Diego M. López

A development framework for semantically interoperable health information systems

BACKGROUND Semantic interoperability is a basic challenge to be met for new generations of distributed, communicating and co-operating health information systems (HIS) enabling shared care and e-Health. Analysis, design, implementation and maintenance of such systems and intrinsic architectures have to follow a unified development methodology. METHODS The Generic Component Model (GCM) is used as a framework for modeling any system to evaluate and harmonize state of the art architecture development approaches and standards for health information systems as well as to derive a coherent architecture development framework for sustainable, semantically interoperable HIS and their components. The proposed methodology is based on the Rational Unified Process (RUP), taking advantage of its flexibility to be configured for integrating other architectural approaches such as Service-Oriented Architecture (SOA), Model-Driven Architecture (MDA), ISO 10746, and HL7 Development Framework (HDF). RESULTS Existing architectural approaches have been analyzed, compared and finally harmonized towards an architecture development framework for advanced health information systems. CONCLUSION Starting with the requirements for semantic interoperability derived from paradigm changes for health information systems, and supported in formal software process engineering methods, an appropriate development framework for semantically interoperable HIS has been provided. The usability of the framework has been exemplified in a public health scenario.

Enhanced Semantic Interoperability by Profiling Health Informatics Standards

OBJECTIVES Several standards applied to the healthcare domain support semantic interoperability. These standards are far from being completely adopted in health information system development, however. The objective of this paper is to provide a method and suggest the necessary tooling for reusing standard health information models, by that way supporting the development of semantically interoperable systems and components. METHODS The approach is based on the definition of UML Profiles. UML profiling is a formal modeling mechanism to specialize reference meta-models in such a way that it is possible to adapt those meta-models to specific platforms or domains. A health information model can be considered as such a meta-model. RESULTS The first step of the introduced method identifies the standard health information models and tasks in the software development process in which healthcare information models can be reused. Then, the selected information model is formalized as a UML Profile. That Profile is finally applied to system models, annotating them with the semantics of the information model. The approach is supported on Eclipse-based UML modeling tools. The method is integrated into a comprehensive framework for health information systems development, and the feasibility of the approach is demonstrated in the analysis, design, and implementation of a public health surveillance system, reusing HL7 RIM and DIMs specifications. CONCLUSIONS The paper describes a method and the necessary tooling for reusing standard healthcare information models. UML offers several advantages such as tooling support, graphical notation, exchangeability, extensibility, semi-automatic code generation, etc. The approach presented is also applicable for harmonizing different standard specifications.

Architectural Approaches for HL7-based Health Information Systems Implementation

OBJECTIVE Information systems integration is hard, especially when semantic and business process interoperability requirements need to be met. To succeed, a unified methodology, approaching different aspects of systems architecture such as business, information, computational, engineering and technology viewpoints, has to be considered. The paper contributes with an analysis and demonstration on how the HL7 standard set can support health information systems integration. METHODS Based on the Health Information Systems Development Framework (HIS-DF), common architectural models for HIS integration are analyzed. The framework is a standard-based, consistent, comprehensive, customizable, scalable methodology that supports the design of semantically interoperable health information systems and components. RESULTS Three main architectural models for system integration are analyzed: the point to point interface, the messages server and the mediator models. Point to point interface and messages server models are completely supported by traditional HL7 version 2 and version 3 messaging. The HL7 v3 standard specification, combined with service-oriented, model-driven approaches provided by HIS-DF, makes the mediator model possible. The different integration scenarios are illustrated by describing a proof-of-concept implementation of an integrated public health surveillance system based on Enterprise Java Beans technology. CONCLUSION Selecting the appropriate integration architecture is a fundamental issue of any software development project. HIS-DF provides a unique methodological approach guiding the development of healthcare integration projects. The mediator model - offered by the HIS-DF and supported in HL7 v3 artifacts - is the more promising one promoting the development of open, reusable, flexible, semantically interoperable, platform-independent, service-oriented and standard-based health information systems.

The hackathon model to spur innovation around global mHealth

Abstract The challenge of providing quality healthcare to underserved populations in low- and middle-income countries (LMICs) has attracted increasing attention from information and communication technology (ICT) professionals interested in providing societal impact through their work. Sana is an organisation hosted at the Institute for Medical Engineering and Science at the Massachusetts Institute of Technology that was established out of this interest. Over the past several years, Sana has developed a model of organising mobile health bootcamp and hackathon events in LMICs with the goal of encouraging increased collaboration between ICT and medical professionals and leveraging the growing prevalence of cellphones to provide health solutions in resource limited settings. Most recently, these events have been based in Colombia, Uganda, Greece and Mexico. The lessons learned from these events can provide a framework for others working to create sustainable health solutions in the developing world.

A mobile system for sedentary behaviors classification based on accelerometer and location data

Abstract Background Sedentary behaviors are associated to the development of noncommunicable diseases (NCD) such as cardiovascular diseases (CVD), type 2 diabetes, and cancer. Accelerometers and inclinometers have been used to estimate sedentary behaviors, however a major limitation is that these devices do not provide enough contextual information in order to recognize the specific sedentary behavior performed, e.g., sitting or lying watching TV, using the PC, sitting at work, driving, etc. Objective Propose and evaluate the precision of a mobile system for objectively measuring six sedentary behaviors using accelerometer and location data. Results The system is implemented as an Android Mobile App, which identifies individual’s sedentary behaviors based on accelerometer data taken from the smartphone or a smartwatch, and symbolic location data obtained from Bluetooth Low Energy (BLE) beacons. The system infers sedentary behaviors by means of a supervised Machine Learning Classifier. The precision of the classification of five of the six studied sedentary behaviors exceeded 95% using accelerometer data from a smartwatch attached to the wrist and 98% using accelerometer data from a smartphone put into the pocket. Statistically significant improvement in the average precision of the classification due to the use of BLE beacons was found by comparing the precision of the classification using accelerometer data only, and BLE beacons localization technology. Conclusions The proposed system provides contextual information of specific sedentary behaviors by inferring with very high precision the physical location where the sedentary event occurs. Moreover, it was found that, when accelerometers are put in the user’s pocket, instead of the wrist and, when symbolic location is inferred using BLE beacons; the precision in the classification is improved. In practice, the proposed system has the potential to contribute to the understanding of the context and determinants of sedentary behaviors, necessary for the implementation and monitoring of personalized noncommunicable diseases prevention programs, for instance, sending sedentary behavior alerts, or providing personalized recommendations on physical activity. The system could be used at work to promote active breaks and healthy habits.

Training the biomedical informatics workforce in Latin America: results of a needs assessment.

Objective To report the results of a needs assessment of research and training in Medical Informatics (MI) and Bioinformatics (BI) in Latin America. Methods and results This assessment was conducted by QUIPU: The Andean Global Health Informatics Research and Training Center. After sending email invitations to MI–BI related professionals from Latin America, 142 surveys were received from 11 Latin American countries. The following were the top four ranked MI-related courses that a training programme should include: introduction to biomedical informatics; data representation and databases; mobile health; and courses that address issues of security, confidentiality and privacy. Several new courses and topics for research were suggested by survey participants. The information collected is guiding the development of curricula and a research agenda for the MI and BI QUIPU multidisciplinary programme for the Andean Region and Latin America.

HapHop-Physio: a computer game to support cognitive therapies in children

Background Care and support of children with physical or mental disabilities are accompanied with serious concerns for parents, families, healthcare institutions, schools, and their communities. Recent studies and technological innovations have demonstrated the feasibility of providing therapy and rehabilitation services to children supported by computer games. Objective The aim of this paper is to present HapHop-Physio, an innovative computer game that combines exercise with fun and learning, developed to support cognitive therapies in children. Methods Conventional software engineering methods such as the Scrum methodology, a functionality test and a related usability test, were part of the comprehensive methodology adapted to develop HapHop-Physio. Results The game supports visual and auditory attention therapies, as well as visual and auditory memory activities. The game was developed by a multidisciplinary team, which was based on the Hopscotch® platform provided by Fraunhofer Institute for Digital Media Technology IDMT Institute in Germany, and designed in collaboration with a rehabilitation clinic in Colombia. HapHop-Physio was tested and evaluated to probe its functionality and user satisfaction. Conclusion The results show the development of an easy-to-use and funny game by a multidisciplinary team using state-of-the-art videogame technologies and software methodologies. Children testing the game concluded that they would like to play again while undergoing rehabilitation therapies.

Towards a Conceptual Framework for the Objective Evaluation of User Experience

Background: The concept of user experience (UX) involves many aspects and different perspectives, making it difficult to evaluate the whole set of what UX represents. Despite existing standards, a clear definition of the UX evaluation concerning the identification of the different aspects to be evaluated according to the perspectives forming the UX (user and system), taking into account a given context of use is missing. Objective: Propose a conceptual framework for identifying differences between the UX evaluation perspectives and their measurable aspects. Methods: We followed a qualitative method for building conceptual frameworks. Results: The proposed conceptual framework identifies and associates the main UX concepts, from the user and system perspectives. The obtained plane of concepts provides a better overview of the phenomenon studied. The built framework led to the definition of an objective UX evaluation method: physiological signals are the convergence point between the physical state of the user and the measurement of emotions. Conclusion: The evaluation of UX is particularly important in ICT solutions for health since users/patients must maintain the motivation to continue using technology, in order to guarantee adherence to their treatments or interventions. The obtained framework and method are the first step towards finding suitable and according-to-context UX evaluation processes allowing an improved interaction between user and system.

NeuroEHR: Open Source Telehealth System for the Management of Clinical Data, EEG and Remote Diagnosis of Epilepsy

Problem: A number of technologies has been developed aiming at improving the availability, opportunity, difficulty of access or efficiency of epilepsy diagnosis based on Electroencephalogram (EEG) data. However, these approaches are not all based on open technologies, neither are they integrated into Electronic Health Record information (EHR) systems to support continuity of care. Objective: To develop an open source EHR system for the management of patient’s information, encounter scheduling, remote registration, and subsequent analysis of EEG data. Methods: The analysis, design, and implementation of the system followed the Scrum framework. The implementation was based on an open source platform for EHR systems named OpenMRS. Results: NeuroEHR supports the provision of Tele-EEG services, integrates patient’s clinical information, and EEG data captured remotely from an EEG device, stores the data in an EEG repository, and allows a neurologist to provide a diagnosis based on clinical and EEG data. Conclusions: The NeuroEHR system is currently being used in the context of the NeuroMoTIC project, in which a pediatric EEG data set is being created and annotated, and some Artificial Intelligence algorithms are being tested to support a telehealth service for the diagnosis of epilepsy.

Human-centered design of a personal health record system for metabolic syndrome management based on the ISO 9241-210:2010 standard

Background Previous studies have demonstrated the effectiveness of information and communication technologies to support healthy lifestyle interventions. In particular, personal health record systems (PHR-Ss) empower self-care, essential to support lifestyle changes. Approaches such as the user-centered design (UCD), which is already a standard within the software industry (ISO 9241-210:2010), provide specifications and guidelines to guarantee user acceptance and quality of eHealth systems. However, no single PHR-S for metabolic syndrome (MS) developed following the recommendations of the ISO 9241-210:2010 specification has been found in the literature. Objective The aim of this study was to describe the development of a PHR-S for the management of MS according to the principles and recommendations of the ISO 9241-210 standard. Methods The proposed PHR-S was developed using a formal software development process which, in addition to the traditional activities of any software process, included the principles and recommendations of the ISO 9241-210 standard. To gather user information, a survey sample of 1,187 individuals, eight interviews, and a focus group with seven people were performed. Throughout five iterations, three prototypes were built. Potential users of each system evaluated each prototype. The quality attributes of efficiency, effectiveness, and user satisfaction were assessed using metrics defined in the ISO/IEC 25022 standard. Results The following results were obtained: 1) a technology profile from 1,187 individuals at risk for MS from the city of Popayan, Colombia, identifying that 75.2% of the people use the Internet and 51% had a smartphone; 2) a PHR-S to manage MS developed (the PHR-S has the following five main functionalities: record the five MS risk factors, share these measures with health care professionals, and three educational modules on nutrition, stress management, and a physical activity); and 3) usability tests on each prototype obtaining the following results: 100% effectiveness, 100% efficiency, and 84.2 points in the system usability scale. Conclusion The software development methodology used was based on the ISO 9241-210 standard, which allowed the development team to maintain a focus on user’s needs and requirements throughout the project, which resulted in an increased satisfaction and acceptance of the system. Additionally, the establishment of a multidisciplinary team allowed the application of considerations not only from the disciplines of software engineering and health sciences but also from other disciplines such as graphical design and media communication. Finally, usability testing allowed the observation of flaws in the designs, which helped to improve the solution.