eHealth Platform Research Articles

The Architecture of an Automatic eHealth Platform With Mobile Client for Cerebrovascular Disease Detection.

BackgroundIn recent years, cerebrovascular disease has been the leading cause of death and adult disability in the world. This study describes an efficient approach to detect cerebrovascular disease.ObjectiveIn order to improve cerebrovascular treatment, prevention, and care, an automatic cerebrovascular disease detection eHealth platform is designed and studied.MethodsWe designed an automatic eHealth platform for cerebrovascular disease detection with a four-level architecture: object control layer, data transmission layer, service supporting layer, and application service layer. The platform has eight main functions: cerebrovascular database management, preprocessing of cerebral image data, image viewing and adjustment model, image cropping compression and measurement, cerebrovascular segmentation, 3-dimensional cerebrovascular reconstruction, cerebrovascular rendering, cerebrovascular virtual endoscope, and automatic detection. Several key technologies were employed for the implementation of the platform. The anisotropic diffusion model was used to reduce the noise. Statistics segmentation with Gaussian-Markov random field model (G-MRF) and Stochastic Estimation Maximization (SEM) parameter estimation method were used to realize the cerebrovascular segmentation. Ball B-Spline curve was proposed to model the cerebral blood vessels. Compute unified device architecture (CUDA) based on ray-casting volume rendering presented by curvature enhancement and boundary enhancement were used to realize the volume rendering model. We implemented the platform with a network client and mobile phone client to fit different users.ResultsThe implemented platform is running on a common personal computer. Experiments on 32 patients’ brain computed tomography data or brain magnetic resonance imaging data stored in the system verified the feasibility and validity of each model we proposed. The platform is partly used in the cranial nerve surgery of the First Hospital Affiliated to the General Hospital of People's Liberation Army and radiology of Beijing Navy General Hospital. At the same time it also gets some applications in medical imaging specialty teaching of Tianjin Medical University. The application results have also been validated by our neurosurgeon and radiologist.ConclusionsThe platform appears beneficial in diagnosis of the cerebrovascular disease. The long-term benefits and additional applications of this technology warrant further study. The research built a diagnosis and treatment platform of the human tissue with complex geometry and topology such as brain vessel based on the Internet of things.

Patient Engagement and Reported Outcomes in Surgical Recovery: Effectiveness of an e-Health Platform

Electronic health information platforms have the potential to support standardized care delivery models, engage patients, and deliver patient self-assessment tools. We tested whether an e-health platform could support the delivery and acquisition of patient-reported outcomes (PROs) during hospitalization after cardiac surgery. Secondarily, we tested if patient reported data were predictive of resource use (length of stay) or outcomes (discharge disposition). Subjects were 149 cardiac surgical patients, over age 50 years, undergoing routine surgery, with an expected length of stay of 5 to 7 days. While hospitalized, patients were provided with iPads (Apple), which delivered a personalized care plan. That plan included daily patient "To Do" lists with self-assessment modules that included recovery-related patient reported outcomes. Those included an early screen for discharge planning (ESDP) as well as daily pain and mobility self-assessments using the visual analog pain scale and the I-MOVE mobility scale. We measured completion rates for the self assessments, determined length of stay (short, intermediate, or long) and discharge disposition (home independently or other), and evaluated whether patient self-assessments were predictive of these outcomes. Patients completed 98% of the 1,418 self-assessments that were delivered. The ESDP and mobility self-assessments were predictive of length of hospital stay (p = 0.004 and p = 0.012, respectively) and of discharge disposition (p < 0.0001 and p < 0.007, respectively). Lower ESDP scores and higher I-MOVE scores were predictive of shorter lengths of stay and a higher likelihood of discharge to home independently. Our trial demonstrated that an e-health platform, combined with mobile computing, can effectively deliver customized care plans with which patients can interact. Furthermore, patient self-reported data are predictive of length of stay and discharge disposition.

PREDIRCAM eHealth Platform for Individualized Telemedical Assistance for Lifestyle Modification in the Treatment of Obesity, Diabetes, and Cardiometabolic Risk Prevention: A Pilot Study (PREDIRCAM 1 &gt;

Healthy diet and regular physical activity are powerful tools in reducing diabetes and cardiometabolic risk. Various international scientific and health organizations have advocated the use of new technologies to solve these problems. The PREDIRCAM project explores the contribution that a technological system could offer for the continuous monitoring of lifestyle habits and individualized treatment of obesity as well as cardiometabolic risk prevention. PREDIRCAM is a technological platform for patients and professionals designed to improve the effectiveness of lifestyle behavior modifications through the intensive use of the latest information and communication technologies. The platform consists of a web-based application providing communication interface with monitoring devices of physiological variables, application for monitoring dietary intake, ad hoc electronic medical records, different communication channels, and an intelligent notification system. A 2-week feasibility study was conducted in 15 volunteers to assess the viability of the platform. The website received 244 visits (average time/session: 17 min 45 s). A total of 435 dietary intakes were recorded (average time for each intake registration, 4 min 42 s ± 2 min 30 s), 59 exercises were recorded in 20 heart rate monitor downloads, 43 topics were discussed through a forum, and 11 of the 15 volunteers expressed a favorable opinion toward the platform. Food intake recording was reported as the most laborious task. Ten of the volunteers considered long-term use of the platform to be feasible. The PREDIRCAM platform is technically ready for clinical evaluation. Training is required to use the platform and, in particular, for registration of dietary food intake.

CPR: STAT! OR STOP! THE END-OF-LIFE CARE ELECTRONIC RECORD (ELCER)

BackgroundAdvance Care Planning is about much more than CPR and the aspiration to support care planning and symptom management to improve care at the end-of-life; empowering and supporting patients in...

Perinatal Data Collection: Current Practice in the Australian Nursing and Midwifery Healthcare Context

The collection of perinatal data within Queensland, Australia, has traditionally been achieved via a paper form completed by midwives after each birth. Recently, with an increase in the use of e-health systems in healthcare, perinatal data collection has migrated to an online system. It is suggested that this move from paper to an ehealth platform has resulted in improvement to error rates, completion levels, timeliness of data transfer from healthcare institutions to the perinatal data collection and subsequent publication of data items. Worldwide, perinatal data are collected utilising a variety of methods, but essentially data are used for similar purposes: to monitor outcome patterns within obstetrics and midwifery. This paper discusses current practice in relation to perinatal data collection worldwide and within Australia, with a specific focus on Queensland, highlights relevant issues for midwives, and points to the need for further research into the efficient use of an e-health platform for perinatal data collection.

Le plan de traitement partagé: un outil à forte valeur ajoutée pour la plate-forme e-toile

Objectives: To describe the design and implementation of a shared treatment plan to provide unified views of medications for professionals and patients, as a new added-value service on the e-toile platform. Results: Based on previous experiences of patient education about their medications, and through an iterative process involving all key stakeholders, a prototype of the shared treatment plan has evolved and is currently reaching production status. It is based on the e-toile secure architecture of federated documents, and is organised in a modular way to enable various interfaces with existing prescription and dispensation systems. The first version is provided as a web-interface on the e-toile portal, but other mechanisms of integration are possible and will be used to streamline processes around medication reconciliation, as well as integration on larger projects such as epSOS, the European-wide interoperability eHealth platform. Discussion: Initial feedback from key stakeholders shows a strong interest in this functionality. Its feasibility has been demonstrated on the e-toile platform. Deployment is scheduled for the summer of 2012.

A robust and simple security extension for the medical standard SCP-ECG

This paper proposes a SCP-ECG security extension after having analyzed the features of this standard, its security requirements and the current measures implemented by other medical protocols. Our approach permits SCP-ECG files to be stored safely and proper access to be granted (or denied) to users for different purposes: interpretation of the test, consultation, clinical research or teaching. The access privileges are scaled by means of role-based profiles supported by cryptographic elements (ciphering, digital certificates and digital signatures). These elements are arranged as metadata into a new section which extends the protocol and protects the remaining sections. The application built to implement this approach has been extensively tested, showing its capacity to authenticate users and to protect the integrity of files and the privacy of sensitive data, with a low impact on file size and access time. In addition, this solution is compatible with any version of the SCP-ECG and can be easily integrated into e-health platforms.

Learning a Lightweight Ontology for Semantic Retrieval in Patient-Centered Information Systems

The paper introduces a web-based eHealth platform currently being developed that will assist patients with certain chronic diseases. The ultimate aim is behavioral change. This is supported by online assessment and feedback which visualizes actual behavior in relation to target behavior. Disease-specific information is provided through an information portal that utilizes lightweight ontologies (associative networks) in combination with text mining. The paper argues that classical word-based information retrieval is often not sufficient for providing patients with relevant information, but that their information needs are better addressed by concept-based retrieval. The focus of the paper is on the semantic retrieval component and the learning of a lightweight ontology from text documents, which is achieved by using a biologically inspired neural network. The paper concludes with preliminary results of the evaluation of the proposed approach in comparison with traditional approaches.

Improving Childhood Obesity Treatment Using New Technologies: The ETIOBE System

Childhood obesity is an increasing public health problem in western culture. Sedentary lifestyles and an “obesogenic environment” are the main influences on children leading to an increase in obesity. The objective of this paper is to describe an e-health platform for the treatment and prevention of childhood obesity called ETIOBE. This e-health platform is an e-therapy system for the treatment of obesity, aimed at improving treatment adherence and promoting the mechanisms of self-control in patients, to obtain weight loss maintenance and to prevent relapse by establishing healthy lifestyle habits. ETIOBE is composed of three different applications, the Clinician Support System (CSS), the Home Support System (HSS) and the Mobile Support System (MSS). The use of new Information and Communication (ICT) technologies can help clinicians to improve the effectiveness of weight loss treatments, especially in the case of children, and to achieve designated treatment goals.

Knowledge-driven delivery of home care services

Home Care (HC) assistance is emerging as an effective and efficient alternative to institutionalized care, especially for the case of senior patients that present multiple co-morbidities and require life long treatments under continuous supervision. The care of such patients requires the definition of specially tailored treatments and their delivery involves the coordination of a team of professionals from different institutions, requiring the management of many kinds of knowledge (medical, organizational, social and procedural). The K4Care project aims to assist the HC of elderly patients by proposing a standard HC model and implementing it in a knowledge-driven e-health platform aimed to support the provision of HC services. This paper focuses on two knowledge-based personalization aspects incorporated in the platform that aim to overcome the difficulties of HC delivery. The first one is the assistance to medical practitioners in the process of defining a customized treatment adjusted to the medical and social conditions of a particular patient in order to consider multiple co-morbidities. The second one is the possibility of tailoring the profiles of the care professionals according to the medical and organizational daily requirements in order to allow a flexible care delivery. Those two aspects, guided by the knowledge explicitly represented in the platform, play a crucial role in the medical and social acceptance of this kind of e-health systems. The paper also includes a real case study designed and tested by healthcare professionals and includes encouraging results from the test of the platform in a real health care environment in the city of Pollenza (Italy).

EHealth in Belgium, a new “secure” federal network: Role of patients, health professions and social security services

eHealth platform is the official federal network in Belgium (created by law on 21 August 2008) devoted to a secure exchange of health data in many types of applications, such as health care purposes, simplification of administrative procedures and contribution to health policy. It implies a controlled access to decentralized databases and uses encrypted personal data. The national identification number has been chosen in order to authenticate the requester, the patient, and the receiver of information exchange. Authorizations have to be respected in order to obtain personal health data. Several questions are raised about its security: the lack of mandatory request for systematic journaling on accesses to the electronic patient record as well as the absence of explicit procedures for sanctions in case of unauthorized access, the new role of social security administration in managing security where a eHealth manager can be both judge and party (in the function of trusted third party for health data encryption and of a required lawyer for texts proposed by physicians to the Commission for the protection of private life). Another critic concerns the number of physicians in minority and the absence of patients’ delegates in the eHealth Board. At a time when the patient is becoming a partner in the care team, should not he be the gate-keeper for the access to his own health record? How could networks help him to get the appropriate knowledge to contribute to care and to write his testament of life? Recent laws (on private life, patient rights and euthanasia) have contributed to a behavioural change in citizens and physician attitudes. Recommendations are made in order to improve the acceptability of eHealth platform.

An e-health platform for the elderly population: The butler system

The Butler system is an e-health platform designed to improve the elderly population’s quality of life. The Butler system has three applications diagnostic, therapeutic and playful. The objective of this work is to present the influence of the use of the platform on elderly users’ mood states and the degree of acceptance. These measures were assessed through visual analogical scales before and after the platform use, with the outcome measures MANOVAS analyses were performed. Seventeen users (from 58 to 79 years old) completed four sessions with the system; they could choose which technological resources they used in each session. The results showed that after using the system, the participants’ insensitive emotions increased and their negative ones decreased. In addition, they obtained high levels of satisfaction, low levels of subjective difficulty and would recommend Butler to other users. Therefore, the results indicate that Butler might be an effective system for improving emotional states in elderly population.

Healthcare Applications and Services in Converged Networking Environments

Healthcare Applications and Services in Converged Networking Environments

Tile-ippokratis: the experience of an ehealth platform for the provision of health care services in the island of chios and cyprus.

Tile-Ippokratis proposed an integrated platform for the provision of low-cost ehealth services to citizens in southeast Mediterranean area (Island of Chios and Cyprus). The aim of the paper is to present the architecture, the design, and the evaluation results of this platform. The platform based on already evaluated state-of-the-art mobile ehealth systems and using wireless and terrestrial telecommunication networks is able to provide the following health care services: (i) telecollaboration and teleconsultation services between health care personnel and between health care personnel and patients and (ii) ehealth services for “at risk” citizens such as elderly and patients with chronic diseases (Island of Chios) and postsurgery patients (Cyprus). The ehealth systems supported capabilities for vital signal measurements (ECG 1 lead, SPO2, HR, BP, weight, and temperature), an Electronic Patient Record (EPR) infrastructure, and video conference, along with communication gateways for data transmission over ADSL, GPRS, and WLAN networks.

An e-Health System for the Elderly (Butler Project): A Pilot Study on Acceptance and Satisfaction

The Butler Project is a technological e-health platform that uses the Internet to connect various users; it was designed to deliver health care to the elderly. The Butler platform has three levels of implementation: diagnosis (mood monitoring, alert system, management reports), therapy (training in inducing positive moods, memory work), and entertainment (e-mail, chat, video, photo albums, music, friend forums, accessibility to the Internet). The objective of this work is to describe the psychological aspects of the platform and to present data obtained from four users. Results show that after using the system, the participants increased their positive emotions and decreased their negative ones; in addition, they obtained high levels of satisfaction and experienced little difficulty in using the system.

Multi-Modal Reasoning medical diagnosis system integrated with probabilistic reasoning

In this paper, a Multi Modal Reasoning (MMR) method integrated with probabilistic reasoning is proposed for the diagnosis support module of the open eHealth platform. MMR is based on both Rule Based Reasoning (RBR) and Case Based Reasoning (CBR). It is not only applied to the identification of diseases and syndromes based on medical guidelines, but also deals with exceptional cases and individual therapies in order to improve diagnostic accuracy. Moreover, a new rule expression frame is introduced to deal with uncertainty, which can represent and process vague, imprecise, and incomplete information. Furthermore, this system is capable of updating the attributes of rules and inducing rules with a small data sample.

An open eHealth platform for health management using adaptable service profiles

An open eHealth platform for health management using adaptable service profiles for different medical specialties is currently being validated in the regional health information network (RHIN) of South Aegean in Greece. The core of the installation is an electronic health record (EHR), customized for primary care, that has been extended with advanced eHealth services. Users of the EHR can create an active episode folder by selecting an eHealth service profile. Relevant clinical data can be added to the folder and users will be aware or be notified of updates. Once in a folder, a connected user perceives the actions of other users in the same folder and may use medical devices in a collaborative manner. The underlying service engineering framework allows maintenance of service profiles without disrupting the operation of the system. Preliminary results show that end-users have recognized the efficiency of the system and are eager to use it in managing the health of their patients both in their office and at the patients' home.

DICOM and XML: union makes strength

Classical medical imaging applications must now participate in sophisticated information workflow. XML has proven to be the support of choice for data exchange. We describe in this paper a DICOM-XML framework part of a general e-Health platform allowing a better integration of DICOM into a web-based application.

Development of muscle afferent projections in relation to neurotrophin-3 expression in transgenic mouse spinal cord

Despite theoretical arguments that brief app-based interventions could be a useful adjunct to longer traditional treatment programs, there has been limited evaluation of the acceptability, feasibility, and efficacy of these micro-interventions. In the present study, 247 women from the general population were randomly assigned to the intervention or wait-list control condition, and provided measurement of body satisfaction and related constructs (body image importance, confidence dealing with body image issues, eating pathology, and self-esteem) at baseline and 21-days (post-intervention). During the 21-day period, the treatment group received access to an eHealth platform containing a series of brief video activities (e.g., gratitude tasks, breathing, and relaxation) previously demonstrated in experimental studies to improve body satisfaction. Findings showed greater improvements in body satisfaction at post-intervention for the intervention group than the waitlist controls (Cohen's d = .42). Use of the intervention content was associated with immediate increases in state-like body satisfaction ratings, and the magnitude of these in-the-moment improvements was predictive of greater post-intervention symptom improvement and retention (ps < .05). However, the intervention did not produce change in constructs related to body satisfaction (Cohen's d ranged from 0.02 to 0.13). Overall, findings offer support for micro-interventions as a spot treatment for specific symptoms, and possible means to maintain engagement and motivation within a broader treatment program.