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A web-based database system for intelligent remote monitoring of an artificial heart has been developed. It is important for patients with an artificial heart implant to be discharged from the hospital after an appropriate stabilization period for better recovery and quality of life. Reliable continuous remote monitoring systems for these patients with life support devices are gaining practical meaning. The authors have developed a remote monitoring system for this purpose that consists of a portable/desktop monitoring terminal, a database for continuous recording of patient and device status, a web-based data access system with which clinicians can access real-time patient and device status data and past history data, and an intelligent diagnosis algorithm module that noninvasively estimates blood pump output and makes automatic classification of the device status. The system has been tested with data generation emulators installed on remote sites for simulation study, and in two cases of animal experiments conducted at remote facilities. The system showed acceptable functionality and reliability. The intelligence algorithm also showed acceptable practicality in an application to animal experiment data.

To develop best practices, tools, capacity and capability for an effective formulary management system for five public health care institutions in Singapore. METHODS: A survey was conducted among formulary committee members of the participating institutions as part of gap analysis. A cross-institution task force comprising decision makers, clinicians, pharmacists and health technology assessment (HTA) researchers from participating institutions was formed to recommend best practices for formulary submission, evidence review and synthesis, pharmacoeconomic evaluation and criteria for decision making. Endorsement from participating institutions' stakeholders was obtained before the implementation of this programme. RESULTS: The gap analysis highlighted three key areas for improvement: 1) methodologies for evidence review and synthesis, and pharmacoeconomic evaluation; 2) criteria for formulary decision making; and 3) capacity and capability building especially in pharmacoeconomics. A set of tools that facilitate evidence review and synthesis including guidelines for pharmacoeconomic evaluation was developed with reference to published literatures and international guidelines. Clinical need, safety, efficacy, cost-effectiveness, budget impact and opinion from subject matter experts were deemed as important decision-making criteria. A decision-making form incorporating these criteria was created to facilitate the consistency and transparency of the decision making process. Workshops focused on HTA were conducted to equip pharmacists supporting formulary management for participating institutions the knowledge and skills to appraise clinical and economic evidence. In addition, a team comprising personnel trained in pharmacoeconomics was set up to provide support to institutions pharmacists on the application of HTA via joint review on selected new drug applications. CONCLUSIONS: Support from participating institutions formulary committees and senior management are keys for the successful implementation of this programme. Moving forward, the challenge is to integrate the proposed changes into current practice.