Ebook: pHealth 2012

The 2012 pHealth conference is the 9th in a series of scientific events bringing together expertise from medical, technology, gaming, and social care domains all related to the provision of personalized health services. Aspects such as health games, terminologies and ontologies as well as social and ethical aspects of health provision are to be addressed by more than 40 speakers from various parts of the world. Keynotes, invited talks, oral presentations and posters, addressing requirements and R&D outcomes enabling the paradigm change towards personalized health, together with demonstrations of existing and emerging applications in the pHealth domain will complement round table discussions and the ambition to define road-mapping activities focusing on the year 2020.

pHealth conferences have emerged as the leading international conference series on wearable micro and nano technologies for personalized medicine and personalized health service provision. Starting in 2004, pHealth has gained importance for attracting well-acknowledged scientists in the domains of relevant technologies, medical doctors, and policy makers from academic institutions, hospital administrations, the healthcare industry and allied professions. Collecting the experience of a dynamically emerging professional community from Europe and beyond, the pHealth meeting series has given visibility to the tremendous potential of micro and nano technologies not only for the future of medicine, but also for the improvement of healthcare and welfare processes today and tomorrow, thereby helping to integrate health and social care.

Microsystems, smart textiles, telemedicine, mobile computing, smart implants and sensor-controlled medical devices as well as the related Internet-based networks – from GRID to CLOUD – have become important enablers for monitoringtreatment in both inpatient and outpatient care. This is, however, just the beginning of evolutionary and revolutionary changes, paradigm shifts, and significant opportunities for patients, citizens, health professionals, healthcare establishments, companies in the micro and nano technologies and, indeed, the entire healthcare industry. The multilateral benefits of the whole gamut of enabling pHealth technologies for all addressed stakeholders lead to a triple win situation with enormous potential, not only for medical quality improvement and industrial competitiveness, but also for increasing access to care whilst managing healthcare costs.

The pHealth 2012 conference will mainly focus on completed and running projects in various domains addressed by the pHealth conference series, but will also include at the same time new research topics and domain road mapping derived from round table discussions. Each session is foreseen to start with a Session Keynote. The remaining session time will address the same topic from different views. These presentations will either be provided by additionally invited speakers or by selected papers. All these topics are very closely linked to the Europe 2020 growth strategy. The pHealth 2012 conference benefits from the experience and the lessons learned from the previous pHealth events, particularly 2009 in Oslo, 2010 in Berlin, and 2011 in Lyon. The 2009 conference brought up the interesting idea of having special sessions focusing on a particular topic, and being organized by a mentor / moderator. The off of the conference. Lyon in 2011 initiated the launch of so-called dynamic demonstrations allowing the participants to dynamically show software and hardware solutions on the fly without needing a booth. The pHealth 2012 has taken these and other experiences into account for a successful conference in Porto. The idea of having a preconference event before the official start of the conference will allow attendees to present and discuss recent developments and provocative ideas that will to help animate the sessions. The Working Groups “Electronic Health Records”, “Personal Portable Devices”, and “Security, Safety and Ethics” of the European Federation for Medical Informatics (EFMI) have been actively involved in the preparation and realization of the pHealth 2012 conference. Furthermore, pHealth 2012 provides the platform to organize a Joint Round Table Event on “Secure mobile devices and implants for realizing pHealth”.

This Proceedings volume covers the Keynotes, Invited Speeches as well as selected submitted contributions assigned as Oral Presentation or Posters. Despite the high quality of the material, all submissions, but also the invited contributions have been carefully and critically reviewed. So, the editors are indebted to the highest expertise representing reviewers for having essentially contributed to the quality of the conference and the book at hand.

Furthermore, they thank Paul Cheshire, London, United Kingdom, for the extraordinary work in polishing the non-native English contributions despite the critical scheduling.

The editors are also grateful to the dedicated efforts of the Local Organizing Committee members, chaired by Filipe Sousa, and their helpers for the smooth operation of the conference. They especially thank Liliana Ferreira, Susana Hotz and Maria Costa from Fraunhofer Portugal AICOS for their continuous involvement in the preparation and realization of the conference.

Bernd Blobel, Peter Pharow, Filipe Sousa

(Editors)

This chapter deals with my view on pHealth both as president of ICMCC, an international foundation dealing with the social, societal and ethical implications of the use of ICT in medicine and care and as a cancer survivor.

Technologies for Human-Computer Interaction (HCI) and Communication have evolved tremendously over the past decades. However, citizens such as mobility impaired or elderly or others, still face many difficulties interacting with communication services, either due to HCI issues or intrinsic design problems with the services. In this paper we start by presenting the results of two user studies, the first one conducted with a group of mobility impaired users, comprising paraplegic and quadriplegic individuals; and the second one with elderly. The study participants carried out a set of tasks with a multimodal (speech, touch, gesture, keyboard and mouse) and multi-platform (mobile, desktop) system, offering an integrated access to communication and entertainment services, such as email, agenda, conferencing, instant messaging and social media, referred to as LHC - Living Home Center. The system was designed to take into account the requirements captured from these users, with the objective of evaluating if the adoption of multimodal interfaces for audio-visual communication and social media services, could improve the interaction with such services. Our study revealed that a multimodal prototype system, offering natural interaction modalities, especially supporting speech and touch, can in fact improve access to the presented services, contributing to the reduction of social isolation of mobility impaired, as well as elderly, and improving their digital inclusion.

The capacity to research, develop and manufacture systems that employ components based on nano- and microstructures with biological functionality, and are capable to share, ubiquitously, information is at the forefront of worldwide competition. A new generation of advanced materials, processes and emerging technologies is building up enabling highly integrated, miniaturized and smart micro-nano-bio-systems to be engineered. These fast technology developments are also stimulating the explosive growth in life sciences, which is leading to an ever increasing understanding of life at the sub-cellular and molecular level. By bringing these parallel developments to biomedicine and health, ultrafast and sensitive systems can be developed to prevent illness, to support lifestyle, to make early diagnosis or treat diseases with high accuracy and less invasiveness, and to support body functions or to replace lost functionality. Such systems will enable the delivery of individualized health services with better access and outcomes at lower costs than previously deemed possible, making a substantial contribution to bringing healthcare expenditures under control and increase its productivity. The MNBS (Micro-Nano-Bio Systems) group of EU funded projects aims at speeding up the convergence of micro- and nanotechnology with the life sciences and accelerating the development of highly integrated diagnostic, monitoring and therapeutics devices. This paper presents R&D activities supported through the MNBS group that are relevant to pHealth and discusses directions to be taken in order to overcome the current problems. Finally, it addresses future challenges to build highly integrated and reliable systems including innovation and usability issues.

Personalization of healthcare has a number of claimants, including pHealth. However, to the citizen real personalization is the delivery of integrated support services to maintain their health and well-being, particularly in times of chronic illness and frailty. The integration of health and social care support has been identified a key but challenging step in this. The pHealth community faces the choice either of reinforcing the isolation of silos of care and thus fragmentation of service, or of seeking to become a unifying agent though thoughtful and considered development of sharing of monitoring from pHealth devices.

This paper describes the theoretical principles for the establishment of a parallel and complementary modality of healthcare delivery – named Coproduction of Health (CpH). This service-model activates digital data, information, and knowledge about health, healthy choices, and the individuals' health-state and computes through personalized models context-aware communication and advice. “Lightweight technologies” (smartphones, tablets, application stores) would serve as the technology close to the end-users (citizens, patients, clients, customers), connecting them with “big data” in conventionally and non-conventionally organized data repositories. The CpH modality aims at providing synergies between professional healthcare, selfcare, informal care and provides data-fusion from several sources such as health characteristics of consumer goods, from sensors, actuators, and health related data-repositories, and turns this into “health added value” for the individual. A theoretical business model respecting healthcare values, ethics, and legal foundation is also sketched out.

Reversing the rising cost of health and social systems is needed in ageing developed and developing countries. A new model of ageing is advocated by the World Health Organization. This new model asks for more personal health accountability and a more integrated approach on care and preventive cure. Information systems and technologies can play an important role in supporting the changes needed in order to have better and more sustainable health and social care systems. Using value and results for patients as criteria by which systems are accepted by users and by organizations can contribute to a value based competition in health and social care systems. The unified theory of acceptance and use of technology is presented, and the pertinence of adding an extension to the theory in order capture Quality of Life improvements expectations is explored.

Wireless sensing is part of our lives; major technological breakthroughs in the areas of sensors, integrated circuits, and also on wireless communications, led to the creation of wireless sensor networks (WSNs). Such networks have multiple uses, from monitoring and tracking of people and goods, to the coordination and processing of activities in different contexts; they are used in industry, defence and healthcare applications. As part of this use in healthcare applications KeepCare, a solution based on monitoring, tracking and processing of healthcare related information, is presented in this paper. This solution uses a WSN based application to monitor peoples' health and quality of life through vital signs and activity information received via wireless sensors. This solution monitors users such as elderly, people suffering from chronic conditions in their home environment, but can as well be used in athletes or other professionals (e.g. first responders) that need to be monitored under hazardous conditions.

NovaMedTech is an initiative funded from EU structural funds for supporting new medical technologies for personalized health care. It aims at bringing these technologies into clinical use and to the health care market. The program has participants from health care, industry and academia in East middle Sweden. The first three year period of the program was successful in terms of product concepts tried clinically, and number of products brought to a commercialization phase. Further, the program has led to a large number of scientific publications. Among projects supported, we can mention: Intelligent sensor networks; A digital pen to collect medical information about health status from patients; A web-based intelligent stethoscope; Methodologies to measure local blood flow and nutrition using optical techniques; Blood flow assessment from ankle pressure measurements; Technologies for pressure ulcer prevention; An IR thermometer for improved accuracy; A technique that identifies individuals prone to commit suicide among depressed patients; Detection of infectious disease using an electronic nose; Identification of the lactate threshold from breath; Obesity measurements using special software and MR camera; and An optical probe guided tumor resection. During the present three years period emphasis will be on entrepreneurial activities supporting the commercialization and bringing products to the market.

In spite of the growing interest verified in the field of technology-based interventions for Stroke rehabilitation, there is still no global solution that is both successful and suitable for a widespread use [1,2]. In this article, we present a novel tele-rehabilitation tool designed to be used for ambulatory patients, and developed towards the motor recovery of the patient's upper-limb. The SWORD system combines a movement quantification system that analyzes the quality of the motor task performed with a biofeedback console. The proposed structure defines the SWORD system as a complete tele-rehabilitation framework that enables a direct connection between clinical and ambulatory settings. Currently a randomized clinical trial is being designed in order to assess the effectiveness of the SWORD tele-rehabilitation system.

Computer games are no longer just a trivial activity played by children in arcades. Social networking and casual gaming have broadened the market for, and acceptance of, games. This has coincided with a realization of their power to engage and motivate players. Good computer games are excellent examples of modern educational theory [1]. The military, health providers, governments, and educators, all use computer games. This paper focuses on Games for Health, discussing the range of areas and approaches to developing these games. We extend a taxonomy for Games for Health, describe a case study on games for dementia sufferers, and finally, present some challenges and research opportunities in this area.

Upper gastrointestinal bleeding is considered the most frequent emergency in endoscopy units. Decisive for successful treatment of acute upper gastrointestinal bleeding is a timely recognition. We have developed a telemetric implant containing a novel optical sensor principle able to detect the presence of blood in the lumen of the GI tract. In-vivo experiments demonstrated the possibility to detect bleeding in situ and to send an alert signal to an extracorporeal receiver.

Endoleaks are one of the major concerns in the long-term follow-up of endovascular aneurysm repair treatment (EVAR). Therefore, periodic monitoring is required to detect eventual damages in an implanted stent-graft. A monitoring system for post EVAR procedure based on inductive-coupling which avoids the need to resorting to more complex biomedical imaging systems is presented here. Endoleaks are detected with capacitive pressure sensors placed in the stent-graft and monitored externally after the measure of the oscillation frequency provided by the LC circuit created by sensors and inductive coupling.

Detecting reduced circulation, which is a major factor in the development of pressure ulcers, can be done using optical methods. PPG and LDF can be combined and used to evaluate blood flow at different depths. In this study the use of a probe combining PPG and LDF to monitor multiple tissue depths is evaluated. The effects on blood flow and temperature without additional provocation was examined. Measurements were performed during 60 min and the use of an active probe was compared with the use of a semi-active probe turned off a major part of the time. Changes in temperature and blood flow using these probe configurations (active and semi-active probe) are compared; four different 5 min segments during a 60 min measurement. A general increase in both temperature and blood flow is found but this increase could not be concluded to occur due to the light sources of the probe.

In order to enhance the quality of life of people with mobility problems like Parkinson's disease or stroke patients, it is crucial to monitor and assess their daily life activities by characterizing basic movements like postural transitions, which is the main goal of this work. This paper presents a novel postural transition detection algorithm which is able to detect and identify Sit to Stand and Stand to Sit transitions with a Sensitivity of 88.2% and specificity of 98.6% by using a single sensor located at the user's waist. The algorithm has been tested with 31 healthy volunteers and an overall amount of 545 transitions. The proposed algorithm can be easily implemented in real-time system for on-line monitoring applications.

Recently, numerous systems for geo-tracking Alzheimer's patients with dementia have been developed and reported to be functional for the purposes of security and data collection. However, studies stated possible loss of freedom and autonomy for patients, along with violations of their privacy, which may lead to loss of prestige/dignity. In this study, a geotracking system that aims to balance patients' security and their need for privacy and autonomy is proposed. The system introduces a personalized, four-level temporal geofence based tracking, warning and notification protocol that incorporates a safety check mechanism operating over Global System for Mobile Communications network.

This work proposes a concept for indoor ambulatory monitoring for Parkinson's disease patients. In the proposed concept, a wearable inertial sensor is kept as the main monitoring device through the day, and it is expanded by an ambient sensor system in the specific living areas with high estimated probability of occurrence of freezing of gait episode. The ambient sensor system supports decisions of the wearable sensor system by providing relevant spatial context information of the user, which is obtained through precise localization.

This paper examines benefits of the exer-learning concept HOPSCOTCH for rehabilitation in spa clinics and at home. It describes a specific application to motivate obese patients in spa clinics for exercise. Furthermore results of an empirical study are reported where HOPSCOTCH was implemented in two spa clinics for a period of four weeks. The results of the study have shown that the concept is very convincing, but mainly depends on the content of the application; however the idea of HOPSCOTCH appeared to have a high potential to be used as a therapeutic agent in terms of motivation for exercise.

Computerized interfaces are able to represent 3D immersive simulations. Most of them make use of joystick, mouse, gloves, or grasp pressure transducers. Those have the drawback of ‘filtering’ the user interaction and/or de-locate the touch with respect to the visual stimulus. To overcome this we developed dexterity rehabilitation games on a novel touch interface that measures also force. The system allows dexterity training through ‘direct’ manipulation of virtual objects in 3D. Two dimensions via the touch screen, the third by the force channel. Tactile feedback is provided with a vibration device mounted on the screen back.

Based on the long-term work of scientific institutions and SDOs dedicated to system architectures, an interoperability framework is presented to help navigation through existing, emerging and even future standards for comprehensive interoperability of intelligent health and social care services. HL7 artifacts as well as work products of competing organizations are classified and semi-formally interrelated. The methodology is proven in many international standard development and health information systems implementation projects.