Turning Access into a web-enabled secure information system for clinical trials.

BACKGROUND: Organizations that have limited resources need to conduct clinical studies in a cost-effective, but secure way. Clinical data residing in various individual databases need to be easily accessed and secured. Although widely available, digital certification, encryption, and secure web server, have not been implemented as widely, partly due to a lack of understanding of needs and concerns over issues such as cost and difficulty in implementation. PURPOSE: The objective of this study was to test the possibility of centralizing various databases and to demonstrate ways of offering an alternative to a large-scale comprehensive and costly commercial product, especially for simple phase I and II trials, with reasonable convenience and security. METHODS: We report a working procedure to transform and develop a standalone Access database into a secure Web-based secure information system. RESULTS: For data collection and reporting purposes, we centralized several individual databases; developed, and tested a web-based secure server using self-issued digital certificates. LIMITATIONS: The system lacks audit trails. The cost of development and maintenance may hinder its wide application. CONCLUSIONS: The clinical trial databases scattered in various departments of an institution could be centralized into a web-enabled secure information system. The limitations such as the lack of a calendar and audit trail can be partially addressed with additional programming. The centralized Web system may provide an alternative to a comprehensive clinical trial management system.

Personalized online information search and visualization.

BACKGROUND: The rapid growth of online publications such as the Medline and other sources raises the questions how to get the relevant information efficiently. It is important, for a bench scientist, e.g., to monitor related publications constantly. It is also important, for a clinician, e.g., to access the patient records anywhere and anytime. Although time-consuming, this kind of searching procedure is usually similar and simple. Likely, it involves a search engine and a visualization interface. Different words or combination reflects different research topics. The objective of this study is to automate this tedious procedure by recording those words/terms in a database and online sources, and use the information for an automated search and retrieval. The retrieved information will be available anytime and anywhere through a secure web server. RESULTS: We developed such a database that stored searching terms, journals and et al., and implement a piece of software for searching the medical subject heading-indexed sources such as the Medline and other online sources automatically. The returned information were stored locally, as is, on a server and visible through a Web-based interface. The search was performed daily or otherwise scheduled and the users logon to the website anytime without typing any words. The system has potentials to retrieve similarly from non-medical subject heading-indexed literature or a privileged information source such as a clinical information system. The issues such as security, presentation and visualization of the retrieved information were thus addressed. One of the presentation issues such as wireless access was also experimented. A user survey showed that the personalized online searches saved time and increased and relevancy. Handheld devices could also be used to access the stored information but less satisfactory. CONCLUSION: The Web-searching software or similar system has potential to be an efficient tool for both bench scientists and clinicians for their daily information needs.

Wireless local area network in a prehospital environment.

BACKGROUND: Wireless local area networks (WLANs) are considered the next generation of clinical data network. They open the possibility for capturing clinical data in a prehospital setting (e.g., a patient's home) using various devices, such as personal digital assistants, laptops, digital electrocardiogram (EKG) machines, and even cellular phones, and transmitting the captured data to a physician or hospital. The transmission rate is crucial to the applicability of the technology in the prehospital setting. METHODS: We created two separate WLANs to simulate a virtual local are network environment such as in a patient's home or an emergency room (ER). The effects of different methods of data transmission, number of clients, and roaming among different access points on the file transfer rate were determined. RESULTS: The present results suggest that it is feasible to transfer small files such as patient demographics and EKG data from the patient's home to the ER at a reasonable speed. Encryption, user control, and access control were implemented and results discussed. CONCLUSIONS: Implementing a WLAN in a centrally managed and multiple-layer-controlled access control server is the key to ensuring its security and accessibility. Future studies should focus on product capacity, speed, compatibility, interoperability, and security management.

Design of an eMonitor system to transport electronic patient care report (ePCR) information in unstable MobileIP wireless environment.

The eMonitor is a component of the ePatient system; a prototype system used by emergency medical services (EMS) personnel in the field to record and transmits electronic patient care report (ePCR) information interactively. The eMonitor component allows each Mobile Data Terminal (MDT) on an unreliable Cisco MobileIP wireless network to securely send and received XML messages used to update patient information to and from the MDT before, during and after the transport of a patient.

Expert verification of the knowledge base of FEED--a feedback expert system for EMS documentation.

Feedback Expert System for Emergency Medical Services (EMS) Documentation (FEED) has a rule-based knowledge base (KB) that was verified against specifications in a focus group consisting of six experts. The focus group suggested changes in almost all rules discussed, indicating that the KB did not meet specifications at that stage of development. However, enough information was gathered to address these issues in the next iteration of development.

Expert validation of the knowledge base for E-CAD - a pre-hospital dispatch triage decision support system.

The knowledge base (KB) for E-CAD (Enhanced Computer-Aided Dispatch), a triage decision support system for Emergency Medical Dispatch (EMD) of medical resources in trauma cases, is being evaluated. We aim to achieve expert consensus for validation and refinement of the E-CAD KB using the modified Delphi technique. Evidence-based, expert-validated and refined KB will provide improved EMD practice guidelines and may facilitate acceptance of the E-CAD by state-wide professionals.

Information needs of pre-hospital care providers - a requirements analysis.

To assess information needs of Emergency Medical Services (EMS) personnel and the potential of electronic decision support tools, we surveyed 39 paramedic students and practicing EMS personnel. We found frequent use of paper-based tools, with imperfect accessibility and ease of use. Potential electronic decision support tools were rated as helpful, but some alerts were rated low. The results may be helpful in design, implementation and research of electronic decision support tools for EMS.

Application of speech recognition data entry enhancements in an Electronic Patient Care Report (ePCR).

Based on the Alabama Patient Care Report we developed a basic Electronic Patient Care Report (ePCR) to collect data in an EMS environment. The ePCR GUI is now enhanced using speech recognition to provide speech-based command and control mechanisms to input structured data and initiate processes. This voice-enabled ePCR (vePCR) is used to evaluate the feasibility of handling EMS test cases and to get user feedback about the speech recognition functionality and usefulness.

Chest pain and validity of an emergency medical dispatch algorithm.

Chest pain is a unique symptom in medical narration because the underlying cause can vary from mild acidity to massive Acute Myocardial Infarction also known as heart attack. Medical dispatching today is geared towards patient safety however too many Advanced Life Support (ALS) responses are made due to protocol of following every chest pain call. These ALS responses lead to inefficient use of community resources. Computerized dispatch protocol integrated with the dispatch station can achieve same level of patient safety with better utilization of Emergency Medical System (EMS) resources.

A regional database of antidote availability.

Timely pre-hospital management of snake bite and poisoning cases is hindered by the lack of information about availability of antidotes in hospitals. We aim to build a regional antidote database by collecting real-time antidote stock information from hospital pharmacy inventory systems and make this information available to the emergency medical technicians (EMTs). This would save valuable time, leading to improved outcomes for the patients.

Development and testing of an algorithm for efficient resource positioning in pre-hospital emergency care.

Response times for pre-hospital emergency care may be improved with the use of algorithms that analyzes historical patterns in incident location and suggests optimal places for pre-positioning of emergency response units. We will develop such an algorithm based on cluster analysis and test whether it leads to significant improvement in mileage when compared to actual historical data of dispatching based on fixed stations.

A study design for comparing electronic patient care report (ePCR) with paper PCR in pre-hospital care.

Data gathering processes in pre-hospital care have been poorly studied. This study aims to compare an electronic PCR with the current paper standard. EMTs will hear a case narrative and enter this information in paper PCR, ePCR or ePCR pre-filled with historical patient data pulled from a database. Time taken, accuracy and completeness will be measured for each encounter. This study will provide better insight into data entry at the point of care.