SVBE: searchable and verifiable blockchain-based electronic medical records system

Central management of electronic medical systems faces a major challenge because it requires trust in a single entity that cannot effectively protect files from unauthorized access or attacks. This challenge makes it difficult to provide some services in central electronic medical systems, such as file search and verification, although they are needed. This gap motivated us to develop a system based on blockchain that has several characteristics: decentralization, security, anonymity, immutability, and tamper-proof. The proposed system provides several services: storage, verification, and search. The system consists of a smart contract that connects to a decentralized user application through which users can transact with the system. In addition, the system uses an interplanetary file system (IPFS) and cloud computing to store patients’ data and files. Experimental results and system security analysis show that the system performs search and verification tasks securely and quickly through the network.

530 An Audit of Appropriate Documentation Following Urethral Catheterisation

Introduction Urethral catheterisation is a procedure frequently done in the hospital by medical personnel. Appropriate documentation is necessary to ensure safe clinical care and to reduce the risk of litigation. Method We randomly reviewed electronic notes of patients seen by the on-call urology team who had a urethral catheter inserted in September 2020. Reviewing the trust’s guidelines, we considered that appropriate documentation should include reference to the following 10 items; indication, chaperone present, consent obtained, groin examination, catheter size, catheter type, insertion process, urine colour, water in balloon and residual volume were reviewed. Results A total of 50 patients were included. 72%(36/50) were inserted by a member of the urology team. Only 28%(14/50) had all 10 items documented. Indication for catheterisation was best documented at 94%(47/50) while presence of a chaperone and groin examination (i.e. presence of a foreskin and its replacement post-catheterisation) were the lowest at 44%(22/50). Conclusions This study shows there is low compliance to adequate documentation of urethral catheterisation. A ‘smart phrase’ has been developed for use with our Trusts electronic medical records system to assist clinicians with appropriate documentation. Clinicians that use the phrase ‘.icat’ are prompted to document all 10 requisite items. This uses the mnemonic i-CATHETAR [indication, Chaperone and consent, groin Assessment, Tube (catheter size and type), insertion process (Hard/Easy), urine Tint, Aqua in balloon, Residual volume]. A second audit cycle is currently being done to review the effectiveness of this intervention.

Role of Prealbumin in Predicting the Prognosis of Severely and Critically Ill COVID-19 Patients

Most critically ill patients experience malnutrition, resulting in a poor prognosis. This study aimed to evaluate the association of prealbumin (PAB) with the prognosis for severely and critically ill coronavirus disease 2019 (COVID-19) patients and explore factors related to this association. Patients with laboratory-confirmed COVID-19 from West Campus of Union Hospital in Wuhan from January 29, 2020 to March 31, 2020 were enrolled in this study. Patients were classified into the PAB1 (150–400 mg/L; N = 183) and PAB2 (< 150 mg/L; N = 225) groups. Data collection was performed using the hospital’s electronic medical records system. The predictive value of PAB was evaluated by measuring the area under the receiver-operating characteristic (AUROC) curve. Patients were defined as severely or critically ill based on the Guidance for COVID-19 (7th edition) by the National Health Commission of China. During this analysis, 316 patients had severe cases and 65 had critical cases. A reduced PAB level was associated with a higher risk of mortality and a longer hospital stay. The AUROC curve for the prognosis based on the PAB level was 0.93, with sensitivity of 97.2% and specificity of 77.6%. For severe cases, a lower level of PAB was associated with a higher risk of malnutrition, higher NK cell counts, and lower B lymphocyte counts; these factors were not significant in critical cases. C-reactive protein and nutritional status mediated the association between PAB and prognosis. This retrospective analysis suggests that the PAB level on admission is an indicator of the prognosis for COVID-19.

Implementation of Electronic Medical Records System EQUALI to Improve Patient Care

In the present, where we live a pandemic because of Covid-19, it presents a challenge and change in the way we live for all, in which a different way of being able to receive health care must be created. in this research aimed to implement the electronic medical records system to improve patient care, such research is descriptive-explanatory in which a population of 67 patients from a health center is sampled. In conclusion, the implementation of the Electronic Medical Records System improved patient administrative care at the Health Center.

Evaluation of physical health assessments for new admissions to the Oleaster during the first wave of COVID-19

AimsPhysical health of psychiatric inpatients is worse than the general population. Physical health monitoring of these patients can have positive effects on outcomes. Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) states that a physical health assessment (PHA) should be completed within 72 hours of admission. This comprises a physical health form (PHF) and minimum data set (MDS): BP, BMI, TB and BBV status, alcohol and drug screen, smoking status, Hba1c and lipids. In a 2017 audit, compliance was shown to need improvement, with 28.3% of admissions not having a PHF documented.ObjectivesTo assess whether PHAs for new admissions to the Oleaster, Birmingham during the first wave of COVID-19 were completed in line with trust policyTo compare findings with a previous auditTo make recommendations to improve inpatient physical health and compliance with trust policyMethodA retrospective audit was conducted, with PHA details accessed via the electronic medical records system RiO. Admissions from 16/03/2020-30/06/2020 were accessed and 158 admissions (155 patients) were included. 21 admissions were excluded as they were internal transfers; only data from the initial admission were included. Data were collected by 2 medical students and a psychiatry trainee using a data collection tool. Data were recorded and analysed on Excel.ResultOf 158 admissions, 81 had PHFs (51.3%). 59 were completed within 72 hours of admission (34.3%); 39 were completed fully (24.7%). Of incomplete PHFs, 2 explicitly stated incompletion due to COVID-19. 22 PHFs were created but not completed within 72 hours. 15 gave a deferral reason e.g., refusal to consent or agitation. For 77 admissions (47.3%), no assessment was documented, with no reason given.2 admissions (1.3%) recorded the full MDS within 72 hours of admission.2 admissions (1.3%) had fully complete PHAs (PHF and MDS) within 72 hours of admission, fulfilling trust policy.Conclusion51.3% of admissions had a PHF, with 34.3% documented within 72 hours of admission. However, only 1.3% of admissions fulfilled trust policy of both a completed PHF and MDS within 72 hours of admission. There were more admissions without a PHF than in the previous 2017 audit; 47.33% compared to 28.3% previously. Given trust targets that a PHA should be fully completed for 100% of admissions, it was found that the Oleaster did not meet these guidelines during this period and improvements must be made to maintain integrity of patient care.

A generic expert system framework with fuzzy Bayesian inference for medical classification and diagnosis in cardialogy [i.e. cardiology

Medical knowledge is expanding fast and it is difficult for general practitioners to remain abreast of all medical domains. Also, access to domain specialist is limited due to availability and geographical constraints. In many situations the diagnosis in [sic] upon the decision of the general practitioner and in cases this has resulted in the problem of patient's misdiagnosis. The purpose of this research is to create an expert system as a decision support model which is capable of risk analysis for diagnosis based on the patient's demography and laboratory tests. The expert system is designed in compliancy with medical communications protocol such as HL7 and can be integrated to any HL7 compliant Electronic Medical records system to provide more intelligence in diagnosis. Using linear scoring models and Fuzzy logic, the patient's demography and laboratory results will be used as rule bases. Such knowledge will be used as priors for a Bayesian engine to create the diagnostic spaces. Patient's information is compared in the space and the general practitioner can select between the possible hypotheses. Each diagnostic decision will be associated with a risk value. Using such scoring model provides a new semantic in diagnosis by providing risk values for every diagnosis made and by suggesting the most suitable treatment. Unlike many other existing expert systems, the architecture is designed in a generic standard which provides the capability to use the system for all medical domains. Achieving this generality has been a major goal achieved and its details are discussed in this document.

A generic expert system framework with fuzzy Bayesian inference for medical classification and diagnosis in cardialogy [i.e. cardiology

Medical knowledge is expanding fast and it is difficult for general practitioners to remain abreast of all medical domains. Also, access to domain specialist is limited due to availability and geographical constraints. In many situations the diagnosis in [sic] upon the decision of the general practitioner and in cases this has resulted in the problem of patient's misdiagnosis. The purpose of this research is to create an expert system as a decision support model which is capable of risk analysis for diagnosis based on the patient's demography and laboratory tests. The expert system is designed in compliancy with medical communications protocol such as HL7 and can be integrated to any HL7 compliant Electronic Medical records system to provide more intelligence in diagnosis. Using linear scoring models and Fuzzy logic, the patient's demography and laboratory results will be used as rule bases. Such knowledge will be used as priors for a Bayesian engine to create the diagnostic spaces. Patient's information is compared in the space and the general practitioner can select between the possible hypotheses. Each diagnostic decision will be associated with a risk value. Using such scoring model provides a new semantic in diagnosis by providing risk values for every diagnosis made and by suggesting the most suitable treatment. Unlike many other existing expert systems, the architecture is designed in a generic standard which provides the capability to use the system for all medical domains. Achieving this generality has been a major goal achieved and its details are discussed in this document.

Implementation of Fingerprint Technology for Unique Patient Matching and Identification in Kenya: This cross-sectional study was conducted at a HIV care and treatment facility in Western Kenya. An open-source fingerprint application was integrated within an implementation of the Open Medical Records System (OpenMRS) which is currently in use at the study setting (Preprint)

BACKGROUND Unique patient identification remains a challenge in many healthcare settings within low- and middle-income countries (LMICs). Without national-level unique identifiers for whole populations, countries rely on deterministic and probabilistic patient matching approaches that have proven suboptimal in LMICs. Affordable bio-metric-based approaches, implemented with consideration of contextual ethical, legal and social implications (ELSI), have a potential to address patient identification challenges and to improve care quality, patient safety and reporting accuracy. However, limited studies exist to evaluate actual performance of biometric approaches and perceptions towards these systems within LMIC contexts. OBJECTIVE To evaluate performance and acceptability of fingerprint technology (FPT) for unique patient matching and identification in the LMIC setting of Kenya METHODS This cross-sectional study was conducted at a HIV care and treatment facility in Western Kenya. An open-source fingerprint application was integrated within an implementation of the Open Medical Records System (OpenMRS) which is an open source electronic medical records system (EMR) and currently in use at the study setting. OpenMRS is nationally-endorsed and deployed for HIV care in Kenya and in over 40 countries, hence potential for ease of translating findings across multiple countries. Adult participants over 18 years of age were conveniently sampled and enrolled into the study. Participants’ left thumbprints were captured, stored and used to retrieve and match patient records. FPT performance was evaluated using standard measures namely: Sensitivity, False Acceptance Rate (FAR), False Rejection Rate (FRR), and Failure to Enroll Rate (FER). Wald test was used to compare the accuracy of the FPT to the EMRs’ probabilistic matching technique. Time to retrieval and matching of records was compared using the independent samples t-test. A survey was administered to evaluate patient acceptance and satisfaction with use of the FPT. RESULTS 300 participants were enrolled, mean age was 36.3 years (SD 12.2) and 174/300 (58%) were female. FPT per-formed as follows: sensitivity 89.3%, FAR 0%, FRR 11%, and FER 2.3%. FPT mean record retrieval speed was 3.2s (SD 1.1) vs. 9.5s (SD 1.9) with demographic-based record retrieval in the EMR (p<.001). Survey results revealed participants’ comfort (96.3%) and willingness (90.3%) to use the FPT. CONCLUSIONS Fingerprint Technology (FPT) performed very well in identifying adult patients within a LMIC setting. Patients reported a high level of satisfaction and acceptance of the technology. Serious considerations need to be given to use of FPT for patient identification in LMICs, but this has to be done with strong consideration on ELSI and security issues.

The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study

Background It is difficult to judge the stability of lateral compression type-1 (LC-1) pelvic fracture, as it is often based on static images of the pelvis. Compared with the traditional experience strategy, ultrasonography examination may be able to distinguish operative and conservative patients before definitive treatment. However, in previous studies, we have not compared the outcomes between traditional experience strategy (TES group) and combined ultrasonography examination (CUE group). Thus, the aim of the study is comparing the differences between TES and CUE strategy, to identify the value of ultrasonography examination. Methods Medical records system for patients with LC-1 pelvic fractures who were treated with TES and CUE strategy were included. Patients’ baseline characteristics, treatment strategy, and function were recorded at follow-up. Functional outcomes were evaluated using the Majeed grading system. Results In total, 77 patients with LC-1 pelvic fractures were included in the study. There were 42 and 35 patients in TES and CUE group, respectively. Compared to TES group (69 %), there were less proportion patients chosen the operative treatment in CUE group (43 %, P = 0.021). The volume of intraoperative blood loss in CUE operative group was more than TES operative group (P = 0.037). There were more patients with complete sacral fracture in CUE operative group than TES operative group (P = 0.002). The Majeed scores in CUE conservative group was higher than TES conservative group (P = 0.008). The overall Majeed scores in CUE group was higher than that in TES group (P = 0.039). Conclusions The ultrasonography examination could relatively accurately identify the unstable LC-1 pelvis than the traditional experience strategy, the operative rate could be reduced and the overall function of LC-1 patients could be improved under the ultrasonography examination. Level of evidence Level III.