Ebook: Medical and Care Compunetics 3

This book accompanies the third annual ICMCC Event. In the 12 months since our previous conference we established the goals of the ICMCC Foundation.

To become the leading source for citizen/patient-related information using the latest medical and care compunetics is the first of these goals. ICMCC has been one of the first organizations recognizing the possible thread to patient safety of the information available on the internet.

ICMCC also recognizes the problems of professionals to find information on the latest developments in medical and care compunetics in a structured way.

These two aspects form the basis for becoming the leading Knowledge Centre on medicine and care.

To realize this goal our third annual event covers aspects concerning:

• Information supply to patient and professional

• Electronic health records, its standards, its social implications

• New developments in medical & care compunetics.

Our third goal is to serve as the central meeting place for exchanging information on all aspects related to medical and care compunetics and for all those concerned. We are therefore pleased to be a platform once again for a number of European Commission (IST) funded projects.

And we are proud to be the platform for the EFMI (European Federation for Medical Informatics) Working Groups “Electronic Health Records”, “Security, Safety and Ethics” and “Cards” and we would like to thank Dr. Bernd Blobel and Dr. Peter Pharow for their work to organise this session.

On September 29, 2005 our co-founder Prof. Swamy Laxminarayan passed away. We will be forever in his debt for his believe in our organisation and goals and his relentless support. To honour the memory of one of the greatest minds in biomedicine and biotechnology of the twentieth century ICMCC will this year initiate an annual Swamy Laxminarayan lecture.

On behalf of the ICMCC Foundation board we wish to thank the IFMBE and the WABT-ICET-UNESCO for accepting us as members and for their support for this conference. We are equally grateful for the endorsement by the IEEE-SSIT.

Finally we would like to thank all the authors who have contributed to making the third ICMCC Event into an interesting and challenging conference.

Lodewijk Bos, Laura Roa, Brian O'Connell, Kanagasingam Yogesan, Andy Marsh, Bernd Blobel

PARKSERVICE is a telemedical application currently being validated in the EU. The objectives are to provide a combination of home clinical and social support for people with Parkinson's disease with a revolutionary walking aid that uses “visual cues” to enable improved mobility. Early results are presented and the outlook of home telemedicine and visual cueing for people with PD is discussed.

In considering the recurrent problems involved in technology led initiatives within the public sector, this paper seeks to identify change management requirements needed to help avoid these latent pitfalls in the widespread introduction of Assistive Technology.

It develops a change process approach based on current clinical psychology techniques used in assessing sources and level of resistance to behavioural change and applies them to managing effective benefits realisation.

Developments in the fields of science and technology have revolutionized Human Life at material level. But in actuality, this progress is only superficial: underneath modern men and women are living in conditions of great mental and emotional stress, even in developed and affluent countries. People from all over the world irrespective of culture and economic background suffer from mental illness and though a number of researches are carried out worldwide but till date it has not been possible to resolve the problem.

In today's world stress is increasing everyday. The individualistic approach towards life; the neonatal family system has increased the burden even further. Without adequate support system of friends and relatives – people are falling prey to mental illness. The insecurities, the inferiority feelings of these persons lead to disruption of communication between the sufferer and the family members and friends. The sufferers prefer to confine themselves within the four walls of their home and remain withdrawn from the whole world. They prefer to stay in touch with their world of fantasy – far away from the world of reality. Disability caused by some of the mental illnesses often remains invisible to the society leading to lack of support system and facilities for them. These unfortunate disabled persons not only need medication and counseling but a thorough rehabilitation programme to bring them back to the main stream of life. The task being not an easy one. According to the research works these persons need some work and income to improve their quality of life.

In this scenario where society is adverse towards them, where stigma towards mental illness prevails; where help from friends and community is not available- training them in computer and forming groups through computer was thought to be an ideal option for the solution- a solution to the problems of modern life through modern technology.

• It was seen that this insecure disabled persons feel free to experiment with machine more easily than with society and people.

• Computer provides them the needed education and information needed for their further developments.

• Computers provide them facilities to interact with others and form self-help groups.

• Computers also enabled them to earn their livelihood.

Thus this modern gadget, which is sometimes believed to make a man loner, has been actually acting as the bridge between the persons suffering from mental illness to the society in general. The disabled person also gains confidence and courage as they gain control over the machine. Gaining control over the machine helps them to gain control over their life. The product of Science and technology has been seen to revolutionized Human Life not only in material level but also on personal level- helping the disabled to gain control over their lives.

There is a significant potential for delivering medical services in rural areas of India using Telemedicine methods. However, there is a continuous emphasis on patient privacy, which is usually not a concern in traditional consultation. We at Centre for Development of Advance Computing, Mohali Punjab have developed a customized Telemedicine solution, which overcomes the barrier – technological as well as professional, legal and financial – to Telemedicine. We implement Telemedicine in rural areas as 70% of total population in India is living in villages. We have, as a pilot project, established Telemedicine Technology at six major locations in India. These locations were subsequently connected to nearby districts and primary health centres to make a Telemedicine hub. Currently, our major project is to deploy Telemedicine sites at various locations in the hilly and remote state of Himachal Pradesh. During these developments, we have faced unavoidable hurdles and tried to overcome them with team effort, perseverance and never give up attitude. This paper will shed light on our journey from scratch to what we have achieved till date.

In recent years, the shortage of medical specialists and access to medical information has necessitated a growing interest for cost effective and efficient telemedicine tools for healthcare delivery. Mobile telemedicine applications are aimed at meeting the mobility requirements of patients and doctors by integrating wireless communications for different health care services and education.

Although, telemedicine holds great promises in enhancing health care delivery in rural area and developing countries, only a few applications exist because of poor frameworks for their deployments. This paper, aims at providing a deployable framework for Mobile Telemedicine Applications for Tropical Diseases (MTATD).

MTATD presented here, provides access to a telemedicine unit via hand held devices over a PSTN/GSM and the Internet for a collaborative health care delivery and education between patients and care providers.

The ePerSpace project has created a distributed service management platform with wide ranging applications at home and globally anywhere else outside home. The project has created an open and trusted home platform where home devices can seamlessly work together providing personalised services, provisioning content adaptation, and managing a variety of services via a residential gateway. Using the personalisation information the system can recognise and form specific user communities towards which specific services such as health care can be directed. This paper presents the main concept and components of the ePerSpace Service Management and discusses its potential in health care applications.

We propose a medical application management architecture that allows medical (IT) experts readily designing, developing and deploying context-aware mobile health (m-health) applications or services. In particular, we elaborate on how our application workflow management architecture enables chaining, coordinating, composing, and adapting context-sensitive medical application components such that critical Quality of Service (QoS) and Quality of Context (QoC) requirements typical for m-health applications or services can be met. This functional architectural support requires learning modules for distilling application-critical selection of attention and anticipation models. These models will help medical experts constructing and adjusting on-the-fly m-health application workflows and workflow strategies. We illustrate our context-aware workflow management paradigm for a m-health data delivery problem, in which optimal communication network configurations have to be determined.

Inequalities in health have been documented for hundreds of years. The causes of these inequalities are complex and related to social, medical, environmental, class, healthcare system and behavioral determinants. Currently governments and healthcare systems are struggling to effectively reduce these differences. In addition, the number of individuals with chronic diseases is rapidly growing, particularly in developed nations. Most of the care needed for effective management of these chronic diseases is performed outside of the hospital setting by non-physicians. However the world's healthcare systems are primarily oriented toward acute, hospital based emergency care and therefore currently largely unable to effectively and consistently provide high quality care to every person.

Recent developments in the computer industry have led to major advances in scientific research capabilities and in like manner will, in the future, likely enable significant advances in the field of compunetics. By enabling the instantaneous capture and utilization of large amounts of diverse data, IT will facilitate a population level orientation in compunetics in addition to the current focus on individual patient applications. Similarly the development of behavioral compunetics or a focus innovative uses of technology to influence health behaviors of patients and physicians are on the verge of occurring. In so doing, these and other advances in compunetincs may significantly increase our ability to provide high quality community oriented care, improve the health of individuals and populations and thereby help reduce health inequalities.

E-Health is producing a great impact in the field of information distribution of the health services to the intra-hospital and the public. Previous researches have addressed the development of system architectures in the aim of integrating the distributed and heterogeneous medical information systems. The easing of difficulties in the sharing and management of medical data and the timely accessibility to these data is a critical need for health care providers. We have proposed a client-server agent that allows a portal to the every permitted Information System of the Hospital that consists of PACS, RIS and HIS via the Intranet and the Internet. Our proposed agent enables remote access into the usually closed information system of the hospital and a server that indexes all the medical data which allows for in-depth and complex search queries for data retrieval.

The research literature on public health information and communication networks shows enormous promise and tremendous obstacles. There is a great deal of evidence to suggest that when electronic health information systems are widely employed, and clinical information is easily shared, trained individuals can track and monitor health status, and avert acute events that can potentially effect an individual or a population. However, the research literature also leaves unresolved important questions about effectiveness vs. efficacy: that is, whether health information sharing can achieve compliance on a large scale, particularly across social, political, economic and geographic boundaries. For this reason, we propose adaptive health care information networks to collect, process and disseminate health information and reduce medical errors. This research assesses existing electronic health monitoring initiatives in the United States and worldwide, discusses their progress and limitations. We identify how health care information networks could be improved by the application of innovative theories and technologies, such as complex adaptive theory, expert systems, and grid technology.

The Metathesaurus of the Unified Medical Language System (UMLS) offers the possibility of mapping between various medical vocuabularies. The Primary Care Electronic Library (PCEL) contains a database of over six thousand Medical Subject Headings (MeSH terms) describing the resources of the electronic library. We were interested to know if it was possible to map from MeSH to the Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT). Such a mapping would aid healthcare professionals to retrieve relevant data from our digital library as it would enable links between clinical systems and indexed material.

Several studies point out the paradox that classic telemedicine by which doctor interacts remotely with patients in real-time is disappearing despite it has not been widely adopted yet. Many cues indicate that health information technologies will be finally adopted because of the growth in health expenditure and the emerging healthcare challenges. Notwithstanding, a detailed analysis of the referred concern has led us to propose a shift in the paradigm of telemedicine systems.

This paper presents the major methodological issues of the information model of a novel telehealthcare system for nephrology (Nefrotel) which supports the cited shift in the paradigm. With this objective, we first revise the technological requirements of the database of Nefrotel, and second analyze the current scenario of health information model standards.

Our study has shown that it is possible to ensure the compliance and evolution of Nefrotel with information model standards, maximizing its interoperability.

HEARTFAID is a research and development project aimed at devising, developing and validating an innovative knowledge based platform of services, able to improve early diagnosis and to make more effective the medical-clinical management of heart diseases within elderly population. Chronic Heart Failure is one of the most remarkable health problems for prevalence and morbidity, especially in the developed western countries, with a strong impact in terms of social and economic effects. All these aspects are typically emphasized within the elderly population, with very frequent hospital admissions and a significant increase of medical costs. Recent studies and experiences have demonstrated that accurate heart failure management programs, based on a suitable integration of inpatient and outpatient clinical procedures, might prevent and reduce hospital admissions, improving clinical status and reducing costs. HEARTFAID aims at defining efficient and effective health care delivery organization and management models for the “optimal” management of the care in the field of cardiovascular diseases. The HEARTFAID innovative computerized system will improve the processes of diagnosis, prognosis and therapy provision, providing the following services:

• electronic health record for easy and ubiquitous access to heterogeneous patients data;

• integrated services for healthcare professionals, including patient telemonitoring, signal and image processing, alert and alarm system;

• clinical decision support in the heart failure domain, based on pattern recognition in historical data, knowledge discovery analysis and inferences on patients' clinical data.

The formalization of the pre-existing clinical knowledge and the discovery of new elicited knowledge represent the core of the HEARTFAID platform.

The IOM report, To Err is Human, Building a Better Health System, galvanized public and political attention to the prevalence of medical errors in the Unites States. The IOM set a clear goal, “given the current knowledge about the magnitude of the problem, the committee believes it would be irresponsible to expect anything less than a 50 percent reduction over five years.” As part of the IOM's four-part strategy was a recommendation that error reporting systems be established. No one denies that errors that occur in medicine can not be reduced if they cannot be defined. To achieve this goal of reducing errors, we have established a definition of a “medical error”, described the current taxonomies that have been created over the last five years for their classification, and suggested a conceptual model for designing and testing a medical error reporting system. A system that facilitates identification, relies on health professionals and electronic repositories of clinical information to report events, and tracks and monitors medical errors, reliably, efficiently, and accurately is the objective of our design. Our next step is to implement, test, and evaluate this system based on our research.

Current multi-agency models of care will be wholly unsustainable when faced with the forecast doubling of over 65s in the developed and developing nations to around 40% of their populations of the next decades. The resulting imbalance between demand and skilled resources is beginning to force radical change towards a fully “joined up” cross-disciplinary, cross-agency service that spans the wide spectrum of medical and social care.

This paper offers a basis for a radically revised model that combines end-to-end service processes optimization; the use of integrated assistive technology systems to help the elderly maintain an independent lifestyle; personal risk reduction through medical and status monitoring; extended care-watch and service co-ordination.

It then develops an IPTV based approach to provide the necessary infrastructure to underpin provision of these facilities both at home and in the community

These substantial benefits are reviewed and weighed against the inherent loss of privacy that can result from the pervasive computing aspects of the care watch approach, together with the trust building and change management aspects that are inevitably involved in the rationalisation process.

In today's global community the ability to prepare for a disease outbreak in order to mitigate the public health, social, and economic impacts on a community depends upon data to support the decision and response process. Data can come from a variety of sources. These sources not only include the medical and health care community, but also geographic, demographic, and socio-economic data. The ability to capture and utilize the data effectively from these types of data sources can mean the difference between a manageable disease outbreak that represents little or no threat to a community and one that causes a significant social and economic impact.

As the health profession expands the applied use of information technology within the medical and health care communities, opportunities are created to expand the use of new data sources to support information based decisions. Information that can be used to provide early warning for disease outbreaks both naturally occurring or through a bioterrorist event; information that can be used to plan, analyze and respond to a disease event; information that can support a community's preparedness activities in order to minimize a public health event.

This chapter illustrates how applied compunetics can be used to support health care as the public health professional responds to, and manages, naturally occurring diseases as well as emerging new disease threats. An electronic health environment (EHE) vision is presented that capitalizes on the use of a variety of environmental, medical, and health care data to support disease early warning, reporting, case and outbreak management and community preparedness.

There are now a number of systems across the world that enables patients to view their electronic health records. These include kiosks that have fingerprint authentication and also net-based access. The paper outlines the approach taken by the UK NHSexplains the legal underpinning of access.

Starting form the premise that record access is here to stay the paper outlines the research on benefits and risks of record access, concluding that, with simple precautions, record access is safe and affords many benefits to both patients and clinicians. It goes on to consider possible impacts of record access on the way records might be written as a co-produced document and emphasizes that national standards for record sharing need to be written.

The development of virtual hospitals and digital medicine helps to bridge the digital divide between different regions of the world and enables equal access to high-level medical care. Pre-operative planning, intra-operative navigation and minimally-invasive surgery require a digital and virtual environment supporting the perception of the physician. As data and computing resources in a virtual hospital are distributed over many sites the concept of the Grid should be integrated with other communication networks and platforms. A promising approach is the implementation of service-oriented architectures for an invisible grid, hiding complexity for both application developers and end-users. Examples of promising medical applications of Grid technology are the real-time 3D-visualization and manipulation of patient data for individualized treatment planning and the creation of distributed intelligent databases of medical images.

Integration of hospital departmental information systems (HDIS) has become a common but difficult issue. In May 2003, the Department of Biostatistics and Medical Informatics implemented a Virtual Electronic Patient Record (VEPR) for the Hospital S. João (HSJ), a university hospital with over 1350 beds. The system integrates clinical data from 10 legacy HDIS plus the Hospital Administrative Database (HAD), aiming to deliver all patient information to health professionals. Currently, around 500 medical doctors use the system on a regular basis and the HSJ-VEPR retrieves an average of 3,000 new reports per day, in PDF or HTML formats. This paper describes and discusses the role of monitoring in the assurance and improvement of data quality. Three approaches were put in place: (a) monitoring the HSJ-VEPR concerning the frequency of clinical records retrieved from the DIS by checking if the daily number of reports sent by the HDIS fell in the normal range from similar week days; (b) monitoring inconsistencies in the patient's identification by cross-checking between HDIS and HAD; and (c) monitoring the integrity of clinical records delivered to medical doctors through the HSJ-VEPR by checking their digital signature. During 2005, the monitoring system detected 53 unusual frequency patterns of which 44 corresponded to real problems. Over a 6 months period, more than 400 alerts were generated concerning inconsistencies in the patient's identification found in laboratory reports. Nevertheless, a significant reduction in the number of these inconsistencies occurred – from 116 in July to 10 in December 2005 – due to implementation of preventive measures by the DIS. Finally, report's integrity was checked each time the report was asked to be visualized i.e. in more than one hundred thousand times during a one year period. In conclusion, all information available in hospital information systems can and should be used to trigger alerts of malfunctions and inconsistencies, in order to improve data quality and ensure a better health care.

Quality of Internet health information is essential because it has the potential to benefit or harm a large number of people and it is therefore essential to provide consumers with some tools to aid them in assessing the nature of the information they are accessing and how they should use it without jeopardizing their relationship with their doctor. Organizations around the world are working on establishing standards of quality in the accreditation of health-related web content. For the full success of these initiatives, they must be equipped with technologies that enable the automation of the rating process and allow the continuous monitoring of labelled web sites alerting the labelling agency. In this paper we describe the European project MedIEQ (Quality Labelling of Medical Web Content Using Multilingual Information Extraction) that integrates the efforts of relevant organizations on medical quality labelling, multilingual information retrieval and extraction and semantic resources, from six different European countries (Spain, Germany, Greece, Finland, Czech Republic and Switzerland). The main objectives of MedIEQ are: first, to develop a scheme for the quality labelling of medical web content and provide the tools supporting the creation, maintenance and access of labelling data according to this scheme and second, to specify a methodology for the content analysis of medical web sites according to the MedIEQ scheme and develop the tools that will implement it.

Reducing mortality from breast cancer through screening has been accepted as a viable tool and breast screening has attracted a lot of attention from healthcare organisations worldwide. Government funded screening programmes in Europe, the Americas and Australia have made good progress in diagnosing and treating breast cancer through effective screening programmes. The UK's National Health Service (NHS) National Screening Programme manages one of the biggest publicly funded breast screening programmes. In the UK, only 75% of the intended population is screened and a diverse set of efforts has attempted to identify and initiate countermeasures to improve screening attendance. This paper identifies how innovative use of information and communication technologies (ICTs) can be the focus for strategising not only improved screening attendance but also better quality of care for women.

For ensuring quality and efficiency of patient's care, the care paradigm moves from organization-centered over process-controlled towards personal care. Such health system paradigm change leads to new paradigms for analyzing, designing, implementing and deploying supporting health information systems including EHR systems as core application in a distributed eHealth environment. The paper defines the architectural paradigm for future-proof EHR systems. It compares advanced EHR architectures referencing them at the Generic Component Model. The paper introduces the evolving paradigm of autonomous computing for self-organizing health information systems.

This paper uses the example of information security to consider ways of ensuring that standards development matches evolving market needs within appropriate timeframes.

It then considers the use of simple process maps as a way to identify interdependencies between emergent standards within specific domains, as well as generic characteristics that cross domain boundaries.

It concludes by briefly examining issues that lie beyond the traditional technical orientation to consider its extension to information content and safety.

In this paper, we discuss two important elements to lowering the barrier to creation of a National Health Information Network. The first element is the adoption of standards that will enable interoperability while guarantee open interfaces (and preventing vendor lock-in). The second element is the role of open source. While adoption of open standards by large EMR vendors is critically important to enterprise healthcare providers and payors, the availability of inexpensive (or free) standardized Healthcare Information Technology for small physician practices is critical. By analogy to the emergence of the World Wide Web, a framework for creating inexpensive and open source applications for physicians will be as important to realizing a National Health Information Network as availability of free browser technology was to the growth of the internet.