Mathias Forjan

Applicability of IHE/Continua components for PHR systems

Capturing personal health data using smartphones, PCs or other devices, and the reuse of the data in personal health records (PHR) is becoming more and more attractive for modern health-conscious populations. This paper analyses interoperability specifications targeting standards-based communication of computer systems and personal health devices (e.g. blood pressure monitor) in healthcare from initiatives like Integrating the Healthcare Enterprise (IHE) and Continua Health Alliance driven by industry and healthcare professionals. Furthermore it identifies certain contradictions and gaps in the specifications and suggests possible solutions. Despite these shortcomings, the specifications allow fully functional implementations of PHR systems. Henceforth, both big business and small and medium-sized enterprises (SMEs) can actively contribute to the widespread use of large-scale interoperable PHR systems.

Development of an Android App in Compliance with the Continua Health Alliance Design Guidelines for Medical Device Connectivity in mHealth

Due to the demographic change and rising amount of people suffering from lifestyle induced chronic diseases, developed countries face a remarkable cost explosion in the health care sector. Additionally a lack of nursing workforce has been predicted [1]. mHealth solutions are seen as a chance for individuals to keep track of their health condition, to take more responsibility for their lifestyle and to improve the efficiency of care by providing high quality data to formal and informal careers and health professionals. In order to implement these mHealth solutions a high level of standardization is necessary for easy and quick integration of personal health devices (e.g. blood pressure monitor, blood glucose meter) with gateway devices (e.g. smart-phones) and electronic health record (EHR) systems. The Continua Health Alliance Design Guidelines describe a set of internationally established standards and frameworks for this purpose. This paper describes the experience gained during the development of an Android application which is capable of communicating via Bluetooth using the Health Device Profile and the ISO/IEEE 11073-20601 Optimized Exchange Protocol. The WAN interface uses the IHE DEC and XUA profiles in order to securely forward health data to health professionals. Building on existing modules from earlier project phases a Continua Health Alliance compliant Android app using commercially available components was implemented within one month by a team of two developers. Therefore it seems feasible for SMEs to build mHealth applications for these purposes from a technical point of view. Additional effort for regulatory purposes needs to be considered.

Semi-automatic evaluation of intraocular lenses (IOL) using a mechanical eye model

As cataracts are the most common reason for loss of vision with an age over 55, the implantation of intraocular intraocular lenses is one of the most common surgical interventions. The quality measurement and test instructions for the patients. Therefore more efforts are put into the individualization of IOL in order to achieve better imaging properties. Two examples of typical quality standards for IOL are the modulated transfer function (MTF) and the Strehl ratio which can be measured in vivo or also in mechanical eye models. A mechanical eye model in the scale 1:1 is presented. It has been designed to allow the measurement of the MTF and Strehl ratio and simultaneous evaluation of physiological imaging quality. The eye model allows the automatic analysis of the IOL especially focused on the tolerance for tilting and decentering. Cornea, iris aperture and IOL type are interchangeable, because all these parts are implemented by the use of separated holders. The IOL is mounted on a shift plate. Both are mounted on a tilt plate. This set-up guarantees an independent decentration and tilt of the IOL, both moved by electrical drives. This set–up allows a two–dimensional tolerance analysis of decentration and tilt effects. Different 100×100 point (decentration×tilt) analyzes for various iris apertures, needing only approximately 15 minutes, are presented.

Mechanical and Electrical Specifications of the Active Lung Simulator i-Lung – Development of i-Lung 1.0 to i-Lung 2.0

Abstract Lung simulators are important for different application fields like respirator manufacturing processes, teaching purposes as well as environmental and analytical aerosol transport measurements. State-of-the-art lung simulators have a great disadvantage of not taking the internal structure of the human lung into account. Furthermore it is not possible to simulate aerosol exposition to these lung equivalents. To overcome these restrictions and disadvantages, the i-Lung has been developed primarily as an active lung simulator, which can also be used as a passive lung simulator. With the i-Lung it is possible to simulate physiological and pathological breathing patterns with different lung equivalents like latex bags, primed porcine lungs or even fresh porcine lungs. The presented versions 1.0 and 2.0 of the i-Lung are compared in the mechanical and electrical setup. As a development of the i-Lung 1.0, the i-Lung 2.0 provides a refined mechanical construction, more flexible fields of application and an interchangeable dual control unit. The control unit of the lung simulator is either an integrated single based computer (SBC) or the NI cRIO system. With the cRIO control unit, the i-Lung 2.0 is able to perform real time data transmission. Due to the further developments and improvements of the i-Lung system, more physiological and realistic breathing simulation can be executed with the i-Lung 2.0. Thus, the developed lung simulator becomes a real alternative to animal testing. This can be especially interesting for the cosmetic industry, as animal testing has been banned within the EU for the hazardousness and toxicity tests of cosmetic products since March 11 th 2013.

The adolescence of electronic health records: Status and perspectives for large scale implementation

Health informatics started to evolve decades ago with the intention to support healthcare using computers. Since then Electronic health records (EHRs) and personal health records (PHRs) have become available but widespread adoption was limited by lack of interoperability and security issues. This paper discusses the feasibility of interoperable standards based EHRs and PHRs drawing on experience from implementation projects. It outlines challenges and goals in education and implementation for the next years.

Sensor system development for the novel spontaneous active breathing lung simulator, i-Lung

Breathing simulation is an indispensable task not only for respirator manufacturing processes. Using an active lung simulator including an aerosol measurement system at different working environments would provide information about the actual aerosol exposure to the respiratory tract of the employees at their specific working places. For this purpose a sensor system is being developed to enhance the options of use of the novel lung simulator i-Lung. The sensor system is designed to gather environmental and simulation specific parameters. The enhancement of the i-Lung module by integrating a sensor system including sensors for temperature, pressure, flow and humidity enlarges the field of potential applications of the simulator. This development is seen as further step in direction of a certification as alternative to animal models and as an essential pre-commercial development of the i-Lung system.

Enhancements of a mechanical lung simulator for ex vivo measuring of aerosol deposition in lungs

With the current exposure to aerosols, nanoparticles and fine dust the cases of pulmonary diseases increase. Nowadays there is still little information about the distribution of inhaled particles in the lung itself. However, this information is important for pharmaceutical industry providing inhalable diagnostics and therapeutics. The presented lung simulator iLung is an active mechanical lung simulator, which offers the use of different lung equivalents, like a primed porcine lung or latex bags. The i-Lung uses a non destructive aerosol measurement system for measuring the size and amount of inand exhaled particles that were produced beforehand. This lung simulator is a first step into the direction of replacing laboratory animals for inhalation test as ordered by the EU REACH regulation. [2]

Mechanical eye model for the comparison of optical imaging quality and physiology of human vision

The implantation of intraocular lenses (IOL) is one of the most common surgical interventions. This surgery is performed using different types of IOL, like monoand multifocal lenses. The measurement and test instructions for IOL are defined in ISO 11979-2[1]. Even though IOL have a high importance there are only approaches for the actual objective evaluation of the quality of an IOL. The reason is given by a still poorly understood human physiology of vision. A direct comparison between physical imaging properties – for example defined by the modulated transfer function (MTF), point spread function (PSF), spot diagrams, Strehl ratio or the coefficients of Seidelor Zernike polynomials – and physiological perception will allow the development of necessary objective quality standards, also for the development of new intraocular lenses. A mechanic eye model in the scale 1:1 is presented, which has been designed to allow the derivation of the intended quality standards. This is achieved by a simultaneous measurement of physiological and physical imaging properties. Moreover the eye model allows the automatic analysis of the tolerance for tilting and decentrating the IOL perpendicular to the optical axis.

Actively Breathing Mechanical Lung Simulator Development and Preliminary Measurements

The active mechanical lung simulator iLung 2.1 provides the possibility of simulating physiological human breathing patterns. The simulator can be used for assessing the environmental impacts as well as the inhaled aerosols with respect to the used lung equivalents, like latex bags and primed porcine lungs, whose anatomical properties are similar to the human lung. The progress in development of the iLung 2.1 and a comparison of the simulator test measurements with preliminary spirometry measurements is presented. The simulator is controlled by a cRIO system. This setup allows to control the simulation settings in real-time. Data for iLung 2.1 test measurements were taken by using a certified medical spirometer. Measurements were conducted in two simulation modes using two different lung equivalents. The iLung 2.1 measurements were compared with human spirometry measurements. Results show similarity between breathing patterns simulated by iLung 2.1 and normal human breathing allowing further validation and possible research applications.

Organ Telemonitoring in Ex-vivo Nutrition Circulation of Porcine Lungs Using Interoperability Standards

Abstract This paper discusses existing communication standards in the field of medicine and their applicability for a telemonitoring system for a mobile circulatory module. This module hosts an explanted porcine lung during transportation from the explantation site to a laboratory environment. The telemonitoring modules must enable to assess the wellbeing of the lung and the survival of the tissue as expressed in basic parameters that are measured in the circulation and nutrition module like liquid pressure, liquid flow and temperature. The parameter readings need to be displayed for monitoring purposes on a tablet-PC. Thresholds for parameters shall be set remotely and exceedance of these thresholds shall trigger the transfer of alarm messages to the tablet-PC. The goal of this work is to evaluate existing interoperability standards according to these requirements in order to select a set of standards that will then be used for implementation of the system. Standards that have identified and examined are ISO/IEEE 11073-20601, HL7 Version 2.x and ANT+. It was found that existing standards support large parts of the requirements. However detailed gap analysis will be necessary as the implementation continues.