Description and Experience of the Clinical Testbeds

This deliverable describes the up-to-date technical environment at three clinical testbed demonstrator sites of the 6WINIT Project, including the adapted clinical applications, project components and network transition technologies in use at these sites after 18 months of the Project. It also provides an interim description of early experiences with deployment and usage of these applications, components and technologies, and their clinical service impact

GridIMAGE: A Novel Use of Grid Computing to Support Interactive Human and Computer-Assisted Detection Decision Support

This paper describes a Grid-aware image reviewing system (GridIMAGE) that allows practitioners to (a) select images from multiple geographically distributed digital imaging and communication in medicine (DICOM) servers, (b) send those images to a specified group of human readers and computer-assisted detection (CAD) algorithms, and (c) obtain and compare interpretations from human readers and CAD algorithms. The currently implemented system was developed using the National Cancer Institute caGrid infrastructure and is designed to support the identification of lung nodules on thoracic computed tomography. However, the infrastructure is general and can support any type of distributed review. caGrid data and analytical services are used to link DICOM image databases and CAD systems and to interact with human readers. Moreover, the service-oriented and distributed structure of the GridIMAGE framework enables a flexible system, which can be deployed in an institution (linking multiple DICOM servers and CAD algorithms) and in a Grid environment (linking the resources of collaborating research groups). GridIMAGE provides a framework that allows practitioners to obtain interpretations from one or more human readers or CAD algorithms. It also provides a mechanism to allow cooperative imaging groups to systematically perform image interpretation tasks associated with research protocols

A Secure Grid Medical Data Manager Interfaced to the gLite Middleware

International audienceThe medical community is producing and manipulating a tremendous volume of digital data for which computerized archiving, processing and analysis is needed. Grid infrastructures are promising for dealing with challenges arising in computerized medicine but the manipulation of medical data on such infrastructures faces both the problem of interconnecting medical information systems to Grid middlewares and of preserving patients' privacy in a wide and distributed multi-user system. These constraints are often limiting the use of Grids for manipulating sensitive medical data. This paper describes our design of a medical data management system taking advantage of the advanced gLite data management services, developed in the context of the EGEE project, to fulfill the stringent needs of the medical community. It ensures medical data protection through strict data access control, anonymization and encryption. The multi-level access control provides the flexibility needed for imple! menting complex medical use-cases. Data anonymization prevents the exposure of most sensitive data to unauthorized users, and data encryption guarantees data protection even when it is stored at remote sites. Moreover, the developed prototype provides a Grid storage resource manager (SRM) interface to standard medical DICOM servers thereby enabling transparent access to medical data without interfering with medical practice

Information Technologies for the Healthcare Delivery System

That modern healthcare requires information technology to be efficient and fully effective is evident if one spends any time observing the delivery of institutional health care. Consider the observation of a practitioner of the discipline, David M. Eddy, MD, PhD, voiced in Clinical Decision Making, JAMA 263:1265-75, 1990, . . .All confirm what would be expected from common sense: The complexity of modern medicine exceeds the inherent limitations of the unaided human mind. The goal of this thesis is to identify the technological factors that are required to enable a fully sufficient application of information technology (IT) to the modern institutional practice of medicine. Perhaps the epitome of healthcare IT is the fully integrated, fully electronic patient medical record. Although, in 1991 the Institute of Medicine called for such a record to be standard technology by 2001, it has still not materialized. The author will argue that some of the technology and standards that are pre-requisite for this achievement have now arrived, while others are still evolving to fully sufficient levels. The paper will concentrate primarily on the health care system in the United States, although much of what is contained is applicable to a large degree, around the world. The paper will illustrate certain of these pre-requisite IT factors by discussing the actual installation of a major health care computer system at the University of Rochester Medical Center (URMC) in Rochester, New York. This system is a Picture Archiving and Communications System (PACS). As the name implies, PACS is a system of capturing health care images in digital format, storing them and communicating them to users throughout the enterprise

Leveraging internet-98 technology for computer healthcare networks: to its limits and its limitations

To what extent can current Internet technology be leveraged to fulfill the vision of the electronic patient record (EPR) as a multimedia object and the healthcare information system as a secure distributed computing network? We explore provision of reliable, secure, intuitive, and inexpensive medical Intranets through simple scripting and configuration – avoiding the need for large programming teams. By prototyping the EPR as a secure newsgroup we demonstrate the feasibility of a basic workflow system that: preserves a signed-paper style visibility of patient data at all times; enriches presentation with multimedia online image exam viewing and user controlled animation; whilst protecting confidential patient data via encrypted data transmission, digital signatures, and authenticated user-access control. In the process several limitation of this technology are uncovered

Enhancing Privacy and Authorization Control Scalability in the Grid through Ontologies

© 2009 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.The use of data Grids for sharing relevant data has proven to be successful in many research disciplines. However, the use of these environments when personal data are involved (such as in health) is reduced due to its lack of trust. There are many approaches that provide encrypted storages and key shares to prevent the access from unauthorized users. However, these approaches are additional layers that should be managed along with the authorization policies. We present in this paper a privacy-enhancing technique that uses encryption and relates to the structure of the data and their organizations, providing a natural way to propagate authorization and also a framework that fits with many use cases. The paper describes the architecture and processes, and also shows results obtained in a medical imaging platform.Manuscript received November 19, 2007; revised July 27, 2008. First published August 4,2008; cur-rent version published January 4,2009. This work was supported in part by the Spanish Ministry of Education and Science to develop the project "ngGrid-New Generation Components for the Efficient Exploitation of eScience Infrastructures," under Grant TIN2006-12860 and in part by the Structural Funds of the European Regional Development Fund (ERDF).Blanquer Espert, I.; Hernández García, V.; Segrelles Quilis, JD.; Torres Serrano, E. (2009). Enhancing Privacy and Authorization Control Scalability in the Grid through Ontologies. IEEE Transactions on Information Technology in Biomedicine. 13(1):16-24. https://doi.org/10.1109/TITB.2008.2003369S162413