Comparison of the safety, effectiveness, and usability of swab robot vs. manual nasopharyngeal specimen collection.

Background: Healthcare workers face a risk of infection during aerosol-generating procedures, such as nasal swabbing. Robot-assisted nasopharyngeal sampling aims to minimize this risk and reduce stress for healthcare providers. However, its effectiveness and safety require validation. Methods: We conducted a controlled trial with 80 subjects at two teaching hospitals and compared robot-collected vs manually-collected nasopharyngeal swabs. The primary outcomes included specimen quality and success rate of nasopharyngeal swab collection. We also recorded the pain index, duration of the collection, and psychological stress using a post-collection questionnaire. Results: During the study period, from September 23 to October 27, 2020, 40 subjects were enrolled in both the robotic and manual groups. The cycle threshold (Ct) value for nasopharyngeal specimens was statistically higher in the robotic group compared to the manual group (30.9 vs 28.0, p < 0.01). Both groups had Ct values under 35, indicating good quality specimens. In the robotic group, 3 out of 40 subjects required a second attempt at specimen collection, resulting in a success rate of 92.5 %. Further, although the pain levels were lower in the robotic group, the difference was not statistically significant (2.8 vs 3.6, p = 0.07). The manual group had a shorter sampling time, which was 29 s (201 vs 29, p < 0.05). However, when factoring in the time needed to put on personal protective equipment, the average time for the manual group increased to 251 s (201 vs 251, p < 0.05). Participants' questionnaire results show comparable psychological stress in both groups. Medical staff expressed that using a robot would reduce their psychological stress. Conclusions: We propose a safe and effective robotic technology for collecting nasopharyngeal specimens without face-to-face contact, which may reduce the stress of physicians and nurses. This technology can also be optimized for efficiency, making it useful in situations where droplet-transmitted infectious diseases are a concern.

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.

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.

Design and implementation of web-based discharge summary note based on service-oriented architecture.

Discharge summary note is one of the essential clinical data in medical records, and it concisely capsules a patient's status during hospitalization. In the article, we adopt web-based architecture in developing a new discharge summary system for the Healthcare Information System of National Taiwan University Hospital, to improve the traditional client/sever architecture. The article elaborates the design approaches and implementation illustrations in detail, including patients' summary query and searching, model and phrase quoted, summary check list, major editing blocks as well as other functionalities. The system has been on-line and achieves successfully since October 2009.

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.

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.

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.

A newborn screening system based on service-oriented architecture embedded support vector machine.

The clinical symptoms of metabolic disorders are rarely apparent during the neonatal period, and if they are not treated earlier, irreversible damages, such as mental retardation or even death, may occur. Therefore, the practice of newborn screening is essential to prevent permanent disabilities in newborns. In the paper, we design, implement a newborn screening system using Support Vector Machine (SVM) classifications. By evaluating metabolic substances data collected from tandem mass spectrometry (MS/MS), we can interpret and determine whether a newborn has a metabolic disorder. In addition, National Taiwan University Hospital Information System (NTUHIS) has been developed and implemented to integrate heterogeneous platforms, protocols, databases as well as applications. To expedite adapting the diversities, we deploy Service-Oriented Architecture (SOA) concepts to the newborn screening system based on web services. The system can be embedded seamlessly into NTUHIS.

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.

A multi-voting enhancement for newborn screening healthcare information system.

The clinical symptoms of metabolic disorders during neonatal period are often not apparent. If not treated early, irreversible damages such as mental retardation may occur, even death. Therefore, practicing newborn screening is essential, imperative to prevent neonatal from these damages. In the paper, we establish a newborn screening model that utilizes Support Vector Machines (SVM) techniques and enhancements to evaluate, interpret the Methylmalonic Acidemia (MMA) metabolic disorders. The model encompasses the Feature Selections, Grid Search, Cross Validations as well as multi model Voting Mechanism. In the model, the predicting accuracy, sensitivity and specificity of MMA can be improved dramatically. The model will be able to apply to other metabolic diseases as well.