Ebook: Medical and Care Compunetics 2

In past times, engineers and other ICT professionals could normally function exclusively within an environment of purely technical dimensions. This sphere could be easily delineated from those involving policy, political or social questions. Consequently, these professions could well be characterized as generally isolated from mainstream society, engendering a condition that Zussman (1985) has described as a “technical rationality that is the engineer's stock‐in‐trade requir[ing] the calculation of means for the realization of given ends. But it requir[ing] no broad insight into those ends or their consequences”. This condition has often led to a perceived technical mindset that according to Florman (1976), draws upon “the comfort that comes with the total absorption in a mechanical environment. The world becomes reduced and manageable, controlled and unchaotic”.

In a relatively short period of time, ICT has been radically transformed in both its capabilities and reach. Specifically, within the context of this event, the permeation of digital technologies into nearly every aspect of bioengineering and healthcare delivery have broken down the borders between technological pursuits and the larger dynamics of society. This has in turn has produced, according to Williams (2000) a discipline that has “evolved into an open‐ended Profession of Everything in a world where technology shades into science, into art, and into management, with no strong institutions to define an overarching mission”. Within ICT, H.C. von Baeyer (2003) affirms this status in noting “the frustration of engineers who have at their disposal a variety of methods for measuring the amount of information in a message, but to none deal with its meaning”.

In many developing countries there is an acute shortage of medical specialists. The specialists and services that are available are usually concentrated in cities and health workers in rural health care, who serve most of the population, are isolated from specialist support [1]. Besides, the few remaining specialist are often isolated from colleagues. With the recent development in information and communication technologies, new option for telemedicine and generally for sharing knowledge at a distance are becoming increasingly accessible to health workers also in developing countries. Since 2001 the Department of Pathology in Basel, Switzerland is operating an Internet based telemedicine platform to assist health workers in developing countries. Over 1800 consultation have been performed since. This paper will give an introduction to iPath – the telemedicine platform developed for this project – and analyse two case studies: a teledermatology project from South Africa and a telepathology project from Solomon Islands.

Telemedicine is a way to support health care delivery in remote areas. With our telemedicine project the Institute of Tropical Medicine, Antwerp, Belgium, intended to facilitate the introduction of antiretroviral therapy (ART) for patients affected by Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in developing countries, providing training, distance support and education to healthcare providers working in those settings.

VIHrtual Hospital is a telemedicine web system for improving home integral care of chronic HIV patients through the Internet. Using the videoconference, chat or messaging tools included in the system, patients can visit their healthcare providers (physician, psychologist, nurse, psychiatrist, pharmacist, and social worker), having these access to the Electronic Patient Record. The system also provides a telepharmacy service that controls treatment adherence and side effects, sending the medication to the patient's home by courier. A virtual community has been created, facilitating communication between patients and improving the collaboration between professionals, creating a care plan for each patient. As a complement, there is a virtual library where users can find validated HIV/AIDS information helping to enhance prevention. This system has been developed using low cost technologies in order to extend the number of patients involved in its trial. Thus, VIHrtual Hospital is now on trial in the Hospital Clinic (Barcelona, Spain) involving a hundred patients and twenty healthcare professionals during two years.

Although we are still waiting for the final results of the trial, we can already say that the use of telemedicine systems developed ad hoc for a chronic disease, like HIV/AIDS, improve the quality of care of the patients and their care team. The system described is a good example of the possibilities that technologies are offering to create new chronic patient care models based on telemedicine.

The United Nations Security Council reports HIV/AIDS as the fastest growing threat to human development. In addition, the World Health Organization [1] reports that nearly 5 million persons (4.3 million adults and 700,000 children) are newly infected with HIV each year; more than 95% of them found in developing countries. Since STDs as a group are a personal problem which few people feel comfortable discussing, we believe that hand‐held PDAs can provide an opportunity for learning about this disease while insuring anonymity. This device will employ the newest technologies including Bluetooth wireless technology, which can transmit and receive data via a short‐range radio link using a globally available frequency band (2.4 GHz ISM band), enabling rapid and accurate synchronous and asynchronous data communication. The first generation of Bluetooth permits exchange of data up to a rate of 1 Mbps, even in areas with much electromagnetic disturbance. This emerging technology can facilitate HIV/AIDS outreach around the globe.

Recent advances in learning have taken a particularly cognitive perspective and these findings have implications for education in general as well as for the development of intelligent tutoring systems in particular. In the past, effective SmartBooks™have been developed for AIDS education to disseminate the critical knowledge relevant to this epidemic [2].

Since 1993, the proliferation of the World Wide Web has created a plethora of new opportunities for the delivery of electronic distance learning systems. However, we feel that it is important that a whatever technology is employed is based on a sound educational theory. A new, comprehensive, web‐based learning system called SmartTutor has been developed, at Brooklyn College of The City University of New York [3]. This technology provides a user‐friendly, self‐paced, easy to modify, software environment intended to serve the user's learning needs and is based on a generic SmartTutor methodology organized around the use of concept mapping. Early assessment of SmartTutor has shown that it is well received by students and helps significantly in their learning processes. It is readily adaptable to the presentation of academic and more general subject matter such as the latest available information on HIV/AIDS. Our new HIV/AIDS SmartTutor will incorporate this SmartTutor paradigm. Our new SmartTutor would provide worldwide access to medical professionals as well as the general public to learn about HIV/AIDS. This new device could also provide a survey tool to facilitate HIV risk assessment. Demonstrations of the SmartTutor learning system will be presented and the continued development of the applications will be discussed.

The Virtual Euro‐Mediterranean Hospital (VEMH) aims to facilitate the interconnection of various medical services through real integration. VEMH will provide an integrated satellite‐terrestrial platform and realize telemedical services such as e‐learning, real‐time telemedicine and medical assistance and offer individual grants to young medical doctors. The methodologies of the VEMH are medical‐need‐oriented instead of technology‐oriented. VEMH will provide for medical professionals in the whole Euro‐Mediterranean area access to the required quality of medical service. For the successful deployment of the services of the VEMH GRID technologies have to be implemented especially for evidence‐based medicine. A Metagrid Service Engine implements an additional software layer between proprietary GRID engines and the different applications. The use of mobile code is envisioned in future GRIDs which allows service creation and deployment on arbitrary nodes of a GRID. Dynamic Grid structures become an important point for the use of mobile code.

The article presents a new solution for the implementation of the DRG classifying system used in Romania to finance hospitals. The new solution implies two proposals. The first one refers to the use of a fragmented and distributed database at level of each hospital, and the second refers to the management and the viewing of this database by means of an on‐line application implemented in Java. The solution proposes that the distributed database should be managed by two powerful tools, meaning Oracle8 Server and Net8. Different types of users are proposed, each type with his own rights for managing and viewing the database. Excepting local users who use only their local database, there are also global users from National DRG Bureau who can see data from all local databases, at any time. This solution is more efficient, secure and modern, than the one used now.

It is widely recognized that the sense of smell plays an important role in the field of medicine. The sense of smell not only assists the physician in the diagnosis of certain disorders, but it also plays a surgical role as well. Historically, learning this skill was contingent upon some level of clinical exposure to medically related odors. The advent of computerized scent production devices could change this. This article proposes a hypothetical surgical simulation model that incorporates olfactory technologies into existing, haptic, surgical simulators. If incorporated into virtual educational settings such as these, computerized scent production devices could be used not only as a novel way to enhance the virtual experience, but also as a way for medical students to begin to recognize the important role that the sense of smell can play during surgery.

Substantial demographic changes in the number of elderly in the developed world are forcing a radical re‐evaluation of how to deliver care more effectively. “Joined up” multi‐disciplinary, multi‐agency extended care co‐ordination and support service centres are beginning to set the pace towards the establishment of “Virtual Service Utilities”. The dual keys to this are the optimizing of end‐to‐end service process chains and real‐time access to comprehensive records and relevant knowledge systems.

Croatian Primary Health Care Information System pilot project, conducted between 2001 and 2003, aimed to develop and deploy a health information system based on the latest technologies which would improve the quality of primary health care and rationalise the consumption. 60 primary health care teams (physician and nurse) were equipped with PCs and connected via central server to the main national health insurer, state treasury and public health institute. Developed information system enabled rapid retrieval of documents, replacement of manual data input and a real‐time insight into needed information as well as prompt interventions within the system. The project also introduced electronic smart cards for physicians and nurses, so that at each medical check‐up the information system verified both the ensuree's and the physician's or nurse's status and rights.

Based on the experiences from the pilot project, plan has been made for comprehensive health information system at national level which would connect primary health care teams, hospitals, laboratories, dentistries, health insurance companies, state treasury, public health institutes and electronic health records database. Its major goals are more rapid diagnostics, accuracy in prescribing therapy, standardisation of the good practice as well as better utilisation of capacities, shorter waiting times and shorter stays in hospitals, which would lead to improvement in overall health care quality and better control over the health care consumption. Estimated 5‐year investment for installing such system would be 125 million EUR. However, information system could save substantially more and yield a return of investment in only two years.

As information system for primary health care should be a strategic component of every health care reform and development plan, we can recommend our model, based on the results of the pilot project, to other transitional countries.

The aim of the project is to create a database in pharmacy, which will include all the medications and treatment schedules of the supervised patients for increase the quality of the health services, identify the possible drug interaction of the chronicle diseases therapy with treatment for acute disease, the possible reaction which could appear during the therapy and avoid the self medication, which could harm results of the therapy instituted by the specialists.

Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide “error‐reducing” reforms to vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in health informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case‐based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web‐based palliative information systems (IS) to transform the delivery of care, streamline processes and improve the efficiency and appropriateness of medical treatment. As a result, medical error(s) that occur with patients dealing with severe, chronic illness and the frail elderly can be reduced.

The palliative model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend this convention, but there is no widely accepted definition. This research will discuss the development life cycle of two palliative information systems: the CONFER QOLP management information system (MIS), currently used by a community‐based palliative care program in Brooklyn, New York, and the CAREN case‐based reasoning prototype. CONFER is a web platform based on the idea of “eCare”. CONFER uses XML (extensible mark‐up language), a W3C‐endorced standard mark up to define systems data. The second system, CAREN, is a CBR prototype designed for palliative care patients in the cancer trajectory. CBR is a technique, which tries to exploit the similarities of two situations and match decision‐making to the best‐known precedent cases. The prototype uses the opensource CASPIAN shell developed by the University of Aberystwyth, Wales and is available by anonymous FTP. We will discuss and analyze the preliminary results we have obtained using this CBR tool. Our research suggests that automated information systems can be used to improve the quality of care at the end of life and disseminate expert level ‘know how’ to palliative care clinicians. We will present how our CBR prototype can be successfully deployed, capable of securely transferring information using a Secure File Transfer Protocol (SFTP) and using a JAVA CBR engine.

With the introduction of the ICD‐10 as the standard for diagnosis, the development of an electronic representation of its complete content, inherent semantics and coding rules is necessary. Our concept refers to current efforts of the CEN/TC 251 to establish a European standard for hierarchical classification systems in healthcare. We have developed an electronic representation of the ICD‐10 with the extensible Markup Language (XML) that facilitates the integration in current information systems or coding software taking into account different languages and versions. In this context, XML offers a complete framework of related technologies and standard tools for processing that helps to develop interoperable applications.

The 1999 report published by the Institute of Medicine (IOM) indicated that between 44,000 and 98,000 unnecessary deaths per year occurred in hospitals alone, as a result of errors committed by medical professionals in the United States. There has been considerable speculation that these figures are either overestimated or underestimated. For example, the possibility that they focus on isolated injuries rather than error, or the majority of surveyed respondents did not know what constitutes a (medical) error. These disagreements have led experts to challenge the estimates of patient harm attributable to error, as well as the methodologies used to enumerate them. Of particular concern is the process used in the identification, classification and prevention of medical errors. There have been numerous attempts to develop classifications of medical errors, and currently an abundance of taxonomies exist to describe their mechanism.

In previous research, (Kopec, Kabir, Reinharth, Rothschild & Castiglione, 2003) a new taxonomy of Medical Errors was designed by expanding the IOM classification. This model and its extension can be used as a blueprint for future design, development and implementation of an expert system for classification of medical errors. Effective classification can facilitate pattern recognition, and pattern recognition will help in understanding the nature, background and abatement of medical errors. Such a system's goal will be to perform convincingly as an advisory consultant, exhibiting expertise on a par with and beyond human experts in specified domains. Despite substantial disagreement on the validity of the published figures for fatalities in hospitals in the IOM report, what is of importance is that the number of deaths caused by such errors is nonetheless alarming. The identification and classification of errors in medical care delivery is a very complex process, and this process can be facilitated and simplified by the implementation of an effective classification system.

Information and Communication Technologies (ICT) are expected to support Healthcare Professionals in reducing medical errors, making the most relevant decisions and finding the most appropriate procedure for each patient. In particular, Knowledge Management and Decision Support Systems provide access to high quality information and to appropriate protocols. The present paper aims at comparing the approaches used in three ongoing R&D projects in order to support risk reduction and clinical governance. This comparison will lead to the presentation of a generic model of Decision Support Tools that transform shared and documented “Good Practices” into software entities that can pro‐actively advice users in their daily work or when they encounter difficult situations.

In this paper we describe some of the optimisation issues relevant to the requirements of high throughput of medical data and video streaming traffic in 3G wireless environments. In particular we present a challenging 3G mobile health care application that requires a demanding 3G medical data throughput. We also describe the 3G QoS requirement of mObile Tele‐Echography ultra‐Light rObot system (OTELO that is designed to provide seamless 3G connectivity for real‐time ultrasound medical video streams and diagnosis from a remote site (robotic and patient station) manipulated by an expert side (specialists) that is controlling the robotic scanning operation and presenting a real‐time feedback diagnosis using 3G wireless communication links.

This article presents an original method of implementation of the color set back‐projection algorithm that is one of the most efficient method of automated detection of color regions from an image. The detected regions are then used in the content‐based region query. The query is realized on one or more regions, having into consideration the color feature. The efficiency of the method was studied by means of a number of experiments effectuated with the help of a software system realized for this purpose, on a collection of medical images collected with an endoscope. The new method for the implementation of the algorithm is compared with the traditional one not only from the point of view of the execution time, but also from the point of view of the retrieval process quality.

The economic evaluation of telemedicine has faced difficulties, both in terms of the effectiveness and cost‐benefit analyses. The main challenges that lie ahead for economic assessment are: (a) technological changes; (b) sustainability of applications; (c) availability of outcomes and other patient data; (d) generalisability of evaluation results. These challenges have lead to an unsatisfactory modeling of cost analysis of teleradiology systems versus non‐teleradiology (visiting radiology services) applications.

This paper presents the analysis on the impact of telemedicine on health care. It particularly emphasizes a model for teleradiology cost systems. We study and compare cost analysis of teleradiology system versus non‐teleradiology systems. Finally, a model is presented which is made viable for computing the number of patients needed to demonstrate the viability of the telemedicine systems.

We conclude the following: (a) that large number of patients is needed to validate the economic impact of telemedicine services; (b) cultural change in USA will bring most prominent effect in improving health care thereby bringing health care costs down. This when combined with improving cost effective technology like telemedicine services will bring the overall health care costs down.

This paper attempts to detail the evolution of a system synergy for more than 3 decades where the health services researchers; clinicians and others have been investigating the use of advanced information and communications technologies (ICT) to improve Indian health care. At the core of all these efforts lies a successful system synergy or a marriage between medicine and ICT and combination of innovative and mainstream technologies. The system is being developed in the context of the medical standards and practices in India, addressing issues, challenges and problems specific to Indian health care scenario where its 1 billion populations are predominantly rural and distributed in distant geographical locations. The health and medical facilities presently available in the non‐urban parts of the country is inadequate and there are wide disparities in terms of health care infrastructure, facility, manpower and funds between rural and urban communities, and between different states and even districts within states. This calls for innovative methods of utilization of science and technology for the benefit of our society and ICT and medicine assumes a greater significance to revolutionise the health care system in India.