Ebook: Medical and Care Compunetics 6

This volume contains the proceedings of the seventh annual Event of the International Council on Medical and Care Compunetics (ICMCC), which will be held in London, UK, from 8–11 June 2010. ICMCC is an international foundation which acts as the knowledge centre for medical and care compunetics, i.e. for the field of the social, societal and ethical implications of computing and networking in health. In contrast to conferences addressing technology, dedicated scientific domains or specialized professionals, ICMCC follows a multidisciplinary approach by nature. Therefore, it addresses all entities involved in health issues such as health professionals, politicians, supporting specialist, administrators, researchers and developers, but primarily the subject of care – the patient or the citizen before they become a patient. ICMCC is unique on the global scene in this bridging and embracing functionality.

The theme of the 2010 annual event is “Personal Health – Intelligent solutions to serve empowered patients”. The seventh ICMCC annual event addresses the active participation of the citizen in his or her health and care pathway with the interactive use of Information and Communication Technologies, in other words; Patient 2.0 Empowerment as defined by ICMCC in 2008. The 2010 Event intends to combine ontology-driven health information system design for advanced interoperability with the paradigm change towards pervasive person-centric care, including prevention, home care and wellness, together forming adaptive distributed health information systems solutions. Important issues to be considered are virtual Electronic Health Records and Personal Health Records acting as a semantically interoperable communication and cooperation platform for personalized ubiquitous health services in a reliable environment.

The scientific topics presented in the proceedings comprise System Design and Evaluation, Computer-Assisted Learning, Knowledge Representation and Ontologies, Electronic Health Records and Patient Empowerment. 82 researchers, residing in 17 different countries from Europe, North and South America, and Asia, have reported their results in this volume. A comprehensive overview and in-depth, first hand information on new developments, advanced systems, technologies and applications will be introduced to an international audience.

The ICMCC has been supported by the European Federation for Medical Informatics (EFMI), notably by the EFMI Working Groups “Electronic Health Records”, “Security, Safety and Ethics” and “Personal Portable Devices”.

The editors would like to thank the scientific board for their assistance and all the authors for their excellent work as well as the reviewers for lending their expertise to the conference. Last but not least the local organizers, for their contribution to the final achievements.

Lodewijk Bos (Event Chair), Bernd Blobel (Scientific Chair)

Health systems turn everywhere, but with different speed, from organization-centered to personalized eHealth or pHealth, i.e. ubiquitous care delivery independent of time and location of the resources involved. As interoperability is an important issue in such distributed, fully integrated, intelligent and individualized environment, pHealth solutions have to comply with advanced architectural solutions based on international standards. Representing concepts and their interrelations, such architectural framework perspectives' system architecture, domains, and development process can be described by the domains' ontologies. Therefore, advanced interoperability approaches have to refer to ontology principles, finally resulting in ontology-driven approaches to semantically interoperable and sustainable health information systems. The paper investigates functional requirements, interoperability levels, architectural approaches to pHealth systems, thereby analyzing and classifying related existing or emerging standards.

The European Union Future Internet Assembly, the roadmap for the Web heading towards semantic interoperabilityand building on the UK's adoption of the Internet and social media are accelerating the development of Web 3.0. A number of health portals are opening, some with facilities for the capture of Patient Based Records. Collective Intelligence will be generated that, applied to health, has potential to support Public Health policy. By using the Internet, millions of people in the course of their daily activities contribute to uncertified data stores, some explicitly collaborating to create collective knowledge bases, some contributing implicitly through the patterns of their choices and actions. An application of soft computing, called Collective Health Intelligence, that reasons uncertified and certified data could enhance the social pool of existing health knowledge available to the public health agencies. Collective Health Intelligence could be used to complement national programmes by employing innovative sampling techniques, cost-effectively generating anonymous data trends that would quantify policy, indicate epidemiological effects and supply metrics to test policy efficacy.

Requirement analysis, design, implementation, evaluation, use, and maintenance of semantically interoperable Health Information Systems (HIS) have to be based on eHealth standards. HIS-DF is a comprehensive approach for HIS architectural development based on standard information models and vocabulary. The empirical validity of HIS-DF has not been demonstrated so far. Through an empirical experiment, the paper demonstrates that using HIS-DF and HL7 information models, semantic quality of HIS architecture can be improved, compared to architectures developed using traditional RUP process. Semantic quality of the architecture has been measured in terms of model's completeness and validity metrics. The experimental results demonstrated an increased completeness of 14.38% and an increased validity of 16.63% when using the HIS-DF and HL7 information models in a sample HIS development project. Quality assurance of the system architecture in earlier stages of HIS development presumes an increased quality of final HIS systems, which supposes an indirect impact on patient care.

This position paper focuses on strategic developments and underlying concepts emerging out of the standards and associated domains. It addresses the issue of personal privacy in the wider context of interoperability across an ever-growing range of e-health and social care support systems and processes. These will increasingly be driven by major growth in the elderly segment of national populations where unambiguous identification of both patients and care staff both in hospitals and the community will become significant issues. This is particularly so where remote patient monitoring and access control to personal data is concerned, and is further complicated where racial, cultural and linguistic barriers are prevalent.

The accuracy in the online measurement of ECG parameters has a decisive role in the better diagnosis and effective treatment of the diseases. The present paper describes a Lab-VIEW based programming using Pan Tompkins method to extract out QRS complex whereas QT interval measurements were carried out using Mat-lab based math-script module. Hilbert transform has been applied on the ECG signal to convert it into an analytical signal for better peak detection. Peak detection and other parameters like RR interval, HR and several time domain measures of heart rate variability such as RR mean and standard deviations, HR mean and standard deviations, RMSSSD, NN50 count, pNN50 etc were calculated for several other clinical applications apart from online disease diagnosis.

Changeover from the traditional paper-based patient records to the computerized patient records has been spreading rapidly in medical facilities. Since ordinary input devices such as a keyboard and mouse are often thought insufficient for the needs of medical workers using electronic patient records (EPR) compared with traditional pens and paper-based patient records, a pen-tablet system (PTS) as a digital pen interface tends to be used instead. On the other hand, with the growing adoption of thin-client computing (TCC) in medical facilities, the usability of PTS with TCC has come to be a concern because of possible reduction of the usability due to delays of response time occurring in TCC environments. To analyze the factors that influence the usability of PTS with TCC, the authors focused on the relationship between length and its scattering of the response time delay. The results indicated that the delay scattering could be a more influencing factor than the delay length itself and that values of the scattering should be within approximately 35 milliseconds for the best usability. This study would provide useful indicators for evaluating the usability of PTS in incorporating it into the EPR system with TCC environments.

A great amount of information is available to be exploited thanks to the use of information technologies. However, the systems that analyze this data lack the ability to alert the right clinical staff to important events, having some of the latest developments centered on the possibility of sending events from specific areas. The following system tries to solve these dependencies and offers a unique system capable of analyzing any data source and communicates the alarms through different means in an effective way.

This study presented a newly developed online groupware system, Metaboli-Net, to yield counseling guidance on diet and exercise to patients with metabolic syndrome. A distinctive feature adopted in the system to maintain the retention rate of patients was the social network service (SNS) that enables the patients to share their dietary and relevant health information with other participants in the same group on the network. A pilot study was conducted to prove the effectiveness of the system in improving the patient's lifestyle and dietary health awareness. SNS also contributed to the participant's adherence to intervention programs.

Current RFID technology deployment is limited by safety, procedural and physical limitations in healthcare field. It is important to define and ensure safe operation of technologies without actual deployment in real operation. Potential problems could arise due to the consequences of technical and physical characteristics of RFID technology and its improper location. This article deals with manipulation of blood products and the definition of suitable places for radio identification. Each suitable place must undergo laboratory experiments and tests. The results can provide a convenient base for defining efficient and safe deployment of RFID technology in Blood Centers with substantial financial savings for Czech healthcare.

The A Coruña University Hospital Complex is developing an expert system to improve the decision support for transplanted patients. The system will access the data collected during the monitoring of patients and generate a database of statistics that will aid health professionals in several stages of the transplant process. All historical data will be revised to give an estimation of the patient's parameters evolution depending on his medical record and his actual treatment. We will use two different machine learning techniques to do both clustering and classification.

Current e-learning systems are still inadequate to support the level of interaction, personalization and engagement demanded by clinicians, care givers, and the patient themselves. For effective e-learning to be delivered in the health context, collaboration between pedagogy and technology is required. Furthermore, e-learning systems should be flexible enough to be adapted to the students' needs, evaluated regularly, easy to use and maintain and provide students' feedback, guidelines and supporting material in different formats. This paper presents the implementation of an Intelligent Tutoring System (SIAS-ITS), and its evaluation compared to a traditional virtual learning platform (Moodle). The evaluation was carried out as a case study, in which the participants were separated in two groups, each group attending a virtual course on the WHO Integrated Management of Childhood Illness (IMCI) strategy supported by one of the two e-learning platforms. The evaluation demonstrated that the participants' knowledge level, pedagogical strategies used, learning efficiency and systems' usability were improved using the Intelligent Tutoring System.

Working interoperability not only requires harmonized system's architectures, but also the same interpretation of technical specifications in order to guide the development process. This paper analyses the commonly used structures of communication standards elaborated with HL7 Version 3 and proposes an ontological structure resulting in the so-called Communication Standards Ontology (CSO). As such a solution has to be developed within an architectural framework, the approach is aligned with the Generic Component Model (GCM).

Ontologies are more and more used in clinical informatics in different settings and supporting different functionalities. Most experts see the role of ontologies as operating in a black box and being invisible for the end-user. With respect to some of the systems that have recently been developed this is only partly possible. Therefore, we provide a methodology to create an end-user perspective on a clinical ontology. This will foster participation of the clinical expert in both ontology exploitation and ontology maintenance. This methodology does not only provide the basis for a better integration of the experts into the ontology-based system, but it can be used to support patient empowerment by helping the patient to understand the content that is stored and partake in its management.

Suva (Swiss National Accident Insurance Fund) is the most important carrier of obligatory accident insurance in Switzerland. Its medical division supports doctors working in inpatient and outpatient care with comprehensive case management and with conciliar advice. The Suva hospitals provide inpatient rehabilitation. In 2002, Suva started the InWiM project. InWiM is an acronym and stands for “Integrierte Wissensbasen der Medizin”, which can be translated as “Integrated Knowledge Bases in Medicine”. Information retrieval within InWiM is achieved by means of the MeSH Index (Medical Subject Headings), the thesaurus of the United States National Library of Medicine (NLM). InWiM has now been extended towards the management not only of publications but also of areas where sound knowledge is missing, so called “knowledge gaps”: Knowledge gaps are indexed with MeSH terms in a similar way to publications. This improves knowledge management: In particular it is possible to search and find knowledge gaps and solutions covering the same or a similar topic, thus allowing adequate collating and it prevents duplication of work. Furthermore, literature search strategies for the NML are predefined and do not need every time to be reinvented from scratch.

New services devoted to improve personalized healthcare are emerging from information technology developments. Personal health record systems allow the patients to participate actively in their healthcare process. However, the dissemination and use of personal health record systems face with some barriers, for example low health literacy that leads to discrepancy in understanding medical concepts. While it is important to present health information using consumer-familiar terms in consumer applications, consistently converting medical terms to consumer-familiar ones is a challenging task. We designed and developed both an ontology-like taxonomic structure devoted to the Geriatrics domain for the outpatient and a software tool, for carrying out the matching between the medical vocabulary of the consumer and that of the doctor from the outpatient's and their family point of view.

The challenge of population-level health problems, such as healthcare disparities, encompasses socio-behavioural, community and biologic factors and advances in information and communication technologies (ICTs). These elements are reflected in the key ethos of contemporary knowledge management (KM), as knowledge emerges from the confluence of people, process and technology. This paper illustrates how knowledge-based health case studies can be used as effective exemplars to illuminate understanding and explore possible connections between populomics and KM.

In this paper standardized vectorial (quantitative) representation of medical data is suggested for use in patient records. Vectorial representations are (as sequences of numbers) language independent, precise, directly comparable, and they allow advanced evaluation, e.g. similarity calculation using well defined distance functions. It is possible to search for a patient with a certain combination of diagnostic parameters on the Web records of patients with similar parameters. The information about chosen treatments and treatment outcome at these patients can be used anonymously or pseudonymously for decision support. Because patient records from all countries can be compared, in the long run this could open systematic access to a very large wealth of clinically relevant information. Here the technical principle is described and illustrated by examples (e.g. similarity search of heart sounds). Previously published material is integrated in parts for explanation of the motivation and background.

The Healthcare Record has been used in a “Before and After” situation to improve patient care. The main paradigm of the modern Health Care is changing towards pervasive person-centric care including prevention and home care. Medical compunetics is a very important applicative field for improving the interoperability and the quality of the healthcare information system, especially in the current climate with the empowerment patients. The success depends on the choice of the Clinical Events Classification for structuring the span of clinical information. For the purposes of universalizing medical electronic data-bases, it is very important to organize the data regarding Clinical Events in such manner that it would be possible to use this information-structure in different fields of Clinical Practice: e.g., for the creation of the diagnostic and drug-assistance protocols, for the evaluation of the quality of drug prescribing, and for communication with patients as well. For this purpose all Clinical Events were divided to 5 classes. This Paper will describe a “Before and After” situation consequent upon the introduction of the Clinical Events Classification and the introduction of Protocols for drug-prescribing. Use of the Protocol brought about a 50% reduction in mortality.

Estonia is the first country which has implemented a nationwide electronic health record system and gives full access to its citizens. This provides new opportunities to citizens, healthcare providers and e-health developers. Combining health data, citizens' self added health and welfare data, decision support and possibilities of service oriented architecture of the Estonian Electronic Health Record System – a new era of e-health services can begin.