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
  
• based on open platform (openEHealth.org)
  
• 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.