informed decision making (diagnoses, therapies, protocols), but always maintaining the same or
even a higher level concerning the quality of service provid
ed.

Doc@Hand

intends thus to develop, test and validate an application that



Allows transparent access to heterogeneous and geographically dispersed databases
owned by separate, but cooperating organizations;



Proactively search


primarily using push tech
nologies as opposed to traditional “pull”
approach
-

for relevant information without the need for the user to perform an explicit
query, based on domain ontology as well as static and dynamic information about the
user profile and current activities;



Pro
vides the user with representation tools and intuitive interfaces to easily filter and
navigate through the information;



Integrates existing decision support systems, and is also able to extract knowledge from
unstructured and semi
-
structured documents;



Incorporates all the above in a cooperative environment that allows virtual communities
to be created for exchanging opinions around patients or scientific issues

The integrated environment developed will be accessible from a variety of platforms like the

standard desktop PC and portable platforms such as tablet PCs, PDAs or any other mobile devices
to support the increasing mobility of Healthcare professionals, and will be validated by major
clinical institutions for full adherence to standards and regula
tions for security and sensitive data
handling.


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3.1.4.2.

DOC@HAND Objectives


The project aims to bridge the gap between patient’s related data and unstructured information
and knowledge, and to dramatically enhance the ability of doctors to explo
it this integrated
information for more effective and cost
-
effective decision
-
making.

This will be achieved by designing, developing, testing and exploiting an IT solution that




Allows transparent access to heterogeneous and geographically dispersed datab
ases
owned by separate, but cooperating organizations;



Proactively search


primarily using push technologies as opposed to traditional “pull”
approach
-

for relevant information without the need for the user to perform an explicit
query, based on domain
ontology as well as static and dynamic information about the
user profile and current activities;



Provides the user with representation tools and intuitive interfaces to easily filter and
navigate through the information;



Integrates existing decision sup
port systems, and is also able to extract knowledge from
unstructured and semi
-
structured documents;



Incorporates all the above in a cooperative environment that allows virtual communities
to be created for exchanging opinions around patients or scientifi
c issues


The Doc@Hand project will develop a system, based on a server side and a client side, which will
be the main tool for Healthcare professionals every time they need, for performing tasks such as
prescribing the best treatment option for their pati
ents, to access information and knowledge that
are located in different repositories.
The server
side is the central node of a network of
cooperating organizations, sharing their repositories


or parts of them


according to a defined
set of rules and pol
icies they have agreed upon. From an architectural point of view, this is
achieved by using WEB services based architecture, which is the most flexible approach to
implement such a feature.
The client
side can be either a desktop PC or, more appropriately,

a
mobile unit such as a tablet PC
or a notebook, as Healthcare professionals working situations
assume different connotations and distinguishing aspects according to the actual context of
applications: they exercise their competencies inside the walls of
an Hospital Wards, could visit
patients at home during rehabilitation therapies, have their own private offices where receive
patients, or perform domiciliary visits as family doctors. The mobile client of
Doc@Hand
will
become the
anytime, anywhere
assista
nt of the Healthcare professional in all of the activities
they are involved in, the intelligent gate to all the information and knowledge he might need at
any given time.

It is
envisioned that the server will most of the times be located at a Hospital pr
emises and
managed by the Hospital IS organization, though this is not an architectural requirement.

Technically, the project has as its main technological objective to design and develop an IT
system made of:

A.

An

Infrastructure
module


This module deals

with the data interoperability issue, and allows flexible and
customisable data exchange policies between the participating organizations based on
open standards (SOAP/UDDI services)

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B.

A

Semantic Subsystem



that performs intelligent, context driven searche
s on the distributed DBs. It will perform
data/text mining and knowledge extraction, exploiting the domain ontologies that will be
developed during the project.

C.

A
Profiling
module, that performs the key functions of

a.

Building and maintaining the static (e.
g. role, preferences) and dynamic (i.e. the
Personal Organizer module, able to track the user activity and feed the
Application Server with information on the current user activities) profile of the
user

b.

“Pushing” the information to the user “desktop”

D.

An

User Interaction
module that performs all functions related to the user, on both the
Application Server and the Client device:

a.

User interface

b.

Knowledge representation and navigation

E.

A
Services
module, that includes:

a.

Security and Authorization

b.

Workgroup too
ls

c.

Data Synchronization tools to keep the user device data base up
-
to
-
date with
relevant information for off
-
line operation

d.

Configuration tools


3.1.4.3.

Participant list

The following legal entities and organizations are participating in DOC@HAND
Project:


Participant.
Role*

Participant.
Number

Participant name

Participant
short name

Country

CO

1

TXT e
-
Solutions


Italy

CR

2

British Maritime Technology


UK

CR

3

NOMOS Sistema


Italy

CR

4

SSM Computer Systems


Cyprus

CR

5

Hospital Clinic


Spain

CR

6

Guy's and St. Thomas Hospital
National Health Service Trust


UK

CR

7

Universita' di Genova,
Dipartimento di Medicina Legale


Italy

Table
5



DOC@HAND Participants






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3.1.4.4.

Relevance to RIDE Project


The relevance of DOC@HAND to RIDE project is presented through the following radar
diagram:



Figure
4



DOC@HAND Radar Diagram


As depicted above DOC@HAND project mainly deals with Decision Suppo
rt Systems and
consequently the specific domain relates it with RIDE. Moreover, DOC@HAND is related with
RIDE in the areas of Business Processes, Clinical Guidelines, Messaging, and Patient Identifiers.

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3.1.5.

IST DICOEMS


Full Project Title

DIC
OEMS
, emergency risk management e
-
health platform

Framework


Sixth Framework Programme

Priority / Strategic
Objective

IST Call1


eHealth


Semantic Based Knowledge Systems

3.1.5.1.

Project Overview


DICOEMS is a STREP project aiming at providing

an integrated environment for
cooperation of actors of the medical sector (doctors, nurses and other paramedical staff)
to assist them to perform proper, i.e., quick and accurate decision making, in critical
situations, where data is collected from care p
roviders on the incident field.

DICOEMS focuses its efforts in cases of emergency situations. Under such stressed and
time critical conditions, the care provider (a medical doctor, nurse, paramedical personnel
etc.) who is in charge of the patient needs a

user
-
friendly utility to:



acquire critical medical data (such as vital signs) to assess the medical condition



offer appropriate first
-
aid



communicate the findings and patient status to a network of health experts
-
no matter
where they are physically locat
ed
-

and closely cooperate under their guidance for the
effective management of the emergency



provide information about the specific geographic area. Given this functionality, the care
provider can specify on
-
demand, real
-
time, accurate information and rece
ive precious
guidance in the management of the incident.


On the other hand, the health experts are offered a valuable set of tools and resources that
enable their early participation in handling medical emergencies, thus contributing
significantly to redu
cing risk and making informed decisions promptly.

The system allow
s

the establishment of an interactive ambulance
-
to
-
hospital
-
to external
experts collaborative system, readily available during emergencies for effective
emergency support.

DICOEMS will be a
user friendly environment that will serve as a tool to the
emergencies staff to perform activities that are relevant to evaluation, diagnosis and then
treatment in remote and critical situations, where the patient/citizen might not have
immediate access to

advanced medical laboratories for various types of analyses.

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3.1.5.2.

DICOEMS Objectives

The research scope of the project lies in the exploitation of the recent advances in these
technologies in order to design and implement a distributed eHealth

environment for
managing medical emergencies. As far as the collaboration grid is concerned, the project
deals with:



Planning and developing an effective methodology for routing and managing
collaboration requests among the peer grid nodes (i.e. the mobil
e workstations), aiming at
fast establishment of the most advisable communication paths.



Hosting a collaboration session between the involved peers, with focus on shared care by
means of transparently sharing human or material resources and knowledge.



Prov
ision of synchronous and asynchronous multimedia
-
based interaction services over
the collaborative session.



Selection of the most appropriate health experts available depending on the nature of the
incident, based on their professional profile and expertis
e as well as other aspects, such as
distance, on
-
duty schedules and duty range.



Design and integration of GPS functionality, so as to enrich the collaboration grid with
precise geographic information about the incident location and the location of distribu
ted
resources (such as care providers, specific doctors, hospital availabilities, health
facilities).



Provision of critical availability information concerning compatible blood resources and
specialised medication and equipment.



Support of a policy
-
based c
ollaboration environment that integrates roles, relationships,
user privileges, access
-
control policies, coordination of user actions, sharing of data,
delegation of responsibility and enforcement of security, with focus on the actual roles of
the peers.



I
mplementation of a mechanism for delivering alerts to the health experts, based on the
severity of the medical incident. The severity criteria that determine prioritisation of
emergency cases are specified by the health experts themselves, by means of cust
omised
rules.



Capability to communicate directly with an administration and operations center for
instruction (crucial in emergency situations) and ‘top
-
down’ management and
coordination of care provider teams that are dispersed across a disaster zone or a
n
accident field.



Implementation of a secure infrastructure and associated management processes that
engender trust among participants.



Exploitation of the widespread growth of advanced wireless technologies and broadband
networks for delivering a scalable

and reliable communications infrastructure with high
degree of connectivity within the grid.

DICOEMS further supplements the decision making process by means of providing
quick access to certified databases and digital libraries that specialize in the dia
gnosis and
treatment of medical emergencies. The push methodology is considered for giving access
on a per
-
case basis to relating medical knowledge, based on the incorporated medical
terminology that comprises the semantics of emergency incidents, medical
status and the
health specialists’ profile.

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3.1.5.3.

Participant list

The following legal entities and organizations are participating in DICOEMS Project:


Participant.
Role*

Participant.
Number

Participant name

Participant
short name

Country

CO

1

Synergia 2000

SYN

Italy

CR

2

Association Medicale
Europeenne

EMA

Spain

CR

3

LITO S.A.

LITO

Greece

CR

4

Fraternita Di Misericordia

MISMIL

Italy

CR

5

SSM Computer Systems Ltd.

SSM

Cyprus

CR

6

Guy's and St. Thomas Hospital
National Health Service Trus
t

GST

UK

CR

7

Information Management Group
Ltd.

IMG

UK

CR

8

Hospitals S.Gerardo Nuovo of
Monza

CES

Italy

Table
6



DICOEMS Participants

















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3.1.5.4.

Relevance to RI
DE Project


The relevance of DICOEMS to RIDE project is presented through the following radar diagram:



Figure
5



DICOEMS Radar Diagram


As presented in the diagram above DICOEMS is mainly related to RIDE in the area of Messagi
ng
and additionally in the areas of Decision Support Systems, Business Processes and Patient
Identifiers.

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3.1.6.

IST ARTEMIS


Full Project Title

A Semantic Web Service
-
based P2P Infrastructure for the
Interoperability of Medical Information Syst
ems

Framework


6th Framework Programme

Priority / Strategic
Objective

2.3.1.11 eHealth

3.1.6.1.

Project Overview

The Artemis project
addresses

the interoperability problem in the healthcare domain where
organizations have proprietary application
systems to access data. To exchange

healthcare

information there are different standards like HL7, GEHR or CEN's ENV 13606. Artemis project
provides an interoperability platform where organizations keep their proprietary systems, but
expose the functionali
ty through Web services.

Furthermore, an ontology based description of
these data exchange standards is proposed within the scope of Artemis infrastructure. One of the
goals of using ontologies is to
semantically mediate data

among the healthcare data exch
ange
standar
ds through semantic mediation.


The interoperability problems of medical information systems are two fold: First there are
multiple, incompatible, proprietary approaches to connecting disparate applications. Secondly,
there are more than one s
tandard to represent the same information, which in turn creates an
interoperability problem.
ARTEMIS
enable
s

medical practitioners to access patient records
securely, seamlessly through a low
-
cost peer
-
to
-
peer infrastructure, regardless of where their
pat
ients or their records might be.


ARTEMIS project
provides the healthcare industry with an ideal platform to achieve difficult
integration problems.

ARTEMIS

Web
service model
encapsulates already existing applications
and access to documents in a standard
way and
incorporates service providers, service consumers
and service registries. Currently most prominent Web service registries are Universal Descriptio
n,
Discovery, Integration (UDDI
) and electronic business XML (ebXML). There are also very
recent effor
ts to use Peer
-
to
-
peer networks based on Web s
ervices.
However both service
registries and P2P architectures available do not provide semantically enric
hed search
capabilities. In the ARTEMIS project it is
provide
d

extensions to these architectures to enab
le
discovery of the
Web
services based on
their semantic descriptions.
Medicine is one of the few
domains to have some domain knowledge in a computable form

which it is exploited in defining
the semantics of medical Web services.


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3.1.6.2.

ARTEMI
S Objectives

One of the key problems in healthcare informatics is the inability to share patient records across
enterprises. There are several standardization efforts to digitally represent clinical data such as
HL7 CDA, EHRcom and openEHR. These EHR stand
ards, which are currently under
development, aim to structure and markup the clinical content for the purpose of exchange. The
HL7 Clinical Document Architecture (CDA) is a document markup standard. It specifies the
structure and semantics of "clinical doc
uments" for the purpose of exchange. However since there
are more than one standard, it is still difficult to achieve interoperability and today the clinical
data is mostly stored in proprietary formats.



Artemis project
addresses

the interoperability pr
oblem in the healthcare domain where
organizations have proprietary application systems.

Within the scope

of the project
, Artemis
message exchange framework is developed to provide the exchange of meaningful clinical
information among healthcare institutes

through semantic mediation. The framework involves
first providing the mapping of source ontology into target message ontology
.

This mapping is
used to automatically transform the source ontology message instances into target message
instances.
T
he framew
ork proposed is generic enough to mediate between any incompatible
healthcare standards that are currently in use.


3.1.6.3.

Participant list

The following legal entities and organizations are participating in ARTEMIS Project:


Participant.
Role*

P
articipant.
Number

Participant name

Participant
short name

Country

CO

1

Software R&D Center, Middle
East Technical University

METU
-
SRDC

Turkey

CR

2

Kuratorium Offis E.V.

OFFIS

Germany

CR

3

South and East Belfast Health and
Social Services Trust

SEBT

UK

CR

4

Altec Information and
Communications Systems S.A.

ALTEC

Greece

CR

5

Tepe Teknolojik Servisler AS

Tepe
Technology

Turkey

CR

6

IT Innovation Center,
Southampton University

IT
Innovation

UK

CO

1

Software R&D Center, Middle
East Technical University


METU
-
SRDC

Turkey

Table
7



ARTEMIS Participants

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3.1.6.4.

Relevance to RIDE Project


The relevance of ARTEMIS to RIDE project is presented through the following radar diagram:




Figure
6



ARTEMI
S Radar Diagram


Artemis project addresses semantic interoperability of healthcare institutes, and provides a
technical solution to this problem through semantically enriched web services and semantic
mediation. In this respect Artemis’s results may provid
e valuable input for RIDE project.

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3.1.7.

IST SAPHIRE


Full Project Title

Intelligent Healthcare Monitoring based on Semantic
Interoperability Platform

Framework


6
th

Framework Programme

Priority / Strategic
Objective

2.4.13 Strengthening the

Integration of the ICT research
effort in an Enlarged Europe Focus: eHealth

3.1.7.1.

Project Overview

The SAPHIRE project aims to develop an intelligent healthcare monitoring and decision support

system on a platform integrating the wireless medic
al sensor data with hospital information
systems. In the

SAPHIRE project, the patient monitoring will be achieved by using agent
technology where the “agent

behavior” will be supported by intelligent clinical decision support
systems which will be based on

computerized clinical practice guidelines, and will access the
patient medical history stored in medical

information systems through semantically enriched Web
services to tackle the interoperability problem. In

this way, not only the observations received

from wireless medical sensors but also the patient medical

history will be used in the reasoning
process of the clinical decision support system. Furthermore, through a

graphical tool to be
developed, while modeling the clinical decision processes, it wil
l be possible to exploit

the
available computer
-
interpretable guideline models.


The intelligent healthcare monitoring system will be deployed through two pilot applications, one
for

homecare monitoring of cardiovascular patients in Germany; the other to m
onitor
cardiovascular patients in a

hospital in Romania. To subscribe to critical data delivery, clinicians
will simply use a Web
-
based program

indicating desired alerts, thresholds, delivery methods
(sms/e
-
mail/Web/pager) or to build a patient coverage

li
st. Once subscribed, clinicians will
immediately receive clinical notifications and reminders.


Creating such an information infrastructure requires safeguards to maintain security and privacy
of

patient data. The SAPHIRE Project proposes comprehensive sec
urity and privacy mechanisms
to

complement the infrastructure proposed. While providing these confidentiality and privacy
mechanisms, the

EU directives presenting the general principles of processing of personal data
will be taken into account.


3.1.7.2.

SAPHIRE Objectives

The medical practitioners at all levels are becoming more overloaded as the aging population of

Europe increases. The health services of the EU can claim conside
rable credit for the decline in
mortality

over the last thirty years.
However this success, particularly the fall in mortality rates
among older people,

has increased the demand for healthcare. Furthermore, there are
discrepancies in health status between the

old and new (CEE) member states due to health system
failures in t
he latter. For example, about a quarter of

the difference in mortality rates between
East and West Europe

has been attributed to
inadequacies in

healthcare. On the other hand
Information Technology, combined with recent advances in networking,

mobile commu
nications
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and wireless medical sensor technologies offers a great potential to support

healthcare
professionals and to deliver health care services at a distance hence providing the opportunities

to
improve healthcare both in the old and new (CEE) member s
tates.


The SAPHIRE project
develop
s

an intelligent healthcare
monitoring and decision support
system

to address this problem in the enlarged EU. In the SAPHIRE proj
ect, the patient monitoring is

achieved

by using agent technology wh
ere the “agent behavior
” is

supported by intelligent
decision support

systems based on clinical practice guidelines. In SAPHIRE system, patient
history stored in medical

information systems is

accessed through semantically enriched Web
services to tackle the

interoperability pro
blem. In this way, not only the observations received
from wireless medical sensors but

also the pat
ient medical history is

used in the reasoning
process.


Clinical Decision Support Systems (CDSS) broadly refer to providing clinicians or patients with

clin
ical knowledge and patient
-
related information, intelligently filtered and processed to enhance
patient

care. Recently, there has been an explosion in basic and clinical research on disease
pathophysiology and

treatment. Coupled with increased demands on h
ealthcare delivery systems,
this rapid growth has made the

practice of medicine increasingly complex. The healthcare
community response to this growing complexity

has been to develop clinical practice guidelines
to simplify and improve healthcare delivery.

As an example,

the National Guideline
Clearinghouse™ (NGC, http://www.guideline.gov/) provides a comprehensive

database of
evidence
-
based clinical practice guidelines and related documents. Despite the widespread

publication of clinical standards and prac
tice guidelines, however, healthcare professionals have
difficulties

in understanding and applying these guidelines in the clinical care setting. This
necessitates computerized

decision support systems automating clinical guidelines to support the
health p
rofessionals. One of the major

challenges in developing computerized decision support
systems is accessing the many disparate data

sources needed to retrieve patient
-
specific
information.


In the SAPHIRE project, the clinical decision support system to be
incorporated into the system
as

an agent behavior,
access patient medical history stored in medical information systems
through

semantically enriched Web services to tackle the interoperability problem. In this way,
not only the

observations received as pa
tient’s physiological signs data but also the

patient
medical history is

used in

the reasoning process. This is an essential component, because in
clinical guidelines, the physiological signs

received from wireless medical sensors, the patient
care plan an
d medical history (such as previous

diagnosis, medication list, allergy/adverse drug
reactions) all affect the clinical path to be followed. More

specifically the interoperability
problem that needs to be addressed to develop an effective intelligent

healt
hcare monitoring tool
is as follows: the data coming from the wireless medical sensors are either in

proprietary format
(for example, for electrocardiogram data, Philips’ XML ECG Data Format) or when it

conforms
to a standard, this still does not solve the

interoperability problem since there are very many

standards (again for electrocardiogram data, the available standards include: SCP
-
ECP, US Food
and Drug

Administration FDA/HL7 Annotate
d ECG, I
-
Med and ecgML). When it is

want
ed

to
integrate this data wit
h

electronic healthcare records, the problem gets more complex since
hospital information systems are also

mostly proprietary and when they conform to an interface
standard, there are again very many standards

(such as HL7v2.x, HL7v3 CDA, CEN ENV 13606
EHR
Extract, openEHR Archetypes) and thus the standards

do not achieve the aimed
interoperability. Furthermore, interoperability of data coming from various wireless

medical
sensors is also essential to infer information by combining data coming from various s
ensors.


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T
he interoperability problem in the SAPHIRE project
is addressed
by exposing the data coming
from

sensors as well as the data stored in medical information systems as semantically enriched
Web services;

that is, it is

annotate
d

both the functional
ity and the messages of these Web
services through standard

based ontologies. In this way, the “functional interoperability” which
allows different platforms to exchange

information is
solved by making use of Web services and
the “semantic interoperability


is

handled

by using ontologies based on medical standards. Using
ontologies lets different medical platforms to

interoperate

at the semantic level, since it

can

be

define
d

mappings and translations between ontologies. Such

an interoperability platf
orm

th
en
allow
s

to develop the intelligent decision support system for monitoring

the healthcare process.


The SAPHIRE system
continuously monitor
s

the patients t
hrough dedicated agents and
support
s

the healthcare professionals through intelligent
decision suppo
rt system it
develop
s

that produce
s

and send
s

alerts to the related people.


SAPHIRE Project

enable
s

healthcare professionals to study and monitor many pre
-
hospital, in

hospital and ambulatory patients any time with a high accuracy with the help of the int
elligent
decision

support system. From the point of view the patients, SAPHIRE advantages are getting
better treatment and

the possibility to be hospitalized at home. Through its homecare ap
plication,
SAPHIRE project
enhance
s
quality of life for
patients
,
improve
s

healthcare through prevention
and early detection of disease; lower
s

soaring healthcare

costs; and unburden
s

family members
and other care givers. Through its “in hospital” demonstration,

SAPHIRE

show
s

how intelligent
clinical decision support sys
tem will offload the healthcare professionals
.

3.1.7.3.

Participant list

The following legal entities and organizations are participating in SAPHIRE Project:


Participant.
Role*

Participant.
Number

Participant name

Participant short
name

Country

C
O

1

Middle East Technical
University

METU

Turkey

CR

2

Cyberfab

Cyberfab

France

CR

3

Kuratorium OFFIS e.V.

OFFIS

Germany

CR

4

ALTEC S.A. Information and
Communication Systems

ALTEC

Greece

CR

5

Institute for Automation
Bucharest

IPA

Romania

CR

6

The In
ternal Medicine and
Cardiology Department o
f
t
he
Emergency Hospital
o
f
Bucharest

SCUB

Romania

CR

7

Schuechtermann Klinik

Schuechtermann
Klinik

Germany

CR

8

Tepe Technology

TEPE

Turkey

Table
8



SAPHIRE Participants

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3.1.7.4.

Relevance to RIDE Project


The relevance of SAPHIRE to RIDE project is presented through the following radar diagram:



Figure
7



SAPHIRE Radar Diagram


SAPHIRE project addresses healthcare monitoring through a clinical decisio
n support system
supported by Clinical Guidelines. It will also address the semantic interoperability problem
Clinical Decision Support Systems, Clinical Guidelines and Semantic Interoperability are all in
the target areas of RIDE Project, hence Saphire pr
oject’s results may provide valuable input for
RIDE project.


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3.1.8.

IST CARE
-
PATHS


Project Acronym


CARE
-
PATHS

Full
Project
Title

An intelligent support environment to improve the quality of
decision processes in health communities

Framewo
rk


Sixth Framework Programme

Priority / Strategic
Objective

Priority 2
-

IST Work Programme 2003/2004/ Strategic
objective 2.3.1.11

3.1.8.1.

Project Overview

The goal of CARE
-
PATHS is to set up an intelligent operational environment for making Cl
inical
Governance effective, to support Health Professionals, Clinicians and Care Operators, in
continually improving the quality of their services and safeguarding high standards of care. The
approach adopted by CARE
-
PATHS is to exploit emerging technol
ogies in knowledge
management and semantic web for enabling the methodology of “Clinical Pathways” to
function, to be effective and to succeed. Starting from the requirements of the Users involved in
the project, in Italy and in Spain, the project wi
ll focus in the integration of the Clinical Pathways
into the daily job offering a real continuity of care in the hospital and out
-
hospital environments
in a coherent way with the workflow of clinical documents on the pilot sites


The output of the projec
t will be a set of intelligent tools for supporting Health Professionals in
authoring conceptual clinical pathways for selected group of pathologies in specific contexts,
putting them in practice in the everyday treatment of individual patients, monitoring

and
managing the variances.


3.1.8.2.

CARE
-
PATHS Objectives

From the technological point of view, the objectives are concentrated primarily, in the following
technologies of the knowledge management and distribution domains:

o

Middle
-
ware enriching t
he semantic web for clinical governance

o

Access to databases from the medical, nursing, and health services literature fully
referenced and individually graded, based upon clearly defined research methodology
and that address aspects of care thought to be t
he key drivers of
quality and cost

in
health services delivery.

o

referential tools that focuses on studies from the peer
-
reviewed medical literature
pertaining to clinical and operational efficiency, utilization of resources, cost of care, and
processes of

care and other factors that influence complications, length of stay, and
readmissions.

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o

Semantic based agents to “broker” between information sources on clinical guidelines,
evidence based medicine and the actual ambient (technology and services availabl
e,
socio/economical constraints, organizational constraints, …)

o

Integration with HER facilities and in general with the information resources available in
the Community


3.1.8.3.

Participant list

The following legal entities and organizations are p
articipating in CARE
-
PATHS Project:


Participant.
Role*

Participant.
Number

Participant name

Participant
short name

Country

CO

1

AIRIAL Conseil

AIRIAL

France

CR

2

Regional Health Care Agency of
Emilia
-
Romagna

ASR

Italy

CR

3

ITACA

ITACA

Spain

CR

4

HIT
ECH Consultants

HIT

Greece

CR

5

GL 2006

GL

UK

CR

6

PATMOS

PAT

Italy

CR

7

Azienda Ospedaliera of Parma

AOP

Italy

CR

8

Hospital La Fe’

HFE

Spain

Table
9



CARE
-
PATHS Participants

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3.1.8.4.

Relevance to RIDE Project


The r
elevance of CARE
-
PATHS to RIDE project is presented through the following radar
diagram:


Figure
8



CARE
-
PATHS Radar Diagram


As presented in the diagram above CARE
-
PATHS is related to RIDE mainly in the area of
Business Processe
s and Clinical Guidelines. Moreover, it is related in the area of Messaging, and
Electronic Health Record.


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3.1.9.

IST ACGT


Full
Project
Title

Advancing Clinico
-
Genomic Clinical Trials on Cancer

Framework


Sixth Framework Programme

Priority /
Strategic
Objective

IST Call4


Priority 2.3.11 eHealth

3.1.9.1.

Project Overview

The completion of the Human Genome Project initiated the development of many new tools to
find the mechanism behind diseases, especially cancer. While the goal is cle
ar, the path to such
discoveries has been fraught with roadblocks in terms of technical, scientific, and sociological
challenges.

ACGT aims to deliver to the cancer research community an integrated Clinico
-
Genomic ICT
environment enabled by a powerful GRID

infrastructure. In achieving this objective ACGT
addresses the design, development, integration and validation of all technologically challenging
areas of work.

GRID: delivery of a European Biomedical GRID infrastructure offering seamless mediation
serv
ices for sharing data and data
-
processing methods and tools, and advanced security;

Integration: semantic, ontology based integration of clinical and genomic/proteomic data
-

taking
into account standard clinical and genomic ontologies and metadata;

Know
ledge Discovery: Delivery of data
-
mining GRID services in order to support and improve
complex knowledge discovery processes.

The technological platform will be validated in concrete settings of advanced clinical trials on
Cancer. Pilot trials have been se
lected based on the presence of clear research objectives, raising
the need to integrate data at all levels of the human being.

ACGT promotes the principle of open source and open access, thus enabling the gradual creation
of a European Biomedical Grid on
Cancer. Hence, the project plans to introduce additional
clinical trials during its lifecycle. It is in line with EU priorities and the objectives of the IST
program. It targets the fulfilment of urgent needs of the cancer research community, a key area
of
societal importance and with a view to strengthening the integration of the European Research
Area.

3.1.9.2.

ACGT Objectives

Information arising from post
-
genomics research, and combined genetic and clinical trials on one
hand, and advances from
high
-
performance computing and informatics on the other hand is
rapidly providing the medical and scientific community with new insights, answers and
capabilities. The breadth and depth of information already available in the research community at
large pr
esents an enormous opportunity for improving our ability to reduce mortality from cancer,
improve therapies and meet the demanding individualization of care needs.

A critical set of challenges, however, currently inhibit our capacity to harvest these oppor
tunities.
Up to now, the lack of a common infrastructure has prevented clinical research institutions from
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being able to mine and analyze disparate data sources. This inability to share technologies and
data developed by different cancer research instituti
ons can therefore severely hamper the
research process. Similarly, the lack of a unifying architecture can prove to be a major roadblock
to a researcher’s ability to mine different databases. Most critically, however, even within a single
laboratory, resea
rchers have difficulty integrating data from different technologies because of a
lack of common standards and other technological and medico
-
legal and ethical issues. As a
result, very few cross
-
site studies and clinical trials are performed and in most ca
ses it isn’t
possible to seamlessly integrate multi
-
level data (from the molecular to the organ, individual and
population levels). Moreover, clinicians or molecular biologists often find it hard to exploit each
other’s expertise due to the absence of a co
operative environment which enables the sharing of
data, resources or tools for comparing results and experiments, and a uniform platform supporting
the seamless integration and analysis of disease
-
related data at all levels.

In summary, today there is n
o unifying infrastructure or common standards for the technologies
that most cancer researchers use. This means that researchers cannot share their data or benefit
from the innovative informatics tools that are been developed by other researchers.

The ulti
mate objective of the ACGT project is the provision of a unified technological
infrastructure which will facilitate the seamless and secure access and analysis, of multi
-
level
clinico
-
genomic data enriched with high
-
performing knowledge discovery operation
s and
services. By doing so, it is expected that the influence of genetic variation in ongogenesis will be
revealed, the molecular classification of cancer and the development of individualised therapies
will be promoted, and finally the in
-
silico tumour g
rowth and therapy response (for the avoidance
of expensive and often dangerous examinations and trials on patients) will be realistically and
reliably modelled. Achieving these goals, ACGT will not only secure the advancement of clinico
-
genomic trials but
will also achieve an expandable (to other studies, technologies and tools)
environment.

In order to achieve its goals and objectives, ACGT will create and test an infrastructure for cancer
research by using a virtual web of trusted and interconnected organ
izations and individuals to
leverage the combined strengths of cancer centres and investigators and enable the sharing of
biomedical cancer
-
related data and research tools in a way that the common needs of
interdisciplinary research are met and tackled. A
major part of the project is devoted to research
and development in infrastructure components that eventually will be integrated into a workable
demonstration platform upon which the selected (and those to be selected during the lifecycle of
the project) u
se cases (the Clinical Pilots) can be demonstrated and evaluated against user
requirements defined at the onset of the project.

Strategically, the ACGT project addresses the following needs and challenges related to
biomedical, technological and scientifi
c aspects:



Integration of Clinical Research Centers on Cancer with varying needs and capabilities in
a common network for sharing data, applications, and technologies.



Demonstration of new enabling tools for supporting multiple Cancer Center research.



Deve
lopment of a useable and scalable biomedical grid that Clinical Research Centers on
Cancer will actively use for added value clinical trials.



Development of new component
-
based data analysis and knowledge discovery tools and
modification of existing ones s
o as to utilise the advantages of grid computing, and
enable high
-
performing data
-
mining and biomedical knowledge extraction operations.



Utilisation of clinical trial management systems based on standards
-
based and
components
-
based clinical trial manageme
nt systems, integrative cancer research
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applications and innovative tools to support (a) ontology
-
based integration and sharing of
data and biomedical information and (b) advanced data mining and biomedical
knowledge extraction.



Sharing of biomedical infor
mation and data upon common standards and utilisation of
and in a manner that protects data privacy and security.



Fostering common usage of vocabularies, common data elements and the formation of a
unifying architecture for the support of the advanced clin
ico
-
genomics clinical trials of
the future.

ACGT’s vision is to become a pan
-
European voluntary network or grid connecting individuals
and institutions to enable the sharing of data and tools, creating a European Wide Web of cancer
clinical research; the u
ltimate goal being to speed the delivery of innovative approaches for the
prevention and treatment of cancer. The infrastructure and tools created by ACGT also have
broad utility outside the cancer community. Ultimately, the most important beneficiaries of

ACGT will be the cancer patients themselves and the public at large. The infrastructure work in
ACGT contains the following main components:



BIOMEDICAL TECHNOLOGY GRID LAYER. The “Basic Grid Technology” layer
comprises the basic “Grid engine” for schedul
ing and brokering of resources. The
“Virtual Organisation (VO)” layer integrates users from different and heterogeneous
organisations. Access rights, security (encryption), trust buildings are issues to be
addressed and solved on this layer based on system

architectural and security analysis.



DISTRIBUTED DATA ACCESS AND APPLICATIONS. In order to provide seamless
and interoperable data access services to the distributed data sources, a set of compatible
software key modules/services will be developed based

on Web Services. These services
will provide ontology
-
based ubiquitous interoperability among the integrated ACGT
environment and other types of heterogeneous information systems, i.e. clinical,
integrated eHealth records, microarray, SNP/genotyping, etc.

Besides, architectures for
data access and for Grid
-
enabling advanced medical applications will be developed, and
relevant legacy and advanced applications will be Gridified.



DATA MINING AND KNOWLEDGE DISCOVERY TOOLS. The “Data mining and
Knowledge Disco
very Services” layer includes basically data mining services. Towards
this end, ACGT will devote efforts towards the evaluation, design and development of
interoperable and smoothly integrated data mining software components and tools. The
ultimate goal is

to offer a GRID
-
enabled Knowledge Discovery Suite


KDS aiming
towards two directions: (i) to support tasks and research inquiries involved in the
combined clinico
-
genomic trials, and (ii) to cope with the high computational cost of
analysing of huge amou
nts of heterogeneous data and information.



ONTOLOGIES AND SEMANTIC MEDIATION TOOLS. Formalised knowledge
representations (ontologies) will play a key role in any future biomedical Grid on cancer
research. This creates the requirement for adopting/extendi
ng or even constructing an
ontology for the disease under investigation. Ontologies provide a formal specification of
how to represent the objects, concepts and other entities that are assumed to exist in some
area of interest, and the relationships that h
old among them. Various ontologies and
controlled vocabularies have grown out of the effort to provide a shared language for
communicating biomedical information (e.g., the Gene Ontology (GO), the MGED
Ontology, the NCI Thesaurus and Metathesaurus, the UML
S Metathesaurus, etc.).
Biomedical ontologies are required to facilitate long term and robust integration, as well
as annotation and data analysis of large
-
scale biomedical data.

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TECHNOLOGIES AND TOOLS FOR IN
-
SILICO ONCOLOGY. ACGT will
demonstrate its adde
d value for in silico modelling of tumour growth and therapy
response. The aim here is to develop four dimensional, patient specific computer
simulation models of the biological activity of malignant tumours and normal tissues in
order to optimize the spat
iotemporal planning of various therapeutic schemes. Ultimately,
the aim is to contribute to the process of effectively treating cancer and to contribute to
the understanding of the disease at the molecular, cellular, and higher level(s) of
complexity.



THE
GRID
-
ENABLED APPLICATION LAYER. The grid
-
enabled application layer
dispatches jobs in parallel to multiple compute nodes; this parallelization of previously
serial tasks to multiple CPUs is where grid gets its power. The ability to execute
transformation t
asks independently enables the load process to be broken into multiple
subprocesses, which can be sent to a different node in the virtual pool.



THE INTEGRATED ACGT ENVIRONMENT. Integration of applications will require
substantial meta
-
information on algori
thms and input / output formats if tools are
supposed to interoperate. Assembly of tools for virtual screening into complex workflows
will only be possible if data formats are compatible and semantic relationship between
objects shared or transferred in wo
rkflows are clear. The combination of the tools in a
workflow and the execution of this workflow in the Grid requires a formal description as
provided e.g. by WPDL or SWFL.

In addition, ACGT will offer the benefits of open access to a rich pool of intero
perable tools,
shared data and standards to the Cancer Research Community, and also the ability to participate
and contribute without compromising individual innovation and creativity. To this end a special
WP has been designed to guide the development pro
cess wrt to clear guidelines regarding
interoperability.


3.1.9.3.

Participant list


The following legal entities and organizations are participating in the ACGT Project:


Partic.
Role*

Partic.
Number

Participant name

Participant
short name

Country

CO

1

GEIE ERCIM


ERCIM

FRA

CR

2

Foundation for Research and
Technology Hellas

FORTH

GRE

CR

3

Institut National de Recherche en
Informatique et en Automatique

INRIA

FRA

CR

4

University van Amsterdam

UvA

NED

CR

5

Philips Electronics Nederland B.V.

Phil
ips

NED

CR

6

Association Hospitaliere de Bruxelles


Centre Hospitalier Universitaire Bordet

IJB

BEL

CR

7

Institut Suisse de Bioinformatique

SIB

SUI

CR

8

Lunds Universitet

LundU

SWE

CR

9

Universidad de Malaga

UMA

ESP

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CR

10

Universidad Politechnica de

Madrid

UPM

ESP

CR

11

Fraunhofer
-
Gesellschaft zur Foerderung
der angewandten Forschung

FHG

GER

CR

12

A. Persidis & SIA O.E.

BIOVISTA

GRE

CR

13

University of Crete

UOC

GRE

CR

14

Unisersitaet Hannover

UHANN

GER

CR

15

Instytut Chemii Biooganicznej pan w
Poznaniu

PSNC

POL

CR

16

Custodix

Custodix

BEL

CR

17

Healthgrid

Healthgrid

FRA

CR

18

Institute of Communications and
Computer Systems

ICCS

GRE

CR

19

Universitaet des Saarland

USAAR

GER

CR

20

S.C. SIVECO ROMANIA SA

SIVECO

ROM

CR

21

Facultes Universita
ires Notre
-
Dame de la

Paix

FUNDP

BEL

CR

22

Universitaet Hamburg

UH

GER

CR

23

The Chancellor, Masters and Scholars of
the University of Oxford

UOXF

GBR

CR

24

(CPF 25)

Hokkaido University

UHok

JPN

CR

25

(CPF 26)

Istituto Europeo di Oncologia s.r.l

IEO

I
TA

Table
10



ACGT Participants


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3.1.9.4.

Relevance to RIDE Project


The relevance of ACGT to RIDE project is presented through the following radar diagram:



Figure
9



ACGT Radar Diagram


As dep
icted above, the main area of relevance of ACGT with RIDE project is the Decision
Support Systems. Moreover, ACGT project is relevant with RIDE since it handles interoperability
issues and semantic information.

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3.2.

eTEN Projects


3.2.1.

eTEN NETC@RDS for eEHIC


Project Acronym

NETC@RDS

Full
Project
Title


Framework


eTEN Framework

Priority / Strategic
Objective


3.2.1.1.

Project Overview

The NETC@RDS Project aims t
o improve the access of mobile E
uropean citizens to the natio
nal
health care systems using advanced smart card technology. It also aims to implement and
evaluate technical solutions for the European Health Insurance Card electronification and for
improving additional services such as the inter
-
E
uropean health costs
clearing/billing processing.

Current Phase A2 is the second of four project steps (initial market validation, full market
validation, initial deployment, full deployment), and it aims to establish and demonstrate new
improved health care administration ser
vices for mobile citizens across the E.U.. It also addresses
the recommendations from the European Commission to evaluate technical solutions for
European Health Insurance Card electronification and for additional services such as health costs
clearing/bil
ling processing.

Phase A2 will establish and evaluate a number of large scale “e
-
EHIC advanced demonstrators”.
Phase A2 will build on the initial market validation work already conducted by the main Health
Insurance Providers and the national clearing hou
ses from Austria, France, Germany and Greece
under NETC@RDS Phase A1. The result will be a Full Market Validation/Evaluation and
preparation of a consolidated final Business Plan based on live applications in pilot regions within
the 10 E.U Member
-
States (
Austria, Finland, France, Germany, Greece, Italy, Czech Republic,
Slovak Republic, Slovenia and Hungary).

In this respect, Project Phase A2 will simultaneously define, demonstrate and evaluate new
associated administrative processes for use by public heal
th insurance and health care service
providers (e.g. hospitals, ambulatory care) when providing necessary health care and/or
immediate care services to European Member State residents traveling or temporarily resident
outside their home country but inside
the E.U. It will also establish and demonstrate practical
technical interoperability for use of different national cards at the NETC@RDS pilot sites. The
expected benefits include:


-

simplified health care access for those with health insurance evidence o
f entitlement to receive
health care while abroad in NETC@RDS pilot regions

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-

reliable source of information for health care provider front office staff checking insured
entitlement or initiating interstate billing/clearing procedures

-

development and use

of Common Administrative electronic dataset for improved health
insurance providers back office billing/clearing workflow applications and further modernization
of post
-
processing activities.

-

valuable lessons from this advanced demonstrator for the fore
seen Phase 3 implementation (i.e.
electronification) of the European Health Insurance Card

The NETC@RDS pilot project regions will accept as proof of entitlement any of the following:


-

an eye
-
readable European Health Insurance Card ,

-

an EHIC compliant NET
C@RDS dataset either issued from existing Health Insurance
smart card and/or downloaded from secure server.

Technically the NETC@RDS services will be implemented as an extension of existing health
information systems including smart cards and/or networking

software applications in pilot
regions of Austria, France, Germany, Greece, Italy, Finland.

Greece (Athens and Thessaloniki) during the Olympic Games in Summer 2004 is
scheduled to be the venue for the first of the envisaged pilots. Services provided to
users
in the pilot regions will be delivered in the frame of the EHIC regulation and in
accordance with the General Agreement from NETC@RDS Phase 1 and signed by the
authorised parties (i.e. health insurance and the clearing/billing liaisons offices of
Mem
ber
-
States) participating in the project.

3.2.1.2.

NETC@RDS Objectives

The NETC@RDS services address the following steps as part of the service to be validated:


1. Providing an electronic evidence of entitlement for the insured person (from within
a smart
card or from server).

2. Keying
-
in entitlement information from the insured person’s EHIC or reading/downloading the
electronic evidence of entitlement at hospital when health care are needed. In both case, the
captured information will contain the

personalised NETC@RDS electronic common dataset.

3.

Processing the NETC@RDS electronic common dataset for further billing/clearing workflow.


Every Health Insurance Service provider willing to implement the NETC@RDS services will do
it on the basis of one

of the four technical scenarios above described. As first milestone, data
capture of insured administrative information from various existing media (e.g. visual EHIC,
health smart cards, downloadable e
-
form) will be implemented in software applications th
at will
be delivered by the NETC@RDS Health Insurance Service Providers during NETC@RDS
project Phase A2 implementation. The eye
-
readable European Health Insurance Card

shown in
the above figure


will be
c
onsidered as well in the context of the following
NETC@RDS
scenario cases. The NETC@RDS services will be delivered in pilot hospitals on the basis of any
of the scenario cases drawn in the above picture. It is up to the Health Insurance Service
Providers to apply their preferred scenario chosen amongst th
e four possible cases.

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Four possible cases outlined below can be considered for each NETC@RDS software
implementation and set
-
up:


CASE 1


Case 1 is a full off
-
line scenario case. The NETC@RDS dataset is captured from smart card
memory by off
-
line software

application for further processing. Scenario Case 1 could improve
existing relatively poor off
-
line eye
-
readable security by requiring the insured to keyin a user
PIN
-
code.


CASE 2

Case 2 scenario combines both smart cards and IT network applications. The

NETC@RDS
dataset is thus downloadable from server when required. In scenario Case 2 the smart card
application applies first for secure network connection to the relevant Health Insurance Provider
server for on
-
line authentication. Insured dataset would b
e downloaded after successful
completion of smart card authentication. However, the dataset could be stored in the card as well
for back
-
up solution in case server would be out of order or remote connections are down. This
would be the preferred scenario.


CASE 3

This is the full on
-
line scenario. The NETC@RDS dataset is downloaded from remote server
when manually typing
-
in insured ID data and password at hospital. Data privacy could possibly
be enhanced by use of health professional authentication certific
ate.


CASE 4

Case 4 is a full off
-
line scenario case that will apply when none of the other scenario cases could
be available. In Case 4, insured information will be captured either from eye
-
readable European
Health Insurance plastic cards that are foresee
n after 1st June 2004 or from certificates
provisionally replacing the visual European Health Insurance Card6. Typing
-
in data from E
-
111/E
-
111+ paper forms as intermediate or temporary solutions for electronic dataset completion
will be / is also considere
d at early stage of the EHIC deployment. It has to be noted that any
insured citizen from any E.U Member
-
States could receive the service provided with Case 4 in
the NETC@RDS pilot hospitals

i.e. not only insured from the Regions in Member
-
States
particip
ating to the project.


3.2.1.3.

Participant list

The following legal entities and organizations are participating in NETC@RDS Project:


Participant.
Role*

Participant.
Number

Participant name

Participant
short name

Country

CO

1

Groupement d’Intérê
t Economique
SESAM
-
Vitale

GIE SESAM
-
VITALE

France

CR

2

Caisse Nationale de l’Assurance
-
Maladie des Travailleurs Salariés

CNAMTS

France

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CR

3

Caisse Primaire d’Assurance Maladie
de Paris

CPAM Paris

France

CR

4

Assistance Publique


Hôpitaux de
Paris

AP
-
H
P

France

CR

5

Centre National des Professionnels
de Santé

CNPS

France

CR

6

Zentralinstitut für die
Kassenärztliche Versorgung in der
Bundesrepublik Deutschland

ZI

Germany

CR

7

AOK Baden
-
Württemberg

AOK BW

Germany

CR

8

Institut für Pflege und
Gesundheit
ssystemforschung

IPG Linz

Austria

CR

9

Hauptverband der
österreichischen
Sozialversicherungsträger

HVOS

Austria

CR

10

Aristotle University of
Thessaloniki

AUTh

Greece

CR

11

Idrima Koinonikon Asfaliseon

IKA

Greece

CR

12

Regione Lombardy

Region of
Lombar
dy

Italy

CR

13

Regione del Veneto


Giunta
Regionale

Region of
Veneto

Italy

CR

14

MEDTEL Telematics in health
care

MEDTEL

Czech
Republic

CR

15

Vseobecna zdravotni pojistovna
CR

VZP

Czech
Republic

CR

16

Všeobecná zdravotná poistovna

GHIC

Slovak
Republic

CR

17

Zavod za zdravstveno
zavarovanje Slovenije

ZZZS

Slovenia

CR

18

Országos Egészségbiztosítási
Pénztár

OEP

Hungary

CR

19

National Research and
Development Centre for Welfare
and Health

STAKES

Finland

CR

20

Social Insurance Institution of
Finland

KE
LA

Finland

Table
11



NETC@RDS Participants

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3.2.1.4.

Relevance to RIDE Project


The relevance of NETC@RDS to RIDE project is presented through the following radar diagram:




Figure
10



NETC@RDS
Radar Diagram


As depicted in the diagram above, NETC@RDS project is related with RIDE in the domain of
Electronic Health Record.


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3.2.2.

eTEN Comprehensive Continuity of Care


Project Acronym

C3

Full
Project
Title

Comprehensive Continuity of Ca
re

Framework


Ten
-
Telecom Framework

Priority / Strategic
Objective


3.2.2.1.

Project Overview

The medical information is contained in the patients Electronic Health Care Records (EHRCs).

These records are not kept in a single system, but are scat
tered over a number of systems

(GPs, specialists, hospitals). The structure of EHRCs vary widely depending on who creates

them and on the purpose for witch they are used.


For example, an EHRC created by an

cardiologist contains data different from that of

e.g. an oncologist.

Moreover, in some countries patients consult several health care professionals for the same


health problem. Second opinions are not yet the rule, but they are becoming an increasingly


common practice.

All this results in health care
information scattered across a number of EHRCs
based on a large

range of different EHCR systems.

On the other hand, due the cost containment pressure, authorities, increasingly ask GPs

to


keep a comprehensive recor
d. This centralization of "
clinical" info
rmation in the GP system,


however, does not solve the problems of sharing this information among several types of


health care professionals who need parts of this information. Access to this information is


the main hurdle to promoting continuity of care
.

There is still a strong reluctance in several countries to have a central repository of personal


medical information.


Security risks are generally put forward as the main argument, but there


are other reasons, the patient may not want some elements of

his care record to be generally


known, e.g. mental health or sexually transmitted disuses.

Those health records are not on the repository of patients data, it is also the winche of


the health care professionals reasoning and actions.

The users of the C³

services will not on be the health care professionals and paramedical staff


or the patient him/her self. The whole healthcare team, i.e. all the parties involved in the lifetime


care of a patient, will be involved in the C³ services in order to extend C
ontinuous Car (C
-
care)


to C³ (Comprehensive Continuous Care) . The involvement of all these parties is essential


in order to guarantee real continuity of care.

C³ builds on the expertise and the developments of the IST project C
-
Care. C
-
Care has


demonst
rated that the technology works, it also resulted in valuable semantic options and

ready
-
for
-
market implementations.

EC funding helps the proposes to more the crucial step from a technical solution witch had been
demonstrated to a well thought
-
through serv
ice witch can be viably provided in various European
scenarios.

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3.2.2.2.

C3 Objectives




in the final stage of its deployment is meant to cover the whole of the European Union.

This long
-
term target will be reached in steps. During the Market Vali
dation phase, the service
will be provided in three regions in three

countries:


Vlaanderen in Belgium,


Lombardia in Italy
and Catalunya in Spain. On the assumption that the revised business plan points to a profitable
business for the

Consortium. The Ini
tial Market Deployment phase will extend the coverage of
the service

to the whole of these three countries. Beyond this, the list of countries to market the
service will be drawn up as part of the

business plan produced in the Market Validation Phase of
th
e project. With regard to its socio
-
economic impact.

C³ will improve the quality and
accessibility of health care, by deployment and use

of

interoperable health systems with
guaranteed confidentiality and quality of service which

promote continuity


Employ
ment levels in
Europe will be positively influenced by C³ , because the

project

helps

European SMEs, which
constitute the industrial component of the Consortium to develop

leading
-
edge system and service
offerings. The mechanisms developed and validated in

C³ will ensure health care professionals
have

access to medical information unconstrained by their physical location. This guarantees that


European citizens can receive an identical level of service irrespective of where they live or work.

3.2.2.3.

Participant list

The following legal entities and organizations are participating in C3 Project:


Participant.
Role*

Participant.
Number

Participant name

Participant
short name

Country

CO

1

Telepolis CIPAL
-
ICA

TELEPOLIS

Belgium

CR

2

Health Informatio
n Management

HIM

Belgium

CR

3

MediBRIDGE

MB

Belgium

CR

4

OmegaSoft Medical

OMEGA

Belgium

CR

5

Algemeen Centrum Ziekenhuis
Antwerpen

ACZA

Belgium

CR

6

Algemeen Ziekenhuis Jan Palfijn

AZJP

Belgium

CR

7

Algemeen Ziekenhuis Middelheim

AZM

Belgium

CR

8

Me
didoc Gebruikers Club

MEDIDOC

Belgium

CR

9

DEDALUS S.p.A.

DEDALUS

Italy

CR

10

Regione Lombardia

REGLOM

Italy

CR

11

Azienda Ospedaliera Sacco

AOS

Italy

CR

12

Stacks

STACKS

Spain

CR

13

Experts Assessorament Sanitari
Integral

EASI

Spain

CR

14

Equip d’As
sistència Primària Vic,
S.L.

EAP VIC, SL

Spain

Table
12



C3 Participants

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3.2.2.4.

Relevance to RIDE Project


The relevance of C3 to RIDE project is presented through the following radar diagram:



Figure
11



C3 Radar Diagram


As presented in the diagram above C3 project is closely related to RIDE in the area of Electronic
Health Record. Moreover, is significantly related to RIDE in the areas of Business Processes and
Patient Identifiers.

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3.2.3.

eTEN i2Health


Project Acronym

I2Health

Full
Project
Title

Interoperability Initiative for a European eHealth area

Framework


Ten
-
Telecom Framework

Priority / Strategic
Objective



3.2.3.1.

Project Overview

Interoperability Initiative f
or a European eHealth area (i2
-
health)



Citizen mobility and borderless care are key European Union

policy priorities, which are supported by the European eHealth Action Plan.



While healthcare is being thoroughly transformed, proper interoperability
measu
res have to assure that patient information in digital form is at least as
accessible and usable as paper based data.



Health policy makers, health professionals, healthcare providers and the IT
-
industry have to work hand in hand to assure the meaningful a
nd secure exchange
of medical data.



i2
-
Health will call on all the relevant stakeholders to join forces.


i2
-
health is an initiative funded by the eTEN Programme of the European Commission.


3.2.3.2.

i2Health Objectives

i2
-
health will identify req
uirements and submit recommendations for the deployment of
interoperable eHealth infrastructures and services for trans
-
European use through the
definition of a generic eHealth interoperability framework and common approaches to



patient/professional ident
ifiers



ePrescribing and health data messages



i2
-
health will review existing approaches and pilot solutions, analyse use cases,
perform need and gap analyses, and develop a concrete work plan towards a pan
-
European solution.

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3.2.3.3.

Participant list


The following legal entities and organizations are participating in i2Health Project:


Participant.
Role*

Participant.
Number

Participant name

Participant
short name

Country

CO

1

empirica GmbH

EMP

Germany

CR

2

European Health Telematics
Association

EH
TEL

Belgium

CR

3

Research institute of the German
National Association of Statutory
Health Insurance Physicians

RGNA

Germany

CR

4

Work Research Centre

WRC

Ireland

CR

5

Technical University of Košice

TUK

Slovenia

Table
13



i2Health Participants

3.2.3.4.
Relevance to RIDE Project

The relevance of i2HEALTH to RIDE project is presented through the following radar diagram:



Figure
12



i2Health Radar Diagram

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As

presented in the diagram above, i2Health project is heavily related to RIDE in the areas of
Business Processes, Messaging and Electronic Health Record.

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3.3.

International Projects

3.3.1.

Active Semantic Documents


LSDIS

3.3.1.1.

Project Overview

Active Semantic Documents (ASD) are documents (typically in XML based format).
ASDs are
semantic

since they are semantically annotated using one or more relevant
ontologies which provide the nomenclature and conceptual model for interpr
eting and
reasoning with the concept, and optionally annotated using lexically significant concepts
and phrases (hence providing weaker semantics than the concepts and phrases that are
annotated with and interpreted with respect to ontologies). ASDs are
ac
tive

because they
support automatic and dynamic validation and decision making on the content of the
document (typically by executing rules on semantic and lexical annotations). ASDs are
displayed using a Web
-
based interface, and provide the ability to mod
ify semantic and
lexical components of its content in an ontology
-
supported and otherwise constrained
manner (such as through lists, bags of terms, specialized reference sources, or a thesaurus
or lexical reference system such as WordNet).

The
LSDIS lab
's collaborative research project on Active Semantic Electronic Patient
Record with the
Athens Heart Center

(AHC) exemplifies an implementation of ASDs in a
healthcare (m
ore specifically cardiology practice) environment. It has so far involved:



the development of populated ontologies in the healthcare (specially cardiology practice)
domain



the development of an annotation tool that utilizes the developed ontologies for
a
nnotation of patient records, and



the development of decision support algorithms that support rule and ontology based
checking/validation and evaluation.

ASEMRs have been implemented as an enhancement of AHC's Panacea electronic medical
management system
. Panacea is a web
-
based, end
-
to
-
end medical records and management
system. This has enhanced the collaborative environment, and has provided insights into the
components of electronic medical records, and the kinds of data available in these systems.


In

the first phase of this project, we have designed, developed, and populated the following
ontologies:



Practice Ontology: includes concepts such as practitioners, patients, insurance, facilities,
etc. AHC's database was the primary source for populating t
his ontology.



Drug Ontology
: includes concepts such as indications, interactions, formulary, etc.
License content equivalent to physician's drug reference was the primary source for
populating this ontology.



Diagnosis/Procedure Ontology
: includes concepts such as medical conditions, treatment,

ICD
-
9, CPT, etc. The current version of the population ontology utilizes licensed
diagnosis/procedure related data, as well as information available from the Georgia
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Medicare website. Licensed SNOMED content is being used in the development of the