Wednesday, August 30, 2006

MIE2006 – open EHR

It is the final day of MIE2006 already. The session I am attending this morning consists of two papers on aspects of openEHR archetypes. The session is very well-attended considering it is the morning after the conference gala dinner.

The first speaker, Sebastian Garde, is speaking on 'Ubiquitous information for ubiquitous computing: expressing clinical data sets with openEHR archetypes'. Sebastian describes openEHR archetypes as intuitive, formal and flexible models of clinical content. He described the conversion of 260 items from the German clinical paediatric data set to 46 archetypes.

He said that one of the problems has been that clinical data sets do not necessarily follow basic design principles, and often do not define when and how often which data item has to be captured, whereas openEHR archetypes have built-in support for defining time series, etc. The website was introduced.

He concluded that archetypes can provide better structure for clinical data sets (not replace them); archetypes are more like a maximum than a minimum data set, having a much broader scope, and sees it as possible to transform existing clinical data sets into archetypes.

In the second talk, Thilo Schuler from Germany talked about 'Towards automatically generating graphical user interfaces from openEHR archetypes'. This is a proof of concept project that uses the clinical concepts described in the previous talk. Thilo said that a new overview paper explaining the basic principles of openEHR archetypes is available on the website. Three prototypes were built, using Mozilla XUL (XML user interface language), which allows for writing of Firefox browser extensions, and using Microsoft's C#. This was a very technically-oriented presentation that I think needed some detailed knowledge of the archetype concepts and of programming.

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Tuesday, August 29, 2006

MIE2006 - free/libre/open source group launch

A workshop held at MIE2006 on 28 August saw the formal launch of the EFMI libre/free and open source software Working Group. The formation of the WG had been previously agreed by the EFMI Council.

About 15 people attended the workshop, although sveveral others who had been unable to attend also expressed interest. Co-chairs Peter Murray and Karl Oyri lead discussions of the nature, format, aims and objectives of the WG. Further information will be made available in due course, and an invitation issued to others interested in joining the group. It will aim to work with other similar groups, but at the same time address and provide a particular European focus.

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Monday, August 28, 2006

MIE2006 – medical informatics in an ageing society

Sabine Koch, Centre for eHealth, Uppsala University, Sweden ( gave the day's first keynote lecture, titled 'Meeting the challenges: the role of medical informatics in an ageing society'.

She began by talking about the demographic changes in the elderly population varying between different European and other countries, although most figures seem to suggest that the elderly will make up between 25 – 40% of the total population by 2050. Spain seems like it might be worst affected in terms of the fewest working age people to support the economically inactive and dependent elderly population.

There is increasing mobility in the population, increases in chronic diseases and patient demands, at the same time as changes in the distribution of healthcare, with more and more home-based healthcare.

Sabine's recent literature review of home telehealth states that there is still little scientific evidence on the effects of home telehealth; most literature seems to be on measurement of parameters and on information systems and decision support; there are few evaluation studies (Int J Med Inf (2006), 565-576). There are various projects developing smart home applications, and increasing interest in robotics (especially in Japan).

What are user needs in the ageing society? - are they the same for all, or are there different needs? There are, Sabine, says, that there is not a 'one size fits all' for 'the elderly, but there is an interaction between the elderly, care providers (professional), differing health and social care needs, the role of relatives, and the role of policy developers. There are different roles, with different needs; independent living with mininal support needs; moving through increasing support needs to various degrees of assisted living, to full support being needed in nursing homes, etc. Systems need to be developed that compensate for age-related declines, but also support independence and help the elderly keep control over their own lives. Access to information is often a key need for relatives of the elderly, to provide feelings of security about the level of support and care received.

The role of medical informatics in the future will/should be about the information about the patient being at the centre of care (which is slightly different from the rhetoric in much policy of the patient being at the centre of care). Work will be needed in the areas of standards, interoperability, knowledge management and ubiquitous computing, human-computer interaction, modelling and simulation – but the ethical aspects also need to be strongly borne in mind.

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MIE2006 – Design of smart homes

It is a wet Monday morning here in Maastricht. George Demiris, now at University of Washington, USA is the first speaker of the parallel paper sessions I am attending; he is speaking about 'Facilitating interdisciplinary design specification of 'smart' homes for aging in place'. Smart homes he defines as a residence equipped with advanced electronics for physiological monitoringto enable early detection of possible problems or emergency situations.

The study focus is of elderly people who have health problems, but are able to undertake many activities of living, but have some limitations. The study used focus groups who rated features and devices; pressure pads and smart cards were felt to be most useful, with PDAs and iris recognition felt less useful. User-friendly and non-intrusive aspects of the devices were seen as important.

One of the aims was to look at design issues for developing an integrated sensor network, which collects data from sensors, including pressure sensors, video sensors etc. that monitor activity levels in the elderly. The study seems to be only of professionals involved in designing care, and not the elderly themselves. The study was based in part on an earlier study that looked at the attitudes and perceived needs of older people in respect of the types of technologies.

The next speaker, Jurgen Broernen from Gothenburg, spoke about 'Rehabilitation after stroke using virtual reality, haptics (force feedback) and telemedicine. He talked of the increasing frequency of strokes and need for rehabilitation in hospital and then at home post stroke. He talked about a proposed system, connecting home and hospital systems via broadband connections, and allowing games-based training exercises as part of the rehabilitation system. The study looked at reference values from 58 healthy subjects to develop a set of reference values against which to compare the results of post-stroke rehabilitation patients. A field study comparing patients using the VR systems against patients not using the system is due to start very soon, which will also include some qualitative measurement of how patients feel about using the system.

In the final talk of the session, Maarten van Steen, from Philips, presented on 'A distributed shared data space for personal health systems'. He began by talking about how he saw 'personal health systems (PHS)' and how new sensors in the future would allow many more parameters to be measured. PHS are seen to be reliant on sensors, which would need low energy consumption. Many current personal health solutions are seen as addressing single diseases or purposes, often without reusable software etc.; the desired future situation is a PHS that support monitoring of multiple diseases, using common middleware layer and distributed shared data space. Data collected from various sensors can be stored in the data space, and different applications can sample a data stream from the data space in different ways (eg sample selectively at different intervals). This is currently a prototype application. Part of the work is within the Dutch government-funded 'smart surroundings' project – The speaker admits the work is not currently standards-related, but there is interest in interoperability issues for smart homecare standards.

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Sunday, August 27, 2006

MIE2006 Opening Ceremony

It is now 6:30pm on Sunday, and I am have just been at the Opening Ceremony of MIE2006, the 20th International Congress of the European Federation for Medical Informatics (EFMI) in Maastricht. The opening speaker is George Mihalas, EFMI President, from Romania. He began by talking about the theme of the event, 'Ubiquity'.

He thanked the chairs of the Organising and Scientific Programme Committees (SPC), Johan van der Lei and Reinhold Haux respectively.

A new Dutch healthcare insurance act has been introduced earlier this year, as was explained by a Dutch government representative. In his view, the keyword is synergy, especially between different programmes of the EU and member state programmes in respect of developing health, especially in terms of public health. Investment in R&D and innovation are supposed to increase in all EU member countries according to the Lisbon agenda. (Graham notes that although there is plenty of synergy, there is not much subsidiarity – an in-joke)

A wireless network is available in the registration area, but it does not seem to extend very far; so reports may be few and far between; not much 'live' blogging.

Reinhold Haux, SPC Chair, reported about 300 submissions, which resulted in approx. 140 oral presentations, as well as posters, scientific demonstrations, and other forms of activity.

The opening keynote speaker is Erich Reinhardt, President and CEO of Siemens Medical Solutions, talking about 'Challenges in healthcare from aging societies can best be mastered leveraging healthcare IT'. He said that 3% of GDP should be invested in R&D to achieve Europe being the leading area in knowledge-based activities; the speaker says that there is a need to invest much in healthcare knowledge development. One of the global megatrends, the aging population in most countries of th world, has many implications for healthcare expenditure. What can be done to\ improve quality and efficiency of care while reducing costs? - if there are answers, he says integrated IT systems will play a key role, and in im\proving workflow. He talked about the 'first dual source CT scanner', which offers not only dual means to help provide the image, but also dual (and potentially different) energies, which can help to differentiate different tissues.

In the future IT and molecular medicine (genomics, proteomics, etc) will enable integration and clinical use of data derived from these to derive therapies and care methods, as well as new modes of prevention and early detection and well as diagnosis and therapy.

I did find that there was a bit too much selling of Siemens and its products in many parts of the talk.

More tomorrow.

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Tuesday, August 22, 2006

Blogging MIE2006

MIE2006 - the 20th International Congress of the European Federation for Medical Informatics (EFMI - takes place in Maastricht, The Netherlands, from 27 - 30 August, 2006. See for the conference website

Rather than setting up a separate blog, as we have done for quite a few events in recent years (see., we will be posting news, stories and comments here, as we did for the AMIA2005 Fall Symposium.

The theme of the event is 'Ubiquity: technologies for better health in aging societies'.

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Monday, August 21, 2006

Criticisms of NHS IT programme were cut from NAO report

Criticisms of NHS IT programme were cut from NAO report

E-Health Insider has some further speculation about the in which the NAO report into NPfIT (see previous item) was "edited" before publication.

A copy of the draft version has been made availble with certain sections "blacked out" however if you copy & paste these sectons into word you can read about some of the problems which had been identified and didn't make it into the final report - interesting reading !

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Thursday, August 17, 2006

Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice

BioMed Central | Abstract | 1472-6920-6-41 | Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education
This new (provisional) paper "Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education" by Maged N Kamel Boulos, Inocencio Maramba and Steve Wheeler has just been published on BMC Medical Education for debate and discussion.

The paper provides lots of backgrond and examples of the development of these technologies and considers the underpinning pedagogy while recognising some of the problems inherent in open and easily accessible technologies.

The paper concludes that: "If effectively deployed, wikis, blogs and podcasts could offer a way to enhance students', clinicians' and patients' learning experiences, and deepen levels of learners' engagement and collaboration within digital learning environments. Therefore, research should be conducted to determine the best ways to integrate these tools into existing e-Learning programmes for students, health professionals and patients, taking into account the different, but also overlapping, needs of these three audience classes and the opportunities of virtual collaboration between them. Of particular importance is research into novel integrative applications, to serve as the "glue" to bind the different forms of Web-based collaborationware synergistically in order to provide a coherent wholesome learning experience."

This is a useful contribution to the growing body of literature and debate around these topic areas.

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Monday, August 14, 2006

Health Informatics Journal -(September 1 2006, 12 [3])

Health Informatics Journal -- Table of Contents (September 1 2006, 12 [3])

The latest edition of Health Informatics Journal (12:3)

Impact of workflow-integrated corollary orders on aminoglycoside monitoring in children
Patricia A. Abboud, Rose Ancheta, Michael McKibben, and Brian R. Jacobs

Clinical, information and business process modeling to promote development of safe and flexible software
Siaw-Teng Liaw, Elizabeth Deveny, Iain Morrison, and Bryn Lewis

Using neural networks and just nine patient-reportable factors of screen for AMI
A. M. Bulgiba and M. H. Fisher

Population access to hospital emergency departments and the impacts of health reform in New Zealand
Lars Brabyn and Paul Beere

When computers should remain computers: a qualitative look at the humanization of health care technology
Ramesh Farzanfar

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Tuesday, August 08, 2006

ToC: He@lth Information on the Internet (52:1)

IngentaConnect Table Of Contents: He@lth Information on the Internet

While I was on holiday the latest (August 2006) editition of He@lth Information on the Internet has been made available. It includes:

TI: Editorial: I pod, you pod, we all pod
AU: Childs, Sue

TI: Bookmarks: Diabetes
AU: Blenkinsopp, John

TI: View from the front line: Basic IT skills for the health professional
AU: Brown, Harry

TI: A review of the Scopus database
AU: Burnham, Judy F.

TI: Launch of the new look and feel for the National Library for Health Specialist Libraries
AU: Hadley, Sharon; Tucker, Laura

TI: Making practice-based learning work
AU: Turnock, Chris

TI: Intute: Health and Life Sciences your new BIOME
AU: Abbott, Robert

TI: What's new?
AU: Williamson, Laurian

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