Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care.

In this paper, we review the results of BIOINFOMED, a study funded by the European Commission (EC) with the purpose to analyse the different issues and challenges in the area where Medical Informatics and Bioinformatics meet. Traditionally, Medical Informatics has been focused on the intersection between computer science and clinical medicine, whereas Bioinformatics have been predominantly centered on the intersection between computer science and biological research. Although researchers from both areas have occasionally collaborated, their training, objectives and interests have been quite different. The results of the Human Genome and related projects have attracted the interest of many professionals, and introduced new challenges that will transform biomedical research and health care. A characteristic of the 'post genomic' era will be to correlate essential genotypic information with expressed phenotypic information. In this context, Biomedical Informatics (BMI) has emerged to describe the technology that brings both disciplines (BI and MI) together to support genomic medicine. In recognition of the dynamic nature of BMI, institutions such as the EC have launched several initiatives in support of a research agenda, including the BIOINFOMED study.

Establishing an agenda for biomedical informatics.

OBJECTIVE: To describe potential areas of collaboration between Medical Informatics (BI) and Bioinformatics (BI) and their effects on planning future work in both disciplines. METHODS: Some reflections on the objectives and rationale underpinning MI and BI are given, and preliminary results from the BIOINFOMED workgroup, supported by the European Commission, are introduced. RESULTS: Applications from both subfields suggest topics for sharing and exchange between the subfields within the emerging field of Biomedical Informatics. CONCLUSIONS: We suggest how the nature and degree of collaboration between the sub-disciplines can impact future work in molecular medicine.

Correcting organ motion artifacts in x-ray CT medical imaging systems by adaptive processing. I. Theory.

X-ray CT scanners provide images of transverse cross sections of the human body from a large number of projections. During the data acquisition process, which usually takes about 1 s, motion effects such as respiration, cardiac motion, and patient restlessness produce artifacts that appear as blurring, doubling, and distortion in the reconstructed images, and may lead to inaccurate diagnosis. To address this problem several processing techniques have been proposed that require a priori knowledge of the motion characteristics. This paper proposes a method, which makes no assumptions about the properties of the motion, to eliminate the motion artifacts. The approach in this paper uses a spatial overlap correlator scheme to accurately track organ motion in computed tomography imaging systems. Then, it is shown that as optimum processing scheme to remove organ motion effects is to apply adaptive interference cancellation (AIC) methods, which treat the output of the spatial overlap correlator as noise interference at the input of the AIC process. Furthermore, an AIC method does not require any kind of periodicity of the motion effects. Synthetic data tests demonstrate the validity of this approach and show that hardware modifications are essential for its implementation in x-ray CT medical imaging systems.

Medical informatics and bioinformatics: European efforts to facilitate synergy.

Over the past decade there have been several attempts to rethink the basic strategies and scope of medical informatics. Meanwhile, bioinformatics has only recently experienced a similar debate about its scientific character. Both disciplines envision the development of novel diagnostic, therapeutic, and management tools, and products for patient care. A combination of the expertise of medical informatics in developing clinical applications and the focused principles that have guided bioinformatics could create a synergy between the two areas of application. Such interaction could have a great influence on future health research and the ultimate goal, namely continuity and individualization of health care. This article summarizes current activities related to facilitating synergy between medical informatics and bioinformatics, emphasizing activities in Europe while relating them to efforts in other parts of the world. The report provides examples of the analysis that European investigators are carrying out, aiming to propose new ideas for collaborations between medical informatics and bioinformatics researchers in a variety of areas.

Improving user acceptance of health-care telematics.

Telehealth represents a new approach to health-care with the potential for improving accessibility and reducing costs. Over the years, technology has become increasingly interactive, cheaper and standardized. Despite this, the uptake of technology has been low. One of the main reasons is that the introduction of telematics in health-care requires more than technology and software--organizational and cultural change is required as well. A suggested approach is based on the principles of service quality and quality management, to produce a partnership between the users and the developers of new technologies. This will in turn make it possible to bring user-validated requirements into the design of the system and create feelings of ownership and motivation on the part of users, in order to prepare their environment for the change. The methodology has been effectively used in various projects of the Telematics Application Programme of the European Commission.

Towards a health telematics infrastructure in the European Union.

Over the last decade information and communication technologies--telematics technologies--have demonstrated their potential to improve the quality, access and efficiency of health care. Health telematics applications are presently revolutionizing the developments not only in diagnosis, treatment, surveillance and rehabilitation of patients, but also on the side of the more collective aspects of health care and health prevention such as clinical trials, epidemiology and health education. Moreover, for the first time in the history of health care the emerging Health Information Infrastructure (HII), i.e. telematics networks together with a set of technologies, health telematics applications and services, is making possible the rapid dissemination and sharing of health information and research results. This is leading to knowledge creation and to promotion of innovative approaches based on evidence collected in medical practice all over the world.

Towards personal health record: current situation, obstacles and trends in implementation of electronic healthcare record in Europe.

In this article, we define the electronic healthcare record and present its purpose as a tool for continuity of care. We briefly describe the current situation of usage and focus on the major challenges to wide implementation in Europe and beyond. Finally, we point out trends that show stronger involvement of the patients-citizens in the health care prevention and promotion processes, and discuss the impact on the future development of the electronic healthcare record into personal health records.

Convincing cases: important component of user acceptance.

This paper is presenting the rational that lead to the organisation of the European workshop on Acceptance of Telematics Applications by Healthcare Professionals "Looking for the convincing cases," that took place in Thesaloniki 12-13 December, 1997. A brief overview is presented of the health telematics sector, the current situation of the usage of some applications, and major challenges towards wide implementation of health telematics applications. It focuses on user acceptance as one of the critical challenges towards wider implementation. It concludes that the support and promotion "Convincing cases" are important components contributing to user acceptance.

From electronic medical record to personal health records: present situation and trends in European Union in the area of electronic healthcare records.

In this article we define the electronic healthcare record (EHR) and present its purpose as a tool for continuity of care. We consider the EHR system as a necessary tool for collaborative work of healthcare professionals linking the traditional stand alone physician's systems or departmental systems, which we refer to here as electronic medical record systems. We briefly describe the current usage of electronic medical records in EU and focus on the major challenges to wide implementation of electronic healthcare record systems. Finally, we point out trends that show stronger involvement of patients (citizens) in the health care process and discuss the impact on future EHR systems. We call the next generation of EHR that takes into account the new role of citizens Personal Health Records.

From electronic medical record to personal health record.

In this paper we attempt to provide a definition and purpose for the electronic patient record, point out the benefits of its use and outline the major challenges in wider implementation that are encountered world-wide. Finally, some trends are highlighted that are believed to play an important role in the future development and use of the electronic patient record.

Improving Tikhonov regularization with linearly constrained optimization: application to the inverse epicardial potential solution.

Two methods to improve on the accuracy of the Tikhonov regularization technique commonly used for the stable recovery of solutions to ill-posed problems are presented. These methods do not require a priori knowledge of the properties of the solution or of the error. Rather they exploit the observed properties of overregularized and underregularized Tikhonov solutions so as to impose linear constraints on the sought-after solution. The two methods were applied to the inverse problem of electrocardiography using a spherical heart-torso model and simulated inner-sphere (epicardial) and outer-sphere (body) potential distributions. It is shown that if the overregularized and underregularized Tikhonov solutions are chosen properly, the two methods yield epicardial solutions that are not only more accurate than the optimal Tikhonov solution but also provide other qualitative information, such as correct position of the extrema, not obtainable using ordinary Tikhonov regularization. A heuristic method to select the overregularized and underregularized solutions is discussed.

A model study of instability of the inverse problem in electrocardiography.

The inverse problem in electrocardiography is studied analytically using a concentric spheres model with no symmetry assumptions on the potential distribution. The mathematical formulation is presented, and existence and uniqueness of the solution are briefly discussed. Solution to the inverse problem is inherently very unstable. The magnitude of this instability is demonstrated using the derived analytical inverse solution for the spherical model. Regularization methods used to date are based on a regularization parameter that does not relate to any measurable physiological parameters. This paper presents a regularization method that is based on a parameter in the form of an a priori bound on the L2 norm of the inverse solution. Such a bound can be obtained from the theoretical estimates based on the measured values of the body surface potentials together with experimental knowledge about the magnitudes of the epicardial potentials. Based on the presented regularization, an exact form of the regularized solution and estimates of its accuracy are derived.