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  1. 1. Evaluation of the effectiveness of midwifery-led services in the Health Service Executive - North Eastern Area: A multi-centre randomised controlled trial Declan Devane, School of Nursing and Midwifery, Trinity College Dublin. declan.devane@tcd.ie To date, no study has prospectively evaluated the effectiveness of midwifery-led care compared to consultant-led care for healthy women without risk factors for labour and delivery in the Republic of Ireland. The MidU study addresses this gap in research and will provide high quality evidence on which to base decisions with regard to the organisation and provision of maternity services. The equipment grant supported the purchase of a fully integrated Maternity Information System to support this research study in addition to providing added value of clinical audit etc. The system will cover all maternity care from initial booking to final postnatal discharge including community contacts, all types of antenatal care including specialist clinics, risk management, critical incidence reporting, inpatient and intrapartum care, adverse outcomes etc. It will hold all this information on a single fully integrated database, which will avoid duplication and redundancy of data. The entire maternity health care record will be available to all authorised users. The Maternity Information System will allow rapid collection of clinical data that would be unrealistic to obtain manually, will allow baseline collection of data to be set against determined standards thus facilitating systematic audit of care, will enable cross-correlation analysis of factors to be performed and applied to clinical outcome and will ensure recording of total maternity care, including multiple admissions, transfers, discharges, ward attendances, out-patient appointment, attendances and community care. It will also enable extensive audit and management reporting facilities, the integration of risk management principles and ensure improved accuracy, legibility, availability and completeness of woman based clinical information. Neuropsychiatric Genetics Group Information Infrastructure Dr. Derek Morris, Division of Psychiatry Trinity College Dublin. morrisdw@tcd.ie Understanding the genetic component of common disease is vital to understanding disease biology, which is key to improving diagnostics and developing new treatments. This project is specifically aimed at identifying the genes that contribute to Autism, ADHD and Psychoses – common neuropsychiatric disorders that can affect 5-10% of the population and exact a huge health, economic and social burden. These complex genetic disorders of the brain are difficult to investigate in the absence of known biomarkers or definite pathophysiology. The award has enabled the establishment of two data management systems to support research activities. These two systems are the BC GENE Data Management System for Genetic Studies and the BC CLIN Data Management System for Clinical Studies. The BC/GENE database supports the three main research programmes within the Neuropsychiatric Genetics Research Group: Autism, ADHD and Psychoses. The BC/CLIN database supports the Resource for Psychoses Genomics, Ireland (RPGI) sample collection programme. RPGI is an all-Ireland collection of psychoses cases and constitutes a collaboration between Trinity College Dublin and University College Cork, University College Dublin, Royal College of Surgeons in Ireland and Queens University Belfast. Both systems have been designed to deal with the needs of modern genotype/phenotype studies and to provide safe, structured, and well-documented storage of valuable research data. All data from each study is collected into one database, facilitating both data
  2. 2. management and analysis. An easy-to-use web browser interface permits significantly increased productivity of the research group by allowing every member to connect to a shared, up-to-date database. The RPGI sample collection programme is scheduled for completion in 2007. At that stage both genetic and phenotypic analysis of data collected will begin. The RPGI is a data resource available to all researchers, both national and international, academic and commercial. The data management system will be developed to be accessible to all potential users in the research community. A Tele-Archiving and Data-Warehouse linked to the Telesynergy Multimedia Medical Imaging Workstation Network Professor Donal Hollywood, Institute of Molecular Medicine, St James’ Hospital. dhlywood@tcd.ie Telesynergy is a multimedia medical imaging workstation for use within an electronic imaging environment. Telesynergy is designed for the simultaneous high-resolution display of medical images from numerous diagnostic-imaging modalities. The Telesynergy system has been installed at two locations within the Republic of Ireland (Academic Unit of Clinical Oncology, TCD and St. Likes Hospital), and at both the Radiation Oncology Branch and Clinical Center within the National Institute of Health. Oncology research conducted between international groups, typified by those involved in the NCI-All Ireland Cancer Consortium, is dependent on the integration of an increasing range of core information technologies and the seamless exchange and storage of large datasets between these systems. The Telesynergy system has facilitated the formation of project teams containing the combination of clinicians and scientists in molecular biology/genetics, radiation biology, computational biology, and engineering/applications support. The objectives of the Telesynergy program include: • The examination, development and integration of existing and novel diagnostic medical imaging technologies • The analysis and integration of these imaging and bioinformatics datasets using sophisticated quantification and visualisation tools • The application and extension of Telesynergy to cancer clinical trials and translational cancer research • The phased and planned extension of these technologies to other hospitals within Ireland • The co-development with the NIH center for Information Technology and the Radiation Oncology Sciences Program of new radiation oncology tools for use within Telesynergy • The development of enhanced partnerships and projects with research collaborators at an international level The Efficacy of Telelemedicine in Increasing Carer Knowledge about Schizophrenia Professor Eadbhard O’Callaghan, St John of God Hospital. eadbhard@gmail.com Schizophrenia is a major public health problem affecting over 30,000 people in Ireland. Public knowledge about schizophrenia is modest. Participating in carer education programs for schizophrenia not only improves the outcome for affected relatives but empowers carers. Standardised programs for carer education are difficult to implement. In this project, a state of the art teleconferencing research program was established between the Donegal Mental Health Services based in Letterkenny and the Cluain Mhuire Service in
  3. 3. Dublin to determine if teleconferencing is an efficacious and viable method for carers to participate in carer education programs. The ‘state of the art’ video conferencing equipment suite in Donegal and Dublin are identical to the systems used to train Navy pilots and provides “as near as it gets” to being live in a room. It allows full screen real time video and audio two-way interaction between the two sites. Multiple cameras allow people on the carer education course to see both the speakers and the slides / educational video pieces on two large screens simultaneously. Since inception, six Carer Education Programmes have been completed (each consisting of seven weekly two hour sessions) using the telemedicine system. Experienced therapists facilitate the Programme. Each carer is referred by their clinical team and to date over 104 carers (74% of target) have participated in the carer education programme. In both Donegal and Dublin, knowledge about schizophrenia and burden on the carers is measured using standardised methodologies before the course begins and repeated at its conclusion. At the end of the project it will be determined whether carer education for schizophrenia can be delivered by videoconferencing as effectively as by the ‘face to face’ format. If effective, there are considerable implications for the health service both in Ireland and elsewhere in terms of delivery of an intervention with no known side-effects yet powerful effects on reducing relapse rates and improving satisfaction. National Cardiovascular Information Systems, Multidisciplinary Interagency Infrastructure Project (NCIS MIIP) Dr. Emer Shelley, formerly National Heart Health Advisor, Department of Health and Children and currently Consultant in Public Health Medicine, HSE Population Health Directorate. emer.shelley@mailf.hse.ie The Cardiovascular Health Strategy Building Healthier Hearts (1999) recommended the establishment of a cardiovascular disease (CVD) surveillance system to facilitate a strategic approach to research and development for cardiology services. A national inventory conducted in 2003 had identified the lack of a central database, an absence of data standards and limited capacity to make comparisons between centres or internationally. The purpose of the grant was to complete the hardware requirements for four modules of a national cardiovascular health information system (NCIS): account feasibility and the potential for clinical audit, percutaneous coronary interventions (PCI), clinical electrophysiology (EP) and cardiothoracic surgery and cardiac rehabilitation (CR). A more detailed inventory was conducted in public tertiary, regional and acute hospitals. Hardware requirements were established and 27 hospitals received funds to purchase hardware. A company was appointed to design NCIS, taking into account systems already in place. Substantial development work remains, particularly regarding interoperability. During Ireland’s EU Presidency, in collaboration with the European Society of Cardiology (ESC), the Cardiology Audit and Research Data Standards (CARDS) project agreed standards for acute coronary syndromes (ACS), PCI and EP. Some hospital units in Ireland have implemented the CARDS standards or intend to do so. Data standards for CR were drafted and pilot tested in Ireland and adopted by the ECS. The standards are in use in the UK audit system for CR. Discussions are planned with stakeholders with a view to implementation in Ireland. The International Healthcare Enterprise (IHE) has scheduled a ‘connectathon’ in 2007 for IT and device manufacturers to test interoperability of equipment using CARDS standards. This will be a major step forward for the development of cardiology information systems worldwide, including in Ireland. The Coronary Heart Attack Ireland Register (CHAIR) is in place in coronary care units in HSE South. ACS has been prioritised for a quality initiative by the HSE. With hardware in place, there is potential for intermittent audit in other locations, with data from CHAIR providing a
  4. 4. basis for assessment of outcomes. The National Anti-Poverty Strategy (NAPS) NCIS group drafted Irish standards for sociodemographics which have been pilot tested in CHAIR. This feasibility study will enable the implementation of European standards which are imminent. The HSE, linking with HIQA, will continue to build on the work already done to develop cardiology health information systems for service planning and clinical audit. Use of a diabetes electronic management system (DIAMOND) to support a shared care diabetes programme Dr Fidelma Dunne, Dept of Medicine, Clinical Science Institute, University College Hospital and NUI, Galway. fidelma.dunne@nuigalway.ie Improvement of the quality of diabetes care is a national priority, with a need for a systematic co-ordinated structured programme of care. A key component in delivering effective care is to ensure that primary and secondary care exchange appropriate, up to date patient information. A shared care programme supported by a diabetes electronic management system (DEMS) is an effective means to manage diabetes. It allows logical care of sub groups of patients with diabetes in an orderly and timely fashion. It avoids duplication of tests and prompts all personnel to adhere to regional and national standards. DIAMOND is a diabetes clinical management system that covers all aspects of multi- disciplinary and multi-professional diabetes care. The DIAMOND was pre-populated with patient demographics from the HSE patient administration system (PAS) and with clinical data from the patient records. Development of an interface with Pathology is ongoing. To date there are approximately 3,000 patient records on the system which is being used in real time in the delivery of diabetes care in the secondary care setting. DIAMOND is currently being used to assess the following St Vincent targets for care of patients with Diabetes: assessing the quality of diabetes care delivered, retinal screening, diabetic pregnancy outcomes and coronary artery disease. Going forward the aim is to consolidate the working relationship between the sister hospitals and the primary care providers, using DIAMOND in ‘real time’ at point of patient care. Audit of sentinel data will help to identify ‘black areas’ in Diabetes care that can be improved. A community nurse facilitator has been appointed to help this process and a set of practice guidelines have been developed. DIAMOND will be used for continuing research in areas already addressed in addition to areas such as retinopathy and nephropathy. Clinical Proteomics Analysis Platform (CPAP) Dr Gerard Cagney, Molecular Medicine, Conway Institute, UCD. gerard.cagney@ucd.ie The science of proteomics involves high-throughput identification and comparative analysis of proteins in samples, for instance in healthy and diseased tissue. For protein identification, mass spectrometers generate ion ‘spectra’ that are compared to theoretical spectra derived from genome sequencing projects, a task that involves repeated sifting through sequence databases using pattern-matching algorithms. These and other steps require hardware resources that a) secure data in its most basic form, b) allow parallel processing of rate- limiting tasks, and c) access to raw and processed data by collaborating clinical scientists, statisticians and bio-informaticians. The Protein Pipeline provides infrastructure to dynamically create, control and monitor computer process workflows across potentially multiple machines. It is tailored towards the support of bioinformatics and proteomics computational tasks. It provides the ability to run, in a potentially parallel and distributed manner, multiple workflows each describing a series of
  5. 5. computational tasks. Now that the functioning protein identification pipeline has been completed, a quantitative proteomics module will be added shortly. The Information System carries out the following: statistical validation of the identifications, a mechanism for capturing post-translational modifications and/or polymorphisms through repeat searching of subset protein/DNA sequence databases and the generation of a database of protein identifications linked to complementary data (describing experiment details and publicly-available data describing protein functions, structure etc). This infrastructure platform has translated directly into improved results and substantial time saved for a number of research projects including an analysis of the proteonomics of the human platelet, examination of novel therapeutic targets in cancer and inflammation and investigations into the proteonomics of bipolar disorder and schizophrenia. A Repository to support Shared Care for Diabetes Dr Gerard Boran, Consultant Chemical Pathologist, Adelaide and Meath Hospital (incorporating the National Children’s Hospital) (AMNCH). g.boran@amnch.ie Two identical diabetes databases based at two hospital diabetes centres and designed to a common specification and internationally agreed dataset were used as initial building blocks for this project. The project aims to implement a web-based diabetes data repository which will interface with the two existing systems and create a repository to enhance clinical care, audits, decision support, and research by allowing a regional and potentially national approach. In addition, the web-based repository will be accessible by GPs and patients. The repository concept allows additional centres to join as they develop suitable infrastructure. During 2005, an opportunity arose to expand the scope of the project to include not only diabetes but also other common endocrine conditions. The IT architecture underpinning the diabetes repository proposal had been generic and hence was easily adapted into an architecture capable of supporting a wide and extensible range of common endocrine conditions and indeed many chronic illnesses. The basis of the generic architecture was the creation of Generic Core Modules which service a range of add-on Disorder-specific Modules. The following Disorder-Specific Modules have been developed in 2006: Diabetes Module, Thyroid Module, Cardiovascular Module, Osteoporosis and Bone Metabolism Module and Reproductive Medicine (Women’s Health) Module (e.g. polycystic ovary syndrome). The fact that it has been possible to extend the scope of this project in collaboration with a major software house will mean that an immensely powerful tool will soon be available for the management of chronic endocrine and other illnesses. It is proposed to hold a Workshop/ Conference on the system in early 2007. HEALTH ATLAS IRELAND Howard Johnson, National Population Health Directorate, HSE. howard.johnson@mailf.hse.ie Health Atlas Ireland will exploit the potential of integrating geographical information systems (GIS), health datasets and statistical techniques through “health mapping” across the health sector. It will enable health mapping in support of service planning and delivery, epidemiology and research on a national basis. The Atlas is built upon open source software and will allow web enabled access to an integrated GIS, computational and health dataset system. The Atlas currently includes
  6. 6. census, HIPE, and cancer registry datasets. Computational capacity includes population density, event frequency and indirect standardisation and will be enhanced to include direct standardisation, time trend, and area and point data cluster analyses. Role based access will be provided throughout the HSE and between the HSE and academic and other institutions as appropriate. The Health Protection Surveillance Centre will use the Atlas to provide public access to infectious disease trends. In addition, the Atlas will support the management and follow up of environmental incidents. Road collision, mortality, birth, prescribing and infectious disease datasets will be added. Depending on funding, future modules will include disability, mental health and health service/location resource data. Stakeholders from all backgrounds will be provided with an opportunity to become involved and to ensure that the system can meet their specific requirements. User training will be of critical importance to exploiting the potential of the Atlas and ensuring adherence to good information governance practice. The Atlas will provide endless possibilities for research within and between the health service and academic environments, and also between government sectors. Examples of such work include resource allocation, the optimisation of the location of health service facilities and the reduction of road collision morbidity and mortality. A Multidisciplinary Application to Support Data Transfer and Spatial Analysis of Intentional and Unintentional Injuries Professor Ivan J Perry, Head Department of Epidemiology and Public Health, University College Cork. i.perry@ucc.ie Intentional and unintentional injuries are the major cause of death and disability in Irish men before middle age. This project aims to establish and implement of an ICT based system that will facilitate reliable and valid capture of deliberate self harm data at hospital/prison level, to extend national data collection from deliberate self harm to non-intentional injuries, and to use GIS technology to investigate the geographic, demographic, environmental and socio- economic correlates of intentional and unintentional injuries at individual and area level in Ireland. Sixteen Data Registration Officers in different counties will be provided with a laptop with a custom-built VB application through which they can record information on hospital treated deliberate self harm. The data inputted will be encrypted and stored in a password-protected database and then transmitted to the National Suicide Research Foundation by Remote Access Server, and converted to facilitate analysis, including GIS analysis. The award builds on the established National Registry of Deliberate Self Harm and the EU Public Health Programme seed-funding to establish an injury surveillance system (based on a draft coding manual for all injury surveillance, including unintentional injuries due to traffic and occupational accidents, home and leisure accidents as well as intentional injuries due to violence and suicide attempts). The research programme underpinned by this award is based on the concept of a continuum of injury across the spectrum from recreation and risk taking behaviour to aggression and violence directed at self and others. This research programme will address a key priority in the Government’s Health Strategy ‘Quality and Fairness’ (“A National Injury Prevention Strategy to co-ordinate action on injury prevention will be prepared”) and is also in line with the National Strategy for Action on Suicide Prevention 2005-2014. A Biobank Information Management System for prostate cancer Professor Jane Grimson, Centre for Health Informatics, Department of Computer Science, O’Reilly Institute, Trinity College. Jane.grimson@tcd.ie
  7. 7. The project concerns the development of a Biobank Information System (BIMS) for prostate cancer. The system will support the integration and management of patient-specific clinical and sample biomedical data with molecular data in a centralised repository, facilitating information and knowledge sharing, data analysis and mining, and knowledge discovery. The Biobank Information Management System (BIMS) integrates three elements: a central repository in which all the relevant data will be brought together; the hospital systems where clinical and sample data are captured and stored; and the systems in the two research laboratories in the Conway and Institute of Molecular Medicine (IMM), where the molecular data will be generated. In the initial phase. the BIMS will provide web-based query, data extraction and reporting tools. Additional functionality including sample tracking, and knowledge discovery will be incorporated over time. To date,the project has been successful in attracting a PhD student to work on the development of a comprehensive system for sample tracking using RFID technology and a student to investigate the development of an ontology for the system. Other projects planned include the development of a consistent and comprehensive system of handling data performance and data quality issues as well as using the biobank as a research tool for investigating novel IT solutions to support the “bench to bedside” cycle. Integrated Case Management information System for Drug Users and Related Services Julian Pugh, Co-ordinator Drug Treatment Services (Prisons), Social Inclusion Care Group, HSE. julian.pugh@mailf.hse.ie DAIS (Drugs and Aids Information System) is a database which is used by two clinical drug treatment teams and a number of drug treatment clinics in the HSE Dublin North East area. The grant awarded will be used to develop a shared care plan module for the DAIS IT system, together with associated informatics, in order to develop the research and development capacity of this operational system. The project will assist in the provision of shared care planning across Irish medical and social systems for a client group that has been given priority within the health strategy. The system, with its enhanced datasets, multidisciplinary dynamics and integrated care working will enable research and development work to be undertaken to improve clinical and psychosocial interventions and improve the efficiency of operational and organisational functioning. The improved system will enable workers to identify holistic needs of clients, assist the co-ordination of care episodes and allow an analysis of client needs and intervention outcomes within the context of integrated care pathways. The evidence-based conceptual structure will be utilised to define need, to provide treatment and other interventions to assess whether outcomes are effective. These aims will be linked to a robust monitoring and evaluation system for workers and policy makers. This system has the capacity to link, on a national basis, with other similar systems within the primary care, homeless and criminal justice systems, provided that the necessary safeguards and protocols are put in place. Breast Cancer Research Portal Dr Leonie Young, Royal College of Surgeons in Ireland. lyoung@rcsi.ie The award was made to establish an integrated system to compile data accrued from Dublin Molecular Medicine Centre (DMMC) institutes and affiliated hospitals. The system comprises both clinical and research data on patients in a comprehensive database. The system is a database-driven, intranet web application, which allows both the storage, and retrieval of
  8. 8. clinical, epidemiological, experimental and research data related to breast cancer. The interactive nature of the system allows users to access, modify and assess information from distant sites. Shared information will significantly increase the productivity and impact of clinical based research. The server is housed within the Conway Institute, UCD and is connected to Ireland's academic and research network, known as HEAnet. HEAnet is a world class, provider of broadband Internet services to Ireland's universities, Institutes of Technology and researchers. Users are able to associate molecular markers identified by high throughput technologies such as gene and tissue micro-arrays with standardised clinical databases, which include patient pathological characteristics and clinical details. The portal enables distinct patient groups to be sourced across participants’ data sets to enable increased statistical power of study designs. Research groups from across the city are currently being invited to upload their data onto to system. A public launch of the system hosted by the DMMC and the investigators is planned for January 2007. Building WISDOM as a National Information Database for Epidemiology, Health Service/Systems and Clinical Research Mr. Martin Rogan, Mental Health, HSE. martin_rogan@hse.ie The National Psychiatric Inpatient Reporting System (NPIRS) was established in 1963 and records all admissions to and discharges from inpatient psychiatric services nationally. NPIRS is managed and maintained by the Health Research Board (HRB), Mental Health Research Unit (MHRU) who provide national and local reports on the data for the health services. The data is used for service monitoring, policy and planning, clinical decision making and research. Data collected include demographic data relating to each patient, such as gender, date of birth, marital status, address from which admitted and socio-economic group, along with clinical and diagnostic information, such as date of admission/discharge, legal category, order of admission, diagnosis on admission and discharge in accordance with the WHO International Classification of Diseases categories (ICD 10) and reason for discharge In 2003 in response to changing patterns of patient care, the HRB developed a Microsoft Access database called COMCAR (COMmunity CARe). COMCAR was designed to record activity at community care level, including outpatient clinics, day centres and day hospitals and was implemented on a pilot basis in a number of sites. COMCAR records patient demographics and clinical data and has the functionality to perform both predefined and ad hoc reports. In 2005 it was decided that both COMCAR and NPIRS would be upgraded to become a single integrated web-based application called WISDOM. WISDOM will record and report data in real time on mental health activity in both hospital and community care facilities. This project, jointly sponsored between the HRB and HSE ICT Directorate will facilitate the phased national roll out of WISDOM. WISDOM will be rolled out in the Donegal Local Health Area as a proof of concept. After the proof of concept, which will last approximately 18 months, WISDOM will be evaluated prior to further national rollout. In addition to forming the basis for a regional and national reporting system capturing activity in community care and inpatient services, WISDOM will also be a national resource for mental health research.
  9. 9. Infrastructure to support the development of an epilepsy Electronic Patient Record (EPR) Mary Fitzsimons, Principal Physicist, Epilepsy Programme, Beaumont Hospital. maryfitzsimons@beaumont.ie Epilepsy is one of the most common neurological conditions in the world, with an estimated 40,000 sufferers in Ireland. At Beaumont Hospital, the epilepsy programme integrates clinical care and research and acts as the main tertiary referral centre for epilepsy and related disorders. The large volumes of data involved are traditionally stored on disparate databases physically located in different locations. An EPR can integrate data from multiple existing hospital systems (data sources) providing access to information when and where it is needed. Appropriate management of this data improves the quality and integrity of patient information, efficiency of our services, and facilitates essential data-mining. The ICT infrastructure to develop an epilepsy EPR has been implemented. This has “connected” epilepsy out-patient clinics, the epilepsy monitoring unit, in-patients, a nurse led telephone advice line, epilepsy community services and epilepsy researchers. A web-based EPR application is currently being designed, developed and implemented on a modular basis. It is based on a systems architecture that captures both epilepsy-specific information and generic patient information, providing an application that will be generalisable to other similarly complex chronic diseases. The epilepsy EPR development is at an advanced stage. Five core modules have been designed and developed and are at various stages of piloting and implementation. These include: Clinic administration, Demographics, Social History, Epilepsy Medications and Epilepsy-specific history. The applicants have also embarked on a socio-technical project, funded through the HRB Health Services R&D Awards, which aims to conduct an on-going development of the EPR to establish an e-Health domain for patients and health professionals and to evaluate the impact of the domain on healthcare process and outcome. A dynamic wound care database to facilitate interdisciplinary combined care, allow further education of health care professionals and to support evidence based practice in the community Professor Henry Paul Redmond, Professor of Surgery, UCC and Cork University Hospital. p.redmond@ucc.ie The development of a dynamic wound care database and IT System will facilitate interdisciplinary research and combined care, allow further education of health care professionals and support evidence based practice in the community. An Internet-based secured system will be designed to record in a longitudinal fashion surgical patients attending the wound care services of a tertiary referral centre. Digital images will record the progress of individuals with chronic wounds including, but not exclusively, pressure, arterial and venous ulcers. Files on individual cases will be kept with relevant case information. These images and details will be updated by those health care professionals involved in patient care both at a primary and specialist level, resulting in a complete & permanent record of wound care management. Each individual case will then contribute to forming a bank of information centering on wound care. The service will incorporate a communications facility enabling the bi-directional exchange of information between researchers, and primary and specialist carers. The system will be allied
  10. 10. with the surgical laboratory facility of Cork University Hospital, where research is ongoing into the pathogeneis and treatment of wounds and the inflammatory process. Using geographical mapping systems to improve health status and to monitor health gain Dr Peter Wright, Director of Public Health, HSE NW. drpwright@eircom.net The overall aim of this project is to ensure a well resourced Health Intelligence Unit in the HSE NW. Incorporating a spatial dimension into health enables connections to be made between people, space and health. GIS allows coordination of data collation and thus enables the integration of data to achieve a holistic view of the population’s health and social needs. GIS enables planning and policy developers to consider a range of factors in the decision- making process, including where disadvantaged subpopulations may be under-serviced and/or whether there is identifiable inequities in geographical access. To date in the HSE NW region, this system has been used to: • Illustrate the spatial distribution of mortality and morbidity and to compare this with the distribution of deprivation and physical accessibility to health services • Implement the Primary Care Strategy through evidenced based development of Primary Care Teams and Networks • Identify areas of low childhood immunisation uptake, to map this data by area of residence of the child, by GP and by public heath nurse and to correlate with deprivation, income and social class etc • Map infectious disease notifications to the Public Health Dept. and analysis of trend • Implement and maintain a comprehensive, robust and flexible computer based GIS solution to support the main functions, processes and management of Regional Ambulance Command and Control in the NW The system is currently in use in Public Health, Ambulance Control, Children’s Services and Primary Care. Roll out to Learning Disability Services and Home Help Services is expected in the coming months. An in-house training unit has been set up to train HSE staff in GIS techniques. Mental Health Research System Development Dr Ronan Hearne, Consultant Psychiatrist, Cluain Mhuire Service, Blackrock, Co. Dublin. ronan.hearne@sjog.ie A common feature of research is that it is carried out at arms length from clinical practice. Quality information gathered in the course of research remains with the researcher, awaiting publication at some future date and patients and clinicians often receive little or no feedback. The corollary is also true. A wealth of information of interest to researchers is collected in a naturalistic setting by clinical teams. In this context data collected by research and clinical teams is significantly underutilised. The goal of this initiative is to bring these two resources together by developing a research database which interfaces directly with electronic clinical records. The Hospitaller Order of St John of God is the only clinical psychiatric services in Ireland to use a fully integrated electronic patient record system (MHIS). In addition, the Order hosts two major research projects (DELTA and DETECT) funded jointly with the Health Services Executive. In this project, a database and a research system will be developed to support the DELTA / DETECT projects and which will interface directly with the MHIS. The interconnectivity of these two systems will enable two way communications between the research database and the clinical record system. ‘Generic’ type interfaces and database
  11. 11. connectivity methodologies will be developed and benchmarked specifically with support for future research developments in mind. Once the link to the adult community care version of the MHIS is established the same interfaces can be used, in future developments, to link with the other versions of the MHIS record system used by all the St John of God Order’s intellectual disability services (Dublin, Kildare, Kerry & Louth) and Child and Adolescent (Lucena) services (Tallaght, Dun Laoghaire, Bray, Rathgar, Wicklow & Arklow). This connectivity will provide proof of concept and act as a model for connectivity between other research databases and other clinical record systems which may be developed in the future. Digital Slide Management System: Application to Biomarker Discovery and Validation Professor William M. Gallagher, Conway Institute, University College Dublin. willam.gallagher@ucd.ie A Digital Slide is an electronic representation of a traditional glass slide, which can be laterally examined and viewed under different magnifications using a computer, in a similar fashion to viewing a glass slide using a microscope. It is a modern tool designed to facilitate the pathologist in the examination, circulation and review of case material, in an efficient and intuitive manner. This award will facilitate the purchase of a high resolution, high-throughput, automated pathology slide scanner for the manufacture of digital slides and will put in place a database management system to allow the efficient archival and distribution of digital slides amongst the research community within UCD, RCSI, and DCU, as well as the other national and international sites. The system will be capable of robustly administering the manufacturing workflow of digital slide libraries and providing access to digital slides in a secure manner for the benefit of dispersed research groups. It is proposed that this 'Digital Slide Management System' will be information-rich in that it will be possible to associate multimedia files and data with digital slides. An increasing number of researchers are utilising tissue microarrays (TMAs) from large cohorts of human and other tissues but high throughput technologies such as TMA have their own drawbacks including the need to interpret vast amounts of data in an objective and validated manner. Once developed, the integrated 'Digital Slide Management System' will result in improved analysis of clinical samples in the context of biomarker discovery and validation in cancer and many other diseases.

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