SAPHIRE Newsletter Issue nr.1 - Interview with the boss

Saphire Gazette: Prof. Dogac, looking at its title, Saphire is about “Intelligent Healthcare Monitoring based on a Semantic Interoperability Platform”. How should we understand this in some relation to our own lives and some practical situations?

Prof Dogac: By intelligent healthcare monitoring we mean the patient follow-up and monitoring especially in remote locations through computerized decision support systems. With the aging society, the remote monitoring of patients becomes a must both to decrease the cost, and the load of general practitioners and serve better healthcare services to the patients. The Saphire Project aims to monitor the vulnerable patients by specific guidelines. The wireless sensors which are gently located over the patient, measures the intended medical values; such as blood pressure, ECG, heart rate, oxygen saturation of blood. The clinical guidelines are executed through a clinical decision support system in a proactive manner for any abnormal case reported by the medical sensors. The decision support system also retrieves patient’s previous medical history from the hospitals where the patient has been previously hospitalized. If some abnormal situation is detected by the decision support system, the identified stakeholders who can be doctors, nurses or patient relatives are informed about the status of the patient immediately.

Gazette: One of the points you raise in the description of the project is that “the medical practitioners at all levels are becoming more overloaded as the aging population of Europe increases”. What is your position? I.e. is this a social problem with economic implications and the Community should address it with an appropriate mix of services, technologies and infrastructures? And: how should we expect Saphire to contribute to the current situation?

Dogac: The European population is getting older and the average life span is getting longer. It is a fact that while people getting older, the possibility to encounter chronic diseases increases. All of these facts directly affect the healthcare domain: the cost of treatment increases, and so does the load of general practitioners. Thus remote monitoring especially for the patients living at their homes has a key role to reduce the costs and to provide better services. Saphire enables to follow up the patients from their homes through wireless medical sensors and clinical decision support system which will lead to a reduction of medical costs by also cutting down rehospitalisation procedures in future.

Gazette: In many cases, and not necessarily in the context of the new member countries, it is difficult to apply an advanced solution concept because of shortcomings in the underlying infrastructures and the people’s and domain experts attitude. Is this holding also for the case of Saphire?

Dogac: The infrastructure has an important role to apply and execute systems for remote healthcare monitoring because it is necessary to transmit sensor data between the remote points such as homes, and healthcare centres such as hospitals or clinics. The communication within the end points mainly between the sensors and interfaces for outer transmission can be handled with Bluetooth standard which is independent from the main public data infrastructure. For the data transmissions between the remote care endpoints and healthcare centres the basic internet infrastructure is enough which exists in all European Countries; such as cablenet, ADSL. Hence we do not think that the underlying infrastructure is an obstacle for Saphire.

We aim to gain the support of domain experts through two pilot applications that will be realized in real life settings. We hope that through these pilot applications the healthcare practitioners will see the direct benefits of the Saphire System.

Gazette: There is a big number of projects that are lacking resources or willingness to make the extra mile which would bring them to a scientific breakthrough or a commercial success. Which are the envisaged goals from your side in Saphire?

Dogac: Saphire project addresses a problem that has not yet been solved in healthcare domain: seamless integration of medical sensor data and electronic healthcare records of the patient for remote healthcare monitoring. We aim to publish the end results of Saphire through highly credible scientific journals to disseminate our results to the scientific community. Also through our pilot applications that will be realized in real life settings, we aim to attract industry, and increase our exploitation opportunities.

Gazette: In the project you collaborate closely with medical doctors. For sure there might be some communication challenges as you don’t have the same background and use different languages. Is this as difficult as it seems to be? How are you going to cope with this?

Dogac: Medical doctors have a key role in the Saphire Project where they will shape the clinical guidelines to be used in the system. The effectiveness of clinical guidelines is vital for the general performance and efficiency of the Saphire System. These healthcare guidelines will be structured by the medical doctors and will be coded into the system by technical partners, so there is a high interaction and dependency between the medical doctors and the technical partners. However we hope that this issue will not create a problem, since the technical partners and the medical doctors will start studying together right in the beginning of the project through the requirements analysis and design phases of the Saphire System. Furthermore, the partners in the Saphire Project have expertise in eHealth domain with various projects.

Gazette: Many projects solve a problem – but it is difficult to replicate the process and provide a solution either to the industry or to the end users. What is your view on this? How is Saphire going to cope with this matter?

Dogac: We aim to base the Saphire architecture according to the requirements of our end users. Right from the beginning of the project we will do our best to create an infrastructure that can be used in real life settings, and will demonstrate the benefits of the system through real life pilot applications. We hope that this effort will increase the chance of an industry uptake.

Gazette: In the project you take a dual approach by means of addressing the requirements of both an in-hospital solution to monitor cardiovascular patients in a hospital in Romania, and a second one for homecare monitoring of cardiovascular patients in Germany. Why? Do you see a potential in both cases, or is it part of some need to examine closer any deficiencies of the two approaches?

Dogac: To prove the applicability of the solutions we have chosen two different settings: homecare and in-hospital monitoring. This is because that the requirements of these two settings are very different. Saphire architecture aims to cover both of these requirements, since it aims to provide a generic solution for remote intelligent healthcare monitoring.

Gazette: Let’s talk about standards: in the last years you have personally participated in standardization activities and have personally contributed as author. On the other hand, you make use of existing de facto and industry standards in the area of Semantic Web and interoperability. What is the ‘perfect mix’ for a company or an organization to cope with the issue of standards in the Saphire area?

Dogac: Saphire project will built upon already existing standards in diverse domains in covers, such as OWL, GLIF, HL7 CDA, EHRCom, FIPA and so on. However we aim to contribute to these standards, by sharing our experiences in applying these standards to a specific healthcare problem: remote healthcare monitoring, and also to propose necessary extensions to these standards when necessary.

Gazette: Currently, there are ongoing initiatives at the international level in the area of Saphire. Can you name some of them that you feel are interesting to watch or even to develop synergies with them?

Dogac: Saphire Project is interested in some projects with similar objectives and with which synergies can be developed. The projects can be stated as followings;

1.	MyHeart (IST 507816, http://www.extra.research.philips.com/euprojects/myheart/) which is an Integrated Project, funded by the IST programme.
2.	The MobiHealth (IST-2001-36006, http://www.mobihealth.org/) which provides a Java service platform for mobile healthcare.
3.	HEARTS (IST-2001-37403, http://heartsproject.datamat.it/hearts) project whose main aim is to develop techniques for early detection of myocardial ischaemia from the ECG signals.
4.	The ARTEMIS (http://www.srdc.metu.edu.tr/webpage/projects/artemis) project which is currently developing a semantic Web services based interoperability framework for the healthcare domain.
5.	U-R-SAFE (IST-2001-33352, http://ursafe.tesa.prd.fr/) project whose aim is to have the elderly person wear medical measuring devices, all connected via short range Wireless Personal Area Network (WPAN) to a central, portable electronic unit, the Personal Base Station.
6.	CASCOM project whose aim is to implement, validate, and trial a value-added supportive infrastructure for Semantic Web based business application services across mobile and fixed networks.
7.	SerAPI is a research and development project in Finland, which focuses on the utilisation of Service-oriented architecture and Web Service technologies for information system and application integration needs in healthcare.
8.	AINGERU is a proposal for a new way of tele assistance for elderly people. Its goal is to overcome the weaknesses that present most of the teleassistance services offered nowadays. AINGERU takes benefit from the new advances in the areas of networking (wireless communications), mobile computing (Personal Digital Assistants) and semantic web and agent technologies to accomplish its goal. This project is been developed by the BDI Group (http://siul02.si.ehu.es/) and the work is mainly supported by the University of the Basque Country, Diputación Foral de Gipuzkoa (cosupported by the European Social Fund) and CICYT [TIN2004-07999-C02-00].

Gazette: Business process integration and service interoperability exhibit a ubiquity in terms that problems related to their lack appear in virtually any application domain. Why do you make an investment in terms of focusing to the area of e-Health?

Dogac: You are right, business process integration and service interoperability can be applied in many domains, however each domain has its own specific problems to be addressed, and semantics is domain knowledge hence these research problems should be applied in a domain specific manner. Also healthcare domain is a very complex domain, where these technologies can help us to tackle some of the unsolved problems in healthcare domain.

Gazette: You are also the Coordinator of another IST Project in the same area of e-Health. As we know, the ARTEMIS project is approaching its completion – do you consider that there is a bridge between these two projects that can exhibit some positive impact?

Dogac: As you have stated, the Saphire Project is mainly built upon the results of a European commission funded project, IST-1-002103 Artemis. Artemis is developing a semantic web service-based P2P Infrastructure for the Interoperability of Medical Information Systems. Artemis project enables the Healthcare Institutes to exchange Electronic Healthcare Records in interoperable manner through semantically enriched web services and semantic mediation. The Saphire Project will exploit these results by integrating the patient data collected through wireless medical sensor devices with the hospital information systems. This infrastructure will constitute the interoperability base for the intelligent healthcare monitoring system.