Despite the rapid application of the Lean method in healthcare, its study in IT environments, particularly in Health Information Systems (HIS), is still limited primarily by a lack of waste identification. This paper aims to review the literature to provide an insight into the nature of waste in HIS from the perspective of Lean management. Eight waste frameworks within the context of healthcare and information technology were reviewed. Based on the review, it was found that all the seven waste categories from the manufacturing sector also exist in both the healthcare and IT domains. However, the nature of the waste varied depending on the processes of the domains. A number of additional waste categories were also identified. The findings reveal that the traditional waste model can be adapted to identify waste in both the healthcare and IT sectors.
A target of telehealth is to maintain or improve the health of people outside the normal healthcare infrastructure. A modern paradigm in healthcare, and one which fits perfectly with telehealth, is "person self-monitoring", and this fits with the concept of "personal health record" (PHR). One factor in maintaining health is to monitor physiological parameters; this is of course especially important in people with chronic maladies such as diabetes or heart disease. Parameters to be monitored include blood pressure, pulse rate, temperature, weight, blood glucose, oxygen saturation, electrocardiogram (ECG), etc. So one task within telehealth would be to help monitor an individual's physiological parameters outside of healthcare institutions and store the results in a PHR in a way which is available, comprehensible and beneficial to the individual concerned and to healthcare providers. To date many approaches to this problem have been fragmented - emphasizing only part of the problem - or proprietary and not freely verifiable. We describe a framework to approach this task; it emphasizes the implementation of standards for data acquisition, storage and transmission in order to maximize the compatibility among disparate components, e.g. various PHR systems. Data from mobile biosensors is collected on a smartphone using the IEEE 11073 standard where possible; the data can be stored in a PHR on the phone (using standard formats) or can be converted in real-time into more useful information in the PHR, which is based on the International Classification for Primary Care (ICPC2e). The phone PHR data or information can be uploaded to a central online PHR using either the Wi-Fi or GSM transmission protocol together with the Continuity of Care Record message format (CCR, ASTM E2369).
Healthcare for elderly people has become a vital issue. The Wearable Health Monitoring System (WHMS) is used to manage and monitor chronic disease in elderly people, postoperative rehabilitation patients and persons with special needs. Location-aware healthcare is achievable as positioning systems and telecommunications have been developed and have fulfilled the technology needed for this kind of healthcare system. In this paper, the researchers propose a Location-Based Mobile Cardiac Emergency System (LMCES) to track the patient's current location when Emergency Medical Services (EMS) has been activated as well as to locate the nearest healthcare unit for the ambulance service. The location coordinates of the patients can be retrieved by GPS and sent to the healthcare centre using GPRS. The location of the patient, cell ID information will also be transmitted to the LMCES server in order to retrieve the nearest health care unit. For the LMCES, we use Dijkstra's algorithm for selecting the shortest path between the nearest healthcare unit and the patient location in order to facilitate the ambulance's path under critical conditions.
Ubiquitous personal health records, which can accompany a person everywhere, are a necessary requirement for ubiquitous healthcare. Contextual information related to health events is important for the diagnosis and treatment of disease and for the maintenance of good health, yet it is seldom recorded in a health record. We describe a dual cellphone-and-Web-based personal health record system which can include 'external' contextual information. Much contextual information is available on the Internet and we can use ontologies to help identify relevant sites and information. But a search engine is required to retrieve information from the Web and developing a customized search engine is beyond our scope, so we can use Google Custom Search API Web service to get contextual data. In this paper we describe a framework which combines a health-and-environment 'knowledge base' or ontology with the Google Custom Search API to retrieve relevant contextual information related to entries in a ubiquitous personal health record.
Health Informatics (HI) has become a world wide issue since 2005 when the WHO Health Metrics Network (HMN) was formed to encourage all of the developing countries (151) to get started in eHealth. Prior to this HMN initiative the only countries with HI in place were the developed countries (40) and a few developing countries (Jamaica, Malaysia, etc.) that were just getting started in HI with a very limited number of applications compared to the developed countries. This paper suggests that much of the experience in HI gained in the developed countries can be shared with the developing countries as 'lessons learnt' - as long as the issue of economics is kept front and foremost in the planning.
Teleconsultation in Neurosurgery was introduced in Malaysia in 2006 with the aims of enhancing quality services in the field of Neurosurgery. The present teleconsultation system is equipped with user friendly features which allow physicians to send and neurosurgeons to gain access to patient data in a swift and effective manner. In the past, teleconsultation in neurosurgery was tied with teleradiology, however we have now developed a multimodality system to cater specifically for neurosurgery. In Malaysia, the teleconsultation service is gaining momentum as evidenced by the large volume of cases channeled through this system. 944 cases within a span of 4 months were recorded on the system. 54.5% of the cases were trauma, 33.2% stroke, 6.1% intracranial tumours, 2% of cases were of spinal pathology, 2% pediatric anomalies and 2.2% intracranial infections. 50.2% of the referrals were after regular working hours reflecting the need for dedicated teleneurosurgery consultative services and the ability to review referrals outside of hospitals. Only 36% of cases needed emergency transfers and 9.9% of the cases were managed remotely at distant hospitals. Another 9.4% of the cases were either transferred electively or brought to the clinic for consultation. The above findings emphasise the importance of teleconsultation as a means to provide wide medical coverage within the region.
Malaysia's national health statistics for the last half century show a remarkable improvement in the nation's health status. One important factor for this improvement is the Malaysian government's proactive intervention in the health sector. Among others, e-health has played a vital role in delivering and managing healthcare services in Malaysia. While the Government has integrated telehealth in its national digital infrastructure re-design, it has heavily invested in telehealth. The enactment of new laws to facilitate telehealth practices can also be noted as an important measure.
Earlier evaluation studies on Health Information Systems (HIS) adoption have highlighted a large number of adoption problems that were attributed to the lack of fit between technology, human and organisation factors. Lessons can be learned from these evaluation studies by identifying the most important factors of HIS adoption. In order to study the adoption issue, a qualitative systematic review has been performed using a recently introduced framework, known as HOT-fit (Human, Organisation and Technology fit). The paper identifies and highlights the following critical adoption factors: technology (ease of use, system usefulness, system flexibility, time efficiency, information accessibility and relevancy); human (user training, user perception, user roles, user skills, clarity of system purpose, user involvement); organisation (leadership and support, clinical process, user involvement, internal communication, inter organisational system, as well as the fit between them. The findings can be used to guide future system development and inform relevant decision making.
The School of Health Sciences, Universiti Sains Malaysia (SHS) is planning to expand its contribution to produce more graduate nurses by offering a nursing degree through e-learning. After three years of using e-learning by four lecturers in seven nursing courses, we conducted a study to get the lecturers feedback and to compare the students' preference and their actual experiences in e-learning. Lecturers' feedback were collected based on six open-ended questions. Feedback from all the 36 final year nursing students were collected using Constructivist On-line Learning Environment Survey (COLLES)--the Student Experience/Preferred Form. Results show that lecturers and students have positive perception on e-learning. They perceive e-learning as a powerful and effective tool for expanding nursing education to meet the demand for a labour force that is knowledgeable, highly skilled and equipped with positive values. We believe blended learning is the most suitable approach to implement e-learning and social constructivism theory provides the dynamic view of learning. To increase success in e-learning implementation for the nursing programme, lecturers should be educated regarding proper instructional design so that their content delivery blends well with the technology and pedagogy.
The mobilisation of cohesive and effective groups of healthcare human resource is important in ensuring the success of healthcare organisations. However, forming the right team or coalition in healthcare organisations is not always straightforward due to various human factors. Traditional coalition formation approaches have been perceived as 'materialistic' or focusing too much on competency or pay-off. Therefore, to put prominence on the human aspects of working together, we present a cohesiveness-focused healthcare coalition formation methodology and framework that explores the possibilities of social networks, i.e. the relationship between various healthcare human resources, and adaptive resonance theory.
Malaysia, like many other countries faces major challenges in meeting increasing demands with limited resources. Changes in demography, life-style diseases, increasing consumer expectations, new medical technologies and rapid economic growth all fuel demand for more healthcare services. There are problems related to the distribution and delivery of healthcare services, and there is inadequate integration of healthcare delivery and continuity of care is a major concern. Resources tend to be concentrated in the very expensive hospital sector, although services would be cost-effectively and conveniently delivered at primary care level. There is no ideal healthcare system, and how healthcare is supported and organized for service delivery influences the country's social, economic and political well-being. Like many other countries, Malaysia is undergoing health reform in meeting these challenges, and is becoming more reliant on telemedicine and telehealth.
The Integrated Telehealth Project of Malaysia is considered a principal enabler for the nation's Vision 2020 as well as the National Health Vision. Being in such an unenviable position, of being not only the pioneer for such an integrated project, but also with no benchmark to compare with, the project implementers have faced manifold challenges along the way. This chapter deals with some of the challenges and lessons learnt that have accumulated as the project progressed.
Initiatives in healthcare knowledge management have provided some interesting solutions for the implementation of large-scale information repositories vis-à-vis the implementation of Healthcare Enterprise Memories (HEM). In this paper, we present an agent-based Intelligent Healthcare Information Assistant (IHIA) for dynamic information gathering, filtering and adaptation from a HEM comprising an amalgamation of (i) databases storing empirical knowledge, (ii) case-bases storing experiential knowledge, (iii) scenario-bases storing tacit knowledge and (iv) document-bases storing explicit knowledge. The featured work leverages intelligent agents and medical ontologies for autonomous HEM-wide navigation, approximate content matching, inter- and intra-repositories content correlation and information adaptation to meet the user's information request. We anticipate that the use of IHIA will empower healthcare stakeholders to actively communicate with an 'information/knowledge-rich' HEM and will be able to retrieve with ease 'useful' task-specific information via the presentation of cognitively intuitive queries.
This paper presents a case for an intelligent agent based framework for knowledge discovery in a distributed healthcare environment comprising multiple heterogeneous healthcare data repositories. Data-mediated knowledge discovery, especially from multiple heterogeneous data resources, is a tedious process and imposes significant operational constraints on end-users. We demonstrate that autonomous, reactive and proactive intelligent agents provide an opportunity to generate end-user oriented, packaged, value-added decision-support/strategic planning services for healthcare professionals, manages and policy makers, without the need for a priori technical knowledge. Since effective healthcare is grounded in good communication, experience sharing, continuous learning and proactive actions, we use intelligent agents to implement an Agent based Data Mining Infostructure that provides a suite of healthcare-oriented decision-support/strategic planning services.
Malaysia's experience in implementing the Integrated Telehealth Project has placed her way ahead in the arena of world Telehealth. Thus, she has become the focus point, reference point and benchmark for similar endeavors around the world. In fact, it would not be presumptuous to state that the Integrated Telehealth project is a trail-blazing pioneer with e-leadership experience and skills developed over the last few years. It is hoped that the Integrated Telehealth concept will find acceptance and credence globally.
Wayfinding ability in older adults with Alzheimer's disease (AD) is progressively impaired due to ageing and deterioration of cognitive domains. Usually, the sense of direction is deteriorated as visuospatial and spatial cognition are associated with the sensory acuity. Therefore, navigation systems that support only visual interactions may not be appropriate in case of AD. This paper presents a concept of wearable navigation device that integrates the haptic-feedback technology to facilitate the wayfinding of individuals with AD. The system provides the simplest instructions; left/right using haptic signals, as to avoid users' distraction during navigation. The advantages of haptic/tactile modality for wayfinding purpose based on several significant studies are presented. As preliminary assessment, a survey is conducted to understand the potential of this design concept in terms of (1) acceptability, (2) practicality, (3) wearability, and (4) environmental settings. Results indicate that the concept is highly acceptable and commercially implementable. A working prototype will be developed based on the results of the preliminary assessment. Introducing a new method of navigation should be followed by continuous practices for familiarization purpose. Improved navigability allows the good performance of activities of daily living (ADLs) hence maintain the good quality of life in older adults with AD.
For medical application, the efficiency and transmission distance of the wireless power transfer (WPT) are always the main concern. Research has been showing that the impedance matching is one of the critical factors for dealing with the problem. However, there is not much work performed taking both the source and load sides into consideration. Both sides matching is crucial in achieving an optimum overall performance, and the present work proposes a circuit model analysis for design and implementation. The proposed technique was validated against experiment and software simulation. Result was showing an improvement in transmission distance up to 6 times, and efficiency at this transmission distance had been improved up to 7 times as compared to the impedance mismatch system. The system had demonstrated a near-constant transfer efficiency for an operating range of 2cm-12cm.
Telehealth and telemedicine are increasingly becoming accepted practices in Asia, but challenges remain in deploying these services to the farthest areas of many developing countries. With the increasing popularity of universal health coverage, there is a resurgence in promoting telehealth services. But while telehealth that reaches the remotest part of a nation is the ideal endpoint, such goals are burdened by various constraints ranging from governance to funding to infrastructure and operational efficiency.
Casemix grouping using procedures classifications has become an important use case for health care terminologies. There are so many different national procedures classifications used for Casemix grouping that it is not possible to agree on a worldwide standard. ICHI (International Classification of Health Interventions) is proposing an approach that standardises only the terminologies' model structure. The poster shows the use of the ICHI alpha to replace ICD9 CM Volume 3 in the UNU-CBG International Casemix grouper.
The healthcare enterprise requires a great deal of knowledge to maintain premium efficiency in the delivery of quality healthcare. We employ Knowledge Management based knowledge acquisition strategies to procure 'tacit' healthcare knowledge from experienced healthcare practitioners. Situational, problem-specific Scenarios are proposed as viable knowledge acquisition and representation constructs. We present a healthcare Tacit Knowledge Acquisition Info-structure (TKAI) that allows remote healthcare practitioners to record their tacit knowledge. TKAI employs (a) ontologies for standardisation of tacit knowledge and (b) XML to represent scenario instances for their transfer over the Internet to the server-side Scenario-Base and for the global sharing of acquired tacit healthcare knowledge.