creating an automated physician system for st. luke hospitals to improve medical service and enhance...

1AUTOMATED PHYSICIAN SYSTEM

Creating an Automated Physician System For St. Luke Hospitals ToImprove Medical Service And Enhance Quality

Assil Abdulrahim

PROFESSOR Russell Hester

Managerial Applications of Information Technology

10/12/2013


Contents1. Abstract....................................................32. Brief Company background....................................3

3. Discussion of business problem(s)...........................44. High level solution.........................................5

Robot Doctor & Questions’ Bank:...................................5Images Bank.......................................................6

Cases Bank........................................................7Indexer and Evaluator.............................................7

5. Benefits of solving the problem.............................76. Business/technical approach.................................8

7. Business process changes...................................118. Technology or business practices used to augment the solution...................................................................119. Conclusions and overall recommendations....................12

Revolutionary....................................................12Difficulties.....................................................12

Nation wide......................................................12Public interface.................................................13

10. High-level implementation plan...............................1311. Summary of project...........................................14

References.........................................................15Appendices.........................................................16

Table of FiguresFigure 1-(Example of Radiology Image)................................7

3AUTOMATED PHYSICIAN SYSTEMFigure 2 (Three-tier architecture)..................................10Figure 3 (Two Data Centers).........................................11


1. AbstractCountless things can be improved by utilizing Information

Technology, there are no limits for imagination, and the medical domain is not an exception.

Automated physician or robot doctor is an example of how technology can enhance and support human activities in most if not all fields.

Providing that each business is a set of processes and proving that each process can be documented then for me all businesses can be automated one way or the other.

These papers walks through some suggested practices that can be automated, the use or the benefits of their automation, and the necessary requirements to do that.

2. Brief Company backgroundSt. Luke's University Health Network is a health network of

regional hospitals connected with each other and covers many

counties in the state of Pennsylvania and one county in the state

of New Jersey.

Hereunder are some facts and numbers extracted from their

website:

“The Network provides services at more than 150 sites. St. Luke's

University Health Network is comprised of six hospital sites. The

Network includes:

More than 80 owned physician-practice sites


300 employed primary care/specialist physicians

Various outpatient testing and service facilities

Home health

Hospice services (inpatient and outpatient)

Largest ambulance provider in Bucks County and second

largest in Lehigh County

Other related organizations

Key Network indicators include:

57,500+ annual admissions

195,000 annual emergency room visits

1,325 physicians on the Medical Staff (96 percent board-

certified)

8,900 employees

More than 1,350 volunteers

St. Luke's is the region's second largest employer.”


The size of the organization is an important factor in the

success of this project, for this concept of this project is

based on a huge data, and the huger the data are, the more

accurate the results will be.

3. Discussion of business problem(s)Researches have shown and also facts in reality have

confirmed that today, in the stream of rendering medical

services, misdiagnosis has reached an alarming rate that might

exceed 20% in some locations, it has also been noticed that

malpractices and not rare exceptions and are not handled as they

should.

As we understand that medical field is not 100% impeccable and

physicians are not infallible, yet medical errors should be

reported duly and properly, researches show that medical error

rates are underreported which can threaten the credibility of the

whole field or industry, let alone the promised quality and the

overall reputation of the hospitals.


“The study - which was co-authored by Dr. David Classen, a professor

at the medical school of the University of Utah - found that about 90

percent of all hospital mistakes go unreported.”

Additionally, Time has always been the most important resource

for both the medical server and the patient; hence any saving in

that special resource is commendable and praiseworthy and will

definitely improve quality, customers’ satisfaction and lead to

excellence.

4. High level solutionThe proposed solution consists of an information technology

system that automates doctors’ procedures in order to reach the

right diagnoses with very little chance of errors.

The new system will use many of the latest technologies to assure

security and privacy and it will build a smart knowledgebase that

is continually growing and auto-corrective which will be in time

the priceless bulk of the hospitals’ intangible assets.

In a bird’s eye, the system consists of many parts or modules,

the most important ones are:

8AUTOMATED PHYSICIAN SYSTEMRobot Doctor & Questions’ Bank:

When any patient walks into a clinic to see a doctor, there is

a good reason for him/her to do so. A doctor asks him/her for

that reason and starts a series of questions in order to reach

the final diagnosis as he believes; each question is logically

and timely related to the previous one and is mostly dependent on

the previous answer too.

Doctors might ask for lab-works, variant radiology images, and

other auxiliary means to help them doing more analysis and reach

the right diagnosis.

Doctors also, would have to follow a set of procedural methods

(especially in USA); otherwise they would be illegitimate, or

subject to judicial consequences.

Additionally, doctors do surf the internet to check the latest

information about medicines, vaccines and sometimes to brush up

on symptoms and treatments.

After all, the diagnosis can be wrong or incomplete and/or the

medication can be wrong too.


The Robot Doctor (RD) will automate this entire process with all

its exceptions, it can ask the patient many logically and

sequentially dependent questions, and reach either the most

probable diagnosis or a set of most probable ones.

The questions’ bank is huge and consists of tremendous number

questions from so many doctors (end users).

Images BankRD uses a mechanism (similar to Google’s Goggles) to understand

and analyze images; it will use a bank of images like the ones in

medical Atlases. (i.e. Atlas of Radiology Images) see figure

below:


Figure 1-(Example of Radiology Image)

Meningioma60 year-old lady with anosmia and short-term memory loss.

MRI: A well-defined strikingly enhancing (arrows) classic meningioma is seen involving thefloor of the anterior cranial fossa, particularly involving the planum spehnoidale and

olfactory groove.Finding responsible for anosmia.

This bank can be used either to compare pictures or reach

potential diagnosis or can simply help physicians do a better

job.

Cases BankRD uses a bank of already defined cases in another bank; this

bank can be fed both manually or mainly automatically using Web

Content Mining for a set of trusted accountable websites, and

Text Mining of texts from Atlases and medical and academic

references.

11AUTOMATED PHYSICIAN SYSTEMIndexer and Evaluator

Because we can’t fully depend on the intelligence of

machines, there will be special software to facilitate authorized

physicians to review recently added questions and merge them if

they have only small differences or different wordings. They will

evaluate the entries and suggest improvements to the software

and/or the whole entry mechanism.

5. Benefits of solving the problemThe new system comes up with a lot of benefits that are probably

direly needed by the hospital and by the medical domain in

general.

These benefits serve the medical suite, the patients and the

administrative suite as well.

Some of these benefits are:

1. Reducing or eliminating misdiagnosis.

2. Measuring, tracking and reducing malpractices.

3. Sharing knowledge between doctors, cases’ experiences of

many locations.

4. Improving the best practices.


5. Improving quality by enabling feedback, measurements,

6. Web Content Mining, will help to get better and fresher

information from trusted medical sites.

7. Improving clients (patients) awareness of health and

ailments and therefore their relationships with physicians

(doctors/patients intimacy).

8. Knowledgebase that will be the best intangible asset and

will have so many benefits itself on the long run such as being a

rich source for researches, improvements in traditional ways of

healing or medicating, finding answers to unanswered questions,

having better estimates, better reports, source of wisdom etc.

6. Business/technical approachThere are criteria and standards which are taken into

consideration when thinking of the business/technical approach,

some of these are: availability, capacity, performance,

organizational requirements, regulatory/data segregation

requirements, functional requirements, licensing, and cost.

In order to achieve these criteria, we need an implementation a

strategy that takes into account the abovementioned, we recommend


what is called “Stretched Farm” that depends on two separate data

centers (preferably in two different physical locations), and

that will require the following as a minimum:

1. Two database SQL servers to provide mirroring and disaster

recovery strategy.

2. Two Servers in the middle tire to enhance performance and

they will provide search, query, indexing and other

computing bound services.

3. Two front end servers to provide load balancing and support

availability and performance.

Further servers can be added on demand to enhance the overall

structure.

The three-tier architecture is shown below:

14AUTOMATED PHYSICIAN SYSTEMFigure 2 (Three-tier architecture)

Whilst the two data center architecture is demonstrated below:

15AUTOMATED PHYSICIAN SYSTEMFigure 3 (Two Data Centers)


7. Business process changesThe solution will enhance end users daily work and save

time, and that is why it is designed to be of the least impact on

the regular daily activities.

One process change will be due to the fact that questions might

vary in phrasing or formatting, and for that purpose, special

software will be provided to help merging similar questions that

might slightly vary, authorized physicians should supervise this.

Another change may take place in a rare case where

physicians do not key in data in an Information system, and then

there will be a change for them since they will have to start

entering each question they pose and their answers too.

In the general case where physicians use some information system,

the solution will have to find ways to integrate these systems

together to prevent double entries and make it easier to use.

On one hand, it’s not much of a change in daily activities for

end uses namely physicians, nonetheless on the other hand, there

might be a big challenge (psychological reluctance and suspicion)


concerning the credibility of the product and the role it might

play in there career.

8. Technology or business practices used to augment thesolution

End users will interact with the system using client

devices.

Client devices can vary between laptops, tablets, handheld

devices, or any device that is convenient for the end user and

serves the purpose of entering the required data and retrieving

the needed information.

Client software also would vary based on the end user needs and

convenience, some may choose to use web applications (onsite),

whilst others may prefer smart client that can be taken on

laptops that are occasionally disconnected (offsite), and

transfer that data in a later time.

Aside from that, there are requirements related to the physical

locations like physical security, and also some other

requirements concerning cooling, heating, power supply,

networking etc.


9. Conclusions and overall recommendations

RevolutionaryI believe this project can create a revolution in the

medical industry, it will not replace doctors in any way, but it

will increase the quality, save time, populate science, and might

sift physicians too.

Difficulties We understand that this is not a small project, and we

understand the risks and the difficulties associated with it,

being accepted on a wide range is the number one challenge.

Nation wideThis project depends greatly on a huge database that is a

hundred millions of documents, pages, references, books and

sources. The bigger the database is, the more successful it will

be, that is why we highly recommend this project to be

implemented in as many different places and also get used by as

many doctors to enhance its quality, accuracy and success.

Simply because the idea behind it depends on what is called the

“The Wisdom of Crowds”.


The same reason why “Google Translate” is better than any

automated translator.

According to Google (2010):

“When Google Translate generates a translation, it looks for

patterns in hundreds of millions of documents to help decide on

the best translation for you. By detecting patterns in documents

that have already been translated by human translators, Google

Translate can make intelligent guesses as to what an appropriate

translation should be. This process of seeking patterns in large

amounts of text is called ‘statistical machine translation’.

Since the translations are generated by machines, not all

translation will be perfect. The more human-translated documents

that Google Translate can analyse in a specific language, the

better the translation quality will be. This is why translation

accuracy will sometimes vary across languages.”

The same concept will be used in this project; the system will

learn from human diagnosis by discovering the patterns.

20AUTOMATED PHYSICIAN SYSTEMPublic interface

After evaluating this product and passing the credibility

test, we can open portion of it to be used by public like a free

or paid service with limited features and see how it would

improve itself too.

10. High-level implementation planTo facilitate drawing an implementation plan, it is better

to divide it into phases; some of these phases can run in

parallel with others.

1. Building the database: That includes designing and building

the database and capturing the minimum amount of data to

make it operable.

2. Building software: There are many pieces of the software and

many modules, all of them would be developed and build at

this phase.

3. Setting environment: That includes purchasing all the needed

servers and other devices and accessories and setting up the

needed network and infrastructure.


4. Integration with existing systems: This phase will include

many activities from the database and backlog etc. to

integrate with the software being used etc. This is also

critical phase because it aims to facilitate seamless

transition to the new system.

5. Pre-operation: A period that is necessary to check and

validate the seamless integration with existing systems,

change management, acceptance of the new system, the

efficiency of the new system, training if needed.

6. Operation Kick off: This is when the system goes to

production and the project closes out.

11. Summary of projectAlthough human medicine is a very high and sensitive

specialty, and although computers could not replace human

intelligence (yet), but this project could be a step forward in

that path, trying to make life easier for everyone, facilitating

researches and populating science.

The failure of this project is nothing but a great experience and

power for another project that complements this and builds up on


it, for that I do believe that these kinds of projects are

sentenced or determined to succeed.


ReferencesMichon, K. (J.D.). Medical Malpractice: Misdiagnosis and

Delayed Diagnosis. Retrieved September 12, 2013, from

http://www.nolo.com/legal-encyclopedia/medical-malpractice-

misdiagnosis-delayed-diagnosis-32288.html

BOWSER, B. A. (APRIL 7, 2011) New Study Finds Medical Error

Rates are underreported. Retrieved, September 12, 2013, from

http://www.pbs.org/newshour/rundown/2011/04/new-study-finds-

medical-error-rates-are-underreported.html

St. Lukes Medical Center admin. Retrieved September 12,

2013, from http://creately.com/diagram/example/hdhaj9mn2/St.

+Lukes+Medical+Center+admin

St. Luke's University Health Network, Retrieved September

20, 2013 from http://www.slhn.org

Atlas of radiological images, Retrieved September 20, 2013

from

http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Harr

isons/Harrisons_f.htm

http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Harrisons/Harrisons_f.htm

http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Harrisons/Harrisons_f.htm

http://www.slhn.org/


Retrieved September 20, 2013 from

http://www.cbsnews.com/8301-204_162-57564058/more-than-one-

third-of-u.s-adults-use-internet-to-diagnose-medical-

condition/

Google Translate, Retrieved September 20, 2013 from

http://translate.google.com/about/

Create a high availability architecture and strategy for

SharePoint 2013, Retrieved September 20, 2013 from

http://technet.microsoft.com/en-us/library/cc748824.aspx

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http://technet.microsoft.com/en-us/library/ff628971.aspx

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AppendicesNA

http://www.slideshare.net/itsec/sharepoint-topology

http://technet.microsoft.com/en-us/library/ff628971.aspx

http://technet.microsoft.com/en-us/library/cc748824.aspx

http://translate.google.com/about/

http://www.cbsnews.com/8301-204_162-57564058/more-than-one-third-of-u.s-adults-use-internet-to-diagnose-medical-condition/



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