Handbook of Research on Distributed Medical Informatics and E-Health docx

Handbook of Research on
Distributed Medical
Informatics and E-Health
Athina A. Lazakidou
University of Peloponnese, Greece
Konstantinos M. Siassiakos
University of Piraeus, Greece
Hershey • New York
Medical inforMation science reference
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Library of Congress Cataloging-in-Publication Data
Handbook of research on distributed medical informatics and e-health / Athina A. Lazakidou and Konstantinos M. Siassiakos, editors.
p. ; cm.
Includes bibliographical references and index.
Summary: "This book provides a compendium of terms, denitions and explanations of concepts, processes and acronyms related to
different areas, issues and trends in Distributed Medical Informatics, E-Health and M-Health" Provided by publisher.
ISBN 978-1-60566-002-8 (h/c)
1. Medical telematics Handbooks, manuals, etc. I. Lazakidou, Athina A., 1975- II. Siassiakos, Konstantinos M.
[DNLM: 1. Telemedicine methods. 2. Medical Informatics Applications. W 83.1 H236 2009]
R119.95.H36 2009
610.285 dc22
2008014431
British Cataloguing in Publication Data
A Cataloguing in Publication record for this book is available from the British Library.
All work contributed to this book set is original material. The views expressed in this book are those of the authors, but not necessarily of
the publisher.
If a library purchased a print copy of this publication, please go to for information on activating the
library's complimentary electronic access to this publication.
Editorial Advisory Board
Sotirios Bisdas
Johann Wolfgang Goethe University, Germany
Andriani Daskalaki
Max Planck Institute of Molecular Genetics,
Germany

Iordanis Evangelou
National Institutes of Health, USA
Anastasia Kastania
Athens University of Economics & Business,
Greece
Konstantinos Konstantinidis
General Hospital Salzburg, Austria
Melpomeni Lazakidou
Institute of Occupational Medicine, Salzburg,
Austria
List of Contributors
Alamantariotou, Kleopatra / City University London, UK 443
Antunes, Luís / LIACC University of Porto, Portugal 30
Apiletti, Daniele / Politecnico di Torino, Italy 478
Apostolakis, I. / National School of Public Health, Greece 367
Baralis, Elena / Politecnico di Torino, Italy 478
Basu, Ambar / University of South Florida, USA 104
Bodie, Graham D. / Louisiana State University, USA 104
Bountis, Christos / Oxford Radcliffe Hospitals, UK 198
Brisk, Philip / Ecole Polytechnique Federale de Lausanne, Switzerland 228
Bruno, Giulia / Politecnico di Torino, Italy 478
Capilla, Rafael / Universidad Rey Juan Carlos, Spain 282
Ceresa, Mario / Politecnico di Milano, Italy 165
Cerquitelli, Tania / Politecnico di Torino, Italy 478
Chadwick, David / University of Kent, UK 30
Chryssanthou, A. / Greek Data Protection Agency, Greece 367
Coronado, Miguel López / University of Valladolid, Spain 152
Crespo, Jesús Poza / University of Valladolid, Spain 152
Cruz-Correia, Ricardo / CINTESIS, Portugal & University of Porto, Portugal 30
Dabiri, Foad / University of California, USA 228

de la Torre Díez, Isabel / University of Valladolid, Spain 152
del Río, Alfonso / Universidad Rey Juan Carlos, Spain 282
Doepp, Manfred / Holistic DiagCenter, Germany 493
Dorado de la Calle, Julian / University of A Coruña, Spain 325
Doyle, D. John / Cleveland Clinic Foundation, USA 17
Drougas, Bill Ag. / HATRLab, Greece & Higher Technological Institute of Epirus, Greece 190
Dutta, Mohan J. / Purdue University, USA 104
Ferreira, Ana / University of Kent, UK & LIACC University of Porto, Portugal 30
Filho, Raimir Holanda / Universidade de Fortaleza, Brazil 399
Gálvez, María Isabel López / University of Valladolid, Spain 152
Hussain, Kashif / University of Valenciennes et Hainaut de Cambrésis, France 456
Ilioudi, Stamatia / University of Piraeus, Greece 382
Ilioudi, Christina / University of Piraeus, Greece 382
Jafari, Roozbeh / University of Texas, USA 228
Kaiser, Carolin / University of Erlangen-Nuremberg, Germany 351
Kart, Firat / University of California, Santa Barbara, USA 117
Kastania, Anastasia / Athens University of Economics and Business, Greece 425
Keeroo, Sandhya / C-DAC School of Advanced Computing, Mauritius 1
Kitsiou, Spyros / University of Macedonia Economic and Social Science, Greece 84
Koszalka, Tiffany A. / Syracuse University, USA 410
Koutsouris, Dimitris / National Technical University of Athens, Greece 241
Lee, Cheon-Pyo / Carson-Newman College, USA 273
Leleu-Merviel, Sylvie / University of Valenciennes et Hainaut de Cambrésis, France 456
Manthou, Vicky / University of Macedonia, Greece 84
Masseroli, Marco / Politecnico di Milano, Italy 165
Massey, Tammara / University of California, USA 228
Mbarika, Victor W.A. / Southern University, USA & A&M College, USA 1
McNeal, Ramona / University of Northern Iowa, USA 500
Melliar-Smith, P. M. / University of California, Santa Barbara, USA 117
Miao, Gengxin / University of California, Santa Barbara, USA 117

Moser, L. E. / University of California, Santa Barbara, USA 117
Mucic, Davor / Psychiatric Centre Little Prince, Denmark 129
Mughal, Shazia Yasin / University of Valenciennes et Hainaut de Cambrésis, France 456
Noshadi, Hyduke / University of California, USA 228
Novóa de Manuel, Francisco Javier / Center of Medical Informatics and Radiological Diagnosis &
University of Corunna, Spain 325
Olson, Bradley / SUNY Upstate Medical University, USA 410
Omar, Azizah / Universiti Sains Malaysia, Malaysia 137
Ordóñez, Juan Luis Pérez / UCenter of Medical Informatics and Radiological Diagnosis &
University of Corunna, Spain 325
Perakis, Konstantinos / National Technical University of Athens, Greece 241
Prakash, Nupur / Gura Gobind Singh Indraprastha University, India 1
Rodrigues, Maria Andréia F. / Universidade de Fortaleza, Brazil 399
Sánchez, José Antonio / Universidad Politécnica de Madrid, Spain 282
Sánchez, Roberto Hornero / University of Valladolid, Spain 152
Sarrafzadeh, Majid / University of California, USA 228
Schaefer, Gerald / Aston University, UK 180
Scharcanski, Jacob / Instituto deo Informatica—Universidade Federal do Rio Grande do Sul,
Brazil 338
Schmeida, Mary / The Cleveland Clinic, USA 500
Seoane Fernández, José Antonio / Articial Neural Networks and Adaptative Systems Group &
University of Corunna, Spain 325
Seth, Ankur / Adobe Systems, India 1
Sevdalli, Maria / Higher Technological Institute of Kalamata, Greece 470
Shim, J.P. / Mississippi State University, USA 273
Siassiakos, Konstantinos / University of Piraeus, Greece 382
Sood, Sanjay P. / C-DAC School of Advanced Computing, Mauritius 1
Surján, György / National Institute for Strategic Health Research, Hungary 48
Tafa, Žilbert / University of Montenegro, Montenegro 305
Tait, Roger / Nottingham Trent University, UK 180

Valero, Miguel Ángel / Universidad Politécnica de Madrid, Spain 282
Varlamis, I. / University of Peloponnese, Greece 367
Veiguela Blanco, Noha / Articial Neural Networks and Adaptative Systems Group &
University of Corunna, Spain 325
Vlachopoulou, Maro / University of Macedonia Economic and Social Science, Greece 84
Vladzymyrskyy, Anton V. / Association for Ukrainian Telemedicine and eHealth Development &
Donetsk R&D Institute of Traumatology and Orthopedics, Ukraine 260
Vucetic, Jelena / Alpha Mission, Inc., USA 215, 390
Welfer, Daniel / Instituto de Informatica—Universidade Federal do Rio Grande do Sul, Brazil 338
Zimeras, Stelios / University of the Aegean, Greece 425
Preface xxvii
Acknowledgment xxviii
Section I
Medical Data and Health Information Systems
Chapter I
Medical Informatics: Thirty Six Peer-Reviewed Shades 1
Sanjay P. Sood, C-DAC School of Advanced Computing, Mauritius
Sandhya Keeroo, C-DAC School of Advanced Computing, Mauritius
Victor W.A. Mbarika, Southern University, USA & A&M College, USA
Nupur Prakash, Guru Gobind Singh Indraprastha University, India
Ankur Seth, Adobe Systems, India
Chapter II
Medical Privacy and the Internet 17
D. John Doyle, Cleveland Clinic Foundation, USA
Chapter III
Security of Electronic Medical Records 30
Ana Ferreira, University of Kent, UK & LIACC, University of Porto, Portugal
Ricardo Cruz-Correia, CINTESIS, Portugal & University of Porto, Portugal
Luís Antunes, LIACC, University of Porto, Portugal
David Chadwick, University of Kent, UK

Section II
Standardization and Classication Systems in Medicine
Chapter IV
The Cultural History of Medical Classications 48
György Surján, National Institute for Strategic Health Research, Hungary
Table of Contents
Chapter V
Overview and Analysis of Electronic Health Record Standards 84
Spyros Kitsiou, University of Macedonia Economic and Social Science, Greece
Vicky Manthou, University of Macedonia Economic and Social Science, Greece
Maro Vlachopoulou, University of Macedonia Economic and Social Science, Greece
Section III
Distributed E-Health Communication Systems and Applications
Chapter VI
The Integrative Model of E-Health Use 104
Graham D. Bodie, Louisiana State University, USA
Mohan J. Dutta, Purdue University, USA
Ambar Basu, University of South Florida, USA
Chapter VII
A Distributed E-Healthcare System 117

Firat Kart, University of California, Santa Barbara, USA
Gengxin Miao, University of California, Santa Barbara, USA
L. E. Moser, University of California, Santa Barbara, USA
P. M. Melliar-Smith, University of California, Santa Barbara, USA
Chapter VIII
Telepsychiatry Within European E-Health 129
Davor Mucic, Psychiatric Centre Little Prince, Denmark
Chapter IX
Pitfalls and Successes of a Web-Based Wellness Program 137

Azizah Omar, Universiti Sains Malaysia, Malaysia
Chapter X
A Web-Based Application to Exchange Electronic Health Records and
Medical Images in Ophthalmology 152
Isabel de la Torre Díez, University of Valladolid, Spain
Roberto Hornero Sánchez, University of Valladolid, Spain
Miguel López Coronado, University of Valladolid, Spain
Jesús Poza Crespo, University of Valladolid, Spain
María Isabel López Gálvez, University of Valladolid, Spain
Chapter XI
Clinical and Biomolecular Ontologies for E-Health 165
Mario Ceresa, Politecnico di Milano, Italy
Marco Masseroli, Politecnico di Milano, Italy
Chapter XII
Distributed Medical Volume Registration 180
Roger Tait, Nottingham Trent University, UK
Gerald Schaefer, Aston University, UK
Chapter XIII
Electronic Commerce for Health Products Services-Problems-Quality and Future 190
Bill Ag. Drougas, HATRLab, Greece & Higher Technological Institute of Epirus, Greece
Chapter XIV
Distributed Knowledge Management In Healthcare 198
Christos Bountis, Oxford Radcliffe Hospitals, UK
Section IV
Wireless Telemedicine and Communications Technologies in Healthcare
Chapter XV
An Analysis of a Successful Emergency Telemedicine Venture 215
Jelena Vucetic, Alpha Mission, Inc., USA
Chapter XVI
Recongurable Embedded Medical Systems 228

Tammara Massey, University of California, USA
Foad Dabiri, University of California, USA
Roozbeh Jafari, University of Texas, USA
Hyduke Noshadi, University of California, USA
Philip Brisk, Ecole Polytechnique Federale de Lausanne, Switzerland
Majid Sarrafzadeh, University of California, USA
Chapter XVII
Third Generation (3G) Cellular Networks in Telemedicine: Technological Overview,
Applications and Limitations 241
Konstantinos Perakis, National Technical University of Athens, Greece
Dimitris Koutsouris, National Technical University of Athens, Greece
Chapter XVIII
Telemedicine Consultations in Daily Clinical Practice: Systems, Organisation, Efciency 260
Anton V. Vladzymyrskyy, Association for Ukrainian Telemedicine and eHealth Development &
Donetsk R&D Institute of Traumatology and Orthopedics, Ukraine
Chapter XIX
Ubiquitous Healthcare: Radio Frequency Identication (RFID) in Hospitals 273
Cheon-Pyo Lee, Carson-Newman College, USA
J. P. Shim, Mississippi State University, USA
Section V
Mobile Health Applications and New Home Care Telecare Systems
Chapter XX
Agile Patient Care with Distributed M-Health Applications 282
Rafael Capilla, Universidad Rey Juan Carlos, Spain
Alfonso del Río, Universidad Rey Juan Carlos, Spain
Miguel Ángel Valero, Universidad Politécnica de Madrid, Spain
José Antonio Sánchez, Universidad Politécnica de Madrid, Spain
Chapter XXI
Mobile Health Applications and New Home Care Telecare Systems: Critical Engineering Issues 305
Žilbert Tafa, University of Montenegro, Montenegro

Section VI
Distributed Problem-Solving Environments and Medical Imaging
Chapter XXII
A New System for the Integration of Medical Imaging Processing Algorithms
into a Web Environment 325
José Antonio Seoane Fernández, Articial Neural Networks and Adaptative Systems Group &
University of Corunna, Spain
Juan Luis Pérez Ordóñez, Center of Medical Informatics and Radiological Diagnosis &
University of Corunna, Spain
Noha Veiguela Blanco, Articial Neural Networks and Adaptative Systems Group &
University of Corunna, Spain
Francisco Javier Novóa de Manuel, Center of Medical Informatics and Radiological
Diagnosis & University of Corunna, Spain
Julián Dorado de la Calle, University of A Coruña, Spain
Chapter XXIII
PACS Based on Open-Source Software Components 338
Daniel Welfer, Instituto de Informatica — Universidade Federal do Rio Grande do Sul, Brazil
Jacob Scharcanski, Instituto de Informatica — Universidade Federal do Rio Grande do Sul, Brazil
Section VII
Medical Decision Support Systems
Chapter XXIV
Case Based Reasoning for Customizing Treatment Processes 351
Carolin Kaiser, University of Erlangen-Nuremberg, Germany
Section VIII
Virtual Environments in Healthcare
Chapter XXV
A Holistic Perspective of Security in Health Related Virtual Communities 367
I. Apostolakis, National School of Public Health, Greece
A. Chryssanthou ,
Greek Data Protection Agency, Greece

I. Varlamis, University of Peloponnese, Greece
Chapter XXVI
Virtual Learning Environments in Health 382
Stamatia Ilioudi, University of Piraeus, Greece
Christina Ilioudi, University of Piraeus, Greece
Konstantinos Siassiakos, University of Piraeus, Greece
Chapter XXVII
Multimedia Distance Learning Solutions for Surgery 390
Jelena Vucetic, Alpha Mission, Inc., USA
Chapter XXVIII
Collaborative Virtual Environments and Multimedia Communication Technologies in
Healthcare 399
Maria Andréia F. Rodrigues, Universidade de Fortaleza, Brazil
Raimir Holanda Filho, Universidade de Fortaleza, Brazi
Chapter XXIX
Transforming a Pediatrics Lecture Series to Online Instruction 410
Tiffany A. Koszalka, Syracuse University, USA
Bradley Olson, SUNY Upstate Medical University, USA
Chapter XXX
Quality and Reliability Aspects in Telehealth Systems 425
Anastasia Kastania, Athens University of Economics and Business, Greece
Stelios Zimeras, University of the Aegean, Greece
Section IX
Data Evaluation, Validation, and Quality Aspects
Chapter XXXI
Quality of Health Information on the Internet 443
Kleopatra Alamantariotou, City University London, UK
Chapter XXXII
A Practical Approach to Computerized System Validation 456
Kashif Hussain, University of Valenciennes et Hainaut de Cambrésis, France

Shazia Yasin Mughal, University of Valenciennes et Hainaut de Cambrésis, France
Sylvie Leleu-Merviel, University of Valenciennes et Hainaut de Cambrésis, France
Chapter XXXIII
Organization and Evaluation of Experimental Measurements of Ergophysiological Data
with the Method of SF12V2 470
Bill Ag Drougas, HATRLab & Higher Technological Institute of Epirus, Greece
Maria Sevdali, Higher Technological Institute of Kalamata, Greece
Chapter XXXIV
Ubiquitous Risk Analysis of Physiological Data 478
Daniele Apiletti, Politecnico di Torino, Italy
Elena Baralis, Politecnico di Torino, Italy
Giulia Bruno, Politecnico di Torino, Italy
Tania Cerquitelli, Politecnico di Torino, Italy
Section X
Ethical, Legal, and Other Issues in E-Health
Chapter XXXV
Chaotization of Human Systems by Technical Electromagnetic Fields 493
Manfred Doepp, Holistic DiagCenter, Germany
Chapter XXXVI
Demographic Differences in Telehealth Policy Outcomes 500
Mary Schmeida, The Cleveland Clinic, USA
Ramona McNeal, University of Northern Iowa, USA
Compilation of References 509
About the Contributors 550
Index 566
Preface xxvii
Acknowledgment xxviii
Section I
Medical Data and Health Information Systems
Chapter I

Medical Informatics: Thirty Six Peer-Reviewed Shades 1
Sanjay P. Sood, C-DAC School of Advanced Computing, Mauritius
Sandhya Keeroo, C-DAC School of Advanced Computing, Mauritius
Victor W.A. Mbarika, Southern University, USA & A&M College, USA
Nupur Prakash, Guru Gobind Singh Indraprastha University, India
Ankur Seth, Adobe Systems, India
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 denitions
of medical informatics. Additionally, they use MeSH (medical subject headings) descriptors relevant to
medical informatics to map 36 peer-reviewed denitions. Ultimately, the authors believe that this research
will serve as a handy and an informative resource and may also catalyze further research.
Chapter II
Medical Privacy and the Internet 17
D. John Doyle, Cleveland Clinic Foundation, USA
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.
Detailed Table of Contents
Chapter III
Security of Electronic Medical Records 30
Ana Ferreira, University of Kent, UK & LIACC, University of Porto, Portugal
Ricardo Cruz-Correia, CINTESIS, Portugal & University of Porto, Portugal
Luís Antunes, LIACC, University of Porto, Portugal
David Chadwick, University of Kent, UK
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’ workow, there
are some barriers that prevent its successful use. These barriers comprise not only costs, regarding re-
sources and time, but also patient / health professional relations, ICT (information and communication

technologies) education as well as security issues. It is very difcult to evaluate EMR systems; however
some studies already made show problems regarding usability and proper healthcare workow modeling.
Legislation to guide the protection of health information systems is also very difcult 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
workow complexity.
Section II
Standardization and Classication Systems in Medicine
Chapter IV
The Cultural History of Medical Classications 48
György Surján, National Institute for Strategic Health Research, Hungary
This chapter outlines the history of medical classications in a general cultural context. Classication
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 classications, particularly medical clas-
sications have been constructed from about the 16
th
-17
th
century. We demonstrate with several examples
that all classications reect an underlying theory. The development of the notion of disease during the
17
th
-19
th
century essentially inuenced disease classications. Development of classications currently
used in computerized information systems started before the computer era, but computational aspects
reshape essentially the whole picture. A new generation of classications is expected in biomedicine that
depends less on human classication effort but uses the power of automated classiers and reasoners.
Chapter V
Overview and Analysis of Electronic Health Record Standards 84

Spyros Kitsiou, University of Macedonia Economic and Social Science, Greece
Vicky Manthou, University of Macedonia Economic and Social Science, Greece
Maro Vlachopoulou, University of Macedonia Economic and Social Science, Greece
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.
Section III
Distributed E-Health Communication Systems and Applications
Chapter VI
The Integrative Model of E-Health Use 104
Graham D. Bodie, Louisiana State University, USA
Mohan J. Dutta, Purdue University, USA
Ambar Basu, University of South Florida, USA
This chapter examines an integrative model of e-health use that connects social disparities at the popu-
lation 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 efcacy, which in turn inuence 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.
Chapter VII
A Distributed E-Healthcare System 117

Firat Kart, University of California, Santa Barbara, USA
Gengxin Miao, University of California, Santa Barbara, USA
L. E. Moser, University of California, Santa Barbara, USA
P. M. Melliar-Smith, University of California, Santa Barbara, USA

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.
Chapter VIII
Telepsychiatry Within European E-Health 129
Davor Mucic, Psychiatric Centre Little Prince, Denmark
In this chapter, Mucic provides a brief review of the wide range of telepsychiatry applications. In ad-
dition, 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 rst international telepsychiatry collaboration in Europe are also reviewed in this chapter. Ben-
ets 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.
Chapter IX
Pitfalls and Successes of a Web-Based Wellness Program 137
Azizah Omar, Universiti Sains Malaysia, Malaysia
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 set-
ting. 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.
Chapter X
A Web-Based Application to Exchange Electronic Health Records and

Medical Images in Ophthalmology 152
Isabel de la Torre Díez, University of Valladolid, Spain
Roberto Hornero Sánchez, University of Valladolid, Spain
Miguel López Coronado, University of Valladolid, Spain
Jesús Poza Crespo, University of Valladolid, Spain
María Isabel López Gálvez, University of Valladolid, Spain
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) specications. The EHR standardization is carried out. The main ap-
plication object is the universal access to the diabetic patients EHR by physicians wherever they are.
Chapter XI
Clinical and Biomolecular Ontologies for E-Health 165
Mario Ceresa, Politecnico di Milano, Italy
Marco Masseroli, Politecnico di Milano, Italy
This chapter mainly focuses on biomedical knowledge representation and its use in biomedicine. It
rst 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, classications 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 eld 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.
Chapter XII
Distributed Medical Volume Registration 180
Roger Tait, Nottingham Trent University, UK
Gerald Schaefer, Aston University, UK

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 dimen-
sion 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 registra-
tion purposes.
Chapter XIII
Electronic Commerce for Health Products Services-Problems-Quality and Future 190
Bill Ag. Drougas, HATRLab, Greece & Higher Technological Institute of Epirus, Greece
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 chapter also presents and analyzes the characteristics and criteria of one particular inter-
net 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.
Chapter XIV
Distributed Knowledge Management In Healthcare 198
Christos Bountis, Oxford Radcliffe Hospitals, UK
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 identied 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 signicantly 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-ori-
ented architectures (SOA), articial 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.

Section IV
Wireless Telemedicine and Communications Technologies in Healthcare
Chapter XV
An Analysis of a Successful Emergency Telemedicine Venture 215
Jelena Vucetic, Alpha Mission, Inc., USA
This chapter 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 eet 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 simplied, which will result
in substantially lower cost of medical care.
Chapter XVI
Recongurable Embedded Medical Systems 228
Tammara Massey, University of California, USA
Foad Dabiri, University of California, USA
Roozbeh Jafari, University of Texas, USA
Hyduke Noshadi, University of California, USA
Philip Brisk, Ecole Polytechnique Federale de Lausanne, Switzerland
Majid Sarrafzadeh, University of California, USA
This chapter introduces recongurable design techniques for lightweight medical systems. The research
presented in this chapter demonstrates how the wise use of reconguration in small embedded systems
is an approach that is benecial in heterogeneous medical systems. By shrewdly designing embedded
systems, one can make efcient use of limited resources through efcient and effective reconguration
schemes that balance the tradeoffs between power consumption, memory consumption, and interoper-

ability in heterogeneous environments. Furthermore, several recongurable architectures and algorithms
presented in this chapter will assist researchers in designing efcient embedded systems that can be
recongured after deployment, which is an essential feature in embedded medical systems.
Chapter XVII
Third Generation (3G) Cellular Networks in Telemedicine: Technological Overview,
Applications and Limitations 241
Konstantinos Perakis, National Technical University of Athens, Greece
Dimitris Koutsouris, National Technical University of Athens, Greece
Evolutions in the eld of telecommunications technologies have signicantly contributed to the ad-
vancement and development of the eld 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 transmis-
sion 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 signicant role that the third generation telecom-
munications systems can play in the eld.
Chapter XVIII
Telemedicine Consultations in Daily Clinical Practice: Systems, Organisation, Efciency 260
Anton V. Vladzymyrskyy, Association for Ukrainian Telemedicine and eHealth Development &
Donetsk R&D Institute of Traumatology and Orthopedics, Ukraine
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 teleconsul-
tation, preparation of medical information, observance of ethics and law conditions, and preparation of
conclusion) are shown. The efciency of teleconsultation is also investigated and, within this discussion,
the author proposes a new method for efciency estimation. Understanding the process of teleconsulta-
tion will make it more accessible and easy-to-use for medical practitioners.

Chapter XIX
Ubiquitous Healthcare: Radio Frequency Identication (RFID) in Hospitals 273
Cheon-Pyo Lee, Carson-Newman College, USA
J. P. Shim, Mississippi State University, USA
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 efcient tasks and processes, and a higher quality of healthcare services. Radio frequency identi-
cation (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 comput-
ing and RFID technologies, current RFID applications in hospitals, and the future trends and privacy
implications of RFID in hospitals are discussed.
Section V
Mobile Health Applications and New Home Care Telecare Systems
Chapter XX
Agile Patient Care with Distributed M-Health Applications 282
Rafael Capilla, Universidad Rey Juan Carlos, Spain
Alfonso del Río, Universidad Rey Juan Carlos, Spain
Miguel Ángel Valero, Universidad Politécnica de Madrid, Spain
José Antonio Sánchez, Universidad Politécnica de Madrid, Spain
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 eld are widely used to improve patient care but new challenges demand the use of new com-
munication, 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.
Chapter XXI

Mobile Health Applications and New Home Care Telecare Systems: Critical Engineering Issues 305
Žilbert Tafa, University of Montenegro, Montenegro
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 elds involved in the design of modern M-H and H-C
applications. Making the optimal application-specic 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.
Section VI
Distributed Problem-Solving Environments and Medical Imaging
Chapter XXII
A New System for the Integration of Medical Imaging Processing Algorithms
into a Web Environment 325
José Antonio Seoane Fernández, Articial Neural Networks and Adaptative Systems Group &
University of Corunna, Spain
Juan Luis Pérez Ordóñez, Center of Medical Informatics and Radiological Diagnosis &
University of Corunna, Spain
Noha Veiguela Blanco, Articial Neural Networks and Adaptative Systems Group &
University of Corunna, Spain
Francisco Javier Novóa de Manuel, Center of Medical Informatics and Radiological
Diagnosis & University of Corunna, Spain
Julián Dorado de la Calle, University of A Coruña, Spain
This chapter presents an architecture for the integration of various algorithms for digital image process-
ing (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.
Chapter XXIII
PACS Based on Open-Source Software Components 338
Daniel Welfer, Instituto de Informatica — Universidade Federal do Rio Grande do Sul, Brazil
Jacob Scharcanski, Instituto de Informatica — Universidade Federal do Rio Grande do Sul, Brazil
This chapter discusses the concept of open-source picture archiving and communication systems (i.e.
PACS), which are low cost, and easy to re-congure and customize for specic 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 diffus-
ing the PACS technology by reducing its development and maintenance costs by using easily available
components (e.g. desktop PCs).
Section VII
Medical Decision Support Systems
Chapter XXIV
Case Based Reasoning for Customizing Treatment Processes 351
Carolin Kaiser, University of Erlangen-Nuremberg, Germany
This chapter introduces a case based reasoning (CBR) system for customizing treatment processes. Ac-
cording to the CBR paradigm, which solves problems based on past experience, the proposed system
uses old treatment processes of similar, former patients and modies them for new patients. In general,
CBR is an established and well suited articial intelligence method to support medical decision making.
However, CBR systems capable of planning treatment processes by adapting old treatment processes
to t 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.
Section VIII
Virtual Environments in Healthcare
Chapter XXV

A Holistic Perspective of Security in Health Related Virtual Communities 367
I. Apostolakis, National School of Public Health, Greece
A. Chryssanthou ,
Greek Data Protection Agency, Greece
I. Varlamis, University of Peloponnese, Greece
A signicant issue in health related applications is protecting a patient’s prole data from unauthorized
access. In the case of telemedicine systems, a patient’s medical prole and other medical information is
transferred over the network from the examination lab to the doctor’s ofce. Patients’ medical proles
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 certied by the patient to access his
medical data. A very important element of virtual communities is trust. Trust should be built upon the
same specications for secure data transfer and leveled access with medical information. Furthermore,
trust requires a strict policy based mechanism, which denes roles, access rights and limitation among
community members, as well as a exible identication mechanism, which allows anonymity of patients,
while, at the same time, guarantees the truthfulness of doctors’ identity and expertise.
Chapter XXVI
Virtual Learning Environments in Health 382
Stamatia Ilioudi, University of Piraeus, Greece
Christina Ilioudi, University of Piraeus, Greece
Konstantinos Siassiakos, University of Piraeus, Greece
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 ood 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
benets for all parties of the simulation and learning environments in health sciences.
Chapter XXVII
Multimedia Distance Learning Solutions for Surgery 390
Jelena Vucetic, Alpha Mission, Inc., USA
Recent advances in medicine, telemedicine, computer technologies, information systems, Web applica-

tions, robotics and telecommunications have enabled new solutions for training and continued education
in various medical disciplines. This chapter 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 mul-
timedia 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.
Chapter XXVIII
Collaborative Virtual Environments and Multimedia Communication Technologies in
Healthcare 399
Maria Andréia F. Rodrigues, Universidade de Fortaleza, Brazil
Raimir Holanda Filho, Universidade de Fortaleza, Brazi
The authors of this chapter show how recent computing technologies such as collaborative virtual envi-
ronments, 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 difcult 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 ap-
plications developed so far that integrate modern computing technologies and health care.
Chapter XXIX
Transforming a Pediatrics Lecture Series to Online Instruction 410
Tiffany A. Koszalka, Syracuse University, USA
Bradley Olson, SUNY Upstate Medical University, USA
A major issue facing medical education training programs across the USA is the recent advent of univer-
sal 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 in-

structional 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 benets, barriers, and initial project outcomes. Plans for
future enhancements and research projects are also discussed.
Chapter XXX
Quality and Reliability Aspects in Telehealth Systems 425
Anastasia Kastania, Athens University of Economics and Business, Greece
Stelios Zimeras, University of the Aegean, Greece
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 satis-
faction and expectations. The underlying structural model is based on a modied SERVQUAL approach
that consists of ve 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.
Section IX
Data Evaluation, Validation, and Quality Aspects
Chapter XXXI
Quality of Health Information on the Internet 443
Kleopatra Alamantariotou, City University London, UK
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 nds it increasingly difcult to
decide what to accept and what to reject. The challenge for consumers is to nd 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 nd
high quality information sources.
Chapter XXXII

A Practical Approach to Computerized System Validation 456
Kashif Hussain, University of Valenciennes et Hainaut de Cambrésis, France
Shazia Yasin Mughal, University of Valenciennes et Hainaut de Cambrésis, France
Sylvie Leleu-Merviel, University of Valenciennes et Hainaut de Cambrésis, France
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 chapter reects a quick guide and addresses one of the “non-technical” aspects of CSV
methodology. A clear approach is presented that denes the CSV activities and provides an efcient means
of validation to new and existing systems, applications, and environments within the organization.