A telematic system for oncology based on electronic health and patient records
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16 IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 5, NO. 1, MARCH 2001 A Telematic System for Oncology Based on Electronic Health and Patient Records A. James, Y. Wilcox, and R. N. G. Naguib, Senior Member, IEEE I. INTRODUCTION In September 1998, a new National Health Service (NHS) strategy was launched in the U.K. [1]. A key goal is to create electronic health records (EHRs) by 2005. The realization of the strategy will have a number of advantages, such as improving patient booking and appoint- ment systems and providing speedier diagnosis, test results, on-line advice, and information to patients and carers. The NHS executive is aware that realizing this strategy is a major challenge. Although infor- mation technology (IT) progress has been made in some sectors of the health service (90% of general practitioner (GP) practices are comput- erized and certain NHS trusts have internationally leading edge clin- ical systems in place), most of the NHS is at the rear of the information technology movement. 1 Most NHS hospitals have not invested in ad- vanced clinical systems. GP practices and hospitals have not collabo- rated to develop integrated systems, partly because of a lack of financial incentive to do so. An additional development is the establishment of a telematic system that captures and supports the clinical and admin- istrative procedures involved in oncology. Such a system will enhance the integrity of the operational processes, record keeping, and secu- rity of information, as well as easing the workload of the professionals involved through the provision of automated support. One of the chal- lenges in developing a telematic system for process support is properly capturing and supporting the processes and the interactions between the various parties involved. This challenge has been addressed by using a framework called Ariadne that supports the specification of cooper- ative work patterns [2]. Previous papers have addressed the structure and development of the multimedia workstation for oncology. Fig. 1 shows the proposed architecture for the workstation [3], [4]. An elec- tronic patient record (EPR) will remain on the server for as long as the care episode is current, i.e., from the date of admission to the date of discharge. It would then be archived. Summary information from each episode, represented as a discharge summary on the EPR, would be designated to form part of the patient’s EHR. Regarding the EHR, a centralized national directory would need to be in place to show locations of individual EPRs relating to a patient. This directory could be distributed, each entry residing with the GP practice at which the patient is registered. In this case, the completion of a care episode would trigger the transfer of the discharge summary from the EPR to the EHR. The EPR could be called if needed. Thus, a combination of push and pull would be used. The use of a data warehouse approach has the added advantage of capturing summary information in a form that is suitable for statistical data analysis. Data mining techniques can be used to find patterns that can have implications for future healthcare requirements and recom- mendations. It is on the basis of this architecture that the telematic system for oncology has been developed. Manuscript received September 21, 1999; revised January 15, 2000. The authors are with the School of Mathematical and Information Sciences, Coventry University, Coventry CV1 5FB, U.K. Publisher Item Identifier S 1089-7771(01)01710-1. 1 U.K. National Database of Telemedicine. [Online]. Available: http://www.dis.port.ac.uk/ndtrr Telemedicine can be seen as covering four main areas. The first and most widespread is its use for remote consultations, diagnoses, and education [5], [6]. Techniques such as audio and video conferencing are very important in this area, as are techniques of image capture and transfer, a teleconferencing subsystem, a communication subsystem, and a database management subsystem [7]. The growth of communica- tions technology, the Internet, and the World Wide Web has made rapid advances possible in this area. A second area in which telemedicine is making a rapid advance is that of the emergency services [8]. A third area of growing importance is that of home-based care using sensors to monitor a patient’s well being [9]. 2 A fourth area that telemedicine covers, but which perhaps has thus far attracted less attention, is that of integrated record-keeping and automatic transfer of routine infor- mation. Information management is a constant problem in healthcare, as inaccurate or incomplete records and unavailable or unlocatable in- formation are frequent difficulties. The development of the EHR and EPR, which is now the subject of much interest, falls into this area [1], [5], [10]. The NHS recognizes six levels of IT adoption in healthcare systems [1] (Table I). Most current healthcare systems are at Level 1 with some notable specialized exceptions. The telematic system for oncology is at Level 6. Oncology is a particularly complicated area, as it draws on most of the other diagnostic systems and also has a number of different treatment regimes, each of which may have their own system, e.g., surgery, chemotherapy, and radiotherapy. Relevant information will be extracted from the underlying systems on a regular basis and stored on a server that can be accessed by various parties. Regarding the EHR, a centralized national directory would need to be in place to show loca- tions of individual EPRs relating to a patient. In order to clearly capture and specify the requirements of the telem- atic system for oncology, it was decided that a framework, based on Ariadne, especially designed for describing computer-supported co- operative work (CSCW) should be used (Table II). The use of such a framework captures the workflow, clearly showing the tasks of each actor within the processes, as well as resources needed by each actor. The Ariadne framework was developed as part of a European Es- prit research project, which studied computational notations for repre- senting CSCW [2]. Ariadne can be considered as a notation for defining multiagent architecture for supporting articulation work among coop- erating actors. Let us consider a simplified typical procedure in the field of on- cology patient care and see how this can be represented in a telematic system for oncology. A patient presents symptoms to his/her GP. The GP refers the patient to the oncologist. The oncologist assesses the pa- tient and requests pathology and radiology tests. On the basis of the test results, the oncologist makes a diagnosis and decides whether to dis- charge or treat the patient. If the patient is to be treated, various options are considered and a course of treatment or surgical intervention is de- termined. This is then carried out. At the end of the period of treatment, the patient is reassessed, diagnostic tests may be performed again, and then the oncologist decides whether to discharge the patient or admin- ister further treatment. This cycle repeats until the patient is discharged or no further treatment is considered viable. The GP is informed of out- comes at various stages of the oncology treatment process. This architecture is in line with a recently published U.K. NHS in- formation strategy. The framework appears to be suitable for defining the telematic oncology system, and the advantage of such a framework 2 Telehome Healthcare, telemedicine articles from past issues index of Telemedicine Today, [Online]. Available: http://telemedtoday.com/arti- clearchive/articles/telemedicine_articles.htm 1089–7771/01$10.00 © 2001 IEEE
Transcript of A telematic system for oncology based on electronic health and patient records
16 IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 5, NO. 1, MARCH 2001
A Telematic System for Oncology Based on ElectronicHealth and Patient Records
A. James, Y. Wilcox, and R. N. G. Naguib, Senior Member, IEEE
I. INTRODUCTION
In September 1998, a new National Health Service (NHS) strategywas launched in the U.K. [1]. A key goal is to create electronic healthrecords (EHRs) by 2005. The realization of the strategy will have anumber of advantages, such as improving patient booking and appoint-ment systems and providing speedier diagnosis, test results, on-lineadvice, and information to patients and carers. The NHS executive isaware that realizing this strategy is a major challenge. Although infor-mation technology (IT) progress has been made in some sectors of thehealth service (90% of general practitioner (GP) practices are comput-erized and certain NHS trusts have internationally leading edge clin-ical systems in place), most of the NHS is at the rear of the informationtechnology movement.1 Most NHS hospitals have not invested in ad-vanced clinical systems. GP practices and hospitals have not collabo-rated to develop integrated systems, partly because of a lack of financialincentive to do so. An additional development is the establishment ofa telematic system that captures and supports the clinical and admin-istrative procedures involved in oncology. Such a system will enhancethe integrity of the operational processes, record keeping, and secu-rity of information, as well as easing the workload of the professionalsinvolved through the provision of automated support. One of the chal-lenges in developing a telematic system for process support is properlycapturing and supporting the processes and the interactions between thevarious parties involved. This challenge has been addressed by usinga framework called Ariadne that supports the specification of cooper-ative work patterns [2]. Previous papers have addressed the structureand development of the multimedia workstation for oncology. Fig. 1shows the proposed architecture for the workstation [3], [4]. An elec-tronic patient record (EPR) will remain on the server for as long as thecare episode is current, i.e., from the date of admission to the date ofdischarge. It would then be archived. Summary information from eachepisode, represented as a discharge summary on the EPR, would bedesignated to form part of the patient’s EHR.
Regarding the EHR, a centralized national directory would need tobe in place to show locations of individual EPRs relating to a patient.This directory could be distributed, each entry residing with the GPpractice at which the patient is registered. In this case, the completionof a care episode would trigger the transfer of the discharge summaryfrom the EPR to the EHR. The EPR could be called if needed. Thus, acombination of push and pull would be used.
The use of a data warehouse approach has the added advantage ofcapturing summary information in a form that is suitable for statisticaldata analysis. Data mining techniques can be used to find patterns thatcan have implications for future healthcare requirements and recom-mendations. It is on the basis of this architecture that the telematicsystem for oncology has been developed.
Manuscript received September 21, 1999; revised January 15, 2000.The authors are with the School of Mathematical and Information Sciences,
Coventry University, Coventry CV1 5FB, U.K.Publisher Item Identifier S 1089-7771(01)01710-1.
1U.K. National Database of Telemedicine. [Online]. Available:http://www.dis.port.ac.uk/ndtrr
Telemedicine can be seen as covering four main areas. The first andmost widespread is its use for remote consultations, diagnoses, andeducation [5], [6]. Techniques such as audio and video conferencingare very important in this area, as are techniques of image capture andtransfer, a teleconferencing subsystem, a communication subsystem,and a database management subsystem [7]. The growth of communica-tions technology, the Internet, and the World Wide Web has made rapidadvances possible in this area. A second area in which telemedicine ismaking a rapid advance is that of the emergency services [8]. A thirdarea of growing importance is that of home-based care using sensorsto monitor a patient’s well being [9].2 A fourth area that telemedicinecovers, but which perhaps has thus far attracted less attention, is thatof integrated record-keeping and automatic transfer of routine infor-mation. Information management is a constant problem in healthcare,as inaccurate or incomplete records and unavailable or unlocatable in-formation are frequent difficulties. The development of the EHR andEPR, which is now the subject of much interest, falls into this area [1],[5], [10].
The NHS recognizes six levels of IT adoption in healthcare systems[1] (Table I). Most current healthcare systems are at Level 1 with somenotable specialized exceptions. The telematic system for oncology isat Level 6.
Oncology is a particularly complicated area, as it draws on mostof the other diagnostic systems and also has a number of differenttreatment regimes, each of which may have their own system, e.g.,surgery, chemotherapy, and radiotherapy. Relevant information will beextracted from the underlying systems on a regular basis and stored ona server that can be accessed by various parties. Regarding the EHR, acentralized national directory would need to be in place to show loca-tions of individual EPRs relating to a patient.
In order to clearly capture and specify the requirements of the telem-atic system for oncology, it was decided that a framework, based onAriadne, especially designed for describing computer-supported co-operative work (CSCW) should be used (Table II). The use of sucha framework captures the workflow, clearly showing the tasks of eachactor within the processes, as well as resources needed by each actor.
The Ariadne framework was developed as part of a European Es-prit research project, which studied computational notations for repre-senting CSCW [2]. Ariadne can be considered as a notation for definingmultiagent architecture for supporting articulation work among coop-erating actors.
Let us consider a simplified typical procedure in the field of on-cology patient care and see how this can be represented in a telematicsystem for oncology. A patient presents symptoms to his/her GP. TheGP refers the patient to the oncologist. The oncologist assesses the pa-tient and requests pathology and radiology tests. On the basis of the testresults, the oncologist makes a diagnosis and decides whether to dis-charge or treat the patient. If the patient is to be treated, various optionsare considered and a course of treatment or surgical intervention is de-termined. This is then carried out. At the end of the period of treatment,the patient is reassessed, diagnostic tests may be performed again, andthen the oncologist decides whether to discharge the patient or admin-ister further treatment. This cycle repeats until the patient is dischargedor no further treatment is considered viable. The GP is informed of out-comes at various stages of the oncology treatment process.
This architecture is in line with a recently published U.K. NHS in-formation strategy. The framework appears to be suitable for definingthe telematic oncology system, and the advantage of such a framework
2Telehome Healthcare, telemedicine articles from past issues index ofTelemedicine Today, [Online]. Available: http://telemedtoday.com/arti-clearchive/articles/telemedicine_articles.htm
1089–7771/01$10.00 © 2001 IEEE
IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 5, NO. 1, MARCH 2001 17
Fig. 1. Architecture for an oncology workstation based on an EPR.
TABLE ILEVELS OFIT ADOPTION ASSEEN BY THE U.K. NHS EXECUTIVE (FROM [1])
TABLE IIARIADNE FRAMEWORK
is that requirements and specification become more reliable and com-municable. It also provides a basis for implementation and securitymanagement. The work described in this communications is part ofa project being carried out at Coventry University, Coventry, U.K., inassociation with regional healthcare institutions.
REFERENCES
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[3] A. James and Y. Wilcox, “Electronic health records, multimedia, objecttechnology, open systems and workstations—A challenge for the mil-lennium and beyond,” inProc. 13th Int. Syst. Eng. Conf., sec. 1, 1999,pp. 67–72.
[4] A. James and Y. Wilcox, “An electronic patient record for oncologyusing a data warehouse approach,”IFMBE J. Med. Biol. Eng. Comput.,vol. 37, no. 2, pp. 1566–1567, 1999.
[5] Y. Makris et al., “Teleworks: A CSCW application for remote medicaldiagnosis support and teleconsultation,”IEEE Trans. Inform. Technol.Biomed., vol. 2, pp. 62–73, June 1998.
[6] J. Bai, Y. Zhang, and B. Dai, “Design and development of an interactivemedical teleconsultation system over the world wide web,”IEEE Trans.Inform. Technol. Biomed., vol. 2, pp. 74–79, June 1998.
[7] C. C. Lin et al., “A unified multimedia database system to supporttelemedicine,” IEEE Trans. Inform. Technol. Biomed., vol. 2, pp.183–192, Sept. 1998.
[8] F. Beltrame, P. Maryni, and G. Orsi, “On the integration of healthcareemergency systems in Europe: The WETS project case study,”IEEETrans. Inform. Technol. Biomed., vol. 2, pp. 89–97, June 1998.
[9] G. Williams, K. Doughty, and D. A. Bradley, “A systems approach toachieving CarerNet—An integrated and intelligent telecare system,”IEEE Trans. Inform. Technol. Biomed., vol. 2, pp. 1–9, Mar. 1998.
[10] J. Grimsonet al., “A CORBA-based integration of distributed electronichealthcare records using the synapses approach,”IEEE Trans. Inform.Technol. Biomed., vol. 2, pp. 124–138, Sept. 1998.
