Risk analysis of a patient monitoring system using Bayesian Network modeling.

In a modern technological environment where information systems are characterized by complexity, situations of non-effective operation should be anticipated. Often system failures are a result of insufficient planning or equipment malfunction, indicating that it is essential to develop techniques for predicting and addressing a system failure. Particularly for safety-critical applications such as the healthcare information systems, which are dealing with human health, risk analysis should be considered a necessity. This paper presents a new method for performing a risk analysis study of health information systems. Specifically, the CCTA Risk Analysis and Management Methodology (CRAMM) has been utilized for identifying and valuating the assets, threats, and vulnerabilities of the information system, followed by a graphical modeling of their interrelationships using Bayesian Networks. The proposed method exploits the results of the CRAMM-based risk analysis for developing a Bayesian Network model, which presents concisely all the interactions of the undesirable events for the system. Based on "what-if" studies of system operation, the Bayesian Network model identifies and prioritizes the most critical events. The proposed risk analysis framework has been applied to a vital signs monitoring information system for homecare telemedicine, namely the VITAL-Home System, developed and maintained for a private medical center (Medical Diagnosis and Treatment S.A.).

A macro-directive mechanism that facilitates automatic updating and processing of the contents of Electronic Healthcare Records: an extension to the CEN architecture.

Facilitating data entry, eliminating redundant effort and providing decision support are some of the factors upon which the successful uptake of Electronic Healthcare Record (EHCR) technology is dependent. The European Standardization Committee (CEN), on the other hand, has proposed a standard EHCR architecture, which allows patient record contents to be highly diverse, customized to individual user needs; this makes their processing a challenging task and poses a demand for specially designed mechanisms. We describe the requirements for a macro-directive mechanism, pertaining to CEN-compatible EHCR software that can automate updating and processing of patient records, thus enhancing the functionality of the software. We have implemented the above-mentioned mechanism in an EHCR application that has been customized for use in the care process of patients suffering from beta-Thalassemia. The application is being used during the last two years in the Thalassemia units of four Greek hospitals, as part of their every day practice. We report on the experience we have acquired so far.

A Java-based electronic healthcare record software for beta-thalassaemia.

BACKGROUND: Beta-thalassaemia is a hereditary disease, the prevalence of which is high in persons of Mediterranean, African, and Southeast Asian ancestry. In Greece it constitutes an important public health problem. Beta-thalassaemia necessitates continuous and complicated health care procedures such as daily chelation; biweekly transfusions; and periodic cardiology, endocrinology, and hepatology evaluations. Typically, different care items are offered in different, often-distant, health care units, which leads to increased patient mobility. This is especially true in rural areas. Medical records of patients suffering from beta-thalassaemia are inevitably complex and grow in size very fast. They are currently paper-based, scattered over all units involved in the care process. This hinders communication of information between health care professionals and makes processing of the medical records difficult, thus impeding medical research. OBJECTIVES: Our objective is to provide an electronic means for recording, communicating, and processing all data produced in the context of the care process of patients suffering from beta-thalassaemia. METHODS: We have developed - and we present in this paper - Java-based Electronic Healthcare Record (EHCR) software, called JAnaemia. JAnaemia is a general-purpose EHCR application, which can be customized for use in all medical specialties. Customization for beta-thalassaemia has been performed in collaboration with 4 Greek hospitals. To be capable of coping with patient record diversity, JAnaemia has been based on the EHCR architecture proposed in the ENV 13606:1999 standard, published by the CEN/TC251 committee. Compliance with the CEN architecture also ensures that several additional requirements are fulfilled in relation to clinical comprehensiveness; to record sharing and communication; and to ethical, medico-legal, and computational issues. Special care has been taken to provide a user-friendly, form-based interface for data entry and processing. RESULTS: The experience gained through the use of JAnaemia in 4 Greek hospitals reveals a significant contribution towards (1) improvement of the quality of the data being recorded, since data entry is guided by appropriate forms, (2) easier cooperation between physicians, who share a common information repository, and (3) increased processing capabilities, which facilitate medical research. CONCLUSIONS: JAnaemia appears to be a useful tool, which can improve the quality of care offered to beta-thalassaemic patients in Greece.

A data protection scheme for a remote vital signs monitoring healthcare service.

Personal and medical data processed by Healthcare Information Systems must be protected against unauthorized access, modification and withholding. Security measures should be selected to provide the required level of protection in a cost-efficient manner. This is only feasible if specific characteristics of the information system are examined on a basis of a risk analysis methodology. This paper presents the results of a risk analysis, based on the CRAMM methodology, for a healthcare organization offering a patient home-monitoring service through the transmission of vital signs, focusing on the identified security needs and the proposed countermeasures. The architectural and functional models of this service were utilized for identifying and valuating the system assets, the associated threats and vulnerabilities, as well as for assessing the impact on the patients and on the service provider, should the security of any of these assets is affected. A set of adequate organizational, administrative and technical countermeasures is described for the remote vital signs monitoring service, thus providing the healthcare organization with a data protection framework that can be utilized for the development of its own security plan.

Managing medical and insurance information through a smart-card-based information system.

The continuously increased mobility of patients and doctors, in conjunction with the existence of medical groups consisting of private doctors, general practitioners, hospitals, medical centers, and insurance companies, pose significant difficulties on the management of patients' medical data. Inevitably this affects the quality of the health care services provided. The evolving smart card technology can be utilized for the implementation of a secure portable electronic medical record, carried by the patient herself/himself. In addition to the medical data, insurance information can be stored in the smart card thus facilitating the creation of an "intelligent system" supporting the efficient management of patient's data. In this paper we present the main architectural and functional characteristics of such a system. We also highlight how the security features offered by smart cards can be exploited in order to ensure confidentiality and integrity of the medical data stored in the patient cards.

Vital signs monitoring from home with open systems.

This study investigates the applicability of a novel codification scheme based on two healthcare informatics standards (namely the VITAL (ENV 13734) and DICOM Sup. 30 Waveform Interchange) in addressing the robust interchange of waveform and medical data in remote healthcare applications. To further address system validation and clinical acceptance issues, pilots were set-up between home-monitoring stations and a hospital-based telemedicine consultation center. The pilots focused in assessing applicability, technical feasibility and performance of the proposed codification scheme based on the two standards. This paper presents the system and services requirements as studied for a home-care application, the design goals for the preservation of security stature, the practical issues of validation and the results of integrating these codification schemes into a commercial patient connected device.