Integration of Automation and Clinical Decision Support Systems

As the world of pathology and laboratory medicine has increasingly headed in the direction of automation, implementation of Clinical Decision Support Systems are becoming a vital part of the process. The advances in technology and costs of human resources are factors pushing for automation. This chapter addresses the advantages and issues encountered during the installation of the new automated system Roche Cobas 8000 and Middleware IT3000 for the Clinical Chemistry Laboratory of one of the major teaching hospitals in Australia. The input and cooperation of Laboratory staff, Clinicians, Roche Diagnostics and LEAN processes has resulted in a fine example of how automation and clinical decision support systems play a major role in Improving Health Management.

Developing a National Registry for Hemochromatosis

Hereditary Hemochromatosis (HH) is a disorder where iron and ferritin concentrations in a patient's blood are much higher than normal healthy levels. The main therapeutic intervention for individuals with HH is removing 300-500 mL of blood every few months to maintain ferritin concentration within acceptable ranges. The blood collected during these venesections is usually discarded as there is a belief that blood with high levels of ferritin are not suitable for blood transfusion purposes. Australian Red Cross Blood Services voluntarily collects blood from donors for subsequent use in blood transfusion. Annually more than 700 thousand units are transfused within Australia and there is a constant need for new donors given the significant imbalance between supply and demand of blood products. Besides red cell transfusions, the Red Cross also issues donor blood for development of many other blood products essential for patient health care. The HH blood can currently be used for other blood products if not for red cell transfusion. However, there is evidence to suggest that there is no significant difference between the red cells of the normal healthy population compared to those from HH patients. Australian Red Cross has developed a mobile computer application (High Ferritin “app”) as they have started collecting blood from HH patients. Though there is little or no awareness about the existence and use of this High Ferritin app in general HH population, their doctors and nurses collecting their blood for therapeutic purposes. This chapter describes possibility of saving and utilizing the blood collected from hemochromatosis patients for therapeutic purposes. A national hemochromatosis patients registry, in collaboration with High Ferritin app (HFa) developed by Australian Red Cross Blood Services, accessible to the patients, their doctors and Red Cross Blood Collection Sservices 24 hours a day anywhere in the country can allow the patients to donate the blood collected for therapeutic purposes at any affiliated blood collection center in the country after they automatically get a message either by email or text message after their blood results have been reviewed by their doctor and they are required to go for venesection.

St. Stephen's Hospital Hervey Bay

St Stephen's Hospital in Hervey Bay, Queensland, Australia, is a new 96 bed state of the art digital hospital that opened on a greenfield site on 13 October 2014. The eHealth project was responsible for providing a fully integrated electronic medical record. The authors explore the unique challenges presented by the project and the solutions deployed. Key components related to the success of the project are identified. The results of the intense two and half year project timeline culminated in a successful go-live and certification as the first hospital in Australia to achieve Stage 6 HIMSS designation.

Pain Assessment through Facial Expression

Pain, assumed to be the fifth vital sign, is an important symptom that needs to be adequately assessed in heath care. The visual changes reflected on the face of a person in pain may be apparent for only a few seconds and occur instinctively. Tracking these changes is a difficult and time-consuming process in a clinical setting. This is why it is motivating researchers and experts from medical, psychology and computer fields to conduct inter-disciplinary research in capturing facial expressions. This chapter contains a comprehensive review of technologies in the study of facial expression along with its application in pain assessment. The facial expressions of pain in children's (0-2 years) and in non-communicative patients need to be recognized as they are of utmost importance for proper diagnosis. Well designed computerized methodologies would streamline the process of patient assessment, increasing its accessibility to physicians and improving quality of care.

A Clinical Decision Support System

Inadequate response and bad decisions taken by mobile physicians may lead to bad consequences threatening rescued people lives. Moreover, there are growing information that overload physicians when facing urgent cases. In order to facilitate the on road decision making for the mobile physicians, we propose a clinical decision support system based on an ontology driven approach for effective emergency management that allows finding out as quickly as possible the needed medical resources and reserves the most suitable health care institutions according to the patient state. Specifically, this work permits to localize rapidly the closets health care institution to the emergency scene, to find out the needed medical resources to deal with the patient first diagnosis, to match the localized health care institutions that contain the necessary medical resources to fulfil the patient determined needs, and to rank medical institutions, according to urgent case requirements, in order to allow the mobile physician to perform the adequate choice of one of them.

Data-Driven and Practice-Based Evidence

Decision making is such an integral aspect in health care routine that the ability to make the right decisions at crucial moments can lead to patient health improvements. Evidence-based practice, the paradigm used to make those informed decisions, relies on the use of current best evidence from systematic research such as randomized controlled trials. Limitations of the outcomes from RCT, such as “quantity” and “quality” of evidence generated, has lowered healthcare professionals' confidence in using EBP. An alternate paradigm of Practice-Based Evidence has evolved with the key being evidence drawn from practice settings. Through the use of health information technology, electronic health records capture relevant clinical practice “evidence”. A data-driven approach is proposed to capitalize on the benefits of EHR. The issues of data privacy, security and integrity are diminished by an information accountability concept. Data warehouse architecture completes the data-driven approach by integrating health data from multi-source systems, unique within the healthcare environment.

Leverage Healthcare Data Assets with Predictive Analytics

Multi-spectral data residing in disparate data bases represents a critical raw asset for today's healthcare organizations (). However, in order to gain maximum value from such data, it is essential to apply prudent technology solutions and tailored analytic techniques. The following chapter proposes how the application of bespoke predictive analytic tools and techniques can be designed and then applied to a hospital data warehouse, called the Hospital Casemix Protocol (HCP) Extended data set, in order to improve decision efficiency in the private healthcare sector in Australia. The main objective of this chapter is to present the developed conceptual model to demonstrate inputs, outputs, components, principles and services of predictive analytics for private hospitals.

Online Spatial HIV/AIDS Surveillance and Monitoring System for Nigeria

HIV/AIDS has now become a big threat to the world generally, most especially the Sub-Saharan Africa region as it continues to increase drastically in the region. This disease has increased the poverty level of the countries in the region. In Nigeria, millions of people infected with this deadly disease are in their productive years between 15 and 49. This surge is having a negative effect on Nigeria and other Sub-Saharan Africa countries as it lowers life expectancy, slows population growth and social and economic effect on the country. Presently, health officers in Nigeria primarily rely on monitoring HIV/AIDS prevalence only among women attending antenatal clinics as that is the only source of getting data from HIV/AIDS patients. In the country, there is no electronic HIV/AIDS database, no electronic means of capturing HIV/AIDS data and no electronic monitoring of HIV/AIDS patients. This chapter presents a prototypical HIV/AIDS surveillance and monitoring system and the prototype was developed using Dreamweaver, PHP and MySQL. With this system, users could spatially query the pattern and distribution of any HIV/AIDS disease using any known location. Also, queries based on occupation, level of education, and gender among other things are possible with this system. Though the system was developed for Nigeria, it can also be extended to other countries within Sub-Saharan Africa region.

Strategic Approach towards Clinical Information Security

Information security in the health information system has been technology-centric and no strategy has been put forward to meet the demands of the rapid adoption of e-Health in the health industry. The implementation of security requires a good understanding of the stake holders involved and requires the technical aspect of clinical information security, including security requirements, access control and disclosure control. However, since technology-centric security is prone to failure, a stringent strategic approach is quintessential. This chapter discusses the ways to safeguard medical information assets from the strategy point of view. This study shows that most of the existing clinical information security literature and practice has been focused on tactical prevention at a technical level. This understanding of the current status of clinical information security not only suggests the need for a shift from the technical approach to the strategic approach but also raises the necessity for the employment of multiple strategies working in a harmonised way.

From the Margins to the Mainstream

Healthcare system performance needs information on cost and revenue of care because of the rising healthcare costs. Empowering clinicians with clinical costing information is central to the success of containing costs. This information holds clinical data linkage unifying clinical, financial and administrative datasets, and seems to facilitate the spending of scarce health care resources in a way that produces the biggest difference in clinical outcomes. This chapter looks at the methodology and processes of clinical costing and its potential applications to facilitate the delivery of value-based healthcare, which confers quality care at lowest unit cost. Policy implications would be purchasing value-based healthcare, based mostly on quality of care after removing avoidable costs for inefficiency and poor quality. Clinician participation in the clinical costing is the key to success, because clinicians will be informed of the options available to choose the most value-based healthcare, which will, in turn, take care of the tight healthcare budget. Yet, this method of clinical costing is still at the margins.