Development of a Frailty Detection Model Using Machine Learning with the Korean Frailty and Aging Cohort Study Data / 대한의료정보학회지

Objectives@#This paper aimed to use machine learning to identify a new group of factors predicting frailty in the elderly population by utilizing the existing frailty criteria as a basis, as well as to validate the obtained results. @*Methods@#This study was conducted using data from the Korean Frailty and Aging Cohort Study (KFACS). The KFACS participants were classified as robust or frail based on Fried’s frailty phenotype and excluded if they did not properly answer the questions, resulting in 1,066 robust and 165 frail participants. We then selected influential features through feature selection and trained the model using support vector machine, random forest, and gradient boosting algorithms with the prepared dataset. Due to the imbalanced distribution in the dataset with a low sample size, holdout was applied with stratified 10-fold and cross-validation for estimating the model performance. The reliability of the constructed model was validated using an unseen test set. The model was then trained with hyperparameter optimization. @*Results@#During the feature selection process, 27 features were identified as meaningful factors for frailty. The model was trained based on the selected features, and the weighted average F1-score reached 95.30% with the random forest algorithm. @*Conclusions@#The results of the study demonstrated the possibility of adopting machine learning to strengthen existing frailty criteria. As the method analyzes questionnaire responses in a short time, it can support higher volumes of data on participants’ health conditions and alert them regarding potential risks in advance.

Health Innovation for Aging Society / 대한의료정보학회지

No abstract available.

Implementation of Medical Information Exchange System Based on EHR Standard / 대한의료정보학회지

OBJECTIVES: To develop effective ways of sharing patients' medical information, we developed a new medical information exchange system (MIES) based on a registry server, which enabled us to exchange different types of data generated by various systems. METHODS: To assure that patient's medical information can be effectively exchanged under different system environments, we adopted the standardized data transfer methods and terminologies suggested by the Center for Interoperable Electronic Healthcare Record (CIEHR) of Korea in order to guarantee interoperability. Regarding information security, MIES followed the security guidelines suggested by the CIEHR of Korea. This study aimed to develop essential security systems for the implementation of online services, such as encryption of communication, server security, database security, protection against hacking, contents, and network security. RESULTS: The registry server managed information exchange as well as the registration information of the clinical document architecture (CDA) documents, and the CDA Transfer Server was used to locate and transmit the proper CDA document from the relevant repository. The CDA viewer showed the CDA documents via connection with the information systems of related hospitals. CONCLUSIONS: This research chooses transfer items and defines document standards that follow CDA standards, such that exchange of CDA documents between different systems became possible through ebXML. The proposed MIES was designed as an independent central registry server model in order to guarantee the essential security of patients' medical information.

The Remote Health System utilizing Wireless Communication of Personal Health Information / 대한의료정보학회지

OBJECTIVE: The current personal health devices are used as stand.alone machines or transmit the personal health information only to local PCs. The objective of this research is to build a system which can transmit personal health information from personal health devices to the healthcare server systems. METHODS: In this research, we used infrared (IrDA) and Bluetooth for wireless communication from the personal health devices to a PDA. And, we utilized SMS (Simple Message Service) and world wide web systems to deliver the data from the PDA to other mobile phones or to the board in the web server. RESULTS: We developed the system that wirelessly communicates personal health information from the personal health devices to a PDA. The system also delivers both glucose and blood pressure data from the PDA to other mobile phones by SMS (Simple Message Service) or automatically register to the board in the web server. CONCLUSION: We showed convenient and easy way of collecting personal health information. Our system will contribute improving personal healthcare environment and personal health device business.

Research and Development Efforts Aimed at Implementing Electronic Health Record Systems with Interoperability and Patient Safety / 대한의료정보학회지

Electronic health records (EHR) hold promise in improving the quality and efficiency of health care, yet the health care system remains years behind other industries with respect to the adoption of information technology (IT). Stakeholders in the medical community, including government and tertiary hospitals, have emphasized the urgent need to adopt IT systems. This paper reviews the current research and development efforts related to EHR in Korea, which have been supported by the government since December 2005, on the basis of the following core EHR components: EHR architectures that incorporate an external, implementation-independent view of a complete EHR; EHR functionality for defining tasks that an EHR system should perform; semantic ontology for developing standard vocabularies at the national level; EHR messaging standards for exchanging data; and clinical decision support systems for improving patient safety. Recent international work on EHR systems and the underlying trends are described, and suitable directions for research and development are suggested under relevant subtopics. Advances in the relevant areas will greatly facilitate our ability to achieve interoperability and promote patient safety. However, EHR systems will perform optimally only if we improve our understanding of the political, structural, and technical foundations for EHR, and reach consensus via collaborations between all the stakeholders in the health care system.

Clinical Document Repository System for Electronic Health Record / 대한의료정보학회지

OBJECTIVE: The needs of sharing clinical documents in order for health professionals to provide better diagnosis and treatment have been tremendously increasing. However, when a patient visits the hospital, current hospital information system doesn't allow for physicians to obtain patient's medical history even though she has some records in different hospital, because the lack of the standardization to overcome the incompatibility among heterogeneous systems. CDA(Clinical Document Architecture) of HL7(Health Level 7) is standardized technology in purpose of creating and exchanging various clinical documents. In this article, we discuss the method of exchanging, storing, and utilizing CDA and present the work of development and implementation based on CDR(Clinical Document Repository) framework reported earlier9). METHODS: We convert paper-based discharge summary from each health institutions into CDA format. And in order to exchange, manage, and utilize those CDA, Registry structure of ebXML is introduced and applied. RESULTS: The relationship among patients, physicians, clinical organizations, and clinical documents is well-organized and modeled. Because transfered CDA document can be easily registered and managed by complying with RIM structure of ebXML, this system can effectively exchange and share patient's CDA document when patient move to other area or among heterogenous systems. CONCLUSION: This system can be utilized to categorize and store various clinical documents such as, ECG and Radiology reading report. In addition, this system suggests the potential of Electronic Health Record system that is able to communicate among heterogenous systems and manage the CDA documents via this CDR system.

Development a New HL7 Interface Engine for Large-size Messages which Include Image Data based on Tree Structure and Streaming Algorithm / 대한의료정보학회지

The almost existing commercial HL7 interface engines apply the string array method which is run in the main memory to HL7 message parsing process. But, if the HL7 message is big, this method will be possible to cause the computer system to raise critical and fatal problems because a long string array can carry a too heavy load to the main memory and the processor. Therefore, the image and the multi-media data which are needed for the modern medical records could be limited to be included into a HL7 message because the size is usually too big in comparison with the main body of a HL7 message and in result, it make the size of the HL7 message expanded. The purpose of this study is to suggest a new HL7 interface algorithm which can solve this problem by the method of the 'Streaming Algorithm'. This new method for HL7 message parsing apply the character-stream object which process character by character between the main memory and hard disk device with the consequence that the processing load on main memory could be alleviated. The main functions of this new engine are generating, parsing, validating, browsing, sending, and receiving of message. And also, this can parse and generate XML-formated HL7 message. This engine had been practically tested in the Discharge Summary Information Exchange System between Kyungpook National University Hospital and Chonnam National University Hospital for the purpose of proofing its usability for a month. Overall, the preliminary results of this test is considered as good, but it is pointed out that some improvement is needed relating to the speed of parsing which was predicted because this engine partly used the memory of hard disk device instead of the main memory.

Development of HL7 Message Browser Based on Web Environment / 대한의료정보학회지

We have developed a prototype HL7(Health Level 7) message browser for web based healthcare networking. Because most of commercial HL7 interface tools have high price, the purpose of this study is to provide a message tool for those who are willing to exchange clinical data in an e fficient and cost-effective manner. The present development is based on HL7 v. 2.3.1 using HTML and JAVA servlet to be implemented on web environment. The preliminary results include 1) input message, 2) parsing and inter pretation via web browse r with HTML and XML, and 3) transf erring message to another site through the socket communication. Although we have found more efficient performance than we expected with numerous encouraging results, error correcting mechanism needs to be improved continuously throughout the on-going project development.

Transmission and Management of DICOM Files Based on Peer to Peer / 대한의료정보학회지

The PACS system built and used in hospitals nowadays has quite significant overload on the central server of it because of both treatment of very large data and full management of medical images. We suggest a distributed communication and management methodology using Peer to Peer multicasting strategy for efficient management of medical images produced by DICOM modalities. It is absolutely necessary for reducing strict degradation of PACS system due to large size of medical images and its very high transport rates. DICOM Peer to Peer component is composed a service manager to execute requested queries, a communication manager to take charge of file transmission, and a DICOM manager to manage stored data and system behavior. Each manager itself is a component to search for requested file by interaction or transmit the file to other Peers. Distributed management and transformation of medical information based on Peer to Peer multicasting methodology will enhance performance of central server and network capacity reducing overload on them.

An Intelligent and Distributed Telemedicine Server for a Continuum of Telemedicine Care / 대한의료정보학회지

Internet application server technologies and browsers make it possible to design and develop a telemedicine application server structure providing a continuum of telemedicine care while reducing the complexity for the end user. Th build many types of "write-once-run-anywhere" telemedicine applications and allow them to dynamically adapt to a variety of platform restrictions, we need a framework to support system services for telemedicine applications. In aims to increase the efficiency of distributed multimedia medical databases in terms of clinical consulting process, we propose to mange external data access using distributed middleware standardizations. In order for our framework to be clinically relevant, we draw on experience and knowledge acquired in the field of urology, dialysis, emergency, and hospice telemedicine in which the Imaging Science and Information Systems Center at Georgetown University Medical Center has undertaken or is undertaking clinical trials. Development of a telemedicine application server for a true continuum of telemedicine care will increase user operability while decreasing the integration complexity.