Louise Pape-Haugaard

Comparison between Mother, ActiGraph wGT3X-BT, and a hand tally for measuring steps at various walking speeds under controlled conditions

Introduction Walking is endorsed as health enhancing and is the most common type of physical activity among older adults. Accelerometers are superior to self-reports when measuring steps, however, if they are to be used by clinicians the validity is of great importance. The aim of this study was to investigate the criterion validity of Mother and ActiGraph wGT3X-BT in measuring steps by comparing the devices to a hand tally under controlled conditions in healthy participants. Methods Thirty healthy participants were fitted with a belt containing the sensor of Mother (Motion Cookie) and ActiGraph. Participants walked on a treadmill for two minutes at each of the following speeds; 3.2, 4.8, and 6.4 km/h. The treadmill walking was video recorded and actual steps were subsequently determined by using a hand tally. Wilcoxon’s signed ranks test was used to determine whether Mother and ActiGraph measured an identical number of steps compared to the hand tally. Intraclass correlation coefficients were calculated to determine the relationship and Root Mean Square error was calculated to investigate the average error between the devices and the hand tally. Percent differences (PD) were calculated for between-instrument agreement (Mother vs. the hand tally and ActiGraph vs. the hand tally) and PDs below 3% were interpreted as acceptable and clinically irrelevant. Results Mother and ActiGraph under-counted steps significantly compared to the hand tally at all walking speeds (p < 0.001). Mother had a median of total differences of 9.5 steps (IQR = 10) and ActiGraph 59 steps (IQR = 77). Mother had smaller PDs at all speeds especially at 3.2 km/h (2.5% compared to 26.7%). Mother showed excellent ICC values ≥0.88 (0.51–0.96) at all speeds whilst ActiGraph had poor and fair to good ICC values ranging from 0.03 (−0.09–0.21) at a speed of 3.2 km/h to 0.64 (0.16–0.84) at a speed of 6.4 km/h. Conclusion Mother provides valid measures of steps at walking speeds of 3.2, 4.8, and 6.4 km/h with clinically irrelevant deviations compared to a hand tally while ActiGraph only provides valid measurements at 6.4 km/h based on the 3% criterion. These results have significant potential for valid objective measurements of low walking speeds. However, further research should investigate the validity of Mother in patients at even slower walking speeds and in free-living conditions.

Design of a Tablet Computer App for Facilitation of a Molecular Blood Culture Test in Clinical Microbiology and Preliminary Usability Evaluation

Background User mobility is an important aspect of the development of clinical information systems for health care professionals. Mobile phones and tablet computers have obtained widespread use by health care professionals, offering an opportunity for supporting the access to patient information through specialized applications (apps) while supporting the mobility of the users. The use of apps for mobile phones and tablet computers may support workflow of complex tasks, for example, molecular-based diagnostic tests in clinical microbiology. Multiplex Blood Culture Test (MuxBCT) is a molecular-based diagnostic test used for rapid identification of pathogens in positive blood cultures. To facilitate the workflow of the MuxBCT, a specialized tablet computer app was developed as an accessory to the diagnostic test. The app aims to reduce the complexity of the test by step-by-step guidance of microscopy and to assist users in reaching an exact bacterial or fungal diagnosis based on blood specimen observations and controls. Additionally, the app allows for entry of test results, and communication thereof to the laboratory information system (LIS). Objective The objective of the study was to describe the design considerations of the MuxBCT app and the results of a preliminary usability evaluation. Methods The MuxBCT tablet app was developed and set up for use in a clinical microbiology laboratory. A near-live simulation study was conducted in the clinical microbiology laboratory to evaluate the usability of the MuxBCT app. The study was designed to achieve a high degree of realism as participants carried out a scenario representing the context of use for the MuxBCT app. As the MuxBCT was under development, the scenario involved the use of molecular blood culture tests similar to the MuxBCT for identification of microorganisms from positive blood culture samples. The study participants were observed, and their interactions with the app were recorded. After the study, the participants were debriefed to clarify observations. Results Four medical laboratory technicians, for example, representative of end users of the app, participated in the clinical simulation study. Using the MuxBCT app, the study participants successfully identified and reported all microorganisms from the positive blood cultures examined. Three of the four participants reported that they found the app useful, while one study participant reported that she would prefer to make notes on paper and later enter them into the LIS. Conclusions The preliminary usability evaluation results indicate that use of the MuxBCT tablet app can facilitate the workflow of the MuxBCT diagnostic test.

Participatory heuristic evaluation of a tablet computer system for clinical microbiology

MultiplexBCT is a molecular-based diagnostic test for rapid identification of microorganisms in positive blood cultures. A MultiplexBCT Android tablet computer application is being developed as an accessory to the diagnostic test. The aim of the application is to facility the end users workflow by supporting data entry and communication of the MultiplexBCT test results in a hospital environment. This paper reports the results and benefit of a participatory heuristic evaluation conducted on the MultiplexBCT application. The design is an extension of heuristic evaluation that includes end users as work-domain experts to complement usability experts for inspection of a user interface. The user interface assessment identified 86 heuristic violations, which consisted of both product- and domain-related issues. These results will be used to guide further development of the MultiplexBCT application to ensure that the system will fully support the workflow of the end users when using the MultiplexBCT diagnostic test.

A future-proof architecture for telemedicine using loose-coupled modules and HL7 FHIR

BACKGROUND AND OBJECTIVES Most telemedicine solutions are proprietary and disease specific which cause a heterogeneous and silo-oriented system landscape with limited interoperability. Solving the interoperability problem would require a strong focus on data integration and standardization in telemedicine infrastructures. Our objective was to suggest a future-proof architecture, that consisted of small loose-coupled modules to allow flexible integration with new and existing services, and the use of international standards to allow high re-usability of modules, and interoperability in the health IT landscape. METHODS We identified core features of our future-proof architecture as the following (1) To provide extended functionality the system should be designed as a core with modules. Database handling and implementation of security protocols are modules, to improve flexibility compared to other frameworks. (2) To ensure loosely coupled modules the system should implement an inversion of control mechanism. (3) A focus on ease of implementation requires the system should use HL7 FHIR (Fast Interoperable Health Resources) as the primary standard because it is based on web-technologies. RESULTS We evaluated the feasibility of our architecture by developing an open source implementation of the system called ORDS. ORDS is written in TypeScript, and makes use of the Express Framework and HL7 FHIR DSTU2. The code is distributed on GitHub. All modules have been tested unit wise, but end-to-end testing awaits our first clinical example implementations. CONCLUSIONS Our study showed that highly adaptable and yet interoperable core frameworks for telemedicine can be designed and implemented. Future work includes implementation of a clinical use case and evaluation.

Exploring end users' system requirements for a handheld computer supporting both sepsis test workflow and current IT solutions.

Sepsis is a systemic response associated with very high mortality. Early initiation of the correct antimicrobial therapy remains a cornerstone in the treatment of sepsis. Currently, a new microbiological test is under development, which aims to detect major, prevalent pathogens in positive blood cultures within an hour. Concurrently, a tablet-based data entry and reporting system will be developed to facilitate the workflow of the test. This study investigated the system requirements for the tablet-based data entry and reporting system in order to support the clinical workflow. By observing the workflow of the blood culture analysis and through interviews with medical laboratory technicians, four main system requirements were identified. The system requirements are; the ability to receive and send data to the laboratory information system, support for the use of barcodes, the ability to access a browser based instruction system, and communication of results between medical laboratory technicians and physicians. These system requirements will be used as a basis in the future development of the tablet-based data entry and reporting system.

Participatory heuristic evaluation of the first iteration of the eWALL interface application

The number of people having a chronic disease is increasing. Telehealth may provide an alternative to traditional medicine as telehealth solutions have shown to have a positive influence on quality of live and to decrease the number of hospital visits. A new telehealth solution is the eWALL system. Previously, the eWALL interface application has been evaluated using participatory heuristic evaluation (PHE). The previous round of PHE lead to drastic changes of the eWALL interface application. Consequently, a second round of PHE was performed. Five usability experts and two work-domain professionals inspected the eWALL interface application and identified usability problems (n = 384). The work domain professionals had a tendency to use other heuristics than the usability experts highlighting the relevance of using PHE in an interface development process.

Feasibility of representing a Danish microbiology model Using FHIR

Achieving interoperability in health is a challenge and requires standardization. The newly developed HL7 standard: Fast Healthcare Interoperability Resources (FHIR) promises both flexibility and interoperability. This study investigates the feasibility of expressing a Danish microbiology message model content in FHIR to explore whether complex in-use legacy models can be migrated and what challenges this may pose. The Danish microbiology message model (the DMM) is used as a case to illustrate challenges and opportunities accosted with applying the FHIR standard. Mapping of content from DMM to FHIR was done as close as possible to the DMM to minimize migration costs except when the structure of the content did not fit into FHIR. From the DMM a total of 183 elements were mapped to FHIR. 75 (40.9%) elements were modeled as existing FHIR elements and 96 (52.5%) elements were modeled as extensions and 12 (6.6%) elements were deemed unnecessary because of build-in FHIR characteristics. In this study, it was possible to represent the content of a Danish message model using HL7 FHIR.

Quality assurance and effectiveness of the medication process through tablet computers

Medication errors during admission to hospitals pose a significant problem. Most of the severe medication errors may be related to dispensation and administration. The medication errors may be induced by cost savings and staff reduction characterizing the current health care system. The objective of this study is to evaluate whether implementation of tablet computers has potential to enhance the quality assurance and efficiency of the medication dispensing and administration stages. The study is based on a combination of participant observation, structured workshop and qualitative interviews. Data has primary been collected on a Danish hospital ward. The study concludes that the technology still needs to mature before implementation and that there is a constant need for redesign of the technology. However, the results also show that technology has the potential to improve patient safety in the dispensing and administration stages because of an easier control and overview of the medicine paradigm; right patient, right drug, right dose and right time. Additionally, the technology appears to have the potential to streamline work flow in the administration stage due to an improved barcode registration mechanism. However, the potential of a successful implementation depends on prior working routines in the individual hospital ward.

Higher level of interoperabtility through an architectural paradigm shift: A study of shared medication record

One of the most significant obstacles for ensuring a dynamic information flow in eHealth is utilization of diverse systems, because this impedes exchange by being proprietary. There has been a long tradition for implementation of standalone systems in eHealth i.e. it-silos. In parallel to implementation of it-silos, electronic message-based EDIFACTS have for nearly two decades been created to underpin part of the communication between sectors in the Danish eHealth. The objective in this paper is to analyze if an architectural paradigm shift to Service Oriented Architecture (SOA) for distributed eHealth systems can induce a higher level of interoperability as defined by [1], which leads to improved information sharing. This is done by considering the present Danish national architecture and infrastructure in comparison to the national to-be reference architecture. It can be concluded that the envisioned eHealth interoperability is possible to obtain through a new organization of data storage and through deployment of SOA based web-services, i.e. through an architectural paradigm shift.

How to ensure sustainable interoperability in heterogeneous distributed systems through architectural approach

A major obstacle in ensuring ubiquitous information is the utilization of heterogeneous systems in eHealth. The objective in this paper is to illustrate how an architecture for distributed eHealth databases can be designed without lacking the characteristic features of traditional sustainable databases. The approach is firstly to explain traditional architecture in central and homogeneous distributed database computing, followed by a possible approach to use an architectural framework to obtain sustainability across disparate systems i.e. heterogeneous databases, concluded with a discussion. It is seen that through a method of using relaxed ACID properties on a service-oriented architecture it is possible to achieve data consistency which is essential when ensuring sustainable interoperability.