Based on the recommendations of one of its former prime ministers, Finland is set for a complete overhaul of innovation policy and its management. Plans for market-oriented innovation and tax incentives to attract foreign brains to the country are set to be adopted in August.

The new strategy will help the country to progress "from words to deeds," said Petri Peltonen, responsible for Finland's technology and innovation policy and implementation, presenteing a proposal for National Innovation Strategy on 24 June in Brussels.

"This is no rocket-science," said Peltonen, adding that the strategy just reflects "the most recent and relevant innovation policies and policy research developments: the role of open innovation, users and market".

A broad definition of innovation

The novelty of the final proposal lies in "the wide definition of innovation," which includes not only science and technology, but also "many non-scientific and non-technological features," explained Peltonen. "Being able to develop both at same level of resources and seriousness is probably something new Finland is doing," he said, listing design, branding, business concepts and innovation in management, production, workplace and services as examples of "the soft side of innovation".

A user-oriented strategy

Another novelty is the role of users and the clear market orientation of the proposal. Peltonen said this is now being taken "seriously" and it is evident that the user and market orientation "call for change in national policies and in particular in the way policies are implemented in different organisations".

In fact, the strategy proposal can, to some extent, be seen as a national implementation plan of the 2006 Aho report on creating an innovative Europe , which urged creation of an innovation-friendly markets in which businesses can launch new products and services. Following that report, the Commission launched an initiative aiming to create EU-wide lead markets (LMI) on sectors such as eHealth or renewable energy.

"Size of the market is not finally important," said Esko Aho, noting that five million people [the size of Finnish population] was enough for creating market-oriented innovation, while some sectors, such as transport and logistics, would need an EU-wide dimension.

Money not an object

Aho also emphasised that "the cheapest solution is not innovative, because cheapest solution is based on current technologies".

"We need to dare to change if necessary and understand future customer needs before the customers themselves," agreed the executive director of the Finnish funding agency for technology and innovation (Tekes ), Riikka Heikinheimo. In addition, "more the policy instruments are market oriented, more they will be appreciated in global competition," noted Mikko Alkio, state secretary to the Minister of Economic Affairs.

The overall strategy consists of four main blocks. These are international dimension of innovation, demand and user orientation of innovation, supporting innovative individuals and communities and broad management of change.

Bold tax plans

"We have bold proposals," some of which, such as taxation, are politically sensitive, acknowledged Peltonen. To boost entrepreneurship, "there are clear recommendations" for tax incentives for private investors investing in risky businesses and for attracting qualified people from abroad with lower tax rates than they would normally see in Finland".

In addition, up to €1 million of public money can be invested in a growth company through a new European young innovative company fund, which is "something reasonably radical in Finland".

The Finnish Government will take a decision on the proposal in August after which it will be passed to the Parliament for discussion. The evaluation of all organisations involved in innovation will be conducted between August 2008 and March 2008 to determine the necessary changes for implementing the new policy.

The director of innovation policy at the Commission's DG Enterprise and Industry, Jean-Noël Durvy, said he was "impressed" by the policy and qualified the proposal as "an ambitious paper".

To read a full interview with Petri Peltonen, please click here.

Links

Governments

Finland: National innovation strategy [Proposal for National Innovation Strategy] (12 June 2008)

Vía: EuroActiv

Post relacionado:
Investigación sobre las TSI en Europa: buena, pero puede mejorar

Jede Schwangere in Deutschland hat einen Mutterpass: 16 Seiten mit allen wichtigen Daten zu Schwangerschaft und Geburt. Die Universitäts-Frauenklinik Heidelberg, sieben niedergelassene Gynäkologinnen und Gynäkologen und zwei Kliniken für Geburtsmedizin der Gesundheitszentren Rhein-Neckar erproben jetzt den elektronischen Mutterpass.

In einem Pilotprojekt ergänzt ein elektronischer Mutterpass (eMP) in der persönlichen Gesundheitsakte der Schwangeren das Papierheft, so dass die Gesundheitsdaten der Schwangeren jederzeit online zur Verfügung stehen. Mit Zustimmung der Schwangeren können ihr Frauenarzt sowie weiteres medizinisches Fachpersonal auf die Gesundheitsdaten zugreifen, ergänzen und sich austauschen.

An dem auf 12 bis 15 Monate angelegten Projekt sollen rund 200 Schwangere teilnehmen.

[slideshare id=446725&doc=googlehealth-1212590705108038-9&w=425]

(Via Kevin, MD)

Further reading:

• Google Health: The First Steps

Medicine 2.0 is a blog carnival devoted to analyze and describe the impact of web 2.0 on medicine and healthcare. If you think there are just a few posts written about this field of medicine during the summer, you're wrong. I've got plenty of submissions.

Let's launch the carnival this time with articles on medical search.

Medical search:

Uri Ginzburg at Medical 2.0 presented an intelligent search engine.

Allan Cho at Allan's Library talked about his interview on Talis on Web 2,0, Semantic Web, and Web 3.0.

Aniruddha Malpani at The Patient's Doctor told us how to search the net for health information.

The Clinical Cases and Images blog featured a video about how to Use Google Trends for Research:

Electronic medical records:

Peter Murray at Release Zero Blog talked about Google Health and some possible scenarios.

Dr. Reece at Medinnovationblog analyzed the frequency of EMR installations.

The HealthBlog posted an update on Microsoft Amalga and HealthVault.

Questions you'll want to ask before you buy an electronic medical record solution for your practice:

Communication:

Joshua Schwimmer at Efficient, MD introduced us to The Doctor's Room on FriendFeed.

Health & Medicine in Second Life asked whether poor communication = poor healthcare.

Dean Giustini at Google Scholar Blog posted about Identi.Ca - Fourth Big Player in the Microblog Wars?

David M Kreindler published an article at Open Medicine: Email security in clinical practice: ensuring patient confidentiality.

FriendFeed Intro:

E-patients:

The Digital Pathology Blog said Mayo was en route to virtual patients.

Bunny Ellerin at Pharma 2.0 analyzed some data on online doctors.

E-Health Tech defined Healthcare Consumers.

Communities:

Jeana H Frost and Michael P Massagli published an article: Social Uses of Personal Health Information Within PatientsLikeMe, an Online Patient Community.

PLoS Biology had an interesting piece on A Gene Wiki for Community Annotation of Gene Function.

The OpenHelix BLog had some comments about the Gene Wiki.

Gunther Eysenbach, the organizer of the Medicine 2.0 Congress, announced MDPIXX (the "youtube" for physicians) sponsors Physician 2.0 Award at Medicine 2.0 congress.

Random thoughts and posts about medicine/health 2.0:

John Sharp at E-health informs us CDC now meets Web 2.0.

Both Medgadget and the Health 2.0 Blog presented the Health 2.0 Accelerator project.

According to OnMedica, Telemedicine network was launched.

YS at Prep4MD told us about Blogger's New Subscription Tool.

Jan Martens at Medblog.nl came up with a new list of medical blogs.

Medical Economics reveiled the secrets of a successful medical practice.

Telemedicine: An Evolving Tool for Improving Health Care

If you want to be up-to-date in this field of medicine, check the next edition of Medicine 2.0 out at monash medical student. You can also follow me on Twitter or follow the room of life scientists on Friendfeed.

Submit your articles through the official form and drop me an e-mail if you plan to host an edition in August

I've always wanted to become a researcher specialized in human genetics, that's why I study genetics at the school of medicine of Debrecen. But as a blogger, I realized how innovative and fast online projects can be and how important e-health is.

My dream job would be a job where my only task is to inspire others with my vision and ideas while travelling through the world; and to understand more and more things that can have global effect.

Robert Scoble seems to be the best example right now.

Regarding the medical field, Alex Jadad has such a job:

Dr. Jadad initiated a new effort, known as the Global eHealth and eWellness Network Initiative (GENI, pronounced as ‘genie’), which seeks to explore innovative ways to promote optimal levels of health and wellbeing through the use of ICTs. Areas of interest include technologically-assisted vital environments, social networks and virtual supportive communities, new modalities of tele-work and tele-mentoring, robotic applications to improve quality of life and innovations in entertainment... Dr. Jadad currently advises the World Health Organization as a member of its Global Observatory for eHealth’s Strategic Advisory Group of Experts (SAGE) .

He is also the leader of the Centre for Global eHealth Innovation.

So I will graduate from medical school before September, 2009; then I plan to start PhD training in genetics but will also work on my blog and the projects I have recently launched. Until then, I will attend conferences focusing on the future of medicine:

• 20th International Conference of the Society for Medical Innovation and Technology (Vienna, Austria; August 28-30): Oral presentation
• Medicine 2.0 Congress (Toronto, Canada, September 4-5): Oral presentation and Medical Bloggers' Panel
• Health 2.0 conference? (Bilbao, Spain; November 20)
• Medicine Meets Virtual Reality conference 17 (Long Beach, CA; January, 2009): I'm a member of the organizing committee.
• NeXtHealth conference (2009)

And of course, we will see how it goes.

At both of these events, I got to watch the following video.  I never get tired of watching the cool tech they show in action.  According to a Microsoft presenter that introduced this back in the fall, all this tech is currently working, albeit in prototype form, in the Microsoft Labs.

(A higher-resolution version of the video is available directly from Microsoft)

• US health data management
• Google Health
• Belgian electronic health platform: BeHealth

Of those three systems, the belgian one seems the most vanguardist for several reasons that will be covered in the next lines.

1. US health data management

The United States is the only wealthy, industrialized nation that does not ensure universal health care coverage [1]. The US system causes problems to many patients and their providers. They experience problems with care coordination. In fact there is almost no coordination at all. For example, a Harris Interactive survey of California physicians found that:

• Four of every ten physicians report that their patients have had problems with coordination of their care in the last 12 months.
• More than 60 percent of doctors report that their patients "sometimes" or "often" experience long wait times for diagnostic tests.
• Some 20 percent of doctors report having their patients repeat tests because of an inability to locate the results during a scheduled visit.

On another hand, SERMO, an American medical social network, offers its customer (65,000 physicians) to share clinical insights, observations, and review cases. Members must be authenticated as US licensed physicians, based on Social Security Number. Although this system is a good opportunity to share knowledge and even launch clinical trials, this is not really a universal health data management system. Patients have no access to it. Strictly speaking, there is even no "patient record".

There is thus no integrated, global solution in the USA for health data management.

2. Google Health

Google Health is yet another Google app intended to provide PHR (Patient Health Record). At the opposite of SERMO, it is patient-centered. Even more: the patient is in charge of everything, so that in fact there is no real control on what is true, false, relevant, etc. in the record. The patient is thus responsible of the information his record contains. What interactions are possible with that PHR? Google Health offers to:

• Search for a medical care provider
• Import medical records and notices (only from some affiliated US services)
• Send your information to some affiliated US services

Google Health is not intended to facilitate communication between several specialists or between your physician and some specialist, etc. You have to give the information to the right person(s). A major drawback of Google Health is that the user may feel lost with medical terms. Dealing with medical conditions, lots of names are rather technical. For example, it may be difficult not to get lost in the middle of the 17 types of Anemia listed. The same problem occurs with medications, immunizations, etc. Finally, there is no sign of a potential genomic data integration.

The PHR offered by Google Health is thus a good information management tool (after all, that's their job) but the user may have a bad experience and feel uneasy with it, being no medical professional. No control about veracity of the information is performed. The integration with other services is really poor. Above all, it is questionable if it is a good thing to send all your medical information to the online advertisement company...

3. Belgian electronic health platform: BeHealth

Belgium has a centralized, universal coverage health care system. Its social security system is one of the most advanced in the world [2]. Every belgian citizen has a social security number and most of the health cares are free of charge.

Family practitioners, hospitals, specialists, social security, all maintain records about parts of the medical history of the patients. Those records are managed by professionals which offers a good quality and relevance of the information. Records are thus not under the patients responsibility but, as a trade-off,  are also fragmented. There is no or few centralization of the patients data. This guarantees privacy but is also an obstacle to more efficient medicine.

A new eHealth project of the Belgian federal government, called BeHealth, is currently being developed. The aims of this platform are:

• Quality and coordination of health care optimization
• Patients security optimization
• Administrative procedure simplification for all actors in the medical field
• Optimally support health care policy

How will it work? Not by centralizing all the information: this is far too dangerous for privacy. BeHealth will be based on the principle of data exchange between all the medical field actors while guaranteeing the highest standards in terms of security and privacy.

What BeHealth won't do:

• Bring modifications to concrete organization of medical cares.
• Record personal data in a centralized way (what google health does).
• Monopolize medical electronic services.
• Realize itself studies and lead experiments on patients data (what sermo does).
• Take part to political choices or influences.
• Be technology-driven (what google health is).

This project will allow the routing of appropriate information to medical providers, communicate anonymized data to some (approved) research projects, control the legitimity of access to patients information. More information (in french) here. Since it is based on a collaborative framework, it makes room for every type of medical data, including genomic data. An actor such as GeneTonix (which is a european company with nearly the same objectives as 23AndMe, Navigenics or deCODEme) could fully integrate personal genomic data into BeHealth services.

The Belgian system seems more advanced than the American one. The Belgian project BeHealth is not yet fully implemented. On June 12, Laurette Onkelinks, belgian public health federal minister anounced that a special series of laws to fully integrate BeHealth are going to be discussed. We will follow BeHealth development in the next months with interest.

This article is not exhaustive and it is probable that comparable system already exist in other countries. What about Canada, Australia, ...?

Do you think today's residents and physicians can answer the questions of e-patients? I know, medicine will never be an online service but there will be more and more e-patients who would like to contact their doctors through e-mail or Skype and would like to get some relevant/useful resources where they can find more information about their medical condition. Do you think today's physicians can help these patients?

If we do not change medical education, there will be a strange situation: e-patients will know more about e-health than medical professionals. How could they help them that way?

I believe medical education is not ready for the 21st century and there are just a few good initiatives (one example). It's not about changing the whole concept of medical education, but we have to implement the tools of medicine 2.0 into all the medical curriculums. We came up with an idea regarding how to achieve this:

Jen McCabe Gorman, Ted Eytan, and me created a Ning community for those who are interested in changing medical education. We're working on a new concept and plan to find a medical school that would use it. Feel free to join us and let us know your thoughts.

Don't forget to check Jen's wonderful post about it.

I would have loved to be the first to publish an article with such name given the previous efforts of this blog, but it really does not matter. What is important is that there are more of us speaking about the challenges ahead for the constantly changing patient-health professional relationship.

I would like to thank all, the authors, for their bold vision; the publishers for seeing the author's vision and; to all patients, for their patience...

Here is the abstract:

Modern Healthcare Systems that have embraced ICT and Internet technologies (referred to as Health 1.0) are evolving towards self management but from a clinical knowledge perspective. In contrast, from a user experience perspective, and using the latest web 2.0 technologies, the developing healthcare social networking communities (referred to as Health 2.0) are evolving towards becoming online medical portals.The growing Grand Challenge for healthcare is therefore: how will health care services (Health 1.0) work together with user-generated health care (Health 2.0) in a consumer market place delivering self management services for a healthier lifestyle and medical compliance. What is foreseen is that the self care information tool of the future will be a combination between the patient's observation record and the Internet, with the doctor and the patient positioned together at the intersection but not having to pay attention to the technology.This article deals with various aspects related to this Grand Challenge like the paradigm shift towards a needs-led and consumer-oriented healthcare, the role, supply and quality of information and the changing doctor-patient relationship.

The electronic health network has been in development by San Antonio, Texas-based AT&T (NYSE: T), since the beginning of the year, in partnership with Memphis-based MidSouth eHealth Alliance and the Governor's eHealth Council.

The purpose was to deploy broadband connectivity for the state's health care professionals. AT&T has created an online collaboration center called AT&T Healthcare Community Online -- a Virtual Private Network-based portal -- designed to securely enable such applications as:

• Prescribing drugs online.
• Securing clinical messaging among the state's health care providers.
• Sharing images such as X-rays, MRIs and CT scans.
• Exchanging patient information via portable health records.
• Delivering telemedicine applications for remote diagnostics.
• Accessing laboratory systems.
• Accessing Tennessee Department of Health applications, including the immunization registry, disease registries, death certificate applications and processing and medical license renewal.

The nationwide system will add capabilities such as:

• Submitting patient registration and consent forms in advance of doctor visits.
• Verifying insurance and other patient coverage options.
• Electronic messaging among the state's health care providers.

The nationwide information exchange initiative is a partnership among AT&T, Covisint , which is a subsidiary of Compuware Corp. (NASDAQ: CPWR), and Microsoft Corp. (NASDAQ: MSFT). Users of Microsoft's HealthVault software, which stores personal health information, can now share information with authorized physicians and health care providers connected to AT&T Healthcare Community Online.

Link:- http://www.bizjournals.com/memphis/stories/2008/06/23/daily6.html

"The doctor-patient relationship has changed dramatically with the demise of 'good ol' doc' and the explosion of medical technology," says Paul M. Ross, an orthopedic surgeon in Pawlet, VT. "Today, patients are not only more knowledgeable, they're more cynical. The increased use of physician extenders, hurried service, and overbooking have all contributed to the number of physician-patient relationships that are adversarial as opposed to collegial."

Practicing medicine is changing rapidly these days. Patients have more resources to get more information about their medical conditions but they also have more tools to contact their doctors. American Well is only one example:

The company’s big idea is more ambitious: A patient who wants an online doctor consult can log on and get something approaching a complete doctor visit, often without waiting. The doc can review the patient’s record, make a diagnosis, write a prescription and make a referral, all online. Patients without a webcam can talk to the doctor on the phone.

Jay Parkinson's Hello Health is another.

Patients can find medical experts with Online Doctor Consultation:

We´ll put you in touch with the world´s leading specialists and medical institutions, giving you fast and comprehensive service that´s easy to access, and personalized to your needs.

The procedure is simple. Just choose your options, and we do the rest. You can start by contacting us now for more information, click on Services to see what we offer, or go to Getting Started to start the ball rolling.

So of course, it's hard to be a patient nowadays (you have plenty of things to choose from); and hard to be a doctor as well (you have to be the good old doc, but should be open to these new technologies).

And if you think the solution would be a healthcare reform, George Halvorson, CEO of Kaiser Permanente, tells you what to do:

[slideshare id=480837&doc=k2halvorsongeorgemon421-1214192455372216-8&w=425]

Further reading:

• Call Your Doctor Online: The Future of Medicine?
• Jay Parkinson and Hello Health
• Call Your Doctor Online: The Future of Medicine?
• Interview with Jay Parkinson, the web-savvy doctor
• From Doctor 2.0 to Patient 2.0: On Video

"This pan-European survey on electronic services supporting healthcare (eHealth) takes the pulse of eHealth in Europe: the study shows that eHealth applications have a growing role in the doctor's practices. However there remain significant country differences in their availability and use across Europe."

Het rapport staat hier.

De landenstudies zijn via deze pagina beschikbaar als zipfile.

Het rapport staat hier.

De landenstudies staan hier.

Medicine 2.0 is a blog carnival dedicated to e-health and the impact of web 2.0 on medicine and healthcare. This is the 26th edition and the 5th time I host it myself.

These days you can review abstracts for the Medicine 2.0 Congress which we, some medical bloggers, plan to attend this September in Toronto. Take a look at the review page and cast your vote. Until then, let me share some interesting articles and blogposts with you.

Pubmed in focus:

Laika's Medlib Blog had two great posts about the past, present and future of Pubmed, the search engine of health science data (part I and part II).

Euan Adie at Nature Network presented Pubmed FaceOff, a new mashup:

It renders PubMed results as a set of photorealistic Chernoff Faces whose facial features are determined by the age, citation count and journal impact factor associated with each paper. The idea is that you can tell at a glance which papers are new, exciting and high impact and which are languishing, uncited and unread.

Gadgets:

Joshua Schwimmer at The Efficient MD says our next stethoscope should be electronic and he tells us why.

Deepak Singh at bbgm talks about medicine and the iPhone.

The Medgadget Team shared some 21st Century Flashcards with us on, of course, iPhone.

Healthcare:

Scott Shreeve at Crossover Healthcare had some comments about consumerism in healthcare.

Jen McCabe Gorman at Health Management RX analyzed the medical home concept.

Jay Parkinson gave a revolutionary presentation at HIMSS.

Don't forget to take a deeper look at this fantastic presentation: Web 2.0 Tools

Web 2.0 and Beyond:

Social networks, wikis and more:

The Clinical Cases and Images blog is curious whether there is a feed for job search for physicians.

David Rothman shared CoPub, a text-minig tool, with us.

Walter Jessen at Highlight Health told us seven ways to connect with the Highlight HEALTH Network.

Uri Ginzburg at Medical 2.0 reported a web world for junior scientists.

Alan J Cann at Science of the Invisible listed the reasons for the lack of adoption of social networks for postgraduate laboratory scientists.

Bunny Ellerin at Pharma 2.0 says physicians continue to get social.

YS at Prem4MD found free resources for MRIs Xrays CTs.

And me at Scienceroll presented Second Life Fitness:

If you want to be up-to-date in this field of medicine, check the next edition of Medicine 2.0 out at Highlight Health 2.0. Or follow me on Twitter or follow the life scientists on Friendfeed.

Submit your articles through the official form and drop me an e-mail if you plan to host an edition in July.

• Please tell us what RedBox is about.

RedBox is the core technology of PointOne. It is a software that takes in patient information from a variety of sources, analyzes the information based on established medical best practices, research findings and our own algorithms, and then provides reports that can focus on overall health assessments, risks and next steps.

• What do I need to do to use it?

Although RedBox has been in development since 1998 and PointOne has been marketing its capability since 2001, the tool has not been available at a consumer level until this year. PointOne is now working on interfaces that will allow consumers direct access. At the end of July PointOne will launch a website called ClearSense that will allow consumers to get reports directly and use their Personal Health Records as a source of information for the reports. The new website will be Beta tested with a select group for a short time and then available to the public for free initially.

• Why do you think it is beneficial to have online health records?

Consumers need to be in control of their own healthcare and having immediate access to our own health records is key to that. If we expect individuals to manage their own health, they need the data to do so. It is ridiculous that I can’t see everything that’s been done to me, my wife or my children from a health perspective in one place. How can I monitor my blood pressure or cholesterol if I don’t have access to that data over time? The doctor has it in his records, along with my immunizations and other things. Why don’t I have it? We talk about it being “private” and “confidential” but right now it’s only “private” and “confidential” to the doctor. For me it’s just a hassle to get access to it.

• Where does the health data come from that is used in RedBox?

Initially the data will come directly from the consumer (answers to a questionnaire) or from a PHR (likely not a lot of these at first). Eventually, however, we’d like to see RedBox access data from anywhere health data resides, whether it’s a fitness club, blood donation center or even home monitoring devices.

• In some of the reports you published, there are action items that can improve my health (e.g. get an annual physical exam or schedule a hypertension evaluation). Are these suggestions made by physicians or this is an automatic feature of the software?

This is an automatic feature of the software. The reports we provide are not dispositive, meaning we don’t say “you have diabetes” or “you have breast cancer”. That’s for a doctor to decide. However, our reports are designed to be educational. In addition to learning something about yourself, it also lists what you should be doing to monitor your health or providing information about tests you should consider. For example, many women do not know that the BRCA1/2 tests are even available. If you had a family history of breast or cervical cancer on one of our reports, the action item would mention the test as something to consider. It’s pushing the right information to the right people.

• What do you expect from the next months? How many users do you think will register?

We do not expect that this is a technology that will explode onto the scene. The use of this technology will be a gradual development as PHRs develop, as people become use to the idea that these reports are possible, as health data becomes more consolidated and cleaner. We use the following analogy to describe the process:

(True Story: http://www.niagarakite.com/history.html) – In 1847 in the United States Charles Ellet was trying to build a suspension bridge over the Niagara Falls gorge. The gorge was 800 feet across and 225 feet deep and the river was very swift. In order to get the suspension cables across the gorge they needed a way across that didn’t involve hiking down, taking the boat across and going back up the other side. So, Mr. Ellet sponsored a kite flying contest to get one thread across the gorge. In 1948 a 15 year old boy got his kite across and won the contest. Mr. Ellet used that single thread to tie ever-increasing gauges of string, rope, wire and ultimately the steel wire cables that supported the bridge.

PointOne has the same approach. We are trying to build the bridge of health data analytics being accessible to everyone. Initially, however, we realize we will need to cast some small threads across and pull ever increasing applications across before we will be able to accomplish our goal in full.

The future of healthcare IT is the analytics. Right now everyone’s focused on the collection, management, movement and protection of health data. That’s an IT exercise. The eventual holy grail of healthcare IT will be the analysis of that data to provide information to the ultimate consumer.

Check out more about it at PointOne.

Gambar 1. Prototipe awal pengaksesan citra medik di PDA

Setahun kemudian lab kami mampu membeli PDA baru, yaitu PDA phone O2 XDA Zinc ... :D ... gaya euy dengan processor yang lebih kuat: Intel XScale 520 MHz dan RAM 128 MB. Mantaplah ... ada koneksi WiFi, GPRS, dan 3G meskipun belum 3.5G (HSDPA) :-( Tapi tidak apa-apalah. Proyek selanjutnya menjadi proyek tugas akhir S1 yang dikerjakan oleh teman saya Renita Ompusunggu (Telekomunikasi STEI ITB) di bawah bimbingan Pak Andriyan Bayu Suksmono dan Bu Tati L.R Mengko. Setelah beberapa bulan melakukan pengembangan menggunakan platform .NET CF (Compat Framework) dan bahasa pemrograman C# munculah hasilnya, yang merupakan pengembangan dari versi sebelumnya. Oh ya pada versi awal saya mencoba menggunakan platform Java (EWE) yang sekarang berubah menjadi EVE. Release terakhirnya adalah EVE Ver. 1.21.  Pada awal perkembangannya JVM ini masih belum memenuhi requirement software yang hendak saya buat. Ke depan saya akan menjadi menggunakan JVM ini lagi. Versi terbarunya bahkan mendukung pengembangan di Windows Mobile 6. Sebagai informasi O2 XDA Zinc memiliki OS bawaan WM 5 yang kemudian saya upgrade ke WM 6.

Hasil dari software pengaksesan citra medik di PDA yang baru ini sudah lumayan. Beberapa fiturnya antara lain adalah:

1. Kecepatan decoding gambar sudah diperbaiki (sekitar 6 detik untuk dimensi gambar 2000 x 2000 piksel)
2. Memiliki kemampuan zoom-in dan zoom-out
3. Sudah mengimplementasikan skema scalable dengan pemilihan ROI (lihat posting kompresi citra medik)

Gambar 2. Menu zoom-in dan zoom-out

Gambar 3. Penampilan citra pada skala 33% (zoom-out)

Gambar 4. Penampilan citra pada skala 50% (zoom-out)

Gambar 5. Penampilan citra pada ukuran sebenarnya (skala 1:1)

Gambar 6. Implementasi skema scalable untuk peningkatan kualitas citra di ROI (kotak putih)

Rencana ke depan, software ini akan kami sempurnakan dengan memperbaiki user interfacenya agar lebih user friendly. Selanjutnya kami akan menggabungkannya dalam sistem besar yang sedang kami rancang, yaitu rekam medis multimedia. Hal-hal yang berkaitan dengan keamanan juga akan diimplementasikan. Banyak akan bisa dikembangkan, mengingat software ini masih dalam tahap awal. Ada keinginan untuk mengembangkannya di iPhone :D sayang harga iPhone apalagi yang iPhone 3G dirasakan mahal. Mungkin ada yang mau memberikan donasi? :D Dengan senang hati akan saya terima hehehe.

Semoga berguna dan saya menunggu umpan balik dari teman-teman. Salam

Terdapat beberapa permasalahan yang menyebabkan informasi citra medik tidak disimpan dalam rekam medis, yaitu besarnya kapasitas penyimpanan dan lebar kanal telekomunikasi yang dibutuhkan untuk mentransmisikan citra medik tersebut. Sebagai ilustrasi, sebuah citra digital sinar-x thorax memiliki dimensi 2000 x 2000 piksel dengan derajat keabuan 8 bit, memiliki ukuran sebesar 3.7 MB. Selain berukuran besar, jumlah citra medik yang disimpan juga sangat banyak. Stephen Wong et al [1], dalam publikasinya menyebutkan bahwa komunitas PACS (Picture Archiving and Communication Systems) di USA mencatat jumlah citra medik digital yang telah disimpan mencapai orde petabyte, 10^15.

Sebuah solusi telah dikembangkan untuk menjawab permasalahan tersebut, yaitu kompresi citra medik. Solusi ini masih berhadapan dengan masalah-masalah legal, sebab berkaitan dengan proses diagnosis yang berujung pada jiwa manusia. Terdapat dua jenis kompresi citra, yaitu kompresi lossless dan lossy. Kompresi lossy memiliki kinerja yang lebih baik dibandingkan dengan lossless dalam pemampatan citra. Sebaliknya, dilihat dari sisi legalitas kompresi lossless tidak memiliki masalah, karena bersifat dapat dikembalikan (reversible). Kompresi ini tidak akan menghilangkan informasi apapun dari citra medik. Akan tetapi, kompresi lossy akan bersinggungan dengan aspek legal, sebab terdapat informasi yang hilang pada citra hasil rekonstruksinya. Banyak kompresi lossy dikembangkan agar memenuhi syarat dalam aspek legalitas, meskipun aspek legal standarnya belum ada.

Saya bersama Pak Andriyan meneruskan penelitian di lab kami sebelumnya untuk mengembangkan pengkodean citra medik ini. Algoritma yang kami gunakan adalah kuantisasi vektor (KV). Pengkodean yang telah kami kembangkan mampu memampatkan citra sinar-x hingga 16 kalinya bahkan hingga 64 kali tetapi tetap memelihara diagnostic value dari citra tersebut. Detail tentang algoritma yang kami kembangkan (Scalable Fuzzy Vector Quantization) [2] akan saya jelaskan pada posting yang lain. Algoritma ini mampu mengkodekan citra sinar-x thorax yang berukuran 3.7 MB menjadi 235 KB. Berikut ini adalah hasil dari implementasi algoritma yang kami kembangkan

Gambar di sebelah kiri adalah citrathorax asli, sedangkan yang di sebelah kiri merupakan citra rekonstruksinya. Terlihat citra rekonstruksi masih memelihara diagnostic information/value. Jika kita lihat dengan skala 1:1, terdapat blocking artifact. Hal ini disebabkan oleh proses kuantisasi. Artifak ini bisa dilihat pada gambar di bawah ini.

Bisa Anda lihat blocking artifact muncul pada citra rekonstruksi di sebelah kiri. Bandingkan dengan citra asli di sebelah kanan. Saat ini kami sedang mencoba mengimplementasikan algoritma tertentu untuk meminimalkan efek blocking ini. Di samping itu kami juga sedang mencoba mengimplmentasikan lossless coding menggunakan search-order coding untuk memampatkan citra terkode (235 KB) menjadi lebih kecil lagi (sekitar 160 - 180 KB).

Sistem pengkodean yang kami kembangkan juga menerapkan skema scalable atau lossy-to-lossless. Artinya citra rekonstruksi yang merupakan citra terkompresi lossy dapat kita tingkatkan kualitas citranya menjadi kualitas yang sama dengan citra aslinya pada suatu daerah tertentu yang ingin dianalisis (region of interest - ROI). Asumsinya, dokter atau radiologis hanya menganalisis pada beberapa daerah tertentu (ROI)dengan luas yang tidak terlalu lebar.

Pada gambar di atas ini, Anda bisa melihat area di dalam kotak telah ditingkatkan kualitasnya dengan tanda hilangnya blocking artifact. Sedangkan, daerah di luar kotak ditemui blocking artifact, sebab daerah tersebut adalah daerah pada citra rekonstruksi (lossy) yang belum ditingkatkan kualitasnya.

Referensi

1. S. Wong et. al., Radiologic image compression-A review, Proc. of the IEEE, Vol. 83, No.2, Feb. 1995
2. A.D. Setiawan, A.B. Suksmono, and B. Dabarsyah, Scalable Radiology Image Transfer and Compression Using Fuzzy Vector Quantization, Jounal of eHealth Tech. & Applications, 2007

Let's see what you have to do if you would like to see a doctor online:

1. Join Hello Health.
2. Make an appointment.
3. You see your doctor.
4. You feel better.

You can choose video chat; IM; in-person visit or e-mail. Ok, despite all the dangers it can lead to, this is the future. I must state that medicine will never be an online service, but there will be more and more patients who want to have a GP who can be contacted online anytime it's needed.

And if you would like to hear more from Jay himself, here are some videos and interviews:

Hello Health:

Jay on Health 2.0:

YourWiredMD.com: Jay Parkinson, MD

Further reading:

• Interview with Jay Parkinson, the web-savvy doctor
• Call Your Doctor Online: The Future of Medicine?
• Physician of the Year: A Web-Savvy Doctor!