Heng-Shuen Chen

Review of telemedicine projects in Taiwan

Taiwan is a heavily populated country, with a small land area and many mountains and isolated islands. Because medical resources are unequally distributed, high quality accessible medical care is a major problem in rural areas. Medical personnel are unwilling to practice in rural areas because of fear of isolation from peers and lack of continuing medical education (CME) in those areas. Telemedicine provides a timeless and spaceless measure for teleconsultation and education. The development of telemedicine in Taiwan began under the National Information Infrastructure (NII) Project. Distance education and teleconsultation were the first experimental projects during the initiation research stage. The cost and effectiveness of the hardware and network bandwidth were evaluated. In the promotion research stage, applications in different medical disciplines were tested to promote multipoint videoconference, electronic journals and VOD. Investigation of user satisfaction put on more emphasis on improving application functions. In 1998, a new Cyber Medical Center (CMC) international collaboration project was begun, integrating technologies of multimedia, networking, database management, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the web. A Taiwan mirror site of Virtual Hospital and two international telemedicine trials through Next Generation Internet (NGI) were done at the end of 1998. In the future, telemedicine systems in Taiwan are expected to combine the Internet and broadband CATV, ADSL, and DBS networking to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend to every household.

Application of Tele-Ultrasound in Emergency Medical Services

In emergency medical services, portable ultrasound scanners have the potential to become new-age stethoscopes for emergency physicians. For trauma cases in particular, portable ultrasound scanners can scan the chest and abdomen of emergency patients both rapidly and conveniently. This study describes the development of tele-ultrasound for pre-diagnosis in a medical emergency setting as a part of the updated Mobile Hospital Emergency Medical System (MHEMS). An emergency medical technician can provide an emergency physician with a patients ultrasound images and medical information during the patients pre-hospitalization and transportation period using a combination of the MHEMS, the portable ultrasound scanner, and the onboard 3G communication capabilities. The MHEMS includes a Dispatch and Mission Control Center that facilitates the communication between the Emergency Department of a specified hospital, the systems aboard the ambulance. Early receipt of information relevant to the patient will enhance pre-diagnosis options for on-duty emergency physicians and allow for a hospitals emergency department to promptly prepare necessary surgical instruments or beds. Furthermore, emergency medical technicians can also obtain instructions from on-duty physicians to enhance damage and disaster control ability in critical moments.

A Study of Ubiquitous Monitor with RFID in an Elderly Nursing Home

The percentage of the elderly population grew rapidly in recent years, so the tremendous life and health care needs became an issue of focus in an aging society. The Elderly Nursing Home plays an important role and intends to provide a comfortable environment and living space and serve as safe and healthy place for the elderly. However, the frailty and fragility of the elderly in both physiologically and psychologically make it an uneasy task. To enhance the service and care quality of an Elderly Nursing Home, a ubiquitous monitor system integrated with biosensors and radio frequency identification (RFID) technology was implemented as a prototyping system. The system was expected to improve the activity of daily living (ADL) of the residents, to detect the emergencies or accidents such as stroke, falling down, fainting, and heart attack, in order to enhance the quality of care and promote efficiency at the same time.

Usability Evaluation of Mobile Medical Treatment Carts: Another Explanation by Information Engineers

Healthcare services integration is a critical task as it attempts to reform the user practices. In response to the request of facilities upgrade, we perform a usability evaluation of the mobile medical treatment carts (MMTC) installed in the Emergency Medicine Department of our healthcare enterprise. A survey conducted in August 2006 identified that our experimental area needs some improvements to support the MMTC adoption. For example, the MMTC can accompany with several popular nursing care items. Follow-up several undertaken investigations indicated that our expectation of the MMTC solution had been reached. Given the evident heterogeneity of viewpoints, it is imperative for a healthcare enterprise to broadly ascertain the requirements of end users before investing in any information technologies.

A cloud based Bluetooth Low Energy tracking system for dementia patients

Location based services of trackers can keep dementia patients safe, but traditional GPS tracker or smartphone based solution device need to be removed for recharging or when taking bath. A water-proof Bluetooth Low Energy (BLE) tag with a CR2302 battery can be used over a year so that it can be worn all the time. By combining BLE technology, smartphones and cloud services provided by Google, we can build a practical location and tracking system with minimal cost.

Context-based model for mobile electronic medical records

Language is used to model the EMR architecture, called Context-based Model, in an object-oriented way. The multi-layer infrastructure, applied to the mobile EMR and wireless telecommunication network in NTUH. NTUH has more than two years of experiences on using theses devices in the FM department. Physicians are satisfied to access mobile patient records via their handheld computers. These results inspire us confidence to construct a more dependable architecture and promote it to community-oriented primary care in the future, such that the point-of-care can be fulfilled not only inside a hospital but also in anywhere. Our Context-based Model is a suitable model for medical records modeling.

Pilot Study on a Community-Based Ubiquitous Healthcare System for Current and Retired University Employees

Entering the 21st century, the aging process and increasing chronic diseases in Taiwan society have become more prevalent. To deal with the problem, we develop a ubiquitous healthcare (u-Health) system platform that integrates wireless telecommunication, sensor network, and information technology to take care of patients having chronic diseases. The u-Health system provides not only telecare at home setting, but also a health community network which can further integrate medical care and life care and emphasize on patent humanity and dignity. For this purpose, a holistic u-Health system focusing on the physiological, psychosocial, arts, recreational, and even spiritual aspects of patients was implemented for people living in the community. In this study, we applied our community based u-Health system to the current and retired employees of National Taiwan University (NTU) who had at least one of the following chronic diseases: hypertension, diabetes mellitus and obesity, and required long term follow up and treatment. A community medical group (CMG) which is formed with family doctors from the Family Medicine Department of NTU Hospital, the Yung-Ho Branch of Cardinal Tien Hospital, NTU Health Center, and several other local clinics in Taipei City was in charge of the medical care along with a dedicated case managing nurse for the medical care at outpatient clinics, home telecare and 24-hour health consultation. Using this integrated community-based system is expected to provide a comprehensive and ubiquitous healthcare and eventually improve the quality of care by increasing compliance and reducing the complications of chronic diseases.

An Agile Enterprise Regulation Architecture for Health Information Security Management

Information security management for healthcare enterprises is complex as well as mission critical. Information technology requests from clinical users are of such urgency that the information office should do its best to achieve as many user requests as possible at a high service level using swift security policies. This research proposes the Agile Enterprise Regulation Architecture (AERA) of information security management for healthcare enterprises to implement as part of the electronic health record process. Survey outcomes and evidential experiences from a sample of medical center users proved that AERA encourages the information officials and enterprise administrators to overcome the challenges faced within an electronically equipped hospital.

Application of wireless network in a medical emergency service network

Life is priceless, so pre-hospital evaluation and management is important in emergency medical service. To enhance the quality of emergency medical service, the mobile hospital emergency medical system (MHMES) is designed to provide for e-prepared services. This system could improve the communication among the ambulance, the dispatch and mission control center and the emergency department of the hospital via a wireless network, and provide comprehensive service during pre-hospital resuscitation and transportation of the patients. The MHMES consists of three sub-systems located in three sites respectively, dispatch and mission control center, emergency department of hospital and ambulance. It includes electrical map to track the ambulances and transfer patients situation and histories with the hospital to follow the symptom. Therefore, this system would be able to reduce the mortality during transportation and enhance the safety and quality of emergency medical service. It structures an emergency informatics system of National Taiwan University Hospital to provide a application of wireless network in a medical emergency service network.

The Strategic Use of Standardized Information Exchange Technology in a University Health System

This article illustrates a Web-based health information system that is comprised of specific information exchange standards related to health information for healthcare services in National Taiwan University Health System. Through multidisciplinary teamwork, medical and informatics experts collaborated and studied on system scope definition, standard selection challenges, system implementation barriers, system management outcomes, and further expandability of other systems. After user requirement analysis and prototyping, from 2005 to 2008, an online clinical decision support system with multiple functions of reminding and information push was implemented. It was to replace its original legacy systems and serve among the main hospital and three branches of 180-200 clinics and 7,500-8,000 patient visits per day. To evaluate the effectiveness of this system, user surveys were performed, which revealed that the average score of user satisfaction increased from 2.80 to 3.18 on a 4-point scale. Among the items, especially e-learning for training service, courtesy communications for system requests, and courtesy communications for system operations showed statistically significant improvement. From this study, the authors concluded that standardized information exchange technologies can be used to create a brand new enterprise value and steadily obtain more competitive advantages for a prestige healthcare system.