Web-Based Dashboard for the Interactive Visualization and Analysis of National Risk-Standardized Mortality Rates of Sepsis in the US.

Sepsis mortality is heavily influenced by the quality of care in hospitals. Comparing risk-standardized mortality rate (RSMR) of sepsis patients in different states in the United States has potentially important clinical and policy implications. In the current study, we aimed to compare national sepsis RSMR using an interactive web-based dashboard. We analyzed sepsis mortality using the National Inpatient Sample Database of the US. The RSMR was calculated by the hierarchical logistic regression model. We wrote the interactive web-based dashboard using the Shiny framework, an R package that integrates R-based statistics computation and graphics generation. Visual summarizations (e.g., heat map, and time series chart), and interactive tools (e.g., year selection, automatic year play, map zoom, copy or print data, ranking data by name or value, and data search) were implemented to enhance user experience. The web-based dashboard (https://sepsismap.shinyapps.io/index2/) is cross-platform and publicly available to anyone with interest in sepsis outcomes, health inequality, and administration of state/federal healthcare. After extrapolation to the national level, approximately 35 million hospitalizations were analyzed for sepsis mortality each year. Eight years of sepsis mortality data were summarized into four easy to understand dimensions: Sepsis Identification Criteria; Sepsis Mortality Predictors; RSMR Map; RSMR Trend. Substantial variation in RSMR was observed for different states in the US. This web-based dashboard allows anyone to visualize the substantial variation in RSMR across the whole US. Our work has the potential to support healthcare transparency, information diffusion, health decision-making, and the formulation of new public policies.

Confidentiality Protection of Digital Health Records in Cloud Computing.

Electronic medical records containing confidential information were uploaded to the cloud. The cloud allows medical crews to access and manage the data and integration of medical records easily. This data system provides relevant information to medical personnel and facilitates and improve electronic medical record management and data transmission. A structure of cloud-based and patient-centered personal health record (PHR) is proposed in this study. This technique helps patients to manage their health information, such as appointment date with doctor, health reports, and a completed understanding of their own health conditions. It will create patients a positive attitudes to maintain the health. The patients make decision on their own for those whom has access to their records over a specific span of time specified by the patients. Storing data in the cloud environment can reduce costs and enhance the share of information, but the potential threat of information security should be taken into consideration. This study is proposing the cloud-based secure transmission mechanism is suitable for multiple users (like nurse aides, patients, and family members).

Implementation of Online Veterinary Hospital on Cloud Platform.

Pet markets involve in great commercial possibilities, which boost thriving development of veterinary hospital businesses. The service tends to intensive competition and diversified channel environment. Information technology is integrated for developing the veterinary hospital cloud service platform. The platform contains not only pet medical services but veterinary hospital management and services. In the study, QR Code andcloud technology are applied to establish the veterinary hospital cloud service platform for pet search by labeling a pet's identification with QR Code. This technology can break the restriction on veterinary hospital inspection in different areas and allows veterinary hospitals receiving the medical records and information through the exclusive QR Code for more effective inspection. As an interactive platform, the veterinary hospital cloud service platform allows pet owners gaining the knowledge of pet diseases and healthcare. Moreover, pet owners can enquire and communicate with veterinarians through the platform. Also, veterinary hospitals can periodically send reminders of relevant points and introduce exclusive marketing information with the platform for promoting the service items and establishing individualized marketing. Consequently, veterinary hospitals can increase the profits by information share and create the best solution in such a competitive veterinary market with industry alliance.

Access Scheme for Controlling Mobile Agents and its Application to Share Medical Information.

This study is showing the advantage of mobile agents to conquer heterogeneous system environments and contribute to a virtual integrated sharing system. Mobile agents will collect medical information from each medical institution as a method to achieve the medical purpose of data sharing. Besides, this research also provides an access control and key management mechanism by adopting Public key cryptography and Lagrange interpolation. The safety analysis of the system is based on a network attacker's perspective. The achievement of this study tries to improve the medical quality, prevent wasting medical resources and make medical resources access to appropriate configuration.

Novel Lagrange interpolation polynomials for dynamic access control in a healthcare cloud system.

The authority of user personal health records (PHRs) is usually determined by the owner of a cloud computing system. When a PHR file is accessed, a dynamic access control algorithm must be used to authenticate the users. The proposed dynamic access control algorithm is based on a novel Lagrange interpolation polynomial with timestamps, mainly functioning to authenticate the users with key information. Moreover, the inclusion of timestamps allows user access within an approved time slot to enhance the security of the healthcare cloud system. According to the security analysis results, this healthcare cloud system can effectively resist common attacks, including external attacks, internal attacks, collaborative attacks and equation-based attacks. Furthermore, the overall computational complexity of establishing and updating the polynomials is O(n*m* (log m)2), which is a promising result, where m denotes the degree of $ polynomial~G\left(x, y\right) $ and n denotes the number of secure users in the hierarchy.

Machine learning approaches for the genomic prediction of rheumatoid arthritis and systemic lupus erythematosus.

BACKGROUND: Rheumatoid arthritis (RA) and systemic lupus erythematous (SLE) are autoimmune rheumatic diseases that share a complex genetic background and common clinical features. This study's purpose was to construct machine learning (ML) models for the genomic prediction of RA and SLE. METHODS: A total of 2,094 patients with RA and 2,190 patients with SLE were enrolled from the Taichung Veterans General Hospital cohort of the Taiwan Precision Medicine Initiative. Genome-wide single nucleotide polymorphism (SNP) data were obtained using Taiwan Biobank version 2 array. The ML methods used were logistic regression (LR), random forest (RF), support vector machine (SVM), gradient tree boosting (GTB), and extreme gradient boosting (XGB). SHapley Additive exPlanation (SHAP) values were calculated to clarify the contribution of each SNPs. Human leukocyte antigen (HLA) imputation was performed using the HLA Genotype Imputation with Attribute Bagging package. RESULTS: Compared with LR (area under the curve [AUC] = 0.8247), the RF approach (AUC = 0.9844), SVM (AUC = 0.9828), GTB (AUC = 0.9932), and XGB (AUC = 0.9919) exhibited significantly better prediction performance. The top 20 genes by feature importance and SHAP values included HLA class II alleles. We found that imputed HLA-DQA1*05:01, DQB1*0201 and DRB1*0301 were associated with SLE; HLA-DQA1*03:03, DQB1*0401, DRB1*0405 were more frequently observed in patients with RA. CONCLUSIONS: We established ML methods for genomic prediction of RA and SLE. Genetic variations at HLA-DQA1, HLA-DQB1, and HLA-DRB1 were crucial for differentiating RA from SLE. Future studies are required to verify our results and explore their mechanistic explanation.

A Mobile Phone-Based Approach for Hearing Screening of School-Age Children: Cross-Sectional Validation Study.

BACKGROUND: Pure-tone screening (PTS) is considered as the gold standard for hearing screening programs in school-age children. Mobile devices, such as mobile phones, have the potential for audiometric testing. OBJECTIVE: This study aimed to demonstrate a new approach to rapidly screen hearing status and provide stratified test values, using a smartphone-based hearing screening app, for each screened ear of school-age children. METHOD: This was a prospective cohort study design. The proposed smartphone-based screening method and a standard sound-treated booth with PTS were used to assess 85 school-age children (170 ears). Sound-treated PTS involved applying 4 test tones to each tested ear: 500 Hz at 25 dB and 1000 Hz, 2000 Hz, and 4000 Hz at 20 dB. The results were classified as pass (normal hearing in the ear) or fail (possible hearing impairment). The proposed smartphone-based screening employs 20 stratified hearing scales. Thresholds were compared with those of pure-tone average (PTA). RESULTS: A total of 85 subjects (170 ears), including 38 males and 47 females, aged between 11 and 12 years with a mean (SD) of 11 (0.5) years, participated in the trial. Both screening methods produced comparable pass and fail results (pass in 168 ears and fail in 2 ears). The smartphone-based screening detected moderate or worse hearing loss (average PTA>25 dB) accurately. Both the sensitivity and specificity of the smartphone-based screening method were calculated at 100%. CONCLUSIONS: The results of the proposed smartphone-based self-hearing test demonstrated high concordance with conventional PTS in a sound-treated booth. Our results suggested the potential use of the proposed smartphone-based hearing screening in a school-age population.

A password-based user authentication scheme for the integrated EPR information system.

With the rapid development of the Internet, digitization and electronic orientation are required in various applications of our daily life. For e-medicine, establishing Electronic patient records (EPRs) for all the patients has become the top issue during the last decade. Simultaneously, constructing an integrated EPR information system of all the patients is beneficial because it can provide medical institutions and the academia with most of the patients' information in details for them to make correct decisions and clinical decisions, to maintain and analyze patients' health. Also beneficial to doctors and scholars, the EPR system can give them record linkage for researches, payment audits, or other services bound to be developed and integrated into medicine. To tackle the illegal access and to prevent the information from theft during transmission over the insecure Internet, we propose a password-based user authentication scheme suitable for information integration.

The enhancement of security in healthcare information systems.

With the progress and the development of information technology, the internal data in medical organizations have become computerized and are further established the medical information system. Moreover, the use of the Internet enhances the information communication as well as affects the development of the medical information system that a lot of medical information is transmitted with the Internet. Since there is a network within another network, when all networks are connected together, they will form the "Internet". For this reason, the Internet is considered as a high-risk and public environment which is easily destroyed and invaded so that a relevant protection is acquired. Besides, the data in the medical network system are confidential that it is necessary to protect the personal privacy, such as electronic patient records, medical confidential information, and authorization-controlled data in the hospital. As a consequence, a medical network system is considered as a network requiring high security that excellent protections and managerial strategies are inevitable to prevent illegal events and external attacks from happening. This study proposes secure medical managerial strategies being applied to the network environment of the medical organization information system so as to avoid the external or internal information security events, allow the medical system to work smoothly and safely that not only benefits the patients, but also allows the doctors to use it more conveniently, and further promote the overall medical quality. The objectives could be achieved by preventing from illegal invasion or medical information being stolen, protecting the completeness and security of medical information, avoiding the managerial mistakes of the internal information system in medical organizations, and providing the highly-reliable medical information system.

Mobile agent application and integration in electronic anamnesis system.

Electronic anamnesis is to transform ordinary paper trails to digitally formatted health records, which include the patient's general information, health status, and follow-ups on chronic diseases. Its main purpose is to let the records could be stored for a longer period of time and could be shared easily across departments and hospitals. Which means hospital management could use less resource on maintaining ever-growing database and reduce redundancy, so less money would be spent for managing the health records. In the foreseeable future, building up a comprehensive and integrated medical information system is a must, because it is critical to hospital resource integration and quality improvement. If mobile agent technology is adopted in the electronic anamnesis system, it would help the hospitals to make the medical practices more efficiently and conveniently. Nonetheless, most of the hospitals today are still using paper-based health records to manage the medical information. The reason why the institutions continue using traditional practices to manage the records is because there is no well-trusted and reliable electronic anamnesis system existing and accepted by both institutions and patients. The threat of privacy invasion is one of the biggest concerns when the topic of electronic anamnesis is brought up, because the security threats drag us back from using such a system. So, the medical service quality is difficult to be improved substantially. In this case, we have come up a theory to remove such security threats and make electronic anamnesis more appealing for use. Our theory is to integrate the mobile agent technology with the backbone of electronic anamnesis to construct a hierarchical access control system to retrieve the corresponding information based upon the permission classes. The system would create a classification for permission among the users inside the medical institution. Under this framework, permission control center would distribute an access key to each user, so they would only allow using the key to access information correspondingly. In order to verify the reliability of the proposed system framework, we have also conducted a security analysis to list all the possible security threats that may harm the system and to prove the system is reliable and safe. If the system is adopted, the doctors would be able to quickly access the information while performing medical examinations. Hence, the efficiency and quality of healthcare service would be greatly improved.

Secure Dynamic access control scheme of PHR in cloud computing.

With the development of information technology and medical technology, medical information has been developed from traditional paper records into electronic medical records, which have now been widely applied. The new-style medical information exchange system "personal health records (PHR)" is gradually developed. PHR is a kind of health records maintained and recorded by individuals. An ideal personal health record could integrate personal medical information from different sources and provide complete and correct personal health and medical summary through the Internet or portable media under the requirements of security and privacy. A lot of personal health records are being utilized. The patient-centered PHR information exchange system allows the public autonomously maintain and manage personal health records. Such management is convenient for storing, accessing, and sharing personal medical records. With the emergence of Cloud computing, PHR service has been transferred to storing data into Cloud servers that the resources could be flexibly utilized and the operation cost can be reduced. Nevertheless, patients would face privacy problem when storing PHR data into Cloud. Besides, it requires a secure protection scheme to encrypt the medical records of each patient for storing PHR into Cloud server. In the encryption process, it would be a challenge to achieve accurately accessing to medical records and corresponding to flexibility and efficiency. A new PHR access control scheme under Cloud computing environments is proposed in this study. With Lagrange interpolation polynomial to establish a secure and effective PHR information access scheme, it allows to accurately access to PHR with security and is suitable for enormous multi-users. Moreover, this scheme also dynamically supports multi-users in Cloud computing environments with personal privacy and offers legal authorities to access to PHR. From security and effectiveness analyses, the proposed PHR access scheme in Cloud computing environments is proven flexible and secure and could effectively correspond to real-time appending and deleting user access authorization and appending and revising PHR records.

A mobile agent approach for secure integrated medical information systems.

Different patient-related information in medical organizations is the primary reference for medical personnel diagnosing, treating, and caring patients. With the rapid development of information technology, paper-based medical records have gradually been changed to electronic forms. However, different medical organizations present individual system specifications and data-saving formats so that the medical information of the same patient cannot be exchanged, shared, and securely accessed. In order not to largely change the present medical information systems as well as not to increase abundant costs, Virtual Integrated Medical-information Systems (VIMS) is proposed to assist various hospitals in information exchange. Furthermore, with Mobile Agent, the dispersed medical information can be securely integrated. It presents confidentiality, non-repudiation, source authentication, and integrity in network transmission. Virtual Integrated Medical-information Systems (VIMS) is a virtual electronic integration system combined with Mobile Agent technology. With the features of independence, adaptability, mobility, objectives, and autonomy, Mobile Agent is applied to overcome the problems from heterogeneous systems. With the features, the over-dispersed medical records can be integrated. Moreover, Mobile Agent can ensure the instantaneity and usability of medical records from which doctors can make the most appropriate evaluation and diagnoses. It will avoid the waste of medical resources, such as repetition medication, as well as become the reference of further consultation or health check. Not only can it improve the medical care quality, but it can be provided for medical research.

An authentication scheme to healthcare security under wireless sensor networks.

In recent years, Taiwan has been seeing an extension of the average life expectancy and a drop in overall fertility rate, initiating our country into an aged society. Due to this phenomenon, how to provide the elderly and patients with chronic diseases a suitable healthcare environment has become a critical issue presently. Therefore, we propose a new scheme that integrates healthcare services with wireless sensor technology in which sensor nodes are employed to measure patients' vital signs. Data collected from these sensor nodes are then transmitted to mobile devices of the medical staff and system administrator, promptly enabling them to understand the patients' condition in real time, which will significantly improve patients' healthcare quality. As per the personal data protection act, patients' vital signs can only be accessed by authorized medical staff. In order to protect patients', the system administrator will verify the medical staff's identity through the mobile device using a smart card and password mechanism. Accordingly, only the verified medical staff can obtain patients' vital signs data such as their blood pressure, pulsation, and body temperature, etc.. Besides, the scheme includes a time-bounded characteristic that allows the verified staff access to data without having to have to re-authenticate and re-login into the system within a set period of time. Consequently, the time-bounded property also increases the work efficiency of the system administrator and user.

A secure integrated medical information system.

The rapid rise and development of the internet has made digitization of our everyday life common. E-medicine, including electronic prescription records, electronic prescriptions, diagnosis information systems, and others are now being regarded as future trends. As development on the structure and format of electronic patient records and prescriptions matures, the implementation of a comprehensive medical information system is imperative, one which is constructed from integrating the various electronic information systems that is being developed. It is important to allow the implementation of such a system applicable to the present medical environment, which facilitates the integration of electronic patient record from all levels of medical centers and clinics, secures the transmission of these integrated patient records between them, enables the combined use of electronic prescriptions with patients' medications, and permits anonymous or confidential transmission of patients' private data. To put the ideas into practice, in this study, we would like to propose an Integrated Medical Information System.