Medical and Care Compunetics – The Future of Patient-Related ICT
Ladies and gentlemen, dear friends,
Welcome to our fourth event.
Thank you Andy, especially for chairing this session, which normally would have been my job. But as some of you know I’m still recovering from a quite serious chemotherapy and my energy level is not yet back to what it should be.
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Luis Kun
Senior Research Professor of Homeland Security at the IRM College of the National Defense University; Fort McNair, USA
On June 14, 2006 three reports were published by the Institute of Medicine (IOM) in regards to “THE FUTURE OF EMERGENCY CARE IN THE UNITED STATES HEALTH SYSTEM”. The three combined reports: Hospital-Based Emergency Care at the Breaking Point, Emergency Medical Services at the Crossroads and Emergency Care for Children Growing Pains, are a clear reflection of the state we currently face, even without a major disaster. Some key findings drawn from all three reports showed that the emergency care system is ill-prepared to handle a major one. For example, many of the 41 million citizens who do not have medical insurance end up using the Emergency Departments (ED) as their source of “regular” care and many of these EDs are at or over capacity, there is little surge capacity for a major event, whether it takes the form of a natural disaster, disease outbreak, or terrorist attack. If we had during the major disaster event, a “contagion” element, i.e. pandemic flu, then the problem would be even more complicated, since the “regular” hospital patient population would need to be isolated from these patients. If we add to this equation the length of time involved in the “current” process of vaccine creation and production (i.e. the volume of vaccines that would be required to be provided to the citizens of the world), the scenario does not look to promising. A new model is needed then to address these requirements. In the developed world we have a number of devices (e.g., radio, TV, Computers, telephones, mobile devices, etc.) and infrastructure (e.g., cable, wireless networks, etc.) that are already supplying the homes and the individuals with a large number of independent applications and different types of information. These stovepipes or independently developed family that include: tele-banking, Telehealth, tele-education, e-commerce, entertainment on demand, etc. when “connected” as an integrated set, may provide an ideal environment, where families may stay at home for a long period of time (quarantine) and would have all the mechanisms in place for getting food and water from supermarkets, drugs from the pharmacy, the children would be able to go to school from home (in turn their school grounds may become temporary hospitals), adults could telecommute to work and minor conditions could be consulted and treated through these systems (with the help of a Telehealth platform that would include electronic health records), etc.
Dipak Kalra a & Bernd Blobel b
a CHIME – Centre for Health Informatics and Multiprofessional Education, University College London, United Kingdom
b eHealth Competence Center, University of Regensburg Medical Center, Regensburg, Germany
This paper describes the challenges that are being tackled and those that remain to be addressed if we are to enable electronic health record information to be shared seamlessly and meaningfully. This goal is known as semantic interoperability, and is needed if computational services are to be able to interpret safely clinical data that has been integrated from diverse sources. Based on sustainable architectural approaches, the paper describes the clinical case for consistently expressed clinical meaning within electronic health records, in particular where computers rather than humans need to be able to process EHR data safely. It outlines the main kinds of information and knowledge artefact that are used to represent meaning within EHRs, and considers for each its role and limitations. The problems that arise with trying to use terminology consistently with EHR reference models is explored, together with the implications for designing EHR archetypes. Examples are given of situations where a diversity of options exists for how to represent compound (multi-part) clinical expressions. Recommendations are made for the kinds of change that are needed both in record structures and in terminology systems to minimise this diversity and thereby aid semantic interoperability.
Catherine Quantin a, François André Allaert b, Maniane Fassa a, Benoít Riandey c, Paul Avillach d,e, Olivier Cohen f
a Service de Biostatistique et Informatique Médicale, CHU de Dijon, France
b Department of Epidemiology and Biostatistics, Mc Gill University, Montreal Canada
c Institut National d’Etudes Démographiques (INED), Paris, France
d LERTIM Faculté de Médecine Université de la Méditerranée, Marseille, France
e ISPED Université Victor Segalen Bordeaux II, Bordeaux, France
f HC Forum, Meylan, France
The multiplication of the requests of the patients for a direct access to their Medical Record (MR), the development of Personal Medical Record (PMR) supervised by the patients themselves, the increasing development of the patients’ electronic medical records (EMRs) and the world wide internet utilization will lead to envisage an access by using technical automatic and scientific way. It will require the addition of different conditions: a unique patient identifier which could base on a familial component in order to get access to the right record anywhere in Europe, very strict identity checks using cryptographic techniques such as those for the electronic signature, which will ensure the authentication of the requests sender and the integrity of the file but also the protection of the confidentiality and the access follow up. The electronic medical record must also be electronically signed by the practitioner in order to get evidence that he has given his agreement and taken the liability for that. This electronic signature also avoids any kind of post-transmission falsification. This will become extremely important, especially in France where patients will have the possibility to mask information that, they do not want to appear in their personal medical record. Currently, the idea of every citizen having electronic signatures available appears positively Utopian. But this is yet the case in eGovernment, eHealth and eShopping, world-wide. The same was thought about smart cards before they became generally available and useful when banks issued them.
Diego M. Lopez & Bernd G.M.E. Blobel
eHealth Competence Center Regensburg, University of Regensburg Medical Center, Germany
Improving public health services requires comprehensively integrating all services including medical, social, community, and public health ones. Therefore, developing integrated health information services has to start considering business process, rules and information semantics of involved domains. The paper proposes a business and information architecture for the specification of a future-proof national integrated system, concretely the requirements for semantic integration between public health surveillance and clinical information systems. The architecture is a semantically interoperable approach because it describes business process, rules and information semantics based on national policy documents and expressed in a standard language such us the Unified Modeling Language UML. Having the enterprise and information models formalized, semantically interoperable Health IT components/services development is supported.
Stefan Schulz and Holger Stenzhorn
Department of Medical Informatics, Freiburg University Hospital, Germany
We present ten principles for clinical ontologies that describe the authors’ opinion about what should be understood by the notion of clinical ontologies and what not. In contrast to clinical terminology systems, clinical ontologies are considered to be semantic reference systems and for that – first of all – strive to account for the properties of the domain entities themselves and their proper formal definitions – rather than just linking clinical terms together.
Peter Pharow a, Bernd G.M.E. Blobel a and Mario Savastano b
a eHealth Competence Center, University of Regensburg Medical Center, Germany
b National Research Council of Italy, Naples, Italy
Communication and cooperation processes in the growing healthcare and welfare domain require a well-defined set of security services provided by a standards-based interoperable security infrastructure. Any communication and collaboration procedures require a verifiable purpose. Without such a purpose for communicating with each other, there’s no need to communicate at all. But security is not the only aspect that needs to carefully be investigated. More and more, aspects of safety, privacy, and quality get importance while discussing about future-proof health information systems and health networks – regardless whether local, regional and national ones or even pan-European networks. The patient needs to be moved into the center of each care process. During the course of the current paradigm change from an organization centered via a process-related to a person-centered healthcare and welfare system approach, different new technologies need to be applied in order to meet the new challenges arising from both legal and technical circumstances. International organizations like WHO, UNESCO and the European Parliament increasingly aim at enhancing the safety aspect in future care settings, and so do many projects and studies. Beside typical information and communication devices, extended use of modern IT technology in healthcare and welfare includes large medical devices like, e.g., CT, X-ray and MR but also very tiny devices like sensors worn or implemented in a person’s clothing. Safety gets on top of the nations priority list for several reasons. The paper aims at identifying some of these reasons along with possible solutions on how to increase patient’s awareness, confidence, and acceptance in future care settings.
Bernd Blobel and Peter Pharow
eHealth Competence Center, University of Regensburg Medical Center, Regensburg, Germany
While health systems in developed countries and increasingly also in developing countries are moving from organisation-centred to person-centred health service delivery, the supporting communication and information technology is faced with new risks regarding security and privacy of stakeholders involved. The comprehensively distributed environment puts special burden on guaranteeing communication security services, but even more on guaranteeing application security services dealing with privilege management, access control and audit regarding social implication and connected sensitivity of personal information recorded, processed, communicated and stored in an even internationally distributed environment.
Frank Oemig a and Bernd G.M.E. Blobel b
a Agfa HealthCare / GWI Medica GmbH, Bonn, Germany,br /> b eHealth Competence Center, University of Regensburg Medical Center, Germany
Communication and cooperation between different applications is mediated by interfaces following corresponding standards. The interpretation of standards, the understanding of requirements and specification of solutions is very different within the vendor community. In a shared care environment based on extended inter-organizational inter-relationships, this interoperability has to be provided at semantic and service-oriented level. For that purpose, harmonized reference models, agreed terminologies, ontologies and concept representations as well as a unified development and deployment process have to be standardized. The latter also includes testing and certification procedures. The paper shortly introduces in the semantic interoperability approach provided by HL7.
Wouter J. Meijer M.D. a, Peter L. Ragetlie M.Sc b
a Partner ICTUS Netwerk
b Partner ICTUS Netwerk, member NEN standardization committee in the Health Care Sector
For the patient, ICT is a resource that helps the individual to cope with illness. On the basis of in depth interviews with diabetic patients, their desired coping strategies that relate to communication and information were identified. The strategies fall into the following categories: Contact with fellow-patients, Care (choice of care, control of care and control of information) and social environment. Patient empowerment by ICT means that ICT enables the patient to cope with illness. A number of ICT-tools currently available for patients were analyzed on the aspect of patient empowerment. Findings are that most tools provide little support for patients’ coping behaviour in choice (of treatment and caregiver), control of care and control of information (by the patient).
This lack of effective instrumental support for a patient’s coping and empowerment is not explained by technical restraints, but by the dominance on the supply side in healthcare. To meet the neglected needs of patients, caregivers would have to adapt the organisation of their work. Examples of success in applying ICT/Telemedicine are given. The structural impediments for patient empowerment must be further clarified and removed or minimised.
Itamar Shabtai a Ph.D., Moshe Leshno b M.D., Ph.D., Orna Blondheim c M.D., Jonathan Kornbluth d Ph.D.
a College of Management Academic Studies
b Tel Aviv University
c Clalit Healthcare Services – HMO
d Hebrew University of Jerusalem
With their ever-growing importance and usability, the healthcare sector has been investing heavily in medical information systems in recent years, as part of the effort to improve medical decision-making and increase its efficiency through improved medical processes, reduced costs, integration of patients’ data, etc. In light of these developments, this research aims to evaluate the contribution of information technology (IT) to improving the medical decision-making processes at the point of care of internal medicine and surgical departments and to evaluate the degree to which IT investments are worthwhile.
This has been done by assessing the value of information to decision-makers (physicians) at the point of care by investigating whether the information systems improved the medical outcomes. The research included three steps (after a pilot study) – the assessment of the subjective value of information, the assessment of the realistic value of information, and the assessment of the normative value of information, the results of each step being used as the starting assumptions for the following steps. Following a discussion and integration of the results from the various steps, the results of the three assessment stages were summarized in a cost-effectiveness analysis and an overall return on investment (ROI) analysis. In addition, we tried to suggest IT strategies for decision-makers in the healthcare sector on the advisability of implementing such systems as well as the implications for managing them.
This research is uniquely pioneering in the manner in which it combines an assessment of the three kinds of measures of value of information in the healthcare environment. Our aim in performing it was to contribute to researchers (by providing additional insight into the fields of decision theory, value of information and medical informatics, amongst others), practitioners (by promoting efficiency in the design of new medical IS and improving existing IS), physicians (by enhancing the efficient use of information resources), patients (by improving healthcare services) and policy decision-makers in the healthcare sector (regarding the advisability of investments in such systems and suggestions for managing them).
Roxana ANTOHI a, Cristina OGESCU a, Livia STEFAN b, Mircea RAUREANU c, Mircea ONOFRIESCU d, Marius TOMA d
a The Company for Research, Development, Engineering and Manufacturing for Automation Equipment an Systems -IPA SA, Bucharest Romania
b Institute for Computers- ITC SA, Bucharest Romania
c National Institute for R&D in Informatics – ICI, Bucharest Romania
d University of Medicine of Iassy Romania
The paper describes a research-development which had the objective to implement and manage the Electronic Patient Record in a multifunctional pilot platform named PROMED. The Electronic Patient Record implemented by PROMED platform is mainly aimed to facilitate both patient and health providers access to the health records and to provide an optimization of diagnostic and decision in healthcare services based on patients’ medical history and medical statistics. The project promotes modern information and communication technologies for increasing quality and efficiency of healthcare services in an information based society. The PROMED platform is expected to contribute specifically to the improvement of the healthcare services in Romania by offering a solution for the integration of the main stakeholders involved in national healthcare system: patients, health service providers and public health authorities. The pilot system is first implemented in the “Cuza Voda” Obstetrics and Gynaecology Hospital in Iassy, an important universitary and cultural city in the North East of Romania.
H.R. Singh and V.R. Singh
Biomedical Measurements and Standards Group National Physical Laboratory, India
The impact of technological advancement and the widespread availability of resources and their utilization, to meet the health care requirements of the community, an important fundamental need of the human being. After food and shelter is discussed. Some of the most sought criteria relating to the technology selection and the practice management are devised and proposed for their implementation to achieve quality health, particularly in the rural areas. An insight into the government policies, programs and as a result, the impact on the ultimate goal of achieving the desired health care, mainly during the last two decades is covered here. A model of health care for remote areas is proposed here to assist in the improvement of the conditions of better health care and better quality of life of the human being.
Ranko Stevanovic a, Vinko Kojundzic b, Galibedin Galijasevic c
a Croatian National Institute of Public Health, Croatia
b Maticnjak Ltd, Croatia
c ABA informatika Ltd, Croatia
Croatian national primary healthcare ICT Implementation strategy is determined by Croatian national health strategy and plan, Croatian ICT development strategy for 21st century, and requirements specifications for the heath information system. National primary healthcare ICT implementation strategy components are accented: purpose of the ICT implementation strategy, information principles, need and ICT enablement in domains of patients, healthcare professionals, policy-makers and managers and public. Based on the determinants, three organizational levels have been established – government, ministerial and project levels. General architecture of Croatian primary healthcare information system and its implementation as well as national ICT environmental accelerations for national primary healthcare ICT environmental accelerators for health ICT implementations are presented.
Steve Chi-Hung Lu
CCR Exchange, Inc., USA
This document demonstrates how we use open source software in building an Internet healthcare community around an emerging Personal Health Record standard called Continuity of Care Record (CCR) format, and how members of the community can share healthcare information securely and efficiently while retaining total privacy.
Judith Symonds a, David Parry a,b and Jim Briggs b
a School of Computing and Mathematics, Auckland University of Technology, New Zealand
b School of Computing, University of Portsmouth, United Kingdom
Radio-frequency Identification (RFID) offers a potentially flexible and low cost method of locating objects and tracking people within buildings. RFID systems generally require less infrastructure to be installed than other solutions but have their own limitations. As part of an assisted living system, RFID tools may be useful to locate lost objects, support blind and partially sighted people with daily living activities and assist in the rehabilitation of adults with acquired brain injury. This paper outlines the requirements and the role of RFID in assisting people in these three areas. The development of a prototype RFID home support tool is described and some of the issues and challenges raised are discussed. The system is designed to support assisted living for elderly and infirm people in a simple, usable and extensible way in particular for supporting the finding and identification of commonly used and lost objects such as spectacles. This approach can also be used to extend the tagged domain to commonly visited areas, and provide support for the analysis of common activities, and rehabilitation.
Massimiliano Testa and John Pollard
Department of Electronic and Electrical Engineering, University College London
Each patient is supplied with a smart-card containing a Radio Frequency IDentification (RFID) chip storing a unique identification code. The patient places the Smart-card on a pill-dispenser unit containing an RFID reader. The RFID chip is read and the code sent to a Base-station via a wireless Bluetooth link. A database containing both patient details and treatment information is queried at the Base-station using the RFID as the search key. The patient’s treatment data (i.e., drug names, quantities, time, etc) are retrieved and sent back to the pill-dispenser unit via Bluetooth. Appropriate quantities of the required medications are automatically dispensed, unless the patient has already taken his/her daily dose. Safe, confidential communication and operation is ensured.
Manuel Prado, Laura M. Roa
Biomedical Engineering Group, Network Center of Biomedical Research in Bioengineering, Biomaterials and Nanomedicine (CIBER-TEC) and University of Seville, Spain
Despite first written references to permanent developmental stuttering occurred more than 2500 years ago, the mechanisms underlying this disorder are still unknown. This paper briefly reviews stuttering causal hypothesis and treatments, and presents the requirements that a new stuttering therapeutic device should verify. As a result of the analysis, an adaptive altered auditory feedback device based on a multimodal intelligent monitor, within the framework of a knowledge-based telehealthcare system, is presented. The subsequent discussion, based partly on the successful outcomes of a similar intelligent monitor, suggests that this novel device is feasible and could help to fill the gap between research and clinic.
Adie C.M. Dumay
TNO Quality of Life, The Netherlands
Innovation is essential to improve accessibility, effectivity and efficiency of healthcare delivery. eHealth promises these improvements provided that it complies to essential requirements with respect to quality and patient safety. eHealth must be implemented thoughtfully to yield full benefit to the patient. However, there exists no structured framework of essential requirements to guide development, implementation and usage. The scope of application of eHealth is wide and new technology is introduced continuously. So, the framework of essential requirements must evolve as well to support and encourage innovation. The author proposes a process for continuous verification and validation of eHealth throughout development, implementation and use and a method to continuously update the framework of essential requirements.
F.J.M. Meiland a, A. Reinersmann a, B. Bergvall-Kareborn b, D. Craig c , F. Moelaert d, M.D. Mulvenna e , C. Nugent e , T. Scully b, J.E. Bengtsson b, R.M. Dröes a
a Dept. of Psychiatry, Alzheimer Centre, VU University medical centre/GGZ Buitenamstel, The Netherlands
b Centre for Distance-Spanning Healthcare, Lulea University of Technology, Sweden
c Division of Belfast City Hospital/ Queen’s University, Division of Psychiatry and Neuroscience, Belfast, Northern Ireland
d Telematica Instituut, The Netherlands
e University of Ulster, Shore Road, Northern Ireland
Dementia is a progressive, chronic disease affecting 5% of all persons above 65 and over 40% of people over 90. The aim of the COGKNOW project is to achieve a breakthrough with research that addresses the needs of those with dementia, particularly those with mild dementia living in the community. This entails cognitive reinforcement in four main areas: helping people to remember, helping to maintain social contact, helping with performing daily life and recreational activities and finally enhance feelings of safety. Based on a sound foundation of needs reported in dementia literature, workshops and individual interviews have been carried out with dementia sufferers and their carers in three European countries. A ranked analysis of information from workshops and interviews, and the state of the art of successful ICT solutions will be the basis for formulating the functionalities of the technical solution and for the development of a cognitive prosthetic device with associated services for people with mild dementia. The research and evaluation will be conducted from human factors, technology, and business perspectives in three phases of one year each.
In this paper we discuss the design of the COGKNOW project, the first results of the user needs inquiry workshops and the ICT solutions the COGKNOW project will focus on in the first year.
