Within this opening chapter, the authors explore various perspectives on medical informatics and, to aid in understanding the evolving meaning of the domain, carry out a systematic review of formal definitions of medical informatics. Additionally, they use MeSH (Medical Subject Headings) descriptors relevant to medical informatics to map 36 peer-reviewed definitions. Ultimately, the authors believe that this research will serve as a handy and an informative resource and may also catalyze further research.

Ever since the Hippocratic Oath of antiquity, protecting the privacy of patients has been an important precept of medical ethics. Technological developments, however, have allowed health information to be used by many organizations and individuals that may be unaware of medical privacy concerns. Within his research, Doyle contends that the rise of e-Health technology should prompt us to take a closer look at the issue of medical privacy.

This chapter reports the authors’ experiences regarding security of the Electronic Medical Record (EMR). Although the EMR objectives are to support shared care and healthcare professionals’ workflow, there are some barriers that prevent its successful use. These barriers comprise not only costs, regarding resources and time, but also patient / health professional relations, ICT (Information and Communication Technologies) education as well as security issues. It is very difficult to evaluate EMR systems; however some studies already made show problems regarding usability and proper healthcare workflow modeling. Legislation to guide the protection of health information systems is also very difficult to implement in practice. This chapter shows that access control, as a part of an EMR, can be a key to minimize some of its barriers, if the means to design, develop and evaluate access control are closer to users’ needs and workflow complexity.

This chapter outlines the history of medical classifications in a general cultural context. Classification is a general phenomenon in science and has an outstanding role in the biomedical sciences. Its general principles started to be developed in ancient times, while domain classifications, particularly medical classifications have been constructed from about the 16th-17th century. We demonstrate with several examples that all classifications reflect an underlying theory. The development of the notion of disease during the 17th-19th century essentially influenced disease classifications. Development of classifications currently used in computerized information systems started before the computer era, but computational aspects reshape essentially the whole picture. A new generation of classifications is expected in biomedicine that depends less on human classification effort but uses the power of automated classifiers and reasoners.

This chapter provides a brief overview of the most relevant Electronic Healthcare Record standards by examining the level of interoperability and functionality they provide in terms of context, structure, access services, multimedia support, and security. Such evaluations will provide healthcare decision-makers and system integrators with a clear perspective regarding the capabilities and limitations of each standard.

This chapter examines an integrative model of e-health use that connects social disparities at the population level with individual characteristics related to the amount and type of online health information usage, thus providing an account of the ways in which societal disparities play out in individual e-health usage patterns. Based on an overview of the literature on e-health disparities, the authors suggest that social-level disparities are manifested in the form of individual-level differences in health information orientation and health information efficacy, which in turn influence the amount and type of online health use. Exploring the underlying social structures that enable individual-level access, motivation, and ability to utilize the Internet for health and how these structures interact with individual motivation and ability advances our understanding of the Internet, the digital divide, and health disparities.

The authors of this chapter describe a distributed e-healthcare system that uses the Service Oriented Architecture as a basis for designing, implementing, deploying, invoking and managing healthcare services. The e-healthcare system that they have developed provides support for patients, physicians, nurses, pharmacists and other healthcare professionals, as well as for medical monitoring devices, such as blood pressure monitors. The system transmits e-prescriptions from physicians to pharmacists over the Internet. It offers multi-media input and output, including text, images and speech, to provide a human-friendly interface, with the computers and networks hidden from the user.

In this chapter, Mucic provides a brief review of the wide range of telepsychiatry applications. In addition, he offers a completely new and innovative approach regarding assessment and/or treatment of asylum seekers, refugees and migrants in Europe. Experiences from both a Danish telepsychiatry survey and the first international telepsychiatry collaboration in Europe are also reviewed in this chapter. Benefits within mental health care systems all over the European Union can be achieved by establishing an International European Telepsychiatry Network. The chapter concludes by providing suggestions for future development within mental health services in EU.

In this chapter, the author discusses several marketing principles and issues related to pitfalls and successes of Telehealth application in the case of a web-based wellness program called Wellness Online Program (WOLP). WOLP takes a holistic approach to health or ‘wellness’ and runs for six weeks. It aims to help individuals to manage and improve their own well being regardless of geographical location. Findings show that the creation of WOLP to deliver wellness among individuals outside the primary healthcare environment is possibly cheaper, more convenient, and more accessible than the primary healthcare setting. However, issues regarding web-based wellness program implementation are very important and it is crucial for service providers to thoroughly analyze the program, as this will determine its success.

This chapter describes a web-based application to store and exchange Electronic Health Records (EHR) and medical images in Ophthalmology: TeleOftalWeb 3.2. The web-based system has been built on Java Servlet and Java Server Pages (JSP) technologies. Its architecture is typical, as it contains three-layers with two databases. The user and authentication information is stored in a relational database: MySQL 5.0. The patient records and fundus images are achieved in an Extensible Markup Language (XML) native database: dbXML 2.0. The application uses XML-based technologies and Health Level Seven/Clinical Document Architecture (HL7/CDA) specifications. The EHR standardization is carried out. The main application object is the universal access to the diabetic patients EHR by physicians wherever they are.

This chapter mainly focuses on biomedical knowledge representation and its use in biomedicine. It first illustrates the existing resources and explains why they need to be better integrated. Then, the authors describe the main problems that machines can encounter in processing the factual biomedical knowledge and explain what terminologies, classifications and ontologies are and why they could help in better organizing and exploiting the bioinformatics resources available online. The authors hope that a concise perspective of the field and a list of selected resources may help interested people quickly understand the main principles of knowledge representation in biomedicine and its high relevance for modern biomedical research and e-health.

The registration of corresponding patient volumes is often a pre-requisite for medical imaging tasks. Accurate alignment, however, usually results in high computational complexity and can hence take a considerable amount of time. This is particularly true with 3-D volume data which adds another dimension to the registration process. One possibility of keeping registration times feasible is to distribute computation among several processors so that it may be accomplished in parallel. This chapter provides a short survey of parallel registration approaches which have been proposed together with some recent research adopting blackboard architecture for distributed high performance image and volume registration purposes.

Within this chapter, the author summarizes literature about online commerce for health products and describes some of the most popular products and the methodology for guiding consumers to quality products. This paper also presents and analyzes the characteristics and criteria of one particular internet health company and its web site. Suggestions for encouraging the effectiveness of electronic health commerce are provided and the future of buying and selling products online is investigated.

This chapter introduces and reviews the concept of distributed knowledge management within the Healthcare environment and between Healthcare and other partner organizations. As management should not be mistaken for control, distributed should not be identified with multi-centered. Trade-offs between managerial centralism and social contextuality should be allowed. Although the core issues in knowledge management are not technological, tools that can support the central versus social dualism of knowledge management are critical to the effective and appropriate use of generated knowledge. Information tools can significantly affect the user experience and local social wiliness to participation and enhance the managerial trends that make use of knowledge networks and shared logistics. They include service-oriented architectures (SOA), artificial intelligence networks (AIN), multiple agent systems (MAS) and the contextual tools of Web 2.0. All of those tools feed their functionality on the semantic detail, the granularity and the trust levels enjoyed by their information sources.

This paper describes business and technological challenges and solutions for a successful emergency telemedicine venture called MediComm. Its objective is to provide a new generation of integrated information and communication systems, targeting medical and emergency care organizations. This system enables multi-directional transfer of information (including voice, data, fax, video) between the organization’s central information system and its mobile fleet of ambulance vehicles. MediComm enables emergency care personnel to take a patient’s vital measurements and personal information in an ambulance on the way to the hospital, send the information to the hospital, and receive from the hospital directions for the patient’s treatment during transportation. When the patient arrives into the hospital, his/her information will be already updated in the information system, and the medical personnel will be ready to provide the necessary care immediately. Thus, time will be saved, which for many patients is of critical importance. The treatment of patients will be more effective and simplified, which will result in substantially lower cost of medical care.

This chapter introduces reconfigurable design techniques for lightweight medical systems. The research presented in this chapter demonstrates how the wise use of reconfiguration in small embedded systems is an approach that is beneficial in heterogeneous medical systems. By shrewdly designing embedded systems, one can make efficient use of limited resources through efficient and effective reconfiguration schemes that balance the tradeoffs between power consumption, memory consumption, and interoperability in heterogeneous environments. Furthermore, several reconfigurable architectures and algorithms presented in this chapter will assist researchers in designing efficient embedded systems that can be reconfigured after deployment, which is an essential feature in embedded medical systems.

Evolutions in the field of telecommunications technologies have significantly contributed to the advancement and development of the field of medicine, and they have also brought forth the need for their utilization in the healthcare sector. Thus, the implementation, operational deployment of services, and promising market for telemedicine and e-Health has clearly become an important issue. Recognizing this trend, the authors of this chapter attempt to familiarize the readers with the impact that high broadband wireless networks have upon telemedicine services and with the way they facilitate the secure transmission of vital information stemming from bandwidth demanding applications in real time. After providing the readers with an overview of telemedical services and commenting on how they can offer added value to existing healthcare services, they provide an analysis of the wireless infrastructure that has facilitated telemedical services over the years, and point out the significant role that the third generation telecommunications systems can play in the field.

This chapter introduces the usage of telemedicine consultations in daily clinical practice. The author describes the process of teleconsultation along with sample schemes of systems, parties of this process and its roles. Also, the main steps of clinical teleconsultation (determination of necessity for teleconsultation, preparation of medical information, observance of ethics and law conditions, and preparation of conclusion) are shown. The efficiency of teleconsultation is also investigated and, within this discussion, the author proposes a new method for efficiency estimation. Understanding the process of teleconsultation will make it more accessible and easy-to-use for medical practitioners.

Ubiquitous healthcare has become possible with rapid advances in information and communication technologies. Ubiquitous healthcare will bring about an increased accessibility to healthcare providers, more efficient tasks and processes, and a higher quality of healthcare services. Radio Frequency Identification (RFID) is a key technology of ubiquitous healthcare and enables a fully automated solution for information delivery, thus reducing the potential for human error. This chapter provides an overview of ubiquitous healthcare and RFID applications. In this chapter, the background of ubiquitous computing and RFID technologies, current RFID applications in hospitals, and the future trends and privacy implications of RFID in hospitals are discussed.

This chapter deals with the conceptualization, design and implementation of an m-health solution to support ubiquitous, integrated and continuous health care in hospitals. Existing technologies from the computer field are widely used to improve patient care but new challenges demand the use of new communication, hardware and software technologies as a way to provide the necessary quality, security and response time at the point of care need. Mobile and distributed developments can clearly help to increase the quality of healthcare systems as well as reduce the time needed to react to emerging care demands. In this chapter, the authors discuss important issues related to m-health systems and describe a mobile application for hospital healthcare and a highly usable application that allows for patient monitoring with handheld devices.

This chapter describes issues regarding Mobile Health (M-H) and Home Care (H-C) Telecare systems, reviewing state of the art as well as theoretical and practical engineering issues crucial for designing these applications. There are several engineering fields involved in the design of modern M-H and H-C applications. Making the optimal application-specific choice in each engineering aspect and achieving the right balance between complementary coupled technological requests are of crucial importance so that critical engineering issues are also presented in detail as well. Systematic theoretical review, along with the design and realization problems given in this chapter, can contribute to better understanding crucial engineering issues and challenges as well as providing proper direction for approaching the practical realization of M-H and H-C Telecare systems.

This chapter presents an architecture for the integration of various algorithms for Digital Image Processing (DIP) into web-based information systems. The proposed environment provides the development of tools for intensive image processing and their integration into information systems by means of JAVA applets. The functionality of the system is shown through a set of tools for biomedical application. The main feature of this architecture is that it allows the application of various types of image processing, with different computational costs, through a web browser and in a transparent and user-friendly way.

This chapter discusses the concept of open-source Picture Archiving and Communication Systems (i.e. PACS), which are low cost, and easy to re-configure and customize for specific users’ needs. Open-source PACS are based on relatively low cost computational resources and are built by integrating open-source software components that implement basic services of PACS. These services, as well as how to integrate them, are described in this chapter. As an example, a PACS based on open-source software components for angiographic studies is discussed. Using the open-source approach, the authors expect to help diffusing the PACS technology by reducing its development and maintenance costs by using easily available components (e.g. desktop PCs).

This chapter introduces a Case Based Reasoning (CBR) System for customizing treatment processes. According to the CBR paradigm, which solves problems based on past experience, the proposed system uses old treatment processes of similar, former patients and modifies them for new patients. In general, CBR is an established and well suited artificial intelligence method to support medical decision making. However, CBR Systems capable of planning treatment processes by adapting old treatment processes to fit new patients are rare. The aim of this system is to increase the treatment quality of the patient by providing physicians with valuable treatment propositions and to contribute to the development of Medical CBR Systems by introducing procedures enabling the formation of new treatment processes by modifying former treatment processes.

A significant issue in health related applications is protecting a patient’s profile data from unauthorized access. In the case of telemedicine systems, a patient’s medical profile and other medical information is transferred over the network from the examination lab to the doctor's office. Patients' medical profiles should be accessible by their doctors in order to support diagnosis and care, but must also be protected from other patients, medical companies and others who are not certified by the patient to access his medical data. A very important element of virtual communities is trust. Trust should be built upon the same specifications for secure data transfer and leveled access with medical information. Furthermore, trust requires a strict policy based mechanism, which defines roles, access rights and limitation among community members, as well as a flexible identification mechanism, which allows anonymity of patients, while, at the same time, guarantees the truthfulness of doctors' identity and expertise.

This chapter aims to present various virtual learning environments for medical purposes in the world. More than ever, medical students and healthcare professionals are faced with a flood of data of which the relevant information has to be selected and applied. The internet and the new media are a fertile ground to meet these requirements. More and more physicians unravel e-learning as new tool and as attractive alternative to traditional face-to-face teaching in medicine. This chapter describes the most important benefits for all parties of the simulation and learning environments in health sciences.

Recent advances in medicine, telemedicine, computer technologies, information systems, Web applications, robotics and telecommunications have enabled new solutions for training and continued education in various medical disciplines. This paper presents the most recent developments and future trends in distance learning for surgeons, focusing on the following goals: a) Building a comprehensive, world-wide, virtual knowledge base for various disciplines of surgery and telesurgery; b) Building a virtual knowledge base for rare medical cases, conditions and recommended procedures; c) Interactive multimedia simulators for hands-on training in all surgical disciplines; d) Building a worldwide surgical community, which will accelerate the accumulation and sharing of the latest surgical breakthroughs and technological advances. Above all, the most important goal is to improve patient health and convenience, and reduce risks of mortality and complications.

The authors of this chapter show how recent computing technologies such as collaborative virtual environments, high speed networks and mobile devices can be used for training and learning in healthcare providing an environment with security and quality of service. Though a number of studies have been conducted in these research areas, the development of integrated care has proven to be a difficult task. Therefore, we aim also to discuss the promising directions of the current work and growing importance on these subjects. This includes comparative analysis of the most relevant computer systems and applications developed so far that integrate modern computing technologies and health care.

A major issue facing medical education training programs across the USA is the recent advent of universal mandatory duty hour limitations and the time pressure it places on formal face-to-face educational sessions. In response to these mandates, many medical education programs are exploring the use of online instruction. This chapter describes the instructional development process followed to transform a classroom-based pediatrics residency lecture series into an on-demand, video-enhanced, online instructional environment. An overview of the learning principles and instructional sciences that guided the design process is provided. The phases of the designed solution are then described in the context of enhancing the lecture series as it was transformed into online instruction. Implementation logistics are described followed by an overview of the benefits, barriers, and initial project outcomes. Plans for future enhancements and research projects are also discussed.

In this chapter, the authors investigate telehealth quality and reliability assurance. Various models and standards can be applied to assess software quality and reliability in telehealth platforms. Models that assess the quality of the system and the quality of care are presented and approaches based on user satisfaction and expectations. The underlying structural model is based on a modified SERVQUAL approach that consists of five dimensions, which have been consistently ranked by customers to be most important for service quality across all industries. The model can thus be used for evaluation of healthcare services and for planning improvements on services. All these aspects for telehealth systems design are discussed to formulate epistemic criteria for evaluation purposes.

Of the over 100 million web sites in existence, there are an estimated 100,000 offering health related information. As the amount of health information increases, the public finds it increasingly difficult to decide what to accept and what to reject. The challenge for consumers is to find high quality, relevant information as quickly as possible. The purpose of this chapter is to provide a brief overview of the different perspectives on information quality and to review the main criteria for assessing the quality of health information on the internet. Pointers are provided to enable both clinicians and patients find high quality information sources.

This chapter provides a practical approach to computerized system validation (CSV). Any computer system can be validated utilizing the techniques described. These activities address the organization commitment to implement the underlying system in order to improve, ensure and maintain the quality standards. The CSV is described as a reference and an orientation guide to understand the related quality processes. The activities presented should be useful for initiating and conducting the principal tasks of validation. This paper reflects a quick guide and addresses one of the “non-technical” aspects of CSV methodology. A clear approach is presented that defines the CSV activities and provides an efficient means of validation to new and existing systems, applications, and environments within the organization.

Ergophysiology, a division of physiology, helps us understand movement in the human body and assists us in creating models and methodologies to understand the mechanisms responsible for movement. Various internal or external conditions impact human movement and if we recognize these problems, we will be able to create scientific methodologies to work to improve the lives of affected individuals. Within this chapter, the authors use the statistical method SF12V2 to organize and select personal information from different individuals and to recognize different problems that affect their daily lives. Using ergophysiological research methodologies, SF12V2 allows researchers to organize the selected data regarding health and kinetics ability level from various individuals.

Current advances in sensing devices and wireless technologies provide an opportunity for improving care quality and reducing medical costs. This chapter presents the architecture of a mobile healthcare system and provides an overview of mobile health applications. Furthermore, it proposes a framework for patient monitoring that performs real-time stream analysis of data collected by non-invasive body sensors. It evaluates a patient’s health conditions by analyzing different physiological signals to identify anomalies and activate alarms in risk situations. A risk function for identifying the instantaneous risk of each physiological parameter has been defined. The performance of the proposed system has been evaluated on public physiological data and promising experimental results are presented. By understanding the challenges and the current solutions of informatics appliances described in this chapter, new research areas can be further investigated to improve mobile healthcare services and design innovative medical applications.

Within this chapter the author describes the observation, within his energy diagnostic department, of an increasing number of cases with irrational stimulus-reaction-patterns and with a chaotic regulation state of the autonomous systems. The ‘Switching phenomenon’ was offered as an immediate answer, however, a new cause for this phenomenon also arose— electrosmog exposure. Three criteria were used to clarify the findings: A) a negative reaction on a pulsating magnetic field, B) a positive reaction on a brain synchronization procedure, and C) the frequency distribution analysis of skin resistance values approximated by a lognormal (order) or by a bell curve (chaos). A retrospective evaluation over 4 years (435 patients) was performed. Results: 1) a positive correlation between the criterium A) and a chaotic tendency in C), and 2) a significant difference between reactions before and after the synchronization procedure B). The hypothesis of an electrosmog-induced chaotization of autonomous systems becomes likely.

This current research on Internet healthcare information and government services only represents an initial step in exploring the impact of online health searches and does not discuss the policy implication of these findings. To minimally understand the healthcare consequences of disparities in Internet usage in the U.S., one needs to examine if telehealth is changing how citizens take care of themselves and others. This chapter discusses these behavioral outcomes and the policy implications. In exploring this issue, this chapter will first examine the literature on barriers to the promises of e-government with a focus on the digital divide. Next, it will outline government policy toward eliminating barriers to Internet use. Finally, multivariate regression analysis will be used to empirically test the impact of one example of telehealth (seeking medical information online) and behavior directed toward improving and maintaining health.