Jesús D. Trigo

Trends and challenges of the emerging technologies toward interoperability and standardization in e-health communications

Information exchange has experienced a paradigm shift due to the appearance of wireless transport technologies. A wide variety of technologies have been proposed recently with different characteristics for diverse application environments. Such emerging technologies can be applied - depending on their specific features - to different e-health use cases. Additionally, some of those technologies have already adopted a path to medical device interoperability, while others are on their way to enable that potential. Hence the need to perform an overview of such technologies, which can be useful when designing interoperable, wireless-enabled e-health solutions. This article therefore reviews the emerging technologies that can be incorporated into the complex e-health information communication ecosystem and details the transport technologies that have adopted a specialized medical profile for ISO/IEEE 11073 interoperability such as USB, Bluetooth, and ZigBee. Discussion is focused on the expected path of novel emerging technologies toward ISO/IEEE 11073-compliant medical device interoperability. As a result, this article provides an up-to-date guideline for designers of standard-compliant wireless-enabled e-health architectures, helping in the selection of the appropriate technology for their designs.

A Review on Digital ECG Formats and the Relationships Between Them

A plethora of digital ECG formats have been proposed and implemented. This heterogeneity hinders the design and development of interoperable systems and entails critical integration issues for the healthcare information systems. This paper aims at performing a comprehensive overview on the current state of affairs of the interoperable exchange of digital ECG signals. This includes 1) a review on existing digital ECG formats, 2) a collection of applications and cardiology settings using such formats, 3) a compilation of the relationships between such formats, and 4) a reflection on the current situation and foreseeable future of the interoperable exchange of digital ECG signals. The objectives have been approached by completing and updating previous reviews on the topic through appropriate database mining. 39 digital ECG formats, 56 applications, tools or implantation experiences, 47 mappings/converters, and 6 relationships between such formats have been found in the literature. The creation and generalization of a single standardized ECG format is a desirable goal. However, this unification requires political commitment and international cooperation among different standardization bodies. Ongoing ontology-based approaches covering ECG domain have recently emerged as a promising alternative for reaching fully fledged ECG interoperability in the near future.

Standard-Based Middleware Platform for Medical Sensor Networks and u-Health

Advances in information and communication technologies, ICT, are bringing new opportunities in the field of middleware systems oriented to ubiquitous environments and wearable devices used for patient telemonitoring. At a time of such challenges, this paper arises from the need to identify robust technical telemonitoring solutions that are both open and interoperable in home or mobile scenarios. These middleware systems demand standardized solutions to be cost effective and to take advantage of standardized operation and interoperability. Thus, a fundamental challenge is to design a plug-&-play platform that, either as individual elements or as components, can be incorporated in a simple way into different telecare systems, perhaps configuring a personal user network. Moreover, there is an increasing market pressure from companies not traditionally involved in medical markets, asking for a standard for personal health devices (PHD), which foresee a vast demand for telemonitoring, wellness, ambient assisted living (AAL) and applications for ubiquitous-health (u-health). However, the newly emerging situations imply very strict requirements for the protocols involved in the communication. The ISO/IEEE 11073 (X73) family of standards is adapting to new personal devices, implementing high quality sensors, and supporting wireless transport (e.g. Bluetooth) and the access to faster and reliable communication network resources. Its optimized version (X73-PHD) is adequate for this new technology snapshot and might appear the best-positioned international standards to reach this goal. This work presents an updated survey of this standard and its implementation in a middleware telemonitoring platform.

The ISO/EN 13606 Standard for the Interoperable Exchange of Electronic Health Records

The standardization of Electronic Health Records (EHR) is a crucial factor for ensuring interoperable sharing of health data. During recent decades, a plethora of initiatives – driven by international organizations – has emerged to define the required models describing the exchange of information between EHRs. These models cover different essential characteristics for building interoperable EHRs, such as architecture, methodology, communication, safety or terminology, among others. In this context, the European reference frame for the standardized exchange of EHR is the recently approved ISO/EN 13606 standard. This multi-part standard provides the syntactic and semantic capabilities (through a dual model approach) as well as terminology, security and interface considerations for the standardized exchange of EHR. This paper provides (a) an introduction to the different standardization efforts related to the interoperable exchange of EHR around the world, and (b) a description of how the ISO/EN 13606 standard provides interoperable sharing of clinical information.

Implementation Methodology for Interoperable Personal Health Devices With Low-Voltage Low-Power Constraints

Traditionally, e-Health solutions were located at the point of care (PoC), while the new ubiquitous user-centered paradigm draws on standard-based personal health devices (PHDs). Such devices place strict constraints on computation and battery efficiency that encouraged the International Organization for Standardization/IEEE11073 (X73) standard for medical devices to evolve from X73PoC to X73PHD. In this context, low-voltage low-power (LV-LP) technologies meet the restrictions of X73PHD-compliant devices. Since X73PHD does not approach the software architecture, the accomplishment of an efficient design falls directly on the software developer. Therefore, computational and battery performance of such LV-LP-constrained devices can even be outperformed through an efficient X73PHD implementation design. In this context, this paper proposes a new methodology to implement X73PHD into microcontroller-based platforms with LV-LP constraints. Such implementation methodology has been developed through a patterns-based approach and applied to a number of X73PHD-compliant agents (including weighing scale, blood pressure monitor, and thermometer specializations) and microprocessor architectures (8, 16, and 32 bits) as a proof of concept. As a reference, the results obtained in the weighing scale guarantee all features of X73PHD running over a microcontroller architecture based on ARM7TDMI requiring only 168 B of RAM and 2546 B of flash memory.

Interoperability in Digital Electrocardiography: Harmonization of ISO/IEEE x73-PHD and SCP-ECG

The ISO/IEEE 11073 (x73) family of standards is a reference frame for medical device interoperability. A draft for an ECG device specialization (ISO/IEEE 11073-10406-d02) has already been presented to the Personal Health Device (PHD) Working Group, and the Standard Communications Protocol for Computer-Assisted ElectroCardioGraphy (SCP-ECG) Standard for short-term diagnostic ECGs (EN1064:2005+A1:2007) has recently been approved as part of the x73 family (ISO 11073-91064:2009). These factors suggest the coordinated use of these two standards in foreseeable telecardiology environments, and hence the need to harmonize them. Such harmonization is the subject of this paper. Thus, a mapping of the mandatory attributes defined in the second draft of the ISO/IEEE 11073-10406-d02 and the minimum SCP-ECG fields is presented, and various other capabilities of the SCP-ECG Standard (such as the messaging part) are also analyzed from an x73-PHD point of view. As a result, this paper addresses and analyzes the implications of some inconsistencies in the coordinated use of these two standards. Finally, a proof-of-concept implementation of the draft x73-PHD ECG device specialization is presented, along with the conversion from x73-PHD to SCP-ECG. This paper, therefore, provides recommendations for future implementations of telecardiology systems that are compliant with both x73-PHD and SCP-ECG.

An Integrated Healthcare Information System for End-to-End Standardized Exchange and Homogeneous Management of Digital ECG Formats

This paper investigates the application of the enterprise information system (EIS) paradigm to standardized cardiovascular condition monitoring. There are many specifications in cardiology, particularly in the ECG standardization arena. The existence of ECG formats, however, does not guarantee the implementation of homogeneous, standardized solutions for ECG management. In fact, hospital management services need to cope with various ECG formats and, moreover, several different visualization applications. This heterogeneity hampers the normalization of integrated, standardized healthcare information systems, hence the need for finding an appropriate combination of ECG formats and a suitable EIS-based software architecture that enables standardized exchange and homogeneous management of ECG formats. Determining such a combination is one objective of this paper. The second aim is to design and develop the integrated healthcare information system that satisfies the requirements posed by the previous determination. The ECG formats selected include ISO/IEEE11073, Standard Communications Protocol for Computer-Assisted Electrocardiography, and an ECG ontology. The EIS-enabling techniques and technologies selected include web services, simple object access protocol, extensible markup language, or business process execution language. Such a selection ensures the standardized exchange of ECGs within, or across, healthcare information systems while providing modularity and accessibility.

Seamless Integration of ISO/IEEE11073 Personal Health Devices and ISO/EN13606 Electronic Health Records into an End-to-End Interoperable Solution

The new paradigm of personal health demands open standards and middleware components that permit transparent integration and end-to-end interoperability from new personal health devices to healthcare information system. The use of standards seems to be the internationally accepted way to face this challenge. In this article, the implementation of an end-to-end standard-based personal health solution is presented. It integrates the ISO/IEEE11073 standard for the interoperability of personal health devices in the patient environment and the ISO/EN13606 standard for the interoperable exchange of electronic healthcare records and proposes a new approach for the end-to-end ISO/IEEE11073-ISO/EN13606 communication. The design strictly fulfills all the technical requirements of the most recent versions of both standards. An entire prototype has been designed, developed, and tested as a proof-of-concept of a personal health solution.

Trends in entertainment, home automation and e-health: Toward cross-domain integration

Recent advances in consumer networking and emerging technologies are promoting a paradigm shift in the way environments such as entertainment, home automation or e-Health are traditionally understood. However, available technologies present different characteristics depending on the environment or the working domain that, in a context of non-experienced users, hinders the development of interoperable services. This article compares the most recent technological proposals and analyzes their key points, and presents a compilation of the major interoperability proposals and initiatives for the considered communication domains. The work is completed with a reasoned discussion on trends on architectural approaches to cross-domain integration that can be used to overcome the issues generated by the segmented ecosystems presented above.

Standard-Based Homecare Challenge

Advances in Information and Communication Technologies, ICT, are bringing new opportunities in the field of interoperable and standard-based systems oriented to ubiquitous environments and wearable devices used for digital homecare patient telemonitoring. It is hoped that these advances are able to increase the quality and the efficiency of the care services provided. Likewise they should facilitate a home monitoring of chronic, elderly, under palliative care or have undergone surgery, leaving beds in the Hospital for patients in a more critical condition. In any case telemonitored patients could continue to live in their own homes with the subsequent advantages as more favorable environment, less need for trips to the hospital, etc.