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Pervasive Health Management:
New Challenges for Health Informatics
J.UCS Special issue
Juan C. Augusto (School of Computing and Mathematics, Faculty
of Engineering, University of Ulster, United Kingdom)
jc.augusto@ulster.ac.uk
Norman D. Black (School of Computing and Mathematics, Faculty
of Engineering, University of Ulster, United Kingdom)
nd.black@ulster.ac.uk
H. Gerry McAllister (School of Computing and Mathematics, Faculty
of Engineering, University of Ulster, United Kingdom)
hg.mcallister@ulster.ac.uk
Paul J. McCullagh (School of Computing and Mathematics, Faculty
of Engineering, University of Ulster, United Kingdom)
pj.mccullagh@ulster.ac.uk
Christopher D. Nugent (School of Computing and Mathematics, Faculty
of Engineering, University of Ulster, United Kingdom)
cd.nugent@ulster.ac.uk
This special issue addresses the area of Pervasive Health
Management, which is beginning to challenge the twentieth century
model of delivery, in which healthcare was organised in specialist
locations and administered to patients by healthcare
professionals. Thus primary care provides the initial contact, large
hospitals administer specialist intervention and disease management,
and long term hospital or rest-home care is provided for those with
special needs and chronic debilitating conditions. This is still the
predominant mode of healthcare interaction, but the contributions in
this volume indicate the potential of the new mode of delivery and the
challenges posed for health informatics.
There are many factors which have contributed to this potential
shift in focus. Significant advances within the realms of Information
and Communication Technology (ICT) include the availability of high
speed Internet communications, the proliferation of wireless and
mobile devices, the deployment of low cost sensor technology, and the
embedding of intelligence within devices. There is of course consumer
demand, which is transforming the discipline of health informatics and
raising expectation of healthcare delivery. Wilson et al. [P. Wilson , C. Leitner and A. Moussalli, 2004]
state that "...Health, like eGovernment and eCommerce, is
about placing citizens at the centre of the circle and easing the
interaction with the wide range of people who look after their
needs". There is also the economic reality of the cost of
healthcare, particularly chronic disease management as people obtain
greater longevity. The World Health Organisation has identified that
chronic conditions will be the leading cause of disability by 2020 and
that if not successfully managed, will become the most expensive
problem for healthcare systems. In the Western Economies the
implications of an aging population will increase expenditure on
healthcare to a level which many experts consider unsustainable. This
is based on predictions of ratios of people of working age to those
dependent on pension provision. Predictions of increased working life
beyond current retirement age have been suggested as a means of
reduction of expenditure on pensions but healthcare provision will
require more efficient means of delivery in order to meet these
needs. In the United States, where significant healthcare is privately
funded the overwhelming opinion is that costs will rise
considerably.
Competition within the private sector will seek market driven
solutions to new and innovative means of sustaining acceptable levels
of care. It is predicted that people themselves will seek new means of
managing their own healthcare in order to minimise the ever increasing
costs.
Health promotion, evidence-based care, self-management and
knowledge management are key enablers for a new health paradigm [UK Department of Health 2004]. With appropriate
support, people can be active participants in their own healthcare,
preventing complications and slowing deterioration of conditions. For
high risk patients, proactive management from healthcare professionals
following agreed protocols, care plans and personal life goals,
requires the support of an ICT infrastructure, e.g. shared electronic
health records. Pervasive health management uses the ICT
infrastructure to deliver this support for assisted, independent
living, keeping people in their own environment for as long as
possible and hence avoiding the requirement of
institutionalisation. As an example of the importance given to the
area we can consider "Ambient assisted living for the aging
society", a key research objective within the European Union
Framework Programme 6, ICT for Health [IST-H1-ICTH]
building upon previous research initiatives in pervasive/ambient
health supported by the European Union (see for example [Lymberis and De Rossi, 2004, Nugent et al., 2005]).
This special issue comprises eight papers, two of which have been invited
to set the scene.
Jean Roberts in her invited paper "Pervasive Health
Management and Health Management utilizing Pervasive Technologies
— Synergies and Issues" explores technological, societal
and health specific issues of the concept of pervasiveness. She
defines pervasiveness according to two criteria:
i) Appropriate computing technologies everywhere and always there when
needed
ii) Technology-enabled information available on a 'just in time basis
The latter criterion implies some intelligent agent, providing the
appropriate information, which appeals to those suffering information
overload. Technical challenges cited include powering mobile devices
from the environment, whereas trust in the operation of the devices
provides a societal issue. The issue of privacy is raised as a
potential risk to uptake of pervasive technologies, which can build a
complex profile of a persons lifestyle and health status.
Diane Cook's invited paper "Health Monitoring
and Assistance to Support Aging in Place" tackles a core
problem for pervasive health, i.e., the 'smart home'. It describes
techniques for using agent-based smart home technologies to provide
at-home health monitoring and assistance. The proposed system is
based on novel inhabitant modeling and automation algorithms providing
remote health monitoring for caregivers. Specifically, the following
technological challenges are addressed:
i) identifying lifestyle trends,
ii) detecting anomalies in current data, and
iii) designing a reminder assistance system.
Solutions presented are being tested in simulation and with volunteers
at the University of Texas at Arlington's MavHome site, an agent-based
smart home project.
Haiying Zhou, Kun Mean Hou, Laurent Gineste, Christophe De Vaulx
and Jean Ponsonnaille's paper "A New System Dedicated to
Real-time Cardiac Arrhythmias Tele-assistance and Monitoring"
presents a system dedicated to real-time cardiac arrhythmias
tele-assistance and monitoring so that monitoring and diagnosis can be
achieved outside a hospital area.
Their system comprises: a real-time automatic ECG diagnostic
algorithm; an embedded real-time multi-task operating system; and a
real-time reliable telemedicine communication protocol. The system has
been evaluated at the coronary heart rehabilitation unit of Gabriel
Montpied hospital (Clermont-Ferrand, France) and has been used to test
athletes' cardiac status during their physical exercises. It provides
a practical example of how current pervasive technology can tackle
both disease and wellbeing, and shows that the 'hospital appointment'
based approach to healthcare can be superceded by a Telecare
approach.
Timothy O'Sullivan, John O'Donoghue, John Herbert and Richard
Studdert's paper "CAMMD: Context-Aware
Mobile Medical Devices" provides details of an intelligent
middleware layer (CAMMD) using an agent-based (where an agent is
described as: an entity within a computer system environment that
is capable of flexible, autonomous actions with the aim of complying
with its design objectives) solution to address key themes in
pervasive systems. These themes consider the notion that the medical
practitioner is mobile and requires information appropriate to
location, time and work schedule, i.e., context-aware. In fact user
interaction with a handheld device is enhanced by such an
approach. Their aim is a ubiquitous telemedicine environment.
Anthony Glascock and David Kutzik's paper on "The Impact of Behavioral
Monitoring Technology on the Provision of Health care in the
Home" addresses the question as to whether a frail individual
can accomplish a specific task and therefore benefit from home based
care. Their system collects and interprets activities of daily living
based on data from motion detection sensors. This can alert the
caregiver to alter care and respond to emergency conditions. Through
seven case studies they have shown that the approach promotes better
care, by permitting the person to retain more independence and hence a
greater sense of well-being.
Adel Taweel, Alan Rector and Jeremy Rogers' paper "A Collaborative
Biomedical Research System" addresses the issue of linking
healthcare with bioinformatics data to form an electronic health
record or coherent 'chronicle' of patient history. The system uses a
cancer repository as a pilot system and potentially provides a record
of care which should aid intervention. It is envisaged that the
repository will assist patient care and research, addressing questions
such as "What was done and Why?" Nevertheless the linkage of
health and biomedical data raises some key ethical issues: security,
privacy, confidentiality and consent. The data is pseudo anonymous,
but this can be reversed by the provider (or their nominated trusted
third party). In the future, it is envisaged that pervasive care will
be personalized, and this paper takes a step in this direction, by
linking genomic data to the health record.
Zhenjiang Miao, Baozong Yuan and Mengsun Yu's paper "A Pervasive Multimodal
Tele-Home Healthcare System" uses a variety of communication
technologies and devices to provide user feedback. Monitoring of
physiological signals can be achieved using a lightweight wearable
signal detection vest, or signal detection bed. Home based wireless
LAN or GSM/GPRS can be used for communication. Applications include
video detecting, tracking and activity measurement, vital sign
detection on the move or whilst in bed, and home based monitoring of a
relative via a web browser.
Chi-Chan Chang, Chuen-Sheng Cheng and Yeu-Shiang Huang in their
paper "A
Web-Based Decision Support System for Chronic Diseases"
describe a web-based statistical model that can assist with the
decision for intervention, when a chronic condition deteriorates. It
implements a Bayesian decision model, which can deal with uncertain
prior knowledge, by considering the optimal prior decision, provide a
sensitivity analysis and provide decision support. This paper is at
the theoretical end of the spectrum but underlines the need for
decision support (based on statistical or artificial intelligence
techniques) to support the pervasive technologies.
As the papers included in this special issue have shown, both from
a practical and theoretical perspective, there are significant
anticipated benefits, from a number of perspectives, to the successful
application of Pervasive Health Management Systems. In the short to
medium term it is expected that there will continue to be greater
emphasis on citizens not being 'institutionalised' for a number of
reasons. The environment itself can often be a daunting experience,
particularly for the elderly. Hospital borne diseases are becoming
more difficult to control as infections spread throughout confined
areas and among vulnerable subjects and there is evidence to suggest
that recovery from illness can be accelerated outside the confines of
the hospital ward. These issues in conjunction with the financial
implications of long term institutionalisation and hospital
re-admittance can only suggest that home based care will be an
attractive alternative to the twentieth century model of confinement
within the hospital for both the recovery from illness and chronic
care. Technology has been developed and applied to move one step
closer to this goal although the correct manner of introducing such
systems into existing practice and the impact from social and ethical
perspectives still requires a degree of refinement and
consideration.
Acknowledgements
The editors would like to acknowledge the contribution of the external
referees: Prof Roy George Clark (Atlanta University, USA), Dr Andres Flores
(University of Comahue, Argentina), Prof J Grimson (Trinity College, Dublin),
Prof Wookey Lee (Sungkyul University, South Korea), Dr Gaye Lightbody (University
of Ulster, UK), Dr Mark McCartney (University of Ulster), Dr César
Navarro (Royal Victoria Hospital, N. Ireland), Dr Cristiano Paggetti (MEDEA,
Italy), Prof Macario Polo Usaola (University of Castilla-La Mancha, Spain),
Dr Jean Roberts (University of Central Lancashire, UK), Mr Tony Scully
(Luleå University of Technology, Sweden), Mr Jonathan Wallace
(University of Ulster, UK), Dr Haiying Wang (University of Ulster, UK),
Dr Huiru Zheng (University of Ulster, UK).
References
[P. Wilson , C. Leitner and A. Moussalli, 2004]
eHealth Research Report: Mapping the potential of eHealth, empowering the
citizen through eHealth tools and services. www.ehealthconference2004.com
[UK Department of Health, 2004] Improving Chronic
Disease Management. www.dh.gov.uk (Gateway Reference: 2843, 03/03/2004).
[IST-H1-ICTH] Information Society Technologies, Unit
H1, ICT for Health] http://www.cordis.lu/ist/health/index.html
[C.D. Nugent, P.J. McCullagh, E.T. McAdams and
A. Lymberis 2005] Personalised Health Management Systems: The Integration
of Innovative Sensing, Textile, Information and Communication Technologies.
Volume 117 Studies in Health Technology and Informatics, IOS Press.
[A. Lymberis and D. De Rossi August 2004] Wearable
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108. Studies in Health Technology and Informatics, IOS Press. August, 2004.
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