No. 4 (2005)
Published:
2005-12-30
ARTICLES FROM THIS ISSUE
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National, regional and international interoperability of Croatian healthcare information system
Abstract
Croatian national health ICT implementation strategy is determined by Croatian national health strategy and plan, Croatian ICT development strategy for 21st century, and requirements specifications for the health information system. National health ICT implementation strategy components are accented: purpose of the ICT implementation strategy, information principles, needs and ICT enablement in domains of patients, healthcare professionals, policymakers and managers and public. Telemedicine and telecare positions and implementation steps are described. Based on the determinants, three organizational levels have been established – government, ministerial and project levels. General architecture of Croatian healthcare information system and respective pilot projects and results of pilot implementations as well as national ICT environmental accelerators for health ICT implementations are presented.
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The use of HL7 as an interoperability framework in a regional healthcare system in Greece
Abstract
The integration of information systems represents one of the most urgent priorities of a regional healthcare authority in order to meet its clinical, organizational and managerial needs. Current practice shows that the most promising approach to achieve a regional healthcare information system is to use a health level 7 (HL7) messagebased communication system implemented by an asynchronous common communication infrastructure between healthcare sites. The system is a complete and integrated information system at a regional level that comprises all types of healthcare levels, that includes interoperability issues, that covers most of the needed components, and that is able to work efficiently in a secure wide area network to ensure data privacy and confidentiality. Another important feature of the proposed solution is that it creates an interoperability framework that can be replicated from one healthcare institution to another. In that sense, common interoperability messages can be used to interconnect heterogeneous information systems. In response to this strategy, more than 10 different consortiums have submitted proposals to the Greek government and the proposed interoperability framework seems to be widely accepted as a solution to enhance information and communication technologies developments in the healthcare sector in Greece.
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An architecture for regional health information networks addressing issues of modularity and interoperability
Abstract
A fundamental pre-requisite for the establishment of a scaleable regional health information network (RHIN) is the development of an architectural framework and tools for the integration of specialized autonomous systems and e-health service platforms supported by an underlying health information infrastructure (HII). In this context, HYGEIAnet, which is the RHIN of Crete in Greece, has identified and utilized a number of critical software components enabling integrated access to clinically significant information, based on an open architecture addressing successfully the various interoperability challenges at hand. HYGEIAnet provides the framework for the reuse of standardized common components and public interfaces, thus enabling integrated and personalized delivery of healthcare.
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Wireless communication for medical applications: the HEARTS experience
Abstract
Wireless networks provide all the functionality of wire-line networks without the physical constraints of the wire itself giving an interesting alternative to phone-line and powerline wiring systems. With a wireless network, physicians can actively monitor a patient’s vital signs from anywhere in a hospital. HEARTS (health early alarm recognition and telemonitoring system) is a research project having the major aim to provide support for prevention and monitoring heart disease, based on advanced technology. The HEARTS idea is to gather biometric and environmental data coming from patients during both hospitalization phase and in their normal lifetime activities, using wireless networks. The wireless network and its composing devices are called personal health network (PHN). WPAN and WLAN technologies have been investigated, each with its pros and cons, for use in health monitoring activities inside hospitals and at home, for improving patient mobility, and to provide patients for "last interconnection hop" to the infrastructure network. Technological and operational problems have been addressed concerning bluetooth, IEEE 802.11b (WiFi), GSM/GPRS/UMTS wireless transports, all of them tested and some of them concretely adopted inside the HEARTS framework.
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A web-based system for personalized patient education and compliance monitoring
Abstract
The economic importance of therapy compliance has grown steadily in recent years, not only because of the efficacy of newer therapeutic methods but also because of the increased costs of treating the consequences of poor compliance. Improved compliance can lead to significant savings by preserving or restoring a patient’s health, improving quality of life, by reducing the number of medical services required when therapy fails or appears ineffective, and by helping limit the rise in national health care costs. Within the framework of the TEN-Telecom European Commission Programme, C-Monitor project developed an integrated health telematics platform to enhance chronic patient compliance to therapy and interactive communication with their attending physicians. The overall aim of the project was to study the potential benefits, both in clinical and financial aspects, of such innovative systems and services along cost-efficiency of care provision. The platform developed has been validated in controlled small-scale trials in a number of European countries. The Greek pilot involved installation of the system in a private hospital in Athens and the validation scenario dealt with morbid obesity patients that have undergone surgical operation. A number of 30 patients were recruited for the trial. Results of the trial indicated the technological robustness of the proposed system and the potential clinical and economic benefits of running such services. Further trials are required to better address cost-efficiency issues with respects to the service goals.
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Cost-effective health services for interactive lifestyle management: the PANACEIA-iTV and the e-Vital concepts
Abstract
Information technology applications in medicine are rapidly expanding, and new methods and solutions are evolving since they are considered pivotal in the success of preventive medicine. In this paper two different concepts will be presented, the PANACEIA-iTV and the e-Vital concept. PANACEIA-iTV is a home care service provision system based on interactive TV technology and supported by the IST programme of the European Commission. The e-Vital service, supported by the eTEN programme of the European Commission, regards an integrated home care and telemonitoring service chain aimed at large sensitive parts of the European population, the "at-risk" citizens, who are usually patients with a stable medical condition that allow a near normal life but may suddenly deteriorate and put life at risk.
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Psychological implications of the application of health state continuous monitoring systems in cardiovascular pathologies
Abstract
In recent years, specialist literature has particularly focused on the understanding of the modes of psychological adaptation to organic pathologies. A number of close investigations within the fields of medical and health psychology have been devoted to the analysis of situations characterised by a state of chronicity of organic pathology. Relying on the data deriving from such studies, the different authors tend to point out that illnesses represent a threat to the subject’s psychophysical and relational integrity, thus constituting as a source of frustration and anxiety. Researchers belonging to different theoretical approaches raise a number of questions as to the role of personality and/or the subjective mode to react to tough, stressful, unexpected, negative situations, such as the emergence of a severe physical illness. Current research approaches essentially intend to explain the individual differences in the reactivity to negative stimuli by analysing the interactions between situational attributes and personality dispositions (for instance, trait anxiety).
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Remote medical education via Internet enhanced services – the REMEDIES platform for distant training
Abstract
Continuing medical education is considered as a very important aspect in the development of skills of practicing physicians and the introduction of new concepts and developments in health care provision. Studies have shown that conventional CME techniques including self-studying and lecture attending have limited impact on clinical practices. The world wide web provides a very efficient and cost-effective delivery system for conveying anywhere and anytime multimedia information to large user groups. Although there are a number of CME web sites available today, the majority of them are static and text-based thus not offering interactive functionality and multiple content. To exploit modern telematics technologies and within the framework of the Leonardo da Vinci programme, the REMEDIES project developed an interactive web-based distance-training infrastructure. The REMEDIES system incorporates two training modules – a web-based training platform and a teleconference training platform. The system has been validated in terms of technical performance and user functionality in a controlled target group comprising of young medical doctors and medical students in the specific areas of radiology and laparoscopic surgery. The results of the trial have demonstrated the compliance of the system to the defined functional requirements and the potential usefulness to the defined training goals. Trial results have also demonstrated the need of extension of the educational material within the platform especially for the purposes of continuous education.
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Information and e-learning services for the efficient management of allergy and asthma, employing an integrated environment monitoring network
Abstract
In this paper we present a distributed telematic platform which is implemented to support health information management and innovative services to people suffering from allergies, asthma and rhinitis. The developed system establishes a trans-European information network offering specialized services to health professionals, patients and the public, by collecting, processing and distributing specialized data and informational content. An integrated monitoring and reporting system of aero-allergens is used to collect Pan-European environmental data and produce allergy maps, forecasting and danger level alerts. Informational content and e-learning resources are also consolidated and combined with personalized health management services. Through the created network, health information is supplied to sufferers via WWW and SMS technologies, and informational and learning resources are offered to health professionals. Sets of services were implemented in pilot form and offered to real users for testing purposes. The results were encouraging towards expansion to fully blown service at a Pan-European level.
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Health applications and grid technologies
Abstract
Biology and genomics in the near future will play a major role in day to day activities related with health. Today biologists and doctors work together in order to decode and analyze large amount of data extracted from the DNA analysis of proteins. Advanced health applications will be needed in order to store, retrieve, process the large amount of data – being produced today by genomics and bioinformatics analysis – in order to extract useful results in a reasonable time frame. In this paper we present the results from our research regarding the use of grid technologies with health applications. We present the current status of standardization activities and working groups, which are currently involved with the specification of health applications and the standardization of needed components such us security, functionality, etc., which are being introduced by the use of grid technologies.
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Wearable biosensing: signal processing and communication architectures issues
Abstract
Long-term monitoring of human vital signs is becoming one of the most important fields of research of biomedical engineering. In order to achieve weeks to months of monitoring, new strategies for sensing, conditioning, processing and communication have to be developed. Several strategies are emerging and show different possible architectures. This paper essentially focuses on issues in wearable biosignal processing and communication architecture currently running at the Swiss Center for Electronics andMicrotechnology (CSEM) in the framework of several European projects.
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WEALTHY – a wearable healthcare system: new frontier on e-textile
Abstract
A comfortable health monitoring system named WEALTHY is presented. The system is based on a wearable interface implemented by integrating fabric sensors, advanced signal processing techniques and modern telecommunication systems, on a textile platform. Conducting and piezoresistive materials in form of fibre and yarn are integrated in a garment and used as sensors, connectors and electrode elements. Simultaneous recording of vital signs allows extrapolation of more complex parameters and inter-signal elaboration that contribute to produce alert messages and patient table. The purpose of this publication is to evaluate the performance of the textile platform and the possibility of the simultaneous acquisition of several biomedical signals.
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Tools for health professionals within the German health telematics platform
Abstract
Shared care concepts such as managed care and continuity of care are based on extended communication and co-operation between different health professionals or between them and the patient respectively. Health information systems and their components, which are very different in their structure, behaviour, data and their semantics as well as regarding implementation details used in different environments for different purposes, have to provide intelligent interoperability. Therefore, flexibility, portability, knowledge-based interoperability and future-orientation must be guaranteed using the newest development of model driven architecture. The ongoing work for the German health telematics platform based on an architectural framework and a security infrastructure is described in some detail. This concept of future-proof health information networks with virtual electronic health records as core application starts with multifunctional electronic health cards. It fits into developments currently performed by many other developed countries. The paper introduces into the German health telematics platform and its tools based on smart card.
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Context awareness and nomadic devices featuring advanced information visualization in clinical routine
Abstract
The demand for ubiquitous and efficient information delivery is increasing rapidly, as the majority of access to professional data, information and knowledge is increasingly relying on the use of technology. Mobile workers become more efficient, if equipped with access means similarly powerful to stationary workplaces. All types of work exhibiting inherently nomadic characteristics are even more affected by these developments. Healthcare personnel in a clinical environment are definitely one of the typical examples, where the access of information is vital and bound to location. Additionally the information needs to be processed in very short periods of time. For this purpose it is of great advantage to deploy advanced information visualization technologies in order to communicate larger amounts of data in a shorter period of time. In this work, we present an IT platform, which emerged from applications in the cultural heritage domain, that can be used to deliver context-aware services and advanced visualization of information to medical personnel in a clinical environment. The location combined with usage profiles for each member of the stuff are used to make the decision about the type and amount of information as well as the visualization type delivered to the handheld devices. Along with the description of the platform and its components, two application examples/medical use cases are presented.
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Improving interpretability: combined use of LVQ and ARTMAP in decision support
Abstract
The learning vector quantization (LVQ) network was used to classify the ECG ST segment into different morphological categories. Due to the lack of data in the ST elevation categories, the classifier was only trained to identify different types of ST depressions (horizontal, upsloping and downsloping). The accuracies were 91%, 85% and 65% respectively for the training, validation and testing data respectively. Despite the low accuracy for the testing data, most of the mis-classifications were downsloping ST depression being classified as horizontal ST depression. We concluded that more data and more training are needed in order to train the LVQ to recognize other morphological types of ST deviation and to improve the accuracy.
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Methodology to measure the quality of service in healthcare information and telecommunications infrastructures
Abstract
The telecommunications industry in last decade went through the dramatic changes motivated by mobility, wireless technologies and miniaturization. The continuous increase in the complexity and the heterogeneity of healthcare telecommunications infrastructures requires reliable methodology to assess the quality of service provision. This article presents a cost effective methodology to assess the user’s perception of quality of service provision utilizing the existing Staffordshire University network by adding a component of measurement to the existing model presented by Walker. This paper offers a cost effective approach to assess the QoS provision within the University campus network, which could be easily adapted to any campus network or healthcare organization in the world.
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Stochastic DEMATEL for structural modeling of a complex problematique for realizing safe, secure and reliable society
Abstract
In this paper we propose a revised Decision Making Trial and Evaluation Laboratory (DEMATEL), called stochastic DEMATEL, to extract structural model of a complex problematique and to represent the priority of each factor taking into account the uncertainty of structure. In the stochastic DEMATEL, the uncertainty of structure is expressed as a stochastic model. From numerical experiments and experimental analyses, the following results are obtained: when the structure is uncertain, stochastic DEMATEL could extract the features of structure by the degree of dispatching influences and the degree of central role; stochastic composite importance could express the uncertainty of priority and decide the priority taking into account the attitude of the decision maker; pessimistic, neutral or optimistic.
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Personal communication services in wireless networks
Abstract
The paper presents modern personal services and new trends observed in evolution of wireless services. The article covers voice and data transmission services offered in mobile networks as well as information services delivered to users over Internet/IP networks. With reference to voice services, selected GSM services based on IN services platform, e.g., the services of flexible scenarios are described. Moreover, the status of VoIP service provided over WLAN is explained. Concerning data transmission services, selected UMTS services are presented as well. Among information services, presentation of wide scope of services offered to mobile users, e.g., messaging, location-based information, transferring text information, unified communications as well as Internet services, e.g., e-commerce, e-shopping, telebanking and micropayments is done. For both, voice and data transmission services, personal services are presented exclusively. Generally, the most attractive services with personal features are selected and described in this paper.
