Hsiao Hsien Rau

Developing Electronic Health Records in Taiwan

The design of the Taiwan Electronic Medical Record Template (TMT) provides the basis for developing a document-based information standard and an information interoperability infrastructure for Taiwans healthcare system. An additional benefit of TMT is its strong data security structure.

Prediction of survival in patients with liver cancer using artificial neural networks and classification and regression trees

This study established a survival prediction model for liver cancer using data mining technology. The data were collected from the cancer registration database of a medical center in Northern Taiwan between 2004 and 2008. A total of 227 patients were newly diagnosed with liver cancer during this time. With literature review, and expert consultation, nine variables pertaining to liver cancer survival were analyzed using t-test and chi-square test. Six variables showed significant. Artificial neural network (ANN) and classification and regression tree (CART) were adopted as prediction models. The models were tested in three conditions; one variable (clinical stage alone), six significant variables, and all nine variables (significant and non significant). 5-year survival was the output prediction. The results showed that the ANN model with nine input variables was superior predictor of survival (p<0.001). The area under receiver operating characteristic curve (AUC) was 0.915, 0.87, 0.88, and 0.87 for accuracy, sensitivity, and specificity respectively. The ANN model is significant more accurate than CART model when predict survival for liver cancer and provide patients information for understanding the treatment outcomes.

Effect of weather and time on trauma events determined using emergency medical service registry data

INTRODUCTION Trauma admissions are associated with weather and temporal factors; however, previous study results regarding these factors are contradictory. We hypothesised that weather and temporal factors have different effects on specific trauma events in an emergency medical service (EMS) system. METHODS EMS data from January 1, 2009, to December 31, 2010, were obtained from the fire department of Taipei City and associated with the local weather data. EMS trauma events were categorised into total trauma, traffic accidents (TAs), motorbike accidents (MBAs), and falls. Hourly data on trauma patients were analysed using the zero-inflated Poisson model. RESULTS The hourly incidence of total trauma increased with the magnitude of precipitation (incidence rate ratio [IRR]=1.06, 1.09, and 1.11 in light, moderate, and heavy rain, respectively), and this effect was more prominent in fall patients than in patients with other injuries (IRR=1.07, 1.21, and 1.32). However, the hourly incidence of TAs and MBAs was associated only with light rain (IRR=1.11 and 1.06, respectively). An hour of sunshine exposure was associated with an increase in the hourly incidence of all groups, and higher temperatures were associated with an increased hourly incidence of total trauma, TAs, and MBAs, but not falls. The hourly incidence of falls increased only in late fall and winter. Compared with the hourly incidence between 3 am and 7 am, the hourly incidence of all groups plateaued between 7 am and 11 pm and declined from 11 pm to 3 am. During the plateau period, 2 peaks in the incidence of TAs (IRR=5.03 and 5.07, respectively) and MBAs (IRR=5.81 and 5.51, respectively) were observed during 7-11 am and 3-7 pm. The hourly incidence of total trauma, TAs, and MBAs plateaued during workdays, peaked on Fridays, declined on Saturdays, and troughed on Sundays. The incidence of falls increased only on Mondays (IRR=1.09). CONCLUSIONS Weather and temporal factors had different impacts on the incidence of traffic-related accidents and falls. Therefore, EMS data may have implications in preventing injuries and planning resource use for prehospital trauma rescue.

Association between Dietary Patterns and Cardiovascular Risk Factors among Middle-Aged and Elderly Adults in Taiwan: A Population-Based Study from 2003 to 2012

Background Cardiovascular disease (CVD) is one of the leading causes of mortality and loss of disability-adjusted life years in developed countries. This study derived a dietary pattern using an a priori method and additionally derived dietary patterns using a posteriori methods, and assessed the relationship with CVD risk factors in Taiwanese middle-aged and elderly adults. Methods Cross-sectional analyses of 62,965 subjects aged 40 years and above from the Mei Jau (MJ) database collected between 2003 and 2012 in Taiwan. Diet was assessed using a 22 item semi-quantitative food frequency questionnaire. Using this information, three dietary patterns were generated. The a priori diet was labeled the Taiwanese dietary pattern and was derived using hypothesized effect of 22 food groups, while two a posteriori dietary patterns, “vegi-fruits” and “meat-processed”, were derived using principal component analysis. The association between dietary patterns and a range of CVD risk factors (i.e. blood lipids, blood glucose and C-reactive protein) was evaluated using linear regression. Results The results showed that high intake (Q5, quintile 5) of Taiwanese diet was negatively associated with CVD risk factors at (p < 0.001, model 3), but not with triacylglycerol. In addition, high intake of vegi-fruit dietary pattern (Q5) was negatively associated with CVD risk factors (p < 0.001), but not with high-density lipoprotein, while high consumption of meat-processed dietary pattern (Q5) was positively associated with CVD risk factors (p < 0.001), but negatively related with triacylglycerol in Q3 level and no association with C-reactive protein. Conclusion A negative association was observed between Taiwanese or vegi-fruit dietary patterns and CVD risk factors, while a positive association was found between meat-processed dietary pattern and CVD risk factors. The findings suggested that a diet rich in vegetables and fruits has a beneficial effect in the management of CVD risk factors.

Association of Dietary Patterns with Components of Metabolic Syndrome and Inflammation among Middle-Aged and Older Adults with Metabolic Syndrome in Taiwan

This study examined the correlation of dietary patterns with components of metabolic syndrome (MetS) and inflammation among middle-aged and older adults with MetS in Taiwan. This cross-sectional study used data from the Mei Jau International Health Management Institution in Taiwan between 2004 and 2013. A total of 26,016 subjects aged 35 years and above were selected for analysis. MetS was defined according to the International Diabetes Federation. Three dietary patterns were identified by principal component analysis. High intake of a meat–instant food dietary pattern (rich in animal protein, saturated fat, sweets, sodium, and food additives) was positively associated with components of MetS and C-reactive protein (CRP), while high intake of a vege–seafood dietary pattern (rich in dietary fiber, vitamins, minerals, and unsaturated fat) or a cereal–dairy dietary pattern (rich in dietary fiber, antioxidants, phytochemicals, complex carbohydrate, prebiotics, and probiotics) was inversely associated with components of MetS and CRP. Our findings suggested that intake of a vege–seafood dietary pattern or a cereal–dairy dietary pattern decreased the risk of developing MetS and inflammation among middle-aged and older adults with MetS.

A Resource-Sharing Platform for Trading Biomedical Intellectual Property

In this paper, a Web-based platform, BiolPMall, consolidates research results from different universities to create a nationwide resource for biotech development. Its unique sharing mechanism for trading and analyzing intellectual property disseminates viable research results to promote IP commercialization. BioIPMall is based on taxonomy system to efficiently classify and categorize biotechnology, and thus facilitate resource and knowledge sharing. The e-commerce-type platforms search capabilities help it match the needs and requirements of IP providers and buyers, facilitating the transfer of biotechnologies from academia into industrial applications.

Information Technology in the Development of Electronic Health Records in Taiwan

The use of electronic medical record is the developmental tendency in Hospital Information Systems (HIS). It can be expanded to form Electronic Health Records (EHR). Its value consists of its ability to integrate the health information of patients from different sources. The Taiwan Electronic Medical Record Template (TMT) was developed to provide a basic structure of reference for establishing electronic medical records in the unique medical environment in Taiwan. This paper will review past developments in electronic medical record between 2004 and 2009 in Taiwan and scrutinize the current application and development of international electronic medical record exchange standards. Additionally, this study will address the TMT construction process and its information architecture as well as its information safety design and describe the TMT information transfer mechanism and present some application samples. Finally, the researchers will present concrete suggestions conducive to the study of future medical information exchange standards.

Applying Taiwan EMR Exchange Architecture to Establish a Mobile-Healthcare Management System for Chronic Disease in an Aboriginal Tribe

The information system of Mobile-healthcare Management is using the newly and sophisticated technology to collocate physicians and nurses’ professional skills. It may improve the healthcare quality of remote areas and increase their medical resources. This research aims at establishing a proper clinical medical information system. Because of most of the aboriginal tribes lack medical service, it is hard for people to visit hospital, so it need the case manager visit the patient weekly, and record the patients’ situation on paper by manually, this research want to build a system to solve some problems. Consider the information device insufficiency in remote areas and need high mobility of peripatetic medical service, we use tablet PC to as a hardware and using it in a tribe which is located in the east of Taiwan. This system will make case managers get patient’s basic and clinical data in their hospitals and also get these data from another hospitals through electronic medical record exchange center. Therefore, it can help case managers know the patients’ conditions before they go to provide care to the patient.

Implementing globally unique identifier architecture in date collection for a health management study in taiwan aboriginal tribe

In present, more and more attention has been put on the effort of protection of personal data and also new encryption technologies are derived. In this article, we introduce a personal information protection technology, global unique identifier (GUID), which is developed by National Institutes of Health U.S. and used for personal health information protection. The GUID is an identifier that allows researchers to associate and share data specific to a study participant without using or exposing personally identifiable information (PII). The GUID is made up of random alphanumeric characters and is not directly generated from PII/Protected Health Information (PHI). It has been approved by the NIH/USA office General Counsel for secure sharing of anonymized database. In our study, we used GUID as key identifier for health data collection from aboriginal tribe in a health promotion project.

Constructing a Resource-Sharing Platform for Biomedical IP Trading

This project aims at designing and building a resource-sharing and online transaction platform to support and facilitate the technology transfer from the biotech academia to the industry and to prosper Biotech industry in Taiwan. This project constructs a web-based platform, namely BioIPMall, for biomedical IP trading, analyzing and developing strategy. To facilitate the classification and categorization of biotechnology, a tree-structured classification framework was constructed to create the taxonomy system in this project. The framework is composed of two main categories: “Industrial Application” and “Biotechnology” and 259 sub-categories totally. This biotechnology classification tree has been used to facilitate data mining and tech matchmaking process in BioIPMall. A prototypical business model was developed for providing IP management and technology transfer services. Currently 342 bio-related patents or technologies have been gathered from research institutes and have been posted on BioIPMall. Website available at: http://www.bioipmall.com.tw/.