Traumatic Brain Injury (TBI) is a problem of major medical and socioeconomic significance, although the pathogenesis
of its sequelae is not completely understood. As part of a large, multi-center project to study mild and moderate TBI, a
database and informatics system to integrate a wide-range of clinical, biological, and imaging data is being developed.
This database constitutes a systems-based approach to TBI with the goals of developing and validating biomarker panels that might be used to diagnose brain injury, predict clinical outcome, and eventually develop improved therapeutics. This paper presents the architecture for an informatics system that stores the disparate data types and permits easy access to the data for analysis.
The creation of an integrated biomedical information database requires diverse and flexible schemas. Although relational
database systems seem to be an obvious choice for storage, traditional designs of relational schemas cannot support integrated biomedical information in the most effective ways. Therefore, new models for managing diverse and flexible schemas in relational databases are required for such systems. This paper proposes several schema models for integrated biomedical information using relational tables, and presents an experimental evaluation of their efficiency.
The current trend towards systems medicine will rely heavily on computational and bioinformatics capabilities to collect,
integrate, and analyze massive amounts of data from disparate sources. The objective is to use this information to make
medical decisions that improve patient care. At Georgetown University Medical Center, we are developing an
informatics capability to integrate several research and clinical databases. Our long term goal is to provide researchers at
Georgetown's Lombardi Comprehensive Cancer Center better access to aggregated molecular and clinical information
facilitating the investigation of new hypotheses that impact patient care. We also recognize the need for data mining
tools and intelligent agents to help researchers in these efforts.
This paper describes our initial work to create a flexible platform for researchers and physicians that provides access to
information sources including clinical records, medical images, genomic, epigenomic, proteomic and metabolomic data.
This paper describes the data sources selected for this pilot project and possible approaches to integrating these databases.
We present the different database integration models that we considered. We conclude by outlining the proposed
Information Model for the project.
The Information Management Toolkit (ImTK) Consortium is an open source initiative to develop robust, freely available
tools related to the information management needs of basic, clinical, and translational research. An open source
framework and agile programming methodology can enable distributed software development while an open architecture
will encourage interoperability across different environments. The ISIS Center has conceptualized a prototype data
sharing network that simulates a multi-center environment based on a federated data access model. This model includes
the development of software tools to enable efficient exchange, sharing, management, and analysis of multimedia
medical information such as clinical information, images, and bioinformatics data from multiple data sources. The
envisioned ImTK data environment will include an open architecture and data model implementation that complies with
existing standards such as Digital Imaging and Communications (DICOM), Health Level 7 (HL7), and the technical
framework and workflow defined by the Integrating the Healthcare Enterprise (IHE) Information Technology
Infrastructure initiative, mainly the Cross Enterprise Document Sharing (XDS) specifications.
This paper describes a system that uses electronic forms to collect patient and procedure data for clinical trials. During clinical trials, patients are typically required to provide background information such as demographics and medical history, as well as review and complete any consent forms. Physicians or their assistants then usually have additional forms for recording technical data from the procedure and for gathering follow-up information from patients after completion of the procedure. This approach can lead to substantial amounts of paperwork to collect and manage over the course of a clinical trial with a large patient base. By using e-forms instead, data can be transmitted to a single, centralized database, reducing the problem of managing paper forms. Additionally, the system can provide a means for relaying information from the database to the physician on his/her portable wireless device, such as to alert the physician when a patient has completed the pre-procedure forms and is ready to begin the procedure. This feature could improve the workflow in busy clinical practices. In the future, the system could be expanded so physicians could use their portable wireless device to pull up entire hospital records and view other pre-procedure data and patient images.
This case study details the experience of system engineers of the Imaging Science and Information Systems Center, Georgetown University Medical Center (ISIS) and radiologists from the department of Radiology in the implementation of a new Teleradiology system. The Teleradiology system enables radiologists to view medical images from remote sites under those circumstances where a resident radiologist needs assistance in evaluating the images after hours and during weekends; it also enables clinicians access to patients’ medical images from different workstations within the hospital.
The Implementation of the Teleradiology project was preceded by an evaluation phase to perform testing, gather users feedback using a web site and collect information that helped eliminate system bugs, complete recommendations regarding minimum hardware configuration and bandwidth and enhance system’s functions, this phase included a survey-based system assessment of computer configurations, Internet connections, problem identification, and recommendations for improvement, and a testing period with 2 radiologists and ISIS engineers; The second phase was designed to launch the system and make it available to all attending radiologists in the department.
To accomplish the first phase of the project a web site was designed and ASP pages were created to enable users to securely logon and enter feedback and recommendations into an SQL database.
This efficient, accurate data flow alleviated networking, software and hardware problems. Corrective recommendations were immediately forwarded to the software vendor. The vendor responded with software updates that better met the needs of the radiologists. The ISIS Center completed recommendations for minimum hardware and bandwidth requirements. This experience illustrates that the approach used in collecting the data and facilitating the teamwork between the system engineers and radiologists was instrumental in the project’s success. Major problems with the Teleradiology system were discovered and remedied early by linking the actual practice experience of the physicians to the system improvements.
This project demonstrates use of OCTAVE, an information security risk assessment method, as an approach to the safe design and planning of a teleradiology system. By adopting this approach to project planning, we intended to provide evidence that including information security as an intrinsic component of project planning improves information assurance and that using information assurance as a planning tool produces and improves the general system management plan. Several considerations justify this approach to planning a safe teleradiology system. First, because OCTAVE was designed as a method for retrospectively assessing and proposing enhancements for the security of existing information management systems, it should function well as a guide to prospectively designing and deploying a secure information system such as teleradiology. Second, because OCTAVE provides assessment and planning tools for use primarily by interdisciplinary teams from user organizations, not consultants, it should enhance the ability of such teams at the local level to plan safe information systems. Third, from the perspective of sociological theory, OCTAVE explicitly attempts to enhance organizational conditions identified as necessary to safely manage complex technologies. Approaching information system design from the perspective of information security risk management proactively integrates health information assurance into a project’s core. This contrasts with typical approaches that perceive “security” as a secondary attribute to be “added” after designing the system and with approaches that identify information assurance only with security devices and user training. The perspective of health information assurance embraces so many dimensions of a computerized health information system’s design that one may successfully deploy a method for retrospectively assessing information security risk as a prospective planning tool. From a sociological perspective, this approach enhances the general conditions as well as establishes specific policies and procedures for reliable performance of health information assurance.