Case+Study+It+Systems

= = = = =Healthcare in an East African Country =

__ Basic Telemedicine consists of: __  Analog telephone lines,  Internet Connectivity with low band-width, to facilitate the exchange of emails etc,  Servers to store the data and which can be used later on as and when required, __Equipment needed:__ • Telephone line  Personal computer • Modem • Subscription with an Internet service provider

__Advanced Telemedicine:__ Advanced telemedicine will be used where there is a drastic need for real time consultation and also where there is high prevalence of certain diseases such as: dysentery, cholera, typhoid, yellow fever, diarrhea, HIV/AIDS, malaria etc. __Advanced Telemedicine should allow for:__  Video-Conferencing.  Radiological images - slides and graphics may be transmitted, as well as voice and chest sounds.  Images, ranging from still photographs to full motion imagery.

__Equipment needed:__  High resolution camera.  Microphone.  Speaker.  Scanner.  Personal computer and video monitor.  Wi-Fi connectivity with high bandwidth.

Issues related to the use of software, hardware, and related information systems
// The following guide is organized in two parts: The first part is organized by sections defined by the course syllabus. The second part is organized by issues specific to Oobunta (Provincial Hospital) and its Village A, B, and C (Clinic) counterparts. //

//System Fundamentals//

 * **Implementing new, developing and evolving IT systems ** -- desktop computers, OS, CT scanners and x-ray machines with IT systems
 * technology competency -- staff **training ** and retraining, //"most medical staff lack appropriate training on existing IT systems" //
 * responsibility of computer use -- **security ** preparations (ie. password, biometrics, authorization...etc.)
 * disadvantages and advantages of IT and digital data -- " //information is periodically **backed up ** to an external hard drive which is **<span style="font-family: Arial,Helvetica,sans-serif;">stored **<span style="font-family: Arial,Helvetica,sans-serif;"> in the server room" //
 * <span style="font-family: Arial,Helvetica,sans-serif;">unreliable IT equipment that mitigates system crashes, power surges, disaster recovery, and backup plans


 * **<span style="font-family: Arial,Helvetica,sans-serif;">Electronic medical records (EMR) **<span style="font-family: Arial,Helvetica,sans-serif;"> -- "no integrated EMR management system present."
 * **<span style="font-family: Arial,Helvetica,sans-serif;">economic value **<span style="font-family: Arial,Helvetica,sans-serif;"> of patient information and document processing **<span style="font-family: Arial,Helvetica,sans-serif;">time **<span style="font-family: Arial,Helvetica,sans-serif;"> -- //<span style="font-family: Arial,Helvetica,sans-serif;">"...time required to get patients to Oobunta Hospital... and lack of medical knowledge... has led to death of patients." //
 * <span style="font-family: Arial,Helvetica,sans-serif;">improves **<span style="font-family: Arial,Helvetica,sans-serif;">accuracy **<span style="font-family: Arial,Helvetica,sans-serif;">of record keeping and efficiency, as well as integration of all medical records, diagnostic imaging and documentation
 * <span style="font-family: Arial,Helvetica,sans-serif;">allows authentication via a digital signature
 * <span style="font-family: Arial,Helvetica,sans-serif;">[|modern standards] relating to specific aspects of EMRs:
 * [|XML] - a document format allowing easy interoperability
 * [|HL7] - messages format for interchange between different record systems and practice management systems.
 * [|ANSI X12] ([|EDI]) - A set of transaction protocols used in the US for transmitting virtually any aspect of patient data.
 * [|CEN] - [|CONTSYS] (EN 13940), a system of concepts to support continuity of care.
 * CEN - [|EHRcom] (EN 13606), a standard for the communication of information from EHR systems.
 * CEN - [|HISA] (EN 12967), a services standard for inter-system communication in a clinical information environment.
 * [|DICOM] - a standard for representing and communicating radiology images and reporting
 * issues include privacy and anonymity -- "//According to the LA Times, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and over 9000 payers, providers and other entities that handle providers' billing data have some access."//


 * **<span style="font-family: Arial,Helvetica,sans-serif;">Operating Systems **
 * **<span style="font-family: Arial,Helvetica,sans-serif;">compatibility **<span style="font-family: Arial,Helvetica,sans-serif;"> issues -- most up-to-date high-tech Oobunta Hospital can communicate to the clinics through built-in conversion software or available file extension changes (.docx, .doc, .txt, .rtf, .html, .pdf, .dotx) which the low-tech clinics lack, thus cannot communicate properly with each other (ie. Windows 98, XP and Microsoft Office 97, 2003, and 2007)

//<span style="font-family: Arial,Helvetica,sans-serif;">Networks //

 * **<span style="font-family: Arial,Helvetica,sans-serif;">Security **
 * <span style="font-family: Arial,Helvetica,sans-serif;">levels of **<span style="font-family: Arial,Helvetica,sans-serif;">access **<span style="font-family: Arial,Helvetica,sans-serif;"> -- access permission, authentication, sysadmin ( //<span style="font-family: Arial,Helvetica,sans-serif;">"hospital has a network administrator...[clinics do not]" //<span style="font-family: Arial,Helvetica,sans-serif;">), raising issues of doctor-patient confidentiality
 * **<span style="font-family: Arial,Helvetica,sans-serif;">equality **<span style="font-family: Arial,Helvetica,sans-serif;">of access -- internet privileges, additional **<span style="font-family: Arial,Helvetica,sans-serif;">online services **<span style="font-family: Arial,Helvetica,sans-serif;"> (ie. telemedicine, via internet most popularly, but tolerably via phone) unavailable or limiting to some clinics


 * **<span style="font-family: Arial,Helvetica,sans-serif;">Speed, efficiency, reliability and effectiveness of networks -- compromises telecommunication **
 * <span style="font-family: Arial,Helvetica,sans-serif;">kinds of networks -- Peer-to-Peer network (P2P), local area network (LAN), land line phone connection (phreaking, disruptive telemarketing), cell phone connection (cannot accept more than one call, multi-task, and easily used for leisure), intranet
 * <span style="font-family: Arial,Helvetica,sans-serif;">network **<span style="font-family: Arial,Helvetica,sans-serif;"> speed **<span style="font-family: Arial,Helvetica,sans-serif;"> -- issues include dial up, low bandwidth, intermittent connection, loss of hospital-village telecommunication
 * <span style="font-family: Arial,Helvetica,sans-serif;">future developments -- 2008, WiFi and broadband improved in Oobunta and major cities under government provision


 * **<span style="font-family: Arial,Helvetica,sans-serif;">Servers **
 * <span style="font-family: Arial,Helvetica,sans-serif;">server management -- Microsoft Small Business Server 2003, **<span style="font-family: Arial,Helvetica,sans-serif;">network administrator **<span style="font-family: Arial,Helvetica,sans-serif;">, accessible via hospital's intranet
 * <span style="font-family: Arial,Helvetica,sans-serif;">provides internet access via **<span style="font-family: Arial,Helvetica,sans-serif;">local service provider **
 * <span style="font-family: Arial,Helvetica,sans-serif;">storage responsibilities -- security, encryption, backup
 * <span style="font-family: Arial,Helvetica,sans-serif;">future developments -- needs updated server management, client/server task handling, efficient disaster plan

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** //<span style="font-family: Arial,Helvetica,sans-serif;">Databases and Spreadsheets // **

 * **<span style="font-family: Arial,Helvetica,sans-serif;">Inequality of access **
 * <span style="font-family: Arial,Helvetica,sans-serif;">hospital patient records in database stored in server that is backed up
 * <span style="font-family: Arial,Helvetica,sans-serif;">clinic patients' records stored in computers that are not backed up
 * <span style="font-family: Arial,Helvetica,sans-serif;">social and ethical effects of damaged, lost client data


 * **<span style="font-family: Arial,Helvetica,sans-serif;">Database management system **
 * <span style="font-family: Arial,Helvetica,sans-serif;">Data **<span style="font-family: Arial,Helvetica,sans-serif;">redundancy **<span style="font-family: Arial,Helvetica,sans-serif;"> and inefficiency issues from no **<span style="font-family: Arial,Helvetica,sans-serif;"> integrated **<span style="font-family: Arial,Helvetica,sans-serif;"> electronic medical records (EMR) -- difficult management of multiple databases (ie. patient records, financial accounting, personnel management records...etc.) and certain paper records (ie. patient history, x-ray, pathology...etc.) for a single patient

As part of their contracts with the vendors, doctors are agreeing to let some vendors access and collect the patient data, scrub it of personally identifying information, and sell it in bulk to pharmaceutical companies and other buyers, the //Times// reports. >> >> George Hill, an analyst at Leerink Swann, a health care investment bank, told the //Times// that the market for health record systems is $8 billion to $10 billion annually. About 5 percent of this income comes not from the sale of information systems but from the sale of data and analysis. As more physicians and hospitals — spurred by federal incentives — switch to electronic recordkeeping, revenue from the sale of health data could grow to $5 billion, Hill said. [] >> >> >> >>
 * **<span style="font-family: Arial,Helvetica,sans-serif;">Reliability and security **
 * <span style="font-family: Arial,Helvetica,sans-serif;">software compatibility issues of different Microsoft Office versions of Microsoft Excel spreadsheets unable to have clinic to clinic, or clinic to hospital data transfer (ie. a patient needs to be transferred from a clinic to the hospital)
 * <span style="font-family: Arial,Helvetica,sans-serif;">social and ethical issues of exposed sensitive client data that is **<span style="font-family: Arial,Helvetica,sans-serif;">sold -- **<span style="font-family: Arial,Helvetica,sans-serif;">solutions include encryption, passwords
 * <span style="font-family: Arial,Helvetica,sans-serif;">EXAMPLE OF SECUIRITY THREAT= SELLING PATIENT RECORDS : unknown to patients, an increasing number of outside vendors that manage electronic health records also have access to that data, and are reselling the information as a commodity.medical data is collected, anonymized and sold, not by insurance agencies and health care providers, but by third-party vendors who provide medical-record storage in the cloud.

<span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px; line-height: 21px;">
 * **<span style="font-family: Arial,Helvetica,sans-serif;">Advantages and disadvantages of digital data **
 * <span style="font-family: Arial,Helvetica,sans-serif;">special-purpose spreadsheets for finance calculations are economically efficient and reliable, however require special IT **<span style="font-family: Arial,Helvetica,sans-serif;"> training **

**//<span style="font-family: Arial,Helvetica,sans-serif;">Modelling & Simulations //**

 * **<span style="font-family: Arial,Helvetica,sans-serif;">Reliability of computer predictions **
 * <span style="font-family: Arial,Helvetica,sans-serif;">subscribed private online medical **<span style="font-family: Arial,Helvetica,sans-serif;">expert system **<span style="font-family: Arial,Helvetica,sans-serif;"> -- limited set of variables and knowledge base, lack human insight, potentially false, hidden, or broad assumptions, feedback loop mechanism that simplifies complex human health
 * <span style="font-family: Arial,Helvetica,sans-serif;">issues of people and machines -- Google promotes laziness, **<span style="font-family: Arial,Helvetica,sans-serif;">confirmation bias **<span style="font-family: Arial,Helvetica,sans-serif;">, potential false information, scams -- //<span style="font-family: Arial,Helvetica,sans-serif;">"[rather than use the expert system] a number of doctors have started to use internet search engines to diagnose patients, which has raised some concerns." //

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**//<span style="font-family: Arial,Helvetica,sans-serif;">Tutorials, Training and Wizards //**

 * **<span style="font-family: Arial,Helvetica,sans-serif;">Training tutorials for staff on medical equipments' IT systems **
 * **<span style="font-family: Arial,Helvetica,sans-serif;">funds **<span style="font-family: Arial,Helvetica,sans-serif;">required
 * **<span style="font-family: Arial,Helvetica,sans-serif;">time **<span style="font-family: Arial,Helvetica,sans-serif;"> lag of transition from paper to digital
 * <span style="font-family: Arial,Helvetica,sans-serif;">unemployment -- in economics, this is called structural unemployment, where technologically inefficient staff are fired for their obsolete skills and technologically capable staff are hired

**//<span style="font-family: Arial,Helvetica,sans-serif;">Communication Systems: The Internet //**

 * **<span style="font-family: Arial,Helvetica,sans-serif;">Technical details **
 * <span style="font-family: Arial,Helvetica,sans-serif;">differing access -- no wireless, low bandwidth landlines or dial-up phone network
 * <span style="font-family: Arial,Helvetica,sans-serif;">limitations across the clinics block communication and wider database or service opportunities on Web

> []
 * **<span style="font-family: Arial,Helvetica,sans-serif;">Uses of the internet **
 * <span style="font-family: Arial,Helvetica,sans-serif;">online medical expert system
 * <span style="font-family: Arial,Helvetica,sans-serif;">internet **<span style="font-family: Arial,Helvetica,sans-serif;">search engine **<span style="font-family: Arial,Helvetica,sans-serif;"> for patient diagnostic help
 * <span style="font-family: Arial,Helvetica,sans-serif;">e-mail communication
 * <span style="font-family: Arial,Helvetica,sans-serif;">connection to Oobunta Hospital intranet which reaches the central data and server
 * <span style="font-family: Arial,Helvetica,sans-serif;">EXAMPLE: App on IPHONe can be used as a personal medical assistant! stores everything from patient data to charts and lists of medications in a streamlined, organized fashion. To ensure diagnostic procedures aren’t outdated, the application regularly updates with new medical data pulled from healthcare networks.
 * <span style="font-family: Arial,Helvetica,sans-serif;">EXAMPLE: App on IPHONe can be used as a personal medical assistant! stores everything from patient data to charts and lists of medications in a streamlined, organized fashion. To ensure diagnostic procedures aren’t outdated, the application regularly updates with new medical data pulled from healthcare networks.

__Importance of the mobile phone__
- in 1999: 5% of emergency phone calls to London ambulance service was from mobile phones -2004: grew to 29% ( 72% of the 29% of the people said they would not have survived if they did not call for help with mobile phone) - Haiti Earthquake 2010 --> a girl rescued under ruble after 8 days because she sent an sms to friends - photo on mobile phones by ambulance workers can show surgeons the area of shock impact (eg: where the car was hit) to enable surgery
 * Evidence:**

-a volunteer at clinics in LDCS can take notes on a patient, take voice notes and take a picture --> uploads them to a server -a physician across the globe will receive an sms that alerts him that he has a pending patient to review - He then can log onto the server and review the case --> sends prescription to the volunteer - therefore, one doctor and serve a thousands of patients 1272276156
 * Project issued by MIT to overcome shortage of doctors in developing countries:**

=Benefits of Iphone in health (over 2000 medical application)= = from Mr Ivor Kovic (Physician) [] =
 * doctors can watch podcasts and lectures on medical review --> broaden medical knowledge
 * ebook application enables him to download thousands of medical books on his iphone
 * MED APPS ON IPHONE:
 * Instant ECG, (teaches basics of electrocardiogram analyses)
 * i Murmur ( sharpens skills in listening to heart sounds), Pocket Lab values (app which investigates real patient information),
 * Medcalc ( calculates drug doses) ,
 * Pedi STAT (base on age, weight, height --> can help doctors diagnose doses in emergencies and what medical equipment to use ON CHILDREN) ,
 * OsinX (helps interpret MRI and CRI scans), uHear (app with sounds which helps doctors to test on patient's hearing)
 * can access EMR/ patient records & information/ hospital database
 * -improves workflow improvement
 * allow doctors to keep an eye on patients with real time data even when doctor is out of hospital (sensors of patient connected to server, in which app on iphone is connected to)
 * doctor in US developed an accessory on the iphone that works like a stethoscope --> iStethoscope. The sound of patients heartbeat can be saved on doctor iphone for future reference and can even be discussed with other doctors for help or educational purposes
 * Zoll (company) developed app PocketCPR, which tells doctors if they are doing CPR correctly at the right speed when holding the iphone while doing CPR 1272276156
 * Zoll (company) developed app PocketCPR, which tells doctors if they are doing CPR correctly at the right speed when holding the iphone while doing CPR 1272276156

**//<span style="font-family: Arial,Helvetica,sans-serif;">Personal and Public Communications //**
1271562634
 * **<span style="font-family: Arial,Helvetica,sans-serif;">Distance learning **
 * <span style="font-family: Arial,Helvetica,sans-serif;">new **<span style="font-family: Arial,Helvetica,sans-serif;">cell phone **<span style="font-family: Arial,Helvetica,sans-serif;"> and phone network potential -- utilized by local doctors to collaborate for patient diagnostics
 * [[image:satellife_plitho.jpg]]
 * The Satellife PDA project was implemented in Ghana, Kenya and Uganda. The aim of the project was to demonstrate the viability of Personal Digital Assistants (PDAs) - also known as handheld computers - for addressing the digital divide among health professionals in Africa. The project linked health professionals to each other and to reliable sources of information, including modem to modem telephone links and the internet using geostationary satellites. [| http://www.genderit.org/en/index.shtml?apc=a--e--1&x=95473]
 * <span style="font-family: Arial,Helvetica,sans-serif;">further development -- **<span style="font-family: Arial,Helvetica,sans-serif;">telemedicine **<span style="font-family: Arial,Helvetica,sans-serif;"> between doctors, which can be expand from simple e-mails, forum discussions to teleconferences, lectures, surgery demonstration media)
 * <span style="font-family: Arial,Helvetica,sans-serif;">issues include vulnerability to spam, inappropriate uses of IT (ie. leisure, telemarketing...etc.), technological incompatibilities which make communication attempts counterproductive in terms of time and effort expended to make a connection happen

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**//<span style="font-family: Arial,Helvetica,sans-serif;">Artificial Intelligence and Expert systems //**

 * **<span style="font-family: Arial,Helvetica,sans-serif;">Responsibility and reliability **
 * <span style="font-family: Arial,Helvetica,sans-serif;">'faulting' judgment when online expert system, online databases, or other external help is used to help diagnose patients; see //<span style="font-family: Arial,Helvetica,sans-serif;">Modeling and Simulations //
 * **<span style="font-family: Arial,Helvetica,sans-serif;">Examples of medical expert systems **
 * <span style="font-family: Arial,Helvetica,sans-serif;">MYCIN -- first recognized medical expert system developed at Stanford University to prescribe drugs
 * <span style="font-family: Arial,Helvetica,sans-serif;">[|EasyDiagnosis] -- by MATHeMEDics Inc
 * <span style="font-family: Arial,Helvetica,sans-serif;">[|Medical Expert Systems in Pakistan] -- helpful for a shortage of doctors in developing countries, //<span style="font-family: Arial,Helvetica,sans-serif;">"ESTA, EXSYS, XpertRule, ACQUIRE, FLEX...etc. are some of the popular software packages used to construct medical expert systems. LISP and PROLOG are two famous AI languages used to develop such expert systems." //

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//Oobunta Hospital//

 * Local area network (LAN) - intranet, patient records' database, financial database, personnel management records database on server
 * Internet access via local service provider -- email, medical expert system
 * 20 desktop computers -- Windows XP and Microsoft Office 2007
 * Diagnostic tools with embedded IT systems
 * External hard drive
 * Medical staff and a network administrator

//Village A//

 * Peer-to-Peer network (P2P) connected via computers -- patient record keeping
 * Dial-up, intermittent, low bandwidth internet connection -- email, intranet, medical expert system
 * 6 desktop computers -- Windows 98 and Microsoft Office 97
 * Cell phone and landline phone connection
 * Healthcare workers

//Village B//

 * 1 desktop computer -- patient record keeping
 * No internet

//Village C//

 * Cellphone and developing phone network
 * Handwritten records

<span style="font-family: Arial,Helvetica,sans-serif;"> //Oobunta Hospital, as the most IT capable and able department, as well as the central hub to all the hospital's services, policies, databases, should simply work to improve its assets, fixing minor errors, such as staff training, IT updates, and integration of all records to digital form, meanwhile mitigating the issue of reliability by investing in a) better servers, b) a back-up plan, c) better infrastructure, if funds allow. Because that is highly unlikely due to limited funds, Oobunta Hospital's first course of action should be to extend its IT capabilities to the rest of its clinics so that the ergonomic, efficient, and certainly beneficial new IT systems can be shared and utilized across Oobunta, maximizing the hospitals' services, as well as increasing communication and collaborative work. Clinic C should get special priority, especially in terms of staff numbers and computer use, though ensuring IT compatibility is equally important. As of now, Clinic B and C appear to be simply diagnostic centers, where patients should perhaps opt to go straight to the main hospital.//