Medical and Care Compunetics 5 accompanies the fifth annual ICMCC Event, which is one of the leading information platforms for medical and care ICT. The focal point of this publication lies on compunetics, the social, societal and ethical aspects of medical and care ICT. This book contains a variety of debatable subjects. Among national and regional projects, issues discussed are aspects of electronic health records and European projects. There is also a discussion of knowledge management, which is lead by Arthur Krukowski and Andy Marsh; other issues that are considered are behavioral compunetics, empowerment and there is also a discussion of personal health paradigm challenging citizens and patients lead by Prof. Dr. Bernd Blobel from the eHealth Competence Center jointly with the European Federation for Medical Informatics, Working Groups ‘Electronic Health Records’ and ‘Security, Safety and Ethics’.
This book accompanies the fifth annual ICMCC Event.
ICMCC is becoming one of the leading information platforms for medical and care ICT. This is reflected in this year's ICMCC event programme which includes even more examples of compunetics, the social, societal and ethical aspects of medical and care ICT. With a growing number of papers, authors come from almost all continents.
The 2008 ICMCC Event deals with the following subjects:
• National and Regional Projects;
• Aspects of Electronic Health Records;
• European Projects, organised by Artur Krukowski and Andy Marsh;
• Knowledge Management, organised by Rajeev Bali and Nilmini Wickramasinghe;
• Behavioral compunetics, organised by Stephen Benton;
• Personal Health Paradigm Challenging Citizens and Patients, organised by Prof. Dr. Bernd Blobel from the eHealth Competence Center (University of Regensburg Medical Center, Germany) jointly with the European Federation for Medical Informatics (EFMI) Working Groups “Electronic Health Records (EHR)” and “Security, Safety and Ethics (SSE)”.
I would like to thank all the members of the scientific board for their work in preparing this event and especially Denis Carroll, Andy Marsh and Bernd Blobel.
On behalf of the ICMCC Foundation board I wish to thank the University of Westminster Business School for hosting this conference.
I also would like to thank the UK Department for Business, Enterprise and Regulatory Reform (BERR),theBritish Computer Society (the HIISCG and the Sociotechnical Group), the IFMBE and the BIOPoM for supporting our event.
Finally I would like to thank all the authors who have contributed to making the fifth ICMCC Event into an interesting and challenging conference.
Modern Healthcare Systems that have embraced ICT and Internet technologies (referred to as Health 1.0) are evolving towards self management but from a clinical knowledge perspective. In contrast, from a user experience perspective, and using the latest web 2.0 technologies, the developing healthcare social networking communities (referred to as Health 2.0) are evolving towards becoming online medical portals.
The growing Grand Challenge for healthcare is therefore: how will health care services (Health 1.0) work together with user-generated health care (Health 2.0) in a consumer market place delivering self management services for a healthier lifestyle and medical compliance. What is foreseen is that the self care information tool of the future will be a combination between the patient's observation record and the Internet, with the doctor and the patient positioned together at the intersection but not having to pay attention to the technology.
This article deals with various aspects related to this Grand Challenge like the paradigm shift towards a needs-led and consumer-oriented healthcare, the role, supply and quality of information and the changing doctor-patient relationship.
To optimize the medical resources in India and Asia empowering the patients with e-health services in order to justify the multi-specialty healthcare provided to the rural and remote areas is the need of the hour. C-DAC Mohali is working in this direction since 1999 and deployed the technology for the amelioration of the rural Indian population. We bring home the bacon by a broad spectrum of professional quality Telemedicine products and customized solutions that fit within any budget constraint. We're experts in telemedicine conferencing and can help find the right solution to empower the patient with the essentials tools. Through this paper a description of the results from our Telemedicine projects, with substantiating and quantifiable data is put forth. Indian Telemedicine establishments need periodic evaluation to rationalize the main objective of the technology i.e. patient care, patient satisfaction, and patient opinion – in one word – patient empowerment.
..In 2007, the Dutch National Technical Agreement (NTA) for Telemedicine was established.
Telemedicine deals with care processes.
The goals of Telemedicine were defined broadly, including quality of life in non-medical terms as seen from the patient's perspective: 1) independence, 2) self-reliance; 3) participation in society and social life and 4) self-determination (autonomy through freedom of choice) for the care consumer and his environment.
Quality aspects were defined at three levels:
1) patient level Telemedicine must be in line with his needs
2) level of information provision, such as: patient's rights in information control were also defined in the NTA: the care consumer has ultimate control over his own data. The care consumer decides who, in which functional capacity within the care process, is entitled to access which data at which level (reading) and is entitled to process it in some way: making additions, changes or possibly deleting (writing). On request, the healthcare provider must allow the care consumer access to his own data as quickly as possible and/or provide a copy of (part of) the record.
3) level of business processes, e.g.it is important that the care process is designed on the basis of statutory requirements for the allocation and registration of the roles, rights and obligations of all actors concerned.
For quality assurance, the processes must be defined on the basis of the function that they perform in the achievement of the goals (intended outcome), from the starting situation (input). The intended outcome means that the needs or requirements of the involved parties are fulfilled.
The quality of the Telemedicine service must be assured in a cyclical and ongoing process. This can best be done by developing a quality management system based on indicators and criteria for quality.
Roxana Antohi, Cristina Ogescu, Daniel Bistriceanu, Livia Stefan, Silviu Dumitru
34 - 41
The paper describes how the PROMED platform can be used as a Electronic Patient Record (EHR) system and also the platform's contribution to the improvement of the healthcare services in Romania as a solution for the integration of the main stakeholders involved in a National Healthcare System: patients, health care providers and public health authorities. By using the PROMED platform, the Public Health Authorities will be able to view various reports about the population health status and can elaborate timely prevention and warning plans in case of epidemic diseases.
Providing an appropriate operation note is not only good practice, it is a professional and legal requirement. It was therefore necessary to ascertain whether operation notes generated by a clinical information system were of acceptable quality compared to handwritten notes when the Bluespier Patient Manager, a clinical information system, was introduced into an orthopaedic trauma unit. A four week prospective audit of operation notes was conducted both before and after its introduction, with standards based on criteria from the Royal College of Surgeons of England, plus additional orthopaedic criteria. 119 operation notes were reviewed before the introduction of computer-generated notes and 137 notes afterwards. Computer-generated notes were of better quality in all areas except the details of the author and time of generation. Previous audits of the quality of general surgical operation notes in district general hospitals have shown variable results and several solutions have previously been tried. With the advent of the National Programme for IT (NPfIT), computer generated notes are the next logical step. The introduction of computer-generated operation notes has improved their quality in terms of compliance with Royal College guidelines and other orthopaedic criteria.
Ola Göransson, Krister Pettersson, Pär A. Larsson, Bo Lennernäs
56 - 60
Background: The aim of this survey was to examine health care professional's attitudes towards technology involving support from artificial intelligence (AI), robots and humanoids. Within 10–15 years, every third student has to choose occupation within the health care sector to obtain the current personal level, due to the aging population and retirement within the health service sector.
Material & Methods: The preliminary investigation interviews presented a wide range of activities. These were nursing tasks, service tasks, monitoring/alarms, telemedicine and social communication. First, a five minutes presentation movie was presented. The movie demonstrated expected personal needs in the future and what robots and AI can do today and tomorrow. After this presentation, the 111 respondents, from different representative care institutions, replied on a questionnaire that dealt with selected areas identified above. The questions included different views of robots as supported aids in healthcare.
Results & Discussion: The respondents were overall negative using AI and robot technology related to caring activities. However, all groups were positive in using robots in service tasks, monitoring/alarms, telemedicine communication. Of 29 assertions, 18 were mostly positive and 13 of them were over 70 % positive. The frequency of positive and negative attitudes, were similar in the central areas. Within the caring area, a positive robot assisted task requires an interaction (collaboration): caregiver-robot-individual and subsequently, within the nursing area; robot assisted tasks must involve a certain degree of human caring.
Catherine Quantin, Maniane Fassa, Gouenou Coatrieux, Vincent Breton, Jean Yves Boire, François André Allaert
61 - 67
The main problem for the patient who wants to have access to all of the information about his health is that this information is very often spread over many medical records. Therefore, it would be convenient for the patient, after being identified and authenticated, to use a kind of specific medical search engine as one part of the solution to this main problem. The principal objective is for the patient to have access to his or her medical information at anytime and wherever it has been stored. This proposal for secure “Google Like” access requires the addition of different conditions: very strict identity checks using cryptographic techniques such as those planned for the electronic signature, which will not only ensure authentication of the patient and integrity of the file, but also protection of the confidentiality and access follow-up. The electronic medical record must also be electronically signed by the practitioner in order to provide evidence that he has given his agreement and accepted responsibility for the content. This electronic signature also prevents any kind of post-transmission falsification. New advances in technology make it possible to envisage access to medical records anywhere and anytime, thanks to Grid and watermarking methodologies.
Luis Kun, Gouenou Coatrieux, Catherine Quantin, Regis Beuscart, Robert Mathews
68 - 79
One of the central pieces for healthcare and public health is information. Through the shared use of the Information Super Highway and the WWW, for example, elder patients can, and indeed are “visited, diagnosed, treated and managed” from their homes, with the help of telemedicine systems. These technologies also provide society with additional benefits within a global health perspective, with applications ranging from disease prevention and genetics to surveillance and epidemiologic studies. For example, discoveries relating to the prevention or curing of a disease in one part of the world should be “known” everywhere else instantaneously. During an emergency, individuals travelling the world should be able to access their healthcare records for proper care, anywhere. Individuals emigrating from a country to any other should be able to use their information “seamlessly” in terms of the “old” and “new” information systems, no matter where they are. The information contained in multiple systems, i.e., civilian, military forces, etc., should appear transparently among all. However, at this time, significant questions regarding privacy of health information, quality of the services delivered and in general, the information assurance, i.e., authenticity, confidentiality, integrity, availability, and non-repudiation persists. A common aspect to information protection and sharing is interoperability. The authors believe that this term is poorly understood and consequently its incorrect use generates immensely negative consequences. The question raised by the authors then is, what is “true interoperability”?
Thomas Pliakas, Serafeim Dermeitzoglou, Christos Papachristos, Artur Krukowski
83 - 92
The main objective of paper is to describe a proposed tele-medicine pilot is for establishing a telemedicine network in a Private Healthcare Organization, to be developed in the frame of the ESA project, HOST
HOST – HELLAS SAT Offering in Satellite Communications, ESA sponsored project: “Applications: Satcom Network Systems and Services”
. The HOST program focuses on the development of the Hellas Sat commercial offering in end-to-end satellite telecommunication services for supporting the delivery of bidirectional (broadband) applications in Greece, the Balkans, SE Europe, and the Middle East. To this effect a satellite broadband network will be implemented and operated 5 remote sites, three of them acting as trainers and the rest two as trainees The pilot system will allow real time exchanges of medical records to aid tele-diagnosis, coordination of medical and administrative processes, tele-assistance using videoconferencing; distant medical equipment or medical records (images and examinations, allergies, medical history, etc) monitoring and real time tele-diagnosis by specialized medical doctors on remote sites.
Andy Marsh, Christos Biniaris, Dimitrios Vergados, Arnold Eppler, Christoforos Kavvadias, Olaf Bigalke, Eric Robert, Boro Jerabek, Alevizos Alevizos, Michael Caragiozidis
93 - 103
Since the population of elderly people grows absolutely and in relation to the overall population in the world, the improvement of the quality of life of elderly people at home is of a great importance. This can be achieved through the development of generic technologies for managing their domestic ambient environment consisting of medical sensors, entertainment equipment, home automation systems and white goods, increasing their autonomy and safety. In this context, the provision intelligent interactive healthcare services will improve their daily life and allowing at the same time the continuous monitoring of their health and their effective treatment. This work is supported by the INHOME Project EU IST-045061-STP, http://www.ist-inhome.eu.
In health systems, there has been an emergence of new types of data and new technologies that allow continuously monitoring the status of the patients and make easy the achievement of real time information. The storage of all the acquired information makes possible to identify trends in medical data by means of new Clinical Decision Support subsystems. Current knowledge management solutions are specific, proprietary and closed and can not perform real-time analysis to improve the patient's diagnosis or treatment. There are neither solutions that integrate the large amount of heterogeneous information that nowadays are available in health environments. To overcome these objections, this paper proposes a new approach to design a data management system in a telehealthcare system with specific real-time constraints on knowledge acquisition and generation. It is a preliminary study and presents the main features of the system architecture and a preview of the technological solution implemented.
The study of knowledge transfer (KT) has been proceeding in parallel but independently in health services and in business, presenting an opportunity for synergy and sharing. This paper uses a survey of 32 empirical KT studies with their 96 uniquely named determinants of KT success to identify ten unique determinants for horizontal knowledge transfer success. These determinants, the outcome measure of Knowledge Use, and separate explicit and tacit transfer flows constitute the KT Framework, extending the work of previous KT framework authors. Our Framework was validated through a case study of the transfer of clinical practice guideline knowledge between the cardiac teams of selected Ontario hospitals, using a survey of senders and receivers developed from the KT literature. The study findings were: 8 of 10 determinants were supported by the Successful Transfer Hospitals; and 4 of 10 determinants were found to a higher degree in the Successful than non-Successful transfer hospitals. Taken together, the results show substantive support for the KT Framework determinants, indicating aggregate support of 9 of these determinants, but not the 10th – Knowledge Complexity. The transfer of tacit knowledge was found to be related to the transfer of the explicit knowledge and expressed as the transfer or recreation of resource profile and internal process tacit knowledge, where this tacit transfer did not require interactions between Sender and Receiver. This study provides managers with the building blocks to assess and improve the success rates of their knowledge transfers.
Lilia Edith Aparicio Pico, Orlando Rodriguez Cuenca, Daniel José Salas Alvarez, Piere Augusto Peña Salgado
130 - 140
The present article shows a study about requirements for teleconsulting in a telemedicine solution in order to create a knowledge management system. Several concepts have been found related to the term teleconsulting in telemedicine which will serve to clear up their corresponding applications, potentialities, and scope. Afterwards, different theories about the art state in knowledge management have been considered by exploring methodologies and architectures to establish the trends of knowledge management and the possibilities of using them in teleconsulting. Furthermore, local and international experiences have been examined to assess knowledge management systems focused on telemedicine. The objective of this study is to obtain a model for developing teleconsulting systems in Colombia because we have many health-information management systems but they don't offer telemedicine services for remote areas. In Colombia there are many people in rural areas with different necessities and they don't have medicine services, teleconsulting will be a good solution to this problem. Lastly, a model of a knowledge system is proposed for teleconsulting in telemedicine. The model has philosophical principles and architecture that shows the fundamental layers for its development.
Suva (Swiss National Accident Insurance Fund) is the most important carrier of obligatory accident insurance in Switzerland. Its services not only comprise insurance but also prevention, case management and rehabilitation. Suva's medical division supports doctors in stationary and ambulatory care with comprehensive case management and with conciliar advice. Two Suva clinics provide stationary rehabilitation. Medicine in general, including insurance medicine, faces the problem of a diversity of opinions about the facts of a case. One of the reasons is a diversity of knowledge. This is the reason why Suva initiated a knowledge management project called InWiM. “InWiM” is the acronym for “Integrierte Wissensbasen der Medizin” which can be translated as “Integrated Knowledge Bases in Medicine”. The project is part of an ISO 9001 certification program and comprises the definition and documentation of all processes in the field of knowledge management as well as the development of the underlying ITC infrastructure. The knowledge representation model used for the ICT implementation considers knowledge as a multidimensional network of interlinked units of information. In contrast to the hyperlink technology in the World Wide Web, links between items are bidirectional: the target knows the source of the link. Links are therefore called cross-links. The model allows annotation for the narrative description of the nature of the units of information (e.g. documents) and the cross-links as well. Information retrieval is achieved by means of a full implementation of the MeSH Index, the thesaurus of the United States National Library of Medicine (NLM). As far as the authors are aware, InWiM is currently the only implementation worldwide – with the exception of the NLM and its national representatives – which supports all MeSH features for in-house retrieval.
Nilmini Wickramasinghe, Rajeev K. Bali, M. Chris Gibbons, Jonathan Schaffer
147 - 162
Knowledge Management (KM) is an emerging business approach aimed at solving current problems such as competitiveness and the need to innovate which are faced by businesses today. The premise for the need for KM is based on a paradigm shift in the business environment where knowledge is central to organizational performance . Organizations trying to embrace KM have many tools, techniques and strategies at their disposal. A vital technique in KM is data mining which enables critical knowledge to be gained from the analysis of large amounts of data and information. The healthcare industry is a very information rich industry. The collecting of data and information permeate most, if not all areas of this industry; however, the healthcare industry has yet to fully embrace KM, let alone the new evolving techniques of data mining. In this paper, we demonstrate the ubiquitous benefits of data mining and KM to healthcare by highlighting their potential to enable and facilitate superior clinical practice and administrative management to ensue. Specifically, we show how data mining can realize the knowledge spiral by effecting the four key transformations identified by Nonaka  of turning: (1) existing explicit knowledge to new explicit knowledge, (2) existing explicit knowledge to new tacit knowledge, (3) existing tacit knowledge to new explicit knowledge and (4) existing tacit knowledge to new tacit knowledge. This is done through the establishment of theoretical models that respectively identify the function of the knowledge spiral and the powers of data mining, both exploratory and predictive, in the knowledge discovery process. Our models are then applied to a healthcare data set to demonstrate the potential of this approach as well as the implications of such an approach to the clinical and administrative aspects of healthcare. Further, we demonstrate how these techniques can facilitate hospitals to address the six healthcare quality dimensions identified by the Committee for Quality Healthcare .
Cristina Ogescu, Claudiu Plaisanu, Florian Udrescu, Silviu Dumitru
165 - 171
The paper presents a web based platform for management of medical cases, support for healthcare specialists in taking the best clinical decision. Research has been oriented mostly on multimedia data management, classification algorithms for querying, retrieving and processing different medical data types (text and images). The medical case studies can be accessed by healthcare specialists and by students as anonymous case studies providing trust and confidentiality in Internet virtual environment. The MIDAS platform develops an intelligent framework to manage sets of medical data (text, static or dynamic images), in order to optimize the diagnosis and the decision process, which will reduce the medical errors and will increase the quality of medical act. MIDAS is an integrated project working on medical information retrieval from heterogeneous, distributed medical multimedia database.
Knowledge driven technological developments, the growth and speed of application oriented products in the field of web based services, medical technology and information science, the use of sensor networks for remote patient monitoring is currently playing a major role in quality healthcare delivery to the masses. However, further research need to be done for more effective diagnosis and treatment of diseases remotely. An improved web based, knowledge driven, patient data monitoring and diagnosis system remotely, is developed to acquire, store and process the data using specially developed GUI (Graphical User Interface) on lab-view platform. The GUI displays, communicates and processes vital biomedical parameters such as Heart rate (HR), beat to beat ratio (R-R), QRS and QT intervals etc after acquiring ECG, pulse rate, body temperature etc. from the patient's body sensors. The system detects any emergency condition automatically, if the patient develops any abnormality in his heart rate or irregularity in rhythm heart line and establishes direct connectivity between specialists and patient. The provision to store the online data on remote PC in auto mode is given. The storage of data files on demand on local and remote PC and online data communication between the two is done through shared variables. A case study to evaluate the performance and to verify the experimental implementation is conducted on two patients with varying heart rate (HR) and varying rhythm and the results were found exactly to be in accordance with the expected outcome.
Isabel Román, Jorge Calvillo, Laura M. Roa, Germán Madinabeitia
181 - 189
A critical issue in healthcare informatics is to facilitate the integration and interoperability of applications. This goal can be achieved through an open architecture based on a middleware independent from specific applications; useful for working with existing systems, as well as for the integration of new systems. Several standard organizations are making efforts toward this target. This work is based on the EN 12967-1,2,3, developed by CEN, that follows the ODP (Open Distributed Processing) methodology, providing a specification of distributed systems based on the definition of five viewpoints. However, only the three upper viewpoints are used to produce EN 12967, the two lower viewpoints should be considered in the implementation context. We are using Semantic Grid for lower views and Semantic Web and Web Services for the definition of the upper views. We analyze benefits of using these methods and technologies and expose methodology for the development of this semantic healthcare middleware observing European Standards.
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