Sunday, July 6, 2008

IEEE HealthCom 2008

  • The Tenth IEEE International Conference on e-Health Networking, Applications & Services (IEEE HealthCom 2008) takes place from 7th July to 9th July 2008 in Singapore (BioPolis - Matrix building 4th floor).
    • 130 attendees. 50% from oversea.
    • papers: 40% acceptance rate
  • Below are my notes of the presentations/sessions I have attended:

Keynote: A Road to Disease Prevention through Telemedecine and e-Health - Prof. Luis Kun Ph.D. FAIMBE, FIEEE.

  • Very interesting presentation on various topics: Interoperability and Globalization!
  • Interoperability is needed not only in Technology, but also in Process and People.
    • Dimension of time in CPR: Very often patient Dental, Mental health, Behavioral, Immunization, Prenatal, Labor and Delivery, Family postmortem related information is often not available at the hospital which increase medical errors.
    • We need single PHRs throughout the lives of the individuals (e.g. Dod and VA administration do not have access to non-military information sources).
    • Longitudinal Health Record (LHR) and intelligent Data WareHouses will be able to acquire and store multi-modality medical Data, fuse it into clinical records, along with laboratory, anatomical pathology, pharmacy, imaging and bio-molecular data, importing data from existing EHR.
    • However, privacy, confidentiality and ethical issues remain.
    • Prof Kun also mentionned the HRBA (Health Record Banking Alliance), a way to promote community repositories of electronic health records - in competition with Goolge Health & MS Health Vault private initiatives?
    • Mobile interoperability: we need better wireless devices integration through standards.
    • More use of micro-systems body worn, implanted mobile systems and location based systems.
    • Chronobiology and chronotherapeutics: taking in consideration the time when you take drugs can be very important.
    • PHRs should be compatible across countries (to take into account he health history of immigrants for example).
  • Globalization We are more interdependent that we think, thus increasing health risks, war, pollution:
    • Populations size and migration increase.
    • Food is imported/exported from more and more countries.
    • Global dust cloud across continents can help transmit diseases.

Session: Geriatrics and Eldercare : a lot of various sensors and methods are used automatically to track behavior.

  • IC Tag Monitoring System Identifies an Unusual Pattern of Toilet use by Patient with Vascular Dementia - (Japan - Hospital Chubu region)
    • Tags are put on the shoulder of the patients with patches.
    • Technology is used to complement training of personnel provides more precise real time monitoring, especially at night-time.
    • Allow statistical studies when merged with demographic and other health related data.
    • Discover specific unusual behavior patterns - e.g. a patient can walk up to 10 km per day, or up to 150 times per day to the toilet (non incontinent patient).
    • Future work will involve combination of tracking staff activities with patient activities.
  • Automatic detection of Activities of Daily living from detecting and classifying electrical events on the residential power line - Norbet Noury - (university of Grenoble)
    • Goal tracking: tracking systems, used to trigger alarms.
    • Watteco : a detector placed in the main electrical supply board to detect instantaneous signatures.
    • Issues: non automatic learning system: setup has to be done manually.
    • Use different weight for various appliances.
    • Issues: need to take into account seasonal variations
    • Activities tracking:
      • feeding, grooming, toilets, day vs night activities
  • Smart Wireless Continence Management System for Elderly with Dementia.
    • use sensor / wetness detection / placed in diapers (cost $50 per sensor -reusable).
    • plan to use RFID as well
    • care giver alerted through LED, Buzzer, 3D /GUI and SMS alerts.
  • Eating Activity Primitives Detection - a step towards ADL recognition.
    • basic safety, daily living and social interactions
      • person location
      • use of potential harmful objects
    • Combination of sensors: motion detecting PIS, pressure, accelerometer, RFID.
  • Approaches and Principles of Fall Detection for Elderly and Patient.
    • 4 types of falls: from sleeping, from sitting, from walking or standing, from standing on ladder, stool.
    • Devices
      • Wearable devices (postures, motion) - e.g. walking sticks
      • Camera based (inactivity detection, body shapec change, 3D head motion)
      • Ambiance devices (presence, posture)

Session: Knowledge Management and Ontology in HealthCare.
  • Design and implementation of a Knowledge-Based Applications in Specimen Collection
    • Tests collection by phlebotomy stations - tracking done via ATOM system
    • Barcode Lab Information System (LIS) based demographic and session ID labels are added to testing tubes/containers.
    • COW (Computer on Wheels) systems at point of care (used by doctor and phlebotomist).
    • Reduce the number of human errors dramatically.
    • Issue: multiple distributed systems can still lead to errors (e.g. if there has been delays in the production of the lab results).
  • An Ontology-Based Framework for Managing Semantic Interoperability Issues in e-Health (Singapore).
    • Need to decouple domain knowledge from underlying intelligent agent infrastructure.
    • Use ontology (explicit domain knowledge) used by multi-agent systems.
    • However, domain knowledge can be very complex.
    • Semantic interoperability is an issue in Health Care - same object for various terms e.g. Anemometer or Sphygmomanometer.
    • Context must be brought in.
    • Use of dialogs/predictions
    • Issues: multi-language interpretation
  • Management of Mobile Social ntework services for families with Developmental Delay Children (Taiwan)
  • Assessment of User Satisfaction with an Internet-Based Integrated Patient Education System for Diabetes Management.
    • different types of formats are used (e.g. text, powerpoint etc ...)
  • A Framework for Personalized HealthCare Service Recommendation (South Korea)
    • see Healthcare provider recommendation system (Bachus et al.) - US patent
    • However there is a need for personalization
    • HSRF provides personalized results.
    • Integrated with MUSS - Mobile U-Health Service Ststem (see Lee et al)
    • Health Status is a combination of Bio Signals & Symptoms
    • Health Vector is generated from patient information.
    • Heuristic calculates the distanced between users vectors and vectors of services
    • Use satisfaction / user feedback to refine the recommendations.
    • Technology use is JSP, AXIS, MYSQL

Session: Security and Privacy in HealthCare
  • A Web-Based Wireless Mobile System design of Security and Privacy Framework for ubiquituous HealthCare (u-HealthCare) - San Jose, CA
    • SSL, data encryption, Windows based solution
  • Secure WBAN Usng Rule-Based IDS with Biometrics and MAC Authentication - India
    • Use Wireless Sensor Networks (sink +sensor) for medical monitoring.
    • Take into account constraints in Sensor Network Security
    • Use strong public key Cryptography technology
    • Cost factor is the limitation
    • Denial of service are the type of attacks that are prevented
  • Privacy-preserving EHR linkage using pseudonyms identifiers.
    • Need to allow patient to keep certain linkages private (e.g. abortion, drug addiction clinics)
    • Need to link only records belonging to the same patient
    • Need to override privacy rules in emergencies?
Session: Discovery
  • Highly Interactive and User Friendly Web Application for People with Diabetes
  • Training Program for e-Health in Tokai University (Japan)
  • Ride Comfort Analysis Based on Tilting Train Simulator for e-Health Train (Korea)
  • Development of the Support System to Help Team Care for Home Care
  • Security and Privacy fro WiMoHS (Wireless Mobile Healthcare System)
  • A Case Report on a e-Learning for Health Initiative in the Philippines
  • Comparison and Optimization of Methods fro Intra-Disc Vascular Architecture Extraction

Keynote: e-Health from the hands of Patients - Prof Yu-Chuang (Institute Biomedical Informatics, National Yang-Ming University Tapei).
  • H2H Exchange: Medical Information Exchange Center. Attempts to interconnect EHRs were not very sucessful. The main reason is that the providers were reluctant.
  • Could ATM machines be a model for Hospital-centric exchange? The problem is that hospitals are afraid to loose patients/customers (in the case of ATM machines, bank accounts are not transfered, whereas EHR transfer would be similar to full bank account transfer).
  • Patients should be the one who initiate the transferts: H2P2H exchange and the content of Health Record belongs to the patient.
  • Standard format?
  • Health Smart Card started in 2004 was a success however.
    • 23M Health Smart cards (non RSA card)
    • 100K Health professionals would would have RSA cards
    • issues:
      • too small for EHR (8KB)
      • patients do not have a reader for their card
  • TMT: Taiwan Electronic Medical Record Templates (2007-2011)
    • 70 templates, 24K data elements, 3 years.
    • A couple of days are necessary to map templates to hospital documents
    • Patient centric, initiated and own exchange (PIX).
    • XML based, signed , but not encrypted
    • Masking function available for the user to keep privacy
    • Patients will be able to use viewers at home to see their records (open source)
    • Data can be stored on USB disks or to Health Data Bank
    • 11 largest hospitals (27K beds) -
    • 2000 pilot patients
    • Would expand to 7M (30% of the population) in 5 years.
  • TET (Travelers Electronic Health Summary)
    • template-based approach
    • Endorsed by APEC, IMIA, EFMI, AMIA, APAMI
    • some degree if international interoperability
    • 88 data elements. Similar to CCR.
Session: e-Health
  • Assistive Care Loop with Electronic Maternity Record -D.B. Hoang - Univ. Sydney.
    • provide alert, notifications, advices (SMS, email)
  • A Framework for Assessing ICT Preparedness for e-Health Implementation
  • Information and Communications Technology Needs Assessment of Philippine Rural Health.
    • few people own laptops, but a lot of people have cell phones.
  • An Approach for E-Health System Assessing ICT Preparedness for e-Health Implementations.
  • An Empirical Analysis of Reduction of Medical Expenditures by the e-Health System: Further Results.
  • Challenging Interoperability and Bandwidth Issues in National e-Health Strategies by a Bottom-up Approach: Establishing a Performant IT Infrastructure Network in a Middle East . State Vienna University of Technology.

Session: Communication Technology in Mobile HealthCare
  • Power and Delay Aware Mobile Application Data Flow Adaptation: the Mobihealth System Case study - Kataryna Wac - University Geneva.
    • patient tele-monitoring services (cardiac sensor: HR, SpO2, pleth, 3 led ECG, alarm (128 Hz)
    • use 2.5/3G WLAN and bluetooth andTMSI box (NL)
    • started in 2001 with Vodafone (Mobihealth) - worked with mobihealth, vodafone and Myotel
    • in 205-06 (project HealthService24)
    • in 2004-08 : Freeband-awareness - location, time, standing status of the patient.
    • in 2008 - MobiHealth BV - Commercial application
    • in 2009 - Myotel project
    • study the optimization of the battery consumption (li-ion polymer 1490 mAh), match delay requirement to emergency/non emergency case.
    • Mobile device: Qtek 9090, Windows Mobile 203 (battery drain!)
    • WWLAN (802.11b) & WWAN-GPRS (class 10: 4+1/3+2 slots)
    • Appplication flow: 5-14 Bytes, 128 Hz, aggregation 1 sec of Data., compression (ZIP) 38-85%, TCI/IP end to end path. continuous 1.2, 1.5, 5.5 or .7.7 kbps or burst 5.5 or 7.7 kbps
  • A study on Intra-Body Communication for Personal HeathCare Monitoring System - Waseda University, Japan
    • use human body (skin and muscle) as signal transmission medium
    • use ECG (future plan to use other types of sensors)
    • use central hub
    • use 3-USB receiver Unit (USB2.0/1-1 12mbps
    • transmiter: Agilent E443B, receiver: tektronix WCAA230
    • 75 MHZ is found to be the optimal frequency for intra-Body human skin communication (electrostatic coupling model).
    • weather and sweating have small effects on the results.
  • A Platform for Personalized Mobile u-Health Application Design and Development - Korea
    • MUSS Mobile U-Health Service System (Application Platform) + Workbench
    • Application model i sbased on 5 phases (sensing, Questionaire, Data processing, Disease Management User feedback).
    • MUSS: 3 layers
      • Component : combine web services
      • Process : BPM engine
      • Application: Application Designer + scenario player are store in application portal
    • Application designer generates Application scenario in XML format for stand alone or web application.
      • Process consist of activities
    • the platform is written in Java
    • the client is written in C++ and C#
    • Heath Care specialist can create questionaires via the Questionaire composer.
    • Example: Stress Application
      • sensing: Bluetooth PPG sensor
      • questionaire: stress response inventory
    • Future work: application designer will use conditional and more complex workflow.