The organisation and the conferences
HealthGrid 2009 (http://berlin2009.healthgrid.org) is the seventh meeting of this open forum for the integration of grid technologies, e-science and e-health methods and their applications in the biomedical and healthcare domains. The principal objective of the HealthGrid conference and of the HealthGrid Association is the exchange and debate of ideas, technologies, solutions and requirements that interest the grid and the life-science communities and are likely to promote the integration of grids into biomedical research and health in the broadest sense. Participation is encouraged for grid middleware and healthgrid application developers, biomedical and health informatics users, ethicists and security experts, and policy makers to participate in a set of multidisciplinary sessions with a common focus on bringing healthgrids closer to real application in the health domain.
HealthGrid conferences have been organized on an annual basis. The first conference, held in 2003 in Lyon (http://lyon2003.healthgrid.org), reflected the need to involve all actors – physicians, scientists and technologists – who might play a role in the application of grid technology to health, whether healthcare or bio-medical research. The second conference, held in Clermont-Ferrand in January 2004 (http://clermont2004.healthgrid.org) reported on the earliest efforts in research, mainly work in progress, from a large number of projects. The third conference in Oxford (http://oxford2005.healthgrid.org) had a major focus on first results and exploration of deployment strategies in healthcare. The fourth conference in Valencia (http://valencia2006.healthgrid.org) aimed at consolidating the collaboration among biologists, healthcare professionals and grid technology experts. The fifth conference in Geneva (http://geneva2007.healthgrid.org) focused on the five domains defined by the European Commission as application areas for ‘vertical integration’ through grids in the biomedical field: molecules, cells, organs, individuals, and populations. For each of these five domains, an invited speaker gave a state of the art address followed by concrete projects. This was a loud signal to the community that the usefulness of grids to potential application domains could be demonstrated at least at the prototype level. This theme was also evident at the sixth conference in Chicago (http://chicago2008.healthgrid.org), which proclaimed its focus as ‘e-Science Meets Biomedical Informatics’. The sixth conference was also a landmark in the history of the organisation HealthGrid – and its newly established affiliate HealthGrid.US – as the first conference to be organised outside Europe. As we put it a year ago, this was a celebration of similarities and differences, a moment to validate models and principles beyond one's familiar shores. The proceedings since the third conference have appeared in the IOS series Studies in Health Technology and Informatics ([1–4]).
While the desire to promote healthgrid applications to real healthcare settings remains central to the community's ambitions, it is also true that the majority of adopters work in academic environments where research is their principal preoccupation. This continues to be reflected in the content of the conference. Nevertheless, we may detect a move in this research towards application in medicine and healthcare, an admittedly slower process than the most optimistic projections, but with worthwhile exemplars to motivate researchers, innovators and those who must take and justify investment decisions.
The deadline for the Chicago conference proceedings more or less coincided with the announcement – I should say, the shock of the announcement – of Jean-Claude Healy's untimely death. I did not know Jean-Claude personally, although he had made a very deep impression on me on the first occasion I met him: the launch in 2002 of the first explicitly health-focussed grid projects to be funded under the Framework Programme 5 of the European Union. He was always a very busy man, as all his formal and informal obituarists have highlighted, so his welcome and introductory remarks had, to someone who had not met him before, a sense of hurry; one could easily imagine that there was also a committee waiting for him to return so that it could continue its deliberations. But on reflection, this was a wrong impression: the urgency arose from his desire to see results from the projects that had just been approved. What now remains with me from that meeting is the passion of his assertion that, while doctors sometimes appear reluctant to embrace new technologies, the potential of our particular technology, healthgrids, was virtually limitless and that the importance of our projects was that they would demonstrate just how much was possible to an often sceptical medical profession. It is salutary to have his memory to remind us, as we endeavour to bring the fruits of our research from the laboratory to the citizen, that there is a real vision of better healthcare through the appropriate and intelligent use of our technologies – and let our success be a tribute to him in the way that would have counted most with him, through the advancement of science and healthcare. Indeed, it seems entirely fitting that Ilias Iakovidis  concludes his intimate tribute in the IMIA Yearbook of Medical Informatics 2008 with the familiar quotation, Jean-Claude's favourite, from George Bernard Shaw about the reasonable and the unreasonable man.
The themes of the conference reflected the anticipated, though slow, move towards real applications. Papers were invited in, though not limited to, certain prominent areas and topics. First among them, perhaps for obvious reasons, Accessibility, the challenge of making Grid more accessible to bio-medical users and the fraught issue of usability: “ready-to-run” healthgrids? The next two focal areas were well known to be active among researchers: one was Core Technologies and Data Integration, with the contrast of grid technology versus web applications, data privacy: confidentiality in distributed medical information systems – and the security challenges, semantic techniques and the challenge of integrating heterogeneous biomedical data, visualization in grids and next generation healthgrids: self adaptive systems. The second was Applications, such as healthgrids for genetics and epidemiological studies, pharmagrids supporting pharma research on grids and, not least, the collaboration area of grid computing and the Virtual Physiological Human. It was also anticipated that the theme of Ethical, Legal, Social and Economic (ELSE) Issues would merit several papers, given the extent to which these were being actively researched. These include topics such as grid business case: sustainability and go-to-market strategies, experiences with production grids in real business, and grid sociology: how to win society over to grids. In the event, and with the impact of road maps that had emerged in the past year joining the two, the other prominent topic, The Future of Grids, merged with ELSE. Indeed, The Future holds some questions that more or less centre on social and economic issues: topics such as ‘cloud’ and on-demand/utility computing and new demands beyond technology.
Semantic Security: Specification and Enforcement of Semantic Policies for Security-driven Collaborations, by Sinnott and Doherty, reports on a project on Advanced Grid Authorisation through Semantic Technologies (AGAST) which seeks to address some of the most glaring deficiencies of typical authorisation processes when fine grained access control is necessary. The application is illustrated through projects that have already been reported in HealthGrid conferences and have attracted considerable interest. Mohammad Shahid et al, in A Robust Framework for Rapid Deployment of a Virtual Screening Laboratory, describe a framework which allows complex in silico screening workflows to be rapidly defined and efficiently executed on a grid infrastructure based on Unicore and Meta Scheduling Service. A discussion of results on the Viola/Phosphorus test bed leads to suggestions for further work. David Hoyle et al, in Shared Genomics: High Performance Computing for distributed insights in genomic medical research, consider the problem of genome-wide association studies and the need for high performance computing (HPC) to conduct the necessary statistical analyses and for annotation tools that will be needed to manage the data flows through such analyses. The relative merits of a grid infrastructure vs. clusters rapidly lead to ethical, legal and security concerns. Work towards a ‘Shared Genomics’ User Interface continues. On the other hand, Weisbecker and Falkner, in Service Engineering for Grid Services in Medicine and Life Science, explore the definition and use of services to support various paradigms of cloud or on demand computing, or on demand applications. The work is being conducted in the context of Services@mediGRID and addresses the need for a systematic way to develop services and also the need to comprehend the underlying business model in provisioning application services, especially when service customers may own or need to also be provisioned with infrastructure elements.
CORE TECHNOLOGIES AND DATA INTEGRATION
Tobias Knoch et al present The GLOBE 3D Genome Platform: Towards A Novel System-Biological Paper Tool to Integrate the Huge Complexity of Genome Organization and Function, an exploration of how to tame the three-dimensional genome problem using a system biology approach. This requires the eponymous tool of the title to integrate existing structural, analytic and regulatory views of the genome into a novel architecture. At present this is a ‘paper’ tool which allows a variety of techniques to be applied, but a release of an integrated tool is promised in the near future. In Metadata Extraction using Text Mining, Shivani Seth et al investigate the derivation and use of metadata in e-Science applications which combine multiple services to construct integrated frameworks and novel solutions. Taking numerous successful projects as exemplars, they justify and derive a method for the extraction of metadata from relevant documentation of a given service algorithm, thus collecting the necessary information for the integration of that algorithm into a new workflow. In particular, they examine the process of conversion from the statistical package R to the grid services of GridR. Ignacio Blanquer et al deal with metadata in a very different context: in Using Grid-Enabled Distributed Metadata Database to Index DICOM-SR, they examine the dichotomy between DICOM data (e.g. images) and DICOM-SR, the structured report format of the same family of standards. They specify how to create a DICOM-SR template, how to use standard grid components to share and store DICOM data and how to seek a DICOM-SR tool to validate XML descriptions of structured reports. The value of the work lies in improved efficiency for queries and updates. Further work is designed to lead to a tool that will take integrated data and the metadata catalog and from there provide support for other grid infrastructures. In XTENS – an eXTensible Environment for NeuroScience, Luca Corradi et al offer a new perspective on medical scenarios providing an integrated system to handle queries and to display results in the domain of EEG signals. In the last paper of this section, Ainsworth and Buchan discuss the issue of Preserving consent-for-consent with feasibility-assessment and recruitment in clinical studies: FARSITE architecture, to deal with the problem of consent to access records to determine whether an individual is eligible to participate in a study. It is argued that Feasibility Assessment and Recruitment System for Improving Trial Efficiency, an example e-Lab, provides better recruitment without any compromises and at the same time reduces clinician workloads.
Antje Wolf et al in DockFlow – A Prototypic PharmaGrid for Virtual Screening Integrating Four Different Docking Tools create a prototypic pharmagrid, i.e. a tool to support pharmaceutical research in silico, identifying molecular matches through ‘docking’ programs and analysing the wide variety of results generated by such methods. In particular, they integrate results from different methods used in various remote centres providing a common platform for their project partners. Matthias Assel et al continue research into ViroLab, reported in previous HealthGrid conferences, in A Collaborative Environment Allowing Clinical Investigations on Integrated Biomedical Databases. Here they create user interfaces to allow the integration of relevant data sources into ViroLab to enable investigation of its use in medical use cases, with investigation of drug effectiveness in the face of viral mutation as a particular example. In a somewhat different vein, Sebastian Canisius et al consider the Application of Grid technology for automated detection of sleep disordered breathing, a major source of ill-health in the west. The application in question identifies such sleep disorders through analysis of standard biosignals; with well known difficulties in the application of as yet unapproved grid technologies in healthcare, the project has been restricted to research and to the analysis of security, accessibility and fault tolerance of their system as a basis for further progress. In another of many MediGRID projects reporting at this conference, Kamen Beronov et al provide a grid-based tool to exploit haemodynamic simulation in Grid computing for detailed hemodynamics-simulation-based planning of endovascular interventions, essentially a virtual vascular surgery environment which allows the computation of blood pressure effects on vessels in different surgical scenarios; they go on to show how this might be used in two specific pathologies, a stenosis and an aneurysm.
Medical imaging has always been a rich source of challenges for healthgrids and the story continues in the same vein here. Frederik Orellana et al in Running Medical Image Analysis on GridFactory Desktop Grid consider a novel batch system for medical imaging which overcomes some of the traditional barriers in hospital settings by accepting and dealing with the multiple firewall problems that inevitably arise in accessing well protected systems. In the same setting at Geneva Hospitals, Xin Zhou et al in their paper An Easy Setup for Parallel Image-Processing: Using Taverna and ARC present a concrete application which uses well established workflow tools to provide relatively easy parallel processing functionality on a grid. Ralf Lützkendorf et al, on the other hand, in Enabling of Grid based Diffusion Tensor Imaging using a Workflow Implementation of FSL, consider a highly detailed technique for precise MRI imaging of nerve fibres in the brain. This has the merit of allowing in vivo research to be conducted in functional areas of the brain in order to study the relationship between certain kinds of fibre deformation and disease patterns. Silvia Olabarriaga et al are also concerned with MRI methods in brain imaging in Crossing HealthGrid Borders: Early Results in Medical Imaging but the problem they tackle is rather different. Dutch and German grid initiatives both support functional MRI research on both sides of the border, with the scientists wishing to collaborate; enabling the two grid infrastructures to work together provides the occasion of this early experiment in cross-border collaboration. Another organ which is a rich source of imaging problems for healthgrid researchers is the heart. Ketan Maheshwari et al report on their effort to provide a close to healthcare tool in Towards Production-level Cardiac Image Analysis with Grids. They consider two important cardiac image analysis problems, myocardium segmentation and motion estimation, and demonstrate the effectiveness of high level workflow for efficient and robust problem solving.
SOCIO-ECONOMICS AND THE FUTURE OF GRIDS
In studies motivated by the economic question, are healthgrids capable of sustained application in a commercially realistic healthcare environment, two studies report their findings. Alexander Dobrev et al in Economic Performance and Sustainability of HealthGrids: Evidence from Two Case Studies have investigated twenty two exemplars of healthgrids and studied two healthgrid case histories, MammoGrid and WISDOM, in depth and analysed the results. Their succinct conclusion is that “The most significant hurdle to sustainability – the discrepancy between social benefits and private incentives – can be solved by sound business models” – an encouraging message! Indeed, Stefan Scholz et al in Business Aspects and Sustainability for Healthgrids – an Expert Survey report on interviews conducted with 33 experts and concluded that (a) there are some areas of potential economic exploitation of healthgrids, and (b) the expert observations help identify a critical path to the establishment and deployment of real healthcare grids. Also in the economic sphere, Frank Dickmann et al have placed sustainability as their principal criterion of success in Perspectives of MediGRID. They ask, how do grids compare with other emerging paradigms, such as cloud computing, in their application to the life sciences? While at present the grid paradigm is a better fit, the future, as they see it, may require the creation of a ‘stock market’ for high-end computing resources to resolve the forces of supply and demand.
Hanene Rahmouni et al consider Ontology-Based Privacy Compliance on European Healthgrid Domains. The question at the heart of this work is, can high level ethical, legal and regulatory requirements be translated into operational ‘commands’ in a healthgrid environment? A simple example demonstrates the possibilities and the limitations of removing, at least as much as possible, human intervention from the operation of an effective healthgrid infrastructure. One of the ways in which medical knowledge is translated into ‘evidence-based’ practice is through so-called integrated care pathways. In the final paper of this section, Olive and Solomonides consider the potential of Variance analysis as practice-based evidence, i.e. the question how best to interpret variations from the standard pathway, adopted by clinicians in the face of real patients, as opposed to an abstract model, so as to improve the knowledge base: a problem that was first motivated by MammoGrid where the evidence base would have continued to build up from the cases considered in the project.
SHORT PAPERS & POSTERS
As well as the papers presented in the main programme of the conference, a number of short papers arose from poster presentations. These represent an interesting cross-section of imaginative applications of healthgrids.
Raúl Isea et al explore The evolution of HPV by means of a phylogenetic study by exploiting the power of a grid infrastructure and comment on the adequacy of classification systems. Zhuchkov and Tverdokhlebov report on Medical Applications for High-Performance Computers in SKIF-GRID Network, a serious attempt to establish a breast cancer healthgrid in Russia. Paul De Vlieger et al have similarly established a Grid-enabled sentinel network for cancer surveillance, in this case in the Auvergne region where there is considerable support for innovation, by linking cytology, breast cancer screening and epidemiology centres. On the other hand, Eberhard Schmitt et al in Conception of an Image Data Base for Cell Nuclei and Geometric Algorithms for Diagnosis and Therapy Monitoring consider cellular distortions brought about by genome or chromosome changes and examine the diagnostic and staging value of nucleic imaging for certain kinds of cancer.
Stefan Rüping et al, in Workflows for Intelligent Monitoring using Proxy Services, consider some aspects of the problem of translating successful healthgrid research into real healthcare use by up-scaling a proof-of-concept workflow to monitor real data streams. Ashiq Anjum et al report on Reusable Services from the neuGRID Project for Grid-Based Health Applications, a project to encompass research in Alzheimer's disease into the tradition of MammoGrid and Health-e-Child. Gaignard and Montagnat discuss A distributed security policy for neuroradiology data sharing and propose an access control policy to overcome some of the common problems of loss of control over data.
The final short paper by Tobias Knoch et al on e-Human Grid Ecology: Understanding and Approaching the Inverse Tragedy of the Commons in the e-Grid Society is a deliberately provocative invitation to a debate concerning the nature of work ‘in the grid’ and ideas from the movement Scientific Commons.
 From Grid to Healthgrid: Proceedings of Healthgrid 2005, T. Solomonides, R. McClatchey, V. Breton, Y. Legré and S. Nørager (Editors), Studies in Health Technology and Informatics Vol 112 IOS Press (2005)
 Challenges and Opportunities of Healthgrids: Proceedings of Healthgrid 2006, V. Hernández, I. Blanquer, T. Solomonides, V. Breton and Y. Legré (Editors), Studies in Health Technology and Informatics Vol 120 IOS Press (2006)
 From Genes to Personalized HealthCare: Grid Solutions for the Life Sciences: Proceedings of HealthGrid 2007, N. Jacq, Y. Legré, H. Muller, I. Blanquer, V. Breton, D. Hausser, V. Hernández, T. Solomonides and M. Hofmann-Apitius (Editors), Studies in Health Technology and Informatics Vol 126 IOS Press (2007)
 Global Healthgrid: e-Science Meets Biomedical Informatics: Proceedings of HealthGrid 2008, T. Solomonides, J.C. Silverstein, J. Saltz, Y. Legré, M. Kratz, I. Foster, V. Breton and J.R. Beck (Editors), Studies in Health Technology and Informatics Vol 138 IOS Press (2008)
 A Tribute to Jean-Claude Healy, a Free Thinker and Visionary Leader in Biomedical Informatics, Ilias Iakovidis, IMIA Yearbook of Medical Informatics 2008, Schattauer (2008)