How can social robot use cases in healthcare be pushed - with an interoperable programming interface.

INTRODUCTION: Research into current robot middleware has revealed that most of them are either too complicated or outdated. These facts have motivated the development of a new middleware to meet the requirements of usability by non-experts. The proposed middleware is based on Android and is intended to be placed over existing robot SDKs and middleware. It runs on the android tablet of the Cruzr robot. Various toolings have been developed, such as a web component to control the robot via a webinterface, which facilitates its use. METHODS: The middleware was developed using Android Java and runs on the Cruzr tablet as an app. It features a WebSocket server that interfaces with the robot and allows control via Python or other WebSocket-compatible languages. The speech interface utilizes Google Cloud Voice text-to-speech and speech-to-text services. The interface was implemented in Python, allowing for easy integration with existing robotics development workflows, and a web interface was developed for direct control of the robot via the web. RESULTS: The new robot middleware was created and deployed on a Cruzr robot, relying on the WebSocket API and featuring a Python implementation. It supports various robot functions, such as text-to-speech, speech-to-text, navigation, displaying content and scanning bar codes. The system's architecture allows for porting the interface to other robots and platforms, showcasing its adaptability. It has been demonstrated that the middleware can be run on a Pepper robot, although not all functions have been implemented yet. The middleware was utilized to implement healthcare use cases and received good feedback. CONCLUSION: Cloud and local speech services were discussed in regard to the middleware's needs, to run without having to change any code on other robots. An outlook on how the programming interface can further be simplified by using natural text to code generators has been/is given. For other researchers using the aforementioned platforms (Cruzr, Pepper), the new middleware can be utilized for testing human-robot interaction. It can be used in a teaching setting, as well as be adapted to other robots using the same interface and philosophy regarding simple methods.

Using Robots in Medical Informatics Education.

Although robots have been used for quite some time in education on school and university level, we found no reports of robots being used in the teaching of medical informatics. Thus we present the timetable and structure of a one week, 2 ECTS blocked course for robots in medical informatics initiated in autumn 2022. 19 participants completed the first iteration. We report about the requirements in terms of an appropriate programming environment, the combination among robots and our medical informatics lab and the results of the student's evaluation of the first instance as well as the experiences with the two types of robots used.

SERO - A New Mobile App for Suicide Prevention.

Mobile apps indicate a positive effect on suicidal ideation and potential impact on suicide attempts. As part of the SERO suicide prevention program, Lucerne Psychiatry in collaboration with partner organizations aims to reduce suicides and suicide attempts in its service area, and to improve the self-management of suicidal individuals with a mobile app. The concept for such an app was developed in a trialog with health professionals, persons at risk and their relatives and its functions were compared to six known essential app-based strategies for suicide prevention, such as the development of a safety plan, access to support networks and tracking of mood. We present the concept and architecture for the app and discuss potential added value, which may result from the intertwining of the strategies within the app, which will be available in its first version in late 2022.

Digi-Care: Exploring the Impacts of Digitization on Nursing Work in Switzerland.

In this paper we present first findings of the Digi-Care project, a multidisciplinary, multi-stakeholder research project investigating the impacts of digitization on nursing work practices and in particular the transmission of patient care information within and beyond nursing work practices. We completed the initial data collection of the funded 3-year research project and report on a plethora of significant and critical IT-related events. Some of them can be attributed to usability issues.

Digitizing the ECG Workflow - A State-of-the-Art Analysis.

ECG is one of the most common examinations in hospitals, e.g. for diagnosing cardiovascular diseases - the most frequent cause of death worldwide. Goal of this paper was to identify and describe the typical digitized workflow, IT systems and data formats for ECG in hospitals: A survey on current ECG-data management practices was conducted with four German speaking hospitals. A generic model of ECG data management was drafted. Today, these hospitals do not use DICOM as exchange format nor do they implement IHE profiles such as REWF for the ECG. Reasons include missing IT infrastructure such as Master Patient Index or electronic archive. ECG data management could be improved at different levels, with the chance to reduce error sources and to improves in patient safety. Storage of ECG raw data promises better diagnoses based on big data and machine learning technologies.

An Interoperable Resuscitation Registry for the University Hospital of Bern.

During resuscitation, the patient is the primary focus with the documentation of actions and outcomes being secondary. In most cases, a cardiac event leads to further treatment or hospitalization, in which complex patient pathways, independent documentation systems and information loss represent the key challenges for successful quality management. Hence, the need for a system that takes all these aspects into account. Market research, system analysis and requirements engineering for such a solution were performed and a prototype was created. A complete reference architecture for a web-based electronic data capture system was developed and implemented that enables healthcare professionals to enter resuscitation-relevant data uniformly and store it centrally in compliance with human research legislation. A qualitative evaluation concerning the process flows of the as-is and the to-be situation suggests that there is potential to achieve benefits in the form of improved data quality and quantity.

Automated identification of diagnostic labelling errors in medicine.

OBJECTIVES: Identification of diagnostic error is complex and mostly relies on expert ratings, a severely limited procedure. We developed a system that allows to automatically identify diagnostic labelling error from diagnoses coded according to the international classification of diseases (ICD), often available as routine health care data. METHODS: The system developed (index test) was validated against rater based classifications taken from three previous studies of diagnostic labeling error (reference standard). The system compares pairs of diagnoses through calculation of their distance within the ICD taxonomy. Calculation is based on four different algorithms. To assess the concordance between index test and reference standard, we calculated the area under the receiver operating characteristics curve (AUROC) and corresponding confidence intervals. Analysis were conducted overall and separately per algorithm and type of available dataset. RESULTS: Diagnoses of 1,127 cases were analyzed. Raters previously classified 24.58% of cases as diagnostic labelling errors (ranging from 12.3 to 87.2% in the three datasets). AUROC ranged between 0.821 and 0.837 overall, depending on the algorithm used to calculate the index test (95% CIs ranging from 0.8 to 0.86). Analyzed per type of dataset separately, the highest AUROC was 0.924 (95% CI 0.887-0.962). CONCLUSIONS: The trigger system to automatically identify diagnostic labeling error from routine health care data performs excellent, and is unaffected by the reference standards' limitations. It is however only applicable to cases with pairs of diagnoses, of which one must be more accurate or otherwise superior than the other, reflecting a prevalent definition of a diagnostic labeling error.

Digitizing Data Management for Intraoperative Neuromonitoring.

Intraoperative neurophysiological monitoring (IOM) enables a function-preserving surgical strategy for surgeries of brain or spinal cord pathologies by neurophysiological measurements. However, the IOM data management at neurosurgical institutions are often either not digitized or inefficient in terms of collecting, storing and processing of IOM data. Here, we describe the development of a web application, called IOM-Manager, as a first step towards the complete digitization of the IOM workflow. The web application is used for structured protocoling based on standardized protocol entry catalog, data archiving, and data analysis. These functionalities are based on the results of the requirement engineering of a process analysis, a survey with potential users and a market analysis. A usability test with one IOM team indicated the IOM-Manager and its other components can in fact solve many problems of existing solutions.

A Protocol Entry Catalog for Intraoperative Neuromonitoring - Steps Towards an Ontology.

In neurosurgery, intraoperative neurophysiological monitoring (IOM) with continuous measurements of neural electrical activity may reduce the risk of postoperative deficits. During an IOM, surgical information as well as neurophysiological, surgical and anesthesia events have to be recorded. So far, there is no common standard for this task available. In this paper, such a standardization with the aim of facilitating the data input and making the protocols data available for different sorts of analyses is described. We developed a protocol entry catalog with 200 standard expressions, which were divided into four categories: IOM, surgical procedure, anesthesia and others. An empirical assessment of the catalog by the IOM team showed the need for subcategories. In the final version of the catalog, the standard terms were grouped into 25 subcategories. The catalog is a first step to support systematic research into the occurrence of clinical events during the IOM and their association with postoperative neurological deficits that could enable improved surgical procedures in the future.

Prototyping a Tool for Processing Genetic Meta-Data in Microbiological Laboratories.

Next generation sequencing (NGS) technologies allow improved understanding of pathogens. In the upstream processing of generating genomic data, there is still a lack of process-oriented tools for managing corresponding meta data. In this paper, we provide a description of how a process-oriented software prototype was developed that allowed the capture and collation of metadata involved when doing NGS. Our question was: How to develop an interactive web application that supports the process-oriented management of genetic data independent of any sequencing technique?

Using Business Intelligence Tools to Support Medical Validation of Laboratory Tests.

Modern clinical laboratories have to confirm that the procedures used for specific tests are reliable and valid. There are several sources of errors and interferences that can invalidate the results. Medical validation refers to the plausibility check of the test results. Implausible results indicate that something might went wrong with a sample retrieved from the patient, e.g., the blood sample got contaminated with another fluid, which requires re-examination. Here, we describe how an integrated R-based business intelligence (BI) tool can be developed that increase the efficiency of the medical validation at the Institute of Clinical Chemistry (ICC) of the University Hospital Zurich. A BI software environment allowed us to digitalize steps in the validation process that were manually done in Excel worksheets, e.g., importing the data, calculating percentiles, and producing graphical outputs.

Integrating Pharmacogenetic Decision Support into a Clinical Information System.

Pharmacogenetic testing can prevent adverse drug events but has rarely found its way into clinical routine. One reason is the lack of tools for smooth and automatable integration of pharmacogenetic knowledge into existing processes. Especially, electronic medical records (EMR) represent a suitable environment for such tools. We developed a modular service-oriented prototype of a pharmacogenetic decision support system within an EMR system of the Bern University Hospital. Here, we present the component architecture of our system and discuss issues required for generalizing our results.

Sensor-Based Decision Support for the Allocation of Patient Attendants in Hospitals.

In hospitals, patient attendants are often necessary in order to closely monitor patients with high risk of self-endangering actions and reactions. However, such additional monitoring of patients is associated with high costs. In this paper, we describe a technical infrastructure for monitoring the patient's activities, which helps to assess whether an attendant should be requested. It was central to for us to use non-invasive sensors and to exploit a variety of patient data such as heart rate, micro-activity and oxygen saturation.

A method for the graphical modeling of relative temporal constraints.

Searching for patient cohorts in electronic patient data often requires the definition of temporal constraints between the selection criteria. However, beyond a certain degree of temporal complexity, the non-graphical, form-based approaches implemented in current translational research platforms may be limited when modeling such constraints. In our opinion, there is a need for an easily accessible and implementable, fully graphical method for creating temporal queries. We aim to respond to this challenge with a new graphical notation. Based on Allen's time interval algebra, it allows for modeling temporal queries by arranging simple horizontal bars depicting symbolic time intervals. To make our approach applicable to complex temporal patterns, we apply two extensions: with duration intervals, we enable the inference about relative temporal distances between patient events, and with time interval modifiers, we support counting and excluding patient events, as well as constraining numeric values. We describe how to generate database queries from this notation. We provide a prototypical implementation, consisting of a temporal query modeling frontend and an experimental backend that connects to an i2b2 system. We evaluate our modeling approach on the MIMIC-III database to demonstrate that it can be used for modeling typical temporal phenotyping queries.

Exchanging Appointment Data Among Healthcare Institutions.

The introduction of national electronic patient records such as the electronic patient dossier EPD in Switzerland provides a new basis for digitizing healthcare processes at a national level. One process however, that is currently neglected within the Swiss EPD, is the scheduling process in healthcare. The objective of this work is to analyze the appointment scheduling process and the involved IT systems in order to develop an appointment data structure and a concept for cross-institutional exchange of appointment data. The analysis showed that various outpatient and inpatient information systems support appointment booking through proprietary solutions. A true standard for appointment data exchange is missing. We suggest an appointment data structure and a corresponding data exchange process based on the FHIR standard. In its current implementation, the Swiss EPD does not support this proposed appointment scheduling process. We discuss how potential additions such as the IHE Care Services Discovery (CSD) profile can provide better compatibility.

Cross-Institutional Pathway Guidance - Chance or Extra Burden?

In this paper, we examine requirements, show potential user interfaces and describe a prototypical development for a Pathway Navigator App that guides the patient through healthcare episodes. Our use case is a fictional patient requiring surgery for a hip total endoprosthesis. Fundamental is the provision of appointment information and the option to contact the healthcare provider for rescheduling. This implied an architecture which was more complicated than expected. We realized an HL7 interface for appointment data from hospital information systems; no comparable standard was found for GP IT systems. The future Swiss Electronic Patient Dossier could enhance the integration of the Path App within a broader health-IT ecosystem.

Current Reasons for Not Using Clinical Pathways in Practice.

Clinical pathways are often promoted as the holy grail of efficient healthcare provision. However, our experiences during the Swiss research project Hospital of the Future demonstrated that most Swiss hospitals do not implement clinical pathways in the sense of '… a document describing the common process of a multidisciplinary treatment for a particular type of patient'. In this paper, we will discuss reasons for the lack of pathway implementations. We differentiate between three different categories of explanations: (i) organization-specific impediments, (ii) environmental hurdles, and (iii) inherent problems of clinical pathways. Without additional support and regulation by the policy maker, it seems rather unlikely that an increase of pathway implementations will take place in the near-future in Switzerland.

Streamlining Hospital IT - Improving the Admission Process.

We analyzed the admission workflow in three Swiss hospitals of different size for normal and emergency admissions. Our goal was to detect shortcomings mainly in the administrative admission process due to media breaks. We obtained 9 different workflows (three per hospital) and a total of 22 shortcomings in the admission process which were present or likely in two or more of the hospitals. A considerable number could be traced back to missing information requiring time consuming extra work. We drafted five potential IT-based workflow changes and made, together with the hospital partners, a cost-benefit analysis which solution would be most interesting. As a result, a concept for an open multi center hospital admission portal was drafted, which, in theory, should influence 8 of the 22 problems found. Specifically, the prototype of the portal was designed for a direct triangular interaction between the referring doctor, the patient and the hospital staff.

Components for Material Master Data Management in Swiss Hospitals.

The material master data catalogue in large hospitals may well exceed 50'000 articles required at one or another location for patient diagnosis and treatment. Most hospitals use a commercial material management IT system to deal with orders, eProcurement, incoming goods, warehouse management, internal commissioning and distribution. An analysis in three Swiss hospitals (including a hospital chain) demonstrated however, that despite existing standards maintenance of the material master data catalogue is often done manually based on different incoming formats such as csv, mail etc. We present components, which may enable seamless master data update using standardized formats and discuss in detail current barriers within hospital supply to give finally recommendations how to overcome them.

A Concept for Improving Cross-Sector Care by a Mobile Patient Navigator App.

Hip and knee joint prosthetic implants are common surgical interventions in Switzerland, as well as in other countries. Different care providers are involved in the care process which constitutes a potential risk of inefficiency and communication deficits. A patient can get lost on his cross-sectoral clinical pathway, miss appointments or underestimate the relevance of certain control visits or examinations. To address this, we introduce a concept for a mobile application that guides patients along the cross-sectoral clinical pathway. The information on appointments is consistently retrieved from information systems at the care provider's side. This facilitates the coordination of activities and appointments not only for the patient, but also for the care providers. The aim is to promote the patients' autonomy, to support their management of appointments, to increase the understanding for their clinical condition and to improve their adherence to the prescribed measures - all of which lead to an improved outcome. Another aim is to increase patient satisfaction in terms of adequate information and quality of treatment. The advantages and disadvantages of the concept will be discussed. goes here.