Ebook: Medical and Care Compunetics 1

During the next decade, the demand for care will grow explosively. This is due not only to the changes in life expectancy and the improving quality of life but definitely also to our more individualised way of living.

ICT (Information and Communication Technology) will be primordial in the fulfilment of this growing demand for individualised care. Although information and technology are key aspects and as such have been the focus for the past several years, the future will see a significant shift in emphasis to communications. The way we communicate with care providers as well as the way care providers and their tools will communicate about us will become central to the way we structure our care, both social and medical.

Compunetics, the combination of computing and networking, carries both meanings of the word networking. In the title of the ICMCC event this terminology was chosen to stress the importance of the networking aspects in the communication between tools as well as humans.

The use of Medical and Care Compunetics (MCC) will become more and more important. In due course patients will be considered as clients with a strong say in how, where and when they want to receive their care, be it social or related to health prevention or medical treatment.

In the coming years ICMCC will serve as a platform event for all aspects related to MCC and for all those concerned. Doctors as well as researchers, industry professionals (medical, pharmacy, ICT) as well as patients, care givers and policy makers and insurers will find the ICMCC event an ideal place to meet with people and to exchange plans and ideas. But it will also be a platform for the latest developments both in science and in industry as well as a splendid meeting place for all types of institutions and organisations.

We, as an organisation, are very grateful to the Dutch ministries, the International Federation for Medical and Biological Engineering (IFMBE) and the European Commission (IST) for their support. We extend a special word of gratitude to all the outstanding scientists and industrialists who joined our advisory boards. Through them we see a strong representation from organisations like IEEE, EHTEL, EAMBES and HL7.

ICMCC is set up as a collection of workshops and smaller symposia. In its first year, ICMCC will cover a broad range of subjects (from imaging to distant monitoring, from policy and legal aspects of the pan-European situation to ways of pan-national disease surveillance, from pharmaceutical R&D to EHR security), that show us the way ahead for the event. We would like to thank all the workshop organisers for their excellent work.

Lodewijk Bos

Swamy Laxminarayan

Andy Marsh

Changes in life expectancy, healthy life expectancy and health seeking behaviour are having an impact on the demand for care. Such changes could occur across the whole population, or for specific groups. Changes for specific groups will be particularly affected by policy initiatives, while both these and wider changes will be affected by people's levels of engagement with their health and the health service itself Levels of education, income and media coverage of health issues are also important. These factors could also encourage an increase in people caring for themselves and their families or community.

People are now expecting a patient-centred service with safe high quality treatment, comfortable accommodation services, fast access and an integrated joined-up system. The uptake of integrated Information and Communication technologies (ICT) will be crucial. Healthcare Compunetics, the combination of computing and networking customised for medical and care, will provide the common policy and framework for combined multi-disciplinary research, development, implementation and usage.

The paper presents the distribution of the parameters of mechanical stiffness in a sample of animal bone. The parameters are measured at different distances from the cortical bone. As it is widely known, bone properties vary significantly depending on the length of the bone. Additionally, the properties of trabecular bone also depend on its distance from the cortical bone. The study presents the results for both samples of normal bone tissue and samples of bone tissue with chemically modified biomechanical properties.

For each sample a matrix of measurement points was defined. For each measurement point, a micro hardness test was performed in order to define hardness of the micro volume and to measure the Young's modulus. This test was carried out using Micro-Combi-Tester equipment. Micro hardness was measured with Vickers diamond, and the analysis of deformation properties was realized by the Olivier and Pharr method. The application of Oliver and Pharr method enabled the calculation of Young's modulus directly from the unloading curve.

Additionally, mineral density for all samples was measured using Dual Energy X-ray Absorptiometry method. This study allowed for comparison of bone mineral density parameter with Young's modulus. The aim of this comparison was to demonstrate changes caused by modification of biomechanical properties of bone.

Recent studies have shown that long-term monitoring of asthma severity can reduce asthma exacerbations, optimise drug therapy and decrease the cost of asthma management [18]. The management of a chronic patient is a collective and cooperative enterprise that may exploit Information Technologies (IT) to improve the overall quality of care [3]. The aim of this paper is to present a web based asthma tool that significantly enhances public information and awareness to support illness prevention, patients independent living through user profiling and personalisation and collaborative work between health professionals, therapists, caregivers and patients through Tele-Care and Tele-Consultation. The system has been tested through a preliminary survey that took place in UK and Greece.

This paper considers the requirement for e-commerce enabled delivery of pharmaceutical prescriptions. First, currently available solutions are critically reviewed and an ideal solution is specified and then the concept of the proposed solution – Dematerialized Prescription (DP), is outlined. Next, the information flows required to enable such a service are considered. The paper then considers a number of possible services which could be made available with DP to deliver medicals to patients. Finally, a proposed solution, which enables physician to fill dematerialized prescriptions online using inexpensive mobile Internet devices is presented in detail, the advantages of such a model are summarized and future research directions are suggested.

This paper describes the development of Vibroacoustic Sound Therapy, an approach which is being developed for use in special schools for children with profound and multiple learning difficulties, and in long-term care homes for the elderly and the elderly mentally infirm. Using non-invasive techniques and music/sound technology, children and the elderly are being empowered and enabled to (re)discover self expression and communication skills. Two case studies drawn from the world of the young disabled, and from the elderly, illustrate the potential for improving quality of life and well-being in these institutional settings.

The representation of texts by term vectors with element values calculated by a TFIDF method yields to significant results in text similarity problems, such as finding related documents in bibliographic or full-text databases and identifying MeSH concepts from medical texts by lexical approach and also harmonizing journal citation in ISI/SciELO references and normalizing author's affiliation in MEDLINE. Our work considered “trigrams” as the terms (elements) of a term vector representing a text, according to the Trigram Phrase Matching published by the NLM's Indexing Initiative and its logarithmic Term Frequency – Inverse Document Frequency method for term weighting. Trigrams are overlapping 3-char strings from a text, extracted by a couple of rules, and a trigram matching method may improve the probability of identifying synonym phrases or similar texts. The matching process was implemented as a simple algorithm, and requires a certain amount of computer resources. An efficiency-focused C-programming was adopted. In addition, some heuristic rules improved the efficiency of the method and made it feasible a regular “find your scientific production in SciELO collection” information service. We describe an implementation of the Trigram Matching method, the software tool we developed and a set of experimental parameters for the above results.

Electronic patient records (EPRs) provide the means for integrated access to patient information that may be scattered across dispersed healthcare organizations that, in general, use heterogeneous systems in order to support their internal functions. XML language and Clinical Document Architecture (CDA) provides a mechanism for defining, structuring, manipulating and visualizing patient medical data using the same semantics through web. In this paper, a prototype implementation of a web-based electronic patient record (EPR) system using XML for data format and CDA for defining and structuring patient clinical documents is presented.

Mobile health technologies provide case studies with potentially rather huge impacts. Examples are provided e.g. by guidelines involving pharmacologic treatment. Knowledge and reasoning need to interact with information management, and often involves utility of various devices. Well organised databases for pharmacological information are also necessary for successful engineering of mobile extensions in these case studies.

Hypertension is the most common cause of death. Therefore it is recognized as a major civilization disease next to diabetes, hyperuricemia, asthma etc.

The objective was to use artificial neural networks (ANNs) to handle demographic data and to produce system of hypertension risk prediction.

Database used in the development of hypertension risk model was obtained from CDC (BRFSS – Behavioral Risk Factor Surveillance System).

Screening for optimal ANN architecture was performed among various backpropagation and fuzzy neural networks with use of 10-fold cross-validation scheme. Single ANNs as well as experts committees were tested. Best results were found to be around 75% - expressed as total classification rate. Java applet was designed to be the interface between ANN system and end user. Spreadsheet form was chosen to facilitate navigation and used by healthcare non-specialists. Free of charge Internet publication is expected soon at the address http://www.cyf-kr.edu.pl/~mfpolak

The use and development of software in the medical field offers tremendous opportunities for making health care delivery more efficient, more effective, and less error-prone. We discuss and explore the use of clinical pathways analysis with Adaptive Bayesian Networks and Data Mining Techniques to perform such analyses. The computation of “lift” (a measure of completed pathways improvement potential) leads us to optimism regarding the potential for this approach.

We created a program, written in the CLIPS language for expert systems, to distinguish migraines from headaches. The system can be web-based, takes seconds to input data and quickly converges to the correct diagnosis. Over time such an application can result in enormous savings to doctors, patients, and health care institutions.

Information and Communication Technology (ICT) assist healthcare professionals in the process of diagnosis, treatment, monitoring, medication prescription, referral, information retrieval and communication, documentation and transactions. This applies to intramural, transmural and extramural conditions. About 67% of patients involved in safety incidents believe that the incidents could have been prevented had an electronic health record been available. However, preliminary research also suggests that about 30% of patient safety incidents relate to software problems. ICT might improve quality of healthcare provided that ICT products, the ICT administration and use comply to essential requirements. This paper presents information about the state of the art of software quality, the measuring of software quality, quality management systems and a evaluation and certification method.

The MET (Mobile Emergency Triage) system is an m-health application that supports emergency triage of various types of acute pain at the point of care. The system is designed for use in the Emergency Department (ED) of a hospital and to aid physicians in disposition decisions. Given patient's condition, MET recommends a triage by consulting decision rules stored in the system's knowledge base. The rules have been created using a data mining method (based on rough set methodology) applied to data collected during a retrospective chart study and verified by the clinicians.

MET is designed following the extended client – server architecture, suited for weak-connectivity conditions, where stable connection between clients and a server cannot be provided. The MET server interacts with the hospital's patient information system in order to retrieve information about patients admitted to the ED. It also stores current patients' demographic and clinical data to be exchanged with mobile clients. The MET mobile client, running on a Personal Digital Assistant (PDA), is used for collecting clinical data and supporting triage decisions. The support function runs solely on the client side, thus it can be invoked anytime and anywhere, even if there is no communication link with the server (e.g., there is no wireless network available in the ED).

Due to implementation on PDAs and working in weak-connectivity conditions, the MET system is very well suited for use in the ED and fits seamlessly into the regular clinical workflow without introducing any hindrances or disruptions that are often reported when using stationary (i.e., working on desktop computers) clinical systems. The system facilitates patient-centered service and timely, high quality patient management. It provides recommendations using a limited amount of clinical data, normally available at the point of care. Furthermore, it provides a possibility for the structured evaluation of this data by an attending physician.

Microsurgery and processes involving cell manipulation or cell surgery are clinical practices where the operator works at or beyond the threshold of human dexterity. Current tools available are conventional in their design, and this limits consistency and the level of reliability and achievement. Surgical robotic devices have been explored to improve precision in minimal access surgical procedures to augment control of tool points in tissues, and have enabled feedback of sensory data from which the operator is able to deduce information on the tool at the working site. In this paper, relevant technologies are described that can be harnessed to improve perception of tool point interaction with tissues at the working site and to improve tool control at the small scale required in clinical practice for microsurgery and for cell surgery.

The voice embodies three sources of information: speech, the identity, and the emotional state of the speaker (i.e., emotional prosody). The latter feature is resembled by the variability of the F0 (also named fundamental frequency of pitch) (SD F0). To extract this feature, Emotional Prosody Measurement (EPM) was developed, which consists of 1) speech recording, 2) removal of speckle noise, 3) a Fourier Transform to extract the F0-signal, and 4) the determination of SD F0. After a pilot study in which six participants mimicked emotions by their voice, the core experiment was conducted to see whether EPM is successful. Twenty-five patients suffering from a panic disorder with agoraphobia participated. Two methods (story-telling and reliving) were used to trigger anxiety and were compared with comparable but more relaxed conditions. This resulted in a unique database of speech samples that was used to compare the EPM with the Subjective Unit of Distress to validate it as measure for anxiety/stress. The experimental manipulation of anxiety proved to be successful and EPM proved to be a successful evaluation method for psychological therapy effectiveness.

We present a new taxonomy of medical errors, with emphasis on human errors. We illustrate errors due to medication, errors due to diagnosis, errors due to hospital treatment procedures, and errors related to clerical procedures. We also discuss a database of 143 papers on medical errors which we have developed.

It is widely recognized in the medical community that the sense of smell plays a very important role in the diagnosis of various associated medical disorders. With the advent of computerized scent detection and scent production devices, smell as a medical diagnostic and educational tool could be carried over into the world of telemedicine, tele-surgery, and distance education.

Chronic care patients are demanding to be more actively involved in the care of their condition. Self-monitoring of blood glucose and blood pressure is strongly advocated for people with type 2 diabetes. We are developing a DI@L-log system that replaces the traditional paper logbook used by diabetes patients, enabling them to send their data to the point of care on a weekly basis using spoken dialogue technologies over the telephone. The motivation for our system is to enhance care by providing patients with a voice and therefore empowering individuals to become active self-managers of diabetes.

An efficient way of closing the gap in medical care between the EU and its Mediterranean partners is the use of satellite-based networks for telemedical applications. Using standard hardware components and specially designed communication software (WinVicos) various telemedical applications (teleconsultation, telementoring, teleteaching, etc.) have been realized.

Two telemedical networks which have been designed and developed recently, MEDASHIP (Medical Assistance for Ships) and EMISPHER (Euro-Mediterranean Internet-Satellite Platform for Health, medical Education and Research), are presented.

This document has been prepared as a set of workshop material, which will be presented in the International Congress on Medical and Care Compunetics in June 2004 in Den Hague, The Netherlands. The workshop is divided into two parts and deals with the fundamentals of the bioavailability and bioequivalence studies. First part of the workshop deals with the pharmacokinetic principles, and the second part discusses the statistical approaches and the data analysis using the Statistical Analysis Software (SAS).

Communication processes are pervasive in the daily practice of health professionals. Reorganizing these daily practices by introducing ICT, inevitably effects one or more communication processes. Understanding exactly what these effects are, is a major problem in designing and implementing ICT-applications. In this paper we present an analysis of these effects, based on a theory of communication processes. The concept of ‘decoupling’ is pivotal in our analysis. Based on the identified effects, and some preconditions that have to be met in order for these effects to take place, we derive a number of guidelines for reorganizing communication processes by means of applying ICT. The application of these guidelines will be demonstrated and discussed in the context of the reorganization of a team conference at the Rehabilitation Clinic of the Rheumatology Department of the Le iden University Medical Center (RCRD/LUMC), a multidisciplinary team care setting.

This case study will provide more insight into the impact of the ICT-based reorganisation regarding its effect on the quality of the communication process during team conferences.