Author: Bridget Moorman

Thoughts on Clinical Decision Support and its Future: Dr Greenes Interview

In two of my last blog posts, I have interviewed people and companies working in the support and implementation of decision support. With this blog post, I have the honor of interviewing Robert A. Greenes, MD, PhD, one of the first and leading researchers in clinical decision support (CDS) and my former CDS professor. He started as a co-developer of MUMPS in the 1960s while at Harvard Medical School and from there has been and continues to be involved in all aspects of CDS. One of his latest works has been editing and writing chapters for the first and second editions of Clinical Decision...

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Data Driven Predictive Medical Devices: An Interview

In 1987, James Gleick wrote the book Chaos which was a layman’s description of different instances where chaotic behavior was displayed in systems. In one of the last chapters titled Inner Rhythms, he described the then latest research regarding physiological system characteristics and the seemingly oxymoronic idea that variable response of the system indicated health versus illness, specifically with regard to heart rate variability, and that these systems exhibited characteristics of nonlinear dynamics in which physiologists ‘began to see chaos as health.’ That book, which I read in 1988, and in particular that chapter re-ignited my desire to become...

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Proof of Concept: Medical Device Directory for Integration Services

This post details the medical device directory I built demonstrating the concept of a knowledge base and expert system that would assist a healthcare organization in their medical device integration efforts. My idea was to input into an expert system (or reasoner) with an associated knowledge base a medical device inventory with the result of the expert system providing a list of the devices that are already integrate-able, need network transformation, and are not integrate-able. As a secondary output, I wanted to list the available sensor and setting outputs available for the interface broker to the EHR. As detailed...

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Update: Integration/interfacing of Medical Devices to an Electronic Health Record

Overview of Medical Device Integration Task I provided an overview of integrating medical device systems and information into an EHR in a paper I wrote in 2008. The figure below provides a graphical representation of the overview. The system architecture for medical device integration consists of a medical device which is attached to a network, and then a series of aggregators and ‘interface brokers’ for the medical device data to flow to the EHR.  Also shown in the figure is a process and system to affiliate the patient information with the specific medical device data (“patient ID binding”).  Generally, the process to implement medical device integration into an EHR consists of identifying a medical device, its networking capability, transforming that networking capability if needed, aggregating the data output from the medical device, and then mapping the data to the EHR or other consumer of the data from the sensors or setting of the medical device. It can be very difficult and time-consuming to implement a medical device integration system as there are many different vendors of medical devices with different sensors and networking capabilities. Many times a medical device does not have the ability to send data or will require a networking transformation to integrate into the system and the EHR.  In addition, depending on the medical device integration vendor, there may not be a ‘driver’ which converts the...

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Usability Heuristic Test of Mobile Fitness Application

I just finished a master’s in healthcare informatics and through that process learned quite a few things.  I am planning a series of blog posts (three or four) that highlight several of the papers I wrote that might be of interest to readers of this blog.  The subjects will cover usability of a popular mobile fitness application, an update on what is happening in the medical device integration space, and an attempt at building a medical device integration knowledge base. My healthcare background as a clinical engineer in the last 26 years has been mainly in operations or industry. ...

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DocBox Introduces New Open Clinical Decision Support Platform

While reading a couple of articles in the healthcare IT industry, several statements stood out as they highlighted some of the issues with EHRs, the data they collect, and how useful that data is to clinicians.  In a recent Healthcare IT news article Dr Anders of Medicomp stated with regard to his desire to follow a diabetic patient that, "I have to click on six different places to see if the patient's renal condition is getting better or worse."  In another article, InterMountain announced that they were working with Clinical Architecture to develop a “clinigraphic technology, which leverages ontologies...

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FHIR in Action – How Well Does It Work?

 Two years ago, I was at eHealth week in Athens, Greece, and stumbled upon several other Americans who represented the Office of the National Coordinator (ONC) touting Fast Healthcare Interoperability Resources (FHIR) as a standard that would help move healthcare interoperability forward more quickly than what we have seen over the last few decades. FHIR has been developed by the HL7 standards organization and among some of its features is based upon RESTful techniques and the Pareto idea of addressing 80% of the most common clinical use cases. At that time (2014), I started a dialogue with some of...

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From Pilot to Policy: Lessons from e-Health Deployed at Scale

As mentioned in previous posts, the United4Health project was intended to test the deployment at scale of mobile health solutions and to integrate those telehealth services as part of the standard of care. Participants took this to heart and used the project to help tackle larger issues of policy, funding, technology, resources and overall workflow. The following interview explores some of these larger issues, specifically:  the need to realign payment models, challenges around the adoption of communications and data standards, the role of test and certification bodies like Continua, overcoming systems integration challenges, patient generated data, and how sensors need...

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Case Study: Sensor Selection for Remote Monitoring

In a previous blog post, I highlighted general principles for implementing and scaling systems to support remote monitoring of chronic conditions, namely congestive heart failure (CHF), Diabetes Mellitus (Type II Diabetes) and chronic obstructive pulmonary disease (COPD).  In this blog post I will focus on COPD as a case study for the development, implementation and scaling of a remote monitoring system. Definition of COPD The World Health Organization (WHO) defines COPD as a “...lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible [...] diagnosis is confirmed by a simple...

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Major EU Remote Monitoring Pilot Results

This post looks at some lessons learned from remote monitoring projects in Europe.  This and subsequent posts are based on my last eight years of supporting these projects combined with some thoughts from my implementation experience of technology systems in many different scenarios over the last thirty years.   I hope that some of it will be of value to the readers wherever they are in the healthcare industry delivery chain. Overview I’m finishing up support  of two long-term projects based in Europe that are focused on using remote monitoring technologies and integrated platforms to support chronic disease management.  One of the...

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