Ethical E-Health

E-health is a rising star that marks the collaboration of medical science and information technology, a ray of hope promising a glorious future of health and prosperity, an easy solution to rely on when in need of medical assistance. But the question arises is E-health an absolute spotless option? In this paper we question the integrity with which e-health is being practised, is the code of ethics being diligently followed? And if not then is ethical e-health entirely impossible? It is of utmost importance to encourage the motivational thinkers who have taken the initiative to provide a better and quicker solution to all health problems by integrating health services and information technology. To do so it becomes necessary to remove the barriers in the way of ethical E-health.

Patient Safety in Community Care

The increasing number of elderly people in need of health and social care is putting pressure on current services to develop better ways of providing integrated care in the community. It is a widely held belief that e-health technologies have great potential in enabling and achieving this goal. This chapter reviews a number of technologies used for this purpose: telecare, telehealth, telemedicine, electronic patient record systems, and technologies to support mobile working. In each case, technocentric-design approaches have led to problematic implementations and failures to achieve adoption into the routine of delivering healthcare. An examination of attempts to implement major changes in the service delivery of integrated care shows that e-health technologies can be successfully implemented when they are seen as an intrinsic part of the creation of a complete system. However, the design process required for successful delivery of these services is challenging; it requires sustained and integrated development work by clinical staff and technologists coordinating their work on process changes, organisational developments, and technology implementations.

A Smart Card Based Software System for Surgery Specialties

This chapter presents a software system based on smart cards technology for recording, monitoring and studying patients of any surgery specialty (General Surgery, Orthopedics, Neurosurgery, etc.). The system is also suitable for the computerization of any surgery specialty clinic and the respective surgical material repositories. Dynamic customization functions adapt the system to the different characteristics of the surgery specialties. Special customization is involved concerning implantable materials. The .NET platform and Java Cards used for the development of the system and the architectural model of the system are designed towards satisfying the basic integration and interoperability issues. The developed system is “doctor-friendly” because it is based on classifications and knowledge grouping used in every day clinical practice provided from medical experts on the field but is not intended to be a complete Electronic Medical Record (EMR). The major scope of this effort is the development of a system that offers a fast and easy installable, low cost solution in health environments still immature in adopting solutions based exclusively on Informatics and is designed to be installed in small Private Medical Consulting Rooms to Community Clinics, Health Centers, Hospital Surgery Departments till Central Health Organizations.

Learner Acceptance of Using Virtual Patient Encounters to Train Foreign Healthcare Professionals in Swedish

Healthcare professionals need good communication skills to be able to communicate with patients. In such provider-patient communication, the professional needs to be well understood by the patient, but also be able to understand subtle parts of a medical history taking dialogue with worried, sick or mentally affected patients. Virtual Patients (VPs) – learning environments that simulate encounters between a patient and a physician – were used to prepare 26 immigrating professionals in Swedish for healthcare practitioners. The professionals were speaking nine different foreign languages and used two different VP systems to train patient communication. Almost all participants welcomed the use of VPs for training communication in healthcare Swedish and 19 of the 26 users indicated that they considered that VPs should be mandatory to use in future courses. Targeted individual training in provider-patient communication with Virtual Patients seems to be of great educational value and well accepted by immigrating healthcare professionals.

Informatics and Socio-Technical Challenges when Designing Solutions for Integrated eCare

The central role of eHealth to enable the successful implementation of integrated care is commonly acknowledged today. This is easier said than done. To provide correct, understandable, and timely information at the point of need and to facilitate communication and decision support for a network of actors with different prerequisites and needs are some of the big challenges of integrated care. This book chapter focuses on the specific challenges related to informatics and socio-technical issues when designing solutions for integrated eCare. Methods for requirements elicitation, evaluation, and system development using user-centred design in collaborative environments involving a variety of stakeholders are presented. Case studies in homecare of older patients, in the care of stroke patients, and regarding citizen eHealth services in general illustrate the application of these methods. Possible solutions and pitfalls are discussed based on the experiences drawn from the case studies. To address the main informatics and socio-technical challenges in integrated eCare, namely informatics-supported collaborative work and to provide coordinated continuity for the patient, top-down activities such as health informatics standardisation, and bottom-up activities resulting in the definition of concrete patient journey descriptions, interaction points, information needs (that can be transformed into standardised data sets), as well as visualisation and interaction patterns need to go hand in hand.

Mining Electronic Health Records to Guide and Support Clinical Decision Support Systems

Clinical decision support systems require well-designed electronic health record (EHR) systems and vice versa. The data stored or captured in EHRs are diverse and include demographics, billing, medications, and laboratory reports; and can be categorized as structured, semi-structured and unstructured data. Various data and text mining techniques have been used to extract these data from EHRs for use in decision support, quality improvement and research. Mining EHRs has been used to identify cohorts, correlated phenotypes in genome-wide association studies, disease correlations and risk factors, drug-drug interactions, and to improve health services. However, mining EHR data is a challenge with many issues and barriers. The aim of this chapter is to discuss how data and text mining techniques may guide and support the building of improved clinical decision support systems.

Improving Quality of Services in Maternity Care Triage System

The main objectives in triage are to improve the quality of care and reduce the risks associated to the waiting time in emergency care. Thus, an efficient triage is a good way to avoid some future problems and how much quicker it is, more the patient can benefit. The most common triage system is the Manchester Triage System that is a reliable system focused in the emergency department of a hospital. However, its use is more suitable for more widespread medical emergencies and not for specialized cases, like Gynecological and Obstetrics emergencies. To overcome these limitations, an alternative pre-triage system, integrated into an intelligent decision support system, was developed in order to better characterize the patient and correctly defined her as urgent or not. This system allows the increase of patient's safety, especially women who need immediate care. This paper includes the workflow that describes the decision process in real time in the emergency department, when women are submitted to triage and identify points of evolution.

A Social Network Framework to Explore Healthcare Collaboration

A patient-centric approach to healthcare leads to an informal social network among medical professionals. This chapter presents a research framework to: (1) identify the collaboration structure among physicians that is effective and efficient for patients; (2) discover effective structural attributes of a collaboration network that evolves during the course of providing care; and (3) explore the impact of socio-demographic characteristics of healthcare professionals, patients, and hospitals on collaboration structures, from the point of view of measurable outcomes such as cost and quality of care. The framework uses illustrative examples drawn from a data set of patients undergoing hip replacement surgery. The practical application of the proposed framework reveals structures of physicians' collaborations that are not favourable to cost and quality of care measures such as readmission rate. The authors believe that such a framework will enable healthcare managers and administrators to evaluate the collaborative work environment within their respective healthcare organisations.

RFID Applications in Healthcare-State-of-the-Art and Future Trends

Implementation of RFID technology-based healthcare services is on the rise. The purpose of this chapter is a thorough, systematic review of the existing literature to provide a discussion of current trends and future directions in this domain. Findings indicate that tracking is the key RFID enabling function. Automatic data collection and transfer is an RFID function also frequently used in relation to assets, staff, and patients. Finally, RFID is employed for sensing, most often in relation to patients, but also to assets. The chapter concludes by highlighting future research directions where the deployment of RFID technology is likely to transform the healthcare sector.

Medical Treatment and Difficult Ethical Decisions in Interdisciplinary Hospital Teams

The chapter focuses on organizational culture and ethics, and authors refer to some studies on organizational climate. Authors analyze the relationship between organizational culture and types of performance indicators, which include key concerns of policy makers and the public regarding of hospital behavior. The indicators include resource use per patient (communication process and treatment method, technology, ethical behavior), productivity in resource use (by improving the teamwork and staff education), short-term profitability, patient satisfaction with medical care, and employee satisfaction with improved work culture.