Image, Signal, and Distributed
PATIENT INFORMATION—ANYTIME ANYWHERE
Data Processing for Networked
eHealth Applications
A View from the Guest Editors
© ARTVILLE, LLC
ILIAS MAGLOGIANNIS, MANOLIS WALLACE,
AND KOSTAS KARPOUZIS
C
omputer-based patient record systems are con-
tinuously expanding in order to support more
clinical activities and serve healthcare profes-
sionals more efficiently. For this reason health-
care organizations and providers are asking their staff to
interact more often with computer systems during their
everyday work. Hospitals and healthcare centers are
nowadays sufficiently rich in their computing infrastruc-
ture to handle the internal administrative and clinical
processes for both inpatients and outpatients. The data
stored in computer-based patient record systems include
medical documents relating to the past, present, or future
physical condition of a patient, the results of examina-
tions in the form of multimedia (text, medical images,
sounds, and videos), and financial and demographic
information [1], [2].
In addition, the rapid development in communications
through fixed or mobile networks has opened new ways in
computer-based health systems by providing the capabili-
ty of remote and distributed access to patient’s medical
data [3], [4]. Remote patient monitoring in terms of
telemedicine and the provision of clinical guidelines used
for the patient's care from distant locations [5] are sup-
ported within networked computer-based patient record
systems, while retrieval of medical data [6] and remote
teleconsultations between healthcare professionals are
also possible [7]. Medical data are captured and transmit-
ted, received or updated, stored or retrieved securely and
in real time by users in geographically distributed and
organizationally independent organizations or distant
locations.
In this era of distributed computing the trend in med-
ical informatics is toward achieving two goals: the avail-
ability of software applications and medical information
anywhere and anytime and the invisibility of computing;
computing modules are hidden in multimedia information
appliances that are used in everyday life [8]. Both afore-
mentioned goals require distributed data processing mod-
ules that will be able to automatically analyze data
provided by medical devices and sensors, exchange
Digital Object Identifier 10.1109/EMB.2007.901781
14 IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
knowledge, and make decisions in a given context [9].
Natural user interactions with such applications are based
on autonomy, avoiding the need for the user to control
every action, and adaptivity, so that they are contextual-
ized and personalized, delivering to the medical person-
nel the right information and decision at the right
moment [10].
A typical application falling into the specific concept,
for instance, is pervasive patient telemonitoring (an
important part of telemedicine), which involves the sens-
ing of a patient’s physiological and physical parameters
and transmitting them to a remote location, typically a
medical center, where expert medical knowledge resides.
A typical telemonitoring system has the ability to record
physiological parameters and provide information to the
doctor in real time through a wireless connection, while it
requires sensors to measure parameters like arterial blood
pressure, heart rate, electrocardiogram, skin temperature
and respiration, glucose, or patient position and activity.
Filtered signals and medical data are either stored locally
on a monitoring wearable device for later transmission or
directly transmitted, e.g., over the public phone network,
to a medical center [11]–[13].
Thus, the field of networked eHealth has clearly already
shown its potential, facilitating exchange of information
between clinicians or between institutions, reducing costs,
extending the scope and reach of medical facilities,
enhancing the quality of service offered on- and off-site,
providing new means of medical supervision and preemp-
tive medicine, and so on. Currently, the integration of
medical networking and medical information systems is
treated as an obvious and irrefragable rule. Although
major progress has been made with respect to the integra-
tion of distributed processing and communication capabil-
ities offered, the field is still considered to be at a
premature stage. In addition to interchangeability and data
exchange, computer science can also offer intelligent
computing services to the medical sector; thus, clinical
decision support is a main focus. In this framework, state-
of-the-art image, signal, and data processing is required,
so that useful information is extracted and reliable auto-
mated recommendations are achieved.
0739-5175/07/$25.00©2007IEEE SEPTEMBER/OCTOBER 2007
 In this era of distributed computing the trend in
medical informatics is toward achieving two goals:
the availability of software applications and
medical information anywhere and anytime
and the invisibility of computing.
In this Issue
Within this special issue we review some of the most
promising prospects for the state-of-the-art and emerging
field of image, signal, and distributed data processing for
networked eHealth applications.
The case of pressure ulcer detection is an appropriate
example for this. With the number of individuals that
belong to high-risk social groups for the development of
pressure ulcers, it is quite difficult for a national health-
care system to have sufficient expert medical personnel
distributed throughout a country and dedicated to the
detection and treatment of pressure ulcers. Kosmopoulos
and Tzevelekou [19] go further than existing manual tech-
niques and propose an automated system for the analysis
of two-dimensional (2-D) images and classification of the
stage of pressure ulcers present in them. Following a sup-
port vector machine approach, they achieve high rates of
tissue classification to healthy or one of six different
stages of pressure ulcers. Such a system can be utilized as
a first filtering step, so that the amount of data that has to
be manually processed by clinicians is both reduced and
labeled for gravity.
In the development of such systems, the availability of
training data is often an issue. Clinical decision support
is most desired in rare medical cases for which a single
clinician usually cannot have adequate practical experi-
ence. In such cases, analyzing medical history records
from a single clinic or medical facility does not typically
suffice for the development of a robust and reliable high-
accuracy system. Thus, we need to combine data residing
at different locations.
Additionally, to the ordinary data format and channel
bandwidth considerations that govern most data intercon-
nection problems, in the medical case we also need to
consider legal and ethical issues related to data ownership
and confidentiality. Medical data transfer is also required
in order to offer medical services at the time and place
they are needed, by making centralized services available
electronically through permanent and ad-hoc networks. In
both cases, healthcare information needs to be accessible
by authorized users only, while its fundamental security
properties, namely integrity, availability, and confiden-
tiality, must be retained. The technological challenges for
this are presented and discussed by Gritzalis et al. in [18].
Vastly augmenting communication bandwidths and
rapidly diminishing costs for digital storage have allowed
the realization of the above-mentioned integrated systems
that handle or exchange large amounts of medical data.
Following this trend, the acquisition, digitization, storage,
remote access to, and analysis of large amounts of med-
ical data are becoming typical things in the field of
IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
eHealth. Although the results of this progress are certainly
beneficial and promising, it is becoming obvious that
some important technological factors may have been over-
looked in the initial enthusiasm. Specifically, we may
have originally underestimated the way in which the sud-
den availability of cheap and trustworthy storage and
communication solutions would affect the amount of med-
ical data retained in digital format.
More and more medical data are becoming available in
digital formats and to greater details. Although this pro-
vides more processable information and thus enhanced
computing opportunities, it also augments the require-
ments in storage and bandwidth, often overweighting the
rise in available resources. Clearly, we desire to have
techniques that will limit the size of the acquired data
but not the information richness, thus enhancing the bal-
ance between available and required resources for opti-
mized medical services. Doukas and Maglogiannis in
[15] provide an excellent review of such techniques in
the field of medical image compression, the medical data
that consumes the vast majority of available resources.
Region of interest coding is analyzed and compared and
classified in 2-D, three-dimensional (3-D), and video
sequence categories.
In all of the above we have assumed that distributed
medical repositories cooperate fully and, thus, that the
only considerations for data exchange are related to data
format, channel capacity, and security. Unfortunately, this
also constitutes an oversimplification. In reality, in most
cases individual medical archives are bound by legal con-
straints not to freely redistribute the medical history
records they possess; ownership and cost issues may also
interfere. As a result, owners of medical information are
often quite reluctant to permit its transmission to other
sites so that it can be processed remotely.
One of the main fields in which electronic healthcare
has been making a major contribution to clinical medicine
is clinical decision support. In this framework, medical
history data is processed automatically using state-of-the-
art algorithms in order to develop automated recommen-
dation systems. With today’s augmented computing
power resources, using the best available processing algo-
rithms is not an issue. What is an issue, on the other hand,
is the availability of medical history data due to the fact
that issues related to security, ownership, and confidential
personal medical data prohibit the gathering of this data to
a main medical database.
Given the statistical nature of utilized algorithms, the
independent processing of the data and the combination of
the individual results cannot provide overall results of
equivalent quality to those of centralized processing of all
SEPTEMBER/OCTOBER 2007 15
 Although major progress has been made with
respect to the integration of distributed processing
and communication capabilities offered, the field
is still considered to be at a premature stage.
the data. Megalooikonomou and Kontos in [17] propose a
novel hierarchical processing algorithm in order to tackle
this. In their approach, although data are only processed at
their original location so that confidentiality issues do not
arise, the distributed processing components are in con-
stant communication with each other throughout the pro-
cedure, thus achieving a coordination that allows for
results equivalent to those acquired when applying cen-
tralized processing algorithms.
With methodologies such as the above we can generate
automated systems able to process medical information
and provide decision support recommendations to clini-
cians; this might not be the only field of application for
distributed eHealth. It is becoming more and more obvious
that healthcare systems cannot possibly offer full coverage
for the geographic and population spread of a country. On
the other hand, we now know that asymptomatic diseases
are difficult to detect at an early stage without comprehen-
sive medical examinations; without an early detection the
chances for treatment are severely narrowed. The only
realistic solution is to identify high-risk population groups
so that medical advice and monitoring can be targeted.
In [14] Kyriacou et al. see the utilization of automated
analysis techniques in the field of medical risk analysis.
With stroke being the leading cause of death in Western
societies, and with the process building up to it often
being free of symptoms, the identification of high-risk
individuals or groups is desired. Such information can
help greatly reduce strokes and related deaths or resulting
disabilities. In the work presented in this article, in order
to acquire this type of knowledge, medical data have been
collected from a high number of patients using noninva-
sive techniques; this data was then analyzed with novel
automated processing techniques in order to extract infor-
mation-rich features. The patients were then monitored for
a period reaching up to 84 months. The study of the statis-
tical correlation between the data collected from patients
and their latter health status and progress is utilized in the
developed medical portal in order to automatically pro-
vide estimations of whether specific individuals or groups
belong to high-risk categories. With both population and
diversity of illnesses augmenting rapidly, it is not possible
to provide constant and detailed medical analysis for all
people and in all cases, so works such as this that utilize
computerized technology to identify high-risk groups pro-
vide a much more realistic approach to preemptive medi-
cine and early detection.
Once someone has been identified as a member of a
high-risk group, we need to be able to provide personal-
ized advice and pervasive monitoring. Ideally, a personal
or family clinician would undertake the task.
16 IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
Unfortunately, the amount and diversity of high-risk
groups and individuals makes this, too, an unrealistic
option. Additionally, few people would be content with
this extent of intervention in their day-to-day life.
Pervasive, automated, citizen-centered care is probably
the most important emerging technological achievement
in the scope of distributed eHealth. In this framework,
automated digital systems monitor an individual belong-
ing to a high-risk group, providing both personalized
lifestyle-related advice and early diagnosis in the individ-
ual’s own environment with little or no interference with
everyday life. This kind of personalized care was not
available in the past outside the clinic and without the
support of clinicians and specialized technicians due to
the cost, size, and complexity of the required equipment.
Recent advances in electronics have made possible the
production of miniscule medical observation and process-
ing devices that come in many flavors, with portable and
wearable ones being the most promising. Out of these, the
wearable type, being the noninvasive one, is the one
receiving most attention and providing the best prospects
for the future. Gatzoulis and Iakovidis in [16] provide a
rich presentation of the state of the art, emerging innova-
tions, and new opportunities in the field.
Acknowledgments
The guest editors wish to thank all the authors for their
contributions, all reviewers for their efforts and valuable
reviews, and especially Editor-in-Chief John Enderle for
his advice and encouragement. Although the topics dis-
cussed in this special issue could not certainly cover the
whole spectrum of distributed eHealth applications, we do
hope that the articles included will attract the interest of
this publication’s audience and serve as an inspiration to
the young researchers working in this field.
Ilias Maglogiannis received a Diploma in
electrical and computer engineering and a
Ph.D. in biomedical engineering and med-
ical informatics from the National
Technical University of Athens (NTUA),
Greece, in 1996 and 2000, respectively,
with a scholarship from the Greek govern-
ment. From 1996 until 2000 he worked as
a researcher in the Biomedical Engineering Laboratory at
NTUA, and he has been involved with several European and
national projects. In 2001 he joined the faculty of the
Department of Information and Communication Systems
Engineering at the University of the Aegean. His published
scientific work includes two books and five lecture notes (in
Greek) on biomedical engineering and artificial intelligence
SEPTEMBER/OCTOBER 2007
topics, 26 journal papers, and more than 40 international
conference papers. He has served on program and organiz-
ing committees of national and international conferences
and he is a reviewer for several scientific journals His scien-
tific activities include biomedical engineering, telemedicine
and medical informatics, image processing, and multimedia
telecommunications. He is a member of the IEEE
Engineering in Medicine and Biology Society, IEEE
Computer Society, IEEE Communications Society, the
International Society for Optical Engineering, the ACM, the
Technical Chamber of Greece, the Greek Computer Society,
the Hellenic AI Society, and the Hellenic Organization of
Biomedical Engineering.
Manolis Wallace was born in Athens in
1977. He obtained his Diploma in Electrical
and Computer Engineering from the
National Technical University of Athens
(NTUA) and his Ph.D from the Computer
Science Division of NTUA. He is with the
University of Indianapolis, Athens Campus
(UIA) since 2001 where he serves now as
an Assistant Professor. Since 2004 he is also the Chair of the
Department of Computer Science of UIA.
His main research interests include handling of uncer-
tainty, information systems, data mining, personalization
and applications of technology in education. He has pub-
lished more than 40 papers in the above fields, ten of
which in international journals. He is the guest editor of
two journal special issues and a reviewer for more than
ten journals and various books. His academic volunteer-
ing work also includes participation in various confer-
ences as organizing committee chair, session organizer,
session chair or program committee member. He is the
general chair of SMAP 2006.
Kostas Karpouzis is an associate re-
searcher at the Institute of Communi-
cation and Computer Systems (ICCS)
and holds an adjunct lecturer position at
the University of Piraeus, teaching data
warehousing and data mining. He gradu-
ated from the School of Electrical and
Computer Engineering of the National
Technical University of Athens in 1998 and received his
Ph.D. degree in 2001 from the same University. His cur-
rent research interests lie in the areas of human computer
interaction, image and video processing, image inter-
change infrastructures using the MPEG-4 and MPEG-21
standards, sign language synthesis, and virtual reality.
Dr. Karpouzis has published more than 70 papers in
international journals and proceedings of international
conferences. He is a member of the technical committee
of the International Conference on Image Processing
(ICIP), the IFIP Conference on Artificial Intelligence
Applications and Innovations (AIAI) and a reviewer in
many international journals. Since 1995 he has partici-
pated in more than 12 R&D projects at Greek and
European level. He is also a national representative in
IFIP Working Groups 12.5 “Artificial Intelligence
Applications” and 3.2 “Informatics and ICT in Higher
Education.”
IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
Address for Correspondence: I. Maglogiannis, Dept. of
Information & Communication Systems Engineering,
University of the Aegean, 83200 Karlovasi, Greece Tel:
+30 22730 82239, Fax: +30 22730 82008. E-mail: ima-
glo@aegean.gr.
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