Ebook: Informatics, Management and Technology in Healthcare

The current volume presents the accepted full papers of the ICIMTH (International Conference on Informatics, Management, and Technology in Healthcare). The Organising Committee and the Scientific Programme Committee would like to present to the academic community the scientific outcomes of the ICIMTH 2013 Conference, which is being held from 5 to 7 July, 2013 in Athens, Greece.

The ICIMTH 2013 Conference is an extended and also a follow-up of the Conference held in Samos Island, Greece for ten consecutive years where the organising institutions of the current conference had also assisted and promoted. Hence, we can easily say that this is the 11th Annual Conference in this series of scientific events, gathering scientists from all continents as well as from the hosting country in the field of Biomedical and Health Informatics.

The Conference has a major focus on the applications of Biomedical Informatics from Clinical Informatics, Health Informatics to Public Health Informatics as well as on ICT applications in the Healthcare domain. Considering that Management and Organisational Issues play an important role in the implementation phase of Biomedical Informatics applications, topics related to the above topics are also included as integral part to the overall theme of the Conference. We are treating the field of Biomedical Informatics in a very broad framework examining the research and applications outcomes of Informatics from cell to populations, including a number of Technologies such as Imaging, Sensors, and Biomedical Equipment.

Therefore, the Conference is open to proposals for full papers, posters, panels, workshops and tutorials in all aspects of Biomedical Informatics as described above and as suggested by the Conference acronym of ICIMTH (International Conference on Informatics, Management, and Technology in Healthcare). However, in this volume we have incorporated only the papers accepted for full oral presentation, whereas all other scientific events within the Conference are incorporated within the electronic version of the proceedings.

At the end of the deadline we have gathered around 135 submissions, from which after reviewing we have accepted 90 as full papers, therefore, to be included in the volume proceedings, and 12 poster presentations as well as 2 workshops and 1 panel. All presentations within the Conference will also be available in an electronic version.

The Organising Committee has selected as venue a luxurious hotel with all necessary facilities for a successful Conference. The location is in the old city of Athens, where the participants may visit historical museums and sites of Ancient Athens as part of the ICIMETH 2013 Conference social programme.

It goes without saying that the compilation of the proceedings is a huge task and this effort could not have been done without the dedication, accuracy, persistence, and tiresome contribution of our two Assistant Editors, Mr. Parisis Gallos, PhD candidate and Miss Katia Kolokathi, MSc postgraduate student of the Health Informatics Laboratory of the University of Athens.

The Organising Committee working along with the Scientific Programme Committee is dedicated to organise a successful scientific event and will arrange also to have an excellent stay for you and your fellows in Athens and enjoy the hospitality, food, and culture of Greece.

Athens, 17.05.2013

The Editors,

John Mantas

Arie Hasman

In this contribution the concept of computer-interpretable guidelines is discussed. Several guideline formalisms are presented and the GASTON and GASTINE formalisms are given as examples. Finally the problems associated with the integration of CIGs with EPR systems are mentioned.

Some thoughts on personal living environments as new diagnostic and therapeutic areas are presented, considering the following aspects: current potentials for diagnosis and therapy in personal living environments, consequences for care processes and for health information systems architectures and infrastructures, and informational self-determination and privacy. They may stimulate further discussion on respective research.

The national e-prescription system of Greece was first introduced in 2010 and already covers more than 80% of all prescriptions prescribed today (more than 5 million per month). Its introduction provided a powerful tool for improving patient services and public health planning. The system is also already a valuable source of planning, control and transparency data for the Greek healthcare system. In addition, the experience from its application at national level in Greece has also shown that e-Prescription systems can also provide a very useful tool for better administrative control and for containing unnecessary expenditure related to medication use.

Increased patient involvement is a goal in contemporary health care, and of importance to the development of patient oriented ICT. In this paper we discuss how the design of patient-user interfaces can affect patient involvement. Our discussion is based on 12 semi-structured interviews with patient users of a web-based solution for patient – doctor communication piloted in Norway. We argue ICT solutions offering a choice of user interfaces on the patient side are preferable to ensure individual accommodation and a high degree of patient involvement. When introducing web-based tools for patient – health professional communication a free-text option should be provided to the patient users.

Studies have shown that pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) can help to restore or enhance residual functional capacity and improve quality of life. Home-based telemedicine systems can promote comprehensive pulmonary rehabilitation in COPD patients. Successful acceptance of such systems depends on how well they reflect needs, values and preferences of older adults with COPD. However, patient-centered characteristics of pulmonary telerehabilitation systems were not systematically defined particularly in older adults. The goal of this pilot study was to assess older COPD patient acceptance of pulmonarytelerehabilitation and to develop patient-centered characteristics of computer technology to support pulmonary rehabilitation at homes of older adults with COPD based on their values, needs, and preferences. A prototype pulmonarytelerehabilitaton system was developed and demonstrated to patients. The system feasibility and acceptance was assessed by identifying patient ability to operate the system independently and by collecting open-ended feedback via semi-structured qualitative interview and attitudinal surveys. Older adults found this technology easy to operate and potentially useful personal rehabilitation. Patient-centered specifications of a comprehensive pulmonary telerehabilitation system in older adults with COPD were identified.

Cognitive impairment is the main cause of disability in developed societies. New interactive technologies help therapists in neurorehabilitation in order to increase patients' autonomy and quality of life. This work proposes Interactive Video (IV) as a technology to develop cognitive rehabilitation tasks based on Activities of Daily Living (ADL). ADL cognitive task has been developed and integrated with eye-tracking technology for task interaction and patients' performance monitoring.

Multiple sclerosis (MS) is a demyelinating and axonal degenerative disease of the central nervous system. It is the most common progressive neurological disorder of young adults affecting over 1 million persons worldwide. Despite the increased use of neuroimaging and other tools to measure MS morbidity, the neurological examination remains the primary method to document relapses and progression in disease. The goal of this study was to demonstrate the feasibility and validity of using a low-cost webcam for remote neurological examination in home-setting for patients with MS. Using cross-over design, 20 MS patients were evaluated in-person and via remote televisit and results of the neurological evaluation were compared. Overall, we found that agreement between face-to-face and remote EDSS evaluation was sufficient to provide clinically valid information. Another important finding of this study was high acceptance of patients and their providers of using remote televisits for conducting neurological examinations at MS patient homes. The results of this study demonstrated potential of using low-cost webcams for remote neurological exam in patients with MS.

Analysis of minimally invasive surgical videos is a powerful tool to drive new solutions for achieving reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and improve patient safety. This paper presents how video analysis contributes to the development of new cognitive and motor training and assessment programs as well as new paradigms for image-guided surgery.

In this paper, we explore the use of videoconferences (VCs) in medical practice, and discuss how characteristics of the context affect the use of VCs. Forty-seven VCs were observed and videotaped, and 41 semi-structured interviews were conducted. Our findings suggest the use of VCs for acute collaborative work differs from the non-acute use of VCs. Non-acute use facilitates collaboration throughout the entire patient trajectory, while acute use facilitates medical problem solving in the moment. Strict specialization and division of labor reduce the cases to discuss and the discussion of complex treatment trajectories. Acute collaborative work is past and present work, while non-acute collaboration reflects past, present, and future treatment, that is, an overall trajectory.

Continuous blood pressure (BP) monitoring during exercise is necessary to ensure exercise safety, particularly in seniors and individuals with cardiovascular conditions. Pulse transit time (PTT) has been suggested for non-invasive BP monitoring however its implementation into clinical practice was hampered by lack of non-expensive practical solutions. The goal of this project was to introduce and to test a practical low-cost solution for using PTT to estimate BP during exercise. Our approach was based on obtaining 3 calibration points during different levels of exertion for each subject and utilizing the resulting individualized BP estimation equitation for patient-specific monitoring of BP during home-based exercise. Evaluation of the proposed approach showed that the mean difference between reference systolic BP (SBP) and estimated SBP was 0.0 mmHg. The optimal way to calculate PTT has been established by comparison of three main characteristic points used to derive PTT.

An increasing amount of electronic health data is being collected for patient care, and with it the opportunity to explore reusing this data, for example to support clinical research. We explore how researchers can be supported in identifying potential study participants using a semi-automated approach to query anonymised datasets remotely. This paper describes the socio-technical considerations when answering this question in a central England case study.

Many people suffering from chronic headaches use headache diaries to help track trends in their episodes. Studies have shown that electronic headache diaries are more effective than paper diaries for both patients and providers. We de-signed and implemented a full-size and mobile Web-based headache tracker and a database management system to store the data from the websites. The fullsize website allows users to retrieve their data by viewing or downloading a table of the raw values they entered, or they can see a graphical visualization linking the severity of their headaches to any of several variables. Through this system's capacity to illustrate trends and track contributing factors for headaches, users, researchers and health service providers may gain better understanding of and control over chronic headaches.

Using a cross-over study design, vital signs were collected from 60 patients by 6 nurses. Each nurse was randomly assigned for manual vital sign collection in 5 patients and for automated data collection in other 5 patients. The mean time taken for vital signs information to be available in EMR was significantly (p <0.004) lower after automated data collection (158.7±67.0) than after the manual collection (4079.8±7091.8 s). The nursing satisfaction score of collecting vital signs was significantly lower (p <0.007) for the manual way (10.3±3.9) than for the automated way (16.5±3.4). We found that 30% of vital sign records were transmitted to EMR with at least one error after manual data collection whereas there wasno transmission error with automated data collection. Allparticipating nurses stated that the automated vital sign collection can improve their efficiency and save their time for direct patient care.

Medical data are, most of the times, very complex both in form and content. One of the greatest challenges for the IT community in healthcare is to enable the full utilization of these data by information systems. This explicit variety combined with the fact that data usually derives from diverse systems are great obstacles to this task. The result is that data stored in medical information systems usually do not accurately represent reality. In order to eliminate the fallacy between stored and real data, specialized applications that facilitate and accelerate data import into information systems must be developed. This is the goal of Natural Language Processing, the scientific field that combines computer science and linguistics. As a result NLP systems use applications for the coding and standardization of information, known as controlled medical vocabularies. The result of these processes is data that can be used by various technologies, such as clinical data warehouses and decision support systems, the functionality of which is fully dependable on the completeness and accuracy of the data on which their analysis is imposed.

Modern telemonitoring systems identify a serious patient deterioration when it already occurred. It would be much more beneficial if the upcoming clinical deterioration were identified ahead of time even before a patient actually experiences it. The goal of this study was to assess artificial intelligence approaches which potentially can be used in telemonitoring systems for advance prediction of changes in disease severity before they actually occur. The study dataset was based on daily self-reports submitted by 26 adult asthma patients during home telemonitoring consisting of 7001 records. Two classification algorithms were employed for building predictive models: naïve Bayesian classifier and support vector machines. Using a 7-day window, a support vector machine was able to predict asthma exacerbation to occur on the day 8 with the accuracy of 0.80, sensitivity of 0.84 and specificity of 0.80. Our study showed that methods of artificial intelligence have significant potential in developing individualized decision support for chronic disease telemonitoring systems.

The aim of the present study is to assess a possibility and validity of prognostic scales ISS-RTS-TRISS, PRISM, APACHE II and PTS to be used for the automated calculation in decision support when treating children with severe mechanical traumas. The mentioned scales are used in the Hospital Information System (HIS) MEDIALOG. The retrospective study was conducted using clinical and physiological data collected at the admission and during the first 24 hours of hospitalization in 166 patients. Scales PRISM, APACHE II, ISS-RTS-TRISS were used for calculating the severity of injury and for prognosis in death outcomes. Scale PTS was used for evaluating the severity index only. Our research has shown that ISS-RTS-TRISS has excellent discrimination ability, PRISM and APACHE II prognostic scales have acceptable discrimination ability; moreover, they all have significant calibration ability. PTS scale has acceptable discrimination ability. It has been showed that automated calculation scales ISS-RTS-TRISS, PRISM, APACHE II and PTS are useful for assessing outcomes in children with severe mechanical trauma.

Internet provides access to vast amounts of comprehensive information regarding any health-related subject. Patients increasingly use this information for health education using a search engine to identify education materials. An alternative approach of health education via Internet is based on utilizing a verified web site which provides structured interactive education guided by adult learning theories. Comparison of these two approaches in older patients was not performed systematically. The aim of this study was to compare the efficacy of a web-based computer-assisted education (CO-ED) system versus searching the Internet for learning about hypertension. Sixty hypertensive older adults (age 45+) were randomized into control or intervention groups. The control patients spent 30 to 40 minutes searching the Internet using a search engine for information about hypertension. The intervention patients spent 30 to 40 minutes using the CO-ED system, which provided computer-assisted instruction about major hypertension topics. Analysis of pre- and post- knowledge scores indicated a significant improvement among CO-ED users (14.6%) as opposed to Internet users (2%). Additionally, patients using the CO-ED program rated their learning experience more positively than those using the Internet.

This paper presents the AMELIE Authoring Tool for medical e-learning applications. The tool allows for the creation of enhanced-video based didactic contents, and can be adjusted to any number of platforms and applications. Validation provides preliminary good results on its acceptance and usefulness.

From the hypothesis that the development of scientific papers, mainly in interdisciplinary areas such as Health Informatics, may bring difficulties to the author, as had its communicative efficacy decreased or compromising their approval for publication; we aim to make considerations on the main items to good players making this kind of text. The scientific writing has peculiarities that must be taken into consideration when it writes: general characteristics, such as simplicity and objectivity, and characteristics of each area of knowledge, such as terminology, formatting and standardization. The research methodology adopted is bibliographical. The information was based on literature review and the authors' experience, teachers and assessors of scientific methodology in peer review publications in the area. As a result, we designed a checklist of items to be checked before submission of a paper to a scientific publication vehicle in order to contribute to the promotion of research, facilitating the publication and increase its capacity in this important area of knowledge.

The paper discusses methodological and organizational problems of teaching the “Medical Informatics” course in institutions of higher education of the Russian Federation.