M. Poulymenopoulou

Emergency Healthcare Process Automation Using Mobile Computing and Cloud Services

Emergency care is basically concerned with the provision of pre-hospital and in-hospital medical and/or paramedical services and it typically involves a wide variety of interdependent and distributed activities that can be interconnected to form emergency care processes within and between Emergency Medical Service (EMS) agencies and hospitals. Hence, in developing an information system for emergency care processes, it is essential to support individual process activities and to satisfy collaboration and coordination needs by providing readily access to patient and operational information regardless of location and time. Filling this information gap by enabling the provision of the right information, to the right people, at the right time fosters new challenges, including the specification of a common information format, the interoperability among heterogeneous institutional information systems or the development of new, ubiquitous trans-institutional systems. This paper is concerned with the development of an integrated computer support to emergency care processes by evolving and cross-linking institutional healthcare systems. To this end, an integrated EMS cloud-based architecture has been developed that allows authorized users to access emergency case information in standardized document form, as proposed by the Integrating the Healthcare Enterprise (IHE) profile, uses the Organization for the Advancement of Structured Information Standards (OASIS) standard Emergency Data Exchange Language (EDXL) Hospital Availability Exchange (HAVE) for exchanging operational data with hospitals and incorporates an intelligent module that supports triaging and selecting the most appropriate ambulances and hospitals for each case.

Specifying Workflow Process Requirements for an Emergency Medical Service

Recent trends in healthcare delivery have led to a gradual shift in the conceptualisation of healthcare information systems towards supporting healthcare processes in a more direct way. The move towards integrated and managed care, which requires designing healthcare processes around patient needs and incorporating efficiency considerations, has led to an increased interest in process-oriented healthcare information systems based on workflow technology. This means to actively deliver the tasks to be performed to the right persons at the right time with the necessary information and the application functions needed. Moreover, workflow technology promotes a component-oriented development whereby the process logic is separated from application logic. This paper presents an approach to capturing process logic requirements for healthcare workflow systems with a view to design a system that is easily adjustable to process changes and to evolving organizational structures at a reasonable cost.

Emergency healthcare process automation using workflow technology and web services

Emergency healthcare delivery involves a variety of interrelated activities performed from the time of a call to the ambulance service until the time of patients exit from the emergency department of a hospital. As these activities can be viewed as parts of inter-organizational healthcare processes that involve at least two organizations (e.g. an ambulance service and a hospital), there is a need to provide the appropriate technological infrastructure for automating and managing these processes even in cases where the organizations involved use heterogeneous systems to support their internal services. Web-based workflow systems in conjunction with web services present a new way for service-oriented integration (SOI) of disparate systems and for developing distributed applications within and between organizations. Thus, process automation with the use of web services can provide an appropriate infrastructure for the integration of pre-hospital and in-hospital emergency healthcare. A prototype development of such a system is presented in this paper.

E-EPR: a cloud-based architecture of an electronic emergency patient record

Limited access to past medical information of emergency cases during emergency healthcare delivery is a proximal cause of increasing emergency care length and risk. Hence, there is a need for ubiquitous access to integrated emergency patient information at the point of care in order to effectively and efficiently manage emergency cases and to apply the appropriate diagnosis and treatment procedures. In this paper, a cloud-based service-oriented architecture (SOA) is described for the implementation of an electronic emergency patient record system (E-EPR) that provide functionality for managing (retrieving, transforming, exchanging and storing) emergency case information and patient critical medical information in a distributed and ubiquitous manner that supports several platforms and applications. The proposed system can be easily integrated with existing ambulance service and hospital information systems because of the use of open-wide standards. An experimental implementation of the system in a simulated laboratory environment is presented.

Specifying process requirements for holistic care

Holistic (health and social) care aims at providing comprehensive care to the community, especially to elderly people and people with multiple illnesses. In turn, this requires using health and social care resources more efficiently through enhanced collaboration and coordination among the corresponding organizations and delivering care closer to patient needs and preferences. This paper takes a patient-centered, process view of holistic care delivery and focuses on requirements elicitation for supporting holistic care processes and enabling authorized users to access integrated patient information at the point of care when needed. To this end, an approach to holistic care process-support requirements elicitation is presented which is based on business process modeling and places particular emphasis on empowering collaboration, coordination and information sharing among health and social care organizations by actively involving users and by providing insights for alternative process designs. The approach provides a means for integrating diverse legacy applications in a process-oriented environment using a service-oriented architecture as an appropriate solution for supporting and automating holistic care processes. The approach is applied in the context of emergency medical care aiming at streamlining and providing support technology to cross-organizational health and social care processes to address global patient needs.

A virtual PHR authorization system

Cloud computing and Internet of things (IOT) technologies can support a new generation of PHR systems which are provided as cloud services that contain patient data (health and social) from various sources, including automatically transmitted data from Internet connected devices of patient living space (e.g. medical devices connected to patients at home care). In this paper, the virtual PHR concept is introduced as an entity on the network consisted of (a) a non-healthcare component containing health and social information collected by either the patient or non-healthcare providers, (b) a medical device component containing health information transmitted from Internet connected medical devices and (c) a healthcare professional component containing information stored into various healthcare information systems. The PHR concept is based on the patient-centered model dictating that patients are the owners of their information. Hence, patients are empowered to authorize other subjects to access it that introduces specific security challenges which are further accentuated by the fact that diverse local security policies may need to be reconciled. The PHR authorization system proposed here is based on a combination of role-based and attribute-based access control (RABAC) and supports patient-specified authorization policies of various granularity levels subject to constraints imposed by the security policies of the various health and social care providers involved. To this end, an ontology of granular security concepts is built to aid in semantically matching diverse authorization requests and to enable semantic rule reasoning on whether a requested access should be permitted or denied.

A LOD-Based Service for Extracting Linked Open Emergency Healthcare Data

The linked open data (LOD) initiative – an initiative taken by governments around the world to open up and link the vast repositories of data they hold across agencies and departments – features particular potential in the health care sector. The real value of linked open data comes from its interpretation, analysis and linking up which, in the healthcare sector, is expected to result in improved quality of care and lower healthcare costs. In particular, emergency healthcare quality is expected to improve by making healthcare data, which is related to emergency healthcare, available to authorized users at the point of care (suitably anonymized for security reasons) and by providing researchers with access to large volumes of data. In addition, the analysis of emergency healthcare LOD can provide insights on a variety of factors contributing to emergency medical services (EMS) usage and to EMS failures so that to formulate sustained emergency healthcare policies and enable effective and efficient decision making that results in improving emergency case morbidity and mortality indices. This paper addresses the general problem of LOD usage in emergency healthcare delivery and describes a LOD-based cloud service that seeks to automatically export appropriate emergency healthcare data of interest from a variety of sources, semantically annotate this data and enriching it through the creation of links with other, relevant, data. To this end the service is designed to interact with EMS information systems, electronic medical records (EMRs) and personal health records (PHRs).

Ontology-Driven Authorization Policies on Personal Health Records for Sustainable Citizen-Centered Healthcare

The citizen-centered paradigm requires that citizens are active participants in their healthcare processes. Personal health records (PHRs) empower citizens and allow them to manage their health and wellness by collecting life-long cross-institutional information from various sources. A virtual PHR is defined here as a collaborative platform, which is enhanced by cloud computing and Internet of Things (IOT) technologies, for sharing citizens’ healthcare data typically stored in distributed, autonomous healthcare data sources as well as healthcare data stored by the citizen him/herself and assistive technology equipment; it can thus be considered as an entity on the network that, in addition to its own medical data, it can, be populated by relevant healthcare information on the fly at the moment of an attempted access. Although the requirement for integrating distributed, heterogeneous data sources for use by PHR services is challenging, pointing to the need for establishing a data sharing policy based on an interoperability platform, to resolve the heterogeneity among the data sources, new security challenges are induced due to the facts that citizens are the owners of their medical data and that various security policies are enforced on the various data sources. This chapter presents an authorization system for a virtual PHR, which is based on semantic technologies such as ontologies and is provided as a cloud service, to enable authorized access to integrated citizen information upon user requests. The system is based on the role and attribute based access control (RABAC) model and supports authorization policies of various granularity levels subject to area-wide constraints imposed by the health and social services involved.

Document Management Mechanism for Holistic Emergency Healthcare

A number of recent studies have showed that early and specialized pre-hospital patient management contributes significantly to emergency case survival. Along with the deployment and availability of appropriate emergency care resources, this also requires the availability of timely and relevant patient information to emergency medical service professionals. However, current healthcare information systems are characterized by heterogeneity and fragmentation, hindering emergency care professionals to have access to holistic or integrated patient information from the various organizations that participate in emergency care processes where and when needed. At the same time, many e-health programs have been undertaken worldwide in the area of emergency and unscheduled care with the objective to facilitate sharing of electronic patient information that may be considered important for the delivery of high quality emergency care and, hence, need to be readily available. In this vein, this paper takes a holistic view of the information needed in emergency healthcare and focuses on developing an appropriate tool for providing timely access to holistic care information by authorized users while retaining existing investments. Thus, a special purpose document management mechanism (DMM) is proposed that facilitates creating standardized XML documents from existing healthcare systems and that enables access to such documents at the point of care. For illustrative purposes, the mechanism has been incorporated into a prototype, cloud-based holistic EMS system.