M-Health

Emerging Mobile Health Systems

TOPICS IN BIOMEDICAL ENGINEERINGINTERNATIONAL BOOK SERIES

Series Editor: Evangelia Micheli-TzanakouRutgers UniversityPiscataway, New Jersey

Signals and Systems in Biomedical Engineering:Signal Processing and Physiological Systems Modeling

Suresh R. Devasaahayam

Models of the Visual SystemEdited by George K. Hung and Kenneth J. Ciuffreda

PDE and Level Sets: Algorithmic Approaches to Static and Motion ImageryEdited by Jasjit S. Suri and Swamy Laxminarayan

Frontiers in Biomedical Engineering:Proceedings of the World Congress for Chinese Biomedical Engineers

Edited by Ned H.C. Hwang and Savio L-Y. Woo

Handbook of Biomedical Image Analysis:Volume I: Segmentation Models Part A

Edited by Jasjit S. Suri, David L. Wilson, and Swamy Laxminarayan

Handbook of Biomedical Image Analysis:Volume II: Segmentation Models Part B

Edited by Jasjit S. Suri, David L. Wilson, and Swamy Laxminarayan

Handbook of Biomedical Image Analysis:Volume III: Registration Models

Edited by Jasjit S. Suri, David L. Wilson, and Swamy Laxminarayan

M-Health: Emerging Mobile Health SystemsEdited by Robert S.H. Istepanian, Swamy Laxminarayan, andConstantinos S. Pattichis

Robert S.H. IstepanianSwamy LaxminarayanConstantinos S. Pattichis(Editors)

M-Health

Emerging Mobile Health Systems

With 182 Illustrations

Robert S.H. IstepanianKingston UniversityLondonUK

Constantinos S. PattichisUniversity of CyprusNicosiaCyprus

Swamy LaxminarayanIdaho State University Biomedical Research

Institute and the Institute of Rural HealthPocatello, IdahoUSA

Library of Congress Control Number: 2005927930

ISBN-10: 0-387-26558-9

Printed on acid-free paper.

ISBN-13: 978-0387-26558-2

C© 2006 Springer Science+Business Media, Inc.All rights reserved. This work may not be translated or copied in whole or in part without the written permissionof the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA),except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any formof information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilarmethodology now known or hereafter developed is forbidden.The use in this publication of trade names, trademarks, service marks, and similar terms, even if they arenot identified as such, is not to be taken as an expression of opinion as to whether or not they ar subject toproprietary rights.

Printed in the United States of America. (TB/MVY)

9 8 7 6 5 4 3 2 1

springeronline.com

e-ISBN: 0-387-26559-7

“Ask, and it shall be given you; seek, and

you shall find; Knock, and it shall be opened

to you. For everyone who asks, receives;

and he who seeks, finds; and to him who

knocks, it shall be opened.”

Matthew 7:7-8.

Dedication

To the God Almighty for His Blessings and alsoto my family (my Wife Helen and to my two Daughters, Carolyn and Sarah).

Robert S.H. Istepanian

To the tireless work and contributions of all my students all around the world andto my family (my wife Marijke, my son Vinod and my daughter Malini).

Swamy Laxminarayan

To the memory of my cousin Andreas Procopiou who, despite physical disability,lived a fruitful life, offering happiness to the people around him.

He believed in innovative technology for making the life of the disabled better.

Constantinos S. Pattichis

Contributors

Editors

Robert S.H. Istepanian Mobile Information and Network Technologies Research Centre (MINT),

School of Computing and Information Systems,

Kingston University, London

UK

r.istepanian@kingston.ac.uk

http://technology.kingston.ac.uk/MINT

Swamy Laxminarayan ISU Biomedical Research Institute and theInstitute of Rural Health, Pocatello, Idaho USAs.n.laxminarayan@ieee.org

Constantinos S. Pattichis Department of Computer ScienceUniversity of Cyprus Cypruspattichi@ucy.ac.cyhttp://www.cs.ucy.ac.cy/People/Profiles/

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M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

Section Editors

Lymberis Andreas European Commission, Directorate General Information Society, Av. De Beaulieu 31, 1160 Brussels Andreas.lymberis@cec.eu.intwww.cordis.lu/ist/directorate_c/ehealth/index.html

Nugent Chris D. University of Ulster, Jordanstown, Northern Ireland, BT37 0QB. cd.nugent@ulster.ac.uk;

Pattichis Marios S. Dept of Electrical and Computer Engineering, and Computer EngineeringThe University of New Mexico ECE Building, The University of New Mexico, The University of New Mexico, Albuquerque, NM 87131-1356. pattichis@ece.unm.edu

Pavlopoulos Sotiris A. National Technical University of Athens Biomedical Engineering Laboratory, Department of Electrical and Computer Engineering, National Technical University of Athens, 9 Iroon Polytecniou str., Zografou Campus, 15773, Athens, Greece spav@biomed.ntua.grwww.biomed.ntua.gr

Vieyres Pierre Université d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France Pierre.Vieyres@bourges.univ-orleans.fr

Authors

Abdallah Rony The George Washington University Hospital, The George Washington University Hospital, 2150 Pennsylvania Avenue NW 6A, Washington DC 20037 ronya@gwu.edu

Alesanco Álvaro University of Zaragoza, Communication Technologies Group (GTC), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, SPAIN alesanco@unizar.es;

Altieri Roberto Area Manager, Nergal S.r.l. Viale B. Bardanzellu, 8 - 00155 Rome, Italy altieri@nergal.itwww.nergal.it

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CONTRIBUTORS

Andreou Panayiotis Department of Computer Science, University of Cyprus, University of Cyprus,P.O. Box 20537, Nicosia, CY 1678, Cyprus cs98ap1@cy.ac.cy

Arbeille Philippe Université de Tours, Centre Hospitalier Universitaire Trousseau, 37032 Tours Cedex, FranceArbeille@med.univ-tours.fr

Bali Rajeev K. Knowledge Management for Healthcare (KMH) subgroup, Biomedical Computing Research Group (BIOCORE), Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom r.bali@ieee.orgwww.mis.coventry.ac.uk/biocore/kmh

Beglinger Christoph Prof. Dr. med University Hospital Basel, Department of Gastroenterology, Petersgraben 4,CH-4031 Basel, Switzerlandbeglinger@ tmr.ch

Ben Shaphrut OdedHebrew University Jerusalem and Interuniversity Institute, Eilat, Israel,P.O.B 469, Eilat 88103, Israel odediver@pob.huji.ac.il

Black Norman D.University of Ulster, Jordanstown, Northern Ireland, BT37 0QB, UK Nd.black@ulster.ac.uk Bonis Julio IMIM. IMAS. Fundació IMIM, c/ Doctor Aiguader, 80, 8003 Barcelona jbonis@imim.es Bults Richard University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands r.g.a.bults@ewi.utwente.nl

Christodoulou Eleni Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus Eleni_Christodoulou@cytanet.com.cy

Clamp Susan Clinical Information Science Unit, University of Leeds, 26 Clarendon Road,Leeds LS2 9NZ, United Kingdom s.clamp@leeds.ac.uk

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M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

Cornelis JanDepartment of Electronics and Information Processing (ETRO),Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgiumjpcornel@etro.vub.ac.bewww.etro.vub.ac.be/Members/cornelis.jan/personal_private.htm

Courrèges Fabien Université d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France Fabien.Courreges@bourges.univ-orleans.fr

de Toledo Paula Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid,E.T.S. Ingenieros de Telecomunicación. Ciudad Universitaria. 28040 Madrid paula@gbt.tfo.upm.es del Pozo Francisco Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid,GBT ETSI Telecomunicación Ciudad Universitaria sn. 28040 MADRID, SPAIN fpozo@gbt.tfo.upm.es

Dhaen Christoffel Language and Computing, Maaltecenter Blok A, Derbystraat 79,9051 Sint-Denijs-Westrem, Belgium christoffel@landc.be

Dikaiakos Marios Department of Computer Science, University of Cyprus,P.O. Box 20537, Nicosia, CY 1678, Cyprus mdd@ucy.ac.cy

Doarn Charles R, Executive Director Center for Surgical Innovation, Research Associate Professor, Department of Surgery, University of Cincinnati, SRU 1466, Cincinnati, OH 45267-0558 charles.doarn@uc.edu

Dokovsky Nikolai Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede The Netherlands n.t.dokovski@ewi.utwente.nl Dos Santos Mariana Casella Language and Computing, Maaltecenter Blok A, Derbystraat 79,9051 Sint-Denijs-Westrem, Belgium mariana@landc.bewww.landc.be

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CONTRIBUTORS

Drion Benoit Airial, 3 rue Bellini, 92800 Puteaux, France

Dunbar Angela IMIM. IMAS. Fundació IMIM, c/ Doctor Aiguader, 80, 8003 Barcelona adunbar@imim.es

Dwivedi Ashish N. Knowledge Management for Healthcare (KMH) subgroup, Biomedical Computing Research Group (BIOCORE), Coventry University, Priory Street, Coventry, CV1 5FBUnited Kingdom ashishdwivedi@ntlworld.comwww.mis.coventry.ac.uk/biocore/kmh/

Dyson Anthony Eddabbeh Najia BFC, 196 rue Houdan, F-92330 Sceaux (France) najia.eddabbeh@business-flow.com

Eich Hans-Peter Heinrich-Heine-University, Dusseldorf, Moorenstr. 5, D - 40225 Düsseldorf, Germany eich@uni-duesseldorf.de

Falas Tasos Department of Computer Science, University of Cyprus,P.O. Box 20537, Nicosia, CY 1678, Cyprus tfalas@ucy.ac.cy

Finlay Dewar D. University of Ulster, Jordanstown, Northern Ireland, BT37 0QB. d.finlay@ulster.ac.uk Fischer Hans Rudolf, PhD University Hospital Basel, Department of Gastroenterology, Petersgraben 4,CH-4031 Basel, Switzerland hrfischer@eblcom.chwww.uhb-moebius.ch

García José Communication Technologies Group (GTC), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, SPAIN jogarmo@unizar.es

García-OlayaAngel Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid, GBT, ETSI Telecomunicación, Ciudad Universitaria sn., 28040 MADRID, SPAIN agarcia@gbt.tfo.upm.es

Georgiadis Dimosthenis Department of Computer Science, University of Cyprus,P.O. Box 20537, Nicosia, CY 1678, Cyprus cspggd@ucy.ac.cy

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M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

Giovas Periklis, MD Cardiology Laboratory, 1

st Department of Propaedeutic Medicine,

Laikon Hospital, Athens University, Athens, Greece periklisgiovas@ath.forthnet.gr

Goens Beth M. Pediatric Cardiology, University of New Mexico, MSC10 5590,1Albuquerque, NM 87131-0001 mbgoens@salud.unm.edu Gómez Enrique J.Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid,GBT, ETSI Telecomunicación, Ciudad Universitaria sn., 28040 MADRID, SPAIN egomez@gbt.tfo.upm.es

Gutzwiller Jean-Pierre University Hospital, CH-4031 Basel, Switzerland. Hadjileontiadis Leontios J. Dept. of Electrical and Computer Engineering, School of Engineering,Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greeceleontios@auth.gr Hernando M. Elena Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid,GBT, ETSI Telecomunicación, Ciudad Universitaria sn., 28040 MADRID, SPAIN elena@gbt.tfo.upm.es

Herzog Rainer Ericsson GmbH, Ericsson GmbH, Maximilianstrasse 36/RG,D-80539 Munich, Germany rainer.herzog@ericsson.com

Incardona FrancescaInforma s.r.l. - Arakne s.r.l., V. dei Magazzini Generali,31, 00154 Roma, Italy f.incardona@informacro.infohttp://www.informacro.info Istepanian Robert S.H. Mobile Information and Network Technologies Research Centre (MINT),School of Computing and Information Systems, Kingston University,Kingston upon Thames, London, UK. r.istepanian@kingston.ac.ukhttp://technology.kingston.ac.uk/MINT

Jimenez SilviaGrupo de Bioingeniería y TelemedicinaUniversidad Politécnica de Madrid,E.T.S. Ingenieros de Telecomunicación., Ciudad Universitaria. 28040 Madrid sjimene@gbt.tfo.upm.es z

xiv

CONTRIBUTORS

Jones Val Faculty of Electrical Engineering, Mathematics and Computer Science,University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands V.M.Jones@ewi.utwente.nl aps.cs.utwente.nl/ Jovanov Emil Electrical and Computer Engineering Dept.,The University of Alabama in Huntsville, Huntsville, AL, 35899, USA jovanov@ece.uah.eduwww.ece.uah.edu/~jovanov

Kirke Chris Clinical Information Science Unit, University of Leeds, 26 Clarendon Road,Leeds, LS2 9NZ, United Kingdom

Kirkilis Harris, Sales Manager Relational Technology, 13 Posidonos Ave., "AEGEAN" Building, 174 55 Alimos,Athens, Greece hkirki@relational.grwww.relational.gr Konstantas Dimitri University of Geneva, Centre Universitaire D’Informatique, Rue General-Dufour 24,CH-1211 Geneve 4, Switzerland Dimitri.konstantas@cui.unige.ch Kontaxakis Georgios Universidad Politécnica de Madrid ETSI Telecomunicación, Dpto. Ing. Electrónica, Ciudad Universitaria s/n, 28040 Madrid, Spain gkont@die.upm.es

Koprinkov George Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands g.t.koprinkov@ewi.utwente.nl

Koutsouris Dimitris Head, Biomedical Engineering Laboratory, Department of Electrical and Computer Engineering, National Technical University of Athens, 9 Iroon Polytecniou str., Zografou Campus, 15773, Athens, Greece dkoutsou@biomed.ntua.grwww.biomed.ntua.gr

Kova evi Branko University of Belgrade, Faculty of Electrical Engineering, Bulevar Kralja Aleksandra 73, 11000, Belgrade, Serbia and Montenegro

Kyriacou EfthyvoulosDepartment of Computer Science, University of Cyprus, 75 Kallipoleos str,P.O.Box 20537, 1678, Nicosia, Cyprus ekyriac@ucy.ac.cywww.medinfo.cs.ucy.ac.cy

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M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

Lauzan José Enrique SCHULERBERGSEMA, Albarracín, 25 28037 Madrid, Spain Lavigne Kevin Vermont Arctic Education Program losepia@yahoo.com

Litos George Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi, Thessaloniki GR-57001, Greece Lugg Desmond J Director, Division of Extreme Environments, Office of the Chief Health and medical Office, NASA HQ. Washington, DC, 20546, USAdesmond.e.lugg@nasa.gov

Markovi Milan, Dr Project Manager, IT Department, Delta banka a.d., 7b Milentija Popovi a,11070 Belgrade, Serbia and Montenegro milan.markovic@deltabanka..co.yuwww.deltabanka.co.yu

Merrell Ronald C., MD Medical Informatics and Technology Applications Consortium,Virginia Commonwealth University, 1101 E Marshall Street,PO Box 980480, Richmond, VA 23298-0480 rcmerrel@mail2.vcu.edu

Montyne Frank Language and Computing, Maaltecenter Blok A, Derbystraat 79,9051 Sint-Denijs-Westrem, Belgium frank@landc.be

Munteanu Adrian Department of Electronics and Information Processing (ETRO),Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium acmuntea@etro.vub.ac.bewww.etro.vub.ac.be/Members/MUNTEANU.Adrian/personal_private.htm

Naguib Raouf N.G. Biomedical Computing Research Group (BIOCORE), Coventry University,Priory Street, Coventry, CV1 5FB, United Kingdom r.naguib@coventry.ac.ukwww.mis.coventry.ac.uk/biocore

Nassar Nahy S Biotech Associates Limited, PO Box 3156, COVENTRY, West Midlands CV8 3YU, Englandn.nassar@ biotechassociates.co.uk www.biotechassociates.co.uk

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CONTRIBUTORS

Nicogossian Arnauld E., MD School of Public Policy, George Mason University, 440 University Drive,MS 3C6 Finley Building anicogos@gmu.edu

Nikolakis George Informatics and Telematics Institute, 1st Km Thermi-Panorama Road,Thermi-Thessaloniki GR-57001, Greece Novales Cyril Université d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France Cyril.Novales@bourges.univ-orleans.fr

Ohmann Christian Heinrich-Heine-University, Dusseldorf Moorenstr. 5,D - 40225 Düsseldorf, Germany ohmannch@uni-duesseldorf.de

Olmos Salvador Communication Technologies Group (GTC), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, SPAIN olmos@unizar.es

Orphanoudakis Stelios C. FORTH and University of Crete Director, Foundation for Research and Technology Hellas (FORTH), PO Box 1385, GR 711 10, Heraklion, Crete, Greece orphanou@ics.forth.grwww.ics.forth.gr/cmi-hta/orphanoudakis.html

Owens Frank J. University of Ulster, Jordanstown, Northern Ireland, BT37 0QB. Fj.owens@ulster.ac.uk

Papachristou Petros ATKO SOFT, 3 Romanou Melodou, Str. Marousi 151 25, Athens, Greece ppap@atkosoft.com

Papadopoulos Constantinos Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus cspgcp3@cs.ucy.ac.cy

Papadopoulos George A. Department of Computer Science, University of Cyprus, P.O. Box 20537, Nicosia, CY 1678, Cyprus george@cs.ucy.ac.cy

Papadoyannis Demetrios Cardiology Laboratory, 1

st Department of Propaedeutic Medicine, Laikon Hospital, Athens

University, Athens, Greece

xvii

M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

Papazachou Ourania, MD Cardiology Laboratory, 1

st Department of Propaedeutic Medicine,

Laikon Hospital, Athens University, Athens, Greece rpapazachou@hotmail.com

Peuscher Jan Twente Medical Systems International, TMS International BV, P.O. Box 1123,7500 BC Enschede, The Netherlands jan.peuscher@tmsi.com Pitsillides Andreas Department of Computer Science, University of Cyprus,P.O. Box 20537, Nicosia, CY 1678, Cyprus Andreas.Pitsillides@ucy.ac.cywww.ditis.ucy.ac.cy

Pitsillides Barbara PASYKAF Larnaca, Kariders Court, Larnaca cspitsil@cytanet.com.cy

Poisson GérardUniversité d’Orléans, Laboratoire Vision et Robotique, 63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France Gerard.Poisson@bourges.univ-orleans.fr

Priddy Brent Electrical and Computer Engineering Dept.,The University of Alabama in Huntsville, Huntsville, AL, 35899, USA toopriddy@gmail.com

Raskovic Dejan Dept. of Electrical and Computer Engineering,University of Alaska Fairbanks, Fairbanks, AK, 99775-5915, USA raskovic@computer.orgwww.uaf.edu/ece/raskovic.htm

Reichlin Serge Division of Endocrinology, Diabetes, Metabolism and Molecular Medicine,Tufts University School of Medicine, New England Medical Center, Boston, USA.reichlin@dakotacom.net

Reid Innes Clinical Information Science Unit, University of Leeds, 26 Clarendon Road, Leeds, LS2 9NZ, United Kingdom

Ricci RobertoResearch Project Coordinator, Informa srl, via dei Magazzini Generali,31 – 00154, Rome, Italyr.ricci@informacro.infowww.informacro

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CONTRIBUTORS

Rienks Rienk Heart Lung Centre and Central Military Hospital, Utrecht,The Netherlands,Heidelberlaan 100, 3584 CX Utrecht r.rienks@chello.nl

Rodriguez Sergio IMIM. IMAS, Fundació IMIM, c/ Doctor Aiguader, 80, 8003, Barcelona srodriguez@imim.es

Rodriguez Paul V. Dept of Electrical and Computer Engineering, ECE Building, The University of New Mexico, Albuquerque, NM 87131-1356 prodrig@ece.unm.edu

Sakas Georgios Dept. Cognitive Computing and Medical Imaging,Fraunhofer Institute for Computer Graphics (IGD), Fraunhoferstr. 5,Darmstadt, Germany D-64283 gsakas@igd.fhg.de

Samaras GeorgeDepartment of Computer Science, University of Cyprus,P.O. Box 20537, Nicosia, CY 1678, Cyprus cssamara@ucy.ac.cy

Sancho Juan J. HOSPITAL DEL MAR. IMIM. IMAS., Servei de Cirurgia General i Digestiva,Passeig Maritim, 25-29, 08003 Barcelona, Spain sancho@imim.es

Savi Zoran SmartIS Group, NetSeT, Kara or eva 65, 11000 Belgrade.

Schelkens Peter Department of Electronics and Information Processing (ETRO),Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium Peter.Schelkens@vub.ac.bewww.etro.vub.ac.be/Members/SCHELKENS.Peter/personal_private.htm

Shashar Nadav Hebrew University Jerusalem and Interuniversity Institute, Eilat, Israel,P.O.B 469, Eilat 88103, Israel nadavs@cc.huji.ac.il

Shimizu Koichi Laboratory of Biomedical Engineering,Department of Bioengineering and Bioinformatics,Graduate School of Information Science and Technology,Hokkaido University, Sapporo, Japan shimizu@bme.eng.hokudai.ac.jp

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M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

Skodras Athanassios N. Department of Computer Science, School of Science and Technology,Hellenic Open University, GR-262 22, Patras, Greece skodras@eap.grhttp://dsmc.eap.gr

Smith-Guerin Natalie Université d’Orléans, Laboratoire Vision et Robotique,63 Ave de Lattre de Tassigny, 18020 Bourges Cedex, France Natalie.Smith@bourges.univ-orleans.fr

Spanakis Manolis FORTH and University of Crete Institute of Computer Science (ICS), Foundation for Research and Technology – Hellas (FORTH),PO Box 1385, GR 711 10,Heraklion, Crete, Greece spanakis@ics.forth.grwww.ics.forth.gr/cmi-hta/spanakis.html

Strintzis Michael ITI CERTH Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi-Thessaloniki GR-57001, Greece strintzi@eng.auth.gr

Thierry Jean Pierre SYMBION, 109 Rue des Cotes, 78600 Maisons-Laffitte, France symbion@club-internet.fr

Thomakos Demetrios , General Manager Proton Labs Ltd, Athens, Greece protonlabs@ieee.org

Thomos Nikolaos ITI CERTH Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi-Thessaloniki GR-57001, Greece nthomos@iti.gr

Torralba Verónica Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid,GBT, ETSI Telecomunicación, Ciudad Universitaria sn., 28040 MADRID, SPAIN torralba@gbt.tfo.upm.es

Traganitis Apostolos FORTH and University of Crete Institute of Computer Science (ICS), Foundation for Research and Technology – Hellas (FORTH),PO Box 1385, GR 711 10, Heraklion, Crete, Greece tragani@ics.forth.grwww.ics.forth.gr/cmi-hta/tragani.html

Triantafyllidis GeorgeITI CERTH Informatics and Telematics Institute, 1st Km Thermi-Panorama Road, Thermi-Thessaloniki GR-57001, Greece gatrian@iti.gr

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CONTRIBUTORS

Tristram Clive Ets TRISTRAM Clive (Futur Dessin), Les Rives, 86460 Availles Limouzine, FRANCE Clive@free [clive.tristram@free.fr] www.med-mobile.org/MEMO3/index.php

Tsiknakis Manolis FORTH Institute of Computer Science (ICS), Foundation for Research and Technology – Hellas (FORTH), PO Box 1385, GR 711 10, Heraklion, Crete, Greece tsiknaki@ics.forth.grwww.ics.forth.gr/cmi-hta/tsiknakis.html Tzovaras Dimitris Informatics and Telematics Institute, Center for Research and Technology Hellas,57001 Thessaloniki, Greece Dimitrios.Tzovaras@iti.gr

van Halteren Aart Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO Box 217, 7500 AE, Enschede The Netherlands a.t.vanhalteren@ewi.utwente.nl Vierhout PieterFaculty of Business, Public Administration and Technology, University of Twente,P.O.Box 1123, 7500 BC Enschede, the Netherlands p.vierhout@orde.nl Virtuoso Salvatore TXT e-Solutions, Via Frigia 27, 20126 Milano, Italy Salvatore.virtuoso@txt.it Walter Stefan MedCom Gesellschaft für medizinische Bildverarbeitung mbH,Rundeturmstr. 12, 64283 Darmstadt, Germany swalter@medcom-online.de

Wang HaiyingUniversity of Ulster, Jordanstown, Northern Ireland, BT37 0QB. Haiying@infj.ulst.ac.uk Widya IngFaculty of Electrical Engineering, Mathematics and Computer Science,University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands i.a.widya@ewi.utwente.nl

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Preface

M-health can be defined as the ‘emerging mobile communications and network technologies for healthcare systems’. This definition can also infer that m-health is the result of evolution of the e-health systems and the ‘addition’ of emerging information and computing technologies in biomedicine to the modern advances in wireless and nomadic communication systems. The recent years have witnessed a major revolution in the technological advances of the next generation of wireless and network technologies paving the way towards the 4G wireless systems. It is clear from these advances and in particular from the anticipated convergence between the future data rates of nomadic and wireless systems within the next decade or so, that such developments will have a challenging and profound impact on future e-health systems.

The recent research relevant to m-health such as advances in nano-technologies, compact biosensors, wearable, pervasive and ubiquitous computing systems will all lead the successful launch of next generation m-health systems within the next decade. They will encompass all these technologies for future healthcare delivery services with the vision of ‘empowered healthcare on the move’. This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. The book also presents a new and forward looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare situation. It also provides a discovery path on the synergies between the 2.5G and 3G systems and other relevant computing and information technologies and how they prescribe the way for the next generation of m-health services.

The book contains 47 chapters, arranged in five thematic sections: Introduction to Mobile M-Health Systems, Smart Mobile Applications for Health Professionals, Signal,

xxiii

Image, and Video Compression for M-Health Applications, Emergency Health Care Systems and Services, Echography Systems and Services, and Remote and Home Monitoring. Each section begins with a section overview, and ends with a chapter on future challenges and recommendations.

This book is intended for all those working in the field of information technologies in biomedicine, as well as for people working in future applications of wireless communications and wireless telemedical systems. It provides different levels of material to researchers, computing engineers, and medical practitioners interested in emerging e-health systems.

The book serves as the basis for understanding the future of m-health technologies and services, exemplifying the impact of mobility on existing m-health and commercial telemedical systems.

We wish to thank all the section editors for their valuable time and efforts in putting together the section chapters, the authors for their hard work and for sharing their experiences so readily, and the numerous reviewers for their valuable comments in enhancing the content of this book. Furthermore we would like to express our sincere thanks to Elena Polycarpou for her excellent secretarial work in communicating with the section editors, authors, and reviewers and for putting together this book. We thank also Dr Henry Wang from the MINT center, and the EU for their funding of most of the work in the MINT centre. Last but not least, we would like to thank, Aaron Johnson, Krista Zimmer and the rest of the staff at Springer for their understanding, patience and support in materializing this project.

We hope that this book will be a useful reference for all the readers in this important and growing field of research and to contribute to the roadmap of future m-health systems and improved and effective healthcare delivery systems.

Robert S. H. Istepanian

Swamy Laxminarayan

Constantinos S. Pattichis

PREFACExxiv

Contents

Dedication ..................................................................................................................vii

I. INTRODUCTION TO MOBILE M-HEALTH SYSTEMS

Constantinos S. Pattichis, Robert S.H. Istepanian, andSwamy Laxminarayan, Section Editors

1. UBIQUITOUS M-HEALTH SYSTEMS AND THE

CONVERGENCE TOWARDS 4G MOBILE

TECHNOLOGIES .......................................................................................3Robert S.H. Istepanian, Constantinos S. Pattichis, and Swamy Laxminarayan

2. THE EFFICACY OF THE M-HEALTH PARADIGM:

INCORPORATING TECHNOLOGICAL,

ORGANISATIONAL AND MANAGERIAL

PERSPECTIVES .......................................................................................15 Ashish N. Dwivedi, Rajeev K. Bali, Raouf N.G. Naguib, and Nahy S. Nasaar

3. WIRELESS INTELLIGENT SENSORS ........................................................33Emil Jovanov and Dejan Raskovic

4. WIRELESS TECHNOLOGIES FOR HEALTHCARE

APPLICATIONS .......................................................................................51Brent Priddy and Emil Jovanov

xxv

Contributors ............................................................................................................... ix Preface.................................................................................................................... xxiii

M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

5. WIRELESS COMMUNICATION TECHNOLOGIES FOR

MOBILE HEALTHCARE APPLICATIONS:

EXPERIENCES AND EVALUATION OF SECURITY

RELATED ISSUES ....................................................................................65Manolis Tsiknakis, Apostolos Traganitis, Manolis Spanakis, andStelios C. Orphanoudakis

6. SECURE MOBILE HEALTH SYSTEMS: PRINCIPLES AND

SOLUTIONS ..............................................................................................81 Milan Markovi , Zoran Savi , and Branko Kova evi

7. COMPUTATIONAL AND WIRELESS MODELING FOR

COLLABORATIVE VIRTUAL MEDICAL TEAMS ..........................107George Samaras, Demosthenis Georgiades, and Andreas Pitsillides

II. SMART MOBILE APPLICATIONS FOR HEALTH

PROFESSIONALS

Andreas Lymberis, Section Editor

8. SECTION OVERVIEW ...................................................................................133 Andreas Lymberis

9. THE MEMO PROJECT - AN ACCOMPANYING MEASURE

FOR MEDICAL MOBILE DEVICES....................................................137Clive Tristram

10. MEDICAL NATURAL LANGUAGE PROCESSING

ENHANCING DRUG ORDERING AND CODING.............................147Mariana Casella Dos Santos, Frank Montyne, and Christoffel Dhaen

11. MOBI-DEV: MOBILE DEVICES FOR HEALTHCARE

APPLICATIONS ......................................................................................163Roberto Altieri, Francesca Incardona, Harris Kirkilis, and Roberto Ricci

12. WARDINHAND...............................................................................................177Salvatore Virtuoso

13. DOCMEM-MOBILE ACCESS TO ELECTRONIC HEATH

RECORDS ................................................................................................187Najia Eddabbeh and Benoit Drion

14. SMARTIE: SMART MEDICAL APPLICATIONS

REPOSITORY OF TOOLS FOR INFORMED EXPERT

DECISION .................................................................................................195

xxvi

Sergio Rodríguez, Chris Kirke, Innes Reid, Hans-Peter Eich, and Clive Tristram

15. TELEMEDICINE AS A NEW POSSIBILITY TO IMPROVE

HEATLH CARE DELIVERY .................................................................203Hans Rudolf Fischer, Serge Reichlin, Jean-Pierre Gutzwiller, Anthony Dyson, and Christoph Beglinger

16. MOBIHEALTH: MOBILE HEALTH SERVICES BASED ON

BODY AREA NETWORKS ....................................................................219Val Jones, Aart van Halteren, Ing Widya, Nikolai Dokovsky, George Koprinkov, Richard Bults, Dimitri Konstantas, and Rainer Herzog

17. MOBIHEALTH: MOBILE SERVICES FOR HEALTH

PROFESSIONALS ...................................................................................237 Val Jones, Aart van Halteren, Nikolai Dokovsky, George Koprinkov, Jan Peuscher, Richard Bults, Dimitri Konstantas, Ing Widya, andRainer Herzog

18. DITIS - A COLLABORATIVE VIRTUAL MEDICAL TEAM

FOR HOME HEALTHCARE OF CANCER PATIENTS ..................247Andreas Pitsillides, Barbara Pitsillides, George Samaras, Marios Dikaiakos, Eleni Christodoulou, Panayiotis Andreou, and Dimosthenis Georgiadis

19. FUTURE CHALLENGES AND RECOMMENDATIONS ........................267Val Jones, Francesca Incardona, Clive Tristram, Salvadore Virtuoso, and Andreas Lymberis

III. SIGNAL, IMAGE, AND VIDEO COMPRESSION FOR

M-HEALTH APPLICATIONS

Marios S. Pattichis, Section Editor

20. SECTION OVERVIEW .................................................................................273 Marios S. Pattichis

21. BIOSIGNALS AND COMPRESSION STANDARDS ................................277Leontios J. Hadjileontiadis

Juan J. Sancho, Susan Clamp, Christian Ohmann, José.E.Lauzàn, Petros Papachristou, Jean P.Thierry, Angela Dunbar, Julio Bonis,

CONTENTS xxvii

M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

22. RESILIENT ECG WAVELET CODING FOR WIRELESS

REAL-TIME TELECARDIOLOGY APPLICATIONS ......................293Álvaro Alesanco , José García, Salvador Olmos, and Robert S. H. Istepanian

23. THE JPEG2000 IMAGE COMPRESSION STANDARD IN

MOBILE APPLICATIONS .....................................................................313Athanasios N. Skodras

24. COMPRESSION OF VOLUMETRIC DATA IN MOBILE

HEALTH SYSTEMS ................................................................................329 Adrian Munteanu, Peter Schelkens, and Jan Cornelis

25. AN OVERVIEW OF DIGITAL VIDEO COMPRESSION FOR

MOBILE HEALTH SYSTEMS ..............................................................345Marios S. Pattichis, Songhe Cai, Constantinos S. Pattichis, and Rony Abdallah

26. FUTURE CHALLENGES AND RECOMMENDATIONS ........................365Marios S. Pattichis

IV. EMERGENCY HEALTH CARE SYSTEMS AND SERVICES

Sotiris Pavlopoulos, Section Editor

27. SECTION OVERVIEW .................................................................................371Sotiris Pavlopoulos

28. ECG TELECARE: PAST PRESENT AND FUTURE ...............................375Chris D. Nugent, Haiying Wang, Norman D. Black, Dewar D. Finlay, and Frank J. Owens

29. MEDICAL ASPECTS OF PREHOSPITAL CARDIAC

TELECARE...............................................................................................389Periklis Giovas, Demetrios Thomakos, Ourania Papazachou, and Demetrios Papadoyannis

30. AN EMERGENCY TELEMEDICINE SYSTEM BASED ON

WIRELESS COMMUNICATION TECHNOLOGY: A

CASE STUDY ..........................................................................................401 Efthyvoulos Kyriacou, Sotiris Pavlopoulos, and Dimitris Koutsouris

31. APPLICATION OF MOBILE COMMUNICATION

TECHNIQUES FOR EMERGENCY TELEMEDICINE ...................417Koichi Shimizu

32. FUTURE CHALLENGES AND RECOMMENDATIONS .......................435Efthyvoulos Kyriacou and Sotiris A. Pavlopoulos

xxviii

V. ECHOGRAPHY SYSTEMS AND SERVICES

Pierre Vieyres, Section Editor

33. SECTION OVERVIEW .................................................................................441Pierre Vieyres

34. MOBILE TELE-ECHOGRAPHY SYSTEMS – TELEINVIVO:

A CASE STUDY .......................................................................................445Georgios Kontaxakis, Georgios Sakas, and Stefan Walter

35. A TELE-OPERATED ROBOTIC SYSTEM FOR MOBILE

TELE-ECHOGRAPHY: THE OTELO PROJECT..............................461Pierre Vieyres, Gérard Poisson, Fabien Courrèges, Natalie Smith-Guerin, Cyril Novales, and Philippe Arbeille

36. USER INTERFACE ENVIRONMENT AND IMAGE

COMMUNICATION IN MOBILE TELE-ECHOGRAPHY ..............475George A Triantafyllidis, Nicolaos Thomos, George Nikolakis, Dimitrios Tzovaras, George Litos, and Michael G. Strintzis

37. OBJECT-BASED ULTRASOUND VIDEO PROCESSING

FOR WIRELESS TRANSMISSION IN CARDIOLOGY....................491Paul Rodriguez V, Marios S. Pattichis, Constantinos S. Pattichis, Rony Abdallah, and Mary Beth Goens

38. FUTURE CHALLENGES AND RECOMMENDATIONS .......................509Pierre Vieyres, Gérard Poisson, George Triantafyllidis, Marios S. Pattichis, and Georgios Kontaxakis

VI. REMOTE AND HOME MONITORING

Chris D. Nugent, Section Editor

39. SECTION OVERVIEW ..................................................................................515 Chris D. Nugent and Dewar D. Finlay

40. CIVILIAN TELEMEDICINE IN REMOTE AND EXTREME

ENVIRONMENTS....................................................................................517 Arnauld E. Nicogossian, Desmond J. Lugg, and Charles R. Doarn

41. TELEMATIC REQUIREMENTS FOR EMERGENCY AND

DISASTER RESPONSE DERIVED FROM ENTERPRISE

MODELS ...................................................................................................531Ing Widya, Pieter Vierhout, Val M. Jones, Richard Bults, Aart van Halteren, Jan Peuscher, and Dimitri Konstantas

CONTENTS xxix

M-HEALTH: EMERGING MOBILE HEALTH SYSTEMS

42. TELEMATIC SUPPORT FOR DISASTER SITUATIONS .......................549Charles R. Doarn, Arnauld E. Nicogossian, and Ronald C. Merrell

43. REMOTE MONITORING FOR HEALTHCARE AND FOR

SAFETY IN EXTREME ENVIRONMENTS ........................................561 Val Jones, Nadav Shashar, Oded Ben Shaphrut, Kevin Lavigne, Rienk Rienks, Richard Bults, Dimitri Konstantas, Pieter Vierhout, Jan Peuscher, Aart van Halteren, Rainer Herzog, and Ing Widya

44. CHRONIC PATIENT’S MANAGEMENT: THE COPD

EXAMPLE.................................................................................................575 Francisco del Pozo, Paula de Toledo, Silvia Jiménez, M. Elena Hernando, and Enrique J. Gómez

45. A MOBILE TELEMEDICINE WORKSPACE FOR

DIABETES MANAGEMENT ................................................................587 M. Elena Hernando, Enrique J. Gómez, Angel García-Olaya, Verónica Torralba, and Francisco del Pozo

46. MOBILE MANAGEMENT AND PRESCRIPTION OF

MEDICATION ..........................................................................................601 Chris D. Nugent, Dewar D. Finlay, Norman D. Black, Tasos Falas,Constantinos Papadopoulos, and George A. Papadopoulos

47. FUTURE CHALLENGES AND RECOMMENDATIONS ........................617Dewar D. Finlay and Chris D. Nugent

AUTHOR INDEX .................................................................................................619

SUBJECT INDEX..................................................................................................621

xxx

I. INTRODUCTION TO MOBILE M-HEALTH SYSTEMS

Constantinos S. PattichisRobert S.H. IstepanianSwamy Laxminarayan

Section Editors

3

UBIQUITOUS M-HEALTH SYSTEMS AND

THE CONVERGENCE TOWARDS 4G MOBILE

TECHNOLOGIES

Robert S. H. Istepanian*, Costantinos S. Pattichis, and Swamy Laxminarayan

1. INTRODUCTION

The increased availability, miniaturization, performance and enhanced data rates of future mobile communication systems will have an increasing impact and accelerate the deployment of m-health systems and services within the next decade. M-Health can be defined as ‘emerging mobile communications and network technologies for healthcare.’ This emerging concept represents the evolution of e-health systems from traditional desktop ‘telemedicine’ platforms to wireless and mobile configurations. The expected convergence of future wireless communication, wireless sensor networks and ubiquitous computing technologies will enable the proliferation of such technologies around healthcare services with both cost-effective, flexible and efficient ways. These advances will have a powerful impact on some of the existing healthcare services and will reshape some of the mechanisms of existing healthcare delivery routes.

It is expected that the developments in this area will evolve towards two complementary tracks. The first will focus on the emerging advances in Third Generation (3G) and beyond 3G (4G) technologies whilst, the second will track the recent developments in biosensors and their networks connectivity issues combined with the pervasive, wearable and ubiquitous computing m-health systems. The current (3G) mobile systems represent a distinctive leap from the 2.5G mobile systems supporting higher data rates and better Quality of Services (QoS) that are more suitable for demanding healthcare applications. It is well known that 3G mobile systems will be able to facilitate the demanding m-health applications with ‘always on healthcare services’. These can now support a variety of medical and well being services within the operational bit rates from

* Robert S.H. Istepanian, Mobile Information and Network Technologies Research Centre (MINT), School of Computing and Information Systems, Kingston University, London KT22 , UK, e-mail: robert.istepanian@kingston.ac.uk

R. S. H. ISTEPANIAN ET AL. 4

144 Kbps in mobile conditions and up to 2 Mbps in indoor scenarios.This chapter outlines some of the current m-health systems and presents an overview

of some successful applications. It also presents some of the future challenges and research issues dealing with the migration of these systems towards 4G mobile technologies and their convergence with such systems from the view of the two complementary tracks outlined above. The chapter also outlines the contributions presented in the introduction to mobile-health section of the book that represent some of these recent developments and illustrate the multidisciplinary nature of this important and emerging area. This will provide an informative reading for the next chapters of the book.

2. AN OVERVIEW OF CURRENT AND EMERGING M-HEALTH SYSTEMS

Recent years have seen the convergence of both computing and wireless communication systems towards next generation m-health systems. The recent announcement from the European Commission for plans to adapt common e-health policies and timeframe to implement European health information networks by 2008 is a clear example of the future trends in these critical areas of future healthcare systems (Europe Adopts e-health Timetables, 2004). The advances in the mobile technologies will soon prove to have a powerful impact on the way different healthcare delivery organizations will reshape the future of these services globally by utilizing such emerging technologies for the enhancement of future healthcare services. M-health is already redefining the original definition and concept of telemedicine as ‘medicine practiced at a distance’ to include the new mobility and ‘invisible communication technologies’ to reshape the future structure of global healthcare systems.

The increased availability, miniaturization, performance, enhanced data rates and the expected convergence of future wireless communication and network technologies around mobile health systems will accelerate the deployment of m-health systems and services within the next decade. These will have a powerful impact on some of the existing healthcare services and will reshape some of the mechanisms of existing healthcare delivery routes. For example, development of smart intelligent sensors and drug delivery devices, some of them implanted, will allow communication with a personal server in complete mobility. The personal server provides global connectivity to the telemedical server using a Wireless Personal Area Network (WPAN), Wireless Local Area Network (WLAN), or wireless Wide Area Network (WAN). The evolving mass markets mainly drive developments in these areas for cell phones and portable computing devices and represent an evolution of the previous generation of telemedical systems. A comprehensive overview of the recent advances in m-health systems can be cited in (Pattichis et al, 2002; Istepanian et al, 2004a; Istepanian et al, 2004b). However, a brief discussion on these technologies will also be presented here for completeness.

In general m-health systems can be classified into the following two categories that are briefly presented here: (i) Current 2.5G and 3G m-health systems; and (ii) Beyond 3G m-health and evolving systems. These are based on the synergy and evolution of the ‘enabling technologies’ in the areas of wireless communications, mobile networks, biosensors and computing technologies.