Marco Eichelberg

A survey and analysis of Electronic Healthcare Record standards

Medical information systems today store clinical information about patients in all kinds of proprietary formats. To address the resulting interoperability problems, several Electronic Healthcare Record standards that structure the clinical content for the purpose of exchange are currently under development. In this article, we present a survey of the most relevant Electronic Healthcare Record standards, examine the level of interoperability they provide, and assess their functionality in terms of content structure, access services, multimedia support, and security. We further investigate the complementarity of the standards and assess their market relevance.

Introduction to the DICOM standard

Abstract. Digital Imaging and Communication in Medicine (DICOM) has become one of the most popular standards in medicine. In the beginning, DICOM was used for communication of image data between different systems. Actual developments of the standardisation enables increasingly more DICOM-based services for the integration of modalities and information systems (e.g. RIS, PACS). In this article a review of the historical background, the technological concept, the organizational structure and current developments is given.

Digital Imaging and Communications in Medicine

Over the past 15 years Digital Imaging and Communications in Medicine (DICOM) has established itself as the international standard for medical image communication. Most medical imaging equipment uses DICOM network and media services to export image data, thus making this standard highly relevant for medical image processing. The first section of this chapter provides a basic introduction into DICOM with its more than 3,600 pages of technical documentation, followed by a section covering selected advanced topics of special interest for medical image processing. The introductory text familiarizes the reader with the standard’s main concepts such as information objects and DICOM media and network services. The rendering pipeline for image display and the concept of DICOM conformance are also discussed. Specialized DICOM services such as advanced image display services that provide means for storing how an image was viewed (“Softcopy Presentation States”) and how multiple images should be aligned on an output device (“Structured Display” and “Hanging Protocols”) are described. We further describe DICOM’s sophisticated approach (“Structured Reporting”) for storing structured documents such as CAD information, which is then covered in more detail. Finally, the last section provides an insight into a newly developed DICOM service called “Application Hosting”, which introduces a standardized plug-in architecture for image processing, thus permitting users to utilize cross-vendor image processing plug-ins in DICOM applications.

Electronic Health Record Standards - A Brief Overview

Most medical information systems store clinical information about patients in proprietary format. To address the resulting interoperability problems, several electronic health record (EHR) standards that enable structured clinical content for the purpose of exchange are currently under development. In this article, we present a brief overview of the most relevant EHR standards, examine the level of interoperability they provide and assess their functionality in terms of content structure, access services, multimedia support and security.

A Service Oriented Platform for Health Services and Ambient Assisted Living

Providing health care and assistance at home becomes more and more important due to the aging society and - in general - a health system under financial pressure. It is generally accepted that these services have to be supported by an eHealth infrastructure that enables the exchange of patient related data between different health institutions and assistance systems athome (referred to by the term AAL). In this paper a service-oriented architecture for delivering eHealth / AAL services at home using a hardware platform such as a residential gateway or a set-top-box is proposedand exemplified by three different services: (1) telerehabilitation of patients after heard surgery, (2) support of hearing impaired people and (3) the monitoring of Activities of Daily Living (ADL).

The Lower Saxony research network design of environments for ageing: towards interdisciplinary research on information and communication technologies in ageing societies

Worldwide, ageing societies are bringing challenges for independent living and healthcare. Health-enabling technologies for pervasive healthcare and sensor-enhanced health information systems offer new opportunities for care. In order to identify, implement and assess such new information and communication technologies (ICT) the ‘Lower Saxony Research Network Design of Environments for Ageing’ (GAL) has been launched in 2008 as interdisciplinary research project. In this publication, we inform about the goals and structure of GAL, including first outcomes, as well as to discuss the potentials and possible barriers of such highly interdisciplinary research projects in the field of health-enabling technologies for pervasive healthcare. Although GALs high interdisciplinarity at the beginning slowed down the speed of research progress, we can now work on problems, which can hardly be solved by one or few disciplines alone. Interdisciplinary research projects on ICT in ageing societies are needed and recommended.

Ten years of medical imaging standardization and prototypical implementation: the DICOM standard and the OFFIS DICOM toolkit (DCMTK)

In 2003, the DICOM standard celebrated its 10th anniversary. Aside from the standard itself, also OFFIS’ open source DICOM toolkit DCMTK, which has continuously followed the development of DICOM, turns 10 years old. On this occasion, this article looks back at the main standardization efforts in DICOM and illustrates related developments in DCMTK. Considering the development of the DICOM standard, it is possible to distinguish several phases of progress. Within the first phase at the beginning of the 1990s, basic network services for image transfer and retrieval were being introduced. The second phase, in the mid 1990s, was characterized by advances in the specification of a file format and of regulations for media interchange. In the later but partly parallel third phase, DICOM predominantly dealt with the problem of optimizing the workflow within imaging departments. As a result of the fact that it was now possible to exchange images between different systems, efforts concerning image display consistency followed in a fourth phase at the end of the 1990s. In the current fifth phase, security enhancements are being integrated into the standard. In another phase of progress, which took place over a relatively long time period concurrently to the other mentioned phases, DICOM Structured Reporting was developed.

Monitoring systems for the support of home care.

In this article, the design of a system for the ambient, unobtrusive and automatic monitoring of Activities of Daily Living (ADL) is described. In the context of the growing imbalance between (potentially young) caregivers and (most often older) people receiving care, technical monitoring systems may help to organise care more efficiently and to identify degrading abilities very early to trigger preventive measures. To improve the acceptance of the system described in this article, the selection process of the sensors to be integrated into the flat or to be worn by the older people has been steered by the results of focus group interviews with older people, their relatives and professional caregivers. The interviews revealed that these people would in general accept such systems, but security, mobility and communication aspects have to be clearly and appropriately addressed. In an experimental study the recognition rate of the activity ‘preparation and intake of food or beverages’ has been measured with two age groups (6 subjects, age between 25 and 40/mean 30 years and 5 subjects, age between 72 and 84/mean 75.3 years). The food preparation was detected with a sensitivity of 74.7% and a specificity of 84.2% using a vision sensor.

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies – outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL)

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human–machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific “GAL technology”, providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL’s highly inter- and multidisciplinary aspects, with respect to research into GAL’s application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

OSAMI-D: An open service platform for healthcare monitoring applications

In this paper conceptions and architectural considerations of the OSAMI project and their specializations towards the requirements of the e-health domain by the German subproject (OSAMI-D) are described. Along with the expected shift of healthcare service between stationary towards ambulatory care, a standardized way of integrating medical data acquired at home into the IT infrastructure of hospitals and the synchronization with medical workflows have to be implemented. Therefore, the OSAMI-D project will provide open source components that implement the required interfaces. Preliminary results of the requirements analysis and the implementation of first domain-specific services are presented. These services are used to realize two home care scenarios, which support ambulant cardiologic rehabilitation (indoor and outdoor). Special emphasis is placed on standards and formats for the communication and storage of patient data.