RESUMO
In the context of hospital management and operation, Intensive Care Units (ICU) are one of the most challenging in terms of time responsiveness and criticality, in which adequate resource management and signal processing play a key role in overall system performance. In this work, a context aware Intensive Care Unit is implemented and analyzed to provide scalable signal acquisition capabilities, as well as to provide tracking and access control. Wireless channel analysis is performed by means of hybrid optimized 3D Ray Launching deterministic simulation to assess potential interference impact as well as to provide required coverage/capacity thresholds for employed transceivers. Wireless system operation within the ICU scenario, considering conventional transceiver operation, is feasible in terms of quality of service for the complete scenario. Extensive measurements of overall interference levels have also been carried out, enabling subsequent adequate coverage/capacity estimations, for a set of Zigbee based nodes. Real system operation has been tested, with ad-hoc designed Zigbee wireless motes, employing lightweight communication protocols to minimize energy and bandwidth usage. An ICU information gathering application and software architecture for Visitor Access Control has been implemented, providing monitoring of the Boxes external doors and the identification of visitors via a RFID system. The results enable a solution to provide ICU access control and tracking capabilities previously not exploited, providing a step forward in the implementation of a Smart Health framework.
Assuntos
Unidades de Terapia Intensiva , Sistemas Computacionais , SoftwareRESUMO
Most healthcare services use information and communication technologies to reduce and redistribute the workload associated with follow-up of chronic conditions. However, the lack of normalization of the information handled in and exchanged between such services hinders the scalability and extendibility. The use of medical standards for modelling and exchanging information, especially dual-model based approaches, can enhance the features of screening services. Hence, the approach of this paper is twofold. First, this article presents a generic methodology to model patient-centered clinical processes. Second, a proof of concept of the proposed methodology was conducted within the diabetic retinopathy (DR) screening service of the Health Service of Navarre (Spain) in compliance with a specific dual-model norm (openEHR). As a result, a set of elements required for deploying a model-driven DR screening service has been established, namely: clinical concepts, archetypes, termsets, templates, guideline definition rules, and user interface definitions. This model fosters reusability, because those elements are available to be downloaded and integrated in any healthcare service, and interoperability, since from then on such services can share information seamlessly.
Assuntos
Retinopatia Diabética/diagnóstico , Registros Eletrônicos de Saúde/normas , Sistemas de Informação em Saúde/normas , Informática Médica/métodos , Informática Médica/normas , Algoritmos , Diagnóstico por Computador/métodos , Humanos , Armazenamento e Recuperação da Informação , Programas de Rastreamento/métodos , Assistência Centrada no Paciente , Desenvolvimento de Programas , Retina/patologia , Espanha , Integração de Sistemas , Interface Usuário-ComputadorRESUMO
BACKGROUND: Health care has evolved to support the involvement of individuals in decision making by, for example, using mobile apps and wearables that may help empower people to actively participate in their treatment and health monitoring. While the term "participatory health informatics" (PHI) has emerged in literature to describe these activities, along with the use of social media for health purposes, the scope of the research field of PHI is not yet well defined. OBJECTIVE: This article proposes a preliminary definition of PHI and defines the scope of the field. METHODS: We used an adapted Delphi study design to gain consensus from participants on a definition developed from a previous review of literature. From the literature we derived a set of attributes describing PHI as comprising 18 characteristics, 14 aims, and 4 relations. We invited researchers, health professionals, and health informaticians to score these characteristics and aims of PHI and their relations to other fields over three survey rounds. In the first round participants were able to offer additional attributes for voting. RESULTS: The first round had 44 participants, with 28 participants participating in all three rounds. These 28 participants were gender-balanced and comprised participants from industry, academia, and health sectors from all continents. Consensus was reached on 16 characteristics, 9 aims, and 6 related fields. DISCUSSION: The consensus reached on attributes of PHI describe PHI as a multidisciplinary field that uses information technology and delivers tools with a focus on individual-centered care. It studies various effects of the use of such tools and technology. Its aims address the individuals in the role of patients, but also the health of a society as a whole. There are relationships to the fields of health informatics, digital health, medical informatics, and consumer health informatics. CONCLUSION: We have proposed a preliminary definition, aims, and relationships of PHI based on literature and expert consensus. These can begin to be used to support development of research priorities and outcomes measurements.
Assuntos
Atenção à Saúde , Informática Médica , Humanos , Técnica Delphi , Consenso , Inquéritos e QuestionáriosRESUMO
The new paradigm of personal health demands open standards and middleware components that permit transparent integration and end-to-end interoperability from new personal health devices to healthcare information system. The use of standards seems to be the internationally accepted way to face this challenge. In this article, the implementation of an end-to-end standard-based personal health solution is presented. It integrates the ISO/IEEE11073 standard for the interoperability of personal health devices in the patient environment and the ISO/EN13606 standard for the interoperable exchange of electronic healthcare records and proposes a new approach for the end-to-end ISO/IEEE11073-ISO/EN13606 communication. The design strictly fulfills all the technical requirements of the most recent versions of both standards. An entire prototype has been designed, developed, and tested as a proof-of-concept of a personal health solution.
Assuntos
Registros Eletrônicos de Saúde/normas , Internacionalidade , Tecnologia Assistiva/normas , Integração de Sistemas , HumanosRESUMO
We propose a telemedicine framework for remote and manufacturer independent pacemaker (PM) follow-up. The main goal is to provide the caregiver at the point-of-care with an efficient screening method to identify possible malfunction of the pacing system in collaboration with the specialist at the PM clinic. The concept was evaluated in a clinical trial on 44 patients (mean age 76 years). A total of 62 electrocardiogram (ECG) recordings were transmitted using a mobile PM follow-up unit. Using the automatic classification algorithm, 32 PMs were classified as 'OK' and eight PMs were classified as 'not OK'. In four cases a prediction regarding the working status of the PM was not possible. The signal processing classification was confirmed by expert classification (manual review of the ECG). The results indicate that the proposed PM follow-up concept has the potential to work as an efficient screening method and may spare a significant number of patients the burden of having to travel to specialized PM clinics.
Assuntos
Marca-Passo Artificial , Telemedicina , Telemetria/instrumentação , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Atenção à Saúde/métodos , Eletrocardiografia , Estudos de Viabilidade , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The Point of Care (PoC) version of the interoperability standard ISO/IEEE11073 (X73) provided a mechanism to control remotely agents through documents X73-10201 and X73-20301. The newer version of X73 oriented to Personal Health Devices (PHD) has no mechanisms to do such a thing. The authors are working toward a common proposal with the PHD Working Group (PHD-WG) in order to adapt the remote control capabilities from X73PoC to X73PHD. However, this theoretical adaptation has to be implemented and tested to evaluate whether or not its inclusion entails an acceptable overhead and extra cost. Such proof-of-concept assessment is the main objective of this paper. For the sake of simplicity, a weighing scale with a configurable operation was chosen as use case. First, in a previous stage of the research - the model was defined. Second, the implementation methodology - both in terms of hardware and software - was defined and executed. Third, an evaluation methodology to test the remote control features was defined. Then, a thorough comparison between a weighing scale with and without remote control was performed. The results obtained indicate that, when implementing remote control in a weighing scale, the relative weight of such feature represents an overhead of as much as 53%, whereas the number of Implementation Conformance Statements (ICSs) to be satisfied by the manufacturer represent as much as 34% regarding the implementation without remote control. The new feature facilitates remote control of PHDs but, at the same time, increases overhead and costs, and, therefore, manufacturers need to weigh this trade-off. As a conclusion, this proof-of-concept helps in fostering the evolution of the remote control proposal to extend X73PHD and promotes its inclusion as part of the standard, as well as it illustrates the methodological steps for its extrapolation to other specializations.
Assuntos
Sistemas Automatizados de Assistência Junto ao Leito/normas , Engenharia Biomédica/normas , Engenharia Biomédica/estatística & dados numéricos , Redes de Comunicação de Computadores , Desenho de Equipamento/normas , Desenho de Equipamento/estatística & dados numéricos , Humanos , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Tecnologia de Sensoriamento Remoto/normas , Tecnologia de Sensoriamento Remoto/estatística & dados numéricos , Software , TelemedicinaRESUMO
A plethora of digital ECG formats have been proposed and implemented. This heterogeneity hinders the design and development of interoperable systems and entails critical integration issues for the healthcare information systems. This paper aims at performing a comprehensive overview on the current state of affairs of the interoperable exchange of digital ECG signals. This includes 1) a review on existing digital ECG formats, 2) a collection of applications and cardiology settings using such formats, 3) a compilation of the relationships between such formats, and 4) a reflection on the current situation and foreseeable future of the interoperable exchange of digital ECG signals. The objectives have been approached by completing and updating previous reviews on the topic through appropriate database mining. 39 digital ECG formats, 56 applications, tools or implantation experiences, 47 mappings/converters, and 6 relationships between such formats have been found in the literature. The creation and generalization of a single standardized ECG format is a desirable goal. However, this unification requires political commitment and international cooperation among different standardization bodies. Ongoing ontology-based approaches covering ECG domain have recently emerged as a promising alternative for reaching fully fledged ECG interoperability in the near future.
Assuntos
Eletrocardiografia , Registros Eletrônicos de Saúde , Sistemas de Informação , Telemedicina , Humanos , Processamento de Sinais Assistido por ComputadorRESUMO
This paper investigates the application of the enterprise information system (EIS) paradigm to standardized cardiovascular condition monitoring. There are many specifications in cardiology, particularly in the ECG standardization arena. The existence of ECG formats, however, does not guarantee the implementation of homogeneous, standardized solutions for ECG management. In fact, hospital management services need to cope with various ECG formats and, moreover, several different visualization applications. This heterogeneity hampers the normalization of integrated, standardized healthcare information systems, hence the need for finding an appropriate combination of ECG formats and a suitable EIS-based software architecture that enables standardized exchange and homogeneous management of ECG formats. Determining such a combination is one objective of this paper. The second aim is to design and develop the integrated healthcare information system that satisfies the requirements posed by the previous determination. The ECG formats selected include ISO/IEEE11073, Standard Communications Protocol for Computer-Assisted Electrocardiography, and an ECG ontology. The EIS-enabling techniques and technologies selected include web services, simple object access protocol, extensible markup language, or business process execution language. Such a selection ensures the standardized exchange of ECGs within, or across, healthcare information systems while providing modularity and accessibility.
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Sistemas de Gerenciamento de Base de Dados , Prestação Integrada de Cuidados de Saúde , Eletrocardiografia , Aplicações da Informática Médica , Bases de Dados Factuais , Registros Eletrônicos de Saúde , Humanos , Interface Usuário-ComputadorRESUMO
Traditionally, e-Health solutions were located at the point of care (PoC), while the new ubiquitous user-centered paradigm draws on standard-based personal health devices (PHDs). Such devices place strict constraints on computation and battery efficiency that encouraged the International Organization for Standardization/IEEE11073 (X73) standard for medical devices to evolve from X73PoC to X73PHD. In this context, low-voltage low-power (LV-LP) technologies meet the restrictions of X73PHD-compliant devices. Since X73PHD does not approach the software architecture, the accomplishment of an efficient design falls directly on the software developer. Therefore, computational and battery performance of such LV-LP-constrained devices can even be outperformed through an efficient X73PHD implementation design. In this context, this paper proposes a new methodology to implement X73PHD into microcontroller-based platforms with LV-LP constraints. Such implementation methodology has been developed through a patterns-based approach and applied to a number of X73PHD-compliant agents (including weighing scale, blood pressure monitor, and thermometer specializations) and microprocessor architectures (8, 16, and 32 bits) as a proof of concept. As a reference, the results obtained in the weighing scale guarantee all features of X73PHD running over a microcontroller architecture based on ARM7TDMI requiring only 168 B of RAM and 2546 B of flash memory.