A Large-Scale Clinical Validation of an Integrated Monitoring System in the Emergency Department

We consider an integrated patient monitoring system, combining electronic patient records with highrate acquisition of patient physiological data. There remain many challenges in increasing the robustness of e-health applications to a level at which they are clinically useful, particularly in the use of automated algorithms used to detect and cope with artefact in data contained within the electronic patient record, and in analysing and communicating the resultant data for reporting to clinicians. There is a consequential plague of pilots, in which engineering prototype systems do not enter into clinical use. This paper describes an approach in which, for the first time, the Emergency Department of a major research hospital has adopted such systems for use during a large clinical trial. We describe the disadvantages of existing evaluation metrics when applied to such large trials, and propose a solution suitable for large-scale validation. We demonstrate that machine learning technologies embedded within healthcare information systems can provide clinical benefit, with the potential to improve patient outcomes in the busy environment of a major Emergency Department and other high-dependency areas of patient care.