Sung-Huai Hsieh

Middleware based Inpatient Healthcare Information System

The paper presents a multi-tier, integrated, distributed, inpatient healthcare information system based on service oriented architecture (SOA) .NET environment in National Taiwan University Hospital (NTUH). The architecture and outcomes of the newly developed inpatient information system (IIS) platform are discussed in details. We also present mechanisms of integration as well as interoperability among the components and multi-database in IIS via health level seven (HL7) Middleware layer. The preliminary performance of the current operating IIS is evaluated and analyzed to verify the efficiency and effectiveness of the architecture we designed.

Design and Implementation of Web-Based Mobile Electronic Medication Administration Record

Patients’ safety is the most essential, critical issue, however, errors can hardly prevent, especially for human faults. In order to reduce the errors caused by human, we construct Electronic Health Records (EHR) in the Health Information System (HIS) to facilitate patients’ safety and to improve the quality of medical care. During the medical care processing, all the tasks are based upon physicians’ orders. In National Taiwan University Hospital (NTUH), the Electronic Health Record committee proposed a standard of order flows. There are objectives of the standard: first, to enhance medical procedures and enforce hospital policies; secondly, to improve the quality of medical care; third, to collect sufficient, adequate data for EHR in the near future. Among the proposed procedures, NTUH decides to establish a web-based mobile electronic medication administration record (ME-MAR) system. The system, build based on the service-oriented architecture (SOA) as well as embedded the HL7/XML standard, is installed in the Mobile Nursing Carts. It also implement accompany with the advanced techniques like Asynchronous JavaScript and XML (Ajax) or Web services to enhance the system usability. According to researches, it indicates that medication errors are highly proportion to total medical faults. Therefore, we expect the ME-MAR system can reduce medication errors. In addition, we evaluate ME-MAR can assist nurses or healthcare practitioners to administer, manage medication properly. This successful experience of developing the NTUH ME-MAR system can be easily applied to other related system. Meanwhile, the SOA architecture of the system can also be seamless integrated to NTUH or other HIS system.

E-Health and Healthcare Enterprise Information System Leveraging Service-Oriented Architecture

OBJECTIVE To present the successful experiences of an integrated, collaborative, distributed, large-scale enterprise healthcare information system over a wired and wireless infrastructure in National Taiwan University Hospital (NTUH). In order to smoothly and sequentially transfer from the complex relations among the old (legacy) systems to the new-generation enterprise healthcare information system, we adopted the multitier framework based on service-oriented architecture to integrate the heterogeneous systems as well as to interoperate among many other components and multiple databases. We also present mechanisms of a logical layer reusability approach and data (message) exchange flow via Health Level 7 (HL7) middleware, DICOM standard, and the Integrating the Healthcare Enterprise workflow. The architecture and protocols of the NTUH enterprise healthcare information system, especially in the Inpatient Information System (IIS), are discussed in detail. IMPLEMENTATION The NTUH Inpatient Healthcare Information System is designed and deployed on service-oriented architecture middleware frameworks. The mechanisms of integration as well as interoperability among the components and the multiple databases apply the HL7 standards for data exchanges, which are embedded in XML formats, and Microsoft .NET Web services to integrate heterogeneous platforms. MEASUREMENTS The preliminary performance of the current operation IIS is evaluated and analyzed to verify the efficiency and effectiveness of the designed architecture; it shows reliability and robustness in the highly demanding traffic environment of NTUH. CONCLUSIONS The newly developed NTUH IIS provides an open and flexible environment not only to share medical information easily among other branch hospitals, but also to reduce the cost of maintenance. The HL7 message standard is widely adopted to cover all data exchanges in the system. All services are independent modules that enable the system to be deployed and configured to the highest degree of flexibility. Furthermore, we can conclude that the multitier Inpatient Healthcare Information System has been designed successfully and in a collaborative manner, based on the index of performance evaluations, central processing unit, and memory utilizations.

Design Ensemble Machine Learning Model for Breast Cancer Diagnosis

In this paper, we classify the breast cancer of medical diagnostic data. Information gain has been adapted for feature selections. Neural fuzzy (NF), k-nearest neighbor (KNN), quadratic classifier (QC), each single model scheme as well as their associated, ensemble ones have been developed for classifications. In addition, a combined ensemble model with these three schemes has been constructed for further validations. The experimental results indicate that the ensemble learning performs better than individual single ones. Moreover, the combined ensemble model illustrates the highest accuracy of classifications for the breast cancer among all models.

Newborn Screening Healthcare Information System Based on Service-Oriented Architecture

In this paper, we established a newborn screening system under the HL7/Web Services frameworks. We rebuilt the NTUH Newborn Screening Laboratory’s original standalone architecture, having various heterogeneous systems operating individually, and restructured it into a Service-Oriented Architecture (SOA), distributed platform for further integrity and enhancements of sample collections, testing, diagnoses, evaluations, treatments or follow-up services, screening database management, as well as collaboration, communication among hospitals; decision supports and improving screening accuracy over the Taiwan neonatal systems are also addressed. In addition, the new system not only integrates the newborn screening procedures among phlebotomy clinics, referral hospitals, as well as the newborn screening center in Taiwan, but also introduces new models of screening procedures for the associated, medical practitioners. Furthermore, it reduces the burden of manual operations, especially the reporting services, those were heavily dependent upon previously. The new system can accelerate the whole procedures effectively and efficiently. It improves the accuracy and the reliability of the screening by ensuring the quality control during the processing as well.

Application of Portable CDA for Secure Clinical-document Exchange

Health Level Seven (HL7) organization published the Clinical Document Architecture (CDA) for exchanging documents among heterogeneous systems and improving medical quality based on the design method in CDA. In practice, although the HL7 organization tried to make medical messages exchangeable, it is still hard to exchange medical messages. There are many issues when two hospitals want to exchange clinical documents, such as patient privacy, network security, budget, and the strategies of the hospital. In this article, we propose a method for the exchange and sharing of clinical documents in an offline model based on the CDA—the Portable CDA. This allows the physician to retrieve the patient’s medical record stored in a portal device, but not through the Internet in real time. The security and privacy of CDA data will also be considered.

Ubiquitous mobile personal health system based on cloud computing

With the wealth of modern life, a rich diet and an irregular lifestyle, physical inactivity trend, leading to obesity and the increase in the proportion of cardiovascular disease, and moderate exercise able to human health promotion and disease prevention benefit. Through personal mobile devices to remind the movement, to develop regular exercise habits and to provide health management services to the general public easy to understand and manage their own health. As mobile devices become increasingly universal, and the rise of cloud computing, this study, its lightweight, portable features, with cloud applications, to achieve personal health management.

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.

WLC34-5: GDCF: Grouping DCF for the MAC layer enhancement of 802.11

The 802.11 has emerged as the prominent wireless LAN technology as the mobile computing devices such as notebooks and PDA have replaced the desktop computers to be the main trend products. However, if the number of active stations is large for the legacy backoff algorithm (DCF) of the 802.11, the capacity will be very low due to high collision cost. In this paper, we introduce the TDMA concept to partition all numerous active stations into several groups to avoid all stations transmitting the frames simultaneously. When Point Coordinator (PC, generally referring to AP) finds that the number of active stations (M) is large i.e. bigger than 16, it broadcasts grouping number and grouping head bits (such as 00000100 00000000) information in the TIM field of the beacon frame. Once all stations receive this instruction, the stations which last two LSB bits of the MAC address are 00 belonging to group 0 will transfer their frame first. On the contrary, all stations belonging to other groups will set their waiting time, that is, Network Allocation Vector (NAV) much more precisely. Analysis shows that the capacity of our GDCF will be near to the theoretical capacity of 802.11 WLAN even if the distributions of all active stations among all groups are not so uniform. This capacity could be independent of the number of active stations and CWmax (contention window maximum).

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.