A pictorial schema for a comprehensive user-oriented identification of medical Apps.

OBJECTIVES: The huge amount of released medical apps prevents medical app users from believing that medical scientific societies and other accreditation bodies as well, have the resources and the power for assigning to any medical app a quality score. By the time being, any medical app user has to take the risks related to the frequently insufficient accreditation of that app. Providing clear user-oriented schemas, to be adopted both when putting a medical App on the market and when an App comes to be evaluated by a cohort or single users, becomes crucial. The aim of our research was to define a pictorial identification one-shot schema for a comprehensive user-oriented identification of medical apps. METHODS: Adopting a pictorial approach is common in software design modeling. To build up our identification schema we started from the limited number of Apps already available on a web site of app reviews (iMedicalApps.com), and we identified an appropriately large set of attributes for describing medical apps. We arranged the attributes in six main families. We organized them in a one-shot comprehensive pictorial schema. We adopted a traffic light color code for assessing each attribute, that was sufficient to provide simple elements of alerts and alarms regarding a single App. Then, we considered apps from iMedicalApps.com web site belonging to three medical specialties: cardiology, oncology, and pharma and analyzed them according to the proposed pictorial schema. RESULTS: A pictorial schema having the attributes grouped in the families related to "Responsible Promoters", "Offered Services", "Searching Methods", "Applications Domains", "Envisaged Users", and "Qualifiers and Quantifiers" has been identified. Furthermore, we produced a one-shot pictorial schema for each considered app, and for each medical specialty, we produced it also in an aggregated form. CONCLUSIONS: The one-shot pictorial schema provides a useful perception of when and where to use a considered app. It fits positively the expectations of potential but different user's profiles. It can be a first step towards a systematic assessment of apps from the user viewpoint.

A comprehensive e-prescribing model to allow representing, comparing, and analyzing available systems.

BACKGROUND: Even though ePrescribing systems are now available in many healthcare systems and have been a crucial milestone of the roadmaps towards eHealth in the last years, there is still a large heterogeneity among functionalities and performances of different systems. OBJECTIVE: In this paper, we propose an updated comprehensive model for the ePrescribing process able to represent, analyze, and compare current systems and to support the design of new, more general, systems suitable also to sustain the ePrescription process in National Healthcare Systems. METHODS: After a preliminary literature review, we identified six main phases of the ePrescribing process, namely Assign, Transmit, Dispense, Administer, Monitor, and Analysis Decision. Each phase produces a digital object characterized by formal properties that ensure the collection of appropriate data and information and works as input for the next one. The impact, in terms of benefits, of ePrescribing on governance, drug surveillance, and quality of care at the individual, territorial, and governmental levels are related to the formal properties of the digital objects created at the end of each phase. RESULTS AND CONCLUSIONS: The model-based implementation of each phase has an impact on the quality of care, the access to care, and the effectiveness of care delivery. The model does not cover cost evaluation, but the benefits identified can be used as basis for cost-benefit or cost-effectiveness analysis of heterogeneous systems.

A three-layer multidatabase system for functional statistical analyses of microarray experiment results.

New high-throughput technologies available for the post-genomic era, such as the microarrays, produce lists of hundreds of genes candidate regulated, or with particular expression profiles, in the conditions under study. These lists need to be biologically interpreted to gain a better knowledge of the pathophysiological phenomena involved. To this aim, several biological annotations are available within heterogeneous and widely distributed databases. Although numerous tools have been developed for annotating lists of genes, most of them do not provide methods for evaluating the relevance of the annotations provided, or for estimating the functional bias introduced by the gene set on the array used to identify the considered gene list. To reach this goal, we developed GFINDer, Genome Function INtegrated Discover, a Web-accessible three-layer multidatabase system that automatically provides large-scale lists of user-classified genes with functional profiles biologically characterizing the different gene classes in the list. GFINDer automatically retrieves annotations of several functional categories from different sources, identifies the categories enriched in each class of a user-classified gene list, and calculates statistical significance values for each category. It also enables to functionally classify genes according to user-selected criteria and to analyse the resulting classifications, aiding in better biologically interpreting microarray experiment results.

Java-based browsing, visualization and processing of heterogeneous medical data from remote repositories.

The actual development of distributed information technologies and Java programming enables employing them also in the medical arena to support the retrieval, integration and evaluation of heterogeneous data and multimodal images in a web browser environment. With this aim, we used them to implement a client-server architecture based on software agents. The client side is a Java applet running in a web browser and providing a friendly medical user interface to browse and visualize different patient and medical test data, integrating them properly. The server side manages secure connections and queries to heterogeneous remote databases and file systems containing patient personal and clinical data. Based on the Java Advanced Imaging API, processing and analysis tools were developed to support the evaluation of remotely retrieved bioimages through the quantification of their features in different regions of interest. The Java platform-independence allows the centralized management of the implemented prototype and its deployment to each site where an intranet or internet connection is available. Giving healthcare providers effective support for comprehensively browsing, visualizing and evaluating medical images and records located in different remote repositories, the developed prototype can represent an important aid in providing more efficient diagnoses and medical treatments.

Web architecture for the remote browsing and analysis of distributed medical images and data.

To provide easy retrieval, integration and evaluation of multimodal medical images and data in a web browser environment, distributed application technologies and Java programming were used to develop a client-server architecture based on software agents. The server side manages secure connections and queries to heterogeneous remote databases and file systems containing patient personal and clinical data. The client side is a Java applet running in a web browser and providing a friendly medical user interface to perform queries on patient and medical test data and integrate and visualize properly the various query results. A set of tools based on Java Advanced Imaging API enables to process and analyze the retrieved bioimages, and quantify their features in different regions of interest. The platform-independence Java technology makes the developed prototype easy to be managed in a centralized form and provided in each site where an intranet or internet connection can be located. Giving the healthcare providers effective tools for browsing, querying, visualizing and evaluating comprehensively medical images and records in all locations where they can need them - e.g. emergency, operating theaters, ward, or even outpatient clinics- the implemented prototype represents an important aid in providing more efficient diagnoses and medical treatments.

A manifesto on telehealth and telemedicine.

An evident contrast exists between the generally easy way medical doctors and administrators use the term "telemedicine" and the wide variety of significantly different technologic methods and devices necessary for correctly performing specific tasks in the field. Many misunderstandings could be avoided by agreeing on the types of services that telemedicine can provide, names for those services, and descriptions of what is included in the services. This manifesto lists representative services, with a proposed name for and description of each.

Symbolic representation of anatomical knowledge: concept classification and development strategies.

In this paper a novel approach to anatomy knowledge representation is described. The focus of the present research has been on the development of a representational framework where the conceptual level has been implemented by using hierarchical and nonhierarchical conceptual networks. This has allowed handling the demand for multiple views of anatomy (systemic and topographical views). The terminological level of the knowledge representation has been implemented by using a compositional strategy which has avoided the explicit storage of the terms used to express composite concepts. Hierarchical relations and composite concept representations have required supervision of both the inheritance and concept reconstruction. For this purpose heuristic knowledge has been stored in terms of consistency rules in the knowledge base. As proof of the capability of this system, we show how the knowledge base has been used to provide symbolic access to spatial information consisting of a reduced set of images from the Visible Human Dataset.

Remote access to anatomical information: an integration between semantic knowledge and visual data.

A novel internet-based application is presented which provides access to anatomy knowledge through symbolic modality expressed by keywords taken from controlled or non-controlled terminology. The system is based on a database where anatomical concepts have been organized into a hierarchical framework. Along with term queries that allow retrieving concepts containing or exactly matching the used keyword, the system also provides semantic access to anatomical information. Queries can be setup, which retrieve concepts relying to a particular meaning and sharing a particular relationship. Moreover, the application has the capability to refine the search of the terms by querying the UMLS knowledge server. Anatomical image data have been integrated by using Visible Human Dataset. A set of these images has been indexed according to our anatomical classification and is used inside the application. The system has been implemented through Java client-server technology and works within standard Internet browsers.

The "MICTRID" concept in the educational offer for medical informatics and telemedicine at the Politecnico di Milano.

Research and training programs in Medical Informatics and Telemedicine offered at the Politecnico di Milano are summarized. The educational pathways refer to the programs of the 5-years based Laurea Degree, the 3-years based Diploma Universitario Degree, of the post-Laurea 3-years-based Doctoral Degree and of the 1-year based Master Degree, as well as of the Continuing Education Program. The Research programs focus on databases and extend to the optimisation of the "Visible Human Dataset--Milano Mirror Site" services. Additional activities relate to standardization at both Italian and European levels and to cooperations with hospitals and manufacturers.

TANCLICO: tools for the analysis of inter-departmental clinical communications.

Patient care management provided by healthcare organizations is complex, involving many different care providers. The information exchange between providers concerns a varying and considerable number of actors and a high transmission load. Based on models, used to characterize specific features of work processes, we propose a new method able to analyze and represent clinical communications inside hospitals. Software has been developed, providing tools for storing and retrieving information resulting from clinical communications. The method, together with data collected in actual situations, may constitute useful tools for health information systems developers.

TEODOLINDA. A communication architecture for hospital information systems.

This paper is focused on a system for the release and distribution of messages and services among hospital units, which extends hospital information systems features in the field of communication and supports hospital organisation to fulfil healthcare commitments.

Security concept in 'MyAngelWeb((R))' a website for the individual patient at risk of emergency.

We describe the Security Plan for the 'MyAngelWeb' service. The different actors involved in the service are subject to different security procedures. The core of the security system is implemented at the host site by means of a DBMS and standard Information Technology tools. Hardware requirements for sustainable security are needed at the web-site construction sites. They are not needed at the emergency physician's site. At the emergency physician's site, a two-way authentication system (password and test phrase method) is implemented.

Security concept in 'MyAngelWeb' a website for the individual patient at risk of emergency.

We describe the Security Plan for the 'MyAngelWeb' service. The different actors involved in the service are subject to different security procedures. The core of the security system is implemented at the host site by means of a DBMS and standard Information Technology tools. Hardware requirements for sustainable security are needed at the web-site construction sites. They are not needed at the emergency physician's site. At the emergency physician's site, a two-way authentication system (password and test phrase method) is implemented.

WWW-based access to object-oriented clinical databases: the KHOSPAD project.

KHOSPAD is a project aiming at improving the quality of the process of patient care concerning general practitioner-patient-hospital relationships, using current information and networking technologies. The studied application field is a cardiology division, with hemodynamic laboratory and the population of PTCA patients. Data related to PTCA patients are managed by ARCADIA, an object-oriented database management system developed for the considered clinical setting. We defined a remotely accessible view of ARCADIA medical record, suitable for general practitioners (GPs) caring patients after PTCA, during the follow-up period. Using a PC, a modem and Internet, an authorized GP can consult remotely the medical records of his PTCA patients. Main features of the application are related to the management and display of complex data, specifically characterized by multimedia and temporal features, based on an object-oriented temporal data model.

Medical Informatics and Telemedicine at the Politecnico di Milano.

Research and training programs in Medical Informatics and Telemedicine offered at the Politecnico di Milano are summarized. The educational pathways refer to the programs of: the (5-years) LaureaDegree, the (3-years) Diploma Universitario Degree, the post-Laurea (3-years) Doctoral Degree, the (I-year) Master's Degree, and a Continuing Education Program. The research programs focus on databases and extend to optimization of the "Visible Human Dataset-Milano Mirror Site" services. Additional activities relate to standardization at both the Italian and European levels, and to cooperation with hospitals and manufacturers.

Angiocardiographic digital still images compressed via irreversible methods: concepts and experiments.

We defined, implemented and tested two new methods for irreversible compression of angiocardiographic still images: brightness error limitation (BEL) and pseudo-gradient adaptive brightness and contrast error limitation (PABCEL). The scan path used to compress the digital images is based on the Peano-Hilbert plane-filling curve. The compression methods limit, for each pixel, the brightness errors introduced when approximating the original image (i.e. the difference between the values of corresponding pixels as grey levels). Additional limitations are imposed to the contrast error observed when considering along the scan path consecutive pixels of both the original and the reconstructed image. After previous testing on angiocardiographic images selected as clinically significant from 35 mm films, we enlarged our experiment to a set of 38 coronary angiograms digitally acquired. BEL and PABCEL methods were experimented according to several values of the implied thresholds. Up to a compression ratio of 9:1 for the BEL method and 10:1 for the PABCEL method, no deterioration of the reconstructed images were detected by human observers. After a visual evaluation, we performed a quantitative evaluation. The visualization of pseudo-colour difference images showed the capability of BEL and PABCEL for preserving the most significant clinical details of the original images. For comparison, we applied the JPEG (joint photographic experts group) image-compression standard to the same set of images. In this case, pseudo-colour difference images showed a homogeneous distribution of errors on the image surface. Quantitative compression results obtained by testing the different methods are comparable, but, unlike JPEG, BEL and PABCEL methods allow the user to keep under his direct control the maximum error allowed at each single pixel of the original image. These different behaviors are confirmed by the values obtained for the considered numerical quality quantifiers.

Electronic communication with patients. Evaluation of distance medicine technology.

OBJECTIVE: To evaluate controlled evidence on the efficacy of distance medicine technologies in clinical practice and health care outcome. DATA SOURCES: Systematic electronic database and manual searches (1966-1996) were conducted to identify clinical trial reports on distance medicine applications. STUDY SELECTION: Three eligibility criteria were applied: prospective, contemporaneously controlled clinical trial with random assignment of the intervention; electronic distance technology application in the intervention group and no similar intervention in the control group; and measurement of the intervention effect on process or outcome of care. DATA EXTRACTION: Data were abstracted by independent reviewers using a standardized abstraction form and the quality of methodology was scored. Distance technology applications were described in 6 categories: computerized communication, telephone follow-up and counseling, telephone reminders, interactive telephone systems, after-hours telephone access, and telephone screening. DATA SYNTHESIS: Of 80 eligible clinical trials, 61 (76%) analyzed provider-initiated communication with patients and 50 (63%) reported positive outcome, improved performance, or significant benefits, including studies of computerized communication (7 of 7), telephone follow-up and counseling (20 of 37), telephone reminders (14 of 23), interactive telephone systems (5 of 6), telephone access (3 of 4), and telephone screening (1 of 3). Significantly improved outcomes were demonstrated in studies of preventive care, management of osteoarthritis, cardiac rehabilitation, and diabetes care. CONCLUSIONS: Distance medicine technology enables greater continuity of care by improving access and supporting the coordination of activities by a clinician. The benefits of distance technologies in facilitating communication between clinicians and patients indicate that application of telemedicine should not be limited to physician-to-physician communication.

Applying object-oriented technologies in modeling and querying temporally oriented clinical databases dealing with temporal granularity and indeterminacy.

The need of managing temporal information given at different levels of granularity or with indeterminacy is common to many application areas. Among them, we focus on clinical data management. Different time granularities and indeterminacy are also needed in querying temporal databases. In this paper, we describe GCH-OSQL (Granular Clinical History-Object Structured Query Language), an object-oriented temporally-oriented extension of SQL. GCH-OSQL is based on an object-oriented temporal data model, GCH-OODM. GCH-OODM allows storage of clinical information at different and mixed granularities or with temporal indeterminacy. GCH-OSQL deals with the valid time of clinical information. The temporal extension of the SELECT construct includes the addition of the TIME-SLICE and MOVING WINDOW clauses, and the capability to reference the temporal dimension of objects in the WHERE and SELECT clauses. Using object-oriented technologies, a system prototype for GCH-OSQL and GCH-OODM has been implemented and applied to data management of follow-up patients after coronary angioplasty intervention.

HyperCare: a prototype of an active database for compliance with essential hypertension therapy guidelines.

HyperCare is a prototype of a decision support system for essential hypertension care management. The medical knowledge implemented in HyperCare derives from the guidelines for the management of mild hypertension of the World Health Organization/International Society of Hypertension, and from the recommendations of the United States Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. HyperCare has been implemented using Chimera, an active database language developed at the Politecnico di Milano. HyperCare proves the possibility to use active database systems in developing a medical data-intensive application where inferential elaboration of moderate complexity is required.