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Smartphone-Based Wound Assessment System for Patients With Diabetes

Diabetic foot ulcers represent a significant health issue. Currently, clinicians and nurses mainly base their wound assessment on visual examination of wound size and healing status, while the patients themselves seldom have an opportunity to play an active role. Hence, a more quantitative and cost-effective examination method that enables the patients and their caregivers to take a more active role in daily wound care potentially can accelerate wound healing, save travel cost and reduce healthcare expenses. Considering the prevalence of smartphones with a high-resolution digital camera, assessing wounds by analyzing images of chronic foot ulcers is an attractive option. In this paper, we propose a novel wound image analysis system implemented solely on the Android smartphone. The wound image is captured by the camera on the smartphone with the assistance of an image capture box. After that, the smartphone performs wound segmentation by applying the accelerated mean-shift algorithm. Specifically, the outline of the foot is determined based on skin color, and the wound boundary is found using a simple connected region detection method. Within the wound boundary, the healing status is next assessed based on red-yellow-black color evaluation model. Moreover, the healing status is quantitatively assessed, based on trend analysis of time records for a given patient. Experimental results on wound images collected in UMASS-Memorial Health Center Wound Clinic (Worcester, MA) following an Institutional Review Board approved protocol show that our system can be efficiently used to analyze the wound healing status with promising accuracy.

The rise of a health-IT academic focus

Introduction The U.S. health care industry is catching up on its lagging information technology (IT) investment, and this trend has important ramifications for IT academics and practitioners. During the 1990s, investing in IT was a relatively low priority for hospitals and health systems, which faced fiscal constraints and pressing need to upgrade aging facilities. Now IT has come to be viewed as a means for improving quality, safety, and productivity in health care. As a consequence, the proportion of hospital revenue that is invested in IT has doubled in recent years with continuing increases forecast through at least 2011. And IT investment is beginning to pay off. Analysis of data from 2,000 U.S. hospitals shows that over 60% have now made a sufficient investment in IT to generate a positive return to the organization. Increasing reliance on IT in health care raises demand for trained workers. It is widely recognized that physicians, nurses, and other medical professionals need training in IT skills related to their work domains. One way this need is being addressed is through the American Medical Informatics Association 10x10™ initiative to provide IT training to 10,000 medical professionals by 2010 (http://www.amia.org/10x10/). Less recognized is the rising demand within health care for trained IT professionals, especially those who combine health care domain knowledge with skills in business IT. Historically, it was typical to recruit graduates of medical informatics and related programs which provide intensive training in specialized aspects of the health domain, such as HL7 (Health Level 7) standards and ICD (International Classification of Diseases) or SNOMED (Systematized Nomenclature of Medicine) terminology. However, recent health care IT investment has been directed in large part toward generalized business IT, including data warehouses, enterprise systems, and web-based applications, such as e-health websites for use by patients. Of the nine top staffing needs identified in the 18th Annual Leadership Survey conducted by the Health care Information and Management Systems Society, six are central to business IT, including application support, systems integration, network support, and systems design. Not surprisingly, it is becoming common for health care positions to be taken by graduates of IT academic programs, including information systems (IS), computer science, and information studies. These new workers arrive on the job with technical skills in business IT, but their experience with specialized aspects of the health care domain is typically limited. This situation does not fully meet the needs of health care organizations. As Lanzalotto writes, health care hiring managers are seeking candidates with strong technical and domain skill sets, as well as extensive industry knowledge. Clearly, academic training in health care topics can benefit IT students who enter health care positions as well as the organizations that hire them. Until recently, however, few IT programs offered a concentration or degree focusing on health care. We refer to this focus as health-IT in recognition that instruction within these programs centers on generalized business IT with supporting curricula in health-related areas. Since 2006, the authors have conducted an annual survey of health-IT programs for the Special Interest Group on IT in Health Care (SIGhealth) of the Association for Information Systems (AIS). Results are reported at http://www.aissighealth.com. To date, 25 programs have been identified, representing a broad range of degree offerings, including six doctoral degrees, 22 masters degrees, and 9 undergraduate degrees. In the following sections, we profile two recent additions to the SIGhealth listing that exemplify the emerging interest in health-IT academics.

Internet-based telemedicine: An empirical investigation of objective and subjective video quality

This study focuses on the Internet-based telemedicine with the goal of understanding the relationship between objective and subjective video quality measures and the decision making capability of medical professional using an ophthalmology video. Objective and subjective measures are calculated using PSNR and the perception of human viewers respectively. An emulated Internet testbed was created for experiments. Results indicate that jitter and delay have significant effect on the objective quality values. Subjective quality, on the other hand, not only depends on the same two factors, but also depends on which critical frames the provider is able to see and work with.

The Business of Telemedicine: Strategy Primer

There is some tacit understanding that telemedicine can provide cost efficiency along with increased access and equality of care for the geographically disadvantaged. However, concrete strategic guidance for healthcare organizations to attain these benefits is fragmented and limited in existing literature. Telemedicine programs need to move from a grant-funded to a profit-centered status to sustain their existence. This article extends work presented at a recent American Telemedicine Association Business and Finance Special Interest Group course to provide a conceptual framework for strategic planning and for effectively implementing telemedicine programs. An expert panel of telemedicine coordinators provides insight and recommendations.

The Electronic Disability Record: Purpose, Parameters, and Model Use Case

The active engagement of consumers is an important factor in achieving widespread success of health information systems. The disability community represents a major segment of the healthcare arena, with more than 50 million Americans experiencing some form of disability. In keeping with the consumer-driven approach to e-health systems, this paper considers the distinctive aspects of electronic and personal health record use by this segment of society. Drawing upon the information shared during two national policy forums on this topic, the authors present the concept of Electronic Disability Records (EDR). The authors outline the purpose and parameters of such records, with specific attention to its ability to organize health and financial data in a manner that can be used to expedite the disability determination process. In doing so, the authors discuss its interaction with Electronic Health Records (EHR) and Personal Health Records (PHR). The authors then draw upon these general parameters to outline a model use case for disability determination and discuss related implications for disability health management. The paper further reports on the subsequent considerations of these and related deliberations by the American Health Information Community (AHIC).

Patient Portals: An Underused Resource for Improving Patient Engagement

The potential of patient portals to improve patient engagement and health outcomes has been discussed for more than a decade. The slow growth in patient portal adoption rates among patients and providers in the United States, despite external incentives, indicates that this is a complex issue. We examined evidence of patient portal use and effects with a focus on the pulmonary domain. We found a paucity of studies of patient portal use in pulmonary practice, and highlight gaps for future research. We also report on the experience of a pulmonary department using a patient portal to highlight the potential of these systems.

Wound image analysis system for diabetics

Diabetic foot ulcers represent a significant health issue, and daily wound care is necessary for wound healing to occur. The goal of this research is to create a smart phone based wound image analysis system for people with diabetes to track the healing process of chronic ulcers and wounds. This system has been implemented on an Android smart phone in collaboration with a PC (or embedded PC). The wound image is captured by the smart phone camera and transmitted to the PC via Wi-Fi for image processing. The PC converts the JPEG image to bitmap format, then performs boundary segmentation on the wound in the image. The segmentation is done with a particular implementation of the level set algorithm, the distance regularized level set evolution (DRLSE) method, which eliminates the need for re-initialization of level set function. Next, an assessment of the wound healing is performed with color segmentation within the boundaries of the wound image, by applying the K-Mean color clustering algorithm based on the red-yellow-black (RYB) evaluation model. Finally, the results are re-formatted to JPEG, transmitted back to the smart phone and displayed. To accelerate the wound image segmentation, we have implemented the DRLSE method on the GPU and CPU cooperative hardware platform in data-parallel mode, which has greatly improved the computational efficiency. Processing wound images acquired from UMASS Medical Center has demonstrated that the wound image analysis system provides accurate wounds area determination and color segmentation. For all wound images of size around 640 x 480, with complicated wound boundaries, the wound analysis consumed max 3s, which is 5 times faster than the same algorithm running on the CPU alone.

Exploring the effect of complex patients on care delivery tasks

PURPOSEnThe needs of complex patients with chronic conditions can be unpredictable and can strain resources. Exploring how tasks vary for different patients, particularly those with complex needs, can yield insights about designing better processes in healthcare. The purpose of this paper is to explore the tasks required to manage complex patients in an anticoagulation therapy context.nnnDESIGN/METHODOLOGY/APPROACHnThe authors analyzed interviews with 55 staff in six anticoagulation clinics using the Systems Engineering Initiative for Patient Safety (SEIPS) work system framework. The authors qualitatively described complex patients and their effects on care delivery.nnnFINDINGSnData analysis highlighted how identifying complex patients and their effect on tasks and organization, and the interactions between them was important. Managing complex patients required similar tasks as non-complex patients, but with greater frequency or more intensity and several additional tasks. After complex patients and associated patient interaction and care tasks were identified, a work system perspective was applied to explore how such tasks are integrated within clinics and the resulting implications for resource allocation.nnnPRACTICAL IMPLICATIONSnThe authors present a complex patient management framework to guide workflow design in specialty clinics, to better support high quality, effective, efficient and safe healthcare.nnnORIGINALITY/VALUEnThe complex patient framework presented here, based on the SEIPS framework, suggests a more formal and integrated analysis be completed to provide better support for appropriate resource allocation and care coordination.

A Real World Perspective: Employee Perspectives of Employer Sponsored Personal Health Record (PHR) Systems

Many employers now provide electronic personal health records (PHR) to employees as part of a free or low cost health benefit program. This paper reports findings from a survey distributed to employees of a large U.S. corporation. The survey focused on identifying employee concerns and expectations from an employer sponsored PHR system and to help understand the utilization and adoption of PHR systems sponsored by the employer. Despite some past research showing significant demand for PHR products across the general public, especially those that are offered for free, responses indicated many barriers. Participants responded with their concerns and expectations prior to using the system as well as their difficulty or ease of use. Key issues are discussed, including current and future role of employers in the PHR marketplace, including the need to x93tetherx94 these offerings to larger health care provider networks in order for employees to realize the value added.

An Automatic Assessment System of Diabetic Foot Ulcers Based on Wound Area Determination, Color Segmentation, and Healing Score Evaluation:

Background: For individuals with type 2 diabetes, foot ulcers represent a significant health issue. The aim of this study is to design and evaluate a wound assessment system to help wound clinics assess patients with foot ulcers in a way that complements their current visual examination and manual measurements of their foot ulcers. Methods: The physical components of the system consist of an image capture box, a smartphone for wound image capture and a laptop for analyzing the wound image. The wound image assessment algorithms calculate the overall wound area, color segmented wound areas, and a healing score, to provide a quantitative assessment of the wound healing status both for a single wound image and comparisons of subsequent images to an initial wound image. Results: The system was evaluated by assessing foot ulcers for 12 patients in the Wound Clinic at University of Massachusetts Medical School. As performance measures, the Matthews correlation coefficient (MCC) value for the wound area determination algorithm tested on 32 foot ulcer images was .68. The clinical validity of our healing score algorithm relative to the experienced clinicians was measured by Krippendorff’s alpha coefficient (KAC) and ranged from .42 to .81. Conclusion: Our system provides a promising real-time method for wound assessment based on image analysis. Clinical comparisons indicate that the optimized mean-shift-based algorithm is well suited for wound area determination. Clinical evaluation of our healing score algorithm shows its potential to provide clinicians with a quantitative method for evaluating wound healing status.