Saturday, July 28, 2007

Project Plan and Tasks for the coming week

On Friday, I handed in my project plan. For an electronic copy click here.

For the following week, Hendy and I have organised to meet with RPA personnelto elicit and uncover workflows in an ICU. Preliminary schedule is as follows:

Tuesday: 8.30am - shadow and interview Doctor
Wednesday: 1.30-4.30 - shadow and interview nurses.
Thursday: TBC
Friday: TBC

Friday, July 27, 2007

ICU General Workflow (Meeting with Angela on 25th and 27th July 2007)

On the 25th and 27th of July 2007, Hendy and I had meetings with Angela Ryan of RPA hospital. Briefly, the core purposes of the meeting were to discuss:
  • The ICU structure at the Royal Prince Alfred Hospital
  • The flow of patient in a general ICU.
  • Brief overview of the “Whiteboard”
  • Core users of RPA ICU’s information system; CareVue
  • Extension of Functional and Non Functional Requirements

ICU Department at RPA

The ICU at the RPA hospital is divided into three/four sub division/department based on the three types of patient that is administered into the ICU. They are:

1.General ICU
– The most generalised ICU unit that is designed to deliver the highest of medical and nursing care to the sickest of patients with non-unique conditions.
General ICU High Dependency Unit (HDU)– deals with patients which need constant care. Often up to two nurses can be assigned to each patient in the High Dependency ICU

2.Cardiothoracic Intensive Care Unit (CICU)/High Dependency Unit (CICU-HDU) - CICU cares for patients who need heart (cardiac) and chest (thoracic) surgery. Surgical procedures may include operations on the heart, the heart’s blood vessels, the chest or the lungs.

3. Coronary Care Unit (CCU) - The Coronary Care Unit or CCU cares for patients who have heart disease and occasionally other medical or surgical problems. In RPA, this unit is more or less combined with CICU.

4. Neurosurgical Intensive Care Unit (NICU)/High Dependency Unit (NICU-HDU) - The Neurosurgical Intensive Care Unit cares for patients with brain or spinal cord conditions and occasionally other medical or surgical problems. (Source)

The General ICU and Neurosurgical ICU/HDU patients are cared by specialist doctors relevant to their area whereas the General ICU HDU and Cariotherastic ICU/HDU care is driven by ICU specific doctors.

Flow of patient in a general ICU

Patients who come into ICU often need constant monitoring and medical care. These are usually patients from lengthy surgery, unconscious and/or require ventilation hookup. A new patient administered into the ICU would follow the procedure:

1. Upon arrival (or even before arrival) a new patient is created in CareVue. Given the MRN, a linkage to the hospital’s patient administration system automatically uploads all other administrative (not medically relevant) data.

2. The patient physically arrives to the ICU department, usually accompanied with several nurses and doctors. During the setup procedure, necessary equipment (such as ventilator, machines measuring vital signs) are attached and linked to the patient. Once linked some of these medical equipment automatically update data into CareVue.

3. Nurses and/or doctors then create a care plan for the patient. (Different depending on diagnosis or investigation).

4. Nurses and doctors perform their duty in caring for the patient (To be investigated next week).

ICU Whiteboard

In almost all hospital departments, exist a whiteboard used to record and keep track of patients, nurses and doctors on shift. The RPA’s ICU uses a whiteboard as a tool to map patients to nurses and to record which doctors are on shift.

Core Users of CareVue
  • Doctors – heavy user
  • Nurses – heavy user
  • Physios – medium user
  • Dieticcian – heavy user
  • Social workers – light users
  • Visiting Medical Teams – medium users
  • Speech Pathologist – medium users
Note: Physios, Dieticians, Speech Pathologists and Pharmacists are usually referred to as Allied Healthcare professionals. These set of users have limited use in CareVue. They often view CareVue information and only enter notes compared to Doctors or Nurses whom extensively use CareVue.

Meeting with Jon Patrick 26/07/07 - Workflow of ICU

On the 26th of July 2007, Hendy and I had a meeting with Jon Patrick to discuss project update. We covered project planning, disambiguation of the project, system analysis of CareVue and where we are heading theoretically.

One important note we got out of the meeting is to focus more on the workflow of the different users in an ICU environment. We must capture the entire workflow, (not necessary how they interact with the information systems around them). By doing so we can then apply the a form based mythology to design a future proofed, interoperable system that exceeds current functionality provided by current products. This is especially interesting as we no longer see information systems used as a data repository but as a tool to facilitate and aide patient care at every level. For example, by providing extensive decision support to nurses and doctors, improve workflow productivity and simplify and streamline tedious and often time consuming administrative events.

It must be noted that the system analysis and interviews are to be done with Hendy as there is so much to cover. The following week’s aim is to perform a more detailed functional analysis of CareVue while gathering data from RPA interviews.

Tuesday, July 24, 2007

Update: Meeting with Angela Ryan

Tomorrow, Hendy and I have scheduled our first meeting with Angela Ryan, one of our major contacts down at the Royal Prince Alfred Hospital. Our aims are to cover the following issues:

1. Work flow of ICU department - how patients are administered into ICU, what process they go through ICUs and when/how patients exit the ICU ward and where they go from there.

2. System Analysis of CareVue including:
  • Range of Current functionality
  • Critique of CareVue - advantages, disadvantages,
  • How CareVue is implemented into their current work flow
3. What an ideal ICU should encompass.

4. Set up meetings with other RPA personnel as required.

A list of interview questions have been listed on thesis notebook but is continually updated on Trac (a wiki and sub version repository and project management tool used for this project).

In addition, a weekly meeting with Jon Patrick (Supervisor) has been scheduled on Thursday at 12 every week. I will update this blog in the following days after the meeting.

Thursday, July 19, 2007

Project Definition and Demonstration of CDAL

As discussed in my previous post, I will give a more detailed summary of the meeting and site visit.

Meeting on 18/07/2007

The objective of the meeting was to meet with 2 other students (David Ding, Victor Chan and Peter Budd) who will be working on extending and developing the Clinical Data Analytical Language (CDAL), discuss how the projects were to be monitored and managed, and increase the understanding of the scope of how all different aspects of the project fit in as a whole.

Administration and Management of projects
In conjunction to this blog, Trac (a project management software) is to be used to record my progress, documentation, code and subversion tool. There may be some redundancies between the blog and information contained in Trac but I do not anticipate that this will poise a significant problem.

Overall Project Picture

The figure above shows the overall picture of how a generalised clinical management information system can be used to develop department specific IS, yet still retain its interoperability across systems.

CDAL is essentially a restricted natural language allowing analytical procedures to be expressed as a query such
that it can be computationally executed. It is similar to SQL except it is less restricted and more closely resembles human language. In the above figure, it can be seen how Victor and David's work on CDAL will fit into the IS. An initial prototype of this (developed by YuZhong) was demonstrated at the RPA site visit.


Following the meeting and site visit, our initial tasks has become a lot clearer. These include:
  1. System Analysis of ICU - A comprehensive system analysis of ICU is to be undertaken in order to gain an understanding of what an ICU IS should be fundamentally be achieving, data capture requirements (design of forms) and overall functional and non functional requirements. Incorporated in this system analysis is a SRS for an ideal ICU IS (SUICUIS). ICU work flow analysis. If possible, system analysis would be conducted at the RPA ICU and two other hospital departments to gain a greater understanding of how hospital information systems differ from department to department.
  2. Extending previous thesis work on G.H.I.M.S (now referred to as G.C.I.M.S) - particularly on the generation of forms and form version control.
  3. Develop a functional ICU IS - using methodology in G.C.I.M.S and incorporating the use of medical terminology server to deliver (in this case) SNOMED-CT terms to instantiate and record data.
While we are undertaking these tasks, we will likely be using all open source software if possible.

Wednesday, July 18, 2007

Meeting with 2007 RPA Health Informatics Team and demonstration at RPA

Today, I had a meeting with Jon Patrick with regards to the theses projects that were concurrently in action in the Health Informatics field in conjunction with the RPA. Present were Jon Patrick, Peter, Hendy, David and Victor. During this meeting we had discussed general overview of all projects, administrative and management of projects as well as dwelling into a more detailed discussion of the thesis project itself.

In the afternoon, the project group headed to the RPA ICU where a prototype of clinical data analytics language was demonstrated to both the team and RPA employees by Yuzhong. The CDAL is effectively a less restricted natural language that allows users to ask complex analytical questions to the ICU database. For example a question could entail "Find the average heart rate for a class of patients exhibiting x,y,z characteristics over a x,y,z time interval".

Tomorrow, my aim is to continue to update this blog with a more detailed recount of the meeting, finish off a rough project plan, as well as update TRAC (a subversion and wiki that the team will also be using to track our progress, ideas and source code). I will also continue to work on my sections of the SRS which Hendy and I aim to at least get a draft level before next week.

Speaking of next week (week 1), we have organised a meeting with Angela (RPA contact) to discuss the how ICU works and the type of workflows that occur within an ICU at the RPA.

Friday, July 13, 2007

System Analysis of current ICU IS and ICU SRS

Our first concrete task for the thesis is to develop a comprehensive ICU SRS (Intensive Care Unit Software Requirement Specification). This is to be done in conjunction with Hendy.

The ICU SRS is to be used as an input specification to generate an ideal ICU IS. Therefore the ICU SRS is to be the broadest description of what an ICU IS should be. The document would be used as a platform to:
    1. Obtain a comprehensive understanding of an ICU, ICU workflows, information requirements and its place in RPA.
    2. Achieve an ultimate and ideal ICU that satisfies all users: Administrators, Clinician, Auditors, Researcher.
The figure below (extracted from the Meeting with Jon Patrick) shows a rough idea of how Hendy and I will attack this problem. Note that data is to be obtained through user interviews (interview questions) and analysis of CareVue software itself.

The thesis notebook will continually be updated with interview questions, findings and any other comments related to the ICU SRS.

Tuesday, July 10, 2007

Meeting with Professor Jon Patrick on 28/06/07

On the 28th June 2007, Hendy and I had a meeting with our supervisor Professor Jon Patrick. The core outcomes of the meeting were to:

  1. Define the project scope and deliverables (still to be finalized)
  2. What parts of the project will Hendy and I be working on separately and collaboratively.
  3. Reading material to familiarise ourselves with previous work and technology that we will be using for my thesis.
  4. Obtain an overall understanding of the project.

A brief summary of events are as follows. As per our discussion with Professor Jon Patrick, my thesis (and Hendy’s) will be divided into two core parts. The first task would be to develop a comprehensive ICU IS software requirement specification. Then we are to demonstrate (certain parts) of the functionality by building the ICU information system using the paradigm information system generator developed by William Chau and Peter Budd’s honours theses. It must be noted that the first task (ICU SRS) is to be done collaboratively with Hendy and I as by doing so, we can obtain a much more detailed system analysis of the current ICU IS (called Careview) and from there develop a comprehensive SRS for an ideal ICU IS.

Task List

For the next few weeks during the mid semester break I envisage to get up to speed with the critical readings and familiarise myself with CareVue. A summary of tasks that I will have to do includes:

Critical Reading Material

  1. Agilent Techonologies (2000), CareVue Clinical Data Management Information Support Mart – User’s Guide, Agilent Technologies
  2. Budd, J P. (2006) ‘Delivering Knowledge Based Data Prepresentations to Hospital Information Systems’, Honours Thesis, University of Sydney.
  3. Chau, W. (2006) ‘A Product and Process model for a Document-Centric Workflow Management System’, Honours Thesis, University of Sydney

Supplementary Reading Material

  1. Philips (2001), CareVue Clinical Information System-ODBC User’s Manual, Philips
  2. Hewlett Packard, (1998), HP CareVue Clinical Data Management – Data Archive Databse Definitions Manual’, Edition 1 Software Revision A1, Hewlett Packard

Technology Familiarisation

  1. Appropriate software and source code (Peter Budd and William Chau).
  2. XML databases
  3. X-Forms
  4. SNOMED CT and problems associated with the representation of SNOMED instances in database form.

Other Tasks

  1. Project plan and deliverables
  2. Scope down of thesis
  3. Interview Questions regarding SUICIUS – in conjunction with Hendy
  4. Outline of SUICIUS SRS – in conjunction with Hendy

Finally, over the next couple of days to post more information about the ICU SRS and an entry on my understanding of the project thus far (which will explain certain terminologies used above).

Thesis Notebook

As discussed in Hendy’s blog, we are going to use Google’s Thesis Notebook to share all information related to our thesis. By facilitating information sharing and collaboration, we believe we can obtain a greater understanding of the problem domain which will aide us in our individual parts and collaborative parts of our thesis. We have already begun brainstorming possible interview questions to ask RPA personnel in the development of the ICU SRS.