Design and Realization of Integrated Management System for Data Interoperability between Point-of-Care Testing Equipment and Hospital Information System

박기상,허혁,최영근 대한의료정보학회 2013 Healthcare Informatics Research Vol.19 No.3

Objectives: The purpose of this study was to design an integrated data management system based on the POCT1-A2, LIS2-A, LIS2-A2, and HL7 standard to ensure data interoperability between mobile equipment, such as point-of-care testing equipment and the existing hospital data system, its efficiency was also evaluated. Methods: The method of this study was intended to design and realize a data management system which would provide a solution for the problems that occur when point-of-care testing equipment is introduced to existing hospital data, after classifying such problems into connectivity, integration, and interoperability. This study also checked if the data management system plays a sufficient role as a bridge between the point-of-care testing equipment and the hospital information system through connection persistence and reliability testing, as well as data integration and interoperability testing. Results: In comparison with the existing system, the data management system facilitated integration by improving the result receiving time, improving the collection rate, and by enabling the integration of disparate types of data into a single system. And it was found out that we can solve the problems related to connectivity, integration and interoperability through generating the message in standardized types. Conclusions: It is expected that the proposed data management system, which is designed to improve the integration point-of-care testing equipment with existing systems, will establish a solid foundation on which better medical service may be provided by hospitals by improving the quality of patient service.

Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea

최욱진,하영록,오제혁,조영순,Won Woong Lee,손유동,조규종,Chan-Young Koh,도한호,정원준,Seung Mok Ryoo,Jae Hyun Kwon,Hyung Min Kim,Su-Jin Kim,Chan Yong Park,이진희,Jae Hoon Lee,Dong Hyun Lee,SIN-YOUL PARK,Bo Seung Kang 대한의학회 2020 Journal of Korean medical science Vol.35 No.7

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Clinical Usefulness of Point-of-care Test Chemistry Analyzer in Neonatal Intensive Care Unit

장영욱,김수남,조혜정,선용한,심수연,손동우,박필환 대한신생아학회 2011 Neonatal medicine Vol.18 No.2

Purpose: Point-of-care tests (POCTs) have the potential to significantly influence management of neonates. The aim of this study was to assess the clinical usefulness of the POCT chemistry analyzer in a neonatal intensive care unit (NICU). Methods: Blood samples of neonates admitted to the NICU were tested using a POCT chemistry analyzer (Piccolo Xpress Chemistry Analyzer, Abaxis, Union City, CA, USA) and a central laboratory chemical analyzer (Chemistry analyzer 7600-110, Hitachi Ltd., Tokyo, Japan) from March to September, 2010. Correlation of 15 analytes between the POCT and the central laboratory machine was evaluated. For consistency of the POCT, three consecutive samplings were performed. Differences among the three tests were recorded. The causes of performance errors were checked through log files. Results: One hundred of 112 pairs of tests for accuracy performed in 54 neonates showed a high correlation between the two machines. Twelve performance errors occurred during the 112 tests. The most common error was insufficient sample error. Eighteen triplet tests performed in 18 patients for consistency revealed a difference range of 3-10%, which was considered to be acceptable. No error occurred during the 54 tests. Conclusion: The POCT is capable of analyzing multiple analytes with a minimal amount of whole blood in a short time. The few performance errors noted presently are likely preventable. This POCT is concluded to be suitable for use as a simple and rapid diagnostic method in the NICU with a minimal amount of blood collected in a less invasive manner.

웹개발 프레임워크를 이용한 디바이스 독립적 심전도 리포팅 시스템 구현

구흥서,정신영 대한의료정보학회 2006 Healthcare Informatics Research Vol.12 No.4

Objective: We developed a Cocoon framework-based device independent electrocardiogram(ECG) Reporting System in order to support such various web devices as desktop Personal Computer(PC), Personal Digital Assistants(PDA) and SmartPhone. Methods: ECG Reporting System, built in the Cocoon framework, consists of modules of ECG Report Module and ECG Image Module. Two modules publish the applied ECG Report to each different templates according to the requesting device. The method of framework-based development in this paper features a reduction of development costs and the robust stability of system. Results: The medical staff may require patient ECG information in ubiquitous healthcare environment, ECG Reporting System supports their correct judgment and expeditious response by servicing ECG report of the patient according to the requesting device. Conclusion: The proposed system and concept in this paper may be a good solution for developing the point of care service system supporting various mobile devices. (Journal of Korean Society of Medical Informatics 12-4,317-327, 2006)

Detection of Clopidogrel Hyporesponsiveness Using a Point-of-Care Assay and the Impact of Additional Cilostazol Administration after Coronary Stent Implantation in Diabetic Patients

( Tae Hyun Yang ),( Doo Il Kim ),( Dong Kie Kim ),( Jae Sik Jang ),( Ung Kim ),( Sang Hoon Seol ),( Dae Kyeong Kim ),( Geu Ru Hong ),( Jong Seon Park ),( Dong Gu Shin ),( Young Jo Kim ),( Yun Kyeong C 대한내과학회 2011 The Korean Journal of Internal Medicine Vol.26 No.2

Background/Aims: Impaired responsiveness to clopidogrel is common in patients with type 2 diabetes mellitus (DM). The aim of this study was to evaluate the clinical application of a point-of-care assay to detect impaired responsiveness to clopidogrel after coronary stent implantation in patients with type 2 DM. Methods: We measured P2Y12 reaction units (PRU) with the VerifyNow point-of-care assay in 544 consecutive patients undergoing dual or triple (i.e., dual plus cilostazol) anti-platelet therapy after coronary stent implantation. High platelet reactivity (HPR) was defined as a PRU value ≥ 240. Results: The mean PRU values were 233.5 ± 83.2 and 190.3 ± 85.5 in patients undergoing dual or triple anti-platelet therapy, respectively (p < 0.001). Patients with DM manifested higher post treatment PRU values (238.3 ± 82.4 vs. 210.8 ± 86.8, p = 0.001) and a higher frequency of HPR (44.8% vs. 31.0%, p = 0.003) as compared to patients without DM. We also found that higher PRU values and a higher frequency of HPR were present in patients with DM who were undergoing both triple and dual anti-platelet therapy. However, the higher post-treatment PRU values observed in patients with DM decreased with triple anti-platelet therapy (219.4 ± 82.5 vs. 247.9 ± 81.1, p = 0.044). Conclusions: A point-of-care assay can detect elevated platelet reactivity and impaired responsiveness to clopidogrel in patients with type 2 DM. The addition of cilostazol to dual anti-platelet therapy may decrease post-treatment PRU values in patients with type 2 DM. (Korean J Intern Med 2011;26:145-152)

Development of a nucleic acid detection method based on the CRISPR-Cas13 for point-of-care testing of bovine viral diarrhea virus-1b

( Sungeun Hwang ),( Wonhee Lee ),( Yoonseok Lee ) 한국축산학회 2024 한국축산학회지 Vol.66 No.4

Bovine viral diarrhea (BVD) is a single-stranded, positive-sense ribonucleic acid (RNA) virus belonging to the genus Pestivirus of the Flaviviridae family. BVD frequently causes economic losses to farmers. Among bovine viral diarrhea virus (BVDV) strains, BVDV-1b is predominant and widespread in Hanwoo calves. Reverse-transcription polymerase chain reaction (RT-PCR) is an essential method for diagnosing BVDV-1b and has become the gold standard for diagnosis in the Republic of Korea. However, this diagnostic method is time-consuming and requires expensive equipment. Therefore, Clustered regularly interspaced short palindromic repeats-Cas (CRISPR-Cas) systems have been used for point-of-care (POC) testing of viruses. Developing a sensitive and specific method for POC testing of BVDV-1b would be advantageous for controlling the spread of infection. Thus, this study aimed to develop a novel nucleic acid detection method using the CRISPR-Cas13 system for POC testing of BVDV- 1b. The sequence of the BVD virus was extracted from National Center for Biotechnology Information (NC_001461.1), and the 5’ untranslated region, commonly used for detection, was selected. CRISPR RNA (crRNA) was designed using the Cas13 design program and optimized for the expression and purification of the LwCas13a protein. Madin Darby bovine kidney (MDBK) cells were infected with BVDV-1b, incubated, and the viral RNA was extracted. To enable POC viral detection, the compatibility of the CRISPR-Cas13 system was verified with a paper-based strip through collateral cleavage activity. Finally, a colorimetric assay was used to evaluate the detection of BVDV-1b by combining the previously obtained crRNA and Cas13a protein on a paper strip. In conclusion, the CRISPR-Cas13 system is highly sensitive, specific, and capable of nucleic acid detection, making it an optimal system for the early point-of-care testing of BVDV-1b.

Development of self-powered & disposable Point-Of-Care (POC) DNA analysis system

한경섭 한국공업화학회 2016 한국공업화학회 연구논문 초록집 Vol.2016 No.0

Self-powered microfluidic lab-on-a-chip system is the most suitable platform for the satisfaction of POC diagnostic system requirements. In this paper, we have developed two types of self-powered pumps & valves. The first pump & valve is made of disposable syringe sets (opened & blocked) and switchgear-typed controller. The negative pressure in the opened syringe is generated by restoring force of the compressed air inside the blocked syringe and utilized to pull reagents in microchannels. The second system is that a hydration reaction based self-powered pump and control tape. Hydrogen gas is generated by hydration reaction of powder with water to push in pre-loaded reagents through microchannel and the flow can be controlled with attaching or detaching the tape from microchannel holes. Finally, the potential of two types of self-powered fluidic systems are confirmed via DNA extraction system and DNA total analysis system to be used for POC diagnostic applications.

현장진단응용을 위한 스마트 폰 기반의 초음파 영상 시스템:프로토 타입 구현 및 평가

여선미,김민,김진현,임창현,계상범,송태경 한국비파괴검사학회 2018 한국비파괴검사학회지 Vol.38 No.1

There has been a recent increase in the need for point-of-care (POC) medical treatment in areas with poor diagnostic environments, such as emergency rooms, accident sites, and battlefields.  Thus, research is being actively conducted on ultra-small ultrasound imaging systems capable of POC diagnosis. In this paper, we present a smart-phone-based ultrasound imaging system to maximize the portability of ultrasound imaging. In order to minimize weight and volume, the proposed ultrasound imaging system consists of a smart transducer (including an analog front-end circuitry and 32-channel beamformer/mid signal processing units), and a smart-phone. In-phase and quadrature data from the smart transducer are transferred to the smart-phone via a general-purpose micro-USB communication system. In addition, we propose a back-end signal processing algorithm suitable for a mobile GPU. The developed system provides a B-mode image with a frame rate of 50 and USB 2.0 communication standard. The battery life is 1.5 h, on average. The weight of ultrasound imaging system is 203 g (excluding the battery), and the size is 173 mm×59 mm×28 mm (length×width×height), which is suitable for POC applications. The performance of the developed system was evaluated with phantom and in vivo experiments. 최근 응급실, 사고현장, 전장 등 진단 환경이 열악한 장소에서의 신속한 현장 진료의 필요성이 강조됨에 따라 Point-of-Care 진단이 가능한 초소형 초음파 영상 장비에 대한 연구가 활발히 진행되고 있다. 본 논문에서는 휴대용 초음파 영상 장비의 효율성을 극대화 할 수 있도록 스마트폰 기반의 초음파 영상 시스템에 대하여 제안한다. 제안한 초음파 영상 장치는 시스템의 무게 및 부피를 최소화하기 위하여 아날로그 회로 및 32 채널 초음파 전처리/중간 신호 처리부를 포함하는 스마트 변환자를 개발하였으며 범용 마이크로 USB 통신 방식을 이용하여 스마트폰과 연동하였다. 또한 스마트폰의 그래픽 프로세서 유닛(GPU)에 적합한 후단 신호처리 알고리즘을 제안한다. 개발된 시스템은 USB2.0통신 기준으로 최대 초당 50프레임의 속도를 갖는 B모드 영상을 제공하며, 배터리의 수명은 평균 1.5시간이며 초음파 영상 시스템의 무게는 배터리를 제외하고 203g, 크기는 173 mm×59 mm×28 mm(길이×폭×높이)으로 현장 진료에 적합한 크기와 성능을 가짐을 확인하였다.

현장검사 화학 분석 장비 Piccolo xpress Chemistry Analyzer 성능 평가

박현웅,고대현,김진규,송상훈 대한진단검사의학회 2009 Annals of Laboratory Medicine Vol.29 No.5

Background : Point-of-care (POC) tests are used increasingly due to fast results and simple test procedures, which enables rapid diagnosis and therapeutic monitoring. We evaluated the performance of the Piccolo xpress Chemistry Analyzer (Abaxis, USA) a POC chemistry analyzer. Methods : Fourteen analytes, Na+, K+, Cl-, Ca2+, total carbon dioxide, AST, ALT, total bilirubin, alkaline phosphatase, blood urea nitrogen, creatinine, albumin, total protein, and glucose; were measured simultaneously with a 100 μL of whole blood sample using a Comprehensive Metabolic Reagent disk. Within-run and total precision and linearity were evaluated according to CLSI EP15-A and EP6-A guidelines, respectively. Comparison with a central laboratory chemistry analyzer was performed using 144 patient samples. Results : The coefficients of variations of within-run and total precision were all within 5% for three levels except for total carbon dioxide, ALT, alkaline phosphatase, total bilirubin, and creatinine in low level, and creatinine in middle level. The results of 14 analytes were linear within a commonly encountered range in clinical samples (r2≥0.98). More than 10% of samples in Na+, AST, ALT, glucose, BUN did not satisfy CLIA analytical quality requirement. Conclusions : The Piccolo xpress Chemistry Analyzer can analyze multiple analytes with a minimal amount of whole blood in a short time. It showed an acceptable performance for precision, linearity and comparison with central laboratory analyzer. It can be useful as a screening tests modality in mobile clinics, ambulances, and field clinics for military use, and for pediatric patients from whom enough sample volume is difficult to obtain. 배경 : 현장검사는 신속하고 간편하여 환자의 진단과 치료효 과 판정에 빠르게 적용할 수 있기 때문에 점차 그 적용범위가 늘 어나고 있다. 저자들은 현장검사 화학분석장비인 Piccolo xpress Chemistry Analyzer (Abaxis, USA)의 성능을 평가하였다. 방법 : Comprehensive Metabolic Reagent 디스크에 100 mcL의 검체를 이용하여 14가지 항목(나트륨, 칼륨, 염소, 칼슘, 총 이산화탄소, AST, ALT, 알칼리인산분해효소, 총 빌리루빈, 혈당, 혈액요소질소, 크레아티닌, 알부민, 총 단백질)을 동시에 측정하였다. 검사차례내 정밀도와 총 정밀도는 CLSI EP15-A 에 준하여 평가하였으며, 직선성은 CLSI EP6-A에 준하여 평 가하였다. 중앙검사실 장비와의 상관성은 144개의 환자 검체를 이용하여 평가하였다. 결과 : 검사차례내 정밀도와 총 정밀도의 변이계수(CV)는 낮 은 농도의 총 이산화탄소, ALT, 알칼리인산분해효소, 총 빌리 루빈, 크레아티닌과 중간농도의 크레아티닌을 제외하고 모두 5% 미만이었다. 14가지 항목의 측정값은 임상 검체에서 흔하게 나타나는 범위에서 직선성을 유지하였다(r2≥0.98). 그러나 나 트륨, AST, ALT, 혈당, 혈액요소질소의 경우 CLIA의 수행능 평가 요구조건에 부합하지 않는 검체가 10% 이상인 점은 임상 환경에서 사용 시 주의가 필요하다. 결론 : Piccolo xpress Chemistry Analyzer는 소량의 전혈 로 짧은 시간에 여러 항목을 측정할 수 있다. 정밀도, 직선성, 중 앙검사실 장비와의 상관성은 수용할 만하였다. Piccolo xpress Chemistry Analyzer는 이동식 진료실, 응급 후송차, 군대의 야전 진료소와 많은 양의 채혈이 어려운 소아 환자 검사 등에서 유용할 것으로 생각한다.

Role of point-of-care ultrasound in critical care and emergency medicine: update and future perspective

Choi Wook Jin,Cho Young Soon,Ha Young Rock,Oh Je Hyeok,Lee Heekyung,Kang Bo Seung,Kim Yong Won,Koh Chan Young,Lee Ji Han,Jung Euigi,Sohn Youdong,Kim Han Bit,Kim Su Jin,Kim Hohyun,Suh Dongbum,Lee Dong 대한응급의학회 2023 Clinical and Experimental Emergency Medicine Vol.10 No.4

Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.