Health Informaticshttp://hdl.handle.net/10222/146642024-03-19T11:03:21Z2024-03-19T11:03:21ZIntegrated Quality DatabaseIzadi, Armanhttp://hdl.handle.net/10222/733222017-12-21T16:54:24Z2017-08-18T00:00:00ZIntegrated Quality Database
Izadi, Arman
The organization: EMC provides ground and air ambulance services to Nova Scotians in emergencies. The services range from basic to advanced life support. Telehealth (811) is also part of this company which provides medical consultation to Nova Scotians for non-emergency conditions.
The internship work: Since the organization uses several different solutions that are not standard and cannot exchange data with each other, different departments should query the databases and review and approve the data, according to their reporting needs. Creating a database to integrate the data from different sources (internal and external), so that, the records could be reviewed only once (not several times by different departments) was the main purpose of the project. I was responsible for requirement assessment, planning, categorization of data, database design and implementation, as well as documentation. I created a relational database in SQL Server with about 70 tables (including the reference tables) that could meet their reporting needs, primarily for cardiac arrest cases, but I designed the structure of the database in a way that other conditions can also be added if needed.
How the internship work relates to health informatics
The project was related to most of the courses in the master of health informatics program, including, project management, health information flow and use, flow and standards, systems and issues, as well as networks and web. The project management course helped me develop a plan for the project, using Microsoft Project. The health information flow and use, and the flow and standards courses made it possible for me to develop a storyboard, recognize the processes, assess the work flow, and understand the indicators. The systems and issues course helped me with the data flow and systems boundaries. Finally, the networks and web helped me identify the entities, categorize the data and the tables, build a logical relationship between the tables and design the database. Querying the existing sources of data helped me in determining the data types and the possible values for each attribute and creating the reference tables.
The problems in EMC that merits a health informatics solution
The main problem is that the software solutions that are used in the company are neither logically related nor standard (lack of interoperability). Reporting and conducting research requires a combination of automatic integration of data from some sources and manual data entry from other sources, as well as manual editing and approval of the integrated data which is labor-intensive. In addition, there are many fields in the application where user errors could be limited but they have been ignored by the vendors. Users have to type in the textboxes in the applications and the user errors have significantly affected the validity of the stored data. The same problem is seen with health card numbers, which are manually entered and card scanners are not used.
Conclusion
The future solutions should see EHS companies as one system and extend the boundaries of their systems or be able to exchange data automatically within the organization. An effective system enables the company to schedule shifts according to availability of the paramedics (the administration system) and the ambulances (the fleet maintenance system), and provide a logical relationship between the computer-assisted dispatch system (CAD) and the electronic patient care record (ePCR), while facilitating transfer of data from defibrillation devices and other subsystems. The current systems are not standard and cannot
exchange data with external entities. Integrating the existing solutions as well as using standard semantic codes for data exchange is one of the options. The software companies should try to limit user errors by creating reference tables from historical data or scientific resources, and by using other methods such as card scanners. Some of the current software solutions are not user-friendly and the companies should try to customize their solutions according to the type of the service
summer internship report - 2017
2017-08-18T00:00:00ZClinical Alarm Management Project Neonatal Intensive Care Unit (NICU) IWK Health Centre, Halifax, NSAbouelela, Marwanhttp://hdl.handle.net/10222/733212017-12-21T16:54:24Z2017-08-18T00:00:00ZClinical Alarm Management Project Neonatal Intensive Care Unit (NICU) IWK Health Centre, Halifax, NS
Abouelela, Marwan
Research confirms that more than 70% of clinical alarms are unnecessary. Exposing clinicians to high volume of undesirable alarms may cause alarm fatigue associated with increasing patient risks and deaths. Alarm fatigue is mainly driven by the excess number of non-actionable alarms which are the alarms associated with self-correcting conditions that do not need clinical intervention. Alarm fatigue is considered as a common and significant healthcare problem that needs special attention. The Emergency Care and Research Institute (ECRI) recommends some strategies to eliminate the alarm fatigue and emphasizes on the importance of involving clinical staff, especially nurses, while working on those strategies. The main objective is to eradicate the alarm fatigue to pave the way for a safer and improved healthcare environment.
The current open-bay NICU at IWK Health Centre was opened in 1992 and was considered as a state of the art at the time. Concerns with this setting include: lack of privacy and confidentiality, no individual control over the environment in terms of noise, light, temperature, and most unfavorable, a lack of space for families to stay with their vulnerable, critically ill infants. Recently, IWK Health Centre has decided to build a new NICU single-family room unit which is expected to solve all issues of the current open-bay model. Families will have a private room with double sleep sofa, three-piece washroom, and privacy doors which is anticipated to increase their comfort and willingness to stay for prolonged times with their baby. Based on many researches, the new model of care will provide numerous benefits for infants, families and staff.
The principle purpose of the internship project was to work with clinical teams and IT teams under the umbrella and guidance of the Biomedical Engineering Department within IWK Health Centre to establish an effective clinical alarm management strategy for NICU and reduce their alarm fatigue. Then, to propose a workflow best practice for assigning care teams to the patient monitors and End User Devices (EUDs) for effective utilization in the new NICU single-family room care setting. The scope of work has been defined to the primary alarm signals produced by patient monitors (Philips) with its various locations inside NICU (please view figure 3), in addition to the primary alarm signals produced by two types of ventilators (Servo-I and VN-500). Patient monitors were desired to be fully integrated with the middleware (Connexall) to produce and escalate secondary alarm signals to the care team EUDs (iPhones). A clinical alarm steering committee was created to provide strategic directions and secure the necessary approvals. Similarly, a NICU task force was created to accomplish major tasks in a timely manner aiming at meeting the project deadline through working in a team collaborative environment. The internship road map and milestones were discussed and agreed with all key stakeholders early in the project.
The internship project ended up by proposing a reasonable new clinical alarm strategy for physiological monitoring and ventilators which represent the majority and most crucial monitoring inside the NICU. The project final deliverables (please view appendix B through H) were submitted to both IT teams and Biomedical Engineering Department at the end of the project for their future work. Based on alarm data for three-real NICU case studies that have been collected during the course of the internship, non-actionable alarms represent an average of more than 60% of the total daily alarms inside NICU. Considerable delta gains of -15%, -30% and -46% are anticipated to be achieved if the non-actionable alarms inside NICU are reduced by 25%, 50% or 75% respectively for the same or similar cases.
The internship project was a great learning experience and was a remarkable tool to implement what have been learnt as a clinician and as a prospective health informatician in a real-life experience. It was a concrete opportunity to implement health informatics concepts in a high-quality project that included a complicated and significant healthcare problem like alarm fatigue. Also, it was a wonderful opportunity to practice working collaboratively with other healthcare professionals in a patient centric approach to accomplish project deliverables with a challenging due time. As planned, the internship project has been completed in sixteen weeks under the supervision and mentorship of Manager, Biomedical Engineering at IWK Health Centre. The internship project was full of challenges but at the same time was interesting, meaningful, worthy and rewarding.
summer internship report - 2017
2017-08-18T00:00:00ZUtilising Bioportal to map terms in the Canada Vigilance Adverse Reaction Online Database to various terminologies and to identify the ideal terminology to supplement MedDRA to aid in Pharmacovigilance activities.Thandavan, Rahulhttp://hdl.handle.net/10222/732442017-12-21T16:54:24Z2017-08-18T00:00:00ZUtilising Bioportal to map terms in the Canada Vigilance Adverse Reaction Online Database to various terminologies and to identify the ideal terminology to supplement MedDRA to aid in Pharmacovigilance activities.
Thandavan, Rahul
The Canada Vigilance Program is Health Canada’s post marketing surveillance program that collects and analyzes data related to the adverse events of health products that are marketed in Canada. Health Canada periodically reviews these events and releases safety profile of drugs based on the reported events. The information collected by the Canada Vigilance Program is made available publicly through an online database. This project consists of two main objectives –
1) To map the adverse reaction terms and drug names in the online database to terminologies like SNOMED-CT, MeSH, UMLS and RxNORM and to identify the best approach to map the terms.
2) To identify the best terminology which can help in grouping previously unrelated fine grained MedDRA terms for use in the analysis of adverse events.
The mappings were performed through the Bioportal web service of the National Centre for Biomedical Ontology(NCBO) and then were analysed to determine the accuracy and the coverage of the mappings. The MedDRA terminology that is used for adverse event reporting is a fine-grained terminology so this project focussed on identifying an ideal terminology to group together similar MedDRA terms that are not previously related through MedDRA hierarchy.
This project is highly relevant to Health Informatics as it deals in entirety with healthcare terminologies like SNOMED-CT, UMLS, MeSH, MedDRA etc. which are the basis upon which health information is stored, shared, accessed and analysed. This project was an excellent opportunity to learn a new coding language like python and to learn on using REST-API for mapping terms .It also provided exposure in using large databases. At the end of this internship, the clinical terms were mapped to the identified terminologies and an ideal process to map the terms to various terminologies has been documented. Also, groupings of related MedDRA terms that were not related previously through the MedDRA hierarchy have been identified utilising SNOMED-CT and documented.
The background of the objectives, methods followed and their results, as well as problems and recommended solutions are included in this report.
summer internship - 2017
2017-08-18T00:00:00ZInvestigating Canadian Business & System Requirements at Allscripts CanadaMiljanovic, Marahttp://hdl.handle.net/10222/732382017-12-21T16:54:24Z2017-08-11T00:00:00ZInvestigating Canadian Business & System Requirements at Allscripts Canada
Miljanovic, Mara
Understanding the foundational principles upon which our healthcare organization is built, is perhaps one of the most crucial things when considering the implementation of healthcare technology within different clinical settings. While performing the internship work-term at Allscripts Canada, the author utilized various knowledge bases and sources in order to fully understand the key principles of healthcare information technology implementation.
Allscripts is a multinational enterprise that equips healthcare providers with electronic health record (EHR) technology, including but not limited to, solutions for patient engagement and care coordination, as well as analytics and finance management. During their term at Allscripts, the author was involved with several multidisciplinary projects. The author contributed to the following projects and initiatives:
o 2bprecise Health: a precision medicine platform using medical ontologies to store and integrate genomic data into healthcare workflows. This project was focused primarily on developing a deep understanding of the product and aligning these features, technical specifications and goals with like-minded research institutions within Canada to build new alliances. The outcome was a future plan to partner with Canadian research institutions and explore grant funding within Canada.
o Follow My Health (FMH): a personal health record (PHR) platform focusing on patient engagement and collaboration with healthcare providers. This project was heavily based on privacy, security and interoperability standards within Canada. The outcome was a complete business requirements plan, projecting towards Canada Health Infoway certification of the PHR platform.
o Discharge Abstract Database (DAD) & National Ambulatory Care Reporting System (NACRS): data repositories capturing information pertaining to administrative, clinical and demographic information upon discharge and for community-based ambulatory care. This project was centered on gathering information pertaining to submission requirements for CIHI. Knowledge regarding data policies, ICD-10-CA standards and health ministry infrastructure was needed to compile relevant and usable information.
o InterRAI-MDS 2.0: InterRAI clinical assessment protocols are individualized assessments and care-plans for residents within long-term care facilities, used to plan and measure care outcomes in standardized and evidence-based ways. This project analyzed the business requirements needed to initiate computerization of these assessment protocols.
At the end of this internship experience, the author was successfully able to identify opportune research avenues for genomic technology, to gather and analyze business requirements pertaining to privacy and security standards within Canada, to succinctly explore CIHI standards for submission to DAD and NACRS and to analyze InterRAI-MDS 2.0 assessment protocols within clinical workflow scenarios. By drawing upon several knowledge sources such as business process modelling, international health classification and coding schemas/systems, health policy standards and legal frameworks, the author was able to gain invaluable experience within the domain of Health Informatics.
This internship report will introduce the background information pertaining to the workplace and the project concepts, and will then describe in full the internship duties as well as the learning outcomes, project contributions, recommendations and proposed solutions. Finally, as concluding remarks, this report will outline the value of this opportunity to a student’s professional and educational paths.
summer internship - 2017
2017-08-11T00:00:00Z