Ebook: Unifying the Applications and Foundations of Biomedical and Health Informatics

The current volume presents the accepted papers of the ICIMTH (International Conference on Informatics, Management, and Technology in Healthcare) Conference, which is being held from 1 to 3 July 2016 in Athens, Greece.

The ICIMTH 2016 Conference is the 14th 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 main theme of the Conference is unifying the applications and foundations of Biomedical Informatics in the whole spectrum from Clinical Informatics, Health Informatics to Public Health Informatics as applied in the Healthcare domain. Considering that management, organizational and public health issues play an important role in the implementation of Biomedical Informatics applications, topics related to the above themes are also included as an integral part to the overall theme of the Conference. We are treating the field of Biomedical Informatics in a very broad framework by examining the research and applications outcomes of Informatics from cell to populations, including a number of Technologies such as Imaging, Sensors, Mobile communications, Biomedical Equipment, and Management subjects, as well as legal and societal issues in applying Health Informatics.

In this volume we have incorporated papers accepted for oral presentation, whereas all other scientific events within the Conference are incorporated within the local electronic version of the proceedings. It should be noted that the Proceedings are published in this series of the Conference as an e-book with e-access for ease of use and browsing, without losing any of the advantages of indexing and citation in the largest scientific literature databases, such as Medline and Scopus, that the series of Studies in Health Technology and Informatics (SHTI) of IOS Press provides.

At the end of the deadline we had almost a hundred submissions. After reviewing we have accepted 68 as full papers for publication in the proceedings.

The compilation of the proceedings is an enormous task which could not have been accomplished without the human effort and the infrastructure provided at the premises of the Health Informatics Laboratory, at the School of Health Sciences of the National and Kapodistrian University of Athens.

The Editors would like to thank the Members of the Scientific Programme Committee, the Organising Committee and all the Reviewers, who have carried out a thorough and objective refereeing of the scientific work in order to produce a high quality publishing achievement aimed at a successful scientific event.

Athens, 30.05.2016

The Editors,

John Mantas,

Arie Hasman,

Parisis Gallos,

Aikaterini Kolokathi, and

Mowafa S. Househ

During the last years there has been considerable progress in the area of health-enabling and ambient assistive technologies (HEAAT). Based on HEAAT, there is the chance that health care and preventive health will more and more take place again in a person's home. The objective of this essay is to report about this progress and to point out and discuss consequences, mainly by referring to a publication in the IMIA Yearbook of Medical Informatics 2016 about “Health-Enabling and Ambient Assistive Technologies: Past, Present, Future”. As a person's home is becoming an important additional ‘institution’ for health care, new forms of care will have to be implemented with consequences that diagnostic and therapeutic procedures, offered by health care institutions, will not end at their ‘walls’. Through HEAAT we now have received new ‘informatics diagnostics’ and new ‘informatics therapeutics’, which might be called engymetric diagnosis and engymetrictherapy. Engymetry, technically based on HEAATand on transinstitutional health information systems, isone of the most promising fields of informatics, helping to contribute to high quality care through new diagnostic and therapeutic opportunities and to a good quality of life for the people on our planet.

The science that deals with evaluation of a scientific article refer to the finding quantitative indicators (index) of the scientific research success is called scientometrics. Scientometrics is part of scientology (the science of science) that analyzes scientific papers and their citations in a selected sample of scientific journals. There are four indexes by which it is possible to measure the validity of scientific research: number of articles, impact factor of the journal, the number and order of authors and citations number. Every scientific article is a record of the data written by the rules recommended by several scientific associations and committees. Growing number of authors and lot of authors with same name and surname led to the introduction of the necessary identification agent – ORCID number.

The paper presents an open source system that allows the user to interact with a 3D molecular viewer using associated hand gestures for rotating, scaling and panning the rendered model. The novelty of this approach is that the entire application is browser-based and doesn't require installation of third party plug-ins or additional software components in order to visualize the supported chemical file formats. This kind of solution is suitable for instruction of users in less IT oriented environments, like medicine or chemistry. For rendering various molecular geometries our team used GLmol (a molecular viewer written in JavaScript). The interaction with the 3D models is made with Leap Motion controller that allows real-time tracking of the user's hand gestures. The first results confirmed that the resulting application leads to a better way of understanding various types of translational bioinformatics related problems in both biomedical research and education.

The pre-grafting Tele-Radiological (TRE) evaluation of the Uterus Graft (UG) on Telemedicine Systems, in Uterus Transplant (UT) is studied by diagnostic sensitivity-specificity analysis based on simulation of TRE of the UG on 10 MR sets of female pelvic digital images by two radiologists, assessing a. The vascular variations of the grafts, and b. The inflammatory and neoplastic lesions of the UG. The pre-grafting TRE of the UG showed: a. Diagnostic unreliability for vascular variations, b. A high diagnostic reliability for inflammatory and neoplastic diseases of the UG (100%), making the MRI based TRE of the UG in UT, feasible and highly reliable for the remote pre-grafting diagnosis of UG pathologic lesions, but unreliable for integrated vascular anatomic and pathologic UG remote evaluation for pre-grafting and pre-transplant decision support and planning.

Modern Implantable Medical Devices (IMDs), implement capabilities that have contributed significantly to patient outcomes, as well as quality of life. The ever increasing connectivity of IMD's does raise security concerns though there are instances where implemented security measures might impact on patient safety. The paper discusses challenges of addressing both of these attributes in parallel.

Organ transplantation comprises of many phases, processes, and activities and involves multiple stakeholders. Effective management of such a complex and costly medical domain requires an efficient, multifaceted solution. Although, Information Technology (IT) can basically play an important role here, it is not clear how IT potentials have been deployed so far. We systematically reviewed MEDLINE, EMBASE, CINAHL, The Cochrane and IEEE databases and identified 27 publications describing IT application in organ transplantation. Although the IT coverage spans over waiting list management, donor-recipient matching, and inpatient and outpatient medication and lab monitoring practices, the coverage is still patchy and whole process IT support is missing in practice.

Medical text contains boilerplated content, an artifact of pull-down forms from EMRs. Boilerplated content is the source of challenges for concept extraction on clinical text. This paper introduces PlateRunner, a search engine on boilerplates from the US Department of Veterans Affairs (VA) EMR. Boilerplates containing concepts should be identified and reviewed to recognize challenging formats, identify high yield document titles, and fine tune section zoning. This search engine has the capability to filter negated and asserted concepts, save and search query results. This tool can save queries, search results, and documents found for later analysis.

This paper introduces a new approach for upper limb neurorehabilitation based on customized devices for monitoring and interacting with virtual environments. A proof-of-concept test involving eight patients at the Guttmann Neurorehabilitation Hospital shows patient's good acceptance and usability scores and demonstrates the technically feasibility of the devices. The final goal is to achieve a more personalized, monitored, intensive and ecological rehabilitation procedures for ABI patients.

The purpose of this study is to review the literature on the use of sensor-based technology in the collection of healthcare data from health consumers and/or patients. A literature search was conducted in November 2015 through the PubMed database. A total of 4,800 articles were retrieved using the terms “sensors-based systems in healthcare” and “sensor monitoring in healthcare”. After scanning the articles, and applying the inclusion and exclusion criteria, 10 articles were found relevant and included in the review. This study highlights the benefits and challenges when using sensor-based systems in the collection of health consumer and/or patient information. Some of the benefits in the collection of data are remote monitoring features and the real-time data collection features. Some of the challenges are privacy, security, and sensitivity to technology issues. Future work should evaluate the quality of the research evidence on sensor-based technologies and how such information impacts quality of care.

Neurological disorders affect the lifestyle and the living conditions of a patient. Virtual Reality is a technology that may be used to simulate various types of tasks in a computerized environment guiding the patient and help on rehabilitation. This review try to answer how Virtual Reality technologies can effect on the patients rehabilitation's results. Treatments which involves Virtual Reality applications offer new ways to make the patients more committed to their program and keeps them motivated. Another characteristic of a Virtual Reality treatment is that both patients and therapists can observe the mistakes made during a physiotherapy session. The insert of VR sessions in traditional rehabilitation therapy of patients with neurological disorders have produced positive results.

Clinical decision support systems (CDSS) are designed to help making clinical decisions regarding the management of patients. CDS alerts can save lives but frequent insignificant ones might cause alert fatigue. Studies discuss that 33% to 96% of clinical alerts are ignored. We categorized best evidence based strategies, to reduce alert fatigue and improve CDSS utilization, into five major areas. Classify alerts in to three main levels; severe, moderate and minor then develop a core set of critical drug to drug interactions. Classify alerts into active and passive groups, where only critical alerts should be interruptive actively while less critical alerts should be non-interruptive to the user. Conduct regular user training on new improvements. Keep monitoring alert response rates and keep ongoing research and improvement efforts. Provide systems with automated feedback and learning mechanisms where frequently ignored and justified alerts could be moved automatically from the active interruptive to the passive non-interruptive model.

While serious games in healthcare have gained much attention in recent years, the pedagogical, social or behavioural frameworks tied to the game elements are still poorly understood. We report the prototyping effort as work-in-progress for a serious social gaming framework for children with diabetes. Motivation theories were combined with child education literature to evaluate potential elements of the framework. Based on the evaluation, we designed cooperation, social comparison and focus on positive achievements as core game elements, and limited the extent of competition. Examining the theoretical foundations that underpin different elements of serious games promises a greater understanding of effective gaming techniques for healthcare.

In cases of emergency, such as out-of-hospital cardiac arrests, the first few minutes are crucial for victims to receive care and have a positive outcome. However, emergency services often arrive on scene after those first few minutes, making any bridging solutions key. Finding a defibrillator or accessing a trained volunteer responder are some of the technological solutions that are being developed to support the chain of survival. This paper looks at technologies, in particular those linked to mobile apps that have been used to locate defibrillators and responder apps that enable responders to attend to nearby emergencies. We review a selection of apps and also assess the challenges and considerations for such apps.

Due to the powerful computer resources as well as the availability of today's mobile devices, a special field of mobile systems for clinical decision support in medicine has been developed. The benefits of these applications (systems) are: availability of necessary hardware (mobile phones, tablets and phablets are widespread, and can be purchased at a relatively affordable price), availability of mobile applications (free or for a “small” amount of money) and also mobile applications are tailored for easy use and save time of clinicians in their daily work. In these systems lies a huge potential, and certainly a great economic benefit, so this issue must be approached multidisciplinary.

Emergency department (ED) crowding has become a major barrier to receiving timely care. King Faisal Specialist Hospital & Research Center, Saudi Arabia worked on identifying evidence based strategies for reducing the ED crowding by improving the intake. In addition to a review of literature, qualitative survey methods were used to identify strategies, which were classified into 10 suggested procedures categorized into three types of changes. Physical improvements include using physician cubicles, creating a team triage area and an internal waiting area for less acute patients instead of occupying beds. Technology improvements; include using informatics to update the electronic emergency record with information, using palmar scanning to instantly identify patients and using radio communication devices. Process improvements; include a scribe program to decrease clerical documentation tasks, switching between low flow and high flow processes, placing a physician in triage and using patient segmentation methods.

The cost of collecting the data and assessing the benefits derived from better information about chronic granulomatous disease (CGD) are rarely examined. Bayesian decision analyses to incorporate individual risk and clinical data to identify patients for when to take the treatment. This study developed a sensitivity analysis to calculate individualized information as a function of individual outcome risk. In addition, we used simulation to explore how the ranges of numerical values for which each option will be most efficient with respect to the input parameters and decision-making thresholds. Experimental results show that, this proposed model can not only for taking action in the light of all available relevant information, but also for minimizing expected loss by considering the optimal prior / posterior decision making.

In this study, it is aimed to generate improved models for detecting undiagnosed type II diabetes mellitus patients by employing data from both undiagnosed and diagnosed patients. The main motivation is that, with the widespread use of electronic health records, increasing amount of data is accumulating for diagnosed patients. In our simulations, the training sets are allowed to include data from both undiagnosed and diagnosed patients. The models generated are then evaluated using the undiagnosed patients. Experimental results have shown that the data from diagnosed patients do not help to improve the detection performance of undiagnosed patients.

Extracting evidence of the absence of a target of interest from medical text can be useful in clinical inferencing. The purpose of our study was to develop a natural language processing (NLP) pipelineto identify the presence of indwelling urinary catheters from electronic medical notes to aid in detection of catheter-associated urinary tract infections (CAUTI). Finding clear evidence that a patient does not have an indwelling urinary catheter is useful in making a determination regarding CAUTI. We developed a lexicon of seven core concepts to infer the absence of a urinary catheter. Of the 990,391 concepts extractedby NLP from a large corpus of 744,285 electronic medical notes from 5589 hospitalized patients, 63,516 were labeled as evidence of absence.Human review revealed three primary causes for false negatives. The lexicon and NLP pipeline were refined using this information, resulting in outputs with an acceptable false positive rate of 11%.

Co-design or participatory design has emerged as a useful concept where stakeholders and end-users have a greater stake in designing the end product. To date, few accounts exist of the use of the concept in serious game design, especially for children with chronic diseases. We report initial steps in serious game co-design for children with type 1 diabetes. Participants included 14 children (mean age 8.6 years, range of 4-13) who were invited to sketch a diabetes game. The most prevalent themes that emerged from the sketches (N=17) include blood glucose monitoring (n=12), nutrition (n=8) and insulin (n=8); all of which are consistent with diabetes education guidelines. Co-design is a promising concept for understanding children's world-view when designing healthcare games.

The use of applications for mobile devices and wireless sensors is common for the sector of telemedicine. Recently various studies and systems were developed in order to help patients suffering from severe diseases such as cardiovascular diseases and Parkinson's disease. They present a challenge for the sector because such systems demand the flow of accurate data in real time and the use of specialized sensors. In this review will be presented some very interesting applications developed for patients with cardiovascular diseases and Parkinson's disease.