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ABSTRACT: BACKGROUND: Advancements in information and communication technologies have allowed the development of new approaches to the management and use of healthcare resources. Nowadays it is possible to address complex issues such as meaningful access to distributed data or communication and understanding among heterogeneous systems. As a consequence, the discussion focuses on the administration of the whole set of resources providing knowledge about a single subject of care (SoC). New trends make the SoC administrator and responsible for all these elements (related to his/her demographic data, health, well-being, social conditions, etc.) and s/he is granted the ability of controlling access to them by third parties. The subject of care exchanges his/her passive role without any decision capacity for an active one allowing to control who accesses what. PURPOSE: We study the necessary access control infrastructure to support this approach and develop mechanisms based on semantic tools to assist the subject of care with the specification of access control policies. This infrastructure is a building block of a wider scenario, the Person-Oriented Virtual Organization (POVO), aiming at integrating all the resources related to each citizen's health-related data. The POVO covers the wide range and heterogeneity of available healthcare resources (e.g., information sources, monitoring devices, or software simulation tools) and grants each SoC the access control to them. METHODS: Several methodological issues are crucial for the design of the targeted infrastructure. The distributed system concept and focus are reviewed from the service oriented architecture (SOA) perspective. The main frameworks for the formalization of distributed system architectures (Reference Model-Open Distributed Processing, RM-ODP; and Model Driven Architecture, MDA) are introduced, as well as how the use of the Unified Modelling Language (UML) is standardized. The specification of access control policies and decision making mechanisms are essential keys for this approach and they are accomplished by using semantic technologies (i.e., ontologies, rule languages, and inference engines). RESULTS: The results are mainly focused on the security and access control of the proposed scenario. An ontology has been designed and developed for the POVO covering the terminology of the scenario and easing the automation of administration tasks. Over that ontology, an access control mechanism based on rule languages allows specifying access control policies, and an inference engine performs the decision making process automatically. The usability of solutions to ease administration tasks to the SoC is improved by the Me-As-An-Admin (M3A) application. This guides the SoC through the specification of personal access control policies to his/her distributed resources by using semantic technologies (e.g., metamodeling, model-to-text transformations, etc.). All results are developed as services and included in an architecture in accordance with standards and principles of openness and interoperability. CONCLUSIONS: Current technology can bring health, social and well-being care actually centered on citizens, and granting each person the management of his/her health information. However, the application of technology without adopting methodologies or normalized guidelines will reduce the interoperability of solutions developed, failing in the development of advanced services and improved scenarios for health delivery. Standards and reference architectures can be cornerstones for future-proof and powerful developments. Finally, not only technology must follow citizen-centric approaches, but also the gaps needing legislative efforts that support these new paradigms of healthcare delivery must be identified and addressed.
International Journal of Medical Informatics 03/2012; · 2.41 Impact Factor
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ABSTRACT: This paper analyses different benefits of the full integration of components for clinical guideline management in the information system architecture of a healthcare organization. Subsequently, we propose a methodology for the development of these components based on the European prEN12967 standard, in order to facilitate this integration. Benefits are studied from several viewpoints. First, from the healthcare professional user viewpoint, as a powerful decision support tool, by which the Electronic Health Record of a specific patient could suggest the appropriate guidelines to apply and a particular assistance plan for him or her. We are centered in co-morbidity patients because these tasks are especially difficult to accomplish in this kind of patients. Second, from the guideline creation viewpoint, we analyze how the tacit knowledge implicit in the healthcare information system could be the base for the explicit representation of knowledge in a guideline and the posterior validation of these guidelines. Our approach is in agreement with today's new paradigm for evidence-based medicine demanded by healthcare professionals. The proposed method for guideline management components development is compliant with CEN's prEN12967 European standard, and consequently follows ITU-T's ODP methodology.
Studies in health technology and informatics 02/2007; 127:117-24.
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ABSTRACT: The purpose of this paper is to provide a further step toward the decentralization of identification and demographic information about persons by solving issues related to the integration of demographic agents in a federated healthcare environment. The aim is to identify a particular person in every system of a federation and to obtain a unified view of his/her demographic information stored in different locations.
This work is based on semantic models and techniques, and pursues the reconciliation of several current standardization works including ITU-T's Open Distributed Processing, CEN's prEN 12967, OpenEHR's dual and reference models, CEN's General Purpose Information Components and CORBAmed's PID service.
We propose a new paradigm for the management of person identification and demographic data, based on the development of an open architecture of specialized distributed components together with the incorporation of techniques for the efficient management of domain ontologies, in order to have a federated demographic service. This new service enhances previous correlation solutions sharing ideas with different standards and domains like semantic techniques and database systems. The federation philosophy enforces us to devise solutions to the semantic, functional and instance incompatibilities in our approach.
Although this work is based on several models and standards, we have improved them by combining their contributions and developing a federated architecture that does not require the centralization of demographic information. The solution is thus a good approach to face integration problems and the applied methodology can be easily extended to other tasks involved in the healthcare organization.
International Journal of Medical Informatics 10/2006; 75(9):671-82. · 2.41 Impact Factor
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ABSTRACT: The increment of life expectancy in our society, and the consequent population ageing, anticipate that the health sector must face the challenges associated with a growing population group of elderly patients with numerous disorders, generally chronic. In this work we introduce a framework to support the communication and information management tasks involved in a coordinated care of this kind of patients. This framework has been developed in the European context, it is compliant with CEN's prEN12967, and follows ITU-T's ODP methodology, that facilitates its integration in any system following this standard.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 02/2006; 1:4062-5.
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ABSTRACT: In this paper we introduce an ontology that covers all the terminology involved in the ODP standard. This ontology has been extended with concepts taken from the prEN12967 in order to apply it in the healthcare domain. Describing components formally and using this ontology, their semantic integration can be eased together with the benefits derived from the assistance to the automatic discovery, selection, invocation and composition of components facilities.
Studies in health technology and informatics 02/2006; 121:257-65.
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ABSTRACT: The main objective of this paper is to contribute into the process of the standardization of a demographic service in a federated healthcare environment. Our approach is based on semantic web techniques and aimed at the reconciliation of several previous standardization works.
Studies in health technology and informatics 02/2005; 114:259-69.
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ABSTRACT: This paper presents an analysis of different methodologies for modelling pharmacokinetic systems under the context of a telemedicine system oriented to the on-line and personalized knowledge generation. We use a simplified 3-pool kinetic system for a better clarification of several relevant modelling formalisms. A more complete 3-pool urea kinetic model is built simply connecting EL components pertaining to a pharmacokinetic library previously developed. The evolution of the urea concentration during the dialysis of a patient provided by this model was compared successfully to the evolution computed by a 2-pool model experimentally validated. The 3-pool model provides more information regarding the interstice and a high capacity to be modified for attending to the knowledge needs of physicians, as well as biomedicine advances. As a major conclusion, our outcomes suggest that virtual modelling is an excellent methodology in biomedical engineering to support the on-line generation of personalized health knowledge for telemedicine systems. This is due to its capacity for reusing components at horizontal and vertical level, and for implementing multiformalism and multidomain models, what simplifies the task to represent complex physiological and artificial systems
Engineering in Medicine and Biology Society, 2005. IEEE-EMBS 2005. 27th Annual International Conference of the; 02/2005
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ABSTRACT: The article presents the early outcomes of the evaluation of an intelligent accelerometer unit (IAU) utilized for detecting the falling events of elderly people . The overall design of the monitor where the IAU is integrated is briefly exposed. The outcomes of a laboratory study carried out over 8 volunteers show that the device is able to distinguish true falling events from normal activities like fast walking or going up/downstairs. The influences of the subject and the environment have been taken into account profiting from the processing capacity of the monitor distributed architecture.
Engineering in Medicine and Biology Society, 2004. IEMBS '04. 26th Annual International Conference of the IEEE; 10/2004
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ABSTRACT: The myelinated axon can be modeled by means of a distributed RGC circuit. The Green function of this model allows for a generic formulation of the internodal segment response to any kind of stimulus, and accounts for the delay of the action potential associated with this segment. The RGC model accuracy is comparable to that of a more complex electromagnetic model, and predicted delay agrees with experimental measurements.
IEEE Transactions on Biomedical Engineering 03/2004; · 2.28 Impact Factor
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ABSTRACT: The article presents the early outcomes of the evaluation of an intelligent accelerometer unit (IAU) utilized for detecting the falling events of elderly people . The overall design of the monitor where the IAU is integrated is briefly exposed. The outcomes of a laboratory study carried out over 8 volunteers show that the device is able to distinguish true falling events from normal activities like fast walking or going up/downstairs. The influences of the subject and the environment have been taken into account profiting from the processing capacity of the monitor distributed architecture.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 02/2004; 3:2180-3.
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ABSTRACT: The proliferation of XML as the standard for information exchange has given rise to an increase of XML based healthcare information system. This is due in part to the increase of standardization works based on this technology. XML facilitates the interoperability among heterogeneous systems, the panacea for electronic patient record systems. This paper addresses the benefits of using XML in the management of discharge summaries, an essential document in the medical context. Further benefits of the integration of heterogeneous healthcare systems are reported too. An architecture for edition, storage, retrieval and query of this kind of documents and first results in this line are presented.
Information Technology Applications in Biomedicine, 2003. 4th International IEEE EMBS Special Topic Conference on; 05/2003
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ABSTRACT: In this paper, the design of an application that allows the integrated management of a burn unit is reported. Starting with the problems associated with the current procedures, technical solutions are found from the requirements demanded by the specialists. The major design considerations and implementation details are outlined. Special attention is devoted to the prescription of drugs and inventory control, as well as reducing the time that healthcare professionals spend in administrative tasks. The developed implementation is an example of a low-cost system suitable for adoption in a wide range of units in a hospital organization.
IEEE Transactions on Biomedical Engineering 01/2003; · 2.28 Impact Factor
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ABSTRACT: We present an analysis of the electromagnetic fields induced in tissues surrounding a myelinated axon. It is shown that tissue anisotropy exerts little influence on these fields.
[Engineering in Medicine and Biology, 2002. 24th Annual Conference and the Annual Fall Meeting of the Biomedical Engineering Society] EMBS/BMES Conference, 2002. Proceedings of the Second Joint; 11/2002
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ABSTRACT: We try to develop a pilot experience in home care teleservices to the elderly through the investigation of solutions based on the application of information technologies and communications. To that end, an individualized attendance to each elderly person will be supplied, which will comprise from the monitoring of certain biological variables, diagnosis and processing, to the advising to his/her family. In addition, a customized service will be offered, not only in the healthcare field, but also at a technological level.
Engineering in Medicine and Biology Society, 2001. Proceedings of the 23rd Annual International Conference of the IEEE; 02/2001
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ABSTRACT: Genetic programming (GP) has proved useful in optimization
problems. The way of representing individuals in this methodology is
particularly good when we want to construct decision trees. Decision
trees are well suited to representing explicit information and
relationships among parameters studied. A set of decision trees could
make up a decision support system. In this paper we set out a
methodology for developing decision support systems as an aid to medical
decision making. Above all, we apply it to diagnosing the evolution of a
burn, which is a really difficult task even for specialists. A learning
classifier system is developed by means of multipopulation genetic
programming (MGP). It uses a set of parameters, obtained by specialist
doctors, to predict the evolution of a burn according to its initial
stages. The system is first trained with a set of parameters and results
of evolutions which have been recorded over a set of clinic cases. Once
the system is trained, it is useful for deciding how new cases will
probably evolve. Thanks to the use of GP, an explicit expression of the
input parameter is provided. This explicit expression takes the form of
a decision tree which will be incorporated into software tools that help
physicians In their everyday work
Evolutionary Computation, 2000. Proceedings of the 2000 Congress on; 02/2000
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ABSTRACT: The National Cooperative Dialysis Study (NCDS) showed the
viability of the single-pool urea kinetic model (spUKM) to maintain the
blood urea nitrogen (BUN) level of the renal patient in an adequate
target interval, defining the single-pool normalized clearance of urea
spKt/V as an index of the hemodialysis dose. However, the urea
distribution is a nonuniform problem, due to the barriers between pools
in the body distribution volume. The urea rebound induced by the
hemodialysis is a consequence of this nonuniform distribution and limits
the applicability of the NCDS. The viability of a more recent index, the
equilibrated Kt/V (eKt/V), is being studied, because it is not affected
by the urea rebound. This index is defined substituting the postdialysis
BUN by equilibrated BUN (measured about an hour from the end of
hemodialysis). In spite of its good results to calculate the
hemodialysis dose in the presence of urea rebound, the eKt/V is unable
to prescribe a hemodialysis, because the equilibrated clearance is
different to the dialyzer clearance. We present a new hemodialysis
prescribing procedure which calculates the adequate dialyzer clearance
to obtain a target time averaged concentration of urea. This procedure
is supported by a new model that we have developed: the normalized
single-pool urea kinetic model (spUKM<sup>norm</sup>), which is able to
calculate a good approximation to the real Kt/V based in dialyzer
clearance. The eKt/V and spKt/V are used in intermediate steps of our
procedure, and so the actual advances in these indexes can be taken into
account
Engineering in Medicine and Biology Society, 2000. Proceedings of the 22nd Annual International Conference of the IEEE; 02/2000
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ABSTRACT: A new segmentation-based lossless compression method is proposed
for colour images. The method exploits the correlation existing among
the three colour planes by treating each pixel as a vector of three
components, and performing region growing and difference operations
using the vectors. The method performs better than the JPEG standard by
an average of 0.68 bit/pixel with a 12 image database
Electronics Letters 03/1999; · 0.96 Impact Factor
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ABSTRACT: Urea Kinetic Modeling (UKM) is recognized as the most efficient method for quantitating hemodialysis treatments, and the dimensionless parameter Kt/V is widely used to monitor dialysis prescription. Although many shortcut methods have been developed to directly calculate it, there is no agreement on which is the best method to be applied. The authors present a new UKM model, which corrects the urea balance carried on by Sargent (1983). The model is checked to the urea rebound into account, and in this way is used as reference model in a clinical study
Engineering in Medicine and Biology Society, 1996. Bridging Disciplines for Biomedicine. Proceedings of the 18th Annual International Conference of the IEEE;
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ABSTRACT: A new technique for the generation of the action potential (AP) in a peripheral nerve is described. Commonly, efforts have been dedicated to the imitation of the typical form of such an AP with mathematical functions, However, in this work we present a structural control model which tries to represent the causes of the AP. The maximum simplicity is pursued in order to facilitate its implementation into a circuit, so only the sodium, potassium and calcium conductances are included. This model also presents the property of subthreshold stimuli. The developed model is validated by the use of some adequate simulations
Engineering in Medicine and Biology Society, 1998. Proceedings of the 20th Annual International Conference of the IEEE;
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ABSTRACT: Work with mentally handicapped people often raises the problem of communication difficulties. Several attempts have been made to provide alternatives in order to improve the relation between these persons and their environment. In most cases communication methods, based on graphical items, need continual attention by teachers to allow subject interaction with the external world. Moreover such a manual method requires a great deal of effort to adapt it to different individuals. In this work an open environment is proposed, subject oriented and based on a modular architecture with a kernel and a sequence of exchangeable adaptable modules in agreement with patient needs. We also show an implementation example
Engineering in Medicine and Biology Society, 1998. Proceedings of the 20th Annual International Conference of the IEEE;
