V. Koutkias

Home care delivery through the mobile telecommunications platform: The Citizen Health System (CHS) perspective

Health delivery practices are shifting towards home care. The reasons are the better possibilities for managing chronic care, controlling health delivery costs, increasing quality of life and quality of health services and the distinct possibility of predicting and thus avoiding serious complications. For the above goals to become routine, new telemedicine and information technology (IT) solutions need to be implemented and integrated in the health delivery scene, and these solutions need to be assessed through evidence-based medicine in order to provide solid proof for their usefulness. Thus, the concept of contact or call centers has emerged as a new and viable reality in the field of IT for health and telemedicine. In this paper we describe a generic contact center that was designed in the context of an EU funded IST for health project with acronym Citizen Health System (CHS). Since the generic contact center is composed by a number of modules, we shall concentrate in the modules dealing with the communication between the patient and the contact center using mobile telecommunications solutions, which can act as link between the internet and the classical computer telephony communication means. We further elaborate on the development tools of such solutions, the interface problems we face, and on the means to convey information from and to the patient in an efficient and medically acceptable way. This application proves the usefulness of wireless technology in providing health care services all around the clock and everywhere the citizen is located, it proves the necessity for restructuring the medical knowledge for education delivery to the patient, and it shows the virtue of interactivity by means of using the limited, yet useful browsing capabilities of the wireless application protocol (WAP) technology.

The citizen health system (CHS): a Modular medical contact center providing quality telemedicine services

In the context of the Citizen Health System (CHS) project, a modular Medical Contact Center (MCC) was developed, which can be used in the monitoring, treatment, and management of chronically ill patients at home, such as diabetic or congestive heart failure patients. The virtue of the CHS contact center is that, using any type of communication and telematics technology, it is able to provide timely and preventive prompting to the patients, thus, achieving better disease management. In this paper, we present the structure of the CHS system, describing the modules that enable its flexible and extensible architecture. It is shown, through specific examples, how quality of healthcare delivery can be increased by using such a system.

In-vivo validation of spatially correct three-dimensional reconstruction of human coronary arteries by integrating intravascular ultrasound and biplane angiography

ObjectivesThe in-vivo validation of geometrically correct three-dimensional reconstruction of human coronary arteries by integrating intravascular ultrasound and biplane coronary angiography has not been adequately investigated. The purpose of this study was to describe the reconstruction method and investigate its in-vivo feasibility and accuracy. MethodsIn 17 coronary arteries (mean length, 85.7±17.1 mm) from nine patients, an intravascular ultrasound procedure along with a biplane coronary angiography was performed. From each angiographic projection, a single end-diastolic frame was selected in order to reconstruct the intravascular ultrasound catheter trajectory in space. In each end-diastolic intravascular ultrasound image, the lumen and media–adventitia contours were detected semi-automatically by an active contour algorithm. Each pair of contours was located on the catheter trajectory appropriately and interpolated with the adjacent pairs creating a three-dimensional volume of the arterial lumen and wall. The reconstructed lumen was back-projected onto both angiographic planes and the agreement between the back-projected and the angiographic luminal outlines was calculated. ResultsThe angiogram-derived catheter length showed very high correlation (y=0.97x+1.8, P<0.001) and agreement with the corresponding pullback-derived values. Accordingly, the semi-automated segmentation of intravascular ultrasound images was also in significant correlation (r≥0.96, P<0.001) and agreement with the reference manual tracing. The back-projected luminal borders showed good overall association with the corresponding angiographic ones (r=0.78, P<0.001) as well as remarkable agreement. ConclusionsSpatially correct three-dimensional reconstruction of human coronary arteries constitutes an imaging method with considerably high in-vivo feasibility and accuracy.

An Open and Reconfigurable Wireless Sensor Network for Pervasive Health Monitoring

Objectives: Sensor networks constitute the backbone for the construction of personalized monitoring systems. Up to now, several sensor networks have been proposed for diverse pervasive healthcare applications, which are however characterized by a significant lack of open architectures, resulting in closed, non-interoperable and difficult to extend solutions. In this context, we propose an open and reconfigurable wireless sensor network (WSN) for pervasive health monitoring, with particular emphasis in its easy extension with additional sensors and functionality by incorporating embedded intelligence mechanisms. Methods: We consider a generic WSN architecture comprised of diverse sensor nodes (with communication and processing capabilities) and a mobile base unit (MBU) operating as the gateway between the sensors and the medical personnel, formulating this way a body area network (BAN). The primary focus of this work is on the intra-BAN data communication issues, adopting SensorML as the data representation mean, including the encoding of the monitoring patterns and the functionality of the sensor network. Results: In our prototype implementation two sensor nodes are emulated; one for heart rate monitoring and the other for blood glucose observations, while the MBU corresponds to a personal digital assistant (PDA) device. Java 2 Micro Edition (J2ME) is used to implement both the sensor nodes and the MBU components. Intra-BAN wireless communication relies on the Bluetooth protocol. Via an adaptive user interface in the MBU, health professionals may specify the monitoring parameters of the WSN and define the monitoring patterns of interest in terms of rules. Conclusions: This work constitutes an essential step towards the construction of open, extensible, inter - operable and intelligent WSNs for pervasive health monitoring.

Using contact centers in tele-management and home care of congestive heart failure patients: The CHS experience

The Citizen Health System (CHS) is a European Commission (CEC) funded project in the field of IST for Health. Its main goal is to develop a generic contact center which in its pilot stage can be used in the monitoring, treatment and management of chronically ill patients at home such as congestive heart failure (CHF) patients. Such contact centers, which can use any type of communication and telematics technology, and can provide timely and preventive prompting to the patients are envisaged in the future to evolve into well-being contact centers providing services to all citizens. In this paper, we present the structure of such a generic contact center focusing on the telecommunication infrastructure, the communication protocols and procedures related to the vital parameters and signals, and finally the educational modules that are integrated into this contact center. We present examples of the communication means between the medical professionals using this contact center and the congestive heart failure patients, and elaborate on the telemedicine and educational issues involved.

Congenital heart disease patient home care services using the interactive TV: the PANACEIA-ITV approach

In the context of the PANACElA-ITV IST European project, a home care service provision system is described based on interactive TV technology. The purpose of PANACEIA-ITV is to facilitate essential lifestyle changes and to promote compliance with scientifically sound self-care recommendations, through the application of interactive digital television for family health maintenance. The means to achieve these goals are based on technological, health services and business models. PANACEIA-ITV is looking for communication of monitoring micro-devices with ITV set-top-boxes using infrared technology, and embodiment of analogous H/W and S/W in the ITV set-top-boxes. The PANACElA-ITV system is used by patients suffering from adult congenital heart disease (ACHD) at the Royal Brompton Hospital. The primary aim of this pilot is to test whether delivery of high quality monitoring, treatment and education for the ACHD or pulmonary hypertension patient is feasible via interactive television and infrared microdevices. Secondary aims of this pilot are to test the hypothesis that intensified home monitoring and guidance for patients of this target group will lead to reduced ACHD related hospitalization and to evaluate the overall attitude of the patients and clinicians towards the use of new technologies such as ITV in healthcare and disease management.

Development and usability of a personalized sensor-based system for pervasive healthcare

Although a plethora of remote health monitoring systems have been proposed for chronic conditions, the challenge posed by the changing patient needs and the requirement for personalization in health monitoring to move beyond proprietary, difficult to extend, and unsustainable solutions still pertains. In this direction, we describe a mobile health system based on a smartphone, portable/wearable sensors for measuring the patients physiological parameters, and back-end platforms for the health professionals to monitor the patient condition and configure monitoring plans in an individualized manner. A prototype system was developed based on a Service-oriented Architecture and integrating commercially available sensing devices. An experimental study has been conducted with 53 patients in order to investigate the usability of the proposed system. The patients were able to perform the majority of the target tasks successfully (Success Rate = 77%), while the perceived usability using the System Usability Scale (SUS) was found to be above average (SUS score = 73%), indicating that the patients overall perceived the system as both easy to use and useful.

Identification of Barriers and Facilitators for eHealth Acceptance: The KONFIDO Study

In this paper, we present one of the key KONFIDO project’s activities, the identification of key barriers and facilitators regarding eHealth solutions acceptance, focusing on security and interoperability. The methodology presented includes an end-user survey and an end-user workshop, engaging various stakeholders from Europe, in order to gain value out of their experience and insight in real-world healthcare settings. The analysis of the results provides a list of explicitly identified barriers and facilitators of adopting eHealth solutions in a Europe-wide scale, useful in the context of KONFIDO and beyond.

Integration of communication means for home care in chronic disease management

Health care delivery is changing drastically. In its current state it tends to use the home care model in order to improve quality of life, to rationalize costs and to achieve wellbeing. Pivotal to these purposes are contact centers, which act as mediators between the medical staff and the citizens seeking advice and/or treatment. The main platforms used for the development of such applications are the Internet and computers, and the telecommunication networks, including mobile solutions. In this paper, an integrated platform is proposed, offering the patient multiple means of communication with the contact center, along with personalization of the services provided. The interactive exchange of messages and data is implemented through multiple communication interfaces such as mobile WAP phone, Internet and automated call center technology.

A Framework for Automatic Detection of Lumen-Endothelium Border in Intracoronary OCT Image Sequences

Intracoronary optical coherence tomography (OCT) is increasingly being used for real-time visualization of coronary arteries aiming to help in the identification of high-risk atherosclerotic plaques associated with geometrical and morphological features of the arterial wall. This paper presents a framework towards the automatic detection of the inner wall of the coronary artery (lumen-endothelium border) in intracoronary OCT image sequences by employing a multi-step image processing method. The major focus of this work was to address difficult cases that are frequently met in intracoronary OCT, e.g. images with small/big branches, multiple branches, blood presence, calcifications, artifacts, etc. We present each step employed and the results obtained both in qualitative and quantitative terms. The proposed segmentation algorithm has been proven very efficient in the majority of the examined cases.