Video recording has become a very common practice in surgery and is one of the paramount methods to teach proper surgical techniques. Traditionally it has been limited by a variety of factors including cost, the need for constant camera reposition, and the use of external photographers, which is both costly and labor-intensive. We describe the use of dual modified point of view (POV) GoPro head mounted cameras to record synchronized POV surgery for the purpose of training surgical assistants. POV cameras are inexpensive, easy to use and manipulate. The GoPro camera was mounted using a head strap on both the surgeon's and surgical assistant's head, providing different optimal views. We used the GoPro Hero4 Silver for the surgeon and the GoPro Hero3+ Black Edition for the assistant. The lens used was optimized for our purposes. With the modified camera for the primary surgeon, the magnification was satisfactory in recording of fine details, and provided a usable depth of field and field of view. We found that using two synchronized POV GoPro head mounted cameras was an innovative way to record otolaryngology surgery and provided excellent video footage which can be used for the education of both surgeons and surgical assistants.
In the information retrieval task, searching and choosing keywords to form the query is crucial. The present study analyzes and describes the keywords' search strategy into a thesaurus in the field of pharmacovigilance. Two ergonomics experts shadowed 22 pharmacovigilance specialists during their daily work. They focus on the strategies for searching and choosing MedDRA terms to build pharmacovigilance queries. Interviews of four pharmacovigilance specialists completed the observations. Results highlight that, for unusual or complex searches, pharmacovigilance specialists proceed iteratively in three main phases: (i) preparation of a list of terms and of evaluation criteria, (ii) exploration of the MedDRA hierarchy and choice of a term, and (iii) evaluation of the results against the criteria. Overall, the search and the choice of keywords within a thesaurus shares similarity with the information retrieval task and is closely interwoven with the query building process. Based on the results, the paper proposes design specifications for new interfaces supporting the identification of MedDRA terms so that pharmacovigilance reports searches achieve a good level of expressiveness.
Use of electronic health record (EHR) data in clinical trials has long been a goal for researchers. However, few demonstrations and fewer evaluative studies have been published. The variability in outcome choice and measurement hinders synthesis of the extant literature. In collaboration with a contemporaneous systematic review of EHR data use in clinical trial data collection, we analyze reported outcomes and recommend a standardized measure set for the evaluation of human safety, data quality, operational efficiency and cost of eSource solutions.
PURPOSE:This review will identify dominant themes, common to published articles that discuss downtime planning in a clinical setting. These common themes will represent key considerations for healthcare organizations' comprehensive downtime plans.METHOD:A scoping study was performed using search results from PubMed, CINAHL and Medline. The 4 articles meeting the inclusion criteria were analyzed for common themes and findings.RESULTS:Four common themes were found in the included articles: 1) Communications plans, 2) Procedure review and revision, 3) Managing system availability and 4) Preparing staff for handling incidents.CONCLUSION:Organizations must have comprehensive downtime plans available to ensure continuity of patient care during the periods of limited availability. A comprehensive downtime plan that includes these four strategies can become the framework for a set of organizational procedures that ensures the best possible access to vital patient information before, during, and after a downtime event.
Oncology, telehealth nursing practice is growing. There has been an increased use of telehealth systems to support patients living with cancer in the community. In this study we explore the impact of integrating electronic symptom management guidelines (eSMGs) and electronic health records (EHRs) upon oncology, telehealth nursing practice. Ten nurses participated in clinical simulations and post-clinical simulation interviews. Participants' identified that several factors that influenced the use of SMGs including nursing experience and experience in using the eSMGs.
Opioid-related harm is a major public health concern in Canada and abroad. There is a growing market of mobile apps that focus on preventing and managing opioid-related harm. The use of mobile health technologies is a promising intervention that can assist with addressing the problem. The aim of this paper is to examine the current state of the mobile app market with respect to prevention and management of opioid-related harm. This will involve a review currently available opioid apps for the major operating systems (iOS, Android, Windows CE and BlackBerry OS) and examine the number of released apps, service providers, operating systems, target user groups, purpose of app, range of features, location, use of evidence, interface, languages, cost and licensing model, and user ratings.
Patient privacy concerns are often cited as a barrier to health information exchange (HIE) implementations; however, the current understanding of patient perspective is limited due to a fragmented approach to patient privacy research. The limited evidence suggests that the patient privacy perspective is context-dependent and may involve benefit-risk tradeoffs. A standardized approach to the contextual factors would allow for more consistent assessment, providing a better understanding or explanation of the contextual factors influencing the patient privacy perspective and their attitudes towards HIE. This paper describes the development of the eHealth Trust Model-an evidence-based theory-grounded conceptual framework intended to guide future patient privacy research.
This paper outlines a framework for identifying and classifying different types of patient engagement tools, available on online patient platforms, according to the flow of information and patient engagement concepts. We demonstrate the application of the framework using data collected from a purposive sample of eleven patient platforms, stratified by various attributes (for-profit/not-for-profit, single/multiple conditions, different conditions). This framework can help health care organizations in better understanding the processes supported by various tools, and thereby determining better ways to engage patients using web-based Platforms.
With the emerging use of speech technology in consumer goods, we experimented with the application of conversational agents for the communication of health information relating to HPV vaccine. Research have stated that one-to-one contact between providers and patients have a variety of positive influences on patients’ perception towards vaccines, even leading to uptake, compared to paper-based methods. We implemented a Wizard of Oz experiment that counsels adults with children (n=18) on the HPV vaccine, using an iPad tablet and dialogue script developed by public health collaborators, and for early testing of a prospective conversational agent in this area. Our early results show that non-vaccine hesitant parents believed that agent was easy to use and had capabilities needed, despite the desire for additional features. Our future work will involve developing a dialogue engine to provide automated dialogue interaction and future improvements and experimentation for the speech interface.
Canada has struggled to make digital health a reality. We identified 6 key issues that appear to impede progress: 1) an inability to coordinate the actions of a rapidly evolving set of stakeholders, 2) patients who lack the ability and resources to play a meaningful role in health system decision-making, 3) world-class innovation that doesn't reach the market, 4) an inability to kick-start interoperability projects that can catalyze system transformation, 5) an inability to procure early-stage innovative technologies at scale, and 6) an inability to share data seamlessly across organizational silos for patient coordination and care, health system management and research. We propose a set of policies and practices that can help Canada assess, monitor and provide feedback to stakeholders and citizens on how well they are progressing toward seamless digital health.
In this paper, we report our practical experience in designing and implementing a platform with Hadoop/MapReduce framework for supporting health Big Data Analytics. Three billion of emulated health raw data was constructed and cross-referenced with data profiles and metadata based on existing health data at the Island Health Authority, BC, Canada. The patient data was stored over a Hadoop Distributed File System to simulate a presentation of an entire health authority's information system. Then, a High Performance Computing platform called WestGrid was used to benchmark the performance of the platform via several data query tests. The work is important as very few implementation studies existed that tested a BDA platform applied to patient data of a health authority system.
Death, as a biological phenomenon, is well understood and a commonly employed endpoint for clinical trials. However, death identification and adjudication may be difficult for pragmatic clinical trials (PCT) that rely upon electronic health record and patient reported data. We propose a novel death identification and verification approach that is being used in the ToRsemide compArisoN with furoSemide FOR Management of Heart Failure (TRANSFORM-HF) PCT. We describe our hybrid approach that includes gathering information from clinical trial sites, a centralized call center, and National Death Index searches. Our methods detail how a possible death is triggered from each of these components and the types of information we require to verify a triggered death. Our different trigger/verification elements collectively define the TRANSFORM-HF PCT's definition of a death event.
The consideration of privacy and policy implications for big data is essential to designing patient-centered health technology. A literature review demonstrated a significant gap to moving forward with information technology in healthcare. Ovid Medline and Google Scholar were searched to identify papers related to health technology, patient outcomes, and policy implications of Big Data. The findings of this research showed that despite a robust legal framework and clear outline of the legislation, there exists an innovative opportunity for health technologies to evolve and become patient-centered by integrating privacy and policy knowledge in health information technology. This historical legal analysis is valuable to health system leaders, decision-makers, health technology companies that are creating innovative platforms, and clinicians in both Canada and the United States.
The Integrated Funding Model (IFM) is designed to measure the impact of a bundled model of health care for patients with Congestive Heart Failure (CHF) for a period of 60 days post discharge. CHF is a primary reason for patient admissions. The goal of this study is to gain insight into the effectiveness of the IFM pathway intervention on health care outcomes for persons living with CHF, using Health data Analytics.
Preventive clinical practice guidelines are valuable. However, they are often difficult for primary care providers to implement in the time sensitive primary care setting and alternate approaches warrant exploration. An app called CANBeWell was developed in an effort to allow consumers to identify appropriate guidelines for themselves. Two investigators conducted a heuristic evaluation to identify potential eHealth literacy and usability issues. Several recommendations were made to make CANBeWell easier for consumers to use and understand. CANBeWell is a promising app for deploying preventive guidelines directly to health consumers. Usability testing is planned for the next iteration to ensure that this app meets the needs and capabilities of health consumers.
Health care organizations are investing in system solutions that can be leveraged across the continuum of care (i.e. electronic medical records (EMR's); electronic health records (EHR's); health information exchanges (HIE's) and patient portals. The importance of these systems and how they have evolved over the past 30 years has been well researched. The value and benefits of these systems are therefore well known; however, it is estimated that most projects are typically 100% over budget and a year behind schedule [1, p. 2]. In this paper the authors examine what literature is available on agile project management methodologies in health care settings. A scoping review of the literature available specifically on agile methods use in implementing systems within health care was undertaken. Findings revealed there is very little literature available on agile project management methodologies used in health care IT systems implementations. The authors identify there is a strong need for research to look into project management methodologies and identify areas in the project lifecycle, where change is needed to increase clinical systems adoption.
In this study, a mobile cloud healthcare system was implemented to assist middle- and old-aged people with diabetes preventive healthcare. First of all, a prototype system was developed. It was a system relying on data mining computing technology and big data analytics. Besides, it was constructed under the environment architecture of VMware cloud computing. This mobile cloud healthcare system was developed via mobile devices. Its purpose was to set up a diabetes preventive healthcare service for users, and to further assess the usability of this mobile cloud care system.
OBJECTIVE:Understand the cognitive processes of telenurses' decision making with the use of health information systems (HIS), specifically Clinical Decision Support Systems (CDSS). In addition, identify the factors that influence how telenurses use CDSS.METHODS:Eight telenurses were recruited to manage two call scenarios in a clinical simulation. The call encounters were video recorded and the phone calls were audio recorded. The screens were also recorded to capture the HIS navigation. After the call was completed, the recordings were played back for the telenurse and discussion ensued regarding any issues with the system; this encounter was also recorded for further analysis.RESULTS:Several factors were identified that influenced how telenurses made decisions while using the CDSS. It was found that the decision ladder model could be applied to describe telenurse strategies while using CDSS. The purpose of this paper is to describe the emerging factors that influence telenurses' decision making during a clinical simulation study in a telenursing call centre.
Usability testing is a vital component in the development of any digital innovation. Thought Spot, a mental health and wellness mobile application designed for and by transition-aged youth, underwent three distinct phases of usability testing (lab testing, field testing and heuristic evaluations). Testing highlighted that participants generally had a positive experience with the platform. Although some app functions were initially difficult for users, positive trends in learnability were observed. The key lesson learned from this process is the need for iterative testing timelines, concurrent with app development.
This paper describes a method by which the Web Ontology Language (OWL) can be used to specify a highly structured health record, following internationally recognised standards such as ISO 13606 and HL7 CDA. The structured record is coded using schemes such as SNOMED, ICD or LOINC, with the coding applied statically, on the basis of the predefined structure, or dynamically, on the basis of data values entered in the health record. The highly structured, coded record can then be linked with external knowledge sources which are themselves coded using the Resource Description Framework. These methods have been used to implement dynamic decision support in the open source cityEHR health records system. The effectiveness of the decision support depends on the scope and quality of the clinical coding and the sophistication of the algorithm used to match the structured record with knowledge sources.
