Mark Gaynor

A standardised pre-hospital electronic patient care system

This paper describes the design, development and testing of a pre-hospital documentation and patient monitoring application called iRevive. The application utilises a sensor gateway and data mediator to enable semantic interoperability with a wide variety of medical devices and applications. Initial test results indicate that complete and consistent pre-hospital Electronic Medical Records (EMR) can be semantically exchanged with two heterogeneous, in-hospital IT applications.

Why common carrier and network neutrality principles apply to the Nationwide Health Information Network (NWHIN).

The Office of the National Coordinator will be defining the architecture of the Nationwide Health Information Network (NWHIN) together with the proposed HealtheWay public/private partnership as a development and funding strategy. There are a number of open questions—for example, what is the best way to realize the benefits of health information exchange? How valuable are regional health information organizations in comparison with a more direct approach? What is the role of the carriers in delivering this service? The NWHIN is to exist for the public good, and thus shares many traits of the common law notion of ‘common carriage’ or ‘public calling,’ the modern term for which is network neutrality. Recent policy debates in Congress and resulting potential regulation have implications for key stakeholders within healthcare that use or provide services, and for those who exchange information. To date, there has been little policy debate or discussion about the implications of a neutral NWHIN. This paper frames the discussion for future policy debate in healthcare by providing a brief education and summary of the modern version of common carriage, of the key stakeholder positions in healthcare, and of the potential implications of the network neutrality debate within healthcare.

A Multi-Level Technical Infrastructure for Diabetes Chronic Care Management in China

This paper specifies the World Health Organizations Innovative Care for Chronic Conditions Framework (ICCC) to diabetes prevention and management activities in China via extensive literature review and verification using qualitative data analysis of both primary and secondary data. We utilize the specified ICCC to propose an integrative and interconnected technical architecture that addresses some of the gaps and needs found at the macro, meso, and micro levels. The proposed technical infrastructure creates an integrative framework, where the technical architecture has strategic alignment with all layers of the ICCC. This will help policy makers and technologists facilitate developing a comprehensive infrastructure to address management of chronic conditions in China, as well as providing a catalyst for new initiatives.

Using Simulation to Teach Security and Encryption to Non-Technical Healthcare Professionals

This paper intends to simplify challenging concepts through role-play demonstrations and serve as a foundation for understanding the basis of securing healthcare data. Disparity exists between the rising need for security of electronic healthcare information and the number of healthcare leaders who understand the concepts behind ensuring privacy and accuracy of such data. Healthcare managers with a basic understanding of data encryption and how it safeguards health information are vital to the success of Electronic Health Records. They often are responsible for proper oversight of such systems and should instill confidence in medical providers and patients that electronic medical data is safe and accurate. However, data security and privacy are complex concepts and remain foreign to many healthcare managers. This paper reviews the benefits of simulation learning and outlines a workshop and simulation game developed in response to difficulties teaching the technology of encryption. The results are validated with anecdotal and indirect statistical evidence. KEywoRdS Encryption, Security, Security for Healthcare, Simulations, Teaching Encryption

A tale of two standards: strengthening HIPAA security regulations using the PCI-DSS

This paper both illustrates the inadequacy of current Health Insurance Portability and Accountability Act (HIPAA) regulations in protecting health-care information and proposes a more cohesive strategy to protect such information based on the organizational model that undergirds the Payment Card Industry Data Security Standards (PCI-DSS). The evidence indicates that the industry consortium model used to develop the PCI-DSS works rapidly and effectively. The success of these standards suggests that their strengths provide a favorable base from which to develop a robust set of standards to enhance information security within health care. A national organization consisting of industry representatives that is devoted to creating a more comprehensive and less vague set of security standards is required to protect health-care information more effectively than is possible under the current HIPAA approach.

Dr. Watson? Balancing Automation and Human Expertise in Healthcare Delivery

IBM’s Watson, the supercomputer that beat two Jeopardy champions in a televised competition, has inevitably engendered speculation about what this surprising performance bodes for the role of computers in the workplace. How can Dr. Watson be best utilized in medicine and clinical support systems? This paper defines Computer Enhanced Medicine technology for healthcare as any medical application where the required tasks are split between a human being and a computer-controlled device.

Successful HIT Requires Inter-Team Communication

When compared to traditional medical centers, academic medical centers have additional complexity caused by tension between clinical research and patient care, which adds structural and organization differences within the organization. Many academic medical centers have a separate physician practice plan and hospital organization. Usually this means the medical school and its faculty are responsible for outpatient practices, and a separate hospital organization performs the daily management and sustainability of the affiliated academic hospitals. With separate governing and executive bodies, information technology IT has additional challenges not found in community hospital settings where one, unified entity exists. Two different financial entities for one unified care delivery model results in differences in technology used at both entities. The hospital organization might use one e-mail system, while the medical school might use another. Though one might argue e-mail system differences are inconsequential, the opposite is true. Different e-mail systems result in meeting cancellations not flowing to the other system, the possibility of an incomplete address book, and security problems. These shortcomings result in user frustration because of inconsistent user experience and inefficient communication between parties. It is important to minimize such frustrations and inefficiencies for user adoption to be successful. Electronic medical records EMRs have similar problems. Due to differences in legal and financial responsibilities, the hospital and physician practice plan may have separate EMRs for the inpatient and outpatient experience respectively. This can not only create an incomplete user experience, but also cause interoperability problems. Therefore, whenever the system is changed for enhancement or to fix bugs, careful consideration must be taken to reduce unnecessary user angst.