Mobile Clinical Decision Support Systems – A Systematic Review

In this review article, we provide a descriptive analysis of the current state of mobile decision support systems in the healthcare domain based on studies published in the following databases: Business Source Complete, CINAHL, Cochrane library, MEDLINE, PsycINFO, PubMed, ScienceDirect and Web of Science databases. A total of 29 studies were identified and analyzed to understand the current state of development, evaluation efforts, usability and challenges to adoption by patients and care providers. Our aim is to evaluate these systems and identify the key challenges which hinders their widespread adoption. Although, mobile based decision support systems in healthcare context have the potential to improve clinical decision making, the current state with low adoption rate and early stage of development need to be addressed for successful health outcomes

Performance evaluation of cooperation strategies for m-health services and applications

Health telematics are becoming a major improvement for patients’ lives, especially for disabled, elderly, and chronically ill people. Information and communication technologies have rapidly grown along with the mobile Internet concept of anywhere and anytime connection. In this context, Mobile Health (m-Health) proposes healthcare services delivering, overcoming geographical, temporal and even organizational barriers. Pervasive and m-Health services aim to respond several emerging problems in health services, including the increasing number of chronic diseases related to lifestyle, high costs in existing national health services, the need to empower patients and families to self-care and manage their own healthcare, and the need to provide direct access to health services, regardless the time and place. Mobile Health (m- Health) systems include the use of mobile devices and applications that interact with patients and caretakers. However, mobile devices have several constraints (such as, processor, energy, and storage resource limitations), affecting the quality of service and user experience. Architectures based on mobile devices and wireless communications presents several challenged issues and constraints, such as, battery and storage capacity, broadcast constraints, interferences, disconnections, noises, limited bandwidths, and network delays. In this sense, cooperation-based approaches are presented as a solution to solve such limitations, focusing on increasing network connectivity, communication rates, and reliability. Cooperation is an important research topic that has been growing in recent years. With the advent of wireless networks, several recent studies present cooperation mechanisms and algorithms as a solution to improve wireless networks performance. In the absence of a stable network infrastructure, mobile nodes cooperate with each other performing all networking functionalities. For example, it can support intermediate nodes forwarding packets between two distant nodes. This Thesis proposes a novel cooperation strategy for m-Health services and applications. This reputation-based scheme uses a Web-service to handle all the nodes reputation and networking permissions. Its main goal is to provide Internet services to mobile devices without network connectivity through cooperation with neighbor devices. Therefore resolving the above mentioned network problems and resulting in a major improvement for m-Health network architectures performances. A performance evaluation of this proposal through a real network scenario demonstrating and validating this cooperative scheme using a real m-Health application is presented. A cryptography solution for m-Health applications under cooperative environments, called DE4MHA, is also proposed and evaluated using the same real network scenario and the same m-Health application. Finally, this work proposes, a generalized cooperative application framework, called MobiCoop, that extends the incentive-based cooperative scheme for m-Health applications for all mobile applications. Its performance evaluation is also presented through a real network scenario demonstrating and validating MobiCoop using different mobile applications

The history and challenges of SCP-ECG: the standard communication protocol for computer-assisted electrocardiography

Ever since the first publication of the standard communication protocol for computer-assisted electrocardiography (SCP-ECG), prENV 1064, in 1993, by the European Committee for Standardization (CEN), SCP-ECG has become a leading example in health informatics, enabling open, secure, and well-documented digital data exchange at a low cost, for quick and efficient cardiovascular disease detection and management. Based on the experiences gained, since the 1970s, in computerized electrocardiology, and on the results achieved by the pioneering, international cooperative research on common standards for quantitative electrocardiography (CSE), SCP-ECG was designed, from the beginning, to empower personalized medicine, thanks to serial ECG analysis. The fundamental concept behind SCP-ECG is to convey the necessary information for ECG re-analysis, serial comparison, and interpretation, and to structure the ECG data and metadata in sections that are mostly optional in order to fit all use cases. SCP-ECG is open to the storage of the ECG signal and ECG measurement data, whatever the ECG recording modality or computation method, and can store the over-reading trails and ECG annotations, as well as any computerized or medical interpretation reports. Only the encoding syntax and the semantics of the ECG descriptors and of the diagnosis codes are standardized. We present all of the landmarks in the development and publication of SCP-ECG, from the early 1990s to the 2009 International Organization for Standardization (ISO) SCP-ECG standards, including the latest version published by CEN in 2020, which now encompasses rest and stress ECGs, Holter recordings, and protocol-based trials

The Application of Computer Techniques to ECG Interpretation

This book presents some of the latest available information on automated ECG analysis written by many of the leading researchers in the field. It contains a historical introduction, an outline of the latest international standards for signal processing and communications and then an exciting variety of studies on electrophysiological modelling, ECG Imaging, artificial intelligence applied to resting and ambulatory ECGs, body surface mapping, big data in ECG based prediction, enhanced reliability of patient monitoring, and atrial abnormalities on the ECG. It provides an extremely valuable contribution to the field

Ontologie pour la traçabilité des manipulations d'images médicales

In medicine, physicians (general practitioner or specialist) realize a diagnosis to determine patients’disease and propose an adapted treatment. This diagnosis is based on research of causes (pathologies)and effects (symptoms) of affection. Today, to realize an effective medical diagnosis, it isimportant to realize a multidisciplinary analysis at a data level. But it is also important to make worktogether experts from different domains. A problem can happen if these experts do not work in thesame place. Thus, how is it possible to ease the way to collaborate together?With evolutions of communication technologies and more particularly Internet, it is easier to developremote collaborative applications. One of the fields covered by theses applications is telemedicineand telediagnosis. Thus, a remote panel of experts can meet together virtually through a virtual roomto ease diagnosis collaboration and co-production. Despite everything, forensic aspects slowed downdevelopment of remote practices due to privacy and personal information sharing.In this context, we developed a platform called COOVADIS (COllabOrative VAscular DIagnoSis) thatenables traceability in such applications based on three original ontologies (pathologies ontology,diagnosis ontology and traceability ontology). This framework was implemented in SaaS (Softwareas a Service) as a web server, to support the collaborative work between health professionals. It wasalso validated from a theoretical and clinical point of view.En médecine, le diagnostic est la démarche par laquelle le médecin, généraliste ou spécialiste vadéterminer l’affection dont souffre le patient, et qui va permettre de proposer un traitement. Il reposesur la recherche des causes (pathologie) et des effets (symptômes) de l’affection. Un diagnosticmédical efficace doit aujourd’hui int égrer des analyses multidisciplinaires tant au niveau des donnéesque des experts: et compte tenu de la r épartition géographique (par exemple de la désertificationm´ edicale), il peut être compliqué de réunir au même endroit les experts.L’ évolution des technologies de communication, en particulier Internet, a ouvert de nouvelles possibilités dans le domaine des applications collaboratives à distance et tout particulièrement celuidu t élé-diagnostic médical : par exemple un panel d’experts distants se réunit virtuellement parl’intermédiaire d’une salle d’examen virtuelle qui favorisera la collaboration afin de coproduire undiagnostic. Mais dans le domaine de la médecine, l’aspect médico-l égal est crucial, et il a freinéledéveloppement de ces pratiques à distances.Dans ce contexte, nous avons développé une plateforme appelée COOVADIS (COllabOrative VAscularDIagnoSis) qui permet la traçabilité dans de telles applications en s’appuyant sur trois ontologiesoriginales (ontologie de la pathologie, ontologie du diagnostic et ontologie de traçabilité). Cette plateformed’aide `a la collaboration entre professionnels de santé à été implémentée en mode SaaS(Software as a Service) sous la forme d’un serveur Web, et validé d’un point de vue théorique et clinique

Avaliação da usabilidade de produtos e serviços "ambient assisted living" numa abordagem "living lab"

Doutoramento em Ciências e Tecnologias da SaúdeO envelhecimento demográfico constitui um desafio à sustentabilidade das sociedades modernas. A população idosa está sujeita a uma evidente diminuição da capacidade funcional, que pode ser minimizada através da utilização de soluções tecnológicas que diminuam a necessidade de assistência e, consequentemente, favoreçam uma velhice autónoma e independente. O Ambient Assited Living (AAL) refere-se a produtos e serviços tecnológicos inteligentes imbuídos no ambiente físico e que são facilitadores de interações inteligentes e naturais entre a pessoa idosa e o ambiente físico. Sendo os produtos e serviços AAL direcionados para a população idosa torna-se fundamental garantir a sua usabilidade. A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), da Organização Mundial de Saúde, é um elemento chave que permite uma abordagem multidisciplinar, completa e centrada no indivíduo para a avaliação da funcionalidade humana. Segundo a CIF, os produtos e serviços AAL enquadram-se nos fatores ambientais que condicionam a funcionalidade humana. Este trabalho consistiu no desenvolvimento de uma metodologia adequada à avaliação da usabilidade de produtos e serviços AAL que utiliza a CIF como modelo enquadrador. O desenvolvimento desta metodologia baseou-se numa abordagem Living Lab que promove o envolvimento de todas as partes interessadas ao longo do processo de desenvolvimento. A metodologia de avaliação de usabilidade Living Usability Lab (LUL) é composta por três fases: validação conceptual, teste protótipo e teste piloto. A sua consolidação exigiu o desenvolvimento, adaptação e avaliação de um conjunto de instrumentos. Para a validação conceptual foram adaptados e criados inquéritos preliminares, personas e cenários. Para o teste protótipo e teste piloto realizou-se a tradução e adaptação cultural e linguística do Post-Study System Usability Questionnaire (PSSUQ) e da System Usability Scale (SUS), e desenvolveu-se e validou-se a ICF Based Usability Scale (ICF-US). Nos testes de validação dos instrumentos estiveram envolvidos cerca de 60 utilizadores. A metodologia de avaliação de usabilidade LUL foi utilizada num estudo experimental com cerca de 80 utilizadores, em que se consideraram vários projetos de investigação em estádios de desenvolvimento diferentes, e que permitiu demonstrar a sua validade e robustez. Dentro dos vários métodos e ferramentas desenvolvidas, a ICF-US deve ser realçada. Esta foi construída com base no modelo conceptual da CIF e permite, por um lado, realizar uma avaliação global de usabilidade e, por outro, discriminar facilitadores e barreiras o que é fundamental numa abordagem Living Lab. Introduzir a CIF na avaliação de tecnologia é de extrema relevância, pois permite conciliar a área da funcionalidade humana com o AAL e assim estabelecer uma linguagem comum entre as diferentes partes envolvidas no desenvolvimento de produtos e serviços AAL.The demographic aging is a challenge to the sustainability of modern societies. The elderly population suffers a clear decrease of functional capacity, which can be minimized through the use of technological solutions that reduce the need for assistance and, consequently, favors autonomy and independence. The Ambient Assisted Living (AAL) refers to products and intelligent technological services imbued in the physical environment that are facilitators of smart and natural interactions between the elderly people and the physical environment. As AAL products and services are directed to the elderly population it is vital to ensure their usability. The International Classification of Functioning, Disability and Health (ICF), proposed by the World Health Organization, is a key element that allows a multidisciplinary and comprehensive approach based on the individual to assess human functioning. According to the ICF, AAL products and services are considered environmental factors that affect individual functioning. This work consisted in developing an appropriate methodology to evaluate the usability of AAL products and services using the ICF as a conceptual model. The development of this methodology was based in a Living Lab approach, which advocates the involvement of all stakeholders in the development process. The usability evaluation methodology Living Usability Lab (LUL) consists of three phases: concept validation, prototype test and pilot test. Its consolidation required the development, adaptation and validation of a set of instruments. For the conceptual validation preliminary questionnaires, personas and scenarios were developed and adapted. For the prototype test and pilot test the translation, cultural and linguistic adaptation of the Post-Study System Usability Questionnaire (PSSUQ) and the System Usability Scale (SUS) were performed, and the ICF based Usability Scale (ICF-US) was developed and validated. The instruments validation tests involved around 60 users. The usability evaluation methodology was validated in an experimental study with 80 users that considered several research projects in different stages of development, and allowed to demonstrate its validity and robustness. Within the various methods and tools developed ICF-US should be highlighted. This was based on the conceptual model of the ICF and allows on the one hand, make an overall assessment of usability and on the other, discriminate facilitators and barriers which is fundamental in a Living Lab approach. Using the ICF in the evaluation of technology is extremely important because it reconciles the areas of human functioning and AAL, establishing a common language between the different parties involved in the development of AAL products and services