Web/Grid Services Approach
Integration Virtual Clinical &
Research Environments
Simon Grange
10th March 2006
The Team
S. Grange1, C. Wang2, L. Gilbert2, Y.W. Sim2,
D.E. Millard2, E. Gardner3 G.B. Wills2
1. The Royal College of
Surgeons of England,
London, UK
2. Electronics and Computer
Science, University of
Southampton, UK
3. Southampton General
Hospital, University of
Southampton, UK
simon@grange.me.uk
Simon Grange
CORE
Overview
Clinicians responsible for audit and research
Projects with basic scientist colleagues.
Regional teaching hospital setting
Collaboration with the medical school computer services
Collaborative Orthopaedic Research Environment (CORE)
project
Pilot study for proof of concept work
Users are mapped
Personal profile implemented
Service oriented architecture (SOA)
Bridge between e-Health and e-Science
Simon Grange
CORE
VOEU
History
Evolved from VOEU
2000-2003
Monolithic
Now part of CORE
Simon Grange
CORE
Dynamic Review
Journal
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CORE
Introduction
Service Oriented Architecture
Transition
Introduction
e-Scientists and e-Clinicians ideal shared environment
Differences in language
Conflicting agendas
From bench to bedside and back to bench.
Legacy technologies
Legacy working practice.
Service oriented architecture and the Grid
Minimize Relearning
Minimize Reengineering
Simon Grange
CORE
Introduction
Integrated Health Record
e-Health and e-Science agendas
Everyday challenge.
Inter-organisational coordination
Requirements capture
Work practice
Data sets
Data quality measures
Simon Grange
CORE
Methodology
Service Oriented Architecture
Transition
Methodology
User empowerment
Profiling
Consistency of data collection
Data management and schemas
Communication
Collection of data
Collation of data
Unbiased semi-automatic
reporting
Extensibility and scalability
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CORE
Methodology
Co-Design
Normal workflow
Medical and nursing staff
Operating theatres
Ward based environments
Software environment ensures
Security and confidentiality
Component library
Service tools can evolve independently and then be
offered to users once tested using a thin client.
The evaluation techniques were by user discussion
groups and survey
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CORE
SOA
Thin Client
Portal
OMII
Services
Analysis
ePrints
Data Services
Forum
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CORE
Results
Observational
In Reality…
Dual Projection with PACS system for;
Decision making
Data Entry
Screen Profiles Evaluation
Requires user cultural acceptance
Needs integration with Coding systems for
audit and PAYMENT
OPCS
HR
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CORE
Dual Projection
Simon Grange
CORE
Operation Lists
Clinical Admissions List
Build Operating Lists
PACS medical imaging
Plan to link to theatre logs
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CORE
Clinical Case Admissions
Tab controlled lists
Supports the Edinburgh
data collection for
Trauma Admissions
Registry
STAR and PorTAR
versions – depending
upon location
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CORE
Clinical Case Discussions
Supports the threaded discussions
Mainly used for bug reporting!
Will link this into image reporting, case handover
and administrative duties
Simon Grange
CORE
Clinical Research
Dynamic Review of records
Surgical Logbooks
Clinical audit and research data collection
Complex media
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CORE
Clinical Teaching
Library archive
Surgical records
Regional presentations for training
Ties in curriculum and syllabus to learning
agreements
Simon Grange
CORE
Results
Trials of data collection are ongoing
Everyday clinical practice and the need to
minimize duplication of data entry
Running for a 6 month trial period to achieve
adequate numbers for full data analysis
techniques to be applied
Reviewed by a multidisciplinary team of 20
Orthopaedic surgeons, theatre and ward staff
Assess the interface
Potential issues of workflow
Simon Grange
CORE
Results
The first month of data is collected alongside the
conventional paper records, for Beta testing
Analysis will be included in one of the national
audits of departmental throughput
Antegrade and retrograde analysis of data
Establishment of focused trials based around schema
Generated to collect specified data
Validated scoring systems
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CORE
Results
By starting with simple analyses
Bugs relating to the interface are removed
Introduce this to the bone laboratory team of
basic scientists
Will depend upon the GRID tools via SOA for
their analyses
Simon Grange
CORE
Results
Patient specific
Potentially sensitive data
Data Controller registration as both a clinical and
research data controller
Users are securely logged on using a unique
password protected system
Prototype research tools can be applied to solve
clinical problems
Security and software are managed through the
University School of Medicine firewall
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CORE
Results
Consent
Patients undergoing orthopaedic procedures are
consented for records to be used for research as
routine
Access
No patient information is released to individuals
beyond those who are currently authorised as
part of their routine clinical practice
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CORE
Discussion
‘It is only when we are pursued
that we become swift’
Anon
Discussion
Middleware - Open middleware and Microsoft
.net™
Processes are being refined to run over a
portlet architecture separating security from
applications
Offers analysis of the clinical record keeping
practice but still has implications for data protection
This work represents the initial roll-out
Once implementation involves multicentre
clinical trials
Data flow directly to the NHS
Simon Grange
CORE
Anonymised Data
Transfer to research
Avoid registration of each user as a data controller
Individual consent forms
Anonymised data will be investigated
This current approach
Develop research tools using anonymized data
Users with qualified clinical profiles able to access
patient specific data
Simon Grange
CORE
Adaptive Hypermedia
Change in work practice needs to be implemented
with the users being informed and made aware of
the potential advantages
User profiling using Adaptive Hypermedia (AH) to
map the user’s ontology onto the workflow
Focused effort increasing efficiency
Accommodation of users limitations e.g. 1st language
adaptation.
Targeting driven work e.g. learning objectives.
User ‘ownership’ of data with selective authorisations for
data release
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CORE
Users Limitations
Accommodation of users limitations
e.g. 1st language adaptation
Individual Learning Agreements
Targeting driven work e.g. learning objectives.
Simon Grange
CORE
Ownership of Data
User ‘ownership’ of data with selective
authorisations for data release
Regional
Hospital
Computer
Science
Department
Regional
Hospital
Medical
School
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CORE
Difficulties encountered
Shifting sand
Scoring systems for outcomes
Access to Data
Firewalls
Data in .pdf files or on paper (Only the NHS)
Physical
Policy (Hardware)
Backup
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CORE
Future of the Semantic Grid
Professor De Roure commented:
‘Semantic Grid computing has
allowed us to bring resources
together to achieve something that
was not previously possible.
We now look forward to working
on some of the remaining
challenges, which include for
example
Intersection between the grid and
the physical world through
pervasive computing devices and
the self-management,
self-optimisation and
self-healing (so called ‘autonomic’
behaviour) necessary for large
scale distributed computing.’
Simon Grange
CORE
Updating
Updating as user profiles change converting
the e-Portfolio
Updating as user profiles change converting
the e-Portfolio into a truly dynamic C.V.
Modernisation of medical careers will provide a
new structure for training
Trust…
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CORE
Conclusions
Why use the GRID
Extend Reach
Overcome Limitations
Part of a shared process
Non-clinical Scientists
Clinical Scientists
Clinicians
Same Data
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CORE
‘Living in interesting times’
Changing clinical practice
Continuing Professional Development
Usability analysis
Innovative pathway
Cyclical implementation and testing
Keep users in the iterative design loop
Simon Grange
CORE
Future Work
Future Work
Online form completion for feedback
Reduce time delay
Not overly intrusive.
Within the context of CORE
Build and sort data for analysis
e-Science, e-Health bridge
Multidisciplinary research potential.
Bioinformation Multilayer GRID (BioMultiGrid)
Simon Grange
CORE
Collaboration
User Interfaces
National Level Databases
Role, Performance, Efficiency
Analysis of clinical workflows
Develop eScience-eHealth integration
BioMultiGrid
Fulcrum for modernisation of medical careers
Research / Industrial partnerships
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CORE
BioMultiGrid
Bioinformation Multilayer GRID
Transition to semantic web technologies
integrating multiscale modelling
Expansion
Ontology mapping
Modelling
Multimedia
Non-repudiation - clear ownership of data.
Simon Grange
CORE
Thank You
simon.grange@btopenworld.com