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IT110

Course Work # 5
Bergantin, Nathan (IT-3)
15, 2015
Buenaventura, Arvin (IT-3)

June

mHealth Program
Professor Mideth B. Abisado

General Purpose: To influence my readers the possible future of


Medical Care.
Specific Purpose: The purpose of the study is to determine what are
the impacts of digital Medicare and its distribution
of public health care in the country.
Central Idea: Now is the time that we should focus more on
improving our health. By doing such, we must not
sacrifice data privacy by complying with the Health
Insurance Portability and Accountability Act (HIPAA)
and offer the best Quality of service (QoS).

Table of Contents
Introduction ............................................................................................................... 3
Attention Material .............................................................................................. 3
Orienting Material ............................................................................................... 3
Interactive Search System for Healthcare Services ...................................................3
Electronic Medical Record retrieval systems ......................................................3
Unified Medical Language System (UMLS) ..........................................................4
Existing Systems ................................................................................................. 4
Medical Retrieval System Design................................................................................5
Applying medical knowledge-bases....................................................................5
Knowing user queries......................................................................................... 5
Expert user queries............................................................................................ 6
Medical Retrieval Model.............................................................................................. 7
Problem Statement.................................................................................................. 7
Search Algorithms................................................................................................ 7
Interactive Retrieval System Architecture............................................................7
Medical Retrieval Algorithm........................................................................................ 8
Sarsa Algorithm for IIR............................................................................................. 8
Trained Value function.......................................................................................... 8
Doctors Search Engine based on ICD-10....................................................................8
Classification of the doctors specialty field.............................................................9
Construction of Doctors Search Engine................................................................9
Data Processing.......................................................................................................... 9
A Framework for Web-based Interactive Applications of High-Resolution 3D
Medical Image Data................................................................................................. 9
Existing systems ............................................................................................... 10
Proposed Framework for processing 3D Data........................................................11
Existing Algorithms for processing 3D Data..........................................................11

Real-time monitoring of patients on remote sites.....................................................13


Functional Requirements....................................................................................... 13
Existing monitoring systems..............................................................................13
Using 3rd party services to provide a secure web-based medical environment.......13
Existing Trusted Third party Services (TTP)...........................................................13
Security Threats................................................................................................. 14
Security Enhancements...................................................................................... 14
References................................................................................................................ 15

Introduction
I.

Attention Material

Health is an issue that has plagued doctors over the past centuries. In today's
day and age, Information Technology has set the bar on healthcare even
further, with the help of the World Wide Web, or more collectively known as
the Internet has bridged the gap between patients and doctors alike. But the
same can be said with all possibly new consequences that IT has brought
along with it. With today's technology people have become ever increasingly
lazy due to the fact that machines and computers do most of the work for us,
thus, making them more vulnerable to certain diseases and illnesses. Doctors
have made an attempt to remedy this situation, or rather, a quick fix so to
speak by making them known and providing their services worldwide through
the use of web-based healthcare systems.

II.

Orienting Material

Unfortunately, prior attempts have fallen short due to various complexities


and overestimations, and some of them include lack of equipment, this is
mostly only a problem for third-world countries who cannot afford to buy the
latest equipment. Connectivity is a concern for every country, companies pay
a royalty for the fastest internet connection possible, hospitals and
emergency clinics who desires to help people globally through the use of the
internet will have to pay for top-notch networking equipment to handle the
massive surge of internet packets coming from thousands, if not, millions of
users worldwide who wants to avail for their medical services.

I. Interactive Search System for Healthcare Services - enables the detection of


user intent transition by judging the relevance of the documents, users actually express
their latest intent in an implicit way. Analyzing the statistics of relevant and non-relevant

documents will assist the system to evolve accordingly, formulate the up-to-date query,
refine the searching space, and further retrieve more satisfactory documents. In addition,
the interactive search scheme is able to bridge

A. Electronic Medical Record retrieval systems - There are two types of


medical record systems: Electronic medical records and Paper medical
records. Apart from the physical differences between the two, there are
several distinct features of electronic medical records that are
advantageous over the paper medical record. First would be the cost. At
first initial costs to implement the system would be high however, the
costs of storing records involve lesser man power, time and physical
storage space while paper records require more personnel to manage and
space to store hard copies of medical documents. Then the storage, paper
medical records require large warehouses in order to store data with the
size of the citys population while electronic medical systems require
smaller physical space whereas having tons of data. Next would be the
data security. Both paper and electronic storage systems are susceptible
to security concerns because if a facility stores records electronically, they
are vulnerable to access by unauthorized individuals, when the proper and
effective security systems and controls are not in place. However, reliance
on an established and compliant managed hosting provider serves as a
good option for providers concerned about the security of an internal
electronic storage system. If records are in paper form, they are open to
compromise resulting from a break in, the loss of a record due to human
error, or damage as a result of a natural disaster such as a fire or flood.
Because many facilities keep just one copy of a paper record, the loss of a
single record could mean that its gone for good. After that would be data
access. For paper medical records sometimes in needs to be shared with
those who need them, they must be recovered from a massive warehouse
or different storage warehouses then shipped or scanned and sent via
email, a time-consuming process whenever a client or doctor needs to
access the data. However, the use of electronic medical records allows
healthcare professionals to access the information they need almost
anywhere, instantly. Whether through the use of email or a third party
application or the companys private content management system, they
can access the data over the cloud. Last would be data reliability and
accuracy. Paper medical records are often difficult to read and understand,
due to the physicians illegible penmanship or simply human errors.
Likewise, paper records often have insufficient space for healthcare
professionals to write all necessary information about their patients.
Electronic records, on the other hand, are often written with a
standardized typeface and terminology that leaves no room for confusion

1. Unified Medical Language System (UMLS) - The UMLS is a


record or database with thousands of medical vocabularies, used to translate
numerous terminologies used in bio-medical sciences (Figure 1.3). It is also
known that the UMLS function as a thesaurus and ontology of biomedical
terms and concepts. Classification of diseases are referred from existing
medical textbooks to electronic encyclopedias.

1.1 askMEDLINE (Fig.A.1.A) is a free-text, natural language query


tool for clients who doesnt have background knowledge on medical
terms used in the program. This screenshot shows how askMEDLINE
accommodates the English Only - search queries made by the user in
order to access it in the MEDLINE/PubMed.
Advantages

Contains useful
technologies

Search filtering for relevant results

Mobile

Free

information

about

medical

terms

and

Disadvantages

Fails to search on inaccurate queries

Poorly designed search category(Will never be understood by lay


people)

Requires internet connection

*(FigA.1.A) A screenshot from askMEDLINE website. Here shows the user-friendly interface the site has
to offer.

1.2. MEDLINE and PubMed (FigA.1.B) on the other hand, is a


medical literature database that holds the actual data for the system. As
seen on the screenshot, MEDLINE shows the complete details about the
pharmaceutical journal, the user has the option to view the whole
document as Full Text or just its summarized form.

* (Fig.A.1.B) A screenshot from askMEDLINE website. Here shows the results of the user.

B. Medical Retrieval System Design is a medical search system which is


applied on medical Knowledge-Bases (KBs) and retrieves information
relevant to the needs of common users or experts. The system returns a
set of ranked documents (for example, documents related to past patients
cases) and it prompts the user to provide feedback on the top retrieved
items.
1. Applying medical knowledge-bases facilitation of increasing the
productivity in a medical environment, support the making of
diagnoses and other types of medical decisions, assist in the training of
medical professionals, and can even handle some routine tasks in a
medical environment.

2. Knowing user queries The system returns a set of ranked


documents (for example, documents related to past patients cases)
and it prompts the user to provide feedback on the top retrieved items.
The user submits feedback judging how relevant each document is
according to her interests, and the system adjusts its learning model
about the user need. Interaction proceeds in independent sessions that
serve particular users with particular needs.

*(FigB.1.2) The picture above is based on the SAP Prototype in managing doctor appointments and
sharing of EMR.

1.1
Common user queries (FigB.2.1) the search system
should provide information services to common users, that is,

non-expert users, such as patients, relatives of patients,


students or scientists with nonmedical background, and
more.

*The picture above is based on the SAP Prototype in handling EMRs

2.2 Expert user queries (FigB.2.2) The screenshot is from


the SAP Prototype and it is now showing the Doctors view of the
patients EMR.

C. Medical Retrieval Model (FigC.1)

*(FigC.1) The picture above is based on the Medical Retrieval Model. From the model, patients
requests a query for available doctors, doctor's information and availability will be retrieved by
the IRS from the medical database. From there the patient will be given out a list of available
doctors and their specialized field for their choosing. Upon a successful treatment, patients and
doctors can provide their feedback, and that feedback will be stored inside the medical database
for future reference for the patient's previous disease and treatment, as well as the doctor's
rating.

1. Problem Statement. Problems encountered by existing systems.


The systems searching accuracy may depend on the users objective and his / her
capability to define dynamic objectives of users.
2. Search Algorithms All possible algorithms for sorting data. Goal
based algorithm, a temporal difference algorithm to predict users information
needs by incorporating both current and predicted knowledge into learning the user
profile. Alternative based - The ANNs-based engine was experimentally proven to be
the most prominent one for handling data from alternative sources. Feedback based
- The goal of the system is to maximize the total feedback submissions received by
the end of the session.

3. Interactive Retrieval System Architecture (FigC.3)

*(FigC.3) The picture above is based on the Medical Retrieval System Architecture. From the image,
the IRS handles and ranks articles based on user preference, history, subject of interest to be
searched for, and results will be given to the user from the medical database.

D. Medical Retrieval Algorithm Here shows all algorithms for retrieving


data from the medical database. State space size is the set of values that a single
process can take. Session-Based Length a sorting algorithm experiment based on

the actual transaction time. Lastly, Feedback-based a sorting algorithm experiment


based on the users feedback.

1. Sarsa Algorithm for IIR (FigD.1) - State-Action-Reward-StateAction - is an algorithm for learning a Markov decision process policy,
used in the reinforcement learning area of machine learning. It was
introduced in a technical note where the alternative name SARSA was
only mentioned as a footnote.

*(figD.2) The picture above is based on the SARSA Algorithm for IIR The algorithm used for querying
and prioritizing user requests.

2.

Trained Value function is the machine learning task of inferring a


function from labeled training data. The training data consist of a set of
training examples, each example is a pair consisting of an input object
(typically a vector) and a desired output value (also called the
supervisory signal). TVF analyzes the training data and produces an
inferred function, which can be used for mapping new examples. An
optimal scenario will allow for the algorithm to correctly determine the
class labels for unseen instances. This requires the learning algorithm
to generalize from the training data to unseen situations in a
"reasonable" ways

II. Doctors Search Engine based on ICD-10 (FigE.1) (10th International


Statistical Classification of Diseases and Related Health Problems) This search
engine has to define the relations between diseases, clinical departments, and
doctors (specialists) who is belonging to them. Next, we have to manage the
database effectively because doctor's position and career change frequently in
major hospital such as university hospital. Finally, we have to create a human
interface which patients can easily search specialists.

*(FigE.1) The picture above is based on the proposed Doctor Search. Engine
Search results are processed and gives out a list of available doctors and their specialized field and relational field depending on the
user's input.

A.

Classification of the doctors specialty field (FigE.1) - It is necessary to


investigate doctors personal data and doctors specialty field in order
to make the database of the doctors who work in our outpatient clinic.
Thus we developed a specialist registration system for the doctors to
register their data. By using this system, doctors are able to register or
update their personal data such as name, clinical department, position,
educational background, the days of the week which they have a
treatment, acquired specialist doctor licenses, and own password. In
addition, they can register the data for search such as doctors specialty
field, roles, and the field of their researches. The registered data are
reflected to doctors search engine directly. However, they can login to
this system only from computers connected with the local area network
of our hospital.

B. Construction of Doctors Search Engine - this system searches a name of a


disease from Standard Disease-Code Master or UML and gain
corresponding ICD-10 code. If there arent completely accorded diseases,
we also search names of diseases that are partially accorded and display
the list of them.

III. Data Processing - the conversion of raw data to machine-readable form.


A. A Framework for Web-based Interactive Applications of High-Resolution 3D
Medical Image Data - The proposed framework consists of three major
components: data storage structure, disk access optimization, and server
query processing.
1.1. Types of medical data that can be processed; Magnetic
resonance imaging a test which produces detailed images
of soft tissues, bones and other internal body structures and
Picture archiving and communication system - a medical
imaging technology that provides convenient access to
images from multiple systems.

2. Existing systems

*(FigIII.A.2.2) The picture above is the user interface of MediTouch Medical Care System

2.1. MACOSTAT - Gustafson et al. have developed a software


package called MACOSTAT for assembly and browsing of 3D
brain atlases. MACOSTAT runs on a stand-alone system, and
provides a friendly user interface to navigate through 3D
brain atlases by translating and rotating the virtual knife.
However, MACOSTAT cannot be easily extended to run in the

Web environments. Due to the same limitations, Web-based


interactive applications are limited to low- or mediumresolution image data which are often insufficient for reliable
use in clinical diagnosis.
Advantages
Advance search feature for specific brain parts(Cortex,
subcortex, neurotransmitter, etc)
Gene Expressions of the brain can be viewed in 3d, as
well as in text format for detailed analyses.
Virtual brain MRI scanner
Disadvantages

Complex user interface

Actual utility has a steep learning curve

Prototype model

2.2. MediTouch (FigIII.A.2.2) A Free Mobile based Medical


Database.
Advantage
Simple design layout
Simplicity of UI layout(Contains specific, type, talk
options)
Doctors can review patient complaints and other
health complications before conducting a meeting.
Designed for mobile
Color coded view for ease of use
Live chat
Supports Dragon NaturallySpeaking software
Disadvatage

Designed for tablets only

*(FigIII.A.2.3) The picture above is the user interface of prognoCIS running on Linux
Operating System

2.3. prognoCIS (FigIII.A.2.3) An open source Linux-based


Medical Database.
Advantages

Excellent customer support

Customizable

Doubles as a e-mailing system for patient-doctor


communication

Disadvantages

UI Cluttered with Tabs and Dropdown menus

Overwhelmingly unnecessary button placement and


icons

*(FigIII.A.2.4) The picture above is NueMD Medical Billing System Company Logo

2.4. NueMD (FigIII.A.2.4) NueMD is a free billing system for


eMedical services.
Advantages
Browser agnostic design(can be used on any web
browsers)
Low system requirements
Portable
Comes with its own VPN for internet security
OS agnostic
Disadvantages:

Not available on Mobile(both Android and iOS)

*(FigIII.A.2.5) The picture above is the kareo Medical Database System Company
Logo

2.5. Kareo (FigIII.A.2.5) Kareo is a free online Medical School


for practitioners. Kareo has the tools and software to make
for doctors, those who manage a practice or who run a
billing company make their job easier.
Advantages

Allows patients to file electronic complaints

Easy to set up, learn, and use

Streamlines redundant tasks(such as charge entry and


payment posting)

Contains an integrated document management system


for insurance

Disadvantages

User Interface may be confusing on some users

Internet connection is required to capture medical


records

Not mobile friendly

2.6. Proposed Framework for processing 3D Data - These


are the algorithms for processing 3D data.

(FigIII.A.3.1.4)

2.6.1. Octree partitioning and labeling


(FigIII.A.3.1.1) This method is used for the
correct representation of solid objects in a 3D
environment, and are the basis for many
modeling. The 3D image data are divided into
many subsets called buckets using octree.
Octree is a space partitioning tree which
recursively divides the 3D image data into eight
octants until the user-specified octree level is
reached.

(FigIII.A.3.1.4)

2.6.2. Minimum Bounding Box (MBB) (FigIII.A.3.1.2)


- For a given 3D medical image data set, we first
derive its minimum bounding box (MBB) based on
its 3D volume. The minimum bounding box of a

point set is the same as the minimum bounding


box of its convex hull.

*(FigIII.A.3.1.4)

2.6.3. Hilbert Curve (FigIII.A.3.1.3) - A space filling


technique which maps a multi-dimensional data
space into a one-dimensional data space; that is, it
defines a linear order to visit every data bucket in
the three-dimensional space exactly once. It is also
a continuous fractal space-filling curve used for
storing compressed buckets on disk. For each
compressed bucket, its octree node ID, its starting
location in the file, its length in the file, and the
corresponding compression technique name are
stored in the header section. The meta-information
in the header section is used to construct the
bucket hash table and octree in main memory for
query processing

*(FigIII.A.3.1.4)

2.6.4. Huffman coding (FigIII.A.3.1.4) - A particular


type of optimal prefix code that is commonly used
for lossless data compression.

* (FigIII.A.3.1.5)

2.6.5. LempelZivWelch (FigIII.A.3.1.5) - A


universal lossless data compression algorithm
2.6.6. JPEG A method of lossy compression for digital
images
2.6.7. JPEG 2000 - An image compression standard and
coding system. To achieve better compression
efficiency for 3D medical images, Aguirre et al.
have proposed a lossy compression technique to
take advantage of inter-slice redundancy in 3D
medical images based on Part 2 of JPEG 2000

B. Real-time monitoring of patients on remote sites in this part of the


study, discuss the main requirements in order for the program to be
functional and usable.

1. Functional Requirements - These are the least requirements in


order to make the program functional. Data Communication the
program must have access to the internet, it has to be 100%
reliable and must deliver a good service. Next would be Data
Access the app must be able to access to the data server securely,
through the internet without any faults.

2.

Existing monitoring systems These are the types of existing


monitoring systems that can enhance the program features and
provide a fail-safe execution.

a. Monitoring Information Service (MIS) Systems that


holds the non-critical data (example: Personal information,
Contact information, etc.)
b. Vital Sign Monitoring Service (VSMS) Systems that
holds the vital-information about the patient (example:
Allergies, Vaccine back-log, etc.)
c. Multimedia Consulting Service (MCS) Systems that
support communication by means of multimedia devices.

C. Using 3rd party services to provide a secure web-based medical


environment in this section of the study, we will discuss some of the
available alternatives for the system.

1. Existing Trusted Third party Services (TTP). Here are 3rd


party services that can host the database for the proposed
program.

1.1. EUROMEDI+ - aims to drive excellence in diagnostic


healthcare through the provision of accessible, affordable
and professional diagnostics. EuroMEDIC Ireland

1.2. EUDAMED an eGovernment Services that hosts a


database of medical records for the public and encourages
the delivery of cross-border public sector services to citizens
and enterprises.

1.3. INFOSEC a multi-media website published by


Information Security Media Group, Corp. (ISMG), a company
specializing in coverage of information security, risk
management,
privacy
and
fraud.
HealthcareInfoSecurity.com

2. Security Threats In this part of the study here, we will find all
possible security threats towards computer-aided medical programs. One

of the main security issues is the back-end source code because the
hacker might download and exploit the source code of mobile app then
distribute it later for phishing. Next would be the execution of the code,
since the app will use the users local resources, the user might change
program values (like billing information, credit card number, etc.) Lastly,
network communication, today we live in a modern world where
everything has to cross through the internet, since everyone has access
to the internet, data privacy has been a problem. It is very crucial to
protect medical records not only for user privacy, but it is also for his/her
safety.

3. Security Enhancements - Here are solutions for the security threats


other researchers found appropriate; Directory services for applet
certification, this ensures the authenticity and integrity of applets where
its source code has its own certification. One of the modern solutions is
securing app data wherein it connects to the private server of the
program provider and reinforces the security in the connection between
client and host. Another modern solution is the access control
management, it allows privileged app to access the server one at a time
and separate connection for anonymous users / guest. Last and least
priority is to rely on existing database providers to host the data.

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