The Use of Virtual Reality in Clinical Psychology Research

This chapter presents research that is laying a foundation for new simulation applications that promise learning-oriented treatments for mental health conditions. After presenting background on their technologies and measurement techniques, the authors describe experimental applications of this approach. Analysis of negative and positive responses to virtual reality (VR) stimuli, as well as their complex composites, can lead to a better understanding of patient responses, including fundamental perceptual and cognitive causal relationships. Measuring patients’ dynamic parameters in VR simulations can possibly lead to new treatment approaches for psychopathologies The biological and behavioral feedback obtained by virtual mediation, based on parameters of the perceptivo-motor dynamics such those described in this chapter, represents a promising avenue for future investigation.

New Technologies in Hospital Information Systems

A hospital information system (HIS), variously also called clinical information system (CIS), is a comprehensive, integrated information system designed to manage the administrative, financial, and clinical aspects of a hospital. This encompasses paper-based information processing as well as data processing machines. As an area of medical informatics, the aim of an HIS is to achieve the best possible support of patient care and administration by electronic data processing. It can be composed of one or few software components with specialty specific extensions, as well as of a large variety of subsystems in medical specialties (e.g., laboratory information system, radiology information system). CISs are sometimes separated from HISs in that the former concentrate on patient and clinical state-related data (electronic patient record), whereas the latter keeps track of administrative issues. The distinction is not always clear, and there is contradictory evidence against a consistent use of both terms.

TACMIS

TACMIS is an inclusive solution to the management of health care and medical information and its design is based on a detailed process analysis of patient journeys and the pathways of clinical care of stroke patients as they progress from acute care, through rehabilitation to discharge and independent living, often with a residual disability. The findings are the work of a team based in the Discovery Research Laboratory at Ritsumeikan University in Japan. The clinical analysis was conducted at King’s College Hospital in London and in several care institutions for the disabled and the aged in Japan.

Simulation Modeling as a Decision-Making Aid in Economic Evaluation for Randomized Clinical Trials

This chapter reports on the use of simulation in supporting decision-making about what data to collect in a randomized clinical trial (RCT). We show how simulation also allows the identification of critical variables in the RCT by measuring their effects on the simulation model’s “behavior.” Healthcare systems pose many of the challenges, including difficulty in understanding the system being studied, uncertainty over which data to collect, and problems of communication between problem owners. In this chapter we show how simulation also allows the identification of critical variables in the RCT by measuring their effects on the simulation model’s “behavior.” The experience of developing the simulation model leads us to suggest simple but extremely valuable lessons. The first relates to the inclusion of stakeholders in the modeling process and the accessibility of the resulting models. The ownership and confidence felt by stakeholders in our case is, we feel, extremely important and may provide an example to others developing models.

Informatics Applications in Neonatology

Neonatal care is an extremely data-intensive activity. Physiological monitoring equipment is used extensively along with web-based information tools and knowledge sources. Merging data from multiple sources adds value to this data collection. Neonatal databases assist with collecting, displaying, and analyzing data from a number of sources. Although the construction of such databases can be difficult, it can provide helpful support to clinical practice including surveillance of infectious diseases and even medical error. Along with recording outcomes, such systems are extremely useful for the support of audit and quality improvement as well as research. Electronic information sources are often helpful in education and communication with parents and others, both within the unit and at a distance. Systems are beginning to be used to help with decision making – for example in the case of weaning neonates from ventilators, and this work is likely to become more important in the future.

The MOBEL Project

This chapter presents results and experiences from the MOBEL (MOBile ELectronic patient record) project at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. MOBEL was a multidisciplinary research project established in 2000. The problem area of the project was communication and information needs in hospital wards, and the aim of the project was to develop and explore methods and prototypes for point of care clinical information systems (PoCCS) that support clinicians in their patient-centered activities. The chapter summarizes four sub studies performed during the project. Each study presents different approaches to user-centered design of PoCCS. Findings from these studies confirm the need for mobile information and communication technology (ICT) in hospitals. Furthermore, the studies demonstrate how more user involvement and complementary approaches to traditional requirements engineering (RE) and system development methods can be useful when developing mobile information and communication systems for clinicians.

Persistent Clinical Encounters in User Driven E-Health Care

This chapter discusses the role of e-health in creating persistent clinical encounters to extend the scope of health care beyond its conventional boundaries utilizing social networking technology to create what the authors’ term ‘user driven health care’. It points out the necessity to direct the development of health information systems such that they serve as important vehicles between patient and health professional users in communicating and sharing information other than their role in automated alerts and responses. A project is described that plans to create a system of online sharing of health information in a user driven manner that necessarily becomes persistent due to being stored in electronic health records.

The Use of Artificial Intelligence Systems for Support of Medical Decision-Making

There is a treasure trove of hidden information in the textual and narrative data of medical records that can be deciphered by text-mining techniques. The information provided by these methods can provide a basis for medical artificial intelligence and help support or improve clinical decision making by medical doctors. In this paper we extend previous work in an effort to extract meaningful information from free text medical records. We discuss a methodology for the analysis of medical records using some statistical analysis and the Kohonen Self-Organizing Map (SOM). The medical data derive from about 700 pediatric patients’ radiology department records where CT (Computed Tomography) scanning was used as part of a diagnostic exploration. The patients underwent CT scanning (single and multiple) throughout a one-year period in 2004 at the Nagasaki University Medical Hospital. Our approach led to a model based on SOM clusters and statistical analysis which may suggest a strategy for limiting CT scan requests. This is important because radiation at levels ordinarily used for CT scanning may pose significant health risks especially to children.

Med-on-@ix

The aim of the project Med-on-@ix is to increase the quality of care for emergency patients by the operationalisation of rescue processes. The currently available technologies will be integrated into a new emergency telemedical service system. The aim is to capture all the necessary information comprising electrocardiogram, vital signs, clinical findings, images and necessary personal data of a patient at the emergency scene and transmit this data in real time to a centre of competence. This would enable a “virtual presence” on site of an Emergency Medical Services physician (EMS-physician, the German Notarzt). Thus, we can raise the quality of EMS in total and counter the growing problem of EMS-physician shortage by exploiting the existing medical resources. In addition, this system offers EMS-physicians and paramedics consultation from a centre of competence. Thereby referring to evidence-based medicine and ensuring the earliest possible information of the hospital.

Wearable Systems for Monitoring Mobility Related Activities

Monitoring the performance of daily life mobility related activities, such as rising from a chair, standing and walking may be used to support healthcare services. This chapter identifies available wearable motion-sensing technology; its (potential) clinical application for mobility assessment and monitoring; and it addresses the need to assess user perspectives on wearable monitoring systems. Given the basic requirements for application under real-life conditions, this chapter emphasizes methods based on single sensor locations. A number of relevant clinical applications in specific older populations are discussed; i.e. (risk-) assessment, evaluation of changes in functioning, and monitoring as an essential part of exercise-based interventions. Since the application of mobility monitoring as part of existing healthcare services for older populations is rather limited, this chapter ends with issues that need to be addressed to effectively implement techniques for mobility monitoring in healthcare.