help to understand the socio-economic impact of telemedicine outcomes in a comprehensive way. The finding from the survey shows the rapid advances in telemedicine technology specifically, visual clinical applications may become an essential healthcare tool in the near future within SSA countries.