HEALTHINF 2010 Abstracts

Full Papers Short Papers
Full Papers
Paper Nr: 20
Title:

PREDICTING THE EVOLUTION OF PRESSURE ULCERS
Authors:

Francisco Veredas, Héctor Mesa, Laura Morente and Juan C. Morilla
Abstract: A pressure ulcer is a clinical pathology of localized damage to the skin and underlying tissue caused by pressure, shear or friction. Diagnosis, treatment and care of pressure ulcers are costly for health services. Accurate wound evaluation is a critical task for optimizing the efficacy of treatment and care. Prediction of wound evolution helps the effective management of health resources and planning of pharmacological treatment and health-care decisions. In this paper, different machine learning approaches have been designed and used to predict the evolution of pressure ulcers. These predictive systems are based on local features extracted from wound images which were weekly taken in uncontrolled lighting conditions. The images were automatically segmented by the mean-shift procedure. A group of clinical experts manually classified the segmented regions into five different tissue types, and a set of local descriptors based on area measurements of these tissues was extracted. The one-week evolution of two different indicators for pressure ulcer evaluation is predicted: the ratio between granulation and devitalized tissue, and the percentage of wound-bed border consisting of granulation tissue. Of the tens of machine learning approaches and architectures tested in this study, support vector machines, naive Bayes classifiers, neural networks and decision trees achieved the highest accuracy rates in the prediction of the two indicators above, with also acceptable sensitivity and positive predictive value rates. Feature selection significantly reduced the number of input features needed for prediction. Neural networks and decision trees gave the best performance results, and the C4.5 algorithm achieved the highest accuracy rate (~ 81%) in the prediction of the granulation/devitalized ratio from a small number of input features.
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Paper Nr: 23
Title:

Performance of Sensor MAC protocols for Medical ICT using IR-UWB Technology
Authors:

Flavia Martelli, Jussi Haapola and Leonardo Goratti
Abstract: In this paper the feasibility of contention-based medium access control (MAC) protocols using impulse radio technology for medical ICT scenarios is shown. The particular scenario refers to a hospital waiting room in which people enter wearing a number of sensors for continuous monitoring of health status. The evaluation of the feasibility is founded on the implementation of slotted Aloha (S-Aloha) and preamble sense multiple access (PSMA) MAC protocols, the physical layer characteristics and the non-coherent receiving scheme for impulse radio ultra wideband (IR-UWB) in the network simulator Opnet. Simulated throughput and delay performance under Poisson traffic assumption are compared with analytical results for validation purposes. The simulation of the medical scenario, not easily tractable by analysis, accounts for important characteristics like capture effect and different bit rates of the sensors that monitor various vital functions. The results show that the used MAC protocols are scalable within the scenario constraints and PSMA exhibits a better delay performance than S-Aloha.
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Paper Nr: 39
Title:

DIAGNOSIS: A GLOBAL ALIGNMENT AND FUSION MEDICAL SYSTEM

Authors:

Evanthia Faliagka, Athanasios Tsakalidis, G. K. Matsopoulos, John Tsaknakis, Giannis Tzimas and Vasilis Syrimpeis
Abstract: In this paper, a global registration-fusion system of medical data is presented in detail. The system is comprised by the following basic subsystems: (1) the multimodal medical image archiving and communication subsystem, (2) the image processing subsystem, and (3) the multimodal registration and fusion subsystem. The system offers various capabilities such as storage, retrieval, distribution and presentation of images from different medical modalities in DICOM format, supports multiple examinations of a patient and uses parallel processing threads to perform the processing of the acquired three-dimensional (3D) data in almost real time. The paper discusses the basic features of the proposed system, analyzes the proposed algorithms for image preprocessing, registration and fusion and presents the results of an experimental study that was carried out for evaluating its performance. The innovation of the proposed work is multilayered. It provides automatic matching based on both segmented surfaces and on different levels of gray and it allows comparison of registration accuracy for the different techniques based on specific criteria to quantify registration. Finally, it improves the registration when there is movement and / or distortion in the data collection of the patient from different imaging systems.
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Paper Nr: 56
Title:

Model Selection Meta-Learning for the Prognosis of Pancreatic Cancer
Authors:

Jennifer Tseng, Sergio A. Alvarez, Sergio Alvarez, Jennifer Tseng, Stuart Floyd, Giles Whalen and Carolina Ruiz
Abstract: Machine learning predictive techniques have been shown to be useful in establishing cancer prognosis. However, no single machine learning technique provides the best results in all cases. This paper introduces an automated meta-learning technique that learns to predict the best performing machine learning technique for each patient. The individually selected machine learning technique is then used for prognosis for the given patient. The performance of the proposed approach is evaluated over a database of retrospective records of pancreatic cancer resections.
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Paper Nr: 57
Title:

VIRTUAL MEDICAL DOCTOR SYSTEMS Status progress report on Virtual medical Doctor System(VDS) interaction interface
Authors:

Hamido Fujita, Jun Hakura and Masaki Kurematsu
Abstract: Human computer Interaction based on emotional modelling is investigated and reported in this paper. Human personality is analyzed based on ego-gram analysis and accordingly human "SELF" emotional model is created. We have created as one part a computerized model which reflects a human user (in this paper Diagnostician model) impeded as a computer based reasoning model and through it, an emotional interaction between that model and the real human user is established. The interaction is based on a screen mask attached to manikin head resemble the diagnostician, that through it the system can act to speak (i.e., mimicking diagnostician) with the patient user. In this paper the interaction scenarios and reasoning of the virtual medical doctor or diagnostician are based on transactional analysis concept. We have implemented the system and empirically, examined it, as experiment in public space for revision and evaluation. The paper is reporting on the project outline, the usage of physiological issue in human reasoning through the virtual system is developed.
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Paper Nr: 66
Title:

DEVELOPING A FLEXIBLE ELECTRONIC PATIENT RECORD AS A WEB OF ACTIVE DOCUMENTS
Authors:

Federico Cabitza and Giovanni Zorzato
Abstract: In this paper, we discuss the architecture of WOAD, a design-oriented framework that we proposed to enact a bottom-up and document-centered approach to the development of Electronic Patient Records. We provide the essential elements of WOAD: the concept of Active Document, Didget, Template and Mechanism. Then we summarize the observational studies that inspired its development and that gave the preliminary user feedback for its validation by means of the deployment of ProDoc, a WOAD-compliant patient record. We then illustrate the core implementation details of the WOAD architecture, as it has been deployed in ProDoc.
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Paper Nr: 68
Title:

Representation and Efficient Management of Multi-Version Clinical Guidelines
Authors:

Fabio Grandi
Abstract: While the world wide web user is suffering from the disease caused by information overload, for which personalization is one of the treatments which works, a physician accessing web-based clinical guideline repositories is not immune from contagion. This seems a good reason to prescribe a personalization treatment also to the professional user of a computerized clinical guideline library. To this end, we apply to clinical guidelines solutions we previously developed for norm texts in the legal domain, and show how multi-version representation capabilities and personalization query facilities can be added to their management.
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Paper Nr: 70
Title:

k-Anonymity in Context of Digitally Signed CDA Documents
Authors:

Daniel Slamanig and Christian Stingl
Abstract: If medical data are provided to third parties for secondary use, the protection of the patients privacy is an essential issue. In general this is accomplished by methods that at least provide k-anonymity for a given data set. However, this ``manipulation'' of the respective data clearly destroys the original integrity as well as the authenticity of these data. Hence, digital signatures which are an invaluable tool for verifying the integrity and authenticity of digital medical data, seem to be inadequate in this context. In this paper we propose a novel approach based on generalized redactable signatures that covers the concept of k-anonymity in context of digitally signed medical documents. To the best of our knowledge this is the first work that combines these seemingly contradictory topics very efficiently. In particular, the proposed solution allows any party to verify the original digital signature for a medical document although these data are ``manipulated'' during the process of achieving k-anonymity. The main advantage of this approach is that all parties involved in the aforementioned process are able to verify the integrity and authenticity based on the original digital signature.
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Paper Nr: 74
Title:

A Flexible Policy Architecture for Medical Information Messaging
Authors:

Edward Brown and Jamie Goodyear
Abstract: We describe a design solution for the problem of changing policies regarding information management in the health care environment. Frequent policy modification regarding security, privacy and workflow through institutional re-organization and policy revision occur at multiple levels of administration, which can leave the health care information users with non-compliant systems (such as electronic medical records) and procedures which are expensive and difficult to update. Our solution is a medical information messaging infrastructure designed to respond flexibly to changes in information policy. Instead of embedding fixed policy into static application code, our architecture provides configurable policy rules as part of the communications framework. This entails two critical components: the dynamic router, which routes messages according to the policy rules, and the medical context header, which attaches policy-relevant information to all communication messages. All information applications are automatically compliant with policy, since it is enforced at the communications level of the system.
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Paper Nr: 89
Title:

RESPONSE AND CONTROL OF HEART RATE VIA POSTURE AND MOVEMENT

Authors:

Martin Wieser, Rafael M. Ruest, Lilith Buetler and Robert Riener
Abstract: After a few days of immobilization, patients need some form of treatment to stabilize their cardiovascular system. It is known that mobilization has a major influence on the cardiovascular system and, therefore, is an important component in neurorehabilitation. In this study a strategy is presented to control the heart rate using two mechanical stimuli: body inclination angle and stepping frequency. First, we could show that the heart rate of healthy subjects, as well as minimally conscious patients, shows a clear and repeatable response to body tilting and stepping. Furthermore, first experiments demonstrated the feasibility to control the heart rate of healthy subjects. Future experiments are required to optimize the control strategy with healthy subjects and to present the feasibility of the controller for use with patients. The long term goal will be to control heart rate, systolic and diastolic blood pressure, as well as respiration frequency, in order to stabilize the patients’ cardiovascular system and improve their health state with a reduced amount of pharmaceutical medication.
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Paper Nr: 101
Title:

AUTOMATING AUTHORIZATION PROPAGATION PROCESS IN PERSONAL HEALTH RECORDS
Authors:

Vassiliki Koufi, George Vassilacopoulos and Flora Malamateniou
Abstract: Traditionally patient records are generated, maintained and controlled by the individual health care providers where the patient has received care. This results in fragmented bits of data stored in diverse information systems which, in many cases, are not interoperable. Hence, a complete picture of a person’s healthcare record cannot be obtained when and where needed. A solution to this problem can be provided by personal health records (PHR), that is electronic health records (EHR) whose architectures are based on the fundamental assumptions that the complete records are centrally stored and that each patient retains authority over access to any portion of his/her record. This paper deals with a particular security issue arising in PHRs which is concerned with the process of granting (revoking) authorization to (from) healthcare professionals without the patient’s involvement. This security issue is particularly important in managing emergency cases. To deal with this problem, authorization propagation process is automated by means of context-aware technology, which is used to regulate user access to data via a fine-grained access control mechanism.
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Paper Nr: 102
Title:

A LIGHTWEIGHT MODEL FOR REPRESENTING AND REASONING WITH TEMPORAL INFORMATION IN BIOMEDICAL ONTOLOGIES
Authors:

Martin O'Connor and Amar Das
Abstract: Over the past decade, the number, size, and complexity of databases for health-related research have grown dramatically. Ontologies are being developed and used by many scientific communities to support sharing, integration, and management of the diverse information in these databases. As critical as ontologies have become, ontology language such as OWL typically provide minimal support for modeling the complex temporal relationships that are common in biomedical research data. As a result, ontologies often cannot fully express the temporal knowledge needed by many biomedical applications and thus users and developers must pursue ad hoc solutions to these challenges. In this paper, we present a methodology and set of tools for representing temporal information in biomedical ontologies. This approach uses a lightweight temporal model to encode the temporal dimension of biomedical data. It also uses the OWL-based Semantic Web Rule Language (SWRL) and the SWRL-based OWL query language SQWRL to reason with and query the temporal information represented using this model.
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Paper Nr: 103
Title:

An intelligent support system for diabetic patients
Authors:

Mark Hoogendoorn, Michel Klein and Nataliya Mogles
Abstract: Diabetes Mellitus type I is a disease that forces patients to manage their blood glucose level manually, by balancing their activities, food intake and insulin dosages. There is a large experience with building computational models for blood glucose level in diabetic patients, which are primarily used to design the medication regime for a specific patient. In this paper, the design of an intelligent support application is presented that uses a standard model for blood glucose level to give patients real-time advice about insulin and food intake. The advice is based on measurements of blood glucose level, the electronic agenda of a patient and model-based predictions of the glucose level in the near future. A simulation of the application is presented that illustrates the feasibility of the system.
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Paper Nr: 104
Title:

USER CENTERED DESIGN OF PATIENT USER INTERFACES FOR REMOTE TRAINING SUPERVISION
Authors:

Andreas Bleiker, Florian Klompmaker, Karsten Nebe, Andreas Bleiker, Clemens Busch and Detlev Willemsen
Abstract: Remote training supervision is a new approach that combines medical and IT knowledge into one system. Such a system enables patients with cardiac diseases to continue a supervised training - on an ergometer bicycle and even when exercising outdoors - after rehabilitation phase in a clinic. The goal of the study presented in this paper is to develop user interfaces for an ergometer. These interfaces have to allow an intuitive interaction and to take the different capabilities, needs and preferences of potential users - often elderly people having visual impairments and different IT knowledge - into account. In order to create minimal attention user interfaces it is mandatory to apply user centered techniques, which involve potential users into the design phase of the development process. The evaluation of the study served as basis for the next iteration of the user centered design process and raised new functional requirements to the underlying system from the user’s perspective.
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Paper Nr: 106
Title:

FROM LEGISLATION TO PRACTICE: A CASE STUDY OF BREAK THE GLASS IN HEALTHCARE
Authors:

Pedro Farinha, Ricardo J. Cruz-Correia, Luís Antunes, Filipe Almeida and Ana M. Ferreira
Abstract: Recommendations and regulations are available in healthcare to protect sensitive medical information. These regulations tend to be generic and orient attitudes within the medical practice and are usually not straightforward to be translated into practice. The main objective of this paper is to present the implementation of the Break the Glass (BTG) concept in a real healthcare setting in order to enforce the legislation for genetic information and evaluate the process of translating legislation into the healthcare practice. The user logs were analysed to assess if the BTG system was working as expected, providing genetic information confidentiality, as well as if the legislation was being enforced in a controlled and responsible manner. Results show that the process to translate legislation into practice could be faster and more efficient. User logs show that in terms of confidentiality the BTG features prevent more non authorised people from accessing genetic reports. We expect the tendency to be that only users who really need to access the reports will go through with the process of BTG. Enhancements to the system include the implementation of the access control management infrastructure within a more robust access control platform to perform the authentication and authorization processes.
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Paper Nr: 110
Title:

VALUE DRIVEN KPI DESIGN FOR HEALTH CARE
Authors:

Erik Perjons and Paul Johannesson
Abstract: A core component in any welfare society is an equal and efficient health care system. Large resources are spent on health care, but a number of problems still remain, such as deficiencies in service quality and long patient queues. A main reason behind these problems is the complexity of health care organisations which make them difficult to govern. One possible approach for improving the governance and management of health care organisations is the use of performance management, which is a management approach aiming at optimising the performance of an organisation. The main instrument in performance management is the Key Performance Indicator (KPI). However, designing effective KPIs is a complex and time consuming task that requires substantial efforts. Therefore, there is a need for methods and tools that assist organisations in designing KPIs. This paper proposes a value driven method for identifying patient oriented KPIs. The method is illustrated using a case study in eye health care.
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Short Papers
Paper Nr: 4
Title:

AUTOMATING THE IMPORTATION OF MEDICATION DATA INTO PERSONAL HEALTH RECORDS
Authors:

Juha Puustjärvi
Abstract: A personal health record (PHR) provides a summary of the health and medical history of a consumer. It includes data gathered from different sources such as from health care providers, pharmacies, insures, the consumer, and third parties such as gyms. Importing data into PHRs is problematic as different data sources use different representation formats. In addition, automating the importation is problematic as many of the sources are built based on proprietary solutions, and thereby are not able to interoperate with PHR systems. In this paper, we described how the importation of e-prescriptions into PHRs can be automated. In our solution e-prescriptions are produced by an electronic prescription writer (EPW) which functionality is specified by BPMN notation and then translated into executable WS-BPEL code. The EPW sends CCR-formatted data of e-prescriptions into PHR system, which first transforms (if needed) the data into the format of the used PHR system, and then stores them into PHRs. In particular, we consider how a PHR system can transform a CCR-formatted data into RDF/XML format. The gain of such transformation is that we can implement the PHR system as an application of a knowledge base system, and thereby we can capture the wide expression power of knowledge base system’s query interface into the PHR system.
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Paper Nr: 8
Title:

SELECTING THE MOST ACCURATE FORECASTING METHOD FOR MEDICAL DIAGNOSIS. BREAST CANCER DIAGNOSIS, A CASE STUDY
Authors:

Alejandro Rabasa, Marc Almiñana, Laureano F. Escudero, Antonio F. Compañ, Laureano Santamaría and Agustín Pérez-Martín
Abstract: Different methods are usually applied for medical diagnosis problems. Most of them are only based on expert knowledge and the results are provided by model-driven methods and they are built from inflexible mathematical expressions. In this paper we suggest a Data-Driven perspective to facilitate the medical expert labour on diagnosis tasks. Furthermore, this paper offers a step by step procedure to select the most accurate forecasting method depending on the nature of the variables and the structure problem constraints. To validate such a selecting procedure, we apply it to a breast cancer diagnosis problem as a real case study.
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Paper Nr: 12
Title:

HIGH-LEVEL MODEL DEFINITION FOR MICROARRAY DATA IN A FUTURE CLINICO-GENOMIC EHR

Authors:

Anca Bucur, Jasper van Leeuwen, Richard Vdovjak and Jeroen Vrijnsen
Abstract: With the new discoveries in cancer research, increasing amounts of genomic data are starting to be used in the context of the cancer patient management and should become part of the patient record. We propose a high level data model for incorporating microarray data in a future genomic-enabled clinical information system (e.g. EMR, EHR) in the context of oncology, based on existing and emerging standards. We argue that a genomic-enabled EHR system is becoming highly relevant for clinical practice taking into account the new validated discoveries from clinical research, but it could also have an important role to support new research (i.e., hypotheses building, retrospective validation, cohort studies, etc.) by collecting and integrating large amounts of data from clinical care and enabling extensive querying.
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Paper Nr: 15
Title:

INTEGRITY AND AUTHENTICITY OF QUALITY ASSURANCE AND CONTROL IN AN IMAGING EXAMINATION WORKFLOW
Authors:

Chung-Yueh Lien, Chia-Hung Hsiao, Tsung-Lung Yang and Tsair Kao
Abstract: In this paper, we evaluated the implementation of digital signature of medical imaging quality assurance and control (QA/C) by technician in accordance with the Digital Image and Communication in Medicine (DICOM). After QA/C, a set of DICOM images were collected into a DICOM Key Object Selection (KOS) document with digital signatures. The digital signature was implemented by RSA public key cryptography combined with a public key health certificate and health professional card (HPC) to digitally sign a series of DICOM images. Our method includes the DCOM Modality Performed Procedure Steps (MPPS) mechanism to provide the image transmission completeness and accuracy in an image examination workflow. The result shows that the method is efficient and requires less extra loading time to create the technician’s signature in an imaging examination workflow.
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Paper Nr: 22
Title:

Data Mining and the functional relationship between Heart Rate Variability and emotional processing: comparative analyses, validation and application

Authors:

Francesco Riganello
Abstract: Aims of the study is 1- to classify emotional responses in healthy subjects and conscious brain injured patients by Data Mining analysis of subjective reports and Heart Rate Variability (HRV) parameters, 2- to compare different procedures for reliability, and 3- test applicability in patients with disordered consciousness (vegetative state). We measured HRV of 26 healthy controls and 16 posttraumatic patients passively listening music samples selected by the emotions they evoke. Each subject was interviewed and the reported emotions were classified by several data mining approaches in order to identify a model assessing the most probable emotional condition by the HRV parameters. Two macro-categories were defined: positive and negative emotions, characterizing a binary classification learning problem. The study matched a three-phases strategy. First, we applied several classification approaches to healthy subjects and evaluated them through suitable validation techniques (10fold-cross and leave-one-out). Secondly, the best performing classifiers were used to forecast emotional responses of posttraumatic patients, without any retraining. In the 3rd phase we used the most reliable decision model both for validation (1st phase) and independent test on posttraumatic patients (2nd phase) in order to classify the “emotional” response of 9 subjects in vegetative state. One HRV parameter (normalized unit of Low-Frequency Band Power) proved sufficient to forecast a reliable classification. Specifically, accuracy was greater than 70% on training and both on validation and independent test. The model represents an objective criterion to investigate possible emotional responses also in unconscious patients (e.g. in vegetative state), who appear reactive to complex sensory stimulation as indicated by electrophysiological and neuroimaging techniques
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Paper Nr: 24
Title:

QUERY BY IMAGE MEDICAL TRAINING. OPTICAL BIOPSY WITH CONFOCAL ENDOSCOPY (OB-CEM).
Authors:

O. Ferrer-Roca, R. TOUS, Jaime Delgado, Claudio R. Teixeira, V DUVAL DA SILVA and V DUVAL DA SILVA
Abstract: The use of Optical Biopsies-OB (in the present case Confocal endomicroscopy-CEM) is limited due to difficulties to interpret images. The OB-CEM are taken by endoscopists, not trained in microscopic morphology which is the domain of the surgical pathology. To gain diagnostic confidence the endoscopists could consult the images to a pathologist or could use the technique proposed in the paper. That is, to search for similar images on Internet to compare the diagnosis. The present paper is a positioning paper of how to build a CEM-image metadata to be used by the multimedia standards ISO-15938-12:2008 and ISO-24800-3 in order to search on line using a “query by image”. Metadata semantics based on Kudo colorectal crypt architecture was used for annotation or automatic image extraction. The training set was composed of 25 OB-CEM chromo-colonoscopy images taken with a FICE (Fujinon Intelligent Chromoendoscopy). Those parameters were, whenever possible, automatically extracted from the image and included in the metadata for image mining. Future developments will annotate histological images is such a way that the query could also retrieve the histological image.
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Paper Nr: 26
Title:

SEMANTIC BASED TEST DATA EXTRACTION FOR INTEGRATED SYSTEMS (iSTDE)
Authors:

Ali Raza and Stephen Clyde
Abstract: Testing an integrated information system that relies on data from multiple sources can be a serious challenge, particularly when the data is confidential. Such is the case for the Child-Health Advanced Record Management (CHARM) system, which is now in production at the Utah Department of Health. CHARM allows various public health-care programs, like vital records, immunization, and hearing screening, to seamlessly access data from each others’ databases in real-time. Since CHARM deals with confidential health-care information, it was impossible to use real data for testing purposes, especially since the development and testing environments were outside the confidential environment in which CHARM operates. This paper describes a test-data extraction tool built and successfully used for testing the CHARM system. This tool, called Semantic based Test Data Extractor for Integrated Systems or iSTDE, reads a consistent cross-section of data from the production databases, manipulates that data to obscure individual identities while preserving overall data characteristics that are critical to thorough system testing, and finally moves that test data from the confidential production environment to the unprotected test environment.
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Paper Nr: 35
Title:

PATIENT JOURNEY OPTIMIZATION USING A MULTI-AGENT APPROACH
Authors:

Ian Cheung, Chung H. Choi and Kwok W. Cheung
Abstract: With the increasing expectation from patients and the regulations enacted by the government, exploring ways to shorten patient journey has caught increasing attention. Patient journey optimization typically involves treatment operation scheduling at multiple medical units. The decentralized nature of the problem makes conventional centralized operation research methods inapplicable in general and motivates the use of the multiagent approach. In this paper, we focus on cancer patient treatment. We model patients and medical units as autonomous agents which interact locally via a bidding process and a coordination process for patient journey optimization. With reference to a dataset containing more than five thousand different cancer patient journeys, the effectiveness of the proposed algorithm under different settings of implementation has been experimentally evaluated via experimental simulations.
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Paper Nr: 36
Title:

OPEN SECURITY ISSUES IN GERMAN HEALTHCARE TELEMATICS
Authors:

Ali Sunyaev, Jan M. Leimeister and Helmut Krcmar
Abstract: Developments in German healthcare telematics aim at connecting existing information systems of various service providers and health insurers via a common network. Such a linking of different systems and infrastructure elements creates a complex situation that has to deal with high priority requirements for data security, data safety, and data integrity as it concerns sensitive data such as personal medical information or administrative operational data. This paper provides a security analysis of the German healthcare telematics infrastructure under development and derives security measures to overcome the identified vulnerabilities. This analysis of open issues in the security concept of German healthcare telematics might be helpful for both future research and practice in healthcare information systems security.
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Paper Nr: 37
Title:

COMPARATIVE EVALUATION OF GOOGLE HEALTH API VS. MICROSOFT HEALTHVAULT API
Authors:

Ali Sunyaev, Alexander Kaletsch and Helmut Krcmar
Abstract: Electronic Health Records (EHR) offer patients the opportunity to access their own medical records. Google and Microsoft recently extended their public services by introducing internet-based personal healthcare information platforms – Google Health and Microsoft HealthVault. Over one hundred thousand people have registered at the two services since they were launched. Both companies invite other for-profit companies as well as non-profit organizations to participate in the design, development, and distribution of their own healthcare-related applications. Such applications are based on the free accessible EHR systems of Google and Microsoft and provide further benefits to patients. Due to its simplicity and usability, an API design could determine the variety of value-added applications developed and thus be essential for the commercial success (and potential market dominance) of one of these EHR systems. This work examines and compares the designs of Google Health API and Microsoft HealthVault API. Such an evaluation provides benefits for both research and practice: on the one hand, the results provide an overview of the different open API designs, and, on the other hand, the results provide the developer community with useful lessons learned from comparing the examined APIs.
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Paper Nr: 40
Title:

DO GERMAN PHYSICIANS WANT ELECTRONIC HEALTH SERVICES? A CHARACTERIZATION OF POTENTIAL ADOPTERS AND REJECTERS IN GERMAN AMBULATORY CARE
Authors:

Ivo Blohm, Sebastian Dünnebeil, Ali Sunyaev, Ivo Blohm, Jan M. Leimeister and Helmut Krcmar
Abstract: Germany is introducing a nation-wide health telematics infrastructure that enables various electronic health services (EHS). Little is known about the burdens and drivers for potential adoption of these innovations. Based on a quantitative study among German physicians participating in pilot test regions for health telematics, this paper clusters potential adopters and rejecters of EHS, based on their usage intention as determined with the UTAUT model. The study furthermore depicts opinions, attitudes, as well as equipment of physicians in ambulatory care to find similarities in terms of IT diffusion, process and security standardization, patient involvement, communication, documentation and general working patterns. The clustering shows that “Supporters” and “Rejecters” of EHS differ significantly in many aspects investigated. Based on these empirical findings, implications for design and introduction of e-health services can be derived, ranging from a different way of approaching physicians in ambulatory care to incentive structures for EHS usage.
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Paper Nr: 45
Title:

AN INFORMATION FILTERING SYSTEM FOR E-HEALTH: THE HEALTH-ON-NET EXPERIENCE
Authors:

Nicola Capuano, Matteo Gaeta, Vincenza Precone and Mario Scherillo
Abstract: This paper describes a work performed in the framework of the HealthOnNet project purposed to define and implement an Internet-based repository of diagnostic exams and medical reports connecting several Italian hospitals. The repository, which will be used as an historical and legal archive of clinical data, offers second opinion teleconsulting features as well as advanced categorization and filtering services. The paper is focused on this latter point and describes the process and the algorithms we defined to automatically classify medical documents (with respect to the widely adopted International Classification of Diseases and Related Health Problems of the World Health Organization) and to filter them on the basis of a user defined profile. Then it describes the developed prototype and some experimentation results.
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Paper Nr: 46
Title:

MULTIVARIATE LINEAR REGRESSION BASED SYNTHESIS OF 12-LEAD ECG FROM THREE BIPOLAR LEADS
Authors:

Ivan Tomasic, Viktor Avbelj and Roman Trobec
Abstract: The development of new technologies for electrocardiographic (ECG) monitoring enables the optimization of ECG recording strategy, in terms of a number and a position of body electrodes. Emerging wireless technology, together with requirements for improved wearing comfort, dictates a special design of a wireless bipolar ECG lead, which is composed of two closely placed electrodes. The measurements from a set of wireless electrodes, can serve for the reconstruction of the standard 12-lead ECG, which is directly applicable for the current medical knowledge. We present a method for synthesizing 12-lead ECG from only three bipolar leads. The result of the proposed method, based on multivariate linear regression, is a coefficients vector that transforms the data from three bipolar leads to a synthesized 12-leads ECG with minimum loss of diagnostic information. Two presented test cases show that a linear combination of only three bipolar leads, each obtained from two electrodes on a distance of 5 cm, suffices for a reliable synthesis of a standard 12-lead ECG. Wireless ECG leads can constitute a body sensor network that eliminates the need for additional wires and therefore improves the applicability of ECG device technology.
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Paper Nr: 48
Title:

DATABASE OF EEG/ERP EXPERIMENTS
Authors:

Roman Moucek and Petr Ježek
Abstract: The article deals with the database of EEG/ERP experiments and its developed prototype. Storage, download and interchange of EEG/ERP data and metadata through the web interface is possible, various user roles are defined. The requirements specification including the system context, scope, basic features, data formats and metadata structures is presented. The system architecture, used technologies and the final realization are described. Additional tools and structures as converters of data formats and generated ontology are mentioned. The possible users of the database are specified.
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Paper Nr: 52
Title:

HUMAN STRESS ONTOLOGY: Multiple Applications and Implications of an Ontology Framework in the Mental Health Domain

Authors:

Ehsan N. Khoozani and Maja Hadzic
Abstract: A large number of articles exist that discuss and define various concepts, terms, and theories relating to human stress. The heterogeneous and dynamic nature of this knowledge, and the growing research, highlight the need and significance of designing a coherent and sharable ontology framework for human stress domain. In response to this need, we design Human Stress Ontology (HSO) to capture stress-related concepts and their relationships in an agreed and machine readable framework. This ontology is organized according to the following five sub-ontologies: causes, mediators, effects, treatments and measurements. Development of an ontology in this field will facilitate interoperability between different information systems and enable the design of ontology-driven software programs tools and semantic web engines for intelligent access, management, retrieval and analysis of stress-related information. The derived knowledge will help identify important relationships between different concepts, and facilitate invention of more valid and consensual psychological tests and development of effective prevention and treatment strategies.
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Paper Nr: 59
Title:

Information Gain of Structured Medical Diagnostic Tests
Authors:

Tomislav Šmuc, Marin Prcela, Tomislav Smuc, Dragan Gamberger and Nikola Bogunović
Abstract: Bayesian networks have already shown their practical value in medical decision support systems as a framework for modelling probabilistic relations among concepts. Usage of such probabilistic model in medical decision support system is twofold: (1) for obtaining probabilities (beliefs) of occurrence of medical events (i.e. possible diagnosis) and (2) for obtaining information gain of actions that can be taken (i.e. medical diagnostic tests). On the other hand, typical role of ontology in medical decision support system is to provide a framework for definition of medical concepts, their structure and relations among them. In medical practice diagnostic tests are commonly comprised of number of measurements or sub-tests – a structure which is straightforwardly described by ontological language. In this paper we are analyzing the information gain of such structured medical diagnostic tests. The purpose of this analysis is to allow finding (1) which structured medical diagnostic test is at the given point the most informative one and (2) which elementary measurements within a given diagnostic test are the most informative ones. Furthermore, we are analyzing some computational issues which arise in the reasoning process. Usage of proposed methodology is demonstrated through its application in a provisional decision support system for diagnosis of heart failure disease.
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Paper Nr: 60
Title:

Do constructs of Technology Acceptance Model predict the ICT appropriation by physicians and nurses in healthcare public centres in Agadir, south of Morocco?
Authors:

Az-Eddine Bennani, Az-Eddine Bennani and Rachid Oumlil
Abstract: This communication explores the constructs of Technology Acceptance Model (TAM) and examines if they do predict the Information and communication technology (ICT) appropriation by physicians and nurses working in healthcare public centers in Agadir City, South of Morocco. The study revealed that Attitude, Perceived Ease of Use (PEOU) and Perceived Usefulness (PU) influence positively the intention of ICT appropriation. Also Perceived Usefulness is still to be a major determinant of the intention of ICT appropriation by these practitioners.
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Paper Nr: 62
Title:

MENTAL CLONING BASE VIRTUAL DIAGNOSTICIAN SYSTEM : Virtual medical Doctor System(VDS) reasoning
Authors:

Masaki Kurematsu, Hamido Fujita, Jun HAKURA and Masaki Kurematsu
Abstract: Human computer Interaction based on emotional modelling and physical views, collectively; has been investigated and reported in this paper. Two types of ontology have been presented to formalize a patient state: mental ontology reflecting the patient mental behaviour due to certain disorder and physical ontology reflecting the observed consequences of such disorder. These two types of ontology have been mapped and aligned for reasoning purposes. We have constructed an integrated computerized model which reflects a human diagnostician as computer model and through it, an integrated interaction between that model and the real human user (patient) is utilized for 1st stage diagnosis purposes. The diagnostician knowledge has been utilized through UMLS for testing, and the integrated mapping of the two views been represented through OWL framework. The reasoning instantiation is done using Description logic. We have implemented the system and empirically, examining it, for revision and evaluation.
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Paper Nr: 72
Title:

SEMIOTICS OF ‘NONCOMPLIANT’ PATIENT
Authors:

Charulata Ramaprasad and Arkalgud Ramaprasad
Abstract: ‘Noncompliant’ (NC) patient is a common label in medical records. While it encapsulates many dimensions of undesired patient behavior, the semiotics by which it is generated and applied is unclear: What data indicate noncompliance? How are the data analyzed and interpreted to label a patient as noncompliant? How does the label frame the physician’s thinking? How does it affect the physician’s diagnosis, treatment, instructions and actions? How does it affect medical outcomes? This lack of semiotic clarity can result in medical errors. We provide a framework (a) for conceptualizing the semiotics of NC, and (b) to understand the sources of potential medical errors. We illustrate the framework with a case study. The framework can be used to manage noncompliance effectively and reduce medical errors, especially with EMRs.
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Paper Nr: 73
Title:

On the evaluation of mined frequent sequences. An Evidence Theory-Based Method.
Authors:

Francisco Guil-Reyes, Francisco Palacios, Manuel Campos-Martinez and Roque Marin-Morales
Abstract: Frequent sequences (or temporal associations) mining is a very important topic within the temporal data mining area. Syntactic simplicity, combined with the dual characteristics (descriptive and predictive) of the mined temporal patterns, allow the extraction of useful knowledge from dynamic domains, which are time-varying in nature. Some of the most representative algorithms for mining sequential patterns or frequent associations are Apriori-like algorithms and, therefore, they cannot handle numeric attributes or items. This peculiarity makes it necessary to add a new process in the data preparation step, the discretization process. An important fact is that, depending on the discretization technique used, the number and type of discovered temporal patterns change dramatically. In this paper, we propose a method based on the Shafer’s Theory of Evidence that uses two information measures proposed by Yager for the quality evaluation of the extracted sets of temporal patterns. From a practical point of view, the main goal is to select, for a given dataset, the best discretization technique that leads to the discovery of useful knowledge. Nevertheless the underlying idea is to propose a formal method for assessing the mined patterns, seen as a belief structure, in terms of certainty in the information that represents. In this work, we also present a practical example, describing an application of this proposal in the Intensive Care Burn Unit domain.
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Paper Nr: 75
Title:

DETECTION OF MICRO ANEURYSMS USING MULTIPLE CLASSIFIERS AND HIDDEN MARKOV MODELS
Authors:

Jonathan Goh and Lilian Tang
Abstract: Diabetic retinopathy is a complication of diabetes and early detection is essential for effective treatment. In this paper, a novel technique for the detection of micro aneurysms is presented. Various features are extracted using image processing techniques and then fed through multiple classifiers for initial classification of candidate micro aneurysms. Hidden Markov models are then used to perform contextual analysis to recognise true micro aneurysms.
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Paper Nr: 77
Title:

ON THE DESIGN OF A HEALTHCARE INFORMATION SYSTEMS CONCENTRATION
Authors:

Shafaq N. Khan
Abstract: Information Systems as a field of academic study has witnessed tremendous growth both in scope and depth since its beginning in 1960s. With rapid growth of Information Technology in the field of healthcare, there is a need growing worldwide for IT personnel specializing in healthcare area as well. Market surveys involving the stakeholders at the regional level indicate the need for a bachelor’s degree in computing and information systems with concentration in healthcare. This paper proposes a curriculum for such a study as an addition to the existing accredited portfolio of BSc. in Computer Information Systems (CIS) program being offered at the university level. Efforts have been made that the proposed HCIS curriculum conforms both to the standards laid out by the accrediting agency and the University mission. The focus of this report is to inform others of local efforts needed on their campuses and to share findings that may be of use to researchers in similar situations.
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Paper Nr: 83
Title:

Intelligent Clinical Decision Support Systems
Authors:

Alexandru Floares
Abstract: Clinical Decision Support Systems (CDSS) have the potential to replace painful, invasive, and costly procedures, to optimize medical decisions, improve medical care, and reduce costs. An even better strategy is to make use of a knowledge discovery in data approach, with the aid of artificial intelligence tools. This results in transforming conventional CDSS in Intelligent Clinical Decision Support (i-CDSS). Evolving i-CDSS give to the conventional CDSS the capability of self-modifying their rules set, through supervised learning from patients data. Intelligent and evolving CDSS represent a strong foundation for evidence-based medicine. We proposed a methodology of building i-CDSS and related concepts. These are illustrated with some of our results in liver diseases and prostate cancer, some of them showing the best published performance.
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Paper Nr: 85
Title:

Towards an EHR Architecture for Mobile Citizens
Authors:

Tiago Pedrosa, Rui P. Lopes, Joao Santos, Carlos Costa and José L. Oliveira
Abstract: Electronic Health Records are typically created and stored in different places, by different healthcare providers, using different formats and technology. This poses an obstacle to patient mobility and contributes to scatter personal health related information. Patients constantly move between healthcare providers, searching for a better service, lower prices or specialists. It is important that healthcare professionals, regardless of technology and location, have access to the complete patient health record. The access to this personal health record can be granted through a network (web-based, for example) or can be carried by the patient, in a usb drive, for example. Either approach has to enforce the patient consent to access his information, cope with different types of EHR systems and formats. This paper is an ongoing research, part of a PhD on Electronic Health Records for Mobile Citizens.
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Paper Nr: 92
Title:

STUDY OF CLINICAL WORKFLOW AND INFORMATION FLOW OF A BREAST CARE UNIT
Authors:

Vitor Silva, Maria João Cardoso, João Fonseca and Ricardo J. Cruz-Correia
Abstract: Introduction. The study of the clinical workflows and information flows in healthcare institutions is of vital importance to improve its effectiveness and efficiency. At Hospital São João, Oporto – Portugal, a Diagnostic Breast Unit (DBU) was recently created. The implementation of a new Electronic Patient Record (EPR) called Breast.Care triggered the need to better understand the DBU processes and suggest improvements. Aim. To describe clinical workflows and information flows in DBU, detect problems and propose solutions for better communication among different actors. Methods. The study started with a direct observation period with a total of 24. The observed processes and flows were transcribed into free text and then into structured text, tables and Unified Modeling Language (UML) diagrams (activity and partition-activity). The structured text and diagrams were analysed to find possible improvements. Results. Seven main processes were identified representing how different actors (humans and computers) work together. Three communication process improvements between humans were detected (e.g. changing timing of patient data insertion to facilitate reading access to others), three human–machine improvements (e.g. changing computer medical forms) and one between machines (creating specific links between information systems). Discussion. Analysing workflow and information flow in DBU allowed the detection of communication problems and the improvement of those through changes in EPR and in DBU current processes.
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Paper Nr: 93
Title:

Usability Problems in a Home Telemedicine System
Authors:

Anders Bruun and Jan Stage
Abstract: Home telemedicine systems have the potential to reduce health care costs and improve the quality of life for many patients, including those suffering from chronic illness. This requires that the systems have functionality that fulfils relevant needs. Yet it also requires that the systems have a high level of usability in order to enable their users to employ the required functionality, especially if the target user group is elderly people. This paper reports from a usability evaluation of a home telemedicine system. Five elderly persons carried out specified tasks with the system, and based on that we identified usability problems with the system. The problems are presented, analysed in relation to 12 different usability themes and related to results from other evaluations of similar systems.
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Paper Nr: 95
Title:

Email-P2P Gateway to Distributed Medical Imaging Repositories
Authors:

Luís Ribeiro, Carlos Costa, Luís Bastião and José L. Oliveira
Abstract: For the healthcare professionals the importance of the medical imaging as a diagnostic tool is undeniable. For this reason, industry and research organizations increased significantly their interest in the medical imaging area, trying to deliver solutions for creating, storing, exchanging and displaying medical images. The raise of hardware and software solutions drove the community of vendors to gradually decrease the price of his solutions. As consequence, there was a rise of small imaging centres competing with bigger healthcare institutions. The market offers drives the patients to move across a wide range of healthcare institutions to undergo all the necessary exams. Producing a great amount of medical data dispersed over several institutions. This scenario of isolated islands of images repositories unable of interacting with each other is, in our opinion, propitious to a peer-to-peer (P2P) archive solution. Until now, medical exams (images and studies) have been exchanged through analogue films, media storage devices (CD, DVD, etc), virtual private networks or manual email procedures. This paper describes the Dicoogle P2P system, a distributed PAC system where its users may easily store, search and exchange DICOM files. However, potential peers of the Dicoogle system are usually inside private networks, behind NATs and firewalls, disabling the inter-institutional peer interaction. Therefore, we propose an Email-P2P gateway to Dicoogle that offers a way to exchange DICOM files through these virtual barriers.
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Paper Nr: 97
Title:

Architecture For Human-Robot Collaborative Navigation
Authors:

Sousso Kelouwani, Patrice Boucher and Paul Cohen
Abstract: Various situations of mobile platform navigation controls require a collaboration between a human agent and autonomous navigation modules. This work presents a new approach for collaborative control between such two agents, based upon a three-layer architecture. An arbitration scheme is proposed in the deliberative layer as well as a collaborative planning method for trajectory following based upon optimal control theory in the sequencer layer. The collaborative control signal in the execution layer is a weighted summation of each agent control signal. This collaborative architecture could be used for the shared control of vehicles such as motorized wheelchairs. Experimental results illustrate the efficiency of the proposed control architecture.
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Paper Nr: 98
Title:

Designing a Physician-Friendly Interface for an Electronic Medical Record System
Authors:

Donald Craig and Gerard Farrell
Abstract: An Electronic Medical Record (EMR) system enables a physician to record patients’ health information, request reports from third partly health care providers and retrieve these reports when they are ready. Despite the numerous benefits of EMRs, several factors have inhibited their widespread adoption. An underappreciated but critical factor has been the proliferation of inferior user interfaces which are confusing to navigate and disruptive to a physician’s workflow. To be useful, an EMR must allow physicians to record and query information in a natural manner that accommodates the non-linear nature of their workflow. In particular, an interface must permit a physician to record the minutiae of a patient’s condition while at the same time preserving the physician’s overview of a patient’s record so that any aspect of the patient’s health can be effortlessly queried and inspected. This paper proposes an interface design that attempts to address several of the usability deficiencies associated with current electronic medical record systems in use today.
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Paper Nr: 105
Title:

Modelling User Behaviour while Driving an Intelligent Wheelchair
Authors:

Carsten Fischer, Shi Hui, Cui Jian, Frank Schafmeister, Nils Menrad, Nicole von Steinbüchel, Kerstin Schill and Bernd Krieg-Brückner
Abstract: This paper reports on our user modelling work based on an empirical study of users' behaviour while driving a power wheelchair with a safety assistant. The focus was on persons with visual perceptional deficits, who show deficits to control a power wheelchair safely if no additional assistance system is available. Our major concern is to identify users' behavioural patterns which lead to the intervention of the safety assistant, although the empirical study itself covers many different research aspects. The goal of the current work is twofold: to adapt the safety assistance for users with hemianopsia who lost one half of their visual field and to improve their navigation skill in narrow space via suitable interaction.
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Paper Nr: 108
Title:

INFORMATION SYSTEMS HETEROGENEITY AND INTEROPERABILITY INSIDE HOSPITALS - A SURVEY
Authors:

Lucas S. Ribeiro, J. S. Cunha and Ricardo J. Cruz-Correia
Abstract: In this paper is presented a study of the heterogeneity and deficient interoperability of IS that exist in Northern Portuguese Hospitals. Structured interviews to each Hospital CIO were performed regarding their opinions, existing IS and integrations. The number of IS is exponentially related of the dimension of the hospital (number of beds), and the relation between the number of IS and the number of integrations follows an exponential model. The ratio between the number of effective integrations and the total possibilities is very low and follows a quadratic model, indicating that the energy spent grows rapidly with the increase of IS number and with poor results. Admission/discharge/transfer and drug related IS are installed more often, and therefore are better candidates for a regional network. Despite numerous efforts to develop standards, it seems that there is a large gap between their development and their applicability. Interoperability inside organizations is a crucial first step, looking for the goal of achieving regional and national EHR. Standardization is vital considering the number of IS and multitude of organizations involved.
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Paper Nr: 117
Title:

A PORTAL FRAMEWORK ARCHITECTURE FOR BUILDING HEALTHCARE WEB-BASED APPLICATIONS
Authors:

Francois Andry, Karsten Klein, Frank Yu, Ben Vigil, Thomas Odenwald, Goutham Naval and Erik-Paul Gibson
Abstract: Portals are Web-based applications that give users a centralized point of access for information and applications of relevance. Therefore the portal paradigm is an attractive proposition for healthcare because it offers a solution to rapidly aggregate heterogeneous applications and services while offering a high level of customization and personalization to the users, patients, care givers and IT personnel. In this paper, we explain the motivations that led us to integrate a portal framework on top of our solution stack to create healthcare solutions for our partners and customers. We describe the challenges associated with this type of infrastructure for healthcare applications including security and context management. We present concrete solutions for specific portal applications integrating EHR, PHR, care and disease management functionalities.
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Paper Nr: 118
Title:

SMART MEDICAL SOFTWARE SYSTEMS FOR DUMMIES? - The case for a user-centered systems design
Authors:

Detlef Zuehlke, Gerrit Meixner and Ulrike Klein
Abstract: In this position paper we ask the question of whether current medical software systems adequately support the “dumb users” in their routine work, or whether the software systems are rather function-oriented and their development far removed from reality. In a multi-year study, the medical faculty of the University of Heidelberg and the German Research Center for Artificial Intelligence (DFKI) cooperated on a review of the current situation in medical software systems. The first project involved the joint development of a prototype of a user-centered software system for the allogeneic stem cell transplantation procedure. Additionally, a comprehensive survey was conducted among the medical staff of the Hematology and Oncology Department at the Heidelberg University Clinic. The results of both the project and the survey are presented here.
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Paper Nr: 120
Title:

FROM STORED CLINICAL DATA TO INTEROPERABLE CLINICAL KNOWLEDGE
Authors:

Idoia Berges, Idoia Berges, Jesús Bermúdez, Alfredo Goñi and Arantza Illarramendi
Abstract: Health Information Systems deal with a great volume of digital clinical data. Although this management has brought several advantages to the healthcare domain, a more intelligent management of those stored data can provide further benefits. In this paper we present a proposal which introduces two main new advantages to those Health Information Systems: First, the possibility of a semantic interoperability among them and second, the ability to share the medical knowledge generated by each system—or by specialized organizations. Our proposal makes use of an ontology to describe the terms used by the different Electronic Health Record standards and the terms used by specific Health Information Systems (not forcing them to use a fixed standard), and a reasoner that allows to interpret on the fly the data of a particular Health Information System by another one, even when they use different data representations. Moreover, our solution provides a rule-based formalism for representing medical knowledge of each system. Thanks to this representation, one system can benefit from the knowledge which is stored on other systems and that was not initially aware of.
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Paper Nr: 122
Title:

INFORMATION VISUALIZATION TECHNIQUES FOR MOTION IMPAIRED PEOPLE
Authors:

Emilio Di Giacomo, Giuseppe Liotta and Stefano Federici
Abstract: Several alternative input techniques have been proposed in order to make computers more accessible to motion impaired people. They include brain computer interaction (BCI), eye movement detection, and speech/sound interaction techniques. Even if these alternative techniques partially compensate the reduced capabilities of the end-users, the overall interaction can become slow and convoluted since the number of commands required to complete a single task can increase significantly, even for the most common computer applications. In this position paper we describe a novel Human-Computer Interaction paradigm for motion impaired people based on sophisticated diagrammatic interfaces. The main idea is to use Information Visualization approaches to overcome the limited interaction capabilities of the alternative input devices typically used by individuals with motor disabilities. Our idea is that the limited information bandwidth of the input devices can be compensated by the broad bandwidth of the adopted diagrammatic interfaces, capable of conveying large amounts of information at once.
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Paper Nr: 125
Title:

IN-VEHICLE MONITORING OF AFFECTIVE SYMPTOMS FOR DIABETIC DRIVERS: In-Vehicle Hypoglycemia Alerting System in EU Project METABO
Authors:

Jonghwa Kim, Jonghwa Kim, Alessandro Ragnoni and Jacopo Biancat
Abstract: Can self-management of emotion help on safety driving of diabetic patients? Fluctuant emotions in driving can lead to very critical situations. In particular for diabetic drivers experiencing hypoglycemic events it is inevitable to provide an intelligent alerting/recommendation system that assesses continuously driver's affective and metabolic states and predicts sudden hypoglycemic events, in order for avoiding dangerous situations during driving. In this paper we introduce an innovative approach to in-vehicle emotion monitoring system conceived in the EU project METABO. The system aims for providing the drivers a self-management opportunity to monitor/control their emotional states and apt recommendations according to detected hypoglycemic symptoms.
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Paper Nr: 13
Title:

TOWARDS FULLY AUTOMATED PSYCHOTHERAPY FOR ADULTS: BAS - Behavioral Activation Scheduling via web and mobile phone
Authors:

Fiemke Both, Mark Hoogendoorn, Pim Cuijpers and Michel Klein
Abstract: Behavioural activation treatment has been found to be an effective psychological treatment for depression, also if delivered as self-administered psychotherapy via the internet. However, the role of supporting professionals remains important for successful application of the therapy. In this paper a system is presented that delivers automated behavioural activation therapy via both a mobile phone and a personal website. The system motivates the client to continue with the treatment and helps him/her through the different procedures of the treatment. The architecture of the system follows a generic ambient agent architecture. A first pilot study of the system indicates that it is technically feasible and perceived as useful.
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Paper Nr: 33
Title:

Realization of Effective Disaster Victim Support through Information Integration and Visualization Using GIS
Authors:

Munenari Inoguchi, Keiko Tamura, Shigeo Tatsuki and Haruo Hayashi
Abstract: Disaster victims, who cannot make progress in their life recovery by themselves, need to be supported generously by local government. However, there is no information management system for the progress of their life recovery process in order to identify the individual needs of victims. In the first step of this research, we designed and developed Victims Master Database which stored the situation of progress of victims’ life recovery process. This master database is developed by the integration of 5 databases; two of those are Residents’ Ledger and Fixed Asset Tax Rolls which are used in daily routine business, and the others are databases for granted certification of building damage degree, relief programs management and public temporary housing management which are constructed after the disaster. In this integration, however, it is unable to connect together simply because there is no relational key in each database. Against this issue, we applied GeoWrap method which can connect databases in GIS by the spatial proximity between pieces of information. In the second step, we developed the information management system which can ascertain victims’ life recovery status and visualize it in spatial. By using this system, responders developed common operational pictures of victims’ status, and provide generous support for victims with special needs effectively.
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Paper Nr: 38
Title:

From Medical Processes to Workflows: Modeling of Clinical Pathways with the Unified Modeling Language
Authors:

Christian Mauro, Jan M. Leimeister, Tobias Happle, Ali Sunyaev and Helmut Krcmar
Abstract: Clinical pathways describe treatment processes within a hospital. They can be used as process models, which can be controlled by implemented workflow models in information systems. This enables (semi-) automated processes, and they are therefore high potential for an improved quality management and seamless IT support. Surprisingly, there are no published process models that describe the implementation of clinical pathways in an information system while taking into account the characteristics of health care specifics. We bridge this gap by proposing a process model using UML as modeling language.
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Paper Nr: 41
Title:

A Novel Evaluation Model of User Acceptance of Software Technology in Healthcare Sector
Authors:

Noor K. Mohamadali and Jonathan Garibaldi
Abstract: Effective evaluation of healthcare information systems is necessary in order to ensure systems adequately meet the requirements and information processing needs of the users and healthcare organisations. A number of studies have proposed evaluation frameworks to aid in evaluation work. However, some of them can be improved upon. This paper proposes a novel evaluation model to evaluate user acceptance of software technology within the healthcare sector. It describes the theoretical basis behind the development of the research model and methodology being employed to validate the model
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Paper Nr: 42
Title:

A UPNP-BASED VIDEOCONFERENCE SYSTEM TO SUPPORT HOME TELECARE SERVICES
Authors:

Jaime Martín, Mario Ibañez, Ralf Seepold and Natividad M. Madrid
Abstract: This paper presents a home healthcare system that implements videoconference calls based on the UPnP standard to support telecare services. Firstly, it reviews the state of the art of telecare and applied technologies. Our approach describes a system architecture that provides capabilities to integrate different telecare services in a residential gateway. It addresses the challenge of the integration of patient relatives and friends in the telecare service to enhance the user’s confidence. We propose a videoconference system to communicate healthcare actors (patient, nurse, doctor and relatives) based on a widespread standard that enables an automatic discovery of multimedia services and presents a seamless streaming negotiation.
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Paper Nr: 47
Title:

Experimental Database Medical System - Data Acquisition Background and Features

Authors:

Jiri Polivka, Jiri Polivka, Jana Kleckova and Petr Maule
Abstract: This article describes features and background of the upcoming scientific medical system. The ambitious goal of the system is to provide relevant medical data for various medical methods and experimental implementations testing. The article presents needs for such system and administrative background which it requires. The main standards which are used in medical applications are also mentioned, like the DICOM, DASTA or HL7 format with the relations to our experimental medical system.
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Paper Nr: 50
Title:

INTEROPERABILITY IN AMBIENT ASSISTED LIVING (AAL): Standardization of sensor-data based on ISO/IEEE 11073
Authors:

Sten Hanke, Philipp Nieke, Stefan Sauermann, Christopher Mayer and Andreas hochgatterer
Abstract: In the process of developing projects in Ambient Assisted Living (AAL), it is very important to avoid isolated and proprietary applications in the Information Technology (IT) infrastructure. Therefore standardization committees try to close the gap between these applications in developing appropriate standards for communication and software-architectures. The ISO/IEEE 11073 standard family and especially the standard specialization ”ISO/IEEE 11073-10471, Independent Living Activity Hub” is the key for establishing interoperability in AAL. The scope is to establish a common software-architecture and communication between agents (any form of medical devices, e.g. Independent Living Activity Hub which represents a sensor network) and managers (software-tool for receiving data; e.g. sensor-data). Consequently the integration of different sensor-networks (agents) from different manufacturers to an ISO/IEEE 11073 manager could be achieved by plug & play interoperability if the agents are designed according to the standard guidelines. However, this study shows that it is possible to apply the standard to existing sensor-networks by designing the agent with appropriate mapping methods between manufacturer- and ISO/IEEE 11073 nomenclature. The flexible bodywork of the designed agent allows its application and use for specific sensor networks from different manufacturers without great effort, whereas the ”once-implemented manager” can be applied for any ISO/IEEE 11073-10471 Independent Living Activity Hub.
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Paper Nr: 63
Title:

AN APPROACH FOR CLASS MODEL DEVELOPMENT
Authors:

Nadja Damij and Talib Damij
Abstract: This paper aims to introduce an approach that can be used by both students and practitioners to develop a class model by analysing users’ documents. The approach is based on the concept of functional dependence and enables the use of the normalization technique in the field of object-oriented modelling. We believe that the normalization technique is applicable, useful and even essential in this field. The approach consists of six steps that lead the analyst through identifying identity attributes, determining functional dependences, defining associations between identity attributes, integrating the analyses, developing an initial class model, and completing the class model by using inheritance. Two documents of a hospitalization process are used as an example to implement the steps of this approach.
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Paper Nr: 64
Title:

HEALTHCARE PROCESS IMPROVEMENT USING SIMULATION
Authors:

Nadja Damij and Talib Damij
Abstract: This study is concerned with business process modelling and improvement as an essential work in creating a successful and competitive enterprise. To achieve this goal, we use a technique called the Activity Table to develop an as-is process model. When the process model is created, it must be checked and validate to find out if it reflects the real process. Then the model is analysed carefully using different "what-if" questions. Scenarios of process behaviour are then simulated to find out their impact on process performance and to compare them in order to choose the best solution. The business process ‘‘Surgery” is used as an example to demonstrate the implementation of the methodology.
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Paper Nr: 69
Title:

Towards Pluggable User Interfaces for People with Cognitive Disabilities
Authors:

Jochen Frey, Christian Schulz, Robert Neßelrath, Verena Stein and Jan Alexandersson
Abstract: We present a multimodal dialogue system which assists people suffering from mild cognitive disabilities that affect their daily activities. A new middleware based upon a new open industrial standard - ISO/IEC 24752 Universal Remote Console (URC) - allows access to any network services or appliances as well as devices for home entertainment and household via abstract user interfaces. This architecture promotes the concept of pluggable user interfaces, that is, the abstract user interface being rendered on a controller. We have implemented two differently rendered user interfaces for our target users: A mobile multimodal dialogue system for interacting with the digital home environment and a multimodal task based calendar application for home automation.
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Paper Nr: 76
Title:

LOW-COST & LOW-BANDWITH INFORMATION SYSTEMS FOR EMERGENCY RESPONSE: The case of the Bull-Running
Authors:

M. Belzunegui, D. Mayor, E. Unzue, Alfredo Pina, Rafael Huarte, Jon Legarrea and Raul Ecay
Abstract: This paper describes one research line carried out by the Public University of Navarra in collaboration with the Spanish Red Cross with an interdisciplinary team of volunteers, students, technicians and lecturers whose main aim is to create low cost information systems, adaptive to irregular infrastructures and dispersed locations for emergency response purposes. The features of such systems require a consolidation of the information at several levels and some times among different organizations. They require as well other features like platform independence, low bandwidth information flow and feedback from the end users in order to optimize the process to acquire and display information. The final aim is to improve the data capture and the needed interpretation of such data in order to help within one Emergency response situation. One specific application has been implemented for the management of the incidences of the bull-running and has been used and tested during the “Fiestas of San Fermin” in Pamplona from the 7th to the 14th of July 2009.
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Paper Nr: 78
Title:

AGENT-BASED SIMULATION TO SUPPORT DECISION MAKING IN HEALTHCARE MANAGEMENT PLANNING
Authors:

Hayden Stainsby, Manel Taboada and Emilio Luque
Abstract: Simulation has proved to be a useful tool in healthcare operational management, although up until now does not appear to have reached its full potential within this area. An area in which simulation is increasingly useful is as in aiding decision making of healthcare managers when planning constructing new Emergency Departments or making changes to existing ones. A simulation based on Agent Based Modelling techniques is proposed with an aim to produce a Decision Support System that takes into account the human and social factors present within such departments and that can also be generalised to be used in multiple hospitals. Work on the creation of this model has already began, with many of its concepts and structures presented.
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Paper Nr: 82
Title:

HD VIDEO IN TELEMEDICINE
Authors:

Cristian Perra and Barbara Podda
Abstract: Modern operating room devices produce several video streams at resolutions up to Full HD. Managing the high quantity of information produced during operating room activities requires a careful analysis and dimensioning of the video storage and streaming systems. A service for telemedicine and e-learning is proposed. The system is based on the ITU-T H.264 video coded for both storing and streaming medical video data. Different scenarios are compared in order to evaluate which solutions can better fit the video services deployment from operating rooms.
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Paper Nr: 86
Title:

Towards semi-automated assistance for the treatment of stress disorders
Authors:

Ton Dijkstra, Frans Van der Sluis, Egon L. van den Broek and Ton Dijkstra
Abstract: People who suffer from a stress disorder have a severe handicap in daily life. In addition, stress disorders are complex and consequently, hard to define and hard to treat. Semi-automatic assistance was envisioned that helps in the treatment of a stress disorder. Speech was considered to provide an excellent tool for providing an objective, unobtrusive emotion measure. Speech from 25 patients suffering from a stress disorder was recorded while they participated in two storytelling sessions. The Subjective Unit of Distress (SUD) was determined as a subjective measure and enabled the validation of the derived speech features. A regression model with four speech parameters (i.e., signal, power, zero crossing ratio, and pitch), was able to explain 70% of the variance in the SUD measure. As such it lays the foundation for semi-automated assistance for the treatment of patients with stress disorders.
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Paper Nr: 88
Title:

GEODADIVAS - Geographic Information Systems for Blood Donation Management in Portugal
Authors:

Juliano Gaspar, Jorge Leal, João Azevedo, Fabio Hedayioglu and Ricardo J. Cruz-Correia
Abstract: Blood donations are a significant part of good medicine nowadays. Needs in this area include geographic allocation off donors and its characteristics. Towards new applications in informatics systems and the implementation of ground theories in information systems (such as work and information flows), the changes in this area are promising. One kind of applications that enhances greatly this area are geographic information systems (GIS). They permit the allocation of raw data or processed information in a map, allowing contextualization of the information itself and the extrapolation of knowledge. Our goals focused on researching the state of the art off current status, data manipulation and processing relative of the donor’s database, modeling and developing a program that could show a varied option of queries that can be done to the database. We used some statistic approach to the data as well as software implementation. After its completion, it was possible to calculate the distribution of blood donors and cross reference this with the places of collect. The distribution of the donors by group or area was made visible for interpretation purposes. Ultimately, the feasibility of such systems is proved and the changes in blood donation management can represent an important improvement towards good care.
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Paper Nr: 90
Title:

COMPREHENSIVE DATA REPORTING APPROACH IN HEALTH CARE INFORMATION SYSTEMS
Authors:

Tatjana Stankovic, Dragan Jankovic and Petar Rajkovic
Abstract: Modern Medical Information Systems cannot be pictured without fast and reliable data reporting that is used not only for medical and state statistics, but for medical research and science as well. We have tried to analyze some of possible ways of using data in medicine. Could one system have only one way of data reporting and still be efficient enough in medical purposes? This paper answers to this question and some other questions related to data reporting in Medical Information Systems, from the aspects of developers, and users as well. It presents three possible ways of data analyzing and reporting, main features of each, and our solutions related to every approach.
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Paper Nr: 91
Title:

Healthcare Information Systems in a network environment - An interoperability model and a real case in a Pathology Network.
Authors:

Emanuele Baj, Paolo Locatelli, Gianni Origgi, Nicola Restifo, Ilaria Marzolla and Silvia Bragagia
Abstract: Interoperability between Healthcare Management Systems is a fundamental requirement to improve the quality of care, to assure patients continuous assistance and to improve clinical research. Pathology Networks create a common virtual environment which allows to overcome single HIS’ borders, by connecting different healthcare organizations adopting common formats to share clinical data and, consequently, knowledge. Syntactic and semantic standards are paramount to enable interoperability in this context, since common document formats ensure efficient communication, while internationally known vocabularies allow the unambiguous interpretation of contents. This paper has the purpose to show a real experience of participation to a Pathology Network, providing a model based on open standards which could be taken as a reference model for similar initiatives in other healthcare environments. Benefits resulting from such an initiatives will be presented, in terms of improvement for clinical research and quality of patients’ care. The real case we describe is an example of how Pathology Networks can provide scientific features to Electronic Health Records, by adding information not usually reported on standard clinical sheets, but necessary to perform new analysis with the purpose of improving clinical research.
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Paper Nr: 99
Title:

Modelling a Portable Personal Health Record
Authors:

Joao Santos, Tiago Pedrosa, Carlos Costa and José L. Oliveira
Abstract: Active and responsible involvement of patients in various aspects of their own health has been gradually accepted as an important contribution towards an increased quality of health services in general. Management of Personal Health Information by the patient can play an important role, not only in the improvement in quality of the information available to health care professionals, but also as a means of making the patient involved in his own health. Patient empowerment increases the quality and efficiency of healthcare delivery. Electronic Health Records are a means of storing this kind of information but their management usually falls under the responsibility of an institution and not on the patient himself. A Personal Health Record under the direct control and management of the patient is the natural solution for the problem. When implemented in a storage hardware portable device, a PHR, allows for total mobility. Personal Health Information is very sensitive in nature and such an implementation can raise security and privacy concerns, therefore special measures have to be taken to appease those concerns. With this in mind we propose a structure for a Patient Health Record stored in a USB pen device under the patient’s direct management and responsibility that meets all the security and privacy concerns.
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Paper Nr: 116
Title:

Web-based and context-sensitive, mobile Geo-Tools to support spatial decision making in health- and emergency management
Authors:

Hardy Pundt, Ronny Weinkauf and Thomas Spangenberg
Abstract: Decision making in health- and emergency management is based on spatial information in many cases. On the one hand, health related issues concern the spatial distribution of medical care stations, hospitals, emergency facilities, and other related entities. On the other hand, many problems occur that concern the spatial relationships between such entities. The "shortest" or "fastest" route between private households and the next hospital, the "nearest" specialized doctor, or pharmacy are examples for such relationships. The relationships become more important taking into account an aging society, where elder people, for instance, aren’t necessarily able to manage large distances to reach medical care. Both, the spatial distribution of medical facilities, as well as the analysis of spatial relationships between them, has to be seen in different spatial contexts (local, regional, and smaller scales). Geographical Information Systems (GIS) are an adequate means to support the collection, analysis, and visualisation of health related information in terms of their spatial distribution and the relationships between "geo-entities". Desktop GIS- , as well as web-based solutions (Web Mapping Services) are effective means to support decision makers. Health-related content, coming from desktop- or web based applications, can be used "outdoors" if mobile geo-tools are applied. They can provide context-sensitive information if they are connected to the GPS. Such mobile GIS can be helpful means, especially in emergency management. The paper will introduce these technologies briefly, based on concrete examples from a running research project. Some aspects that are worthwhile to be discussed to achieve a better IT-support for health and emergency management are highlighted.
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Paper Nr: 119
Title:

REAL-TIME 3D FILTERING OF ULTRASOUND DATASETS
Authors:

Koojoo Kwon, Sang-Chul Lee, Dong-Soo Kang and Byeong-Seok Shin
Abstract: Ultrasound imaging is used in a variety of medical areas. Although its image quality is inferior to that of CT or MR, it is widely used for its high speed and reasonable cost. However, it is difficult to visualize ultrasound data because the quality of the data might be degraded due to artifact and speckle noise. Therefore, ultrasound data usually requires time-consuming filtering before the rendering procedure. In this paper, we present a real-time 3D filtering method for ultrasound datasets. Since we use a CUDATM technology during 3D filtering stage, we can interactively visualize a dataset from the data gathering stage to the rendering stage. As a result, our approach enables interactive volume rendering for ultrasound datasets using a consumer-level PC.
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Paper Nr: 124
Title:

CAN WE IMPROVE THE ACCEPTANCE OF E-HEALTHCARE SERVICES BY ELDERLY PEOPLE?

Authors:

Mariona Estrada, Angelica Ñañez, Raquel Navarro-Prieto and Elena Parra
Abstract: The goal of this position paper is to provide a methodological framework for the development of healthcare information and communication technologies for elderly people. This methodological approach is based in three complementary areas: user centred design; variables in the e-healthcare acceptance by elderly people (social, cognitive and psychomotor aspects); and the methodologies that will allow us to gather critical knowledge about all these aspects. In other to gather information about all these aspects we need to use a multidisciplinary approach that will bring together observational studies about user requirements in real context; experimental methodologies that will gather the impact of psychomotor and cognitive aspects that are relevant to elderly people; and technology specialists that will provide input about ideal technological solutions for the needs of this specific group.
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Paper Nr: 126
Title:

Optimized Data Migration within a Medical Grid
Authors:

Jared Christopherson, Chun-Hsi Huang and Jared Christopherson
Abstract: This paper focuses on creating an intelligent, scalable system that vastly improves the speed and efficiency of looking up medical data. The system automatically and meaningfully organizes the distributed medical data to allow fastest access. Additionally, this research seeks to further improve on the concept of a distributed database service by introducing caching across servers as a means to optimize data retrieval time. Instead of looking to many individual sources, researchers would be able to access data from a single source, which is optimized on a per-region basis to ensure the shortest access times.
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Paper Nr: 128
Title:

MODELLING STABILOMETRIC TIME SERIES
Authors:

Juan A. Lara Torralbo, África López-Illescas, Aurora Pérez and Juan P. Valente
Abstract: Stabilometry is a branch of medicine that studies balance-related human functions. Stabilometric systems generate time series. The analysis of these time series using data mining techniques can be very useful for domain experts. In the field of stabilometry, as in many other domains, the key nuggets of information in a time series are concentrated within definite time periods known as events. In this paper, we propose a technique for creating reference models for stabilometric time series based on event analysis. After testing the technique on time series recorded by top-competition sportspeople, we conclude that stabilometric models can be used to classify individuals by their balance-related abilities.
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Paper Nr: 129
Title:

Wireless Body Area Networks: Information Dissemination Analyses
Authors:

Boudjit Saadi
Abstract: Wearable health monitoring systems integrated into a telemedicine system are novel information technology that will be able to support early detection of abnormal conditions and prevention of its serious consequences. Many patients can benefit from continuous ambulatory monitoring as a part of a diagnostic procedure, optimal maintenance of a chronic condition or during supervised recovery from an acute event or surgical procedure. Recent Advances in technology has led to the development of small, intelligent, wearable sensors capable of remotely performing critical health monitoring tasks and then transmitting patient's data back to health care centers over wireless medium. But to the day, energy remains to be a big constraint in enhancing Wireless Body Area Networks (WBAN)[1] lifetime. Some recent literature on WBANs proposes multi-hop sensor to gateway data relay as more energy efficient than single hop communication. There are studies which argue contrarily . This study analyzes the single vs multi-hop energy consumption effect for real short range sensor devices.
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