Ebook: Ubiquity: Technologies for Better Health in Aging Societies

Medical informatics as a discipline is not very old, yet in the fifty years of its existence some shifts in interest have occurred. The development and evaluation of information systems has been there from the beginning. This topic was driven by technology changes (new database approaches, progress in electronic communication and standardization issues, etc.). In the first decades research was also devoted to investigating basic medical and biological processes. The analysis of signals, for example EKGs, EEGs and signals from chemical analyzers images was an important research area. Emphasis was initially on data analysis techniques but gradually shifted to interpretation of the processed data by means of statistical and pattern recognition methods. This trend continued and gradually the emphasis shifted from the provision of information to the provision of knowledge.

At present computers are ubiquitous. New technologies make computers almost invisible. Nanotechnology provides important extensions to our armamentarium. Computing based on DNA and enzymes is currently investigated in several research centers. Such computers can help us for example to determine certain pathological cells in tissues and when detected the “computers” release a drug to kill these cells. Ubiquitous computing will support our aging societies. People can stay longer at home with the help of computers that monitor them.

Some of the problems that we have to solve – apart from technical ones – in our opinion are reminiscent of the problems we had to solve in the beginning of medical informatics. But now we have the advantage of hindsight.

About three hundred manuscripts were submitted and finally 143 of them were accepted. We thank all the reviewers for their work. Without them it would have been impossible to obtain a program with a quality as the one that is presented in this Proceedings. We are also very much indebted to NWO (Netherlands Organisation for Scientific Research) that provided grants for inviting two keynote speakers.

We are sure that the program contains interesting information for a broad audience. We wish you a happy stay in Maastricht and much pleasure in reading articles from this Proceedings.

Arie Hasman, Reinhold Haux, Johan van der Lei, Etienne De Clercq, Francis H. Roger France

In a retrospective review, a parallel is drawn between the challenges by which a research department in biomedical informatics is confronted and those of a symphony orchestra. In both areas, different disciplines and different groups of instruments can be discerned. The importance of mastering one's instrument and the harmony between the team members is stressed. The conductor has to stimulate the individual players so that they can all have a successful career. Competition between orchestras and performance assessments determine survival and success. A record of refereed publications is crucial for continued existence.

Conclusions are that biomedical informatics is typically multidisciplinary, that hypotheses underlying research should be carefully formulated, that the time from research to application may easily take 20 years or more, that mutual trust and knowing each other's competences is essential for success, that a good leader gives enough room to all team members to develop their careers, and that the outcomes of assessment studies are related to the quality of publications.

Expanding on our previous analysis of Biomedical Informatics (BMI), the present perspective ranges from cybernetics to nanomedicine, based on its scientific, historical, philosophical, theoretical, experimental, and technological aspects as they affect systems developments, simulation and modelling, education, and the impact on healthcare. We then suggest that BMI is still searching for strong basic scientific principles around which it can crystallize. As -omic biological knowledge increasingly impacts the future of medicine, ubiquitous computing and informatics become even more essential, not only for the technological infrastructure, but as a part of the scientific enterprise itself. The Virtual Physiological Human and investigations into nanomedicine will surely produce yet more unpredictable opportunities, leading to significant changes in biomedical research and practice. As a discipline involved in making such advances possible, BMI is likely to need to re-define itself and extend its research horizons to meet the new challenges.

The objective of this paper is to identify trends and new technological developments that appear due to an ageing society and to relate them to current research in the field of medical informatics. A survey of the current literature reveals that recent technological advances have been made in the fields of “telecare and home-monitoring”, “smart homes and robotics” and “health information systems and knowledge management”. Innovative technologies such as wearable devices, bio- and environmental sensors and mobile, humanoid robots do already exist and ambient assistant living environments are being created for an ageing society. However, those technologies have to be adapted to older people's self-care processes and coping strategies, and to support new ways of healthcare delivery. Medical informatics can support this process by providing the necessary information infrastructure, contribute to standardisation, interoperability and security issues and provide modelling and simulation techniques for educational purposes. Research fields of increasing importance with regard to an ageing society are, moreover, the fields of knowledge management, ubiquitous computing and human-computer interaction.

Ubiquitous informatics in health care can be seen as its pervasively presence everywhere, at home as well as in office and patient room, for various purposes such as patient follow up, health care professional training, aid to decision making and to public health management.

Its worldwide rapid extension could only happen in relation to major progresses such as overall availability of personal computers, diffusion through the worldwide web as well as coverage of almost all fields of medicine.

Challenges include a profound change in patient-physician relationship, a reform in health care management and financial methods, as well as the need to identify uniquely all healthcare partners, while respecting confidentiality and private life.

“Smart homes” are defined as residences equipped with sensors and other advanced technology applications that enhance residents' independence and can be used for aging in place. The objective of this study is to determine design specifications for smart residences as defined by professional groups involved both in care delivery to senior citizens and development of devices and technologies to support aging. We assessed the importance of specific devices and sensors and their advantages and disadvantages as perceived by the interdisciplinary expert team. This work lays the ground for the implementation of smart home residencies and confirms that only an interdisciplinary design approach can address all the technical, clinical and human factors related challenges associated with home-based technologies that support aging. Our findings indicate that the use of adaptive technology that can be installed in the home environment has the potential to not only support but also empower individual senior users.

We have constructed a haptic immersive workbench to be placed in the patients' home for daily adjusted rehabilitation. We also propose a system for Internet based connection and communication between patients and between patients and a clinical rehabilitation center and clinical assessment/evaluation centers. The benefits of a system for rehabilitation after stroke, based on VR, Haptics and Telemedicine should be: increased quality of life, lesser isolation, feeling more secure, fewer tiring transportations, more frequent exercising, better compliance to training, lower cost for transportation. The long term recovery for a larger group of patients with motor impairments is presently under evaluation.

Ubiquitous computing is a promising paradigm to support health care outside traditional care institutes. Sensor-based systems may continuously collect data on a person's health status and context, and provide immediate feedback or contact a remote physician. This paper presents a novel programming model to facilitate the development of such systems. The model, which has been inspired by tuple spaces, offers robustness for ad hoc mobile environments and explicit support for data streams

In spite of their name, 'ubiquitous' technologies are not yet ubiquitous in the true sense of the word, but rather are 'novel', being at the research, pilot, and selective use stages. In future, the proliferation in types of application, the major increase in cases and data volumes, and above all the dependence on ubiquitous technologies will raise practical, ethical, and liability issues. Equally significantly, it will require health service redesign, including new response services. Health informaticians need to be active in stimulating consideration of all these issues, as part of both social and professional responsibility.

When care professionals from different organisations are involved in patient care, their different views on the care process may not be meaningfully integrated. Objective: To use visualisation and interaction design solutions addressing the specific demands of shared care in order to support a collaborative work process. Methods: Participatory design, comprising interdisciplinary seminar series with real users and iterative prototyping, was applied. Results: A set of interaction and visualisation design solutions to address care professionals' requirements in shared home care is presented, introducing support for identifying origin of information, holistic presentation of information, user group specific visualisation, avoiding cognitive overload, coordination of work and planning, and quick overviews. The design solutions are implemented in an integrated virtual health record system supporting cooperation and coordination in shared home care for the elderly. The described requirements are, however, generalized to comprise all shared care work. Conclusion: The presented design considerations allow healthcare professionals in different organizations to share patient data on mobile devices. Visualization and interaction design facilitates specific work situations and assists in handling specific demands in shared care. The user interface is adapted to different user groups with similar yet distinct needs. Consequently different views supporting cooperative work and presenting shared information in holistic overviews are developed.

Under the safety net of hospital-based patient safety informatics (PSI) system, RFID is build to adapt emergency department safety needs and the process improvement activities. We implemented the RFID framework as the electronic patient identifier into the process improvement of ED workflow; it defined as the safety portal to introduce PSI safety features on the real-time basis. METHODS. Since 2004, we were applying RFID technology into a 200 daily visits emergency department of the regional medical center in Taipei, Taiwan. We then developed wireless web-based RFID safety portal to implement the real-time safety reminders such as the laboratory and radiology reports to the physician who can make decision promptly to the patients in the ED. RESULTS. Under the ED safety portal, the diagnosis time for physicians to make clinical decision is largely reduced nearly 40 percent due to the safety enhancement RFID system. ED physician who could actively receive patient's updated clinical data to make clinical decision via web-based informatics system reasonably decreases. CONCLUSIONS. The effectiveness of RFID system not only enhance patient identification during ED process but combine ED safety net which providing needed data for ED physician and staff who visit ED patients with valuable real-time data on time. Patient safety on ED can be clearly improved from the embracing modern technology and build up a patient centered ED environment.

Mobile Medical Services, such as Home Care and EMS (Emergency Medical Services) are to the general public probably most visible part of public health care. A great amount of expectations are placed on the quality of care given by these units. Sometimes providing this care is very intensive and all available attention has to be placed on the patient. However, documenting the treatment is very valuable for the treatment of the patient later on. In this paper we present a system that automates many tasks in documenting the treatment. Furthermore, our system is capable of producing a far more detailed documentation that has been available before. This makes reliable research of mobile medical care possible and opens new possibilities in educating paramedics and nurses.

The emerging amalgamation of informatics, communication technologies, and entertainment electronics in the field of Biomedical Technology combined to, first, the increase in length of the mean life expectance, and, second, the hospitalization cost avalanche, will facilitate gradually the development of a new Hi-Tec home-care environment. We have developed a home-computer based system, addressing crucial aspects of the development of contemporary home – care that comprises of: First, the employment of low-cost commercially available components, supporting home-care patient's well-being observation, including eventually vital-signs monitoring. Second, software means for the processing, the evaluation, and the targeted transmission of the acquired health-data. Third, software tools for the planning, the documentation, and the management of the corresponding home-care case. The present paper constitutes a progress report of the ongoing development efforts.

This paper proposes a novel method for aligning multiple genomic or proteomic sequences using a fuzzyfied Hidden Markov Model (HMM). HMMs are known to provide compelling performance among multiple sequence alignment (MSA) algorithms, yet their stochastic nature does not help them cope with the existing dependence among the sequence elements. Fuzzy HMMs are a novel type of HMMs based on fuzzy sets and fuzzy integrals which generalizes the classical stochastic HMM, by relaxing its independence assumptions. In this paper, the fuzzy HMM model for MSA is mathematically defined. New fuzzy algorithms are described for building and training fuzzy HMMs, as well as for their use in aligning multiple sequences. Fuzzy HMMs can also increase the model capability of aligning multiple sequences mainly in terms of computation time. Modeling the multiple sequence alignment procedure with fuzzy HMMs can yield a robust and time-effective solution that can be widely used in bioinformatics in various applications, such as protein classification, phylogenetic analysis and gene prediction, among others.

Modelling in systems biology currently lacks clinical applications. As a possible approach leading to clinical relevance the modelling of tissue homeostasis is proposed. As an example a model of epidermal homeostasis is presented which reproduces central morphological and kinetic characteristics of epidermal tissue. Each individual cell is modelled as an agent. The tissue arises as an emergent phenomenon from the interactions of agents. Each agent's behaviour is qualitatively modelled by a simple differentiation state-flow program. Epithelialisation under the influence of parameters concerning stem-cell location is briefly demonstrated.

The most important knowledge in the area of biology currently consists of raw text documents. Bibliographic databases of biomedical articles can be searched, but an efficient procedure should evaluate the relevance of documents to biology. In genetics, this challenge is even trickier, because of the lack of consistency in genes' naming tradition. We aim to define a good approach for collecting relevant abstracts for biology and for studied species and genes. Our approach relies on defining best queries, detecting and filtering best sources.

This paper presents a novel approach for the extraction of gene regulatory networks from DNA microarray data. The approach is characterized by the integration of data coming from static and dynamic experiments, exploiting also prior knowledge on the biological process under analysis. A starting network topology is built by analyzing gene expression data measured during knockout experiments. The analysis of time series expression profiles allows to derive the complete network structure and to learn a model of the gene expression dynamics: to this aim a genetic algorithm search coupled with a regression model of the gene interactions is exploited. The method has been applied to the reconstruction of a network of genes involved into the Saccharomyces Cerevisiae cell cycle. The proposed approach was able to reconstruct known relationships among genes and to provide meaningful biological results.

The recent advances on genomics and proteomics research bring up a significant grow on the information that is publicly available. However, navigating through genetic and bioinformatics databases can be a too complex and unproductive task for a primary care physician. In this paper we present diseasecard, a web portal for rare disease that provides transparently to the user a virtually integration of distributed and heterogeneous information.