HEALTHINF 2013 Abstracts

Full Papers Short Papers
Full Papers
Paper Nr: 21
Title:

A New Method for Assessing the Exploratory Field of View (EFOV)
Authors:

Enkelejda Tafaj, Sebastian Hempel, Martin Heister, Kathrin Aehling, Janko Dietzsch, Ulrich Schiefer, Wolfgang Rosenstiel and Frank Schaeffel
Abstract: Intact visual functioning is a crucial prerequisite for driving safely. Visual function tests usually include the assessment of the visual acuity and binocular visual field. Based on these results, persons suffering from some types of visual field defects that affect the central 20 degree region are prohibited from driving, although they may have developed patterns of eye and head movements that allow them to compensate for their visual impairment. We propose a new method to assess the exploratory field of view (EFOV), i.e. the field of view of a subject when eye movements are allowed. With EFOV testing we aim at capturing the visual exploration capability of a subject and thus understand the real impact of visual field defects on activities of daily living and potential compensatory strategies.
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Paper Nr: 25
Title:

TEBRA: An Automatic Prompting System for Persons with Cognitive Disabilities in Brushing Teeth
Authors:

Christian Peters, Thomas Hermann and Sven Wachsmuth
Abstract: We introduce a novel Cognitive Assistive Technology. The TEBRA system assists persons with cognitive disabilities in brushing teeth by prompting the user. We develop the system based on an analysis of the task using qualitative data analysis. We recognize different subtasks applying a hierarchical recognition framework based on a Bayesian Network. The user’s progress in the task is monitored using a Finite State Machine and dynamic timing model which allows for different velocities of task execution. We evaluate the TEBRA system in a first study with regular users. We found that the system is able to provide appropriate prompts in terms of timing and modality to assist a user through the complex task of brushing teeth.
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Paper Nr: 33
Title:

Immersive Sonification for Displaying Brain Scan Data
Authors:

Agnieszka Roginska, Hariharan Mohanraj, Mark Ballora and Kent Friedman
Abstract: Scans of brains result in data that can be challenging to display due to its complexity, multi-dimensionality, and range. Visual representations of such data are limited due to the nature of the display, the number of possible dimensions that can be represented visually, and the capacity of our visual system to perceive and interpret visual data. This paper describes the use of sonification to interpret brain scans and use sound as a complementary tool to view, analyze, and diagnose. The sonification tool SoniScan is described and evaluated as a method to augment visual brain data display.
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Paper Nr: 39
Title:

Semantic Interoperability Solution for Multicentric Breast Cancer Trials at the Integrate EU Project
Authors:

Sergio Paraiso-Medina, David Perez-Rey, Raúl Alonso-Calvo, Brecht Claerhout, Kristof de Schepper, Philippe Hennebert, Jérôme Lhaut, Jasper Van Leeuwen and Anca Bucur
Abstract: The introduction of –omic information within current clinical treatment is one of the main challenges to transfer the huge amount of genomic-based results. The number of potential translational clinical trials is therefore experiencing a dramatic increase, with the corresponding increment on patient variability. Such scenario requires a larger population to recruit a minimum set of patients that may involve multi-centric trials, with associated challenges on heterogeneous data integration. To ensure sustainability on clinical trial management, semantic interoperability is one of the main goals addressed by international initiatives such as the EU funded INTEGRATE project: “Driving Excellence in Integrative Cancer Research”. This paper describes the approach adopted within an international research initiative, providing a homogeneous platform to manage clinical information from patients on breast cancer clinical trials. Following the project “leitmotif” of reusing standards supported by a large community, we have developed a solution providing a common data model (i.e. HL7 RIM-based), a biomedical domain vocabulary (i.e. SNOMED) as core dataset and resources from the semantic web community adapted for the biomedical domain. After one year and a half of collaboration, the INTEGRATE consortium has been able to develop a solution providing the reasoning capabilities required to solve clinical trial patient recruitment. The next challenge will be to extend the current solution to support a cohort selection tool allowing prospective analysis and predictive modeling.
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Paper Nr: 40
Title:

Inclusion of Data from the Domestic Domain in the Process of Clinical Decision Making using the Example of a Comprehensive Ambient Energy Expenditure Determination for COPD Patients
Authors:

Axel Helmer, Frerk Müller, Okko Lohmann, Andreas Thiel, Marco Eichelberg and Andreas Hein
Abstract: Patients suffering from COPD benefit from the performance of any kind of physical activity. The 3D layer context (3DLC) model characterizes data from different domains in relation to their relevance for the clinical decision making process. We have used this model to show how data from an ambient activity system in the domestic environment can be used to provide better diagnoses and prognoses for COPD patients. As a proof of concept an experiment has been conducted to provide an individual intensity relation between household activities and telerehabilitation training on a bicycle ergometer. We have extracted features from the power data of the activities ironing and vacuuming to calculate the energy expenditure for the performance of these activities.
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Paper Nr: 42
Title:

Contextualisation of ABAC Attributes through a Generic XACML Functionality Extension Mechanism
Authors:

Brecht Claerhout, Kristof De Schepper, David Pérez del Rey and Anca Bucur
Abstract: Authorisation solutions that exist today offer a broad range of functionality for defining complex access control policies. A common requirement that is not covered by these solutions is dynamically instantiated contexts in collaborative environments. This requirement is one of the research topics of the EU funded INTEGRATE project. This paper will focus on the solution proposed for the INTEGRATE project which is XACML based. The approach taken to make XACML context aware, is to enrich the XACML specification using a contextual extension through a generic mechanism, without changing the XACML language itself. This contextual extension operates on the XACML requests with ultimate goal to simplify the management of context aware policies.
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Paper Nr: 49
Title:

Collaborative Filtering for Identifying Prescription Omissions in an ICU
Authors:

Anima Singh and John Guttag
Abstract: Medication errors in critical care are frequent and can lead to adverse consequences. One important category of errors is prescription omission, i.e., failure to prescribe a potentially useful medication. Studies have shown that failure to prescribe a medication can result in adverse consequences leading to patient morbidity or even patient mortality (Aspden et al., 2007; Olsen et al., 2007). In this paper, we present a machine learning based approach to building a system that can be used to provide physicians with an ordered list of possible omissions. We investigated three different collaborative filtering approaches as well as simple prevalence and co-occurrence methods. When evaluated on over 19,000 ICU admissions, each of the CF approaches outperformed both prevalence and co-occurrence based methods. This work highlights the importance of capturing a multi-scale view of the prescription data for the task of identifying omissions. Our results suggest that latent factor models and neighborhood models are better at capturing different kinds of omissions. Latent factor models demonstrated improved performance on identifying omission of rarely prescribed medications while neighborhood models were slightly better at identifying omissions of commonly prescribed medications.
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Paper Nr: 60
Title:

StorageBIT - A Metadata-aware, Extensible, Semantic and Hierarchical Database for Biosignals
Authors:

Carlos Carreiras, Hugo Silva, André Lourenço and Ana Fred
Abstract: Acquisition of biomedical data is, nowadays, widespread, originating a deluge of data that may contain relevant and interesting information for health-care professionals, biosignal researchers, and the individuals themselves. This creates the need to organize the information in a structured way, facilitating collaboration and research efforts. Therefore, for that purpose, this paper investigates database systems and file formats, discussing current technologies, requirements and possible implementations. These implementations were put through a benchmarking package to analyze their insertion, query and update performance. A final approach combining the use of HDF5, a hierarchical file format for numerical data, and MongoDB, a NoSQL database, is proposed, as it showed the best combination of properties from the tested solutions.
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Paper Nr: 61
Title:

Towards Adapting Scientific Workflow Systems to Healthcare Planning
Authors:

Bruno S. C. M. Vilar, Claudia Bauzer Medeiros and André Santanchè
Abstract: Healthcare and research environments have common characteristics and needs, such as managing people and resources, planning and conducting distributed activities, event-sensitive and monitoring processes. There are several examples in which Workflow Management Systems can aid healthcare management, systematizing, logging and automating activities. In this work we propose a context-driven approach to produce health workflows, which goes beyond an adaptation of workflows tasks to afford health procedures – as proposed in related work – departing from the rationale born from health professionals and materialized in CIG. This paper presents our proposal to support nursing processes through customization of workflows tools using as a starting point a comparative study of systems with respect to features required by healthcare professionals.
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Paper Nr: 63
Title:

Supporting Strategic Planning with Interactive Visualization - A Case Study of Patient Flow through a Large Hospital
Authors:

Dominique Brodbeck, Markus Degen and Andreas Walter
Abstract: Hospitals collect large amounts of data during their daily operation. Next to its immediate primary purpose, this data also contains implicit information that can be used to improve clinical and administrative processes. We present a case study of how strategic infrastructure planning can be supported by the analysis of enriched patient flow through a hospital. Data from various hospital information systems was collected, enriched with topographical and organizational data, and integrated into a coherent data store. Common analysis tools and methods do not support exploration and sense-making well for such large and complex problems. We therefore developed a highly interactive visual analytics application that offers various views onto the data, and provides fast access to details in order to show them in context. The analysts were able to validate their experiences, confirm hypotheses and generate new insights. As a result, several sub-systems of clinics were identified that will play a central role on the future hospital campus. This approach was successful enough that we envision to extend it towards other process optimization tasks in hospitals.
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Paper Nr: 64
Title:

Better Choice? Combining Speech and Touch in Multimodal Interaction for Elderly Persons

Authors:

Cui Jian, Hui Shi, Nadine Sasse, Carsten Rachuy, Frank Schafmeister, Holger Schmidt and Nicole von Steinbüchel
Abstract: This paper presents our work on developing, implementing and evaluating a multimodal interactive guidance system that features spoken language and touch-screen input for elderly persons. The development foundation of the system comprises two systematically designed and empirically improved aspects: a set of development guidelines for elderly-friendly multimodal interaction according to common ageing-related decline of important human abilities, and a hybrid dialogue modelling approach with a formal method triggering and agent-based management for the elderly-centered multimodal interaction. To evaluate the minutely developed and implemented system, an experimental study was conducted with thirty-three elderly persons and empirical data were analyzed by applying an adapted version of a general evaluation framework, which provided overall positive analysis results and validated our effort to develop an effective, efficient and elderly friendly multimodal interaction.
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Paper Nr: 67
Title:

Electronic Health Records Research in a Health Sector Environment with Multiple Provider Types
Authors:

Samantha S. R. Crossfield and Susan E. Clamp
Abstract: Where healthcare provision is divided into provider types, such as child health and palliative care, it is difficult for researchers to access comprehensive healthcare data. Integrated electronic health records offer an opportunity for cross-provider type care research. In this paper a new model for accessing such data is justified using the critical success factors as determined from an established research data provider. This validates a model that will enhance integrated health research for the benefit of clinical practice across multiple provider types.
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Paper Nr: 80
Title:

The PartoPen in Training and Clinical Use - Two Preliminary Studies in Kenya
Authors:

Heather Underwood, S. Revi Sterling and John K. Bennett
Abstract: This paper presents the findings from two studies of the PartoPen system – a digital pen software application that enhances the partograph, a paper-based labor-monitoring tool used extensively in developing regions. The PartoPen provides nurses with real-time decision support, instructions, and patient-specific reminders by playing short audio clips when a nurse records data on the existing paper partograph form. Previous studies have shown that correct use of the partograph significantly reduces pregnancy complications; however, the partograph is not always reliably or correctly completed due to resource and training challenges commonly found in developing world clinics. The PartoPen system addresses several significant barriers to correct partograph use in developing countries. The preliminary studies described in this paper examine how the PartoPen system affects classroom-based partograph training among nursing students at the University of Nairobi, and partograph completion and accuracy in actual labor and delivery situations by nurse-midwives at Kenyatta National Hospital in Nairobi, Kenya. The initial results of these studies indicate that using the PartoPen system enhances student performance on partograph worksheets, and that use of the PartoPen system in labor wards positively affects partograph completion rates and nurses’ level of expertise using the partograph form.
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Paper Nr: 83
Title:

Computational Modeling of Sleep Stage Dynamics using Weibull Semi-Markov Chains
Authors:

Chiying Wang, Sergio A. Alvarez, Carolina Ruiz and Majaz Moonis
Abstract: In this paper, a semi-Markov chain of sleep stages is considered as a model of human sleep dynamics. Both sleep stage transitions and the durations of continuous bouts in each stage are taken into account. The semi-Markov chain comprises an underlying Markov chain that models the temporal sequence of sleep stages but not the timing details, together with a separate statistical model of the bout durations in each stage. The stage bout durations are modeled explicitly, by the Weibull parametric family of probability distributions. This family is found to provide good fits for the durations of waking bouts and of bouts in the NREM and REM sleep stages. A collection of 244 all-night hypnograms is used for parameter optimization of the Weibull bout duration distributions for specific stages. The Weibull semi-Markov chain model proposed in this paper improves considerably on standard Markov chain models, which force geometrically distributed (discrete exponential) stage bout durations for all stages, contradicting known experimental observations. Our results provide more realistic dynamical modeling of sleep stage dynamics that can be expected to facilitate the discovery of interesting and useful dynamical patterns in human sleep data in future work.
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Short Papers
Paper Nr: 8
Title:

A Roadmap to Implement a Quality Management System
Authors:

Derek Flood, Fergal Mc Caffery and Valentine Casey
Abstract: In recent years the proportion and complexity of software in medical devices has increased considerably. This has presented an opportunity for software development organisations to expand into the medical device domain. Due to the high level of risk associated with medical devices, strict regulations must be adhered to in order to market such products. One key aspect of these regulations is the necessity to have in place a Quality Management System to help ensure an organisations’ ability to consistently meet customer and regulatory requirements. This paper presents a roadmap which can be used to assist organisations, wishing to develop medical device software to implement a Quality Management System.
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Paper Nr: 11
Title:

Doctor, Nurse or Apomediary? - What Role should Healthcare Professionals Play in Assisting Patients with Long Term Conditions to Access, and Make Sense of, Information from the Internet
Authors:

Jaqui Hewitt-Taylor and Carol S. Bond
Abstract: This position paper explores healthcare professionals’ roles in mediating the information that people with long term conditions obtain via the Internet. It explores how the way in which long term conditions are conceptualised may influence the roles and approaches which healthcare staff should adopt, and contrasts the intermediary and apomediary roles which this may include, and how such roles may be enacted in healthcare provision.
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Paper Nr: 15
Title:

Making the Case for Business Process Re-engineering in Health Informatics - Focusing on MDRTB in South Africa
Authors:

Harsha Desai and Rosemary Quiling
Abstract: The potential misalignment between new technologies entering healthcare requires attention. This paper will compare the fit between an Open Source Electronic Medical Record Solution (OpenMRS) and a clinical guideline that outlines the requirements for the care of a patient. Design/methodology: A process analysis technique is used to construct and analyse the fit between the processes as stipulated by the South African clinical guidelines for Tuberculosis (TB) and that of the OpenMRS. This technique has been used to identify inefficiencies and opportunities. Lean principles are applied in the analysis to identify waste in the process. Findings: Process analysis has provided valuable insight into the working of both the system and the provision of this healthcare service. The OpenMRS solution has a good fit to the South African healthcare context with some minor gaps between the system processes and that of the clinical guidelines. In addition, wasteful tasks have been flagged within the clinical guideline processes which appear to be due to limited consideration being paid to the patient's end-to-end care process.
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Paper Nr: 16
Title:

ePULab - An Adaptive e-Learning Tool for Pressure Ulcer Evaluation
Authors:

Laura Morente and Francisco J. Veredas
Abstract: Pressure ulcers (PrU) are considered as one of the most challenging problems that Nursing professionals have to deal with in their daily practice. Nowadays, the education on PrUs is manly based on traditional lecturing, seminars and face-to-face instruction, sometimes with the support of photographs of wounds being used as teaching material. This traditional educational methodology suffers from some important limitations, which could affect the efficacy of the learning process. This current study has been designed to introduce information and communication technologies (ICT) in the education on PrU for undergraduate students, with the main objective of evaluating the advantages an disadvantages of using ICT, by comparing the learning results obtained from using an e-learning tool with those from a traditional teaching methodology. In order to meet this major objective, a web-based learning system named ePULab has been designed and developed as an adaptive e-learning tool for the autonomous acquisition of knowledge on PrU evaluation. In this article, the ePULab software is described in details and the general results from an experimental educational validation study are also presented and analysed.
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Paper Nr: 24
Title:

Identifying Most Relevant Concepts to Describe Clinical Trial Eligibility Criteria
Authors:

Krystyna Milian, Anca Bucur, Frank van Harmelen and Annette ten Teije
Abstract: Since eligibility criteria of clinical trials are represented as free text, their automatic interpretation and the evaluation of patient eligibility is challenging. Our approach to the criteria processing is based on the identification of contextual patterns and semantic concepts that together define the machine-interpretable meaning. The goal of this research is to find the most relevant concepts occurring in eligibility criteria that need to be mapped to patient record to enable automatic evaluation of patient eligibility. Based on the analysis of annotation of breast cancer trials obtained using different concept recognizers and ontologies from UMLS Thesaurus, we chose to use MetaMap and SNOMED CT to create the mapping set. To prioritize the identified concepts, we used the tf-idf measure and the corpus of over 38, 000 various clinical trials, to detect concepts specific for breast cancer, and cancer in general. The obtained results can guide the mapping order of criteria concepts to patient data. The observed substantial overlap between the terms occurring in criteria from the trials related to breast cancer and other diseases will reduce the cost of extending the trial matching system to other diseases.
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Paper Nr: 27
Title:

Policy-based Emergency Bio-data Transmission Architecture for Smart Healthcare Service
Authors:

Jae-Wook Nah, Seung-Man Chun and Jong-Tae Park
Abstract: In this paper, we propose a policy-based emergency bio-data transmission architecture for smart healthcare service. Using the proposed service architecture, the medical staff or doctors can monitor the emergency bio-data of remote patients in accordance with policy. The proposed system consists of three tiers: measurement tier of bio-data of patients, policy-based transmission tier of bio-data of patients, and message conversion tier between IEEE 11073 PHD (Personal Health Device) message and HL7 CDA (Clinical Document Architecture). Bio-data of patients are monitored by an IEEE 11073 PHD agent such as a pulse oximeter, glucose meter, etc., and it is transmitted to IEEE 11073 PHD manager. The manager diagnoses the bio-data information in accordance with policy. The manager software can be installed in either a smartphone or PC where it transmits the bio-data information to the UMS (Urgency Management Server). The UMS converts the IEEE 11073 PHD message to a HL7 CDA standard message, after which it sends the converted HL7 CDA message to the medical staff or medical system. Finally, the medical staff can perform diagnoses using the patient bio-data information. Details of the proposed system architecture are discussed.
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Paper Nr: 38
Title:

A Purpose Model and Policy Enforcement Engine for Usage Control in Distributed Healthcare Information System
Authors:

Annanda Thavymony Rath and Jean-Noël Colin
Abstract: This paper addresses two issues: the purpose model designed for distributed healthcare and the purpose-based usage policy enforcement engine based on our purpose-based UCON (the extended UCON model). UCON has been proposed and applied to support security requirements in different computing environments such as resources sharing in collaborative computing systems and data control in remote users or platforms, but apparently absent in its core model is “purpose”, which is important for formulating a more sound privacy sensitive policy. In this paper, by observing a lack of comprehensive enforcement mechanism for purpose, we extend the UCON core model to explicitly support purpose expression and then propose a usage purpose enforcement engine, particularly for ongoing-enforcement, applied in distributed healthcare information system.
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Paper Nr: 44
Title:

Managing Data and Knowledge for the InmunoFlu Research Project
Authors:

G. Lopez Campos, Enrique de Andres, R. Almansa, I. Martin-Loeches, V. Lopez-Alonso, J. F. Bermejo-Martin and F. Martin-Sanchez
Abstract: The InmunoFlu project was funded during 2009-2011 by the Government of Spain (Biomedical Research Fund-FIS) for the study of the H1N1pdm influenza. It was an integrative project were clinicians from intensive care units (ICUs) across Spain came together with fundamental researchers to analyse at the molecular level the H1N1 infection. The multidisciplinary and geographical dispersion of the participants required the development of data and knowledge management tools. The InmunoFlu database was developed as a tool for the storage of all clinical data from patients associated with the ICUs and for the subsequent clinical annotation of the samples used in the molecular analysis of the infection and host response. The dispersion of participants in different centres fostered the development of InmunoFlu Web portal, a collaborative web portal using web 2.0 technologies, which served as a knowledge management tool for the project community. The web portal enabled among other characteristics document sharing as well as other collaborative tools such as chat, wiki, etc... The use of both tools played a central role in the success of this complex project.
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Paper Nr: 46
Title:

Health Information Systems - Investigating Greek Hospital Employees’ Intention to Use Electronic Health Records
Authors:

Prodromos D. Chatzoglou, Leonidas L. Fragidis, Argiro Nestoridou and Vassilios P. Aggelidis
Abstract: This research examines the factors affecting Greek hospital employees’ intention to use Electronic Health Records (EHR). The findings indicate that perceived ease of use and perceived usefulness are very significant drivers in the adoption of the EHR. Moreover, the intention to use EHR by employees is also affected by management support and subjective norms.
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Paper Nr: 47
Title:

Action Sequencing and Error Production in Stroke Patients with Apraxia - Behavioral Modeling using Bayesian Logic Networks
Authors:

Charmayne Mary Lee Hughes, Moritz Tenorth, Marta Bienkiewicz and Joachim Hermsdörfer
Abstract: Individuals with Apraxia often suffer from cognitive impairments during the execution of activities of daily living (ADL). In this study, we used a statistical relational learning approach (Tenorth, 2011) to model the behavior of apraxic patients and neurologically healthy individuals (n = 14 in each group) during ADL performance. Video analysis indicated that apraxic patients committed more errors than control participants, typically committing omission, addition, and substitution errors. The results of the Bayesian Logic Network (BLN) approach indicate that the relevance of the nodes (i.e., actions) differed between the control participants and apraxia patients. Furthermore, there were more nodes in the patient group, which is likely a result of addition and substitution errors, or by alternative ways of solving the task using a different set of tools. Overall, the results of the present study highlight the variability inherent in ADL performance, which need to be considered when developing action and error prediction models.
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Paper Nr: 48
Title:

eXiTCDSS: A Framework for a Workflow-based CBR for Interventional CDSS - Application to Transcatheter Aortic Valve Implantation (TAVI)
Authors:

Andres El-Fakdi, Francisco Gamero, Joaquim Meléndez and Roberto Petite
Abstract: The work presented in this paper presents a workflow-based Clinical Decision Support System (CDSS) designed to give case-specific assessment to clinicians during complex surgery or Minimally Invasive Surgery (MISs). Following a perioperative workflow, the designed software will use a Case-Based Reasoning (CBR) methodology to retrieve similar past cases from a case base to give case-specific advice at any particular point of the process. The graphical user interface allows easy navigation through the whole support progress, from the initial configuration steps to the final results organized as sets of experiments easily visualized in a userfriendly way. The tool is presented giving advice to an example application, a complex minimally invasive surgery which is receiving growing attention lately, the Transcatheter Aortic Valve Implantation (TAVI).
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Paper Nr: 50
Title:

Diagnosing Chronic Obstructive Pulmonary Disease with Artificial Neural Networks using Health Expert Guidelines
Authors:

Maria Angélica de Oliveira Camargo-Brunetto and André R. Gonçalves
Abstract: Chronic Obstructive Pulmonary Disease (COPD) is characterized by airflow limitation and the spirometry is one of the tests that can be used to detect such disease. However there is a great problem related to the different ways of interpreting the values provided by spirometric devices, regarding different guidelines and reference values. Artificial Neural Networks (ANN) can be used to help with tasks of diagnosis as that. This work presents the modeling and analysis of three ANN models to classify subjects with COPD, based on different sets of variables: a set of observed measures from spirometry and a set of interpreted values according to the guideline proposed by the American Thoracic Society. The results shown that it is possible to achieve a good accuracy in the diagnosis of COPD using ANNs, besides these features set conducted the COPD identification problem to a nearly linearly separable classification problem.
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Paper Nr: 57
Title:

Mobile Healthcare Systems: Generating Dynamic Smartphone Apps to Serve Multiple Medical Specializations - Assisting Monitoring Patient@Home and Health Record Follow-up
Authors:

Mersini Paschou, Nikolaos Nodarakis, Athanasios Tsakalidis and Evangelos Sakkopoulos
Abstract: During the recent years mobile devices and especially smartphones have been embraced by a rapidly increasing number of people worldwide. In fact, this trend is expected to evolve even more in the years to come. One of the many fields of their utilization is the health domain, with numerous applications that record critical medical data and communicate with other applications in an effort to solve a single health issue each time. However, these applications demand time and effort for maintenance, both from developers and users. In this work we propose, design and implement a single solution which gives healthcare researchers and professionals the ability to create smartphone applications on the fly, regardless of the desired healthcare content that has to be recorded. The proposed approach applies efficient techniques for development and is based on dynamically receiving business and UI at the first time of application download.
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Paper Nr: 58
Title:

Use of Biological Motion based Cues and Ecological Sounds in the Neurorehabilitation of Apraxia
Authors:

Marta Bieńkiewicz, Georg Goldenberg, José M. Cogollor, Manuel Ferre, Charmayne Hughes and Joachim Hermsdörfer
Abstract: Technological progress in the area of informatics and human interface platforms create a window of opportunities for the neurorehablitation of patients with motor impairments. The CogWatch project (www.cogwatch.eu) aims to create an intelligent assistance system to improve motor planning and execution in patients with apraxia during their daily activities. Due to the brain damage caused by cardiovascular incident these patients suffer from impairments in the ability to use tools, and to sequence actions during daily tasks (such as making breakfast). Based on the common coding theory (Hommel et al., 2001) and mirror neuron primate research (Rizzolatti et al., 2001) we aim to explore use of cues, which incorporate aspects of biological motion from healthy adults performing everyday tasks requiring tool use and ecological sounds linked to the action goal. We hypothesize that patients with apraxia will benefit from supplementary sensory information relevant to the task, which will reinforce the selection of the appropriate motor plan. Findings from this study determine the type of sensory guidance in the CogWatch interface. Rationale for the experimental design is presented and the relevant literature is discussed.
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Paper Nr: 59
Title:

Towards Medication Management in Smart Homes
Authors:

Andrej Grguric, Saša Dešić, Miran Mošmondor and Mario Kušek
Abstract: Due to current demographic trends and ageing more and more people are living alone and need proper support in their daily activities. We propose a model for smart home environment upon which we base our solution described in this paper. Example solution aims to increase reassurance for people living alone by providing them with the reminding and smart home functionalities encapsulated in terms of OSGi bundles. Medication management and timely notifications combined with lighting and audio system control allow elderly users to individually increase their autonomies while living alone.
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Paper Nr: 71
Title:

Automatic Wheeze and Respiratory Phase Detectors to Evaluate Respiratory Physiotherapy in LRTI - A Preliminary Study
Authors:

João Dinis, Ana Oliveira, Cátia Pinho, Guilherme Campos, João Rodrigues and Alda Marques
Abstract: Respiratory physiotherapy is a gold standard intervention for chronic respiratory conditions. However, its application in acute respiratory diseases (e.g., LRTI) is not well established. The objective and reliable measurement of adventitious lung sounds (ALS), such as wheezes, has the potential to contribute to respiratory physiotherapy evidence base. This paper reports on the implementation of reliable and published automatic wheeze and respiratory phase detectors to assess wheezing parameters pre/post respiratory physiotherapy treatment in patients with LRTI. Twenty patients with LRTI were randomly allocated to control group, which received standard medication treatment, or experimental group, which received standard medication plus respiratory physiotherapy treatment. Respiratory sounds were recorded in seven chest locations. Wheeze parameters, namely occupation rate, main frequency, duration and type were obtained per respiratory phase. Wheeze occupation rate was statistically significantly reduced in both groups following treatment (p<0.001). There was a greater reduction in wheeze occupation rate in the experimental group reaching statistical significance for the inspiratory phase (p=0.019). This promising result indicates the potential value of respiratory physiotherapy in LRTI. It also highlights the potential to use acoustic methods to establish respiratory physiotherapy efficacy.
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Paper Nr: 79
Title:

Multi-algorithm Respiratory Crackle Detection
Authors:

João Quintas, Guilherme Campos and Alda Marques
Abstract: Four crackle detection algorithms were implemented based on selected techniques proposed in the literature. The algorithms were tested on a set of lung sounds and their performance was assessed in terms of sensitivity (SE), accuracy (PPV) and their harmonic mean (F index). The reference annotation data for calculating these indices were obtained through agreement by majority between independent annotations made by three health professionals on the same set of lung sounds. Agreement by majority of the four algorithms afforded more than 7% performance improvement over the best individual algorithm.
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Paper Nr: 97
Title:

A Comparison of Multivariate SARIMA and SVM Models for Emergency Department Admission Prediction
Authors:

Alexander Zlotnik, Juan Manuel Montero Martínez and Ascención Gallardo-Antolín
Abstract: A comparison of multivariate SARIMA model with a multivariate regression-based time series based on a Support Vector Machine model was performed for emergency department admissions prediction. The same input variables were used in both models. Both models were trained with consecutive daily samples of data corresponding to the January 2009 – August 2012 period (n=1339). Performance was evaluated on the September 2012 test dataset (n=30). The results obtained with the Support Vector Machine were found to be more accurate with a 46,53% RMSE improvement and a 48,89% MAE improvement on the train set. The experiment was repeated six times with varying time periods. The SVM approach produced better results in all cases. Error measurements on the test set were compared with a paired T test. The differences between all comparisons were found to be statistically significant in all cases with a 95% CI.
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Paper Nr: 100
Title:

Development of a Process Assessment Model for Assessing Security of IT Networks Incorporating Medical Devices against ISO/IEC 15026-4
Authors:

Anita Finnegan, Fergal Mc Caffery and Gerry Coleman
Abstract: Advancements in medical device design over the last number of years have allowed medical device manufacturers to add more complex functionality particularly through the use of software. Such advancements include the ability for devices to communicate wirelessly across networks, from device to device and over the Internet. However, with such advancements comes additional risks; these are security risks, vulnerabilities and threats. In the past twelve months, concern within the medical device community has led to the US Government calling upon the FDA to take responsibility of medical device security. In support of this, this position paper details a research proposal to address medical device security issues through the development of a Process Reference Model (PRM) and a Process Assessment Model (PAM) to assess the capability of the processes used to develop medical devices intended to be incorporated onto healthcare networks and also determine the product security capability through the development of security assurance cases created following the lifecycle process. Further, in support of IEC 80001-2-2, the output from this PRM will be an assurance case with a security assurance level, which will be used to communicate the security capabilities of the product between Medical Device Manufacturers (MDMs) and Healthcare Delivery Organisations (HDOs). The intent is to build a better awareness of vulnerability types, threats and related risks to assist in reducing the likelihood of harm resulting from a security risk.
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Paper Nr: 102
Title:

Paradigm Shifts in Health Informatics
Authors:

Luca Dan Serbanati and Serban Radu
Abstract: There are many reasons to reflect upon the importance of paradigms in healthcare, their explicit use in health system restructuring and the possibility to anticipate the health field evolution with paradigms. For instance, it is known that an improving or restructuring strategy is needed to adapt health systems to major changes in the way of thinking or doing that occurred in the recent years in the health sector and the society. Such changes are often characterized as paradigm shifts where a paradigm is intended as a reference model of fundamental value widely accepted in a particular sector of activity. The paper claims that an explicit use of paradigms can speed up the restructuring process in healthcare. Some paradigms recently transferred from business modelling and engineering to healthcare could be more helpful if explicitly used in health system restructuring. Two recent paradigms in software engineering that will be found particularly useful to health informatics are also introduced.
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Paper Nr: 103
Title:

On a Formal and User-friendly Linguistic Approach to Access Control of Electronic Health Data
Authors:

Andrea Margheri, Massimiliano Masi, Rosario Pugliese and Francesco Tiezzi
Abstract: The importance of the exchange of Electronic Health Records (EHRs) between hospitals has been recognized by governments and institutions. Due to the sensitivity of data exchanged, only mature standards and implementations can be chosen to operate. This exchange process is of course under the control of the patient, who decides who has the rights to access her personal healthcare data and who has not, by giving her personal privacy consent. Patients’ privacy consent is regulated by local legislations, which can vary frequently from region to region. The technology implementing such privacy aspects must be highly adaptable, often resulting in complex security scenarios that cannot be easily managed by patients and software designers. To overcome such security problems, we advocate the use of a linguistic approach that relies on languages for expressing policies with solid mathematical foundations. Our approach bases on FACPL, a policy language we have intentionally designed by taking inspiration from OASIS XACML, the de-facto standard used in all projects covering secure EHRs transmission protected by patients’ privacy consent. FACPL can express policies similar to those expressible by XACML but, differently from XACML, it has an intuitive syntax, a formal semantics and easy to use software tools supporting policy development and enforcement. In this paper, we present the potentialities of our approach and outline ongoing work.
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Paper Nr: 106
Title:

Towards Distributed Sociotechnical System for Reporting Critical Laboratory Results
Authors:

Msury Mahunnah, Annike Koorts and Kuldar Taveter
Abstract: In healthcare domain, reporting of laboratory results by biomedical scientists to caregivers is a common practice. Many healthcare centres follow different kind of guidelines for reporting laboratory results for the purpose of improving the process. In this paper, we first analyze current procedure for reporting Critical Laboratory Results (CLRs) followed by North Estonia Medical Centre (NEMC) located in Estonia. We then identify weaknesses and argue that reporting of CLRs requires advanced mechanisms because a patient with CLRs is always in need of a prompt treatment or decisions on medication from the appropriate caregiver. We then critically analyze a problem of reporting CLRs to caregivers with the aim to support this process by appropriate sociotechnical system. We do this by using the approach of agent-oriented modelling. The analysis is followed by models for designing a distributed sociotechnical system for managing CLRs.
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Paper Nr: 107
Title:

A New Approach to the Transition from Paper to Electronic Medical Records
Authors:

Ghadah Khojah
Abstract: Electronic medical records (EMR) offer much potential. However, various problems have made the widespread use of EMR an unachieved reality (West and Blake, 2009). The problems reached such levels that in some countries, the transition from paper to electronic version has slowed down, if not stopped. For example, the U.K. NHS abandoned some of its ambitious plans for full transition from paper to electronic medical records (Daily Mail, 2011 Aug 03). In other countries, like Saudi Arabia, some started questioning the wisdom of electronic systems, and seek new methods of implementations, that do away from the previous mistakes. To address these issues, one needs to discover what went wrong. The myriads of issues involved, is proving rather complex, needing a sophisticated approach to expose them. Ahmad (2012) has explored an approach called Down-To-Earth (DTE) which provides a rich picture of information systems (IS) use. This paper adopts Ahmad approach to gain a richer picture of medical records. The DTE approach is based on what is called Dooyeweerd's aspects, which is a set of distinct ways in which things like medical records function and are meaningful. The main aim of this paper is to explore the potential of the Down To Earth approach with Dooyeweerd's aspects as a way to better understanding health-care giver behaviour with medical records, as a prelude to discussing how to effect more appropriate transition to EMR. By health-care giver we include: physician, nurse, technician and administration.
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Paper Nr: 108
Title:

Enterprise Architecture based Assessment of Healthcare Information System Strategic Alignment
Authors:

Nabil Alrajeh, Kaoutar Elhari and Bouchaïb Bounabat
Abstract: Traditionally, most Information Technology (IT) implementations in healthcare are concerned primarily with improving the efficiency of operational tasks, without considering the effectiveness of the strategic management decision processes. This paper objective aims at filling this lack by presenting a new approach for Assessment of Healthcare Information Systems (HIS) Strategic Alignment. The underlined concepts are based on Enterprise Architecture (EA) related concepts, providing a clear and comprehensive view of the structure and operations of the healthcare system. This paper focus on how to carry out an internal EA analysis that aims at measuring HIS alignment via a set of metrics determining if the business processes, sub-processes, applications and databases are actually achieving their purpose. This will enable all parties involved in the HIS management process to stay abreast of what has been really attained, which goals are being met, and what needs to be changed.
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Paper Nr: 5
Title:

Integrating CCD Documents - A Way towards Effective Analysis of Patients’ Health Documentation
Authors:

Juha Puustjärvi and Leena Puustjärvi
Abstract: Although the original purpose of the HL7’s Continuity of Care Documents (CCD) was to deliver clinical summaries between healthcare organizations, nowadays they are increasingly used for collecting patients’ health documentation from various healthcare providers. Usually the collected CCD documents are organized into hierarchical structures that simplify the search of documents, e.g., grouping together the documents by episode, clinical specialty or time period. Yet each clinical document is stored as a stand-alone artefact, meaning that each document is complete and whole in itself. Considering each document only as a complete and a whole in itself also has its drawback: the efficient usage of patients’ health documentation often is data centric, meaning that data should be extracted from various documents and then integrated according to specific criteria. Processing such queries requires the integration of the data of the CCD documents. In this paper we present two methods for integrating CDD documents. In the first method an XML-database is developed and the content of the documents are stored in the database. So the content of clinical documentation can be effectively accessed by database query languages such as SQL. In the second method an OWL ontology for CDD documents is developed and the CCD documents are transformed in the format that is compliant with the ontology and then stored in the ontology. So the content of clinical documentation can be easily accessed by query languages such as RQL and SPARQL. Which integration method is appropriate depends on whether the CDD documents are based on CDA Level 2 or CDA Level 3.
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Paper Nr: 9
Title:

Towards a Process Assessment Model for IEC 80001-1
Authors:

Silvana Togneri MacMahon, Fergal McCaffery and Frank Keenan
Abstract: Medical Devices are widely used in patient care for both diagnosis and treatment purposes. Typically, modern medical devices are intended to be networked at their point of use. The incorporation of medical devices opens up new opportunities and new vulnerabilities to patients and medical facilities. In 2010, the first standard to address the risks of incorporating a medical device into an IT network was published in the form of IEC 80001-1. Currently no method exists to allow responsible organisations - entities that operate and maintain a network that incorporates a medical device- to assess themselves against this standard. This paper discusses the how healthcare providers can be assessed against IEC 80001-1. This paper discusses the work carried out to date to develop a Process Reference Model and future work to allow this Process Reference Model to be extended to form a Process Assessment Model is also presented within this paper.
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Paper Nr: 10
Title:

Assessing Against IEC 80001-1
Authors:

Silvana Togneri MacMahon, Fergal Mc Caffery, Sherman Eagles, Frank Keenan, Marion Lepmets and Alain Renault
Abstract: Medical devices are designed and produced subject to various standards. These standards are recognized by the regulatory authorities within the region in which they are going to be marketed. Traditionally medical devices were placed on a proprietary network; however emergent technology is increasingly seeing medical devices being included on to the general hospital IT network. The incorporation of a medical device into an IT network can introduce risks which can impact the safety, effectiveness & security of the medical device. 80001-1: Application of Risk Management for IT networks incorporating Medical Devices addresses the risk that healthcare can be compromised when a medical device is incorporated into an IT network. In order to address these risks, an assessment of the network against IEC 80001-1 must be performed. To perform an assessment which is compliant with ISO/IEC 15504-2 of an IT network against IEC 80001-1, a process assessment model is required. This paper examines how a process assessment model could be developed to assess against IEC 80001-1.
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Paper Nr: 17
Title:

Clustering of Gabor Atoms Describing Event-Related Potentials - Solution for ERP Detection Algorithm based on Matching Pursuit when ERP Waveform is Approximated by Two or More Gabor Atoms
Authors:

Tomas Rondik and Pavel Mautner
Abstract: In our research group, we also focus on methods for automatic detection of event-related potentials in the EEG signal. We published the algorithm for event-related potential detection based on the matching pursuit algorithm in one of our previous papers. As usual, this method does not work well under special circumstances which can occur (it is a situation when the waveform of event-related potential is approximated by more than one function from the matching pursuit base functions dictionary). This paper introduces solution of this issue which is based on the self-organizing map and the connected-component labeling algorithm (it allows to group the functions related to a one kind of event-related potential to a cluster - this should prevent the detection algorithm based on matching pursuit from the fault described above).
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Paper Nr: 18
Title:

An Efficient Application of Gesture Recognition from a 2D Camera for Rehabilitation of Patients with Impaired Dexterity
Authors:

G. Ushaw, E. Ziogas, J. Eyre and G. Morgan
Abstract: An efficient method for utilising a 2D camera to recognise hand gestures in 3D space is described. The work is presented within the context of a recuperation aid for younger children with impaired movement of the upper limbs on a standard Android tablet device. The hand movement recognition is achieved through attaching brightly coloured models to the child’s fingers, providing easily trackable elements of the image. The application promotes repeated use of specific hand skills identified by the medical profession to stimulate and assess rehabilitation of patients with impaired upper limb dexterity.
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Paper Nr: 19
Title:

Leveraging an Electronic Medical Record to Improve Compliance with Pediatric Asthma Care Documentation
Authors:

James A. Menke and Jeffery Hoffman
Abstract: Asthma is our institution’s third most common admitting diagnosis with 653 admissions in 2011. The Joint Commission monitors core measures of pediatric asthma care during hospitalization: (1) were relievers given (2) were systemic corticosteroids given and (3) was the patient discharged with a complete asthma action plan (AAP). We describe the sue of three standard quality improvement (QIP) cycles to improve compliance using a computerized AAP. Our historical compliance using paper documentation averaged 32%. In Phase 1, we replaced the paper AAP form with an electronic version within our Electronic Medical Record (EMR) and improved our average compliance to 45%. In Phase 2, we identified barriers to additional improvement and modified the electronic form with soft stops and visual reminders. These modifications improved our compliance to 70%. In Phase 3, we identified remaining barriers, modified the form to include automated decision support and defaulting and improved our compliance to 90%. Using this phased QIP, we were able to achieve significant improvement in overall compliance with the core measure of providing an accurate and complete asthma action plan at the time of hospital discharge. With additional QIP cycles, we believe achievement of 100% documentation compliance for this core measure is possible.
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Paper Nr: 23
Title:

Automatic Wheeze Detection and Lung Function Evaluation - A Preliminary Study
Authors:

Ana Oliveira, Cátia Pinho, João Dinis, Daniela Oliveira and Alda Marques
Abstract: The automatic detection of wheeze offers the potential for diagnosing and monitoring respiratory diseases, e.g., lower respiratory tract infection (LRTI). By determining the relationship between wheeze detection and other lung function data, it is possible to develop a more sensitive tool for detecting respiratory conditions. This pilot study aimed to: i) explore the robustness of a time frequency wheeze detector (TF-WD) and ii) describe the correlation between wheezing and spirometry parameters. Lung sounds and spirometry parame-ters were acquired from six outpatients with LRTI (five with right lung infection). Number, fundamental frequency and duration of wheezes were obtained through a TF-WD algorithm. The performance of the TF-WD algorithm was evaluated by comparing its findings in 40 files with those annotated by two experts. Re-sults suggest that the TF-WD algorithm is an efficient and robust method for computerised wheeze detection in LRTI (SE=72.5%; SP=99.2%). Furthermore, significant correlations were found between the percentage predicted of forced expiratory volume in 1 second and forced vital capacity (FEV1pp and FVCpp) and wheeze duration at lateral (rs=-0.9, p=0.03) and posterior (rs=-0.9, p=0.01) right regions respectively. These results support the use of pulmonary auscultation and spirometry to detect areas of obstruction in LRTI.
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Paper Nr: 28
Title:

Evaluation of a Web-based Mentor Functional System for Employment Support Training of Nurses who Have Not been Employed
Authors:

Yumiko Nakamura, Yukie Majima, Yasuko Maekawa, Kaori Fukayama and Kazumi Hoshi
Abstract: We developed a mentor functional system combined with an e-learning training program to support nurses who have not been employed. Subsequently, to evaluate it, we conducted a survey using a constitutive questionnaire and a group interview of 14 monitors who had used it for a month. In the mentor functional system, the questions they asked were related exclusively to nursing techniques and new information, showing that their concern for reemployment had been reduced by taking counseling from the mentor. From these observations, it follows that the mentor functional system is effective.
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Paper Nr: 37
Title:

Access and Usage Control Requirements for Patient Controlled Record Type of Healthcare Information System
Authors:

Annanda Thavymony Rath and Jean-Noël Colin
Abstract: This paper addresses the issue of access and usage control requirements in healthcare information system. Our work aims at identifying the access and usage control requirements for a particular healthcare information system where patients have pivotal right to grant or deny access to their health records. We term this system ”Patient Controlled Record type of Healthcare Information System or PCRHIS”. It is worth noting that the requirements, presented in this paper, are the results of our studies from both user’s requirements and legal issues (based on 95/46/EC Directive ) under the scope of Walloon Healthcare Network (WHN). The WHN project aims at providing an electronic healthcare facility for patients inWalloon region, Belgium, that joins all healthcare institutions, clinics, and physicians and allows sharing of patients’ health records when needed. The main contribution of this work is that, with these requirements as a reference, one can identify an appropriate access and usage control model. This applies not only to the proposed system under the scope of WHN project but also to any system that has similar model.
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Paper Nr: 51
Title:

Classifying Heart Sounds - Approaches to the PASCAL Challenge
Authors:

Elsa F. Gomes, Peter J. Bentley, Miguel Coimbra, Emanuel Pereira and Yiqi Deng
Abstract: In this paper we describe a methodology for heart sound classification and results obtained at PASCAL Classifying Heart Sounds Challenge. The results of competing methodologies are shown. The approach has two steps: segmentation and classification of heart sounds. We also describe the data collection procedure.
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Paper Nr: 52
Title:

Assistive Technology Divide - A Developing Country Perspective
Authors:

Allen Nnanwuba Adum, Uche Patricia Ekwugha and Mercy Aguocha
Abstract: Potentially, Information and Communication Technologies (ICTs) can shape our individual and collective lives. Access to information, in relation to physical challenge, especially visual impairment, is a problematic issue. This is more so, in the light of digital divide. The question now is who among visually impaired adults in developing countries are aware of; have physical access to, and the resources and skills needed to use assistive digital and information technologies? Against this backdrop, this study explored awareness, accessibility and use of specialized ICTs among visually impaired adults in selected urban cities in South- eastern Nigeria. Thirty In-depth Interviews were conducted to collect data from purposively chosen visually impaired students and government employees. The study established a general awareness of ICTs, and limited awareness of specialized ICTs, among these visually impaired persons. It also found that ownership and access to these specialized ICTs, among these persons, were almost equal to zero; while the use of specialized ICTs among them appeared a distant reality. This led to the conclusion that a ‘divide’ exists in terms of accessibility and use of assistive technology for the visually impaired persons in this region. The study recommended individual and governmental interventions, to help bridge this ‘divide’.
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Paper Nr: 65
Title:

TICE-Healthy - A Dynamic Extensible Personal Health Record
Authors:

Pedro Catré, Alcides Marques, João Quintas and Jorge Dias
Abstract: This paper presents a system that enables the configuration of a Personal Health Record supporting informal care services in a way that is extremely flexible and simple and allows the development of dynamic extensions even in a production environment. With this system powering the Personal Health Record it is possible to modify the repository’s data structure, clinical data viewer and business logic, adapting the system to new requirements in a fast and easy manner without the need for redeploy.
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Paper Nr: 66
Title:

Model of Software and Hardware Infrastructure for Electrophysiology
Authors:

Petr Ježek, Jan Štěbeták, Petr Brůha and Roman Mouček
Abstract: Large amounts of EEG/ERP (electroencephalography, event-related potential) data, various data formats and non-standardized domain description lead to incompatible results and interpretations of EEG/ ERP experimental data/metadata and to difficult communication between interested laboratories. Authors’ research group has solved these problems and has contributed to the building of a neuroinformatics infrastructure by developing and integrating data management and analytic tools for EEG/ERP research. The model of the software and hardware infrastructure for electrophysiology, and the context and architecture of the developed EEG/ERP Portal, serving to manage, share and process EEG/ERP experiments, are presented. Other additional tools are briefly described.
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Paper Nr: 69
Title:

Electroencephalography Data Processor - Framework for Running Signal Processing Methods
Authors:

Petr Ježek and Roman Mouček
Abstract: This paper introduces difficulties related to running of signal processing methods. Although several systems that implement signal processing methods exist, their sharing and remote calling is not satisfactorily solved. Authors present a custom server-side approach that provides a powerful plug-in engine for integration of signal processing methods. The plug-in engine ensures high modularity and flexibility of the system. Since the implemented methods are accessible via the SOAP Web Service, integration with another system is available. There is also possible to use the system locally via a web browser. The set of basic methods is already implemented and presented. The architecture and the most important parts of the system are also presented.
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Paper Nr: 70
Title:

Towards a Better Understanding of EHR Systems using Architectural Views
Authors:

Liliana Dobrica, Cernian Alexandra and Traian C. Ionescu
Abstract: The content of this paper addresses the issue of understanding electronic health records (EHRs) systems under a developer perspective on the existent confusion about this concept. The current standard definition of EHR is discussed in terms of the main characteristics, data models and functional decomposition for clinical research. The key components of these models are identified and specified under two considerations namely, direct care and support. Also they are organized in architectural views describing an EHR system infrastructure for records management. The value of this work is the architecture centric approach by creating graphical representations of the system architecture based on top level standard descriptions.
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Paper Nr: 73
Title:

MobileBIT - A Framework for Mobile Interaction Recording and Display
Authors:

Michel Cânovas, Hugo Silva, André Lourenço and Ana Fred
Abstract: The proliferation of mobile devices and smartphones, together with their built-in sensors and the ability to easily connect to other peripherals using Bluetooth, is enabling new and promising signal processing applications. However, the development of mobile applications that use these features is still in the early days, requiring advanced development skills. In our work, we propose a generic framework for rapid prototyping in a mobile environment. The proposed framework enables real-time data acquisition, processing, recording, communication and visualization. As proof of concept we present an application used for electrocardiographic (ECG) signals monitoring.
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Paper Nr: 74
Title:

Savecare - EHR HIV/AIDS System - Development of a Prototype for Data Analisis and Collection
Authors:

Nuno Rocha, Carla Esteves, Emanuel Catumbela, Tiago Silva-Costa and Alberto Freitas
Abstract: Human immunodeficiency virus treatment demands constant monitorization and evaluation and tracing tools are important weapons against this epidemic. SaveCare stands for System for HIV/AIDS Virtual Evaluation. It is our goal to develop web-based tools which can motivate the HIV/AIDS patients’ data collection adjusted to both Portugal and Angola. As a result is presented a prototype with a module for HIV/AIDS patients personal and clinical data collection; a module for the performance and quality of healthcare evaluation, that uses a set of indicators and has as output printable reports; and an additional module for configuration purposes. Clinicians find the many features of the prototype very usefull, but additional modules are in need.
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Paper Nr: 76
Title:

Managing the Process Conglomeration in Health and Social Care
Authors:

Monica Winge, Paul Johannesson, Erik Perjons and Benkt Wangler
Abstract: The organisation and processes of today’s health and social care are becoming ever more complex as a consequence of societal trends, including an ageing population and an increased reliance on care at home. One aspect of the increased complexity is that a single patient may receive care from several separate care providers, which easily results in situations with potentially incoherent, uncoordinated and interfering care processes. In order to describe and analyse such situations, the paper introduces the notion of a process conglomeration. This is defined as a set of patient care processes that all influence the same patient, which are overlapping in time, and that all have the goal of improving or maintaining the health and social wellbeing of the patient. Problems and challenges of process conglomerations are investigated using coordination theory and speech act theory. In order to address the challenges, a number of information services are proposed.
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Paper Nr: 78
Title:

Combining Syntactic and Semantic Vector Space Models in the Health Domain by using a Clustering Ensemble
Authors:

Flora Amato, Francesco Gargiulo, Antonino Mazzeo, Sara Romano and Carlo Sansone
Abstract: The adoption of services for automatic information management is one of the most interesting open problems in various professional and social fields. We focus on the health domain characterized by the production of huge amount of documents, in which the adoption of innovative systems for information management can significantly improve the tasks performed by the actors involved and the quality of the health services offered. In this work we propose a methodology for automatic documents categorization based on the adoption of unsupervised learning techniques. We extracted both semantic and syntactic features in order to define the vector space models and proposed the use of a clustering ensemble in order to increase the discriminative power of our approach. Results on real medical records, digitalized by means of a state-of-the-art OCR technique, demonstrated the effectiveness of the proposed approach.
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Paper Nr: 84
Title:

SOA and Cloud based Architecture for Non-invasive Health Monitoring
Authors:

Mohamed Adel Serhani, Elarbi Badidi and Abdelghani Benharref
Abstract: The increasing incidence of chronic diseases is becoming a heavy burden for both public and private healthcare sectors. Many industrial and academic efforts are trying to alleviate this burden using various clinical solutions. Establishment and execution of prevention plans and subjects’ monitoring are among the promising solutions. In keeping with these efforts, we describe in this paper our proposed architecture, for health monitoring of patients with chronic diseases. The architecture relies on the service Oriented Architecture (SOA) and cloud computing for the implementation and integration of services from various stakeholders. The monitoring scheme allows to proactively detect risks of disease’ aggravation and dynamically generates and customizes prevention plans according to the patient’s health profile and context. A prototype of our system is under development and preliminary data have been collected and analysed.
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Paper Nr: 86
Title:

Development and Implementation of an openEHR Archetype for HIV/AIDS Diagnosis
Authors:

Carla Esteves, Nuno Rocha, Emanuel Catumbela, Tiago Silva-Costa, Gustavo Bacelar-Silva and Alberto Freitas
Abstract: One of the biggest challenges in maintaining Electronic Health Record (EHR) systems is the necessity to keep clinical knowledge up-to-date with the scientific evidence. Recently the standard modeling based on archetypes, proposed by the openEHR Foundation has proved effective in creating flexibly and semantically interoperable medical records. This paper describes the process of specifying and modeling an archetype for the diagnosis of HIV/AIDS in a hospital information system designated by SaveCare.
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Paper Nr: 93
Title:

Medical and Nursing Staff Perspectives on an Electronic Health Record Implementation in Hospital Outpatient Departments - A Qualitative Study in Four English Hospital Trusts
Authors:

Kate Marsden, Tony Avery, Sarah P. Slight and Nicholas Barber
Abstract: Objective: The authors sought to investigate the attitude of the staff using computers in outpatient departments and whether their perceptions altered as a result of the NHS Care Record Service (CRS) implementation. Design: Qualitative study using semi-structured interviews and observations. Participants: A total of 70 interviews were undertaken representing a broad range of staff involved in the outpatient department including doctors, nurses, managers, medical records staff, clerks and IT staff. In addition, 361 hours of observations were carried out in the outpatient departments over a six week period. Setting: UK Results: This study highlighted the dependence that outpatient department staff placed on IT and the complexity of issues surrounding their use of computer systems. All outpatient staff used a computer to some degree in their work and were relatively computer literate but recognised that there were problems with the technology such as the length of time it took to get information from the system, the number of times it crashed and the lack of interoperability between different systems. The implementation of the NHS in one trust created additional problems for the outpatient staff, especially during the rather protracted bedding-in time. As the software was more complex than the previous system, it required a greater number of clicks to find the information needed. The added scale and complexity of the NHS CRS was perceived to have resulted in an overall slower system, with problems finding relevant patient information on the screen. The clinic booking system configuration created difficulties with double or triple booking of clinics or clinics cancelled. During this process, staff did not feel that senior managers were listening to their concerns. Conclusions: The outpatient department has different and unique requirements which must be considered during the development stage of any new electronic health record system. IT development processes must acknowledge that new software systems require a degree of maturity and undergo testing in the different departments prior to the implementation process. Staff need to feel part of the software implementation process and their problems addressed to reduce stress and anxiety. The software design flaws described decreased the acceptance of the NHS CRS by staff but it is important to recognise that staff opinions and views may change over time as the system becomes embedded and matures.
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Paper Nr: 95
Title:

Management of Multiple Data Streams in Sensor Networks for Medicine
Authors:

Jan Sliwa and Emmanuel Benoist
Abstract: In this paper we discuss the privacy aware management of data streams generated by wireless sensor networks (WSN) in medical applications. Such data are primarily used to ensure the direct health support for a specific patient. They can also be used for other purposes, like quality assurance of applied devices and comparative evaluation research of medical treatments. Considering the novelty of the WSN-based medical application, every information helping to improve the service is extremely useful. As privacy in medicine is an important issue, care should be taken to harmonize the legal requirements with the medical necessities. Data used for different purposes have different characteristics, different users and different access rules. Therefore the raw data stream has to be split and processed (condensed, anonymized, etc.) in various ways dependent on the use. The access to data has to defined differently for different output data streams.
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Paper Nr: 96
Title:

AAL Information based Services and Care Integration
Authors:

Alexandra Queirós, Sandro Carvalho, João Pavão and Nelson Pacheco da Rocha
Abstract: Health and social care systems are currently faced with a set of challenges that continually require more sophisticated responses. The integration of health, social and informal care and the care personalization are important issues in the organization of the care systems. This article aims to propose an information architecture for Ambient Assisted Living (AAL) environments that can contribute to integrated and personalized care.
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Paper Nr: 98
Title:

Towards an Integrated Approach to Monitor and Analyse Health Care Data using Relational Databases
Authors:

Philip Schmiegelt, Jingquan Xie, Gereon Schüller and Andreas Behrend
Abstract: In modern patient monitoring systems a tremendous amount of data is gathered, stored, and analysed to support doctors in making important decisions in a timely manner. To this end, different types of data from different sources have to be processed such as sensor readings of patients vitals, meta-data like the age and weight of a patient, and historical data like performed treatments or therapies. Most of the data is low-level and has an intrinsically temporal nature which need to be preprocessed for doctors to find high-level information in an efficient way. In monitoring scenarios however, aside from the detection of critical situations of patients, medics are often interested in the phases in which their patients are most probably in. In this paper, we show how phase analysis can considerably reduce the syntactic complexity of continuous queries as provided by the Continuous Query Language (CQL). Such phases provide an advanced and higher level of abstraction enabling effective and intuitive formulation of queries comparing to classic CQL. This can greatly improve the development efficiency and reduce the maintenance complexity of patient monitoring system.
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Paper Nr: 105
Title:

Investigation of the Sensorimotor Training using Wireless Sensor Networks - Analyzing Three Different Exerciser
Authors:

A. Thiers, L. Meffofok, K. Orlowski, K. Schrader, B. Titze, A. l'Orteye and T. Schrader
Abstract: The sensorimotor training method is more and more applied in therapy, rehabilitation, prevention as well as to increase performance. The training comprises of the practice of motor action and the improvement of the proprioception. The increasing demand for training has led to a growing range of training equipment. However, this can only be achieved when the training equipment is applied correctly. The application of the training equipment is influenced by two factors: the indiviual behavior when using the equipment as well as the subjective impression of effort by each patient, both of which can differ strongly. For the purpose of this study, 18 healthy test persons were recruited. The test comprised of each person having to use each device at various levels of difficulty. Physiological data measured by EMG and ECG as well as psychological data were collected. The study revealed that the equipment demands different levels of effort from the individual depending on the physical abilities. Furthermore, it was shown that changing tasks on the particular exerciser improved the effort of the test persons.
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Paper Nr: 109
Title:

Improving Usability of EHR Software through Design for Progressive Enhancement - With a Case Study of Anfani Open Source EHR Software

Authors:

Timi Ogunjobi
Abstract: EHR software are the way of the future for healthcare delivery. They can help recognize and contain epidemics, cut healthcare administration costs and enable doctors to search records more rapidly or share patient data with remotely located specialists. However, the typical EHR package is seen as an intrusive addition to the workflow of many established healthcare establishments, primarily because they are usability deficient. This paper takes an alternative look at the design of EHR software from the perspective of usability and with a focus on progressive enhancement in terms of available functionality. An insight to how this model works is shown as a case study of the open source Ànfàní EHR.
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