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Over the last four years, a community of researchers working on Grid and High Performance Computing technologies started discussing the barriers and opportunities that grid technologies must face and exploit for the development of health-related applications. This interest lead to the first Healthgrid conference, held in Lyon, France, on January 16th-17th, 2003, with the focus of creating increased awareness about the possibilities and advantages linked to the deployment of grid technologies in health, ultimately targeting the creation of a European/international grid infrastructure for health. The topics of this conference converged with the position of the eHealth division of the European Commission, whose mandate from the Lisbon Meeting was "To develop an intelligent environment that enables ubiquitous management of citizens' health status, and to assist health professionals in coping with some major challenges, risk management and the integration into clinical practice of advances in health knowledge." In this context "Health" involves not only clinical procedures but covers the whole range of information from molecular level (genetic and proteomic information) over cells and tissues, to the individual and finally the population level (social healthcare). Grid technology offers the opportunity to create a common working backbone for all different members of this large "health family" and will hopefully lead to an increased awareness and interoperability among disciplines. The first HealthGrid conference led to the creation of the Healthgrid association, a non-profit research association legally incorporated in France but formed from the broad community of European researchers and institutions sharing expertise in health grids. After the second Healthgrid conference, held in Clermont-Ferrand on January 29th-30th, 2004, the need for a "white paper" on the current status and prospective of health grids was raised. Over fifty experts from different areas of grid technologies, eHealth applications and the medical world were invited to contribute to the preparation of this document.

Innovation in cancer therapy has increased childhood cancer survival rates. However, survivors are still at risk of developing late effects. In the digital transformation of the health sector, the Survivorship Passport (SurPass) can support long-term follow-up care plans. Gaps in seamless connectivity among hospital departments, primary care, combined with the time of health professionals required to collect and fill-in health data in SurPass, are barriers to its adoption in daily clinical practice. The PanCareSurPass (PCSP) project was motivated to address these gaps by a new version of SurPass (v2.0) that supports semi-automatic assembly from organizational Electronic Health Record (EHR) systems of the treatment summary data using HL7 FHIR, to create SurPass, and to link it to regional or national digital health infrastructures in six European countries. In this paper we present the methodology used to develop the SurPass technical implementation strategy with special focus on the European Health Data Space (EHDS). The recently provisionally approved EHDS regulation instruments a digital health data ecosystem with opportunities for cost-effective SurPass implementation across Europe. Moving forward, a European HL7 FHIR SurPass Implementation Guide along with synthetic data sets, and validation tools can enrich the European Electronic Health Record Exchange Format (EEHRxF) with use cases on health & wellness of childhood cancer survivors.

This paper provides insights into user perspectives on telemedicine for cancer based on Focus Group Discussions (FGDs) within the eCAN Joint Action. Two FGDs centered on the eCAN mobile app and the eCAN dashboard, aiming to confirm user acceptance and understand cancer patients' and healthcare professionals' views. The findings highlight the importance of personalized deployment of telemedicine technologies to meet the specific needs of end users.

We consent to many things in life, but sometimes we do not know what we consent to. When discussing data protection in Europe, consent has been associated with permission under the GDPR, and health data are highly sensitive. Patients cannot make an informed decision without being provided with the information they need upfront: no informed decision, no informed consent. This paper presents a consent management system for patient-generated health data stored with HL7 FHIR specification, tested on Type 1 diabetes synthetic data. This architecture, based on using FHIR as an unequivocal data exchange format, can lead to individuals (patients) taking control of their data, enabling potential data exchange and reuse of health data across countries and organisations, in line with the European Commission proposal of a European Health Data Space.

Results of two major projects funded by the European Union are taken into consideration: Fair4Health regarding the possibility of sharing clinical data in various environments applying FAIR principles and 1+Million Genome for the in-depth study of the human genome in Europe. Specifically, the Gaslini hospital plans to move on both areas joining the Hospital on FHIR initiative matured within the fair4health project and also collaborate with other Italian healthcare facilities through the implementation of a Proof of Concept (PoC) in the 1+MG. The aim of this short paper is to evaluate the applicability of some of the tools of the fair4health project to the Gaslini infrastructure to facilitate its participation in the PoC. One of the aims is also to prove the possibility of reuse the results of well-performed European funded projects to boost routine research in qualified healthcare facilities.

Background: Long-term care faces severe challenges on the supply (shortages of formal and informal carers) as well as on the demand side (increasing number of care-dependent people). To cope with these challenges, new forms of support for the professional care network are needed., Objectives: This paper describes the concept and implementation of a Remote Care Assist (RCA) service, consisting of a web-application for the Care Expert Center (CXC) and Remote Support (RS) applications for the HoloLens 2 as well as for Android and iOS smartphones., Methods: Using the evidence-based and user-centred innovation process (EUIP), a Remote Care Assist service was conceptualized and implemented for home care service settings in three European countries., Results: After five iterations within two phases of the EUIP, the final feature set of the RCA-service was determined and implemented., Conclusion: By working closely with the target group, it was possible to identify potential hurdles and additional requirements such as a well-thought-out interaction concept for the HoloLens or a good organizational embedding of the service.

Covid-19 pandemic continues to cause great losses in human lives and adverse consequences in many sectors of the EU economy. The aim of the paper is to evaluate the effects of the pandemic in small and medium-sized enterprises (SMEs), in culture - entertainment industry and to investigate the effectiveness of the corresponding entrepreneurship support measures have been taken. This review was conducted based on related articles that were published during the years 2020-2021, using the online databases of Google Scholar, Science Direct, Elsevier, PubMed, OECD, IOBE. A total of 16 eligible studies were included in this literature review. EU authorities have launched measures, setting up policy and funding instruments to mobilize the economy. The impact of these measures is of great significance for many EU countries and sectors. However, measures taken for small and medium-sized enterprises, tourism and culture were not evaluated effectively to get the sectors back on track. Those measures were effective in short term and were insufficient to boost the recovery of the EU economy in long term. Since Covid-19 still exists, the fear of a recurrence is fed back. Long-term support measures need to be re-evaluated and new strategies must be established, that will set, sustainability criteria for companies, according to future investment and development policies.

The development of electronic services for healthcare presents challenges related to the effective cooperation of systems and stakeholders in a highly regulated environment. In order to facilitate healthcare for all at the point of need it is important to establish the necessary conditions to guide the development and implementation of digital health solutions that are interoperable by design. Interoperability in eHealth is challenging for various reasons, including the fact that different products and solutions in the market do not follow well-known standards and interoperability guidelines. The paper draws upon the global, European and national policies, strategies, and implementation initiatives to offer an integrated approach towards interoperability in healthcare ecosystems. The authors provide guidelines and recommendations to support interoperability at legal, organizational, semantic, and technical levels.

In recent years, software has evolved from being static, closed source, proprietary products to being dynamic, open source, ecosystems contributing to the global good. To this end, the open source software (OSS) solution and global good, Surveillance Outbreak Response Management and Analysis System (SORMAS), rapidly adjusted to the demands of the Coronavirus disease 2019 (COVID-19) outbreak by introducing a COVID-19 module. This allowed countries that were already making use of the software as part of their public health surveillance infrastructure to make use of the new module in order to respond to the pandemic. New countries in continental Europe, most notably Germany, Switzerland, Liechtenstein and France subsequently chose to adopt the software for public health surveillance purposes for the first time during 2020, requiring additional adaptations to meet local needs. As a result, in this paper, we aim to gain a better understanding of how rapidly SORMAS was adapted to meet global needs by analyzing the SORMAS COVID-19 module introduction timeline, as well as the overall development activity of the software during 2020 and 2021 in response to the pandemic. Favorable initial feature response times in combination with development scale-up possibilities speak to some of the potential advantages of implementing global good OSS tools such as SORMAS for public health surveillance, in response to an emergency. Overall, SORMAS serves as proof of concept for developing a global good OSS solution on an international scale.

Accreditation is the evaluation and monitoring process assuring that educational programs and institutions meet academic standards and operational integrity and quality. The number of programs in the field of Biomedical and Health Informatics is rapidly increasing. In this paper we briefly introduce the accreditation procedure that has been established by Accreditation Committee (AC2) of European Federation of Medical Informatics according to international standards.

Industry and academic perspectives have become more focused on designing for Diversity and Inclusion (D&I) over the past few years, both in general and particularly within the built environment. This renewed interest appears to have stemmed from a basis of respect-based 'due diligence' in 2018 to one of necessity in 2020, when the COVID-19 pandemic brought areas of difference into focus and exacerbated them, making it harder for people to live their everyday lives. In this paper, the authors seek to bridge the divide between academia and industry on the subject of Inclusive Design (ID) through their use of a combination of an academic and grey literature review as well as empirical research conducted with scholars and practitioners. These multiple methods focus less on the academic perspectives and more on how the industry has responded to the research and market demand. It clarifies nuanced differences among ID-related terms, provides best practice examples for wellness in the built environment, and identifies governing body guidelines (i.e., principles, protocols, policies) that have been enacted for ethical and business differentiating purposes.

For many decades English language was dominant in international scientific communications, but during the last decade it threatens to become the only language for communicating medical science at international level. The aim of this article was to make an overview of publication practices in regard to language of publication of MEDLINE-referenced articles from European countries in year 2020. Scientific publications referenced in MEDLINE database during year 2020 were chosen for analysis. The inclusion criteria were publications affiliated with one of European countries, published in either English or national languages of those countries. The countries with less than 100.000 inhabitants were excluded from the study. Only 11 of 38 European countries had any number of medical publications in national language that were referenced in MEDLINE; the authors from twenty-seven European countries completely stopped publishing in national language at international journals. While economic strenght of a country was strongly correlated with number of international publications per 100.000 inhabitants, the correlation with international papers published in national languages was much less pronounced. Researchers from majority of European countries are publishing their studies predominantly or only in international medical journals printed in English language. Additional efforts should be made in the future to promote publishing in national languages.

To facilitate personalised healthcare provision across Europe, we envision solutions that enable the secure integration and sharing of medical health records. These solutions should address privacy concerns, such as granular access control to personal data, establishing what should be accessible when and by whom, whilst complying with collective regulatory frameworks such as the European General Data Protection Regulation (GDPR) and adhering to international standards on how to manage information security. The proposed healthcare system design integrates technologies such as blockchain and scalable data lakes with adequate system routines to guarantee the secure access of confidential data. In this paper, we present the essential architectural components for the secure integration of medical records in a blockchain-based platform. We present a patient-centric data retrieval approach which incorporates a structured format to compose access rules.

The potential of healthcare systems worldwide is expanding as new medical devices and data sources are regularly presented to healthcare providers which could be used to personalise, improve and revise treatments further. However, there is presently a large gap between the data collected, the systems that store the data, and any ability to perform big data analytics to combinations of such data. This paper suggests a novel approach to integrate data from multiple sources and formats, by providing a uniform structure to the data in a healthcare data lake with multiple zones reflecting how refined the data is: from raw to curated when ready to be consumed or used for analysis. The integration further requires solutions that can be proven to be secure, such as patient-centric data sharing agreements (smart contracts) on a blockchain, and novel privacy-preserving methods for extracting metadata from data sources, originally derived from partially-structured or from completely unstructured data. Work presented here is being developed as part of an EU project with the ultimate aim to develop solutions for integrating healthcare data for enhanced citizen-centred care and analytics across Europe.

The International Patient Summary Standard (EN 17269) normalizes the dataset within the European Guideline on cross-border exchange of a patient summary. This dataset has been widely appreciated and been taken as the basis for projects in both Europe and wider afield, e.g. U.S.A, Canada and more. The dataset is a relatively mature dataset and it is currently in its third iteration (i.e., 2013, 2016, 2020). Even so, to move from a policy-driven guideline to a formal standard was not straight forward. The paper describes how the 'minimal and non-exhaustive' dataset could be the basis for a reference standard; one that was intended to facilitate both an 'implementable' and 'sustainable' solution. In particular, the requirement of 'extensibility' for the standard dataset had to be addressed.

The Accreditation and Certification Committee (AC2) of the European Federation for Medical Informatics (EFMI) has initiated, firstly, a collection of data on the existing academic programs in Europe in Biomedical and Health Informatics in Europe, and, secondly, the implementation of the accreditation process for programs. This paper presents the background and the procedures to be applied for the implementation.

Conduction of clinical trials may benefit from the reuse of EHR data. The upcoming EHR system eHDSI provides data exchange between European countries and thus represents an attractive data source for multinational trials. In this paper we analyze to what extent eHDSI could provide data relevant for trials with a focus on patient recruitment. Data elements identified in the EHR4CR project to be frequently used in trials were mapped to the HL7 templates of the eHDSI document types using the open source tool ART-DECOR. From the 149 EHR4CR data elements, 44 (30%) could be mapped to eHDSI document components. Despite this moderate coverage, eHDSI could still provide a substantial contribution for recruitment by an automatic pre-filtering process of large groups of potential trial candidates.

Rare conditions can make it difficult for physicians and healthcare providers to find the right answers and treatment for patients suffering rare diseases. The number of experts specializing in rare diseases in Europe is low. In order to ensure qualified diagnosis, treatment and care for these patients, the European Commission has founded the European Reference Networks (ERNs), which are virtual networks that include healthcare providers across Europe aiming to provide better care for patients across Europe. The European Reference Network LUNG (ERN-LUNG) has been established for patients with rare respiratory diseases seeking care and advice on all aspects of rare respiratory diseases. In the context of ERN-LUNG, the Expert Advisory Board (EXABO) was implemented. EXABO is a pan-European internet platform based on a question-answering system to support answering questions regarding all areas of rare respiratory diseases. This paper gives a brief overview of the first steps taken regarding the implementation of the EXABO platform, the challenges faced and the lessons that have been learned.

General Data Protection Regulation came into effect across the European Union in May 2018 but its implications in healthcare are yet to be fully understood. The aim of this study was to identify the fronts and hot topics in research on GDPR in healthcare. We analyzed the relevant records in Scopus through bibliometric and scientometric approach and visualization techniques. A set of 155 records was obtained and processed for co-occurrence analysis of key terms and concept mapping. The number of published papers showed a steep rise in the past two years, mainly by European countries. Analysis of the abstract of the papers showed that data protection, privacy, and big data were the most frequently used terms. Three dominant research fronts of GDPR are 1) general implications of GDPR, 2) technology aspects of GDPR, and 3) GDPR in healthcare service. Blockchain and machine learning are among the remerging topics of GDPR research.

Online digital tools are considered an innovative method to promote HIV, hepatitis and STIs prevention, testing and treatment services, overcoming individual and social barriers, especially for younger people and other, possibly hard-to-reach, target population groups. In this paper, we introduce INTEGRATE RiskRadar, a web and mobile application developed in the scope of the EU-supported INTEGRATE Joint Action (JA), that aims to enhance the integration of combination prevention, testing and linkage to care for HIV, hepatitis, STIs and tuberculosis by providing integrated information and digital tools regarding all four diseases to population groups at increased risk, aiming to eliminate the individual and social barriers to effective adoption of prevention practices, testing and linkage to care, and thus reduce the incidence and burden of these diseases in the European Region.

The eStandards methodology stressed the importance of trust and flow for health data as a key characteristic of well-functioning health systems. A digital health compass, leveraging perspectives of health systems, digital health markets, citizens, and workforce, drives a process of co-creation, governance and alignment in eStandards. A repository of best practices and common components further advances interoperability, as new projects add their experience. This paper proposes a governance framework for requirements management, intelligence gathering, specification use, and updates to promote sustainable governance for International Patient Summaries. It is based on interviews of 14 patient summary projects and initiatives in Europe and the United States.

The number of people with diabetes is increasing in every European country and like all chronic diseases it cannot be cured. However, patient empowerment is an acknowledged strategy for improving the patients' health situation. This paper describes the Action Plan Engine developed as a tool for diabetes patients in the POWER2DM project. The Action Plan Engine offers a guided workflow based on treatment goals and activities. A periodic review evaluates how successful a patient has fulfilled these goals and activities. Part of the evaluation is detailed feedback, in particular about 170 interventions based on Behaviour Change Techniques in order to change a patient's lifestyle behaviour towards a healthier, diabetes-appropriate lifestyle. Additionally, the Action Plan Engine offers decision trees for coping with barriers regarding glucose monitoring, exercise, carbohydrate, insulin and stress.

There is a growing understanding of the widespread societal benefits of a universal design (UD). To achieve these benefits, architectural professionals must have the knowledge and skills to implement UD in practice. This paper investigates UD in the context of recent architectural education. It traces changing attitudes in the culture of architectural education, and the evolving perception of UD as an important aspect of architectural practice. Specifically, continuous professional development (CPD) can advance knowledge of UD within a human-centred design paradigm. An overview of courses and resources available to architectural professionals in a number of countries in Europe and the USA is provided. Specific recommendations and guidelines are presented that were derived from a process of engagement with Irish and international architectural professionals, architectural educators and client bodies through online survey, workshops, interviews and CPD prototypes. The research described was commissioned by the Centre for Excellence in Universal Design at the National Disability Authority, working in partnership with the Royal Institute of the Architects of Ireland (RIAI).

The recently completed Massive Open Online Course for Accessibility Partnership project (MOOCAP), had the twin aims of establishing a strategic partnership around the promotion of Universal Design and Accessibility for ICT professionals and of developing a suite of Open Educational resources (OERs) in this domain. MOOCAP's eight university partners from Germany, Norway, Greece, Ireland, the UK and Austria have a significant history in developing and providing courses in the domains of Universal Design and Accessibility, as well as leading research and advocacy roles within Europe. The MOOCAP project consisted of two phases: the development of an introductory MOOC on Digital Accessibility and the delivery of set of online courses with more in-depth and focused learning topics. During the lifetime of the project over 10,000 students signed up for these courses. This paper reflects on the challenges of creating and delivering MOOCs, especially in topics around Digital Accessibility and Universal Design. It considers the outcomes, impacts and legacies of the project. Based on our experiences of integrating these materials into our courses and on feedback and project evaluations, this paper will assess the potential of MOOCs to promote Universal Design for ICT and other professionals, while pointing up the possible trials and opportunities of such activities.

Translational medicine is becoming fundamental in promoting information flow between basic research and clinical practice, and in improving patients' health. The need for efficient systems to process and share information from multiple sources--including distinct areas of medicine--is a pressing need in biomedical research. Nevertheless, healthcare information systems are fragmented over different databases, medical institutions, and geographical locations. There are already several approaches to tackle this problem based on centralized or distributed solutions. Nonetheless, mainly due to privacy reasons, these models only work for specific silos. In this paper, we present a new ecosystem for connecting database owners and researchers. Our approach consists of gathering, via a common fingerprint, an extensive characterization of dispersed databases. This fingerprint typically contains high-level aggregated information addressing questions at a population level and allowing, for instance, quick identification of databases with data that may help to answer a specific research question. This work is being conducted in the context of EMIF (European Medical Information Framework), an IMI (The Innovative Medicines Initiative) joint undertaking funded project, wherein the Catalogue is being used to collect data from cohorts and Electronic Health Record systems of several European countries.

This paper presents the computational framework that is employed for the analysis of health related key drivers and indicators within ACT, a project aiming to improve the deployment of Care Coordination and Telehealth services/programmes across Europe, through an iterative evidence collection-evaluation-refinement process. An open-source solution is proposed, combining a series of established software technologies. The paper focuses on technical aspects of the framework and presents a worked example of a usage scenario.

In an increasingly mobile world, many citizens and professionals are frequent travellers. Access during unplanned care to their patient summary, their most essential health information in a form physicians in another country can understand can impact not only their safety, but also the quality and effectiveness of care. International health information technology (HIT) standards such as HL7 CDA have been developed to advance interoperability. Implementation guides (IG) and IHE profiles constrain standards and make them fit for the purpose of specific use cases. A joint effort between HL7, IHE, and HealthStory created Consolidated CDA (C-CDA), a set of harmonized CDA IGs for the US that is cited in the Meaning Use II (MU-II) regulation. In the EU, the Patient Summary (PS) Guideline recently adopted, cites the epSOS IG also based on HL7 CDA, to support cross-border care in the EU and inform national eHealth programs. Trillium Bridge project supports international standards development by extending the EU PS Guideline and MU-II in the transatlantic setting. This paper presents preliminary findings from comparing patient summaries in the EU and US and reflects on the challenge of implementing interoperable eHealth systems in the cross-border or transatlantic setting.

Adverse drug events (ADEs) are common, costly and one of the most important issues in contemporary pharmacotherapy. Current drug safety surveillance methods are largely based on spontaneous reports. However, this is known to be rather ineffective. There is a lack of automated systems checking potential ADEs on routine data captured in electronic health records (EHRs); present systems are usually built directly on top of specific clinical information systems through proprietary interfaces. In the context of the European project "SALUS", we aim to provide an infrastructure as well as a tool-set for accessing and analyzing clinical patient data of heterogeneous clinical information systems utilizing standard methods. This paper focuses on two components of the SALUS architecture: The "Semantic Interoperability Layer" (SIL) enables an access to disparate EHR sources in order to provide the patient data in a common data model for ADE detection within the "ADE Detection and Notification Tool" (ANT). The SIL in combination with the ANT can be used in different clinical environments to increase ADE detection and reporting rates. Thus, our approach promises a profound impact in the domain of pharmacovigilance.

Quality assurance for planned radiation exposure situations (e.g. Digital Radiography, Computed Tomography or Radio Fluoroscopic studies) requires the application of examination-specific scans protocols. These are tailored to patient age or size, body region and clinical indication for ensuring that the dose applied to each patient is as low as reasonably achievable for the clinical purpose of the image acquisition (ALARA principle). The European legal framework--2013/59/EURATOM--points that health authorities will be more pervasive on inspecting the dosimetry applied to patients. This paper discusses these legal alterations and presents an interoperable distributed system for dose monitoring, which is compliant with legal procedures and the IHE Radiation Exposure Monitoring profile (REM). The system combines the most representative stakeholders affected and directly interested in the patient radiological protection: patients, radiologists, practitioners, health authorities, and ethics committee. The system is capable of gathering, in real-time, dose information applied to the patient and storing it in a regional or national wide dose registry. The paper addresses which information should such systems hold and which should be accessed, from each stakeholder perspective. Furthermore, the system may detect irregular dose patterns, which could indicate dose abuses, and signal those findings to the appropriate stakeholders.

Although personalized medicine is optimizing the discovery, development and application of therapeutic advances, its full impact on patient and population healthcare management has yet to be realized. Electronic health Records (EHRs), integrated with data from other sources, such as social care data, Personal Healthcare Record (PHR) data and genetic information, are envisaged as having a pivotal role in realizing this individualized approach to healthcare. Thus, a new generation of EHRs will emerge which, in addition to supporting healthcare professionals in making well-informed clinical decisions, shows potential for novel discovery of associations between disease and genetic, environmental or process measures. However, a broad range of ethical, legal and technical reasons may hinder the realization of future EHRs due to potential security and privacy breaches. This paper presents a HIPAA-compliant framework that enables privacy-preserving access to next-generation EHRs.

This paper presents an on-line research in Greek universities websites and an international literature review on electronic learning in the field of Health Informatics. The results reveal that there are a lot of e-learning programs offered by universities in Greece, but unfortunately none of them related to Health Informatics domain. On the other hand, the finding of the international literature shows that other European universities conduct e-learning studies in Health Informatics field. Future actions for the enrichment of e-learning service in Greek Health Informatics education are necessary.

This paper describes a study aiming to investigate the opinions of administrative personnel concerning the effectiveness of a cost sharing mechanism (of euro 5/visit) at public hospitals' outpatient departments. Data was derived through a structured questionnaire (developed by the researchers) which appealed to 112 administrative directors of public hospitals. Results highlighted a positive attitude concerning the function of the cost - sharing mechanism at public hospitals, a rather fair measure for the users (vulnerable groups are excluded) which probably is enhancing the monetary flow in public hospitals.

The revised Medical Device Directive has been adopted by the EU in 2010. A major change is that software for certain purposes is now considered a medical device. This entails that a new view needs to be developed on the design, development, evaluation and post-market surveillance of medical software that meets the definition of a medical device. This paper identifies some issues at stake and discusses them.

Personal health monitoring (PHM) can be defined as comprising all technical systems, processing, collecting, and storing of data linked to a person. PHM involves several legal issues that are described in this paper. This article analyses firstly the short term actions that are needed at the European level to allow personal health monitoring in respect of the interests and rights of patients such as the need to have more harmonised medical liability rules at the EU level. Introducing PHM implies also legal action at the EU level on the long run. These long-term actions are related to e.g. the way in which hospitals are organised in their relation with healthcare professionals and with other hospitals or healthcare actors. The paper analyses finally also how health monitoring projects may change the traditional (non-)relationship between patients and pharmaceutical/medical device industry. Today, the producers and distributors of medicinal products have no specific contact with patients. This situation may change when applying telemonitoring projects and may require new legal rules.

Standard Operating Procedures (SOPs) has been introduced as a way to provide direction, improve communication, reduce training time and improve work consistency. In healthcare, SOPs may be considered as a means that can fundamentally change the way healthcare is provided, affecting all types of healthcare stakeholders and improving healthcare decisions and patient safety. Nowadays, providing ehealth services is a necessity, even though some healthcare organizations are reluctant to fully use them. An online mobile training facility embedded within ehealth services may increase the likelihood of their adoption by healthcare professionals, who feel that, when needed, they are provided the necessary support for performing each task, as handheld devices and other mobile technologies are showing increased adoption rates. This paper presents a mobile service that provides training content on SOPs, that can be embedded in a relevant ehealth service and can be accessed by authorized healthcare professionals where and when needed.

The European Commission identified active and healthy ageing as a societal challenge common to all European countries, and an area which presents considerable potential for Europe to lead the world in providing innovative responses to this challenge (http://ec.europa.eu/active-healthy-ageing). To tackle the challenge of an ageing population, the European Commission launched the European Innovation Partnership (EIP) on Active and Healthy Ageing. What can cyberpsychology offer to this process? After presenting the main features of cyberpsychology, this paper identifies in patient engagement and positive technologies the key assets that will allow the technological innovations constantly being developed to provide greater help and care in enabling elderly people to live more normal, happier, fulfilling lives.

The paper describes the Eurogene portal for sharing and reusing multilingual multimedia educational resources in human genetics. The content is annotated using concepts of two ontologies and a topic hierarchy. The ontology annotation is used to guide search and for calculating semantically similar content. Educational resources can be aggregated into learning packages. The system is in routine use since 2009.

Many people suffering from chronic headaches use headache diaries to help track trends in their episodes. Studies have shown that electronic headache diaries are more effective than paper diaries for both patients and providers. We de-signed and implemented a full-size and mobile Web-based headache tracker and a database management system to store the data from the websites. The fullsize website allows users to retrieve their data by viewing or downloading a table of the raw values they entered, or they can see a graphical visualization linking the severity of their headaches to any of several variables. Through this system's capacity to illustrate trends and track contributing factors for headaches, users, researchers and health service providers may gain better understanding of and control over chronic headaches.

The sexually transmitted diseases are a group of infectious diseases with increasing incidence worldwide. In recent years, these diseases have taken epidemic proportions in many countries and huge efforts have been made to prevent them. The gonococcus infections, the HPV virus, AIDS, chlamydia, herpes genitalia, hepatitis B and C, the trichomonas and syphilis are the most common sexually transmitted diseases. This paper describes the clinical and epidemiological symptoms and the preventive measures that should be taken for each disease. lt also presents the dimensions of the sexually transmitted diseases in adolescents who are particularly a "sensitive" group. One of the most important and widely disseminated measures of prevention is the use of condoms. We can also see the importance of and other preventive measures which can be taken against sexually transmitted diseases. Finally, it is noted also the role of the state to treat these diseases, which are unfortunately quite common, and the measures taken by it to prevent and treat them.

Central venous catheters (CVCs) play an essential role in the care of the critically ill, but their use comes at the risk of infection. By using fuzzy set theory and logic to model clinical linguistic CVC-related infection criteria, clinical detection systems can detect borderline infections where not all infection parameters have been (fully) met, also called fuzzy results. In this paper we analyzed the clinical use of these results. We used a fuzzy-logic-based computerized infection control system for the monitoring of healthcare-associated infections to uncover fuzzy results and periods, after which we classified them, and used these classifications together with knowledge of prior CVC-related infection episodes in temporal association rule mining. As a result, we uncovered several rules which can help with the early detection of re-occurring CVC-related infections.

An often reported challenge of evidence-based medicine concerns increasing use of clinical guidelines in practice. One of the proposed improvements is to promote guidelines by presenting them in conjunction with virtual patients. Three approaches to linking clinical guidelines to virtual patients are presented in this paper: (1) guidelines as a source for generating virtual patients; (2) guidelines hyper-flowchart as a virtual patient progress indicator; (3) guidelines flowchart reconstruction as a learning activity in virtual patient systems. The scenarios have been preliminarily evaluated using two demonstrator applications: Bit Pathways and CASUS. Challenges and direction for further development are proposed.

While HL7 CDA is a widely adopted standard for the documentation of clinical information, the archetype approach proposed by CEN/ISO 13606 and openEHR is gaining recognition as a means of describing domain models and medical knowledge. This paper describes our efforts in combining both standards. Using archetypes as an alternative for defining CDA templates permit new possibilities all based on the formal nature of archetypes and their ability to merge into the same artifact medical knowledge and technical requirements for semantic interoperability of electronic health records. We describe the process followed for the normalization of existing legacy data in a hospital environment, from the importation of the HL7 CDA model into an archetype editor, the definition of CDA archetypes and the application of those archetypes to obtain normalized CDA data instances.

In the context of PROTECT European project, we have developed an ontology of adverse drug reactions (OntoADR) based on the original MedDRA hierarchy and a query-based method to achieve automatic MedDRA terms groupings for improving pharmacovigilance signal detection. Those groupings were evaluated against standard handmade MedDRA groupings corresponding to first priority pharmacovigilance safety topics. Our results demonstrate that this automatic method allows catching most of the terms present in the reference groupings, and suggest that it could offer an important saving of time for the achievement of pharmacovigilance groupings. This paper describes the theoretical context of this work, the evaluation methodology, and presents the principal results.

The aim of this paper is to demonstrate the potential of positive technology to productively and positively transform the mental health of European and American citizens in the modern era. This work will describe three aspects - hedonic, eudaimonic, and social/interpersonal - of these technologies. We approach them with guarded optimism, as all of them seek to improve our lives through various techniques. After exploring the relevant technologies, this piece will then examine the future for research within this domain.

The capacity to research, develop and manufacture systems that employ components based on nano- and microstructures with biological functionality, and are capable to share, ubiquitously, information is at the forefront of worldwide competition. A new generation of advanced materials, processes and emerging technologies is building up enabling highly integrated, miniaturized and smart micro-nano-bio-systems to be engineered. These fast technology developments are also stimulating the explosive growth in life sciences, which is leading to an ever increasing understanding of life at the sub-cellular and molecular level. By bringing these parallel developments to biomedicine and health, ultrafast and sensitive systems can be developed to prevent illness, to support lifestyle, to make early diagnosis or treat diseases with high accuracy and less invasiveness, and to support body functions or to replace lost functionality. Such systems will enable the delivery of individualized health services with better access and outcomes at lower costs than previously deemed possible, making a substantial contribution to bringing healthcare expenditures under control and increase its productivity. The MNBS (Micro-Nano-Bio Systems) group of EU funded projects aims at speeding up the convergence of micro- and nanotechnology with the life sciences and accelerating the development of highly integrated diagnostic, monitoring and therapeutics devices. This paper presents R&D activities supported through the MNBS group that are relevant to pHealth and discusses directions to be taken in order to overcome the current problems. Finally, it addresses future challenges to build highly integrated and reliable systems including innovation and usability issues.

The realisation of semantic interoperability, in which any EHR data may be communicated between heterogeneous systems and fully understood by computers as well as people on receipt, is a challenging goal. Despite the use of standardised generic models for the EHR and standard terminology systems, too much optionality and variability exists in how particular clinical entries may be represented. Clinical archetypes provide a means of defining how generic models should be shaped and bound to terminology for specific kinds of clinical data. However, these will only contribute to semantic interoperability if libraries of archetypes can be built up consistently. This requires the establishment of design principles, editorial and governance policies, and further research to develop ways for archetype authors to structure clinical data and to use terminology consistently. Drawing on several years of work within communities of practice developing archetypes and implementing systems from them, this paper presents quality requirements for the development of archetypes. Clinical engagement on a wide scale is also needed to help grow libraries of good quality archetypes that can be certified. Vendor and eHealth programme engagement is needed to validate such archetypes and achieve safe, meaningful exchange of EHR data between systems.

Developed societies are currently facing severe demographic changes: the world is getting older at an unprecedented rate. In 2000, about 420 million people, or approximately 7 percent of the world population, were aged 65 or older. By 2050, that number will be nearly 1.5 billion people, about 16 percent of the world population. This demographic trend will be also followed by an increase of people with physical limitations. The traditional health care systems, not only in Portugal, but also in all other European states, will be faced with new challenges. There is an urgent need to find solutions that allow extending the time people can live in their preferred environment by increasing their autonomy, self-confidence and mobility. AAL4ALL presents an idea for an answer through the development of an ecosystem of products and services for Ambient Assisted Living (AAL) associated to a business model and validated through large scale trial. This paper presents the results of the first survey developed within the AAL4ALL project: the users' survey targeted at the Portuguese seniors and pre-seniors. In this way, this paper addresses the lives of the Portuguese population aged 50 and over.

The INHERITANCE project, funded by the European Commission, is aimed at studying genetic or inherited Dilated cardiomyopathies (DCM) and at understanding the impact and management of the condition within families that suffer from heart conditions that are caused by DCMs. The project is supported by a number of advanced biomedical informatics tools, including data warehousing, automated literature search and decision support. The paper describes the design of these tools and the current status of implementation.

In this paper, we introduce a data integration methodology that promotes technical, syntactic and semantic interoperability for operational healthcare data sources. ETL processes provide access to different operational databases at the technical level. Furthermore, data instances have they syntax aligned according to biomedical terminologies using natural language processing. Finally, semantic web technologies are used to ensure common meaning and to provide ubiquitous access to the data. The system's performance and solvability assessments were carried out using clinical questions against seven healthcare institutions distributed across Europe. The architecture managed to provide interoperability within the limited heterogeneous grid of hospitals. Preliminary scalability result tests are provided.