Editorial: pervasive healthcare. Selected papers from the Pervasive Healthcare 2008 Conference, Tampere, Finland.

OBJECTIVE: Introducing the Special Topic of Methods of Information in Medicine on pervasive healthcare, with selected papers from the Pervasive Healthcare Conference at Tampere, Finland, January 30 to February 1, 2008. METHODS: Describing pervasive healthcare as field. Reporting about the content of the selected papers in this Special Topic. Developing and evaluating physiological measurement techniques, assistive care ambient notification and reminding systems, ambulatory monitoring, architectures and platforms for personalized home-health tele-monitoring, means of privacy-protecting health-sensitive information, and establishing a clinical proof-of-concept methodology. RESULTS AND CONCLUSIONS: Pervasive healthcare is an emerging field with considerable technological breadth and expected strong impact for the quality and efficiency of healthcare in an aging society. However, this field is still a nascent one, with a good deal of exploratory research. There is also hypothesis-based and empirical research, which tests the assumptions or feasibility of a solution using clinical evidence, but most such trials at this time are preliminary and small. The emergence of a truly evidence-based outcomes assessment will take some time, but is in the making.

National health IT services in Finland.

OBJECTIVES: In 2002 a decision was reached to set up a nation-wide electronic health record system in Finland. The legal framework of actors with the necessary mandate was approved in the parliament in December 2006. A set of standards and norms have been selected that all health care actors need to follow. Functional specifications of the services were completed in 2006. Setting up the centralized health IT services begins in 2007. Centralization of patient record data allows the reorganization of health service providers to take place at local and regional levels according to need. The services allow users to access patient records securely from anywhere with the provision that they have the right to access private patient data. METHODS: The functionality of the services and the necessary infrastructure has been agreed to in projects and working groups involving users, experts, key stakeholders and vendors. RESULTS: The legal framework was approved in the parliament in December 2006. The functional specifications of the centralized health IT services were finalized in 2006. CONCLUSIONS: The implementation of the services will start in 2007.

Framework for biosignal interpretation in intensive care and anesthesia.

Improved monitoring improves outcomes of care. As critical care is "critical", everything that can be done to detect and prevent complications as early as possible benefits the patients. In spite of major efforts by the research community to develop and apply sophisticated biosignal interpretation methods (BSI), the uptake of the results by industry has been poor. Consequently, the BSI methods used in clinical routine are fairly simple. This paper postulates that the main reason for the poor uptake is the insufficient bridging between the actors (i.e., clinicians, industry and research). This makes it difficult for the BSI developers to understand what can be implemented into commercial systems and what will be accepted by clinicians as routine tools. A framework is suggested that enables improved interaction and cooperation between the actors. This framework is based on the emerging commercial patient monitoring and data management platforms which can be shared and utilized by all concerned, from research to development and finally to clinical evaluation.

Healthcare Information Framework.

CEN committee TC 251 Medical Informatics, has set up a project team charged with producing a European pre-standard ENV on Healthcare Information Framework (HIF). The HIF is based on abstraction from a specific information system architecture to a reference architecture and further to a conceptual architectural framework based on serving open, distributed and heterogeneous healthcare enterprises. To specify the suitable healthcare information system architecture modelling of the healthcare enterprise is required. As there is no one method serving all needs, the HIF gives guidance on what aspects to look at in selecting a suitable modelling method. It is expected that the work will be completed by early 1995.

Round table discussions: standardisation and its role in PACS and medical imaging.

The round table discussions dealt with standardisation and its role in PACS and medical imaging, and with the assessment of medical imaging and targeting R & D based on that. Two approaches to enable image files to be transferred were discussed in the standardisation sessions. Firstly, the standardisation efforts in Europe, USA and Japan which all focus on a single standard on image transfer and file format were discussed. A plea was made to merge these three approaches. It was also noted that the Japanese IS&C standard is essentially a standard for off-line PACS. Secondly, an argument was raised that as several i age file formats are already in existence (because of the different computer platforms in use), what is needed are converters between these de-facto formats instead of striving towards one common standard. The round table on assessment focused on the changes in the radiological practices which are already emerging following the introduction of new digital imaging modalities. It was argued that PACS will cause further organisational changes because a hospital-wide PACS enables images to be viewed everywhere. The radiology meetings have been the mechanism for discussing difficult cases. In the PACS world their role may change. However, PACS will only diffuse when it offers clear advantages over the present procedures. This means that PACS, digital imaging and radiology practices evolve in parallel and incrementally.

User requirements and standards for PACS. 2nd Japan-Nordic PACS Symposium.

PACS has been regarded as a system which will bring a new era to image handling, radiology departments and its services to other departments of the hospital. However, many recently held international conferences indicate that a worldwide consensus on 'what is PACS, why is PACS needed and who is PACS for' has not been established. Although the actual PACS implementation will vary among the countries and according to each situation, a worldwide consensus of PACS should be possible. This would help those involved to speed up the implementation of PACS. It is suggested that this consensus needs to be developed by convergence of three points of view; the availability, maturity and cost of the technologies on which PACS is built, the user requirements for PACS and standardization in PACS. These themes were the topics of the 2nd Japan-Nordic PACS Symposium which was arranged in Tampere, Finland, June 9-11th 1991. A summary of the papers and discussions of the symposium is produced in this paper.

PACS in Japan and the Nordic Countries. First Japan-Nordic PACS symposium.

The ingredients seem to exist for switching from film-based radiology to digital radiology utilizing the concept Picture Archiving and Communication System (PACS). Why has this not happened? What are the barriers limiting the diffusion of PACS into health care? This was the theme of the 1st Japan-Nordic Symposium in PACS, which was held in Tokyo, March 29-30, 1990. Over 40 radiologists and technical specialists in PACS participated. The topics discussed ranged from the present status of PACS in Japan and the Nordic Countries, to functional specifications and user requirements for PACS, to organizational and other changes brought about by PACS and to teleradiology as a solution for communication of images over wide distances. The symposium was quite successful and will be followed by a 2nd symposium in Finland in the summer of 1991.

Knowledge-based systems in medicine--a Nordic research and development programme.

A Nordic research and development programme, 'KBS in Medicine' (KUSIN-MEDICINE), was run in 1986-89. Its main goal was to acquire an understanding of applying knowledge-based techniques in medicine and of the limitations of present-day artificial intelligence (AI) methodologies. The programme comprised four experimental installation sites (Tampere in Finland, Uppsala and Linköping in Sweden, and Aalborg in Denmark) each prototyping in one or more medical domains. The programme was financed by the Nordic Fund for Technological and Industrial Development, by national funds for applied research and by a number of industries. Prototype decision support systems were produced in the following domains: intensive care (Tampere, Uppsala, Linköping, Aalborg), clinical chemistry (Tampere, Uppsala) and clinical neurophysiology (Aalborg in collaboration with Turku and Uppsala). These served to transfer this technology to industry and helped to identify limitations of this technology.

Diurnal blood pressure profiles and variability in normotensive ambulant subjects.

The 24-hour variability in blood pressure and heart rate of 14 normotensive subjects was examined under ambulatory conditions with a continuous, invasive method. The results were analysed with 30-second means calculated from beat-to-beat values. The registered time series had three different types of variation: (1) a continuous, fast variation around the mean level; (2) a stepwise, permanent change to a new level; and (3) a slow, continuous rise or fall. Variability in blood pressure and heart rate was determined by the 80 percent range of variation calculated from the cumulative distribution as the difference between the 90th and 10th percentiles. The variability in blood pressure and heart rate was significantly greater during waking hours than during night-time. Variability followed a similar type of diurnal profile as the mean level. However, variability of diastolic pressure changed to a lesser extent than that of systolic pressure. Total 24-hour variability was on average 45 mmHg in systolic blood pressure, 24 mmHg in diastolic pressure and 40 b.p.m. in heart rate. Using night-time to describe the basal state, physical and mental activities in the evening and during daytime were found to raise variability in systolic pressure with 66%, diastolic with 8-16% and heart rate with 130-180%, respectively. The results show that in normotensive subjects the sleep-wake state and activity are the major factors that affect both the diurnal profile and the variability in blood pressure and heart rate.