The Standard Problem

Crafting, adhering to, and maintaining standards is an ongoing challenge. This paper uses a framework based on common models to explore the standard problem: the impossibility of creating, implementing or maintain definitive common models in an open system. The problem arises from uncertainty driven by variations in operating context, standard quality, differences in implementation, and drift over time. Fitting work by conformance services repairs these gaps between a standard and what is required for interoperation, using several strategies: (a) Universal conformance (all agents access the same standard); (b) Mediated conformance (an interoperability layer supports heterogeneous agents) and (c) Localized conformance, (autonomous adaptive agents manage their own needs). Conformance methods include incremental design, modular design, adaptors, and creating interactive and adaptive agents. Machine learning should have a major role in adaptive fitting. Choosing a conformance service depends on the stability and homogeneity of shared tasks, and whether common models are shared ahead of time or are adjusted at task time. This analysis thus decouples interoperability and standardization. While standards facilitate interoperability, interoperability is achievable without standardization.Comment: Keywords: information standard, interoperability, machine learning, technology evaluation 25 Pages Main text word Count: 5108 Abstract word count: 206 Tables: 1 Figures: 7 Boxes: 2 Submitted to JAMI

Conceptual Framework for Semantic Interoperability in Sensor-enhanced Health Information Systems (SIOp4Se-HIS)

Transducer integration into different accessories such as eyeglasses, wristbands, vest, wristwatches, among others, has brought myriads of physiological data that could be of help in making patients health monitoring easier. However, this myriad of data are generated from different devices with different formats and uncoordinated data types which ultimately compromises the data integrity and renders it medically less importance. Furthermore, several wearables do operate as data island as they cannot incorporate their captured data into the Health Information Systems (HIS) for easy accessibility by the health-care professionals for further processing, interpretation and actions on the patients’ health. Therefore, to enable the flow of data that will be useful to both patient and health-care professional, the existing HIS should be transducer enhanced / enabled, and they should operate at the same semantic interoperability level to allow for exchange of meaningful data from transducers to HIS. In bid to achieve this, several attempts have been made using standards, and archetypes, which goes a long way in providing interoperability at the technical and syntactic level. However, repositories of heterogeneous transducer data as provided by health monitoring systems, requires actionable knowledge of context (environment) from which the data is collected for it to be medically useful and interoperate at the semantic level with the HIS. There are three approaches: the model-driven; standard based and archetype approach but only the ontology driven guarantees making the applications smarter, or make the data smarter. The study propose the latter option using a dual model approach to leverage semantic technologies in order to provide and apply more meaningful health monitoring data representation between transducers and HIS. We approached this study using the design science research methodology and developed a hybrid methodology by combining two methods to develop our ontologies that are based on standards in the domains, with this unique method we achieved a novel approach to solve the obstacle of semantic interoperability through our proposed framework for Semantic Interoperability for Sensor-enhanced Health Information Systems (se-HIS) and bridged the gaps in systems’ interoperability between monitoring units and HIS. The outcome is a robust, explicit conceptual framework for sensor-enhanced health information systems Interoperability (IOp) at the semantic level. This semantically enabled our HIS, to interoperate with Transducers that are compliant with the Institute of Electrical and Electronics Engineers (IEEE) 21451 family of standards, and it provides the ability to query high-level knowledge of the data context as well as low-level raw data accessibility in a multi-transducer enable HIS

Identifying Outcomes of Care from Medical Records to Improve Doctor-Patient Communication

Between appointments, healthcare providers have limited interaction with their patients, but patients have similar patterns of care. Medications have common side effects; injuries have an expected healing time; and so on. By modeling patient interventions with outcomes, healthcare systems can equip providers with better feedback. In this work, we present a pipeline for analyzing medical records according to an ontology directed at allowing closed-loop feedback between medical encounters. Working with medical data from multiple domains, we use a combination of data processing, machine learning, and clinical expertise to extract knowledge from patient records. While our current focus is on technique, the ultimate goal of this research is to inform development of a system using these models to provide knowledge-driven clinical decision-making

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

Managing healthcare transformation towards P5 medicine (Published in Frontiers in Medicine)

Health and social care systems around the world are facing radical organizational, methodological and technological paradigm changes to meet the requirements for improving quality and safety of care as well as efficiency and efficacy of care processes. In this they’re trying to manage the challenges of ongoing demographic changes towards aging, multi-diseased societies, development of human resources, a health and social services consumerism, medical and biomedical progress, and exploding costs for health-related R&D as well as health services delivery. Furthermore, they intend to achieve sustainability of global health systems by transforming them towards intelligent, adaptive and proactive systems focusing on health and wellness with optimized quality and safety outcomes. The outcome is a transformed health and wellness ecosystem combining the approaches of translational medicine, 5P medicine (personalized, preventive, predictive, participative precision medicine) and digital health towards ubiquitous personalized health services realized independent of time and location. It considers individual health status, conditions, genetic and genomic dispositions in personal social, occupational, environmental and behavioural context, thus turning health and social care from reactive to proactive. This requires the advancement communication and cooperation among the business actors from different domains (disciplines) with different methodologies, terminologies/ontologies, education, skills and experiences from data level (data sharing) to concept/knowledge level (knowledge sharing). The challenge here is the understanding and the formal as well as consistent representation of the world of sciences and practices, i.e. of multidisciplinary and dynamic systems in variable context, for enabling mapping between the different disciplines, methodologies, perspectives, intentions, languages, etc. Based on a framework for dynamically, use-case-specifically and context aware representing multi-domain ecosystems including their development process, systems, models and artefacts can be consistently represented, harmonized and integrated. The response to that problem is the formal representation of health and social care ecosystems through an system-oriented, architecture-centric, ontology-based and policy-driven model and framework, addressing all domains and development process views contributing to the system and context in question. Accordingly, this Research Topic would like to address this change towards 5P medicine. Specifically, areas of interest include, but are not limited: • A multidisciplinary approach to the transformation of health and social systems • Success factors for sustainable P5 ecosystems • AI and robotics in transformed health ecosystems • Transformed health ecosystems challenges for security, privacy and trust • Modelling digital health systems • Ethical challenges of personalized digital health • Knowledge representation and management of transformed health ecosystems Table of Contents: 04 Editorial: Managing healthcare transformation towards P5 medicine Bernd Blobel and Dipak Kalra 06 Transformation of Health and Social Care Systems—An Interdisciplinary Approach Toward a Foundational Architecture Bernd Blobel, Frank Oemig, Pekka Ruotsalainen and Diego M. Lopez 26 Transformed Health Ecosystems—Challenges for Security, Privacy, and Trust Pekka Ruotsalainen and Bernd Blobel 36 Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine Alexandra Prodan, Lucas Deimel, Johannes Ahlqvist, Strahil Birov, Rainer Thiel, Meeri Toivanen, Zoi Kolitsi and Dipak Kalra 49 EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic Laura Paleari, Virginia Malini, Gabriella Paoli, Stefano Scillieri, Claudia Bighin, Bernd Blobel and Mauro Giacomini 60 A Review of Artificial Intelligence and Robotics in Transformed Health Ecosystems Kerstin Denecke and Claude R. Baudoin 73 Modeling digital health systems to foster interoperability Frank Oemig and Bernd Blobel 89 Challenges and solutions for transforming health ecosystems in low- and middle-income countries through artificial intelligence Diego M. López, Carolina Rico-Olarte, Bernd Blobel and Carol Hullin 111 Linguistic and ontological challenges of multiple domains contributing to transformed health ecosystems Markus Kreuzthaler, Mathias Brochhausen, Cilia Zayas, Bernd Blobel and Stefan Schulz 126 The ethical challenges of personalized digital health Els Maeckelberghe, Kinga Zdunek, Sara Marceglia, Bobbie Farsides and Michael Rigb

Automatic Generation of Personalized Recommendations in eCoaching

Denne avhandlingen omhandler eCoaching for personlig livsstilsstøtte i sanntid ved bruk av informasjons- og kommunikasjonsteknologi. Utfordringen er å designe, utvikle og teknisk evaluere en prototyp av en intelligent eCoach som automatisk genererer personlige og evidensbaserte anbefalinger til en bedre livsstil. Den utviklede løsningen er fokusert på forbedring av fysisk aktivitet. Prototypen bruker bærbare medisinske aktivitetssensorer. De innsamlede data blir semantisk representert og kunstig intelligente algoritmer genererer automatisk meningsfulle, personlige og kontekstbaserte anbefalinger for mindre stillesittende tid. Oppgaven bruker den veletablerte designvitenskapelige forskningsmetodikken for å utvikle teoretiske grunnlag og praktiske implementeringer. Samlet sett fokuserer denne forskningen på teknologisk verifisering snarere enn klinisk evaluering.publishedVersio