M-Health: Emerging Mobile Health Systems

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M-Health Emerging Mobile Health Systems

TOPICS IN BIOMEDICAL ENGINEERING INTERNATIONAL BOOK SERIES Series Editor: Evangelia Micheli-Tzanakou Rutgers University Piscataway, New Jersey

Signals and Systems in Biomedical Engineering: Signal Processing and Physiological Systems Modeling Suresh R. Devasaahayam

Models of the Visual System Edited by George K. Hung and Kenneth J. Ciuffreda

PDE and Level Sets: Algorithmic Approaches to Static and Motion Imagery Edited by Jasjit S. Suri and Swamy Laxminarayan

Frontiers in Biomedical Engineering: Proceedings of the World Congress for Chinese Biomedical Engineers Edited by Ned H.C. Hwang and Savio L-Y. Woo

Handbook of Biomedical Image Analysis: Volume I: Segmentation Models Part A Edited by Jasjit S. Suri, David L. Wilson, and Swamy Laxminarayan

Handbook of Biomedical Image Analysis: Volume II: Segmentation Models Part B Edited by Jasjit S. Suri, David L. Wilson, and Swamy Laxminarayan

Handbook of Biomedical Image Analysis: Volume III: Registration Models Edited by Jasjit S. Suri, David L. Wilson, and Swamy Laxminarayan

M-Health: Emerging Mobile Health Systems Edited by Robert S.H. Istepanian, Swamy Laxminarayan, and Constantinos S. Pattichis

Robert S.H. Istepanian Swamy Laxminarayan Constantinos S. Pattichis (Editors)

M-Health Emerging Mobile Health Systems

With 182 Illustrations

Swamy Laxminarayan Idaho State University Biomedical Research Institute and the Institute of Rural Health Pocatello, Idaho USA

Robert S.H. Istepanian Kingston University London UK

Constantinos S. Pattichis University of Cyprus Nicosia Cyprus

Library of Congress Control Number: 2005927930 ISBN-10: 0-387-26558-9 ISBN-13: 978-0387-26558-2

e-ISBN: 0-387-26559-7

Printed on acid-free paper. C

2006 Springer Science+Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identiﬁed as such, is not to be taken as an expression of opinion as to whether or not they ar subject to proprietary rights. Printed in the United States of America. 9 8 7 6 5 4 3 2 1 springeronline.com

(TB/MVY)

“Ask, and it shall be given you; seek, and you shall find; Knock, and it shall be opened to you. For everyone who asks, receives; and he who seeks, finds; and to him who knocks, it shall be opened.”

Matthew 7:7-8.

Dedication

To the God Almighty for His Blessings and also to my family (my Wife Helen and to my two Daughters, Carolyn and Sarah). Robert S.H. Istepanian

To the tireless work and contributions of all my students all around the world and to my family (my wife Marijke, my son Vinod and my daughter Malini).

Swamy Laxminarayan

To the memory of my cousin Andreas Procopiou who, despite physical disability, lived a fruitful life, offering happiness to the people around him. He believed in innovative technology for making the life of the disabled better. Constantinos S. Pattichis

Contributors

Editors Robert S.H. Istepanian Mobile Information and Network Technologies Research Centre (MINT), School of Computing and Information Systems, Kingston University, London UK [email protected] http://technology.kingston.ac.uk/MINT Swamy Laxminarayan ISU Biomedical Research Institute and the Institute of Rural Health, Pocatello, Idaho USA [email protected] Constantinos S. Pattichis Department of Computer Science University of Cyprus Cyprus [email protected] http://www.cs.ucy.ac.cy/People/Profiles/

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M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

Section Editors Lymberis Andreas European Commission, Directorate General Information Society, Av. De Beaulieu 31, 1160 Brussels [email protected] www.cordis.lu/ist/directorate_c/ehealth/index.html Nugent Chris D. University of Ulster, Jordanstown, Northern Ireland, BT37 0QB. [email protected]; Pattichis Marios S. Dept of Electrical and Computer Engineering, and Computer Engineering The University of New Mexico ECE Building, The University of New Mexico, The University of New Mexico, Albuquerque, NM 87131-1356. [email protected] Pavlopoulos Sotiris A. National Technical University of Athens Biomedical Engineering Laboratory, Department of Electrical and Computer Engineering, National Technical University of Athens, 9 Iroon Polytecniou str., Zografou Campus, 15773, Athens, Greece [email protected] www.biomed.ntua.gr Vieyres Pierre Université d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France [email protected]

Authors Abdallah Rony The George Washington University Hospital, The George Washington University Hospital, 2150 Pennsylvania Avenue NW 6A, Washington DC 20037 [email protected] Alesanco Álvaro University of Zaragoza, Communication Technologies Group (GTC), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, SPAIN [email protected]; Altieri Roberto Area Manager, Nergal S.r.l. Viale B. Bardanzellu, 8 - 00155 Rome, Italy [email protected] www.nergal.it

CONTRIBUTORS

Andreou Panayiotis Department of Computer Science, University of Cyprus, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected] Arbeille Philippe Université de Tours, Centre Hospitalier Universitaire Trousseau, 37032 Tours Cedex, France [email protected] Bali Rajeev K. Knowledge Management for Healthcare (KMH) subgroup, Biomedical Computing Research Group (BIOCORE), Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom [email protected] www.mis.coventry.ac.uk/biocore/kmh Beglinger Christoph Prof. Dr. med University Hospital Basel, Department of Gastroenterology, Petersgraben 4, CH-4031 Basel, Switzerland beglinger@ tmr.ch Ben Shaphrut Oded Hebrew University Jerusalem and Interuniversity Institute, Eilat, Israel, P.O.B 469, Eilat 88103, Israel [email protected] Black Norman D. University of Ulster, Jordanstown, Northern Ireland, BT37 0QB, UK [email protected] Bonis Julio IMIM. IMAS. Fundació IMIM, c/ Doctor Aiguader, 80, 8003 Barcelona [email protected] Bults Richard University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands [email protected] Christodoulou Eleni Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected] Clamp Susan Clinical Information Science Unit, University of Leeds, 26 Clarendon Road, Leeds LS2 9NZ, United Kingdom [email protected]

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Cornelis Jan Department of Electronics and Information Processing (ETRO), Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium [email protected] www.etro.vub.ac.be/Members/cornelis.jan/personal_private.htm Courrèges Fabien Université d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France [email protected] de Toledo Paula Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid, E.T.S. Ingenieros de Telecomunicación. Ciudad Universitaria. 28040 Madrid [email protected] del Pozo Francisco Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid, GBT ETSI Telecomunicación Ciudad Universitaria sn. 28040 MADRID, SPAIN [email protected] Dhaen Christoffel Language and Computing, Maaltecenter Blok A, Derbystraat 79, 9051 Sint-Denijs-Westrem, Belgium [email protected] Dikaiakos Marios Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected] Doarn Charles R, Executive Director Center for Surgical Innovation, Research Associate Professor, Department of Surgery, University of Cincinnati, SRU 1466, Cincinnati, OH 45267-0558 [email protected] Dokovsky Nikolai Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede The Netherlands [email protected] Dos Santos Mariana Casella Language and Computing, Maaltecenter Blok A, Derbystraat 79, 9051 Sint-Denijs-Westrem, Belgium [email protected] www.landc.be

CONTRIBUTORS

Drion Benoit Airial, 3 rue Bellini, 92800 Puteaux, France Dunbar Angela IMIM. IMAS. Fundació IMIM, c/ Doctor Aiguader, 80, 8003 Barcelona [email protected] Dwivedi Ashish N. Knowledge Management for Healthcare (KMH) subgroup, Biomedical Computing Research Group (BIOCORE), Coventry University, Priory Street, Coventry, CV1 5FB United Kingdom [email protected] www.mis.coventry.ac.uk/biocore/kmh/ Dyson Anthony Eddabbeh Najia BFC, 196 rue Houdan, F-92330 Sceaux (France) [email protected] Eich Hans-Peter Heinrich-Heine-University, Dusseldorf, Moorenstr. 5, D - 40225 Düsseldorf, Germany [email protected] Falas Tasos Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected] Finlay Dewar D. University of Ulster, Jordanstown, Northern Ireland, BT37 0QB. [email protected] Fischer Hans Rudolf, PhD University Hospital Basel, Department of Gastroenterology, Petersgraben 4, CH-4031 Basel, Switzerland [email protected] www.uhb-moebius.ch García José Communication Technologies Group (GTC), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, SPAIN [email protected] García-Olaya Angel Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid, GBT, ETSI Telecomunicación, Ciudad Universitaria sn., 28040 MADRID, SPAIN [email protected] Georgiadis Dimosthenis Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected]

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Giovas Periklis, MD st Cardiology Laboratory, 1 Department of Propaedeutic Medicine, Laikon Hospital, Athens University, Athens, Greece [email protected] Goens Beth M. Pediatric Cardiology, University of New Mexico, MSC10 5590, 1Albuquerque, NM 87131-0001 [email protected] Gómez Enrique J. Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid, GBT, ETSI Telecomunicación, Ciudad Universitaria sn., 28040 MADRID, SPAIN [email protected] Gutzwiller Jean-Pierre University Hospital, CH-4031 Basel, Switzerland. Hadjileontiadis Leontios J. Dept. of Electrical and Computer Engineering, School of Engineering, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece [email protected] Hernando M. Elena Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid, GBT, ETSI Telecomunicación, Ciudad Universitaria sn., 28040 MADRID, SPAIN [email protected] Herzog Rainer Ericsson GmbH, Ericsson GmbH, Maximilianstrasse 36/RG, D-80539 Munich, Germany [email protected] Incardona Francesca Informa s.r.l. - Arakne s.r.l., V. dei Magazzini Generali, 31, 00154 Roma, Italy [email protected] http://www.informacro.info Istepanian Robert S.H. Mobile Information and Network Technologies Research Centre (MINT), School of Computing and Information Systems, Kingston University, Kingston upon Thames, London, UK. [email protected] http://technology.kingston.ac.uk/MINT Jimenez Silvia Grupo de Bioingeniería y TelemedicinaUniversidad Politécnica de Madrid, E.T.S. Ingenieros de Telecomunicación., Ciudad Universitaria. 28040 Madrid [email protected] z

CONTRIBUTORS

Jones Val Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands [email protected] aps.cs.utwente.nl/ Jovanov Emil Electrical and Computer Engineering Dept., The University of Alabama in Huntsville, Huntsville, AL, 35899, USA [email protected] www.ece.uah.edu/~jovanov Kirke Chris Clinical Information Science Unit, University of Leeds, 26 Clarendon Road, Leeds, LS2 9NZ, United Kingdom Kirkilis Harris, Sales Manager Relational Technology, 13 Posidonos Ave., "AEGEAN" Building, 174 55 Alimos, Athens, Greece [email protected] www.relational.gr Konstantas Dimitri University of Geneva, Centre Universitaire D’Informatique, Rue General-Dufour 24, CH-1211 Geneve 4, Switzerland [email protected] Kontaxakis Georgios Universidad Politécnica de Madrid ETSI Telecomunicación, Dpto. Ing. Electrónica, Ciudad Universitaria s/n, 28040 Madrid, Spain [email protected] Koprinkov George Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands [email protected] Koutsouris Dimitris Head, Biomedical Engineering Laboratory, Department of Electrical and Computer Engineering, National Technical University of Athens, 9 Iroon Polytecniou str., Zografou Campus, 15773, Athens, Greece [email protected] www.biomed.ntua.gr Kovaþeviü Branko University of Belgrade, Faculty of Electrical Engineering, Bulevar Kralja Aleksandra 73, 11000, Belgrade, Serbia and Montenegro Kyriacou Efthyvoulos Department of Computer Science, University of Cyprus, 75 Kallipoleos str, P.O.Box 20537, 1678, Nicosia, Cyprus [email protected] www.medinfo.cs.ucy.ac.cy

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Lauzan José Enrique SCHULERBERGSEMA, Albarracín, 25 28037 Madrid, Spain Lavigne Kevin Vermont Arctic Education Program [email protected] Litos George Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi, Thessaloniki GR-57001, Greece Lugg Desmond J Director, Division of Extreme Environments, Office of the Chief Health and medical Office, NASA HQ. Washington, DC, 20546, USA [email protected] Markoviü Milan, Dr Project Manager, IT Department, Delta banka a.d., 7b Milentija Popoviüa, 11070 Belgrade, Serbia and Montenegro [email protected] www.deltabanka.co.yu Merrell Ronald C., MD Medical Informatics and Technology Applications Consortium, Virginia Commonwealth University, 1101 E Marshall Street, PO Box 980480, Richmond, VA 23298-0480 [email protected] Montyne Frank Language and Computing, Maaltecenter Blok A, Derbystraat 79, 9051 Sint-Denijs-Westrem, Belgium [email protected] Munteanu Adrian Department of Electronics and Information Processing (ETRO), Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium [email protected] www.etro.vub.ac.be/Members/MUNTEANU.Adrian/personal_private.htm Naguib Raouf N.G. Biomedical Computing Research Group (BIOCORE), Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom [email protected] www.mis.coventry.ac.uk/biocore Nassar Nahy S Biotech Associates Limited, PO Box 3156, COVENTRY, West Midlands CV8 3YU, England n.nassar@ biotechassociates.co.uk www.biotechassociates.co.uk

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Nicogossian Arnauld E., MD School of Public Policy, George Mason University, 440 University Drive, MS 3C6 Finley Building [email protected] Nikolakis George Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi-Thessaloniki GR-57001, Greece Novales Cyril Université d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France [email protected] Ohmann Christian Heinrich-Heine-University, Dusseldorf Moorenstr. 5, D - 40225 Düsseldorf, Germany [email protected] Olmos Salvador Communication Technologies Group (GTC), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, SPAIN [email protected] Orphanoudakis Stelios C. FORTH and University of Crete Director, Foundation for Research and Technology Hellas (FORTH), PO Box 1385, GR 711 10, Heraklion, Crete, Greece [email protected] www.ics.forth.gr/cmi-hta/orphanoudakis.html Owens Frank J. University of Ulster, Jordanstown, Northern Ireland, BT37 0QB. [email protected] Papachristou Petros ATKO SOFT, 3 Romanou Melodou, Str. Marousi 151 25, Athens, Greece [email protected] Papadopoulos Constantinos Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected] Papadopoulos George A. Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected] Papadoyannis Demetrios st Cardiology Laboratory, 1 Department of Propaedeutic Medicine, Laikon Hospital, Athens University, Athens, Greece

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Papazachou Ourania, MD st Cardiology Laboratory, 1 Department of Propaedeutic Medicine, Laikon Hospital, Athens University, Athens, Greece [email protected] Peuscher Jan Twente Medical Systems International, TMS International BV, P.O. Box 1123, 7500 BC Enschede, The Netherlands [email protected] Pitsillides Andreas Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected] www.ditis.ucy.ac.cy Pitsillides Barbara PASYKAF Larnaca, Kariders Court, Larnaca [email protected] Poisson Gérard Université d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France [email protected] Priddy Brent Electrical and Computer Engineering Dept., The University of Alabama in Huntsville, Huntsville, AL, 35899, USA [email protected] Raskovic Dejan Dept. of Electrical and Computer Engineering, University of Alaska Fairbanks, Fairbanks, AK, 99775-5915, USA [email protected] www.uaf.edu/ece/raskovic.htm Reichlin Serge Division of Endocrinology, Diabetes, Metabolism and Molecular Medicine, Tufts University School of Medicine, New England Medical Center, Boston, USA. [email protected] Reid Innes Clinical Information Science Unit, University of Leeds, 26 Clarendon Road, Leeds, LS2 9NZ, United Kingdom Ricci Roberto Research Project Coordinator, Informa srl, via dei Magazzini Generali, 31 – 00154, Rome, Italy [email protected] www.informacro

CONTRIBUTORS

Rienks Rienk Heart Lung Centre and Central Military Hospital, Utrecht, The Netherlands, Heidelberlaan 100, 3584 CX Utrecht [email protected] Rodriguez Sergio IMIM. IMAS, Fundació IMIM, c/ Doctor Aiguader, 80, 8003, Barcelona [email protected] Rodriguez Paul V. Dept of Electrical and Computer Engineering, ECE Building, The University of New Mexico, Albuquerque, NM 87131-1356 [email protected] Sakas Georgios Dept. Cognitive Computing and Medical Imaging, Fraunhofer Institute for Computer Graphics (IGD), Fraunhoferstr. 5, Darmstadt, Germany D-64283 [email protected] Samaras George Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus [email protected] Sancho Juan J. HOSPITAL DEL MAR. IMIM. IMAS., Servei de Cirurgia General i Digestiva, Passeig Maritim, 25-29, 08003 Barcelona, Spain [email protected] Saviü Zoran SmartIS Group, NetSeT, Karaÿorÿeva 65, 11000 Belgrade. Schelkens Peter Department of Electronics and Information Processing (ETRO), Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium [email protected] www.etro.vub.ac.be/Members/SCHELKENS.Peter/personal_private.htm Shashar Nadav Hebrew University Jerusalem and Interuniversity Institute, Eilat, Israel, P.O.B 469, Eilat 88103, Israel [email protected] Shimizu Koichi Laboratory of Biomedical Engineering, Department of Bioengineering and Bioinformatics, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan [email protected]

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Skodras Athanassios N. Department of Computer Science, School of Science and Technology, Hellenic Open University, GR-262 22, Patras, Greece [email protected] http://dsmc.eap.gr Smith-Guerin Natalie Université d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France [email protected] Spanakis Manolis FORTH and University of Crete Institute of Computer Science (ICS), Foundation for Research and Technology – Hellas (FORTH), PO Box 1385, GR 711 10, Heraklion, Crete, Greece [email protected] www.ics.forth.gr/cmi-hta/spanakis.html Strintzis Michael ITI CERTH Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi-Thessaloniki GR-57001, Greece [email protected] Thierry Jean Pierre SYMBION, 109 Rue des Cotes, 78600 Maisons-Laffitte, France [email protected] Thomakos Demetrios , General Manager Proton Labs Ltd, Athens, Greece [email protected] Thomos Nikolaos ITI CERTH Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi-Thessaloniki GR-57001, Greece [email protected] Torralba Verónica Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid, GBT, ETSI Telecomunicación, Ciudad Universitaria sn., 28040 MADRID, SPAIN [email protected] Traganitis Apostolos FORTH and University of Crete Institute of Computer Science (ICS), Foundation for Research and Technology – Hellas (FORTH), PO Box 1385, GR 711 10, Heraklion, Crete, Greece [email protected] www.ics.forth.gr/cmi-hta/tragani.html Triantafyllidis George ITI CERTH Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi-Thessaloniki GR-57001, Greece [email protected]

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Tristram Clive Ets TRISTRAM Clive (Futur Dessin), Les Rives, 86460 Availles Limouzine, FRANCE Clive@free [[email protected]] www.med-mobile.org/MEMO3/index.php Tsiknakis Manolis FORTH Institute of Computer Science (ICS), Foundation for Research and Technology – Hellas (FORTH), PO Box 1385, GR 711 10, Heraklion, Crete, Greece [email protected] www.ics.forth.gr/cmi-hta/tsiknakis.html Tzovaras Dimitris Informatics and Telematics Institute, Center for Research and Technology Hellas, 57001 Thessaloniki, Greece [email protected] van Halteren Aart Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede The Netherlands [email protected] Vierhout Pieter Faculty of Business, Public Administration and Technology, University of Twente, P.O.Box 1123, 7500 BC Enschede, the Netherlands [email protected] Virtuoso Salvatore TXT e-Solutions, Via Frigia 27, 20126 Milano, Italy [email protected] Walter Stefan MedCom Gesellschaft für medizinische Bildverarbeitung mbH, Rundeturmstr. 12, 64283 Darmstadt, Germany [email protected] Wang Haiying University of Ulster, Jordanstown, Northern Ireland, BT37 0QB. [email protected] Widya Ing Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands [email protected]

Preface

M-health can be defined as the ‘emerging mobile communications and network technologies for healthcare systems’. This definition can also infer that m-health is the result of evolution of the e-health systems and the ‘addition’ of emerging information and computing technologies in biomedicine to the modern advances in wireless and nomadic communication systems. The recent years have witnessed a major revolution in the technological advances of the next generation of wireless and network technologies paving the way towards the 4G wireless systems. It is clear from these advances and in particular from the anticipated convergence between the future data rates of nomadic and wireless systems within the next decade or so, that such developments will have a challenging and profound impact on future e-health systems. The recent research relevant to m-health such as advances in nano-technologies, compact biosensors, wearable, pervasive and ubiquitous computing systems will all lead the successful launch of next generation m-health systems within the next decade. They will encompass all these technologies for future healthcare delivery services with the vision of ‘empowered healthcare on the move’. This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. The book also presents a new and forward looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare situation. It also provides a discovery path on the synergies between the 2.5G and 3G systems and other relevant computing and information technologies and how they prescribe the way for the next generation of m-health services. The book contains 47 chapters, arranged in five thematic sections: Introduction to Mobile M-Health Systems, Smart Mobile Applications for Health Professionals, Signal,

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Image, and Video Compression for M-Health Applications, Emergency Health Care Systems and Services, Echography Systems and Services, and Remote and Home Monitoring. Each section begins with a section overview, and ends with a chapter on future challenges and recommendations. This book is intended for all those working in the field of information technologies in biomedicine, as well as for people working in future applications of wireless communications and wireless telemedical systems. It provides different levels of material to researchers, computing engineers, and medical practitioners interested in emerging ehealth systems. The book serves as the basis for understanding the future of m-health technologies and services, exemplifying the impact of mobility on existing m-health and commercial telemedical systems. We wish to thank all the section editors for their valuable time and efforts in putting together the section chapters, the authors for their hard work and for sharing their experiences so readily, and the numerous reviewers for their valuable comments in enhancing the content of this book. Furthermore we would like to express our sincere thanks to Elena Polycarpou for her excellent secretarial work in communicating with the section editors, authors, and reviewers and for putting together this book. We thank also Dr Henry Wang from the MINT center, and the EU for their funding of most of the work in the MINT centre. Last but not least, we would like to thank, Aaron Johnson, Krista Zimmer and the rest of the staff at Springer for their understanding, patience and support in materializing this project. We hope that this book will be a useful reference for all the readers in this important and growing field of research and to contribute to the roadmap of future m-health systems and improved and effective healthcare delivery systems. Robert S. H. Istepanian Swamy Laxminarayan Constantinos S. Pattichis

Contents

Dedication ..................................................................................................................vii Contributors ............................................................................................................... ix Preface.................................................................................................................... xxiii

I. INTRODUCTION TO MOBILE M-HEALTH SYSTEMS Constantinos S. Pattichis, Robert S.H. Istepanian, and Swamy Laxminarayan, Section Editors 1. UBIQUITOUS M-HEALTH SYSTEMS AND THE CONVERGENCE TOWARDS 4G MOBILE TECHNOLOGIES ....................................................................................... 3 Robert S.H. Istepanian, Constantinos S. Pattichis, and Swamy Laxminarayan 2. THE EFFICACY OF THE M-HEALTH PARADIGM: INCORPORATING TECHNOLOGICAL, ORGANISATIONAL AND MANAGERIAL PERSPECTIVES ....................................................................................... 15 Ashish N. Dwivedi, Rajeev K. Bali, Raouf N.G. Naguib, and Nahy S. Nasaar 3. WIRELESS INTELLIGENT SENSORS ........................................................ 33 Emil Jovanov and Dejan Raskovic 4. WIRELESS TECHNOLOGIES FOR HEALTHCARE APPLICATIONS ....................................................................................... 51 Brent Priddy and Emil Jovanov

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5. WIRELESS COMMUNICATION TECHNOLOGIES FOR MOBILE HEALTHCARE APPLICATIONS: EXPERIENCES AND EVALUATION OF SECURITY RELATED ISSUES .................................................................................... 65 Manolis Tsiknakis, Apostolos Traganitis, Manolis Spanakis, and Stelios C. Orphanoudakis 6. SECURE MOBILE HEALTH SYSTEMS: PRINCIPLES AND SOLUTIONS .............................................................................................. 81 Milan Markoviü, Zoran Saviü, and Branko Kovaþeviü 7. COMPUTATIONAL AND WIRELESS MODELING FOR COLLABORATIVE VIRTUAL MEDICAL TEAMS.......................... 107 George Samaras, Demosthenis Georgiades, and Andreas Pitsillides

II. SMART MOBILE APPLICATIONS FOR HEALTH PROFESSIONALS Andreas Lymberis, Section Editor 8. SECTION OVERVIEW ................................................................................... 133 Andreas Lymberis 9. THE MEMO PROJECT - AN ACCOMPANYING MEASURE FOR MEDICAL MOBILE DEVICES.................................................... 137 Clive Tristram 10. MEDICAL NATURAL LANGUAGE PROCESSING ENHANCING DRUG ORDERING AND CODING............................. 147 Mariana Casella Dos Santos, Frank Montyne, and Christoffel Dhaen 11. MOBI-DEV: MOBILE DEVICES FOR HEALTHCARE APPLICATIONS ...................................................................................... 163 Roberto Altieri, Francesca Incardona, Harris Kirkilis, and Roberto Ricci 12. WARDINHAND............................................................................................... 177 Salvatore Virtuoso 13. DOCMEM-MOBILE ACCESS TO ELECTRONIC HEATH RECORDS ................................................................................................ 187 Najia Eddabbeh and Benoit Drion 14. SMARTIE: SMART MEDICAL APPLICATIONS REPOSITORY OF TOOLS FOR INFORMED EXPERT DECISION ................................................................................................. 195

CONTENTS

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Juan J. Sancho, Susan Clamp, Christian Ohmann, José.E.Lauzàn, Petros Papachristou, Jean P.Thierry, Angela Dunbar, Julio Bonis, Sergio Rodríguez, Chris Kirke, Innes Reid, Hans-Peter Eich, and Clive Tristram 15. TELEMEDICINE AS A NEW POSSIBILITY TO IMPROVE HEATLH CARE DELIVERY ................................................................. 203 Hans Rudolf Fischer, Serge Reichlin, Jean-Pierre Gutzwiller, Anthony Dyson, and Christoph Beglinger 16. MOBIHEALTH: MOBILE HEALTH SERVICES BASED ON BODY AREA NETWORKS .................................................................... 219 Val Jones, Aart van Halteren, Ing Widya, Nikolai Dokovsky, George Koprinkov, Richard Bults, Dimitri Konstantas, and Rainer Herzog 17. MOBIHEALTH: MOBILE SERVICES FOR HEALTH PROFESSIONALS ................................................................................... 237 Val Jones, Aart van Halteren, Nikolai Dokovsky, George Koprinkov, Jan Peuscher, Richard Bults, Dimitri Konstantas, Ing Widya, and Rainer Herzog 18. DITIS - A COLLABORATIVE VIRTUAL MEDICAL TEAM FOR HOME HEALTHCARE OF CANCER PATIENTS .................. 247 Andreas Pitsillides, Barbara Pitsillides, George Samaras, Marios Dikaiakos, Eleni Christodoulou, Panayiotis Andreou, and Dimosthenis Georgiadis 19. FUTURE CHALLENGES AND RECOMMENDATIONS ........................ 267 Val Jones, Francesca Incardona, Clive Tristram, Salvadore Virtuoso, and Andreas Lymberis

III. SIGNAL, IMAGE, AND VIDEO COMPRESSION FOR M-HEALTH APPLICATIONS Marios S. Pattichis, Section Editor 20. SECTION OVERVIEW ................................................................................. 273 Marios S. Pattichis 21. BIOSIGNALS AND COMPRESSION STANDARDS ................................ 277 Leontios J. Hadjileontiadis

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22. RESILIENT ECG WAVELET CODING FOR WIRELESS REAL-TIME TELECARDIOLOGY APPLICATIONS ...................... 293 Álvaro Alesanco , José García, Salvador Olmos, and Robert S. H. Istepanian 23. THE JPEG2000 IMAGE COMPRESSION STANDARD IN MOBILE APPLICATIONS ..................................................................... 313 Athanasios N. Skodras 24. COMPRESSION OF VOLUMETRIC DATA IN MOBILE HEALTH SYSTEMS................................................................................ 329 Adrian Munteanu, Peter Schelkens, and Jan Cornelis 25. AN OVERVIEW OF DIGITAL VIDEO COMPRESSION FOR MOBILE HEALTH SYSTEMS .............................................................. 345 Marios S. Pattichis, Songhe Cai, Constantinos S. Pattichis, and Rony Abdallah 26. FUTURE CHALLENGES AND RECOMMENDATIONS ........................ 365 Marios S. Pattichis IV. EMERGENCY HEALTH CARE SYSTEMS AND SERVICES Sotiris Pavlopoulos, Section Editor 27. SECTION OVERVIEW ................................................................................. 371 Sotiris Pavlopoulos 28. ECG TELECARE: PAST PRESENT AND FUTURE ............................... 375 Chris D. Nugent, Haiying Wang, Norman D. Black, Dewar D. Finlay, and Frank J. Owens 29. MEDICAL ASPECTS OF PREHOSPITAL CARDIAC TELECARE............................................................................................... 389 Periklis Giovas, Demetrios Thomakos, Ourania Papazachou, and Demetrios Papadoyannis 30. AN EMERGENCY TELEMEDICINE SYSTEM BASED ON WIRELESS COMMUNICATION TECHNOLOGY: A CASE STUDY .......................................................................................... 401 Efthyvoulos Kyriacou, Sotiris Pavlopoulos, and Dimitris Koutsouris 31. APPLICATION OF MOBILE COMMUNICATION TECHNIQUES FOR EMERGENCY TELEMEDICINE ................... 417 Koichi Shimizu 32. FUTURE CHALLENGES AND RECOMMENDATIONS ....................... 435 Efthyvoulos Kyriacou and Sotiris A. Pavlopoulos

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V. ECHOGRAPHY SYSTEMS AND SERVICES Pierre Vieyres, Section Editor 33. SECTION OVERVIEW ................................................................................. 441 Pierre Vieyres 34. MOBILE TELE-ECHOGRAPHY SYSTEMS – TELEINVIVO: A CASE STUDY ....................................................................................... 445 Georgios Kontaxakis, Georgios Sakas, and Stefan Walter 35. A TELE-OPERATED ROBOTIC SYSTEM FOR MOBILE TELE-ECHOGRAPHY: THE OTELO PROJECT.............................. 461 Pierre Vieyres, Gérard Poisson, Fabien Courrèges, Natalie SmithGuerin, Cyril Novales, and Philippe Arbeille 36. USER INTERFACE ENVIRONMENT AND IMAGE COMMUNICATION IN MOBILE TELE-ECHOGRAPHY .............. 475 George A Triantafyllidis, Nicolaos Thomos, George Nikolakis, Dimitrios Tzovaras, George Litos, and Michael G. Strintzis 37. OBJECT-BASED ULTRASOUND VIDEO PROCESSING FOR WIRELESS TRANSMISSION IN CARDIOLOGY.................... 491 Paul Rodriguez V, Marios S. Pattichis, Constantinos S. Pattichis, Rony Abdallah, and Mary Beth Goens 38. FUTURE CHALLENGES AND RECOMMENDATIONS ....................... 509 Pierre Vieyres, Gérard Poisson, George Triantafyllidis, Marios S. Pattichis, and Georgios Kontaxakis

VI. REMOTE AND HOME MONITORING Chris D. Nugent, Section Editor

39. SECTION OVERVIEW.................................................................................. 515 Chris D. Nugent and Dewar D. Finlay 40. CIVILIAN TELEMEDICINE IN REMOTE AND EXTREME ENVIRONMENTS.................................................................................... 517 Arnauld E. Nicogossian, Desmond J. Lugg, and Charles R. Doarn 41. TELEMATIC REQUIREMENTS FOR EMERGENCY AND DISASTER RESPONSE DERIVED FROM ENTERPRISE MODELS ................................................................................................... 531 Ing Widya, Pieter Vierhout, Val M. Jones, Richard Bults, Aart van Halteren, Jan Peuscher, and Dimitri Konstantas

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42. TELEMATIC SUPPORT FOR DISASTER SITUATIONS ....................... 549 Charles R. Doarn, Arnauld E. Nicogossian, and Ronald C. Merrell 43. REMOTE MONITORING FOR HEALTHCARE AND FOR SAFETY IN EXTREME ENVIRONMENTS ........................................ 561 Val Jones, Nadav Shashar, Oded Ben Shaphrut, Kevin Lavigne, Rienk Rienks, Richard Bults, Dimitri Konstantas, Pieter Vierhout, Jan Peuscher, Aart van Halteren, Rainer Herzog, and Ing Widya 44. CHRONIC PATIENT’S MANAGEMENT: THE COPD EXAMPLE................................................................................................. 575 Francisco del Pozo, Paula de Toledo, Silvia Jiménez, M. Elena Hernando, and Enrique J. Gómez

45. A MOBILE TELEMEDICINE WORKSPACE FOR DIABETES MANAGEMENT ................................................................ 587 M. Elena Hernando, Enrique J. Gómez, Angel García-Olaya, Verónica Torralba, and Francisco del Pozo 46. MOBILE MANAGEMENT AND PRESCRIPTION OF MEDICATION.......................................................................................... 601 Chris D. Nugent, Dewar D. Finlay, Norman D. Black, Tasos Falas, Constantinos Papadopoulos, and George A. Papadopoulos 47. FUTURE CHALLENGES AND RECOMMENDATIONS ........................ 617 Dewar D. Finlay and Chris D. Nugent AUTHOR INDEX ................................................................................................. 619 SUBJECT INDEX.................................................................................................. 621

I. INTRODUCTION TO MOBILE M-HEALTH SYSTEMS Constantinos S. Pattichis Robert S.H. Istepanian Swamy Laxminarayan Section Editors

THE EFFICACY OF THE M-HEALTH PARADIGM: INCORPORATING TECHNOLOGICAL, ORGANISATIONAL AND MANAGERIAL PERSPECTIVES Ashish N. Dwivedi, Rajeev K. Bali, Raouf N.G. Naguib, and Nahy S. Nassar*

1. THE ROLE OF TECHNOLOGY IN TELEHEALTH Technology strongly influences the way we work and is creating opportunities and new demands for a range of different approaches to telehealth (Feldman and Gainey, 1997). Telecommunications have evolved and have been accompanied by an evolution in attitudes to information and communications technologies (Stanworth, 1998). Previously, only companies owned computers and it was the IT specialists, rather than ordinary users, who determined their use and application. Today's response to technological change is profoundly different. On average, around 1 in 4 European households already owns a personal computer; in some countries this rises to more than 50% and in some local communities it is even higher. A recent study confirms this trend and predicts that, in two years time, it is expected that the use of information communication technology will increase markedly (Marien, 1989). The ease with which we use them and the take-up of remote working in the European Union continues at a rapid pace. Recent estimates (European Telework Organization, 1999) show that approximately 6.7 million Europeans (4.5% of the workforce) were practising remote working in one form or another at the beginning of 1999. Social, cultural, economic and regulatory factors determine how we organise our business, our work and, hence, our lives (Stanworth, 1998). Technology-led change opens up opportunities for new working methods in three main ways: allowing existing activities to be carried out more rapidly, with more consistency and at a lower cost than could previously be achieved. *

Rajeev K. Bali, BIOCORE, School of Mathematical and Information Sciences, Coventry University, UK. 15

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Today, the explosive growth of the Internet has promoted the trend for investment in information and communication devices and the healthcare industry is an active participant in this trend (Kazman and Westerheim, 1999). It would be fair to state that advances in communications technology are dramatically changing the delivery of healthcare services (Schooley, 1998).

2. THE HEALTHCARE SECTOR Modern healthcare is the largest sector of the US economy (Kazman and Westerheim, 1999). However, IT expenditure in healthcare organisations, as a portion of revenues, is in the region of 2%, far below the 7-10% mark in other information-intensive industries (Moran, 1998). HIs are demanding healthcare applications that offer a number of utilities whilst they themselves allocate only a very small component of the total funds at their disposal (see table 1) (Morrissey, 2000, 2001 and 2002). Analysts are confident that the above situation is about to undergo a sea change. Investor confidence in technology growth in healthcare is so strong that, between 1992 to 1996, there was a quintuple leap in the number of publicly traded health information technology companies. In 1998, the top 35 companies had market capitalization of over $25 billion (Moran, 1998). In 1999, about 43% of US-based Internet users used the Web to locate healthcare related information (Kazman and Westerheim, 1999). This clearly indicates that e-healthcare and its applications (such as m-health) are here to stay. 2.1 Budgeted Expenditure on IT in Healthcare Institutions and Healthcare Trends An analysis (see Table 1) of the Budgeted IT expenditure (as a ratio of the information systems budget to the total operating expenses) shows that some of the major technologies that have showed a lot of promise are Workflow Management Systems, Mobile Computing technologies such as Personal Digital Assistant (PDA), Wireless Local Area Network (WLAN) and Object Oriented Technology (Dwivedi et al, 2001a, 2001b; 2002). 2.2 The Role of Telecommunications Technology in Health The changes in information technology, particularly in the telecommunications technology have brought about fundamental changes throughout the healthcare process (Applebaum and Wohl, 2000). The change process undergone is confirmed by research which states that in the period 1997-2000, 85% of healthcare organizations have undergone some sort of transformation (Sherer, 1995). One of the most important technological changes in electronics has been the ability to convert signals from an analogue to a digital medium (images or signals are converted into digital code by using an analogue-to-digital conversion device) – a process referred to as Digitization (Wallace, 1997). Digitization in healthcare has meant that it is now possible to take healthcare related information in different formats (audio, video, sound) and deliver the same at high speeds in the same basic format.

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Table 1. Modern Healthcare's annual survey of information system trends in the healthcare industry Adapted from (Morrissey, 2000, 2001 and 2002) Year No of healthcare organizations surveyed

2000

2001

2002

224 healthcare organizations



Budgeted IT expenditure (Ratio of the information systems budget to the total operating expenses)

Average IT expenditure at 2.6% Over 50% put it between 2% and 4%

Average IT expenditure at 2.53% 25% spent about 1.5% on IT whilst 60% are spent around 2.5%

Average IT expenditure at 2.56% More than 50% spent between 2% and 3.5%

Information systems (IS) priorities

Internet and intranets priority Clinical information systems (CIS) tops the IS priority General-accounting software was the predominant application that was being used on the Intranet

65% considered CIS as the most important IS priority 73% were not willing to outsourcing clinical information systems and services

71% considered CIS as the most important IS priority Need felt to improve IS for better clinical communication for physicians 80% - No interest in outsourcing clinical information systems and services

60% - felt that could IT could facilitate data exchange among caregivers i.e. physician ordering of tests and access to test results

Low interest in maintaining a patient's personal health record accessible via the WWW and matching patients with clinical research. However there is renewed importance of addressing changes in this area due to regulatory obligations

Despite acknowledging that medication interaction and dosing alerts are possible within most IS implementation has not commenced The few organizations who had made big investments in different HIS (EPR and pharmacy) are reporting substantial returns

Limited use as shown by the following 15% - to share clinical guidelines13% - to access multiple databases simultaneously 33% - as a bridge to other information systems 40% - for network wide communication of any kind

Some early success from linking “billing and insurance-query operations to payers via the Web” “Significant interest …in using the Web to improve data exchange with physicians and their office staff” About 50% indicated that they had no plans to try anything Web-related in the care-management area

33% - Using existing clinical and financial information sources to construct data repositories so as to that help spot trends and improve decision-making Further 22% are working to implement such practices whilst about 13% plan to start implementation of similar activities within a year

Clinical Use of Web technology (Intranets)

General Uses of Web and Intranet technology

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Simultaneously there has been a change in technology (from simple copper wires to optical fibres) via which information is transmitted. This in turn has exponentially increased the bandwidth (Wallace, 1997). The phenomenon of Multimedia has made possible the exchange of information – that can be combined from different formats (sound, video, animation, text and graphics) and presented in an interactive manner. This is fast making multimedia technology the “technology of choice” for the delivery of information (Wallace, 1997).

3. M-HEALTH : THE TECHNOLOGY FOR HEALTHCARE DELIVERY IN THE FUTURE In the healthcare sector, different information technology applications such as clinical information systems, electronic patient records and telemedicine have been used successfully thereby demonstrating their potential to greatly improve the standard of medical care and healthcare administration (Rao, 2001). Advances in information technology applications have resulted in an “accelerated pace of innovation” (Johns, 1997). Such innovation has resulted in the creation of new opportunities and healthcare concepts such as healthcare information – a term indicating the combined synergistic application of “a science of information, technology, and knowledge…to ‘health care” (Johns, 1997). All this has led industry experts to predict that, in the near future, healthcare technologies (and, in particular, technologies such as m-health) will be computerized to a considerable extent (Crompton, 2001).

4. TELEMEDICINE AND M-HEALTH : ORIGINS AND SCOPE Telemedicine has been derived from two Greek and Latin words. “Tele” in greek translates as distance while “Mederi” in latin means to heal (Rao, 2001). In a modern context, telemedicine can be stated to be a method of healthcare delivery where advanced video communications technologies are used to bridge the geographical gap that exists between the licensed caregivers and/or the care receiver, so as to provide medical diagnosis and treatment (European Health Telematics Observatory, 1999; Charles, 2000; Nairn, 2001; Garets and Hanna, 1998). Telehealth has a much broader scope in comparison to telemedicine, as telehealth relates to the bigger issues in healthcare administration and regulation, whilst telemedicine is concerned with the clinical aspects of healthcare delivery (European Health Telematics Observatory, 1999 and Johnson, 2000). Some authors (Nairn, 2001; Noring, 2000) have further delineated between the two by positing that, in telemedicine, healthcare providers fall into the category of physicians whilst, in telehealth, the category of healthcare providers can be extended to include non-physicians, as telehealth encompasses health promotion and disease prevention.


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The earliest documented use of telemedicine can be traced to the 1920s when radio was employed to link up physicians located on land with ships at sea who were facing medical emergencies. The next leap in telemedicine took place in the 1960s when the US-based National Aeronautics and Space Administration (NASA) pioneered the use telemedicine in space (astronauts had their pulse rates and blood pressure monitored remotely). By the 1970s, telemedicine additionally took advantage of new emerging satellite technologies (Rao, 2001). UK, Canadian and Malaysian governments have seized the opportunity to make substantial efforts to link electronically different healthcare centres. In the UK, the Government has committed about USD $1.4 billion to bring about a transformation in all facets of healthcare. A significant component of this funding is being used in developing a nationwide electronic platform (Crompton, 2001). This high volume of investment worldwide in healthcare technologies has brought about the emergence of several mhealth schemes all over the world (Crompton, 2001; Collins, 2001;The Economist, 1997). 4.1. Objective of M-Health Applications The aim behind any m-health application is to transfer the expertise of the caregiver from one location to another (Johns, 1997). One of the most widely used applications of m-health is teleradiology (use of “image acquisition, storage, display, processing and transport”) from one geographical location to another location for diagnosis (Johns, 1997). With advances in technologies, such as telecommunications, multimedia and IT healthcare applications, m-health has the potential to transform the delivery of healthcare permanently. 4.2. Current M-health Technologies The cost of setting up an average m-health station works about to $50,000 and incorporates “a computer workstation with 21-inch monitor, electronic stethoscope, ear, nose and throat scope, and an exam camera through which the patients and doctors can see each other”(Tieman, 2000). There are two main models in m-health: (1) interactive video and (2) store-andforward (Kazman and Westerheim, 1999; Nairn, 2001). The main difference between them is that interactive video allows real-time patient care, whilst the store-and-forward technology is asynchronous (there is a gap between transmission of data and patient care diagnosis). Today, store-and-forward technology applications in m-health include telepathology and teleradiology (Nairn, 2001). The use of email to transmit medical prescriptions by physicians to their patients is fast becoming another major application of store-and-forward technology in m-health (Convey, 2000). Since store-and-forward technology is asynchronous (communication over telephone lines linking two computers or other peripheral devices using start and stop bits), applications based on this type of technology are being more widely used in comparison to interactive video applications, as they can easily be transmitted over a network. Modern store-and-forward technology applications, in conjunction with advances in telecommunications technologies (such as digital imaging, WAP and fibre optics) are resulting in the creation of a much larger m-health market (Johnson, 2000; Beavan and Frederick, 2000).

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Technologies that offer healthcare videoconferencing as a substrate are still evolving. It is possible to send large amounts of clinical multimedia data (compressed audio and video images) on high speed lines such as broadband technologies over the internet (Nairn, 2001). Given the current pace of advances in internet and videoconferencing technologies, interactive m-health applications will feature heavily in futuristic healthcare systems. The advantages of m-health include enabling direct links between the caregivers and/or care receivers thereby enabling effective medical care especially to rural populations, saving time and money for caregivers and faster diagnosis and treatment for care receivers (Kazman and Westerheim, 1999; Schooley, 1998; Charles, 2000; Huston and Huston, 2000; Fishman, 1997). Whilst it is clear that m-health is more viable compared to traditional telephonic consultations (Sandberg, 2001), in a normal patient care scenario it enables patients to have faster access to alternative specialists and, more importantly, to have access to information about their sickness (Blair, 2001). One of the major bottlenecks affecting the uptake of m-health in the US is the fact that insurance coverage of m-health is generally limited to teleradiology and a few cardiac monitoring procedures (Health Care Strategic Management, 2000). Furthermore in the US, legislation affecting m-health is different in each state. Another major limitation in m-health is that there is no adequate regulatory structure which addresses such issues as licensure, credentialing, intellectual property and MediCare payments (in the US) (Schooley, 1998; Edelstein, 1999). Governments have started to address these issues with the US Congress taking a pioneering stand in this regard. In 1999, it introduced 22 pieces of legislation relating to m-health (Edelstein, 1999).

5. THE INTERNET AND M-HEALTH An American Medical Association study in 1999 (Swartz, 2000) indicated that 37% of all physicians in the US were using the Web and by 2000 this figure had risen to about 50%. It has been pointed out that more caregivers have adopted modern ICT applications such as wireless phones and PDAs which allow them to be in contact with patients and, in certain circumstances, to save lives. The use of e-mail by physicians as a method of keeping in touch with patients tripled in less than one year -10% of all physicians now use e-mail on a daily or weekly basis to be in contact with their patients (Swartz, 2000). Initial web-based multimedia patient record systems have been developed which give remote access to telecare providers (Nairn, 2001). We believe that, in the future, webbased multimedia patient administration systems will become the norm for m-health. A similar concept has been put forward by the National Health Service (NHS) in the UK, where healthcare institutions are being asked to adopt an Electronic Patient Record (EPR) system at six varying levels of implementation (NHS, 1998). One of the biggest indicators that portends the rise of m-health has been the ruling by the Federal Communications Commission (FCC) in the US who had recently cast “…an historic vote dedicating a portion of the radio spectrum for wireless medical telemetry devices such as heart, blood pressure and respiratory monitors” (Health Management Technology, 2000, p12 ).


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5.1. Mobile Computing and Workflow In the near future, third generation technologies such as Code Division Multiple Access (CDMA) 2000 are expected to raise the transmission standard to about 2.0 Mbps (Cancela, 2001). When this happens, it is quite likely that the vision of an “integrated voice, data, video technology” (Cancela, 2001) will become a reality which is likely to have a significant impact on the use of m-health. The success of second-generation wireless networks has led to an explosion in the use of wireless applications to transfer voice and data services. This has raised the possibility that future wireless networks might support cost-effective broadband multimedia services (Pinto and Rocha, 1999). Technologies such as Wireless Application Protocol (WAP) have enabled patients and doctors to remain in closer contact. There are successful WAP-based products (such as LifeChart.com) through which doctors can monitor online their patient’s condition, and take care of their healthcare needs (Purton, 2000). Another example of the use of WAP is WirelessMed, through which UK Doctors have wireless access to clinical data on Medline, the largest US government database comprising more than 12 million medical references (which supports download speeds of up to 400-words in a few seconds). Another example of WAP-enabled healthcare products is MedicinePlanet which aims to bring local health information (health news, current health alerts, details on prevailing healthcare systems) to travellers using mobile phones (Purton, 2000). WAP technology is facing strong competition from other medical wireless systems based around PDA (Personal Digital Assistant) platforms which support downloads of a standard patient image in 10-15 seconds (Parkes, 2001). The main disadvantages of mobile computing (limited battery and processor power) should diminish as new technologies, allowing higher bandwidths, are introduced onto the market (Satyanarayanan, 1996). Workflow-based applications, in conjunction with mobile computing technologies such as WAP and PDA, have the potential to transform the delivery of healthcare information. Modern day IT applications in healthcare use protocols centered on Mobile Computing and the Internet. Some of them such as Wireless Local Area Network (WLAN) have already demonstrated their potential and financial viability. WLAN-based mobile computing allow healthcare workers to interact in real-time with the hospital's host computer system to enter, update and access patient data and associated treatment from all clinical departments. All this is possible not only from the patients’ bedside, but also from a number of geographical locations within the hospital where the WLAN is installed. The fact that a WLAN takes about one hour to be made operational has been trumpeted as one of the biggest advantages in comparison to a more traditional network, installation of which would take significantly longer (McCormick, 1999). It has been found that the average pay-back period for the initial costs of WLAN installations is 8.9 months. In a survey of WLAN healthcare installations, 97% of customers indicated that “WLANs met or exceeded their expectation to provide their company a competitive advantage” and that “if the productivity benefits are measured as a percentage return on the total investment … the return works out to be 48%” (McCormick, 1999, p13).

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The use of Personal Digital Assistant (PDA) by physicians has witnessed rapid acceptance in recent times. About 40% of all physicians currently use PDAs (Serb, 2002). However, the majority of physicians are using PDAs to perform static functions. Most of them use PDAs to collect reference material with ePocrates - a drug reference application that can assist physicians in looking up drugs by name or diagnoses, crossreference analogous medications or generic alternatives and obtain alerts on interactions. This application has been categorised by the US based Journal of the American Medical Association to be indispensable (Serb, 2002). A few pioneering physicians have started to use PDAs in an interactive way i.e. to write prescriptions, to keep a record of all daily clinical patient interactions and for bedside charting. The financial viability of PDAs have been demonstrated by a pilot study which has shown that for every US $1 that was invested in PDAs, the return in the form of lower administrative costs was over $4 (Serb, 2002).

6. FINANCIAL ESTIMATES FOR M-HEALTH Estimates for worldwide m-health services suggests that the market is valued at $2.5 billion a year (Surry, 2001). Other estimates for 2002 project the US market alone to be around $3 billion – a big leap from $65 million in 1997 (Industrial Robot, 1998). A study by Waterford Telemedicine Partners Inc in Feburary 2000 has indicated that m-health is projected to have an annual growth rate around 40% in the first decade of the 21st century. The study predicts that, by the year 2010, m-health will account for at least 15% of healthcare expenditure (Health Care Strategic Management, 2000). M-health technologies, in conjunction with state-of-the-art Electronic Health Record (EHR) systems, are changing the face of healthcare. M-health technologies have the potential to replace 5% of hospital stays, 5% of nursing home care, and 20% of home health visits (Fishman, 1997), resulting in savings of time and money for both patients and doctors. Additionally, caregivers have more time to devote to clinical activities such as medical diagnosis and treatment. A study on the medical reimbursement of m-health applications indicates that “telemedicine for radiology, prisoner health care, psychiatry, and home health care are the most cost effective applications …that are paid for by insurers” (Charles, 2001, p66).

7. WORLDWIDE APPLICATIONS OF M-HEALTH One of the most widely used applications of m-health is teleradiology (Rao, 2001). The use of m-health applications to monitor patients has been recommended in asthma, congestive heart failure and for diabetes (Friedewald Jr, 2001). A study carried out by the Agency for Healthcare Research and Quality in the US identified 455 telemedicine programs worldwide out of which 362 are being used in the US (Trembly, 2001). The study has indicates that m-health is most commonly used for: 1] Consultations or second opinions (performed in 290 programs), 2] Diagnostic test interpretation (169), 3] Chronic disease management (130), 4] Post-hospitalization or post-operative follow-up (102), 5] Emergency room triage (95), 6] Visits by a specialist (78) and that about 50 programs provide services in patients' homes.


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Countries such as Malaysia have already integrated m-health with the electronic health record concept and there is a national telemedicine strategy in place. Teleconsultations are being carried out on a regular basis in Malaysia. In Sweden, mhealth is being used to reduce the stay of children in hospital. This is being achieved by using local telecommunications to connect to the health monitoring equipment (for heart rate, rhythm and blood pressure) and is installed at the residence of the patient (Collins, 2001). In the UK, at the West Surrey Health Authority, patients who are regarded as potential heart failures are monitored electronically for 24 hours a day at their residences (Crompton, 2001). A report by the US based Association of Telehealth Service Providers has indicated that in 1996 there were about 22,000 telemedicine consultations, which rose to 42,000 in 1997 and by 1998 to about 58,000 (Tieman, 2000). 7.1. True Life Examples that Validate M-Health Applications In the UK, the North Manchester primary care group has used telemedicine applications to reduce the “average waiting time for a dermatology appointment from 18 months to 17 days” (Cross, 2000). In the US, m-health is said to have had tremendous benefits in reducing hospital intensive care costs (ICU). Each day in ICU costs on average $2,500 to the insurance company, which can be reduced to $35 by a routine teleconsultation (Cross, 2000). The use of m-health can significantly aid patients in the battle to combat diabetes whilst reducing the associated expenditure. It has been estimated that the use of m-health can save the US government, about “$247 million per year through early intervention and nearly double that if telemedicine can extend the reach of treatment” (Blair, 2001, p4). In Cornwall (UK) a pilot telemedicine project for teledermatology was undertaken. General Practitioners (GPs) from three surgeries (medical centers) used to send pictures of skin conditions from Cornwall to the county's two consultant dermatologists. They would then make an assessment as to whether the patient was required to visit the dermatologists for treatment or whether the GP could treat them in Cornwall itself. This m-health application found that “one in four patients did not need to see a specialist and could be treated by their family doctor” and reduced the workload of the two overworked dermatologists (The Guardian, 2001). In 2001, a telemedicine application was used for the first time to carry out telesurgery. Doctors via computer from New York operated on a 68-year-old woman in Strasbourg, France to remove her gall bladder (Alpert, 2001; Johnson, 2002). The patient was released from the hospital 48 hours after surgery and recommenced regular activities the following week (Johnson, 2002).

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Telemedicine has been used very successfully in the US state of Arizona. Due to the geographical nature of Arizona, it is not possible for its residents which number in thousands to have immediate access to leading edge healthcare, as closet centres are exist 150 miles away or more (Health Management Technology, 2001). The Arizona Telemedicine Program today has more then 96 telephysicians representing 60 medical sub-specialities such as teleradiology, teledermatology, telepsychiatry, telecardiology, teleorthopedics, teleneurology and telerheumatology. These telephysicians have seen more than 11,000 patient cases and have provided primary diagnoses, expert consultation and provision of second opinions. Another pioneering advantage of telemedicine in Arizona has been to decrease risky travel, especially for patients with unstable medical conditions (Health Management Technology, 2001). The Arizona Telemedicine Program has resulted in significant cost saving for healthcare delivery as the average cost “for a rural patient's visit to an urban health center has dropped from $520 to $105” and there exists significant potential in lowering “the average cost for routine home health visits … from $140 to as low as $55 per visit”. One of the more significant achievements of the Arizona Telemedicine Program was to reduce healthcare expenditures in prisons, with the average cost for a prison inmate's healthcare visit falling from $415 to $140 (Health Management Technology, 2001, p47). One of the most important technological enablers that is likely to affect transmission of healthcare information and healthcare delivery is the connectivity via satellite technology. It was estimated that there were about 150 satellites in orbit in 2001 (Rao, 2001). More significant is the fact that about “1,700 commercial satellites are scheduled for launch in the next decade worldwide” (Rao, 2001, p227). This could be the technological catalyst that brings about a transformation in the manner how healthcare delivery takes place, particularly in those areas where there is a geographical gap between the caregivers and carereceivers or where there is a substantial time constraints on specialized caregivers. Tele-consultations between caregivers and carereceivers and between themselves could see a likely increase (Rao, 2001).

8. IMPORTANT INNOVATIONS THAT HOLD GREAT POTENTIAL TO BE REVOLUTIONARY CHANGE CATALYSTS FOR THE HEALTHCARE SECTOR 8.1. Biomedical Knowledge: The Untapped Potential in Healthcare Advances in technology have been the hallmark of the healthcare sector, particularly with regard to advances in biomedical sciences. Today there are “10,000 known diseases, 3,000 drugs, 1,100 lab tests, 300 radiology procedures, 1,000 new drugs and biotechnology medicines in development and 2,000 individual risk factors” (Pavia, 2001, p12). This has had an enormous impact on healthcare and, in particular, has rendered the concept of an expert in a particular domain in healthcare irrelevant as shown above it is not possible for one human being to have all the relevant knowledge in their domain of speciality (Pavia, 2001; Rockefeller, 1999).


25

For example today, “Organ and tissue scanning speed is doubling every 26 months, making tests both faster and cheaper…Image resolution is doubling every 12 months…the increase in computer power (four-fold over the next 20 years) and the availability of inexpensive bandwidth” (Pavia, 2001, p12). All of the above is likely to change our own perception of what information is available and even possible for one human being to acquire. 8.2. The Genetic Engineering (un)revolution Advances in modern day genetic sciences have increased the number of potential drug compositions from a mere 400 to over 4,000 (Pavia, 2001). This has occurred despite the fact that the rate of adoption of computer applications in healthcare is slower in comparison to other industries (Johns, 1997). The pace of discovery of new drugs may well undergo an exponential leap when the above observation is seen in context of the forecasted increase in computing power as discussed previously in this chapter. Perhaps the biggest tragedy in the history of modern science was the fact that the announcement regarding the completion of the Human Genome project did not create any ripples in the mindset of healthcare decision-makers and academics or propel a new wave of healthcare discoveries (Jones, 2001). We hypothesize that this situation is not likely to prevail for much longer. The impact of the completion of the project will profoundly change the concept of healthcare itself within the next 25 years (Jones, 2001). Unfortunately, the contemporary focus in m-health is only on how best to disseminate the information, which could be fatal for the future of telehealth and mhealth. Rather than creating or disseminating contextual knowledge, m-health applications are being used to disseminate data and/or information. Futuristic m-health schemes would need to support the transfer of information with context (i.e., such schemes would have to become dynamic in nature). One of the big drawbacks of mhealth is that most systems force the caregiver specialist to look at medical issues in isolation, whereas more detailed information (such as the patient's medical history) might help in arriving at a better informed medical diagnosis (Nairn, 2001).

9. DISCUSSION This section summarises how m-health will affect healthcare delivery. It is argued that m-health will alter healthcare delivery in the following ways: (a) It would be important to consider having a definition of what is meant by the term “healthcare”. This is by no means an easy task. We believe that m-health will reduce both critical and non-critical healthcare treatments. However, in the immediate future mhealth is likely to reduce the cost of routine consultations. Advances in technology will help patients carry out routine medical tests, reducing the number of visits to the physician, thereby reducing costs for routine consultations. However there could be an increase for non–routine expenditure for complex treatments. (b) m-health applications such as teleradiology will increase. In addition, m-health will be used increasingly for the following purposes: consultations or second opinions, diagnostic test interpretation, post-hospitalization or postoperative follow-up, emergency room triage and televisits. The use of m-health applications to monitor patients will see an increased use (eg. for asthma, congestive heart failure, diabetes).

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9.1. Need for Incorporating Organisational Perspectives in M-Health Processes The last two decades of the twentieth century has witnessed a shift in the concept of healthcare information. This shift has been marked by the coming of age of paradigms such as m-health, bioinformatics, biomedical and genetic engineering resulting in exponential advances in healthcare knowledge (Dwivedi et al, 2002). One of the most significant implications of this shift has been the realization that the applications of IT advances in the healthcare sector have caused an information explosion. Individual healthcare stakeholders are not going to be in position to adapt to the above with ease. Any solution would call for significant integrated technological support in the human healthcare decision-making process (Dwivedi et al, 2001a; 2001b; 2002). It has been proposed that holistic health will emerge as an alternative to complement traditional medicine (Church et. al, 1996; Dervitsiotis, 1998). As patients’ homes become the homebase for delivering more and better types of care, people will expect “King Quality, Queen Value” (Nelson, Batalden and Mohr, 1998, p3). Healthcare organisations need to be fully aware of the organisational implications of telehealth initiatives. The technology associated with m-health schemes transcends geographical, institutional and disciplinary boundaries. M-health redefines organisational roles and responsibilities and by disseminating knowledge and information, it allows healthcare professionals and patients to relate to each other. The astonishing rate of change makes strategic planning extremely difficult. Appreciating the role of management and how it controls and monitors resource requirements needs is crucial. Having identified suitable individuals and jobs, it must be emphasized that m-health is an additional health-delivery avenue and no healthcare provider should be forced to use the new technology. M-health delivery may be better suited to people who tend to exhibit such traits as a greater ability to structure their workday, more efficiently separate work and family life, or those whose jobs are more independent and proactive. 9.2. Knowledge Management Knowledge management (KM) is considered as a source of great competitive advantage (Nonaka, 1991; Wiig, 1994). Knowledge can either be tacit or explicit (Beijerse, 1999; Gupta , Iyer and Aronson, 2000; Hansen, Nohria, and Tierney, 1999). Explicit knowledge typically takes the form of company documents and is easily available, whilst tacit knowledge is subjective and cognitive. The ultimate objective of KM is to transform tacit knowledge into explicit knowledge to allow effective dissemination (Gupta , Iyer and Aronson, 2000). Knowledge Management and Information and Communication Technologies (ICT) as disciplines do not have commonly accepted or de-facto definitions. However some common ground has been established which covers the following points. KM is a multi-disciplinary paradigm (see Figure 1) which uses technology to support the acquisition, generation, codification and transfer of knowledge in the context of specific organisational processes. ICT refers to the recent advances in applications of communication technologies that have enabled access to large amounts of data and information when seeking to identify problems or solutions to specific issues (Dwivedi et al, 2001a).


27

Figure 1. KM Process and Enabling Technologies. Adapted from (Skyrme, 1999)

9.3. Impact of KM on M-health There are many factors which may influence m-health which can be reduced to three fundamental areas: technological, business and social (Bali, 2000b). These areas all consider the current pace of technological change. The commercial environment is undergoing a period of accelerated information technology change, which some would argue is a revolution. Developments in technology, social considerations, government fiscal policy and business aims and objectives need to be fully understood in order to fully exploit the social and economic benefits that are emerging as a result of m-health (Bali and Naguib, 2001). Healthcare organisations are in a constant state of change and m-health is both a key manifestation and enabler of this change. However, researchers and practitioners need to appreciate the implications and ramifications of such a change. The multi-disciplinary aspect of KM research has resulted in a multitude of models and approaches, all of which look at KM from perspectives similar to m-health. KM is viewed as a methodology involving the interaction between people, culture, information technology, and organisations. A different perspective discusses KM’s relationships between culture, content, process, and infrastructure. Another approach reflects that a successful KM programme must bring together political, organisational, technical and cultural organisational aspects (Bali, 2000a; Puccinelli, 1998; Chait, 1999; Havens and Knapp, 1999) We would like to establish the interrelationship between KM and m-health by stating that both have been brought about by the ICT revolution, and that both are bringing about fundamental changes which are redefining the work place of contemporary healthcare organisations. Another common point is that both KM and m-health are concerned with dissemination of information in a manner which ensures that information is available when required.

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We believe that the difference between KM applications and m-health applications lies in the application of ICT. As compared to KM, ICT in telehealth and telemedicine is in its relative infancy. Unfortunately, the contemporary focus is only on how best to disseminate the information - which could be fatal for the future of m-health (i.e., current use is static). Rather than creating or disseminating contextual knowledge, m-health applications are being used to disseminate data and or information. Futuristic m-health schemes would have to support the transfer of information with context (i.e., such schemes would have to become dynamic in nature). One of the big drawbacks of m-health is that most systems force the caregiver specialist to look at medical issues in isolation, whereas more detailed information (such as the patient's medical history) might help in arriving at a better informed medical diagnosis (Nairn, 2001). Initial web-based multimedia patient records systems have been developed, which give remote access to the telecare providers (Nairn, 2001). We believe that, in the future, web-based multimedia patient administration systems will become the norm for m-health. A similar concept has been put forward by the NHS (National Health Service) in the UK, where healthcare institutions are being asked to adopt an Electronic Patient Record (EPR) system at six varying levels of implementation (NHS, 1998). Healthcare institutions require a framework which would help assess how best to identify and create knowledge from internal and external organisational experiences and how best to disseminate these on an organisation-wide basis. This would call for the contextual recycling of knowledge which has been acquired from the adoption of mhealth trials. KM can assist m-health to become viable by giving healthcare information context, so that other healthcare providers can use m-health to extract knowledge and not information. For this to happen, futuristic m-health systems would have to shift their emphasis to deal with the intangibles of knowledge, institutions and culture and that the KM paradigm is aptly suited for this role. This is due to the fact that one of the important reasons behind the emergence of the KM concept is that, even though our access to data and information has increased exponentially, our capability to acquire knowledge (by giving the information context) has not become an industry-wide reality. This also holds true for the healthcare industry.

10. THE NEED FOR A KM FRAMEWORK FOR M-HEALTH Healthcare managers are being forced to examine the costs associated with healthcare and are under increasing pressure to discover approaches that would help to carry out activities better, faster and cheaper (Dwivedi et al, 2001b; Latamore, 1999). For this to happen, the m-health sector needs to shift it’s emphasis to deal with the intangibles of knowledge and culture (Dwivedi et al, 2001a). Healthcare institutions (HIs) adopting mhealth applications would require a KM framework which, in light of their ICT implementation level, would assist in the discovery and creation of new knowledge (see Figure 2).


29

Figure 2. Need for a KM Framework for the m-health sector

HIs need to identify key sociological and technological roles affecting the knowledge-transfer process and to develop organizational-specific measures for identifying best knowledge transfer practices (see Figure 2). Any KM strategy that is being proposed should extend best knowledge transfer practices on an organization-wide basis. Our contention above has been confirmed by the Canadian Department of Health (Health Canada, 2001). KM can assist healthcare institutions to become viable by giving healthcare information context, so that other healthcare providers can extract knowledge and not information (Dwivedi et al, 2001a). The cornerstone of this chapter is that the KM paradigm can enable the healthcare sector to successfully overcome the information and knowledge overload in healthcare (Dwivedi et al, 2002).

11. CONCLUSIONS We have discussed important technologies that are driving forces in healthcare and have considered the implications of their advances on healthcare in general. We contend that if the impact of these healthcare technologies are seen together, then the conclusion from a healthcare informatics perspective is clear. In the future, m-health systems would have an increased interest in knowledge recycling of the collaborative learning process acquired from previous m-health practices.

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Twenty first century clinical practitioners need to acquire proficiency in understanding and interpreting clinical information so as to attain knowledge and wisdom whilst dealing with large amounts of clinical data. This would be dynamic in nature and would call for the ability to interpret context-based healthcare information. This challenge cannot be met by an IT led solution. The solution needs to come from a domain that supports all the three integral healthcare system components (i.e. people, processes and technology) of the future. We believe that the KM paradigm can offer solutions to healthcare institutions, allowing them to face the challenge of transforming large amounts of medical data into relevant clinical information by integrating information using workflow, context management and collaboration tools, and give healthcare a mechanism for effectively transferring the acquired knowledge, as and when required.

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II. SMART MOBILE APPLICATIONS FOR HEALTH PROFESSIONALS Andreas Lymberis Section Editor

III. SIGNAL, IMAGE, AND VIDEO COMPRESSION FOR M-HEALTH APPLICATIONS

Marios S. Pattichis Section Editor

IV. EMERGENCY HEALTH CARE SYSTEMS AND SERVICES Sotiris Pavlopoulos Section Editor

V. ECHOGRAPHY SYSTEMS AND SERVICES Pierre Vieyres Section Editor

VI. REMOTE AND HOME MONITORING Chris D. Nugent Section Editor

AUTHOR INDEX

Abdallah Rony Alesanco Álvaro Altieri Roberto Andreou Panayiotis Arbeille Philippe

345, 491 293 163 247 461

Bali Rajeev K. Beglinger Christoph Beth Goens Mary Black Norman D. Bonis Julio Bults Richard

15 203 491 375, 601 195 219, 237, 531, 561

Cai Songhe Casella Dos Santos Mariana Christodoulou Eleni Clamp Susan Cornelis Jan Courrèges Fabien de Toledo Paula del Pozo Francisco Dhaen Christoffel Dikaiakos Marios Doarn Charles R. Dokovsky Nikolai Drion Benoit Dunbar Angela Dwivedi Ashish N. Dyson Anthony Eddabbeh Najia Eich Hans-Peter

345 147 247 195 329 461 575 575, 587 147 247 517, 549 219, 237 187 195 15 203 187 195

Falas Tasos Finlay Dewar D. Fischer Hans Rudolf

601 375, 515, 601, 617 203

García José García-Olaya Angel Georgiadis Dimosthenis Giovas Periklis Gómez Enrique J. Gutzwiller Jean-Pierre

293 587 107, 247 389 575, 587 203

Hadjileontiadis Leontios J. Halteren Aart van Hernando M. Elena Herzog Rainer Incardona Francesca Istepanian Robert S.H. Jiménez Silvia Jones Val M. Jovanov Emil Kirke Chris Kirkilis Harris Konstantas Dimitri Kontaxakis Georgios Koprinkov George Koutsouris Dimitris Kovaþeviü Branko Kyriacou Efthyvoulos Lauzàn José.E. Lavigne Kevin Laxminarayan Swamy

277 219, 237, 531 575, 587 219, 237, 561 163, 267 3, 293

575 219, 237, 267, 531,561 33, 51 195 163 219, 237, 531, 561 445, 509 219, 237 401 81 401, 435 195 561 3

619

620

Author Index

Litos George Lugg Desmond J. Lymberis Andreas

475 517 133, 267

Markoviü Milan Merrell Ronald C. Montyne Frank Munteanu Adrian

81 549 147 329

Naguib Raouf N.G. Nassar Nahy S. Nicogossian Arnauld E. Nikolakis George Novales Cyril Nugent Chris D. Ohmann Christian Olmos Salvador Orphanoudakis Stelios C. Owens Frank J.

15 517, 549 475 461 375, 515, 601, 617 195 293 65 375

Papachristou Petros 195 Papadopoulos Constantinos 601 Papadopoulos George A. 601 Papadoyannis Demetrios 389 Papazachou Ourania 389 Pattichis Constantinos S. 3, 345, 491 Pattichis Marios S. 273, 345, 365, 491, 509 Pavlopoulos Sotiris A. 371, 401, 435 Peuscher Jan 237, 531, 561 Pitsillides Andreas 107, 247 Pitsillides Barbara 247 Poisson Gérard 461, 509 Priddy Brent 51 Raskovic Dejan Reichlin Serge

33 203

Reid Innes Ricci Roberto Rienks Rienk Rodriguez Paul V Rodríguez Sergio Sakas Georgios Samaras George Sancho Juan J. Saviü Zoran Schelkens Peter Shaphrut Oded Ben Shashar Nadav Shimizu Koichi Skodras Athanassios N. Smith-Guerin Natalie Spanakis Manolis Strintzis Michael G. Thierry Jean P. Thomakos Demetrios Thomos Nicolaos

195 163 561 491 195 445 107, 247 195 81 329 561 561 417 313 461 65 475 195 389 475

Torralba Verónica Traganitis Apostolos Triantafyllidis George A Tristram Clive Tsiknakis Manolis Tzovaras Dimitrios

587 65 475, 509 137, 195, 267 65 475

van Halteren Aart Vierhout Pieter Vieyres Pierre Virtuoso Salvatore

561 531, 561 441, 461, 509 177, 267

Walter Stefan Wang Haiying Widya Ing

445 375 219, 237, 531, 561

SUBJECT INDEX

Access AMI Between Medical Biosensors Biosignal Compression Biosignals Biotelemetry Body Area Network

133 389 137 219 273 277 417 33, 219, 237, 531

Care City-Hospital Collaboration Civilian Clinical Calculators Coding Of Motion Coding Collaborative Virtual Healthcare Teams Communication Compliance Compression Standards Compression COPD Decision Support Systems Diabetes Digital Video Compression Disaster Management Disaster Distributed Health Record Diving ECG Coding

435 187 517 195 475 147 107, 247 51 601 277 313 575 195 587 345 515, 517, 531 549 267 561 293

ECG 389 E-Health 65, 163 Electrocardiology 375 Electronic Health Record 187 Embedded Coding 329 Emergency Care 417 Emergency Medicine 371 Emergency 401, 435 EMR (Electronic Medical Records) 163 Endocrinology 195 Enterprise Model 531 E-Prescribing 163 E-Prescription 601 Error Concealment 345 Error Figures 277 Error Resilience 345 Evaluation of Medical Mobile Devices, 137 Extreme Environments 517, 561 Force Feedback Future

475 435

Gastroenterolgy GPRS GSM

195 203 203, 401

H.263X Hand Held Computers in Healthcare Handheld Computer Handheld Devices Health Healthcare Human-Computer Interfaces

345 137 177 163 435 51, 517 267

621

622

Subject Index

Image Coding Teleconsultation 441, 461, 509 Image Coding 313 Image Compression Standards 273 Image Modeling 329 Information and Communication Technologies 133 Information Systems 515 Information Systems 617 Integrated Mobile Health Care Solution 203 Intelligent Access 187 Interface Sharing 441 Interface Sharing 445 Interface Sharing 461 Interface Sharing 509 Internet Based Care Models 515 Internet Based Care Models 617 Interoperability 137 Interoperability 267 IST Frame 5 Project 137

Ontology Management System (OMS) 147 Overview 515, 617

Joint Coding JPEG2000

Satellite Communication 417 Satellite 401 Scalable Coding 365, 491 Secure Mobile Healthcare Systems 81 Security 65, 133, 187 Shared Care 587 Smart Cards 81 Speech Recognition on Medical Mobile Devices 137 Speech Recognition 177 Standards 375

Lossless Compression Lossy/Lossless Compression

365 313, 475 491 277

Medical Image Compression 329 Medical Imaging 313 Medical Mobile Devices 137 Medical Monitors 33 Medical Ontology 147 Medical Terminology 147 Medication 601 M-Health Framework 15 M-Health Systems 3 M-Health 65, 219, 237, 531, 575 M-Mode 491 Mobile Collaborative Workspace 587 Mobile Communication 417 Mobile Health 267 Mobile Healthcare Computing Device (MHCD) 81 Mobile Healthcare 133 Mobile Medical Devices 137, 267 Mobile Services 531 Mobile Systems 195 Mobile 33, 51, 375, 601 Mobility 187 Monitoring 561 MPEG-2 345 MPEG-4 345 Multi-Access 587 Multilayered Security Architecture 81 Natural Language Processing/Understanding (NLP/NLU) 147 Nurse 237 Obesity Treatment Object-Based Coding

203 365

Paperless Patients Record Paramedic Patient Monitoring PDA PKI Systems Polar Portable Workstation Prehospital Preparedness

177 237 219 575 81 561 441, 445, 461, 509 389 549

Quality Reality Real-Time Remote Robot

133 475 293 517 441, 461, 509

Taxonomy 33 Technological, Organisational Perspectives 15 Technology 51 Telecardiology 293, 375 Telecommunications 549 Teleconsultation 445 Tele-Echography 3, 441, 461, 509 Telehealth 549 Telemedicine 277, 401, 417, 445, 517, 549, 575, 587 Telemedicine, Health Care Delivery 203 Telemonitoring 575 Thrombolysis 389 Transmission 389 Trust Infrastructure 65 Ubiquitous Computing Ultrasound Video Compression Standards Virtual 3D Volumetric Coding Wavelet Coder Wavelet Coding Wavelet Transform Wavelet-Based Compression Wireless Communications

3 441, 461, 509 273 329 475 491 293, 313 329 293

Index

Wireless Communications Wireless Connectivity Wireless Home-Based Health Care Services Wireless Networks Wireless Sensors Wireless Technologies Wireless Telemedicine

623

65 177 107, 247 163 33 515, 617 371

Wireless Workflow XML 3D Freehand Ultrasound 3G Mobile Technologies 4G Mobile Technologies

51, 601 177 375 441, 445, 461, 509 3 3

M-Health: Emerging Mobile Health Systems

Exercise, Health and Mental Health: Emerging Relationships

Mobile Cellular Telecommunications Systems

Mobile Information Systems

Mobile Database Systems

Mobile Communication Systems

Mobile Information Systems

Mobile Communication Systems

Watershed Health Monitoring: Emerging Technologies

W-CDMA Mobile Communication Systems

Mobile communication systems and security

Coffee: Emerging Health Effects and Disease Prevention

Mobile Health Solutions for Biomedical Applications

Advances in Mobile Information Systems (Artech House Mobile Communications Library)

Emerging Topics and Technologies in Information Systems

Emerging Spatial Information Systems and Applications

Emerging Wireless Technologies and the Future Mobile Internet

Communication Systems for the Mobile Information Society

DSP for In-Vehicle and Mobile Systems

Communicating and Mobile Systems: the pi-calculus

Cellular Mobile Radio Systems: Designing Systems for Capacity Optimization

Mobile Government: An Emerging Direction in E-government

Mobile Enterprise Transition and Management (Advanced and Emerging Communications Technologies)

Fixing Health Systems (In-Focus)

Communicating and mobile systems: the pi-calculus

Communicating and mobile systems: the pi-calculus

Communicating and Mobile Systems. the Pi-Calculus

The World Health Report 2000 - Health Systems: Improving Performance

Towards High-performing Health Systems: Policy Studies (OECD Health Project)

M-Health: Emerging Mobile Health Systems

Exercise, Health and Mental Health: Emerging Relationships

Mobile Cellular Telecommunications Systems

Mobile Information Systems

Mobile Database Systems

Mobile Communication Systems

Mobile Information Systems

Mobile Communication Systems

Watershed Health Monitoring: Emerging Technologies

W-CDMA Mobile Communication Systems

Mobile communication systems and security

Coffee: Emerging Health Effects and Disease Prevention

Mobile Health Solutions for Biomedical Applications

Advances in Mobile Information Systems (Artech House Mobile Communications Library)

Emerging Topics and Technologies in Information Systems

Emerging Spatial Information Systems and Applications

Emerging Wireless Technologies and the Future Mobile Internet

Communication Systems for the Mobile Information Society

DSP for In-Vehicle and Mobile Systems

Communicating and Mobile Systems: the pi-calculus

Cellular Mobile Radio Systems: Designing Systems for Capacity Optimization

Mobile Government: An Emerging Direction in E-government

Mobile Enterprise Transition and Management (Advanced and Emerging Communications Technologies)

Fixing Health Systems (In-Focus)

Communicating and mobile systems: the pi-calculus

Communicating and mobile systems: the pi-calculus

Communicating and Mobile Systems. the Pi-Calculus

The World Health Report 2000 - Health Systems: Improving Performance

Towards High-performing Health Systems: Policy Studies (OECD Health Project)

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