HEALTHINF 2011 Abstracts

Full Papers Short Papers
Full Papers
Paper Nr: 7
Title:

SEMANTIC PROCESS MINING FOR THE VERIFICATION OF MEDICAL RECOMMENDATIONS
Authors:

M. A. Grando, M. H. Schonenberg and W. van der Aalst
Abstract: The dissemination of best medical practices should contribute to a higher quality of care. Because natural language specifications can be ambiguous, their miss interpretation can lead to all kinds of errors. Here we propose a declarative approach for precisely defining medical recommendations. We also propose an approach based on semantic process mining to verify that an arbitrary Computer Interpretable Guideline (CIG) complies with the medical recommendations. Taking into account that some medical recommendations are critical, our work can be seen as a contribution to the design of safer CIGs. Moreover, we introduce some novel strategies to take full advantage of the information provided by the semantic conformance checker in order to: 1) suggest scenarios than could lead to violations of the medical constraints in the CIG and, 2) estimate how flexible is the CIG with respect to the medical recommendations used as starting point.
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Paper Nr: 9
Title:

i-m-Walk - Interactive Multimedia Walking-Aware System
Authors:

Meng-Chieh Yu, Cheng-Chih Tsai, Shih-Ta Liu, Hao-Tien Chiang, Ying-Chieh Tseng, Wei-Ting Chen, Wan-Wei Teo, Mike Y. Chen, Ming-Sui Lee and Yi-Ping Hung
Abstract: i-m-Walk is a mobile application that uses pressure sensors in shoes to visualize phases of footsteps. Through a mobile device, it will raise the awareness for the user to improve his walking behaviour. As an example application in slow technology, we use i-m-Walk to help beginners to learn “walking meditation,” a type of meditation where users aim to be as slow as possible in taking pace, and to land every footstep with toes first. In our experiment, we asked 30 participants to learn walking meditation over a period of 5 days; the experimental group used i-m-Walk from day 2 to day 4, and the control group did not use it. The results showed that i-m-Walk could effectively assist beginners in slowing down the walking speed and while decreasing the incorrect rate of pacing during walking meditation. To conclude, this study may serve as a key in providing a mechanism to assist users to better understand his pacing and walking habits. In the future, i-m-Walk could be used in other applications, such as walking rehabilitation.
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Paper Nr: 33
Title:

A MOBILE APPLICATION ACCESSING PATIENTS’ HEALTH RECORDS THROUGH A REST API - How REST-Style Architecture can Help Speed up the Development of Mobile Health Care Applications
Authors:

Francois Andry, Lin Wan and Daren Nicholson
Abstract: Mobile devices offer new ways for users to access health care data and services in a secure and user-friendly environment. These new applications must be easy to create, deploy, test and maintain, and they must rely on a scalable and easily integrated infrastructure. In this paper we present the motivations and technical choices for creating a REST API integrated with a mobile application (iPhone/iPad) that offer physicians, access to their patients’ health records via a community, regional or state Health Information Exchange (HIE). We describe the architecture of the system, including how we address security and privacy concerns, the REST API operations and HL7 subset data format used for lab results and observations. We also explain why the early use of unit tests and integration tests were essential to the success of the project.
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Paper Nr: 42
Title:

PATIENT-BASED LITERATURE RETRIEVAL AND INTEGRATION - A Use Case for Diabetes and Arterial Hypertension
Authors:

Ana Jimenez-Castellanos, Izaskun Fernández, David Perez-Rey, Elisa Viejo, Francisco Javier Díez, Xabier García de Kortazar, Miguel García-Remesal, Víctor Maojo, Antonio Cobo and Francisco del Pozo
Abstract: Specialized search engines such as PubMed, MedScape or Cochrane have increased dramatically the visibility of biomedical scientific results. These web-based tools allow physicians to access scientific papers instantly. However, this decisive improvement had not a proportional impact in clinical practice due to the lack of advanced search methods. Even queries highly specified for a concrete pathology frequently retrieve too many information, with publications related to patients treated by the physician beyond the scope of the results examined. In this work we present a new method to improve scientific article search using patient information. Two pathologies have been used within the project to retrieve relevant literature to patient data and to be integrated with other sources. Promising results suggest the suitability of the approach, highlighting publications dealing with patient features and facilitating literature search to physicians
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Paper Nr: 46
Title:

A CHALLENGE FOR HEALTHCARE WEB APPLICATIONS - From Data- to Process-Orientation
Authors:

Martin Schmollinger, Friedemann Iwanowski, Timo Kußmaul, David Schwarting, Julian Stark, Eric Stricker and Marcus Rall
Abstract: In recent years web applications have evolved from pure data-centric towards complex process-based applications that involve multiple users, organizations and systems. Web applications in the area of healthcare have been particularly affected by this evolution. New process-oriented technologies like business process management systems were used for the development of such web applications. They facilitate the implementation of the processes by providing tools for the process design, execution, administration and integration and guarantee performance and scalability. However, most web applications are implemented conventionally and therefore, cannot take advantage from these new technologies. What they are lacking is a methodology for converting conventionally implemented, intrinsically process-oriented web applications to process-oriented platforms. In the following article, a methodology is introduced that shows how web applications may be re-engineered towards process-oriented platforms. Furthermore, the relevance of this methodology to solve the challenges arising in a concrete web application in the area of healthcare, specifically incident reporting in hospitals, is outlined.
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Paper Nr: 53
Title:

AN AUTONOMIC COMPUTING FRAMEWORK FOR SELF-MANAGED EMERGENCY DEPARTMENTS

Authors:

Serene Almomen and Daniel Menascé
Abstract: The delivery of cost-effective and quality Emergency Department (ED) services remains an important and ongoing challenge for the healthcare industry. ED overcrowding has become a common problem in hospitals around the world, threatening the safety of patients who rely on timely emergency treatment. Despite numerous advances in medical procedures and technologies, EDs continue to experience overcrowding problems. The combination of increased demand and diminished resources makes optimizing emergency departments a difficult problem for healthcare decision makers. We examine this problem by applying an autonomic computing framework for self-managed emergency departments to maintain optimal Quality of Service (QoS) during its operation. Our work has potential implications in guiding a hospital’s effort to optimize their emergency department system.
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Paper Nr: 81
Title:

INFORMATION SECURITY IN HEALTH CARE - Evaluation with Health Professionals
Authors:

Robin Krens, Marco Spruit and Nathalie Urbanus-van Laar
Abstract: Information security in health care is a topic of much debate. Various technical and means-end oriented approaches have been presented over the years, yet have not shown to be sufficient. This paper outlines an alternative view and approaches medical information security from a health professional’s perspective. The Information Security Employee’s Evaluation (ISEE) is presented to evaluate and discuss medical information security with health professionals. The ISEE instrument consists of seven dimensions: priority, responsibility, incident handling, functionality, communication, supervision and training and education. The ISEE instrument can be used to better understand health professional’s perception, needs and problems when dealing with information security in practice. Following the design science approach, the ISEE instrument was validated within a focus group of security experts and pilot tested as workshops across five hospital departments in two medical centers. Although the ISEE instrument has by no means the comprehensiveness of existing security standards, we do argue that the instrument can provide valuable insights for both practitioners and research communities.
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Paper Nr: 100
Title:

UNDERSTANDING MEDICINE 2.0 - Social Network Analysis and the VECoN System
Authors:

Sam Stewart and Syed Sibte Raza Abidi
Abstract: Web 2.0 provides new and valuable tools to the world of medicine, and Social Network Analysis (SNA) can provide insight into how these communication networks function. This paper explores the potential for SNA methods to explain the communication patterns in the Pediatric Pain Mailing List, including identifying content experts and isolating potential subgroups of interest. These results are incorporated into VECoN, a novel network visualization designed to improve the standard network exploration process by presenting the network graphically and incorporating SNA statistics into the presentation.
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Paper Nr: 109
Title:

NUCLEAR MEDICINE IMAGE MANAGEMENT SYSTEM FOR STORAGE AND SHARING BY USING GRID SERVICES AND SEMANTIC WEB
Authors:

Daniela Giordano, Carmelo Pino, Concetto Spampinato, Marco Fargetta and Angela Di Stefano
Abstract: Large amounts of images (SPECT, PET, scintigraphy) in the nuclear medicine field have been routinely produced in the last decades. In this paper we propose an image management system that allows nuclear medicine physicians to share the acquired images and the associated metadata both locally (i.e. within the same medical institute) and globally with other nuclear medicine physicians located anywhere in the world by using GRID services for data (LFC) and metadata (AMGA) storage. The proposed system guarantees medical data protection by anonymization that removes most sensitive data for unauthorized users, and encryption, that guarantees data protection when it is stored at remote sites. Another important issue is that often nuclear medicine data is associated with other medical data (e.g. neurological data) for diagnosis and therapy follow-up. In order to correlate images with other clinical information, the common metadata are enriched by developing a controlled vocabulary, which integrates known standards such as FOAF, CCR and GeneOntology. All the metadata are stored in an RDF (Resource Description Framework) repository in order to make the system fully compatible with existing metadata storage systems following the semantic web’s philosophy.
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Paper Nr: 112
Title:

A SECURITY ARCHITECTURE FOR ACCESSING HEALTH RECORDS ON MOBILE PHONES
Authors:

Alexandra Dmitrienko, Zecir Hadzic, Hans Löhr, Marcel Winandy and Ahmad-Reza Sadeghi
Abstract: Using mobile phones to access healthcare data is an upcoming application scenario of increasing importance in the near future. However, important aspects to consider in this context are the high security and privacy requirements for sensitive medical data. Current mobile phones using standard operating systems and software cannot offer appropriate protection for sensitive data, although the hardware platform often offers dedicated security features. Malicious software (malware) like Trojan horses on the mobile phone could gain unauthorized access to sensitive medical data. In this paper, we propose a complete security framework to protect medical data (such as electronic health records) and authentication credentials that are used to access e-health servers. Derived from a generic architecture that can be used for PCs, we introduce a security architecture specifically for mobile phones, based on existing hardware security extensions. We describe security building blocks, including trusted hardware features, a security kernel providing isolated application environments as well as a secure graphical user interface, and a trusted wallet (TruWallet) for secure authentication to e-health servers. Moreover, we present a prototype implementation of the trusted wallet on a current smartphone: the Nokia N900. Based on our architecture, health care professionals can safely and securely process medical data on their mobile phones without the risk of disclosing sensitive information as compared to commodity mobile operating systems.
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Paper Nr: 122
Title:

EEG AND ECG CHARACTERISTICS OF HUMAN SLEEP COMPOSITION TYPES
Authors:

Amro Khasawneh, Sergio A. Alvarez, Carolina Ruiz, Shivin Misra and Majaz Moonis
Abstract: Unsupervised clustering of staged human polysomnographic recordings reveals a hierarchy of sleep composition types described primarily by sleep efficiency and slow wave sleep content. Associations are found between these sleep clusters and health-related variables including BMI, smoking habits, and heart disease, showing that sleep types correspond to objective and medically relevant groupings. The present work describes the sleep type hierarchy, and studies the EEG and ECG correlates of sleep composition type. It is found that measures of EEG variation such as δ, θ, and α spectral content, as well as average heart rate, and measures of heart rate variability, including the standard deviation of the sequence of RR intervals, and Hjörth activity and mobility of the ECG signal, differ significantly among sleep composition type clusters. EEG analysis is shown to allow approximate reconstruction of sleep type without the need for ECG data, while ECG alone is found to be insufficient for accurate sleep type classification.
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Paper Nr: 123
Title:

iBALANCE - Hardware and Software Design for a Mobile Diagnostic Device that Assesses Human Balance
Authors:

Qian Yang, Bradford Diephuis, Virginia Chu and Katharine E. Forth
Abstract: Balance deterioration is a major risk factor for falling, particularly among the elderly. Early detection of emerging balance problems can allow behavioral and medical interventions to reduce the impact and severity of balance-related incidents. The iBalance technology presents a small, mobile platform that integrates hardware and software engineering for balance monitoring at a low cost for use in the home, physical therapy office, or other point of care setting. The hardware solution has the form factor of a bathroom scale and takes the standard approach of a force plate with four load cells arranged in the corners beneath the platform. The load cells output 12-bit data to a computing device running the accompanying software. There is less scientific consensus about the most effective software solution for performing analysis on balance data. A survey of the literature reveals 16 commonly used metrics of balance derived from force plate data. Using principal component analysis, we identify three underlying clusters of metrics from which a representative metric for each cluster may be chosen to construct an exogenous balance score. Finally, we have developed a graphical user interface for the iBalance that allows researchers to collect raw and/or processed data and view analytic visualizations of the data, with ease of extensibility for further research and analysis.
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Paper Nr: 128
Title:

iTrem
Authors:

Robert Delano, Brian Parise and Leanne West
Abstract: iTrem is an iPhone application that uses the phone’s built-in accelerometers to collect frequency and amplitude data of hand tremor in people with Essential Tremor, Parkinson’s Disease, and other neurological conditions. iTrem makes it possible to take frequent tremor data samples from a subject and communicate it in real time to a doctor or researcher independent of the subject’s location. Aggregating the tremor data collected by iTrem provides a way for patients, doctors and researchers to collaborate on a grand scale, possibly shedding light on new avenues of treatment and therapy.
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Short Papers
Paper Nr: 5
Title:

CONTEXT-AWARE SECURITY IN CLOUD EMERGENCY MEDICAL SERVICES
Authors:

Vassiliki Koufi, Flora Malamateniou and George Vassilacopoulos
Abstract: Recently, there has been a remarkable upsurge in activity surrounding the adoption of Personal Health Records (PHRs). Since PHRs contain global patient information and not certain pieces collected by individual healthcare providers, they can be used as basic infrastructures for building and operating several important systems for both healthcare and the tax payers. Emergency medical systems (EMS) are among the most crucial ones as they involve a variety of activities which are performed from the time of a call to an ambulance service till the time of patient’s discharge from the emergency department of a hospital and are closely interrelated so that collaboration and coordination becomes a vital issue for patients and for emergency healthcare service performance. This paper is concerned with the development of a PHR-based EMS in a cloud computing environment and focuses on the security aspect of delivering this particular service. Although cloud-based services can prove important in healthcare delivery, the inherent nature of medical service delivery underscores the need for ensuring that data security is better maintained. Moreover, high expectations for emergency care delivery can be achieved only if provider organizations select systems with the appropriate features, security being among the most prominent ones. Thus, the proposed EMS system comes with a suitable security mechanism in order to ensure secure access to medical information when and where needed. To this end, context-aware authorization has been embedded into the emergency care process, enabling authorization to be based not only on static rules and roles but also to be influenced by the process execution context to ensure precise and tight access control.
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Paper Nr: 6
Title:

SOFTWARE-ASSISTED IMPROVEMENT OF SURGICAL MANAGEMENT AT CARLOS HAYA REGIONAL UNIVERSITY HOSPITAL IN MALAGA, SPAIN
Authors:

Julio Díaz, Juan Cano, Adolfo Jiménez and Antonio Alonso
Abstract: This paper reports the features of a computer program (AQuA) developed to improve surgical management at the Carlos Haya Regional University Hospital in Málaga, Spain. Several factors have forced the development of this digital solution: i) our hospital is made of four buildings some 5 km apart, ii) there are 41 operating rooms attended by 319 surgeons and 72 anaesthesiologists and, most important, iii) some predefined pathologies are protected by law in our region and have a guaranteed limited waiting time (LWT) before surgery. In this complex milieu our program was conceived, developed and put to work. It has been running for just over a year with progressive implementation in surgical departments. Some facts that seem to indicate the usefulness of the program: the number of patients with diseases with LWT that have received operations has increased in 14 months from 1,145 to 1,564 patients/month (36.59% increase) and surgical performance has increased from 65.93% to 71.80% in the same period. Since all other conditions related to surgical activity have remained unchanged the improvement seems to be attributable to the AQuA program. AQuA is a comprehensive, flexible, friendly and open program capable of dealing with most hospital settings.
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Paper Nr: 28
Title:

FUNCTIONAL STATUS AND THE EYE-TRACKING RESPONSE - A Data Mining Classification Study in the Vegetative and Minimaly Conscious States
Authors:

A. Candelieri, F. Riganello, D. Cortese and W. G. Sannita
Abstract: Eye-tracking is defined as the “pursuit eye movement or sustained fixation that occurs in direct response to moving or salient stimuli”; it is a key descriptor of the evolution from the vegetative (VS) to the minimally conscious (MCS) state and predicts better outcome. In this study, several physiological parameters (such as heart beat, Galvanic Skin Response [GSR], Blood Volume Pulse [BVP], respiratory rate and amplitude) were recorded while a medical examiner searched for eye-tracking by slowly moving a visual stimulus horizontally and vertically in front of the subject. Seven patients in VS and 8 in MCS were studied. The Heart Rate Variability (HRV) was analyzed to obtain time and frequency descriptors. Different classification methods were adopted to search for a plausible relationship between the subject psycho-physiological state and observable eye-tracking to stimuli. The performance of different classifiers was computed as Balanced Classification Accuracy (BCA) and evaluated through suitable validation technique. A Support Vector Machine (SVM) classifier provided the most reliable relationship: BCA mean was about 84% on fold cross validation and about 75% on an independent test set of 6 patients (3 VS and 3 MCS).
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Paper Nr: 32
Title:

THE IMPORTANCE OF SYSTEM INTEGRATION IN INTENSIVE CARE UNITS - A Review
Authors:

Rui Fonseca and Pedro Pereira Rodrigues
Abstract: Due to the severity of patients treated in the intensive care units, these units are commonly equipped with a variety of equipment that is handled by a multidisciplinary team. In order to identify problems, present and future, clinicians perform periodic assessments that produce huge amount of data, which availability is of vital importance. This study was performed in order to assess the impact of clinical data centralized in a clinical information system for inpatients in an intensive care unit, when compared with data disseminated in different systems. A literature search was conducted on PubMed in order to identify relevant articles published between 2000 and 2010. From a total of 48 articles, 7 articles were selected for assessment. 2 articles studied the impact of system integration, 4 articles studied the impact of computerized medical records and 1 article studied both the impact of computerized medical records and system integration. A centralized clinical information system was proved to have a positive impact for inpatients in an intensive care unit. These systems allow time savings on vital signs transcription, reduced medication errors, a quicker access to clinical data and a reduction in prescription errors.
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Paper Nr: 38
Title:

THINKING SPATIALLY, ACTING COLLABORATIVELY - A GIS-based Health Decision Support System for Improving the Collaborative Health-planning Practice

Authors:

Ori Gudes, Virendra Pathak, Elizabeth Kendall and Tan Yigitcanlar
Abstract: The field of collaborative health planning faces significant challenges due to the lack of effective information, systems and the absence of a framework to make informed decisions. These challenges have been magnified by the rise of the healthy cities movement, consequently, there have been more frequent calls for localised, collaborative and evidence-driven decision-making. Some studies in the past have reported that the use of decision support systems (DSS) for planning healthy cities may lead to: increase collaboration between stakeholders and the general public, improve the accuracy and quality of the decision-making processes and improve the availability of data and information for health decision-makers. These links have not yet been fully tested and only a handful of studies have evaluated the impact of DSS on stakeholders, policy-makers and health planners. This study suggests a framework for developing healthy cities and introduces an online Geographic Information Systems (GIS)-based DSS for improving the collaborative health planning. It also presents preliminary findings of an ongoing case study conducted in the Logan-Beaudesert region of Queensland, Australia. These findings highlight the perceptions of decision-making prior to the implementation of the DSS intervention. Further, the findings help us to understand the potential role of the DSS to improve collaborative health planning practice.
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Paper Nr: 39
Title:

WEARABLE BLOOD PRESSURE MONITORING SYSTEM - Case Study of Multiplatform Applications for Medical Use
Authors:

Maxime Labat, Guillaume Lopez, Masaki Shuzo, Ichiro Yamada, Yasushi Imai and Shintaro Yanagimoto
Abstract: Blood pressure measurement methods used nowadays have considerable drawbacks, as non-invasive measurements are non-continuous while invasive measurements are confined to in-hospital use. In this paper, we expose our solution of a continuous, non-invasive blood pressure measurement method, using electrocardiogram (ECG) and photopletysmograph (PPG) as a basis of calculation. We present the two applications we designed in order to collect, process, display and monitor the gathered information accurately. A mobile application, using a smartphone connected to a sensor data logging device, is in charge of controlling data acquisition from wearable sensors, displaying general information and signals for real-time monitoring. A desktop application is designed to perform more detailed processing and complex analysis on the recorded data and is therefore aimed at doctors and/or researchers.
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Paper Nr: 41
Title:

DETERMINANTS OF IT ADOPTION IN HOSPITALS - IT Maturity Surveyed in an European Context
Authors:

Patrick Mikalef and Ronald Batenburg
Abstract: Following the increase of investments in Information Technology (IT) in organizations and companies during the past decade, hospitals are expected to increase their IT maturity as well. But what drives hospitals to invest in IT, in particular integrative and enterprise-wide IT? In the present study we make an attempt to identify key elements of IT adoption for the hospital enterprise, and formulate a model in order to assess their level of IT adoption and maturity. Driven by this model and based on survey data from an European research conducted on 18 countries, statistical analysis is performed. It indicates that IT adoption in hospitals is strongly related to size, i.e. the number of employees and the number of beds of a hospital. Additionally, it is revealed that there are significant differences in adoption levels between general and specialized health care hospitals. Finally, a cross-country analysis shows striking differences between the 18 EU countries in the IT maturity of hospitals as well, from which pioneering as well as the straggling clusters of countries can be classified.
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Paper Nr: 47
Title:

STANDARDIZED DATA ACCESS FOR TELEMEDICINE DEVICES
Authors:

Mari Ibañez, Álvaro Reina Nieves, Jaime Martínez Jiménez, Natividad Martinez Madrid and Ralf Seepold
Abstract: Currently, there is a great number of telemedicine devices that can be connected to a computer in order to collect medical data of a patient, but these devices usually use proprietary protocols with a low level of interoperability. This paper proposes the use of a standardized protocol like UPnP to enhance the diffusion and utilization of a telemedicine device. This work presents an UPnP wrapper that allows announcing, discovering and managing of those telemedicine devices into an UPnP network. Additionally, the integration of this wrapper into an OSGi service platform allows the use of a telemedicine device by other services/applications that can need the medical data.
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Paper Nr: 49
Title:

THE C@ROLIN@ SOFTWARE - A System for Monitoring Skills Development of Children with Down Syndrome
Authors:

Salvatore Cuomo, Aniello Murano and Francesco Piccialli
Abstract: The study of medical protocols for monitoring and analyzing the cognitive development of children with disabilities is a fundamental research area. In this context, a well established curriculum-based assessment is the Carolina Curriculum for Infants and Toddlers with Special Needs(CCITSN). This is a suitable curriculum for early intervention programs, where sequenced items data collection and analysis allow for monitoring, incremental program change, and recognition of areas of relative strength and weakness in children with mild, moderate, or severe disabilities. This paper describes the design and the development of an information system based on a client-server software application, named C@rolin@, which carries out all CCITSN abilities and more, for the monitoring and the analysis of data coming from a medical protocol for children with the Down syndrome. In particular, by means of user-friendly graphic interfaces, the C@rolin@ software helps users to add, modify, recover, and analyze data, to watch singular and aggregate data via customized reports, as well as to interpolate data among children to determine or prevent specific behaviors.
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Paper Nr: 51
Title:

INTELLIGENT PHONOCARDIOGRAM ANALYSIS AND REPRESENTATION TOOL
Authors:

J. P. Ramos, P. Carvalho, R. P. Paiva, L. Vale and J. Henriques
Abstract: Cardiac auscultation is a highly sensitive, specific, cost effective and comfortable diagnosis technique for many cardiovascular diseases. Unfortunately, it is observed that the art of auscultation is mastered by an increasingly lower number of medical professionals. This paper presents a Matlab tool to support physicians in performing auscultation. This application enables real time signal acquisition using off-the-shelf sensors and performs several automatic annotation functions of heart sounds, such as noise contamination detection, segmentation into S1, S2 and S3, S2-split detection, murmur detection and classification, systolic time intervals measurement, contractility and stroke volume. These are related to the most pertinent clinical applications of this signal. Moreover, it can also be used for auscultation training.
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Paper Nr: 55
Title:

REQUIREMENTS AND SYSTEM ARCHITECTURE FOR A HEALTHCARE WIRELESS BODY AREA NETWORK
Authors:

Finn Overgaard Hansen and Thomas Skjødeberg Toftegaard
Abstract: Wireless body area networks enable new opportunities for personal healthcare monitoring and personal healthcare applications. This paper presents a comprehensive set of requirements and challenges for building a wireless body area network to support diverse user groups and a corresponding set of healthcare applications. Based on the identified requirements, the paper presents an architecture for a wireless body area network and describes how this architecture is connected to an existing it-infrastructure supporting healthcare at home. Finally the paper presents our on-going research with development of an ASE-BAN test bed. The major goal for this test bed is to be a platform for research and experiments with development of an ultra-low power body area network including sensor, communication nodes, communication protocols and a body gateway component.
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Paper Nr: 58
Title:

MODEL-DRIVEN VIRTUALIZATION OF HEALTHCARE RECORDS
Authors:

Daniel Alexander Ford
Abstract: This paper describes an approach to solving scalability, distribution and accessibility problems associated with large collections of healthcare records. The technique described in the paper explains how to exploit Model-Driven Healthcare record implementations of the Health Level Seven (HL7) standards for Clinical Documents (CDA) and Continuity of Care Documents (CCD), such as those developed by the Model-Driven Healthcare Tools (MDHT) project to quickly and easily enable highly scalable, distributed healthcare applications. The MDHT project has developed models in the Unified Modeling Language (UML) of the HL7 standard that it uses to automatically generate high quality software implementations of the standard. The technique described in the paper shows how to retarget this code generation process to automatically create an alternative implementation using a technology called Connected Data Objects (CDO). This new implementation immediately supports scalable, distributed access to document collections. The paper then goes on to describe example applications made possible by the new capabilities provided by the alternative implementation.
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Paper Nr: 62
Title:

HEALTH INFORMATION RETRIEVAL AND USAGE AMONG THE ELDERLY - Potential use of the Internet and Personal Health Records in Health Awareness and Accountability
Authors:

Dennis Cheung
Abstract: As North America anticipates an increase in the number of individuals expected to retire and fall into the group of “older adults,” questions are raised regarding Canada’s healthcare system and its ability to deal with this surge in consumption of resources. As the population ages, so too will the demands placed on the current medical work force thus creating a shortage of medical practitioners available. By utilizing information technologies such as personal health records (PHRs) and the internet, it is believed that this can leverage some of the burden away from Canada’s healthcare system. By creating awareness and accountability among this aging population through the use of ICT (information communication technologies), cultural and behavioural changes in how this population consumes healthcare resources may be altered. Not only are behaviours being changed due to ICT, but the way in which consumers are utilizing resources and knowledge are also shifting. As the medical community is shifting away from the illness model to that of a more patient centered one, it is important to understand the value of ICT solutions in the prevention and continued well being of a patient in an economy where resources are scarce.
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Paper Nr: 65
Title:

AUGMENTED OBJECTS TO SUPPORT PEOPLE WITH MILD COGNITIVE DEFICIENCES IN EVERYDAY ACTIVITIES
Authors:

Andrea Piras, Davide Carboni, Antonio Pintus and Sylvain Giroux
Abstract: The cognitive deficiencies are the spectrum of deficiencies related to the reduction of brain cognitive capability. They mainly affect decision-making, reasoning, planning and solving capabilities of daily activities. The consequence is cognitively impaired people become dependent by families, caregivers or Health Institutes. Not-intrusive information technology applications can be applied onto augment the house of mild cognitive impaired people to maintain their autonomy and facilitate their daily activities. At the same time, the applications combat the deficiency effects and are a good mean to promote self-esteem and increase the independent time living at home. In this paper, we propose an approach to use everyday objects as input and output devices for a processing system supporting people affected by mild cognitive deficiencies in successfully complete activities of daily living.
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Paper Nr: 66
Title:

MENTAL HEALTH DECLINE PREDICTION - A Smart Sensor for Day to Day Activity Recognition
Authors:

Thomas Kaegi-Trachsel, Juerg Gutknecht and Dennis Majoe
Abstract: The ambulatory activity of a person may be used as one component within an overall wearable sensor system that predicts the onset of mental health problems. Ergonomic smart sensors that can determine the total energy expenditure and type of ambulation may provide unique insights to the coping behaviour of stressed people. Rather than relying on wearable computers, a single smart miniature sensor that is worn 24/7 should perform the complex embedded recognition tasks while meeting difficult battery life, wireless communications and ergonomic constraints. The development and testing of such a smart sensor is described which takes into account action timeline variations, as well as action variations both intra individual and inter individual.
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Paper Nr: 73
Title:

CONTINUOUS CLINICAL PATHWAYS EVALUATION BY USING AUTOMATIC LEARNING ALGORITHMS
Authors:

Carlos Fernández-Llatas, Teresa Meneu, Jose Miguel Benedí and Vicente Traver
Abstract: The standardization of care processes in medicine, like Clinical pathways, is becoming more and more a common practice in health care organizations. Nevertheless, their design is not an easy task. Some approaches in the literature are based on using Workflow technology for defining Clinical Pathways. These approaches allow the creation of unambiguous, complete and automatically executable protocols. In addition to this, the use of Process Mining technology can help the design using information from real executions of Clinical Pathways cases. Nevertheless, to ensure a correct continuous evaluation and improvement of care processes, the creation of a tool that allows to know the current status of the Clinical Pathway execution it’s mandatory. In this paper, we present a tool able to compare the designed Clinical Pathways with the real implantation cases in order to detect their differences. This allows Clinical Pathways designers to improve the care protocols making them more adequate to real cases.
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Paper Nr: 76
Title:

COMBINING PARTICLE SWARM OPTIMISATION WITH GENETIC ALGORITHM FOR CONTEXTUAL ANALYSIS OF MEDICAL IMAGES
Authors:

Jonathan Goh, Lilian Tang, Lutfiah Al turk and Yaochu Jin
Abstract: Micro aneurysms are one of the first visible clinical signs of diabetic retinopathy and their detection can help diagnose the progression of the disease. In this paper, we propose to use a hybrid evolutionary algorithm to evolve the structure and parameters of a Hidden Markov Model to obtain an optimised model that best represents the different contexts of micro aneurysms sub images. This technique not only identifies the optimal number of states, but also determines the topology of the Hidden Markov Model, along with the initial model parameters. We also make a comparison between evolutionary algorithms to determine the best method to obtain an optimised model.
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Paper Nr: 77
Title:

COMPLEXITY REDUCTION IN CONTROL OF HUMAN HAND PROSTHESIS FOR A LIMITED SET OF GESTURES
Authors:

Giovanni Saggio, Pietro Cavallo, Daniele Casali and Giovanni Costantini
Abstract: This paper carried out a statistical analysis of human finger’s joint angles during hand specific daily activities, studying the correlations among the joints and applying a linear regression to express their correlations. The aim was to reduce the number of myoelectric sensors necessary in devices such as prosthesis, stands the current surgery difficulties and the problem of rejection, but without losing too many degrees of freedom. Measures were taken using our special hand movement acquisition system called HITEG data glove. As a preliminary work, we decided to limit the set of gestures performed to 9 of the most common movements of the human hand. The results shown that the number of sensors can be reduced from 14 to 7 with an acceptable error on the presumed value of each finger joint angle which can be as low as 10 degrees.
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Paper Nr: 78
Title:

ELECTRONIC INTERFACE AND SIGNAL CONDITIONING CIRCUITRY FOR DATA GLOVE SYSTEMS USEFUL AS 3D HMI TOOLS FOR DISABLED PERSONS

Authors:

Giovanni Saggio, Stefano Bocchetti, Carlo Alberto Pinto and Giancarlo Orengo
Abstract: A simple PC screen can be considered as an interface of a virtual environment where an user can move objects and interact with them. The interaction tools can be simply a virtual mouse or a keyboard. But it is evident how these tools cannot provide an immersive experience since the bi-dimensionality of the screen. So in the latter years the virtual reality is becoming more and more accomplished by new hardware interfaces capable to increase the realism degree. Among all, the sensorized glove is becoming one of the more interesting and promising of these interfaces. Here we propose the electronic interface and signal conditioning circuitry we adopt as the most suitable for our developed data glove system. The same solution we adopted can be usefully extended for other specific systems that treat signals coming from sensors which read kinematics from disabled persons with reduced Range Of Motion (ROM) capabilities.
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Paper Nr: 79
Title:

A COMPUTATIONAL ANALYSIS OF DIFFERENCES IN THERAPY BETWEEN BENCHMARK AND NON-BENCHMARK HOSPITALS FOR PATIENTS WITH ACUTE MYOCARDIAL INFARCTIONS

Authors:

Raphael Bahati, Michael Bauer and Femida Gwadry-Sridhar
Abstract: Acute Myocardial Infarction (AMI) remains a leading cause of mortality in most industrialized nations. Mortality rates for AMI patients are often used as a measure of the overall effectiveness of care provided by hospitals. Age, gender, and severity adjusted, the mortality rates within Canada have been shown to vary significantly from province to province. Some studies, for example, have shown significant variations between counties, even when adjacent to each other. In this paper, we present an approach aimed at understanding the causes of this variability by investigating the extent to which evidence-based therapies and processes within hospitals might be affecting mortality rates. We use cluster analysis to identify beneficial therapies and processes responsible for the improvement in treatment outcomes (as measured in terms of standardized mortality ratio) in benchmark compared to non-benchmark hospitals.
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Paper Nr: 82
Title:

USE OF MOBILE TECHNOLOGY TO SUPPORT PROVISION OF COMMUNITY-BASED MATERNAL AND NEONATAL CARE IN DEVELOPING COUNTRIES

Authors:

Marlen Stacey Chawani and Caroline Ngoma
Abstract: The health systems in many developing countries in Africa are facing critical shortages in nursing and midwifery health professionals and the situation is worse in the rural areas resulting in poor maternal and neonatal health outcomes. One of the interventions to address this challenge has been the use of Community Health Workers to supplement the provision of maternal and neonatal healthcare services within their communities. The international community is advocating for the use of Mobile technology in supporting various health service areas including community-based healthcare. This paper presents findings of a research on the information and communication needs of Community Health Workers in the provision Community -Based Maternal and Neonatal care in the rural areas of a developing country, Malawi, and it examines the potential use for adopting mobile technologies in such a setting to meet their needs.
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Paper Nr: 87
Title:

USER CENTERED DESIGN PROCESS OF OSAMI-D - Developing User Interfaces for a Remote Ergometer Training Application
Authors:

Florian Klompmaker, Björn Senft, Karsten Nebe, Clemens Busch and Detlev Willemsen
Abstract: In this paper we present the user centered design process of the research project OSAMI-D. The project addresses cardiac disease patients during the rehabilitation at home by offering an IT-based solution for a supervised ergometer training. The user centered design process consisted of multiple user studies. We analyzed the needs and preferences of a specific user group and developed user interfaces that are easy to operate by them.
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Paper Nr: 90
Title:

INFORMATION AND COMMUNICATION TECHNOLOGIES (ICTS) FOR BIOBANKING AND ONCOLOGY RESEARCH - Analysis, Support Scenarios and a Case Study
Authors:

Elena Sini, Michele Torresani, Silvia Veneroni, Paolo Locatelli and Nicola Restifo
Abstract: Human Tissue Banks are key for Oncological research and practice. Biobanking processes cross many care departments and have a number of stakeholders, often carrying different objectives: quality assurance and process efficiency are hard to garrison. Key issues in a biobanking project are: dedicated organization, process control, completeness of clinical information on samples, integrated Information and Communication Technologies. Fondazione IRCCS Istituto Nazionale dei Tumori is an oncologic research and treatment institution in Milan (Italy). Our project started in October 2007 aiming at revising the whole tissue collection process (from Surgery to Anatomical pathology assessment, to analysis and storage in the Biobank), developing a clinical biobank management system collecting structured data on cases, and designing an RFId-based system able to track the time- and temperature-sensitive specimens’ flow. Now that go-live has begun, technological and - above all - organizational challenges of the project can be discussed in detail. We hope other organizations will appreciate our efforts and are willing to apply a biobanking network as soon as possible.
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Paper Nr: 91
Title:

TOWARDS KNOWLEDGE-BASED INTEGRATION OF PERSONAL HEALTH RECORD DATA FROM SENSORS AND PATIENT OBSERVATIONS

Authors:

John Puentes and Jaakko Lähteenmäki
Abstract: Personal Health Records (PHR) containing physiological data collected by multiple sensors are being increasingly used for wellness monitoring or disease management. These abundant complementary raw data could be nevertheless disregarded given the challenges to understand and process it. We propose a knowledge-based integration model of PHR data from sensors and personal observations, intended to facilitate decision support in scenarios of cardiovascular disease monitoring. The model relates knowledge at three data integration layers: elements identification, relations assessment, and refinement. Details on specific elements of each layer are provided, along with a discussion of use and implementation guidelines.
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Paper Nr: 92
Title:

DEVELOPMENT OF A FRAMEWORK MATURITY MODEL FOR THE CONTINUED QUALITY IMPROVEMENT OF A LOCALLY CUSTOMISED CLINICAL INFORMATION SYSTEM USED IN CRITICAL CARE MEDICINE
Authors:

Frank Kirrane, Anne Mulvey and Michael Campion
Abstract: This study examines the development of a maturity model (MM) to help determine and monitor perceived improvement areas that would support the ongoing development of a locally customised hospital critical care Clinical Information System (CIS). The model arose from qualitative data collected from a critical care service in a large teaching hospital. The method involved a first principles examination of the priorities of a critical care service through a textual analysis of the documents considered by the hospital to underpin the strategic, professional and operational priorities of the service. These priorities form the dimensions of a MM, where a series of interviews with staff examine how the CIS can facilitate improvement along each dimension. The MM developed consists of seven dimensions, each illustrated along a percentage scale of increasing sophistication. This model is piloted in the critical care department which has been using a CIS for over four years. Results show that the method proposed is suitable for the development of a CIS MM. The results of the pilot study highlight different individual perceptions on the current level of CIS maturity. The MM is also demonstrated as a tool to assess current performance, and guide ongoing CIS customisation effort.
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Paper Nr: 96
Title:

EVALUATION OF A TELERADIOLOGY SYSTEM - Impact and User Satisfaction
Authors:

Carla Pereira, Ana Ferreira and Luis Antunes
Abstract: Teleradiology is the acquisition and transmission of radiologic images and respective diagnosis from a different location where the patient performed the exam. A teleradiology system was implemented in the ACES Alto Trás-os-Montes I Nordeste, in the Northeast of Portugal in 2008, aiming to overcome the shortage of this healthcare resource and expertise in the region. The main objective of this paper is to assess users’ satisfaction with the use of the teleradiology system presented above and investigate the main changes and impact that this system had for the patients and healthcare professionals involved in the process. Focus groups were applied and allowed to ascertaining the users’ perspectives regard the system. The main characteristic of the participants was that they used the system to perform their work on a daily basis or they benefited from its use. A focus group was performed for each of the three categories: Radiology Technicians, Primary Care Physicians and Patients, and they lasted one hour on average. Both healthcare professionals and patients have benefited with the introduction of the teleradiology system. The methodology applied allowed to better explore why it is so for each different group and for the various aspects of the system.
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Paper Nr: 98
Title:

MINING THE WEB FOR MEDICAL HYPOTHESES - A Proof-of-Concept System
Authors:

Diana MacLean and Margo Seltzer
Abstract: As the prevalence of blogs, discussion forums, and online news services continues to grow, so too does the portion of this Web content that relates to health and medicine. We propose that everyday, medically-oriented Web content is a valuable and viable data source for medical hypothesis generation and testing, despite its being noisy. In this paper, we present a proof-of-concept system supporting this notion. We construct a corpus comprising news articles relating to the drugs Vioxx, Naproxen and Ibuprofen, that were published between 1998-2002. Using this corpus, we show that there was a significant link between Vioxx and the concept “Myocardial Infarction” well before the drug was withdrawn from the market in 2004. Indeed, within the Vioxx-related content, the concept ranks amongst the top 3.3% in terms of importance. When compared with the Naproxen and Ibuprofen control literatures, the term occurs significantly more frequently in the Vioxx-related content.
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Paper Nr: 111
Title:

COLLABORATIVE IT PLATFORM FOR RARE DISEASES
Authors:

Dragan Jankovic, Tatjana Stankovic and Branimir Todorovic
Abstract: For a long time the rare diseases have not been in the "focus" of pharmaceutical companies and research because of potentially lower wages and the fact that very few institutions have a representative set of data necessary for quality research. Unfortunately, patients suffering from rare diseases are left in the margins of many societies, their drugs are usually not on the “positive lists” of insurance organisations and their price is extremely high. The number of rare diseases is between 6000 and 8000 and the estimated number of cases is about 5%, i.e. about 250 million. This paper presents Collaborative IT platform model for rare diseases by reviewing four important aspects: creating a national register of people suffering from rare diseases that can potentially grow into an international; establishment of a central repository for rare diseases with a collections of medical data characteristic for rare diseases, with modern data analysis tools in order to create better conditions for scientific research in the field of rare diseases, where some tools would be oriented to help doctors to more easily and with less cost came to proper diagnosis; improving living conditions and treatment of patients by forming a set of virtual patient’s associations to exchange experiences and find useful information; to create conditions for better education of medical workers and patients. The proposed platform is the subject of the project that we apply to the call for proposals of the Ministry of Science and Technological Development (MSc&TD) in the Republic of Serbia for a period 2011 - 2014.
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Paper Nr: 114
Title:

MARKETPLACES FOR HEALTH APPLICATIONS - Assessment of Requirements in Case of the German Public Health System
Authors:

Sebastian Dünnebeil, Jan Marco Leimeister and Helmut Krcmar
Abstract: Multiple innovations in e-health have the proven potential to improve treatment success, reduce adverse events and healthcare spending. Despite the promising potential, verified in various studies, the diffusion speed of healthcare application is very low. A major challenge in healthcare is therefore not only the research and development for improved treatment, but also the comprehensive and effective diffusion of selected technologies to caregivers and patients. Hence the paper investigates the theoretical background influencing the diffusion of innovations. It adopts the concept of application stores, which have shown high potential as accelerators for extensive distribution of software applications, for the domain of e-health. Requirements for such a marketplace are derived from the constraints of the public health system. The involved actors are identified and linked in a high level model.
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Paper Nr: 116
Title:

COPERNICUS - AN EXPERT SYSTEM SUPPORTING DIFFERENTIAL DIAGNOSIS OF PATIENTS EXAMINED USING THE MMPI TEST - An Index-rule Approach
Authors:

Jerzy Gomuła, Krzysztof Pancerz and Jaroslaw Szkoła
Abstract: In the paper, we present the Copernicus system - a computer tool supporting differential diagnosis of patients with mental disorders. As an example, we discuss results for a sample of 479 women examined by means of the MMPI-WISKAD personality inventory. There have been used the inductive classifiers based on the C4.5 decision tree algorithm. We have accomplished an overview of indexes generated on the basis of examined sample by several systems: Eichmann’s, Diamond’s, Goldberg’s, Taulbee-Sisson’s, and Panda-APAP (mixed with respect to indexes).
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Paper Nr: 117
Title:

TOUCH’N’DOCUMENT - A Nutrition Management System on an NFC-tagged TFT-display
Authors:

Philip Koene, Felix Köbler, Jan Marco Leimeister and Helmut Krcmar
Abstract: Self-reporting of patient data is a valuable tool for data capture in clinical trial studies and to support ailment treatment. However, traditional paper-based self-reporting is cost- and time-consuming and consequently suffers from low patient compliance. NFC-based electronic data capture methods allow a quick and easy self-reporting for patients and the real-time presentation of patient data enables direct medical intervention by physicians. Malnutrition, for example can be attenuated by continuous medical supervision of nutrition data. Consequently, we introduce an NFC-based prototype system called Touch’n’Document (TnD) that supports automatic aggregation and measurement of self-reported nutrition status. The hardware of TnD consists of a TFT-display that was outfitted with an array of NFC-tags on the backside. These allow an NFC-enabled mobile phone to be used as an input device to any software system, running on the TFT-display. The patients simply have to touch the display with their mobile device to log into the system and report and analyze their current nutrition. This ensures an adequate usability of the nutrition management system, especially for non tech-savvy or physically impaired patients, consequently increasing patient compliance. The technical feasibility, benefits, limitations and future research prospects of the prototype system are discussed in this manuscript.
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Paper Nr: 118
Title:

STUDYING THE RELEVANCE OF BREAST IMAGING FEATURES
Authors:

Pedro Ferreira, Inês Dutra, Nuno A. Fonseca, Ryan Woods and Elizabeth Burnside
Abstract: Breast screening is the regular examination of a woman’s breasts to find breast cancer in an initial stage. The sole exam approved for this purpose is mammography that, despite the existence of more advanced technologies, is considered the cheapest and most efficient method to detect cancer in a preclinical stage. We investigate, using machine learning techniques, how attributes obtained from mammographies can relate to malignancy. In particular, this study focus is on how mass density can influence malignancy from a data set of 348 patients containing, among other information, results of biopsies. To this end, we applied different learning algorithms on the data set using theWEKA tools, and performed significance tests on the results. The conclusions are threefold: (1) automatic classification of a mammography can reach equal or better results than the ones annotated by specialists, which can help doctors to quickly concentrate on some specific mammogram for a more thorough study; (2) mass density seems to be a good indicator of malignancy, as previous studies suggested; (3) we can obtain classifiers that can predict mass density with a quality as good as the specialist blind to biopsy.
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Paper Nr: 119
Title:

SUPPORTING POLICY DEFINITION IN THE E-HEALTH DOMAIN - A QCA based Method
Authors:

Paolo Spagnoletti, Valentina Albano, Attilio Caccetta, Rocco Tarquini and Alessandro D’Atri
Abstract: eHealth is broadly considered as a promising strategy to improve the economic sustainability and quality of the healthcare service provision in Europe. Nevertheless, despite the enthusiastic declarations of eHealth potential, the adoption of IT in health care has progressed very slowly. A critical factor, not deeply addressed in literature, is related to the process of prioritization of the eHealth solution to adopt, in presence of financial constrains, external and internal pressure from a wide range of heterogeneous stakeholders, and conflicting information on different technological solutions. In this paper we introduce a method supporting policy definition in the eHealth domain. This method is based on a qualitative comparative analysis (QCA) of best practices and previous experiences performed through the lens of an analytic framework whose dimensions and categories are well situated in the eHealth context. This method could support policy-makers in the identification of the properties and characteristics of innovative projects at European level and to analyze the gap between the international scenario and the local context in order to understand trends and dynamics of development, to evaluate the best opportunities for innovation and, therefore, to assign priorities for the next investments by respecting the constraints of available resources.
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Paper Nr: 120
Title:

ON THE USE OF openEHR IN A PORTABLE PHR

Authors:

Cândido Santos, Tiago Pedrosa, Carlos Costa and José Luís Oliveira
Abstract: Quality medical acts rely on patient medical information. With paper records, the responsibility of gathering the disparate information and making it available to the caregivers, falls exclusively upon the patient. This still is, to great extent, the case with electronic health documents. The consensus is that the advantages of patient involvement in his own health are numerous. With the advent of recent technologies and their deployment in healthcare, new ways of involving the patient and making him an active part of his own health are possible. Electronic Health Records (EHR) and specially Personal Health Records (PHR) are important tools for patient empowerment but data population and management through non-intuitive structured forms is time consuming, takes a great amount of effort, and can be deterring specially for people that are not very computer-oriented. PHRs can be simple and scalable applications that the patient uses to get started and afterwards evolve towards complexity. In any case, compliance with standards must be accomplished. In this paper we present a PHR simple to use, implemented on a USB Flash pen for mobility, and compliant with the openEHR specification. Our model builds on openEHR and adds security and privacy features, allows patient data management and can work as an information repository.
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Paper Nr: 125
Title:

TOWARDS AN ARTIFICIAL THERAPY ASSISTANT - Measuring Excessive Stress from Speech
Authors:

Frans van der Sluis, Egon L. van den Broek and Ton Dijkstra
Abstract: The measurement of (excessive) stress is still a challenging endeavor. Most tools rely on either introspection or expert opinion and are, therefore, often less reliable or a burden on the patient. An objective method could relieve these problems and, consequently, assist diagnostics. Speech was considered an excellent candidate for an objective, unobtrusive measure of emotion. True stress was successfully induced, using two storytelling sessions performed by 25 patients suffering from a stress disorder. When reading either a happy or a sad story, different stress levels were reported using the Subjective Unit of Distress (SUD). A linear regression model consisting of the high-frequency energy, pitch, and zero crossings of the speech signal was able to explain 70% of the variance in the subjectively reported stress. The results demonstrate the feasibility of an objective measurement of stress in speech. As such, the foundation for an Artificial Therapeutic Agent is laid, capable of assisting therapists through an objective measurement of experienced stress.
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Paper Nr: 131
Title:

FUZZY DECISION TREE LEARNING FOR PREOPERATIVE CLASSIFICATION OF ADNEXAL MASSES
Authors:

Emad Ahmadi, Hoda Javadi, Amin Khansefid, Atousa Asadi, Mohammad Mehdi Ebadzadeh and Dirk Timmerman
Abstract: The study problem was learning a fuzzy decision tree to classify patients with adnexal mass into either of benign or malignant class prior to surgery using patients’ medical history, physical exam, laboratory tests, and ultrasonography. A learning algorithm was developed to learn a fuzzy decision tree in three steps. In the growing step, a binary decision tree was learned from a dataset of patients while fuzzy discretization was used in decision nodes testing continuous attributes. The best degree of fuzziness was automatically found by an algorithm based on optimization procedures. In the pruning step, the overfitted nodes were removed by an algorithm based on critical value post-pruning method. In the refitting step, the labels of the leaf nodes were optimized. The final resulted tree had 10 decision nodes and 11 leaf nodes. Performance testing of the tree gave AUC of ROC of 0.91 and mean squared error of 0.1. The tree was translated into a set of 11 fuzzy if-then rules and the clinical plausibility of the rules was assessed by domain experts. All rules were verified to be in agreement with medical knowledge in the domain. Despite the small learning set and the lack of some important input variables, this method gave accurate and, more importantly, clinically interpretable results.
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Paper Nr: 134
Title:

INTEGRATED ELECTRONIC PRESCRIBING AND ROBOTIC PHARMACY DISPENSING - Are there Any Benefits?
Authors:

R. J. Beard
Abstract: Sunderland Royal Hospital (1,000 beds) has used an integrated electronic prescribing (EP) system for 8 years, and recently (2009) linked 2 robotic dispensing machines to the pharmacy module. The impact on dispensing error rates (quality) and efficiency (costs) were assessed. The implementation delivered staff efficiencies above expectation, whilst not adversely affecting the dispensing error rates. It was significant that although the combination of EP plus robot did eliminate dispensing errors, some errors continue to occur for items not stocked in the robot (e.g. part-packs). In achieving this, the professional pharmacy model changes.
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Paper Nr: 135
Title:

IMPROVING CLINICAL ACCESS AND QUALITY OF PATIENT CARE - A Case of Integration
Authors:

Bob Telford
Abstract: Health care systems face increasing challenges to meet the sophistications of 21st Century medicine, not least the current fragmentation of patient information. Electronic Health Records (EHR) provide an opportunity to optimise clinical workflow and improve patient outcome. Trusts across the UK face the need to implement systems that will work smoothly with existing legacy systems, but will also bridge the gap to future central IT implementation systems. Using a case study this paper presents the challenges faced by UK Trusts to implement systems that work with existing legacy software to optimise information already retained and future information input.
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Paper Nr: 142
Title:

PERSONAL HEALTH BOOK - A Novel Tool for Patient Centered Healthcare
Authors:

Juha Puustjärvi and Leena Puustjärvi
Abstract: Patient centered healthcare is based on the assumption that physicians, patients and their families have the ability to obtain and understand health information and services, and make appropriate health decisions. This in turn presumes that patient’s personal health information is presented according to individuals understanding and abilities. Based on this argument our research has focused on analysing whether the existing PHRs (Personal Health Records) support patient centered healthcare in an appropriate way. The analysis of these questions led to the introduction of the Personal Health Book (PHB). It is an extension of PHR in that all healthcare providers, who are involved in patient’s healthcare, augment the PHB by links to relevant information entities. In this paper we consider two approaches for maintaining PHBs: one extends XML based PHRs while the other exploits semantic web technologies in PHBs’ implementation. In particular, we present the advantages that can be achieved in using semantic web technologies such as RDF and OWL.
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Paper Nr: 144
Title:

PULAB - Computational-Intelligence Aided Management, Diagnosis, Teleassistance and e-Learning of Pressure Ulcers

Authors:

Laura Morente, Francisco J. Veredas, Héctor Mesa and Enrique Morris
Abstract: The pressure ulcer is a clinical pathology with high prevalence rates, which involve high costs for the Health systems. The health promotion carried on these lesions, as well as the prevention, suitable evaluation and correct treatment, have become effective indicators of the quality of health assistance. PULAB (Pressure Ulcer LABoratory) is a computational tool that enables remote management, diagnosis and monitoring of pressure ulcers, which include digital images of the wounds. This teleassistance software gives support to the collaborative work of multiple clinical experts to concurrently evaluate the pressure ulcers by reaching consensus on each particular case, based on the effective analysis of automatically segmented and tissue-labeled images of the wounds. In the current phase of our research project an e-learning module for pressure ulcer diagnosis education is being designed, which will turn this software into a valuable pedagogical tool for pressure-ulcer-management training for undergraduate students and professional clinicians.
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Paper Nr: 163
Title:

COMPUTER ASSISTED CANCER DIAGNOSIS SYSTEM USING PET/CT DELAYED SCAN IMAGE

Authors:

Rui Zhang, Takako Sato and Hiroshi Arisawa
Abstract: In this paper, a new method for CADS (computer assisted diagnosis system) is proposed: whole-body PET/CT delayed scan. Whole-body PET/CT imaging is quite useful for detecting cancerous regions, however sometimes too many “suspicious areas” due to ambiguous signs within 3D images. We propose a method in which two images i.e. original images and whole-body delayed scan images are compared and the true positive regions are identified. For the purpose of detection, a matching algorithm for comparing each region on both two images has been developed. It contributes not only to improve accuracy of a diagnosis but to reduce “false positive” regions. We compare this new method with the routine one and show its supporting technologies and advantages. In the end we indicate our research emphasis.
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Paper Nr: 165
Title:

MOBILE TIMELINE EMR SYSTEM - Support System for Doctors’ Cognition/Analysis
Authors:

Keisuke Ogawa, Kazunori Matsumoto, Masayuki Hashimoto, Tatsuaki Hamai and Yoshiaki Kondo
Abstract: In this paper, we propose a novel electronic medical record system (EMR) based on a brand new concept to support doctors’ cognition and medical analysis wherever they are. Conventional EMR systems have the advantage of helping doctors easily retrieve and manage mass medical records. On the other hand, medical records have been expected to support doctors’ planning. Most conventional EMR systems don’t have an appropriate function for such purpose, however. Because of its poor user interface, which is similar to legacy medical records written on paper, they can’t help doctors analyze medical data that occurs chronologically. To attain that purpose, the system has to have the ability to visualize medical data that occurs over various time spans. This is because the relationship among the different medical data should be observable when we look at it over various time spans. In addition, doctors aren’t always at their desks, so they can’t always use EMR systems with a desktop PC. Therefore, in view of these problems, we propose a system that has timeline interface which visualizes medical data that occurs over various time spans and its client application works on a mobile device. In this manner, the system can support doctors’ cognition and medical analysis wherever they are. In addition, we are verifying this system in the medical field.
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Paper Nr: 168
Title:

ENVISIONING uHEALTH - An Ontological Framework
Authors:

Arkalgud Ramaprasad and Shazia A. Sathar
Abstract: Ubiquitous health care (uHealth) is becoming feasible today, more so than ever before, due to rapid advances in information technology. We can glimpse its possibilities in the care of the wounded in war and the diagnosis and treatment of diseases from a distance. However, the visions of uHealth are many and partial, ill-defined and unclear. We present a set of four ontologies to envision uHealth systemically. The ontologies deconstruct uHealth into spatial, temporal, and semiotic ubiquity. Each aspect of ubiquity is further deconstructed into three components. These ontologies can be used to construct a comprehensive natural-language narrative of uHealth. They can also be used to (a) map the states-of-the-potential, art, and -practice of uHealth, and (b) systematically design the trajectory for the transformation to uHealth.
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Paper Nr: 173
Title:

AN AGENT-BASED DECISION SUPPORT SYSTEM FOR HOSPITAL EMERGENCY DEPARTMENTS
Authors:

Manel Taboada, Eduardo Cabrera and Emilio Luque
Abstract: Healthcare operational management provides many areas where modelling and simulation have been shown to be useful tools, and within this field there is probably no area more fluid or dynamic than hospital emergency departments (ED). This paper presents the results of an ongoing project that is being carried out by Individual Oriented Modelling (IoM) research group of the UAB, with the participation of Hospital ED Staff Teams. The general objective is creating a simulator that, used as decision support system (DSS), aids the heads of the ED to answer both, “what if...” questions in order to make the best informed decisions possible, and more complex questions involving the optimisation of the system. The defined ED model is a pure Agent-Based Model, formed entirely of the rules governing the behaviour of the individual agents which populate the system. Two distinct types of agents have been identified, active and passive. Active agents represent human actors, meanwhile passive agents represent services and other reactive systems. Active agents are described by Moore state machines extended to include probabilistic transitions. With the aim of verifying the proposed model a simulation has been created using NetLogo.
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Paper Nr: 176
Title:

THE DANGERS OF E-HEALTH
Authors:

Shane O'Hanlon
Abstract: In 2005 there were 51 unique definitions of e-Health in use, and a wide range of themes covered, suggesting a lack of clarity on the subject. It is an exciting area with much potential. There is a proliferation of activity, including huge funding invested by the European Commission. Given the large financial investment, we should ensure that the return is an effective e-Health intervention, and a resultant improvement in patient safety. But can e-Health actually do harm? All doctors are aware of the potential for harm, for example in telemedicine there are numerous reports of adverse events. There is little work in the scientific literature on the dangers of e-Health. The evidence base for e-Health is strikingly narrow, and there are few high quality studies demonstrating that patient safety benefits. Most studies do not have a structured system of reporting adverse outcomes. This leads to some ambiguity as to whether clinicians should advocate for e-Health on behalf of their patients. Other sectors have already embraced evaluations. We need a phased system of evaluation, with clear and transparent processes for reporting outcomes. High quality studies should be conducted and the results published so that all stakeholders can make an informed decision.
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Paper Nr: 178
Title:

HOW TO BUILD A MODERN PATIENT CARE APPLICATION
Authors:

Dieter Gawlick, Adel Ghoneimy and Zhen Hua Liu
Abstract: Patient care is typically supported by several incompatible applications in terms of their data models and semantics, ranging from support for surgery, to ICUs, to standard health care. These programs are focused on specific situation and give doctors a very limited view at patient information. This paper argues that the IT technology has evolved to a point that it is now possible to develop a generic patient care application that manages all patient data for all situations. Furthermore, this application provides a framework for capturing medical knowledge. With this knowledge the application is able to extract medically relevant information from data, even if the extraction is outside of the medical expertise of a doctor or if the extraction is outside of the capability of the human brain. Medical knowledge can be customized by domain, personal views, and patient condition. Additional benefits are: alerting the right doctor of time critical situations, identifying relevant information from a (new) patient’s history, and timely sharing of (new and codified) medical knowledge and experience across the medical community. The ideas are based on prototype work between the University of Utah, Health Science Center (UUHSC), the University of Coimbra, and Oracle (Guerra et al., 2009).
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Paper Nr: 179
Title:

HUMAN-CENTERED PHONE OXIMETER INTERFACE DESIGN FOR THE OPERATING ROOM - Pulse Oximeter Interfaced to a Mobile Device for Anesthesia Monitoring in the Developing World
Authors:

Walter Karlen, Guy Dumont, Chris Petersen, Jennifer Gow, Joanne Lim, Jules Sleiman and J. Mark Ansermino
Abstract: Mobile phones offer huge potential as platforms for clinical decision making in resource-poor and remote areas. We present methods for the development of a human-centered interface for anesthesia monitoring that is targeted to remote operating rooms in developing countries. The Phone Oximeter is compatible with major PC and mobile phone operating systems and is optimized for small phone screens. It displays vital physiological parameters in the corresponding clinical colours. Combined with an easily identifiable icon, this guarantees that accessibility is language-independent. To evaluate the acceptance and usability of the initial prototype of the Phone Oximeter, the Think Aloud process while completing a specific Task List, followed by the Mobile Phone Usability Questionnaire (MPUQ) were tested on 20 subjects with varying medical and mobile phone experience. The acceptance rate of 81.9 % from the MPUQ questionnaire clearly demonstrates the usability of the Phone Oximeter. The incorporation of the most relevant errors and complaints into the design of the next iteration of the Phone Oximeter prototype enhanced its capabilities further.
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Paper Nr: 3
Title:

SOLO-MEDICINE IN OPTICAL BIOPSIES - A Way to Practice Telemedicine
Authors:

Olga Ferrer, Francesco Ettorre, Xiomara Santos, Thomas Zinkl, Ruben Tous and Jaime Delgado
Abstract: A way to practice Telemedicine is to access a data-base capable to assist you in medical procedures (diagnosis, treatment and prognosis), similarly to consult a book or to ask a college. In many countries the lack of specialists and training capabilities demand to practice solo-medicine, that in the case of surgery require robots capable to induce anesthesia or help in vision or handling instruments. A relevant case is the diagnostic self-training requirements for optical biopsies (OBs) obtained with confocal laser endomicroscopy (CLE) or the assistance in the diagnosis of pathology slides. In both cases it is required a training set of digital images against which to compare the question case by means of image-queryformat. The present paper present a content-based image retrieval system (CBIR) based on the MPEG Query Format Standard in order to provide a set of similar pictures and the corresponding diagnosis to help on diagnosis or just to train the doctor. The paper defined the Image Solo-Medicine Paradigm (ISMP) architecture merging medical image standards and MPEG and JPEG standards. It tested the solution with normal, and benign colon OBs with 90% congruency. The ISMP is of particular interest viewed the proliferation of iPhone medical applications aiming to train doctors and support medical decisions.
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Paper Nr: 10
Title:

IMPROVING THE QUALITY OF PRIMARY CARE DATA WITH INTEROPERABLE STANDARDS

Authors:

Wilfred Bonney
Abstract: The quest to improve the quality and safety of healthcare delivery has resulted in the development of many interoperable standards. Most of these standards are developed so as to ensure that primary care data are captured, represented and conveyed appropriately in integrated healthcare information systems. Appropriate representation of primary care data will facilitate the secondary uses of the health data. Secondary uses of primary care data have the potential to not only support the clinical decision-making process by healthcare providers but also provide an evidence-based practice. In this paper, a literature review methodology is used to explore how the quality of primary care data can be improved using interoperable standards.
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Paper Nr: 17
Title:

MAIN BARRIERS FOR QUALITY DATA COLLECTION IN EHR - A Review
Authors:

Rui Mendes and Pedro Pereira Rodrigues
Abstract: The volume of health data is rising and health information technologies which include electronic health records are a promising solution, on data management and collection, to achieve greater quality outcomes. However, they often cause errors instead of preventing them. To study the main barriers to high quality data collection from electronic health records, a qualitative review study was conducted using 5 different database engines having only considered data quality and documentation issues, opportunities and challenges for proper data collection, electronic health records data and corresponding databases quality. It were included 16 articles from which data availability, format, accuracy and data accessibility were the most focused problems to address. Still, solutions are available: early recognition of those problems, well structured and designed EHRs, standard coding use, periodic accuracy monitoring and feedback and broad use of such systems for the most daily tasks possible, among others. Altogether they can improve EHR data quality for everyday use.
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Paper Nr: 19
Title:

KEY ISSUES AND FUTURE PERSPECTIVES ON IDENTITY MANAGEMENT IN EHEALTH - A Review
Authors:

Maria João Campos and Pedro Pereira Rodrigues
Abstract: Identity management represents an essential component for identification, authentication and authorization of patients, professionals, stakeholders and organizations in eHealth, combining information technologies and organizational procedures to provide security and privacy to health information. A literature search was conducted to identify relevant articles which were then grouped into themes according to the main subject. From the selected articles, plus their references, main findings, issues and future perspectives were systematized. A total of 31 articles were obtained, and after selection methodology 13 articles were included and grouped in four different themes: identity pseudonymisation and anonymization for secondary use, privacy preserving identity, identification, authentication and authorization identity in eHealth and identity and standardization. Through references cited in articles, research programs and working areas were also identified. Very few implementations could be found in literature, showing that this problem is even more complex than it seems and future adoption requires further research on new models and architectures. Furthermore, there is the need for a standard methodology for identity attributes interoperability between different stakeholders. Although there is a known large research effort in the context of identity in the information society in general, very few studies and experiences were found in the eHealth context.
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Paper Nr: 20
Title:

DECISION SUPPORT SYSTEMS AND TECHNOLOGIES USED IN PERIODONTOLOGY

Authors:

Jorge Filipe Ribeiro and Pedro Pereira Rodrigues
Abstract: The use of computer systems to aid clinical decision making is growing. Besides clinical practice, computer applications, decision support systems or technologies can be used during dentistry and periodontology learning. A research was made using 30 searching expressions, based on MeSH Terms. A total of 17 articles were selected from the initial 249. Dental Students’ Ability to Assess Gingival Health Status Software (DAAGS) and Virtual Learning Environment (VLE) are two examples of computer programs used in Priodontology learning. 3D technologies, electronic devices and image analysis systems are tools used during periodontal diagnosis. Dental informatics and periodontology are extremely connected, because, many systems, technologies or electronic devices could be used during diagnose, treatment or pre-operative phase. Computer applications could also be used to improve learning skills during pre-clinical and clinical stages, and at same time other technologies as 3D can present more detailed data to clinician, leading to a correct decision.
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Paper Nr: 21
Title:

A MOBILE PERSONAL HEALTH SYSTEM ENABLING PERVASIVE HEALTHCARE - SmartPhone
Authors:

Patrick Crilly and Vallipuram Muthukkumarasamy
Abstract: Pervasive health care is regarded as an integral component to facilitate expenditure reduction and enable efficient disease management. Integration of modern wireless communication systems and sensor technology permit the real time acquisition, transmission and processing of critical medical information. Researchers have focused on streaming vital signs and physiological data over a wireless network to a central data server for medical decision making. Constraints in wireless data communication have been reported as the major impediment for using this technique, mainly because of the energy consumption. In this paper, we examine the optimal way of storing data and performing analysis on sensors and on the mobile device. We show that when a patient is mobile, a smart phone is the device best suited to perform the initial processing of vital signs and sending of medical alerts. A smartphone has sufficient storage and computational ability, if exploited appropriately, to process and store sensed data from multiple sources.
Paper Nr: 23
Title:

ATTRIBUTE SELECTION BY MULTIOBJECTIVE EVOLUTIONARY COMPUTATION APPLIED TO MORTALITY FROM INFECTION IN SEVERE BURNS PATIENTS

Authors:

A. Jara, R. Martínez, D. Vigueras, G. Sánchez and F. Jiménez
Abstract: The problem of selecting variables in data-mining can be modelled as an optimisation problem involving multiple objectives which must be simultaneously optimised. This contribution proposes a multiple objective optimisation model for the problem of selecting variables applicable to the classification of mortality in patients from a hospital burns unit. The evolutionary multiobjective algorithm NSGA-II was adapted to resolve the proposed multiobjective optimisation model proposed and the results obtained were compared with those obtained with a battery of algorithms intended for selecting variables included in the Weka data-mining platform. The comparison underlines the efficacy and suitability of the proposed model and of the use of multiobjective evolutionary computation in this type of problem.
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Paper Nr: 24
Title:

USING 3D VISION FOR THE DIAGNOSIS AND TREATMENT OF AMBLYOPIA IN YOUNG CHILDREN
Authors:

Angelo Gargantini
Abstract: The 3D4Amb project aims at developing a system based on the NVIDIA 3D Vision for the diagnosis and treatment of amblyopia in young children. It exploits the active shutter technology to provide binocular vision, i.e. to show different images to the amblyotic (or lazy) and the normal eye. It would allow easy diagnosis of amblyopia and its treatment by means of interactive games or other entertainment activities. It should not suffer from the compliance problems of the classical treatment, it is suitable to domestic use, and it could at least partially substitute occlusion or patching of the normal eye.
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Paper Nr: 25
Title:

A COST-EFFECTIVE INDOOR VIBROTACTILE NAVIGATION SYSTEM FOR THE BLIND
Authors:

Marco Altini, Elisabetta Farella, Marco Pirini and Luca Benini
Abstract: This paper describes the development of an indoor vibrotactile navigation system for the visually impaired people. We aimed at realizing a wearable, low-cost, and effective system able to help blind users in unknown indoor environments that they might visit occasionally, such as hospitals, airports, museums, etc. The designed system implements a Bluetooth (BT) localization service, and provides wayfinding cues to the user by means of a wearable device equipped with five motors. The last part of our work describes early results obtained by the use of electroencephalographic (EEG) analysis to evaluate the vibrotactile feedback.
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Paper Nr: 26
Title:

AUTOMATIC ORGAN DELINEATION OF COMPUTED TOMOGRAPHY IMAGES FOR RADIOTHERAPY PLANNING IN PROSTATE CANCER - An Overview
Authors:

Celeste Marques Oliveira and Pedro Pereira Rodrigues
Abstract: Prostate cancer is a common cancer worldwide and a leading cause of death. Radiotherapy is usually the first-line treatment for patients with slow-growing cancer that is confined to the prostate. In Radiation Therapy Planning (RTP), the recognition and outlining of clinical volumes in computed tomography (CT) images are one of the most time-consuming steps carried out by human experts. The aim of this review is to identify and summarize evidence of the use of automatic organ delineation of CT images for radiotherapy planning in prostate cancer. From the literature search, a total of seven studies, reported between 1994 and 2009, were selected. We associate the selected studies in order to compare results, in spite of their differences in methodology and outcome evaluators. Most of the studies conclude that the automatic approach is faster, while having equivalent accuracy to manual method. Concerning the observer’s variability, automatic segmentation reaches significant gains in reproducibility. As future directions, it is recommended the improvement of the segmentation algorithms in the delineation of problematic soft tissues and future validation studies with large scale trials and possible studies of meta-analysis in the specific problems.
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Paper Nr: 30
Title:

THE USE OF ORANGE CANVAS PROGRAM TO ANALYZE THE PERFORMANCE OF CHILDREN WITH CONGENITAL BLINDNESS IN THE PLANNED CODES SUBTEST ADAPTED

Authors:

Felipe Pulcherio, Carla Verônica M. Marques, Carlo Oliveira E. S. de Oliveira, Maria M. D. Poyares, Eloisa Saboya and Lidiane F. Silva
Abstract: At Laboratory of Cognitive Neuropsychology of the Benjamin Constant Institute (NEUROLAB-IBC) was realized a study aiming at exploiting the cognitive component and a possible clinical guidelines of children with congenital blindness from the adaptation of Planned Codes subtest of Das and Naglieri and the use of artificial intelligence laboratory Orange Canvas of the University of Ljubljana. Due to the scarcity of neuropsychological tests that assess brain function in congenital blind children in Brazil, Planned Codes provided satisfactory scenery and needed to adapt to the reality of the applicator and children, containing, therefore, features tactile, visual and translated into Portuguese. Moreover, the high-tech offered by Orange Canvas program, favored the possibility of completely automating the entire subtest. The sample consisted of 59 congenital blind children which are students of Specialized School, where 32 realized the whole subtest being 2 of 7 years old and 28 from 8 to 12 years old. To validate this study, was made a clustering of data inherent to the subtest with predictions drawn from behavioral analysis of children, through the Orange Canvas, where it was confirmed the effectiveness of that procedure in clustering the data associated with the predictions suggested. From the children performance, opens itself an intervention and creation field of neuropedagogical strategies computerized to improve the cognitive processing of congenital blind children.
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Paper Nr: 31
Title:

USE OF COMPUTATIONAL INTELLIGENCE AND VISION IN THE STUDY OF SELECTIVE ATTENTION OF CONGENITAL BLIND CHILDREN

Authors:

Kim Bins, Felipe Pulcherio, Maria M. D. Poyares, Eloisa Saboya, Carla Verônica M. Marques, Carlo Oliveira E. S. de Oliveira and Lidiane F. Silva
Abstract: The test Cognitive Assessment System (CAS) of Das and Naglieri was translated and adapted by Laboratory of Neuropsychology at Instituto Benjamin Constant for the cognition study in congenital blind children to understand the peculiarities of cognitive development in the absence of vision. Our emphasis is Expressive Attention subtest, showing its adaptation and manual implementation for the visually impaired. This subtest assesses selective attention and may identify if the child has difficulty in cognitive process. The sample consisted of 64 congenital blind students of Benjamin Constant Specialized School, where 21 performed the test. Data obtained during the application were grouped and analyzed by artificial intelligence laboratory Orange Canvas, which helped define the attention profiles of the sample. It can be created, in the future, new pedagogical techniques for a better development of their cognition. It was also presented here the automated adaptation which was developed by the Group for Information Technology Applied to Education Electronic Computer Center, Rio de Janeiro Federal University based on system technology "Geometrix”. The proposal is that this software evaluates the attention of visually impaired people more quickly and efficiently, being more reliable to the original subtest, and also makes the statistical analysis of data, generating profiles.
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Paper Nr: 40
Title:

REMOTE REHABILITATION OF STROKE PATIENTS
Authors:

Rafal Wcislo, Jacek Kitowski, Michal Wrzeszcz, Janusz Otfinowski, Karolina Probosz, Artur Sobczyk and Malgorzata Pisula
Abstract: In the paper we present a concept of remote rehabilitation of stroke patients. Rehabilitation plays a vital role in helping stroke survivors partly or fully recover their functions lost after brain injury. The duration of the rehabilitation plays a crucial role. We believe that many of common disabilities that result from a stroke can be treated at patients’ homes with the use of a specially designed computer system. The architecture of the system is presented as well as its main goals and assumptions.
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Paper Nr: 45
Title:

MODELING DECISIONS FOR HOSPITAL BED MANAGEMENT - A Review
Authors:

Joaquim Matos and Pedro Pereira Rodrigues
Abstract: With today’s hospital demands and financial constraints, hospital inpatient bed management is becoming increasingly complex. The use of decision support systems could enable hospital staff and health decision makers to perform more focused management of the hospital inpatient beds, thus potentially reducing costs and inpatient length of stay. A literature review was carry out on both PubMed and ISI Web of Knowledge in order to identify studies evaluating the use of decision support systems when applied to hospital inpatient bed management. Two different approaches were identified: one approach based on the use of mathematical models to support the planning and allocation of hospital inpatient beds and another approach consisting in the utilization of information technologies to support timely inpatient placement. It was perceived that mathematical models could be safely used to model annual patient arrival rates and bed occupancy, thus forecasting hospital/department bed demand and underlying cost structures/revenues. It was also perceived that the use of bed management information systems provides hospital staff (administrative clerk, clinicians and housekeepers) with the necessary information to timely assess performance measures based on the hospital/department activity thus increasing resource effectiveness, optimizing established clinical pathways, reducing inpatient length of stay and associated costs.
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Paper Nr: 48
Title:

THE RED DOT SYSTEM - Emergency Diagnosis Impact and Digital Radiology Implementation: A Review
Authors:

José Manuel Coelho and Pedro Pereira Rodrigues
Abstract: Radiographer abnormality detection schemes (RADS) were introduced in the early 1980s to assist emergency departments. The development of PACS systems are affecting health professionals forcing them to evolve along, reviewing images on a computer monitor rather than on radiographic film. This article reviewed published articles that evaluated the impact of the use of a Red Dot System in patient outcome of emergency trauma patients and assessed the implementation of a Red Dot System in a Radiology Department with digital radiography and PACS. Few articles addressed the implementation issues and use of a Red Dot system in Computed Radiology. Radiographer skeletal red dot studies, had sensitivity and specificity of, respectively, 0.71 and 0.96 pre-training, and 0.81 and 0.95 post-training, compared with a reference standard. The use of radiographer abnormality detection schemes such as Red Dot and reporting has the potential to improve the diagnosis and outcome of emergency patients. The arrival of Information Technologies (IT) to healthcare and the introduction of Digital Radiography have limited the functionality of RADS due to incompatibility of new technology with the standard practice. New image technology solutions in Radiology should enhance the development and utilization of radiographer skills in RADS environments.
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Paper Nr: 50
Title:

ICT SUPPORTED APPROACHES TO AUTISM
Authors:

Ileana Hamburg
Abstract: Autism is a disorder that affects human skills and behaviour essentially. The use of ICT can support education and rehabilitation of people with autism and also teachers, parents and social workers benefit from using ICT. ICT and particularly the Internet support the creation of Virtual Communities of Practice (VCoPs) as a promising approach for learning, housing reviews of research evidence and engaging persons working in the ASD field to share practical knowledge and to make practical innovations. In this paper we present aspects of training and cooperation for people with autism particularly by using ICT and VCoPs and give an example of a successful project.
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Paper Nr: 52
Title:

UNOBTRUSIVE DATA RETRIEVAL FOR PROVIDING INDIVIDUAL ASSISTANCE IN AAL ENVIRONMENTS
Authors:

Carsten Rachuy, Sandra Budde and Kerstin Schill
Abstract: We present a prototype for a wearable device that measures physiological data in an unobtrusive way. The aim is to utilize changes in these physiological patterns to infer about the user’s affective state which is used as a evidential source of contextual information for recognizing activities of daily living (ADL) in an ambient assisted living (AAL) environment. We describe the device, compare it to a commercial stationary solution and give an outlook on possible scenarios for its application.
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Paper Nr: 54
Title:

INTEGRATING CLINICAL INFORMATION FROM A PERSONAL HEALTH RECORD INTO THE VIRTUAL HEALTHCARE RECORD
Authors:

Andrei Vasilateanu, Luca Dan Serbanati and Mihai Isaroiu
Abstract: In this paper we describe our proposed architecture for an integrated eHealth solution based on a patientcentric electronic health record called Virtual HealthCare Record (VHCR). VHCR is a central, unifying, internet-based entity acting as a flagship in the eHealth ecosystem and integrating different sources of medical information in a longitudinal record. The focus of this paper is how VHCR interacts and integrates data from a Personal Health Record.
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Paper Nr: 57
Title:

GLYCAEMIA REGULATION PREDICTIVE CONTROL SYSTEMS PERFORMANCES EVALUATION - A Comparative Study of Neural and Mathematical Models
Authors:

Nathanaël Cottin, Olivier Grunder and Abdellah ElMoudni
Abstract: Type 1 blood glucose regulation remains a complex problem to simulate. Different blood glucose control schemes for insulin-dependent diabetes therapies and systems have been proposed in the literature. This article presents an adaptative predictive control system for glycaemia regulation based on feedforward Artificial Neural Networks trained with the resilient propagation (RPROP) method. Experiments performed on a mathematical (theoretical) compensation model and our system aim to objectively compare the behaviour of each approach when both exact and perturbated data are presented. These experiments, which make use of a virtual patient, not only cover the ANN’s best configuration and training parameters on exact training information, they also demonstrate the accuracy of the neural approach when up to 20% perturbated data are supplied. As a result of the experiments on perturbated data, the neural approach gives slightly better evaluations than the theoretical model. This demonstrates the neural system’s ability to adapt to perturbated environments.
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Paper Nr: 64
Title:

RAINBOW BRIDGE - Training Center based on Voice Technology for People with Physical Disabilities
Authors:

Jan Nouza, Petr Cerva and Josef Chaloupka
Abstract: The Rainbow Bridge is an EU-supported project that aims to teach Czech people with physical disabilities to benefit from voice technology products in their lives and prospective jobs. All products - voice control tools and dictation programs - have been developed in our lab during the last decade. At this stage, the main goal is to teach the target group how to use PCs in hands-free manner (though some have no previous experience with computers), how to adapt the tools to their specific speech abilities and how to acquire the skills that can be useful for their potential employers. One of the lecturers is a quadriplegic person who herself has been using our voice products for almost 5 years.
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Paper Nr: 69
Title:

DEVELOPMENT OF AN INTEGRATED RISK ASSESSMENT PLATFORM FOR THE MANAGEMENT OF CARDIOVASCULAR DISEASES, DIABETES AND HYPERTENSION
Authors:

Bhanu Priya, Shruthi Nadig, Saloni Maru, A. Srinivas, Nitish Shangari, Abhishek Biswas and Suresh Krishnamurthy
Abstract: Health care is an important requirement of life. It is defined as the prevention, treatment or management of health related problems by using diverse strategies and services. Information Technology (IT) has pervaded every sphere of life including health care. It not only includes information systems in hospitals for managing clinical information about patients but also includes telemedicine, computer-assisted instructions to patients as well as doctors, and extends to computer-assisted imaging and surgery. IT has now become a key component in Disease Management Systems used in the assessment and management of chronic diseases such as Diabetes and Coronary artery disease. We have developed an Integrated Risk Assessment and Health Management System [IRAHMS] to assess the risk of developing “life-style” diseases such as Cardio Vascular Disease, Type 2 Diabetes Mellitus and Hypertension. This includes a patient clinical information database; a Framingham data based cardiovascular risk calculator and a module that provides personalized health management advice and healthy life style modifications that help an individual to lead a healthy life. The system also features an interactive risk analysis facility to analyze the contribution of each clinical parameter to the overall risk that can help motivate patients to see the overall benefits of risk factor modification or elimination.
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Paper Nr: 70
Title:

EFFECTIVENESS OF A BUSINESS INTELLIGENCE SOLUTION TO MANAGE THE ANTIRETROVIRAL THERAPY PROGRAMME
Authors:

Eduan Kotzé and Theo McDonald
Abstract: The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) has caused the death of millions of people worldwide. To combat the effect of HIV/AIDS, the South African government started with the provisioning of Antiretroviral Therapy (ART) in the public health sector. Monitoring and evaluating the effectiveness of this ART programme is of the utmost importance. A business intelligence approach was followed that first of all integrated several independent operational sources into one data warehouse and then delivered strategic management information with easy to use business intelligence tools that was developed and deployed for the users. The business intelligence solution was then evaluated by the users of the system and the results indicated that the users deemed the solution to be an effective way to obtain strategic information on the rollout of the ARV treatment programme.
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Paper Nr: 71
Title:

A MEDICAL DEVICE INFORMATION SYSTEM AND ITS ARCHITECTURE

Authors:

Daniela Luzi and Fabrizio Pecoraro
Abstract: The paper describes a Medical Device Information System (MEDIS) that supports applicants in the submission of a new clinical investigation (CIV) proposal as well as National Competent Authority in the evaluation and monitoring CIVs carried out at national level. An overview of system design is provided in the description of its conceptual model and architecture as well as providing an example of the interface of the system developed.
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Paper Nr: 72
Title:

CONTINUED PROFESSIONAL DEVELOPMENT AND INTERNET TOOLS IN EDUCATION OF HEALTH WORKERS
Authors:

Zoran Stevic, Dubravka Nikolovski and Branislava Matic
Abstract: The Objective of this paper was to describe the current status of continued professional development of healthcare workers in Serbia and knowledge of Internet tools being a support to their education. A cross-sectional descriptive study was applied utilizing an interviewer-administered questionnaire. The sample consisted of 201 health workers from two Serbian districts. Results show that 27 (13.4%) had no permanent Internet access. At Internet based continued medical education courses participated 45 (22.4%) health workers and only 10 (5.0%) used electronic services of Serbian Library Consortium for Coordinated Acquisition. In any time of their professional life 155 (77.1%) had never wrote any paper. There were 73 (36.3%) users of social Internet network, 33 (16.4%) were in contact with telemedicine, 14 (7.0%) heard something about distance e-health, 184 (91.5%) thought that has insufficient computer skills and 15 (7.5%) has no skills. Healthcare professionals in Serbia use mostly the scientific meetings for CME but without active participation. The research shows a great need for development of computer skills, Internet tools knowledge and inclusion in Serbian Library Consortium for Coordinated Acquisition.
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Paper Nr: 75
Title:

A SHORT OVERVIEW OF THE SECURITY CONCEPT OF THE GERMAN ELECTRONIC HEALTH INFORMATION INFRASTRUCTURE
Authors:

Stefan Knipl and Ali Sunyaev
Abstract: Germany is about to introduce a nation-wide healthcare telematics system, intending to connect existing information systems of all stakeholders. This could result in new threats to highly sensitive medical data. In this paper we shortly describe the security concept itself and point out a few possible problems at reaching the goals of information security.
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Paper Nr: 93
Title:

HEALTHCARE IS INTEROPERABILITY - Challenges and Solutions
Authors:

Vasiliki Mantzana, Konstantinos Koumaditis and Marinos Themistocleous
Abstract: Healthcare systems seek to provide services of high quality and profound safety through Healthcare Information Systems (HIS). Despite the potential benefits of HIS and the significant efforts that have been made, it has been reported that healthcare systems have a low success rate. It has been reported that the lack of interoperability still affects the services provided to patients and citizens. In this paper we (a) propose a novel healthcare processes and services classification, (b) present the HIS challenges and (c) suggest a solution based on Service Oriented Architecture (SOA), which can increase the interoperability among systems and hence the quality of provided healthcare services.
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Paper Nr: 94
Title:

INTEGRATION OF SIGNAL PROCESSING METHODS INTO EEG/ERP SYSTEM

Authors:

Petr Ježek and Roman Mouček
Abstract: This paper deals with the processing of signals from EEG/ERP experiments. Selected methods for EEG/ERP signal processing are shortly presented. Since these methods are usually implemented for various platforms and within various tools, a new designed and developed software system, which allows users running them uniformly, is presented. The methods are added and processed as plug-ins. It ensures a high modularity and flexibility of the system. The main system components (JERPA, JUIGLE) are introduced and shortly described.
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Paper Nr: 95
Title:

PROTECTION OF CLINICAL DATA - Comparison of European with American Legislation and Respective Technological Applicability

Authors:

C. Pereira, C. Oliveira, C. Vilaça and A. Ferreira
Abstract: The use of computer applications in health services is essential but difficult to make it right. The challenge is to balance two values: the free access to patient sensitive and personal information and the protection of the privacy and confidentiality of the patient. The European Union and the United States tried to solve this challenge by implementing legislation on the protection of clinical data. The European legislation is comprehensive and regulated by Supervisors and each Member State creates its own legislation in accordance with the Recommendations. On the other hand, the American legislation is specific, the organizations have a self-regulatory system and each state creates the State Law which is governed by Federal Law. The aim of this paper is to compare the European legislation - “Recommendation No R (97)5”with the American legislation – “Health Insurance Portability and Accountability Act” at the level of information security in healthcare, regarding new security technologies and mechanisms applied in the area of safety monitoring of clinical data. Both legislations are neutral concerning the selection of technology that the State wants to use. These laws must be adaptive to the changing technology, to ensure patients’ privacy under any circumstance.
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Paper Nr: 101
Title:

HYBRID ELECTRONIC HEALTH RECORDS
Authors:

Tiago Pedrosa, Rui Pedro Lopes, João C. Santos, Carlos Costa and José Luis Oliveira
Abstract: The research related with digital health records has been a hot topic since the last two decades, producing diverse results, particularly in two main types – Electronic Health Records and Personal Health Records. With the current wider citizen mobility, the liberalization of health care providing, as well as alternative medicine, elderly care and remote patient monitoring, new challenges had emerged. These brought more actors to the scene that can belong to different healthcare networks, private or public sector even from different countries. For creating a true patient-centric electronic health record, those actors need to collaborate in the creation and maintenance of the record. In this work, the Hybrid Electronic Health Record (HEHR) is presented, describing how information can be created and used, as well as focusing on how the patient defines the access control. Some new services are also discussed.
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Paper Nr: 104
Title:

A SYSTEMATIC REVIEW OF OUTLIERS DETECTION TECHNIQUES IN MEDICAL DATA - Preliminary Study
Authors:

Juliano Gaspar, Emanuel Catumbela, Bernardo Marques and Alberto Freitas
Abstract: Background: Patient medical records contain many entries relating to patient conditions, treatments and lab results. Generally involve multiple types of data and produces a large amount of information. These databases can provide important information for clinical decision and to support the management of the hospital. Medical databases have some specificities not often found in others non-medical databases. In this context, outlier detection techniques can be used to detect abnormal patterns in health records (for instance, problems in data quality) and this contributing to better data and better knowledge in the process of decision making. Aim: This systematic review intention to provide a better comprehension about the techniques used to detect outliers in healthcare data, for creates automatisms for those methods in the order to facilitate the access to information with quality in healthcare. Methods: The literature was systematically reviewed to identify articles mentioning outlier detection techniques or anomalies in medical data. Four distinct bibliographic databases were searched: Medline, ISI, IEEE and EBSCO. Results: From 4071 distinct papers selected, 80 were included after applying inclusion and exclusion criteria. According to the medical specialty 32% of the techniques are intended for oncology and 37% of them using patient data. Considering only articles that used administrative medical data, 59% of the techniques were statistical based. Conclusion: The area with outliers detection techniques most widely used in medical administrative data is the statistics, when compared with techniques from data mining such as clustering and nearest neighbor.
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Paper Nr: 105
Title:

RAPID APPLICATION DEVELOPMENT USING WEB TECHNOLOGIES - An Application to Communicative Competence Promotion of Children with ASD
Authors:

Margarida Lucas da Silva, Hugo Plácido da Silva, Carla Simões, Fernanda Botelho and Tiago Guerreiro
Abstract: This paper describes a framework, devised for rapid application development, and rapid application customization of standalone multimedia and rich content software, targeted at students with special needs. We present a proof-of-concept software application for promotion and training of social communication skills in children with autism spectrum disorders. Web technologies and related standards are used as a way of easily involving tutors, professionals in the field, and end users themselves in the software development and customization process with minimal training and support.
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Paper Nr: 115
Title:

DEVELOPMENT OF A SOFTWARE QUALITY PLAN FOR HOSPITALS

Authors:

Vispi Shroff, Louise Reid, Sajid Hashmi, Gerard Mulligan, Daniel Sheehy, Keyang Xiang and Ita Richardson
Abstract: This paper describes research into the development of a quality plan for the management of software in an Irish Hospital. It studies relevant standards, models and legal acts. Synergies between the Irish Health Service Executive’s Quality and Risk Management Standard and the Capability Maturity Model Integration are utilised to build and study a quality plan. While exploring the possibility of utilising software engineering quality standards to improve the quality standards within health care, this has also led to a greater understanding of the interlinked issues within a hospital.
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Paper Nr: 121
Title:

A PROTOCOL FOR DYNAMICALLY MAINTAINING AN INTEGRATED MEDICAL RECORD DATABASE FROM A SET OF DIFFERENT MEDICAL RECORD DATABASES
Authors:

Emilio Hernández and Mireya Morales
Abstract: Merging distributed medical record databases into an integrated database is an alternative approach for the implementation of the unified medical record concept. One of the main advantages of this approach is that the integrated database could be a backup for medical record databases. Additionally, the integrated database may be useful for medical research and may help improve the decisions on public policies related to health care. We propose a protocol for dynamically maintaining an integrated database that is the merge of different medical record databases, under some limitations related to security and control of the medical record.
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Paper Nr: 124
Title:

A MEDICAL INFORMATION RETRIEVAL BASED ON RETRIEVERS’ INTENTIONS

Authors:

Osamu Takaki, Koichiro Murata, Noriaki Izumi and Koiti Hasida
Abstract: This paper introduces a methodology to retrieve information from medical databases based on intentions and viewpoints of retrievers, who retrieve some information from databases. The methodology above helps a retriever to organize his/her intention and viewpoint and to make a proper query based on the viewpoint. It also helps a retriever to record historical data of retrieving with intentions. This paper introduces a series of ontologies to organize a relationship between intentions, viewpoints and keywords that are used to make queries and each of that has interpretations based on viewpoints of retrievers, and explains the methodology based on the ontologies.
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Paper Nr: 126
Title:

MEDICAL ERROR DETECTION BASED ON INSURANCE CLAIMS

Authors:

Huanmei Wu, Adam Jones and Ekta Agrawal
Abstract: The administrative health claim data collected by insurance companies often contain versatile information on individual patients, such as their interaction with doctors, medical labs, pharmacies, and other health care facilities. Since all the information for a patient is gathered in one place this is an excellent source to identify potential medical errors from multiple sources of services. Once identified, the errors can be verified. If necessary, the potential errors will be forwarded to the associated physicians. An application prototype of an administrative medical error detection and prevention had been created. The system is tested and validated by examples to detect medical errors through the creation of a list of medical error rules. Experimental results showed that medical errors can be identified using the insurance claim database. This is an inexpensive way for identifying and preventing medical errors, which will provide benefits to patients, providers and payers.
Paper Nr: 136
Title:

DIGITAL CAMERAS AS LOW-COST TOOLS FOR TELEMEDICINE AND E-HEALTH - Opportunities and Constraints
Authors:

Vesselin Gueorguiev, Ivan Evg. Ivanov and Desislava Georgieva
Abstract: The aim of this paper is to present part of a research work oriented to selection and usage of low-cost imaging devices for Telemedicine and e-Health. The results presented are oriented to increase the usability of digital photo cameras as a device for creating and/or digitalizing medical images. All activities are part of a DAPSEpro project “Medical data acquisition, processing and collection for e Health solutions”.
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Paper Nr: 145
Title:

STRUCTURING MEDICAL AGILITY
Authors:

Christoph J. Stettina, Lucas P. J. Groenewegen and Bernhard R. Katzy
Abstract: Technology is omnipresent in intervention rooms, potentially having enormous impact on workflows and on flexibility. Despite ICT systems’ more flexible support of medical protocols, the styles of collaborating do not really match. Intervention support systems are as yet stand alone and not sufficiently interoperable. Taking an ICT perspective, we seek to understand medical work, how to view the way it is organized and how to improve its integration with intervention support systems, driven by highly dynamic coordination models embedded in the framework of clinical pathways.
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Paper Nr: 172
Title:

SEMANTIC WEB TECHNOLOGIES IN EEG/ERP DOMAIN - Software Solution
Authors:

Roman Mouček, Petr Ježek and Václav Papež
Abstract: The paper shortly describes EEG/ERP domain and the system for storage and management of data and metadata from EEG/ERP experiments. The system has been developed using common technologies and data structures (object oriented code, relational database). A registration of the system as a recognized data source requires representation of its data and metadata by semantic web resources. A short overview of differences between common data structures and semantic web representations is given and possible approaches to automated transformation of data and metadata from common data structures are mentioned. The existing semantic web frameworks and tools, widely tested for our purposes, are listed. Finally, the integration of selected tools and the software solution for automated transformation from the relational database to a semantic web representation is described.
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Paper Nr: 177
Title:

THE DEVELOPMENT OF A PROTOTYPE E-P.O. BOX AND ITS APPLICATION TO PERSONAL HEALTH INFORMATION MANAGEMENT SYSTEM
Authors:

Joong-Sun Lee, Hiroyuki Suzuki, Naoko Taira, Kouichi Kita, Takashi Obi, Masuyoshi Yachida, Takahiro Yokoyma, Hiroshige Yamamoto, Kazuhisa Uryu, Masahiro Yamaguchi and Nagaaki Ohyama
Abstract: We introduce e-Post Office Box system which renders individuals their personal information management and safe access through the Internet to share and utilize their personal information under their own control. We have developed a personal health information management system based on the e-P.O.Box conception. All the personal information dealt in the system is securely protected in the network complying with the government guidelines for safety management of medical information systems. The system is connected with medical institutions using on-demand VPN and, the access to it is securely guarded by the use of IC card. We conducted a field experiment for the evaluation of the developed system with the staffs of Tokyo Institute of Technology and doctors in a hospital, simulating the cases of clinical consultation of patients with some adult disease. The experiment confirmed the effectiveness of the system for the patients.
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