Research and Education

Nicos Maglaveras, Research and Education C. Pappas

Aristotle University, The Medical School Lab of Medical Informatics Research and education directions Thessaloniki, Macedonia Greece in Medical Informatics at the Aristotle University of Thessaloniki

Abstract: The field of Medical Informatics is one of the most active fields both in research and education at the Aristotle University of Thessaloniki. The nucleus of this scientific field at the Aristotle University resides in the Medical School and in particular in the Laboratory of Medical Informatics. Education programs exist in undergraduate, graduate and post-graduate levels, and are targeted towards medical students and doctors and information technology related students and professionals. Research projects cover a wide area of medical informatics including medical information processing and management, electronic health records design and implementation, medical decision support, biological systems simulation, telemedicine applications, integration and communication issues related to regional health information systems, and quality assessment of health services and systems. The description and brief presentation of the output of these educational and research directions shall be presented in this paper.

Medical Informatics lectures and laboratories. Medical Medical Informatics is used [3]. The Education Informatics I is a mandatory course laboratories and projects are completed for all medical and dental students in the premises of the Laboratory of Undergraduate Courses and whereas Medical Informatics II is an Medical Informatics, which is the Education elective. Medical Informatics I is INTERNET provider of the Medical Although Medical Informatics (MI) offered at the first semester while School, being one of the main network is a well established discipline in most Medical Informatics II can be elected nodes of the network of the Aristotle European countries [1], in Greece for by students from the second semester University of Thessaloniki. Currently a long time only the Medical School at and on. more than 2000 active users are the Aristotle University through the The aim of the undergraduate courses registered in the Medical School’s node. Laboratory of Medical Informatics in Medical Informatics is to make the More specifically, the thematic areas offered Medical Informatics courses medical students aware of the possibilities covered by the two courses are the since 1990 [2]. At the undergraduate given by informatics and information following: level the Laboratory of Medical Infor- technologies to the medical profes- matics offers two courses entitled sionals as it regards the way the health Medical Informatics I Medical Informatics I and Medical services are practiced and delivered Informatics II. These courses are today and in the near future. The · Introduction to computer and tele- offered to the students of the medical primary aim is to render the medical matics systems architecture and dental schools of the Aristotle students good users of the IT solutions · Introduction to Boolean algebra and University of Thessaloniki. Each of in health care. The students have to binary logic the two courses are semester courses complete a number of applied projects, · Programming essentials and logic and last for 13 weeks and 32 hours of and as a reference, the Handbook of diagrams

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· Introduction to Windows environ- pilot phase for this initiative started in engineering, informatics, physics and ment, INTERNET and networking 1998, and was co-funded by the EC mathematics. In this program, the tools and the Greek State. Master lasts for two years (three · Basic tools for data management After the submission of proposals semesters coursework and one for a · Introduction to WWW tools for from the Greek Universities and follow- thesis), and the PhD lasts for a minimum searching and navigating ing the selection process, the following of two additional years. Coursework is · Introduction to HTML and multi- programs linked to Medical Informatics offered in the following disciplines. media information acquisition and and the Aristotle University were set-up for use in the WWW accepted for funding. · Basics of Systems Physiology · Basics of Systems Morphology and Medical Informatics II · The graduate program on Medical Anatomy Informatics of the Aristotle Univer- · Computer Networking · Information Technologies (IT) for sity of Thessaloniki (PROMESIP) · Biomedical Signal Processing health in Greece and the European coordinated by the Medical School, · Biomedical Image Processing and Union with the collaboration of the Infor- Coding · Principles of electronic health matics School and the Department · Applied Mathematics records of Electrical & Computer Engineer- · Electronic Health Record · Data entry mechanisms in elec- ing of the Aristotle University. · Medical Databases tronic health records in diabetes · The graduate program on Medical · Simulation of nonlinear biological and cardiology Research Technology of the systems · Principles and types of decision Medical School of the Aristotelian · Telematics applications in medicine support systems University of Thessaloniki · Medical Decision Support Systems · Evaluation of medical decision (PROMESI). · Security aspects of health informa- support systems tion systems · Telemedicine applications in the The above mentioned programs · Workshops and lectures of

medical field started their pilot phase in 1998, and advanced topics in Medical Infor- they awarded the first degrees matics Graduate Courses and Education (Masters) in the year 2000. PhD At the graduate level the Greek degrees are expected to be awarded A full time student must take four Ministry of Education launched in 1997 from the year 2003 and on. It is courses per semester and in the fourth calls for the development of pilot important to stress here that the ministry semester the student must prepare a graduate programs which would aid in of education favors the development thesis. Each semester, the student bridging the technological and educa- of collaboration with international spends a minimum of 250 hours attend- tional gap between Greece and the Medical Informatics related programs ing lectures and laboratories. Special- rest of the European Union (EU) especially those belonging to European ized workshops and lectures are also countries. The call was under the Universities, and thus suggests that the part of this program. The courses can umbrella of EPEAEK which was a course material should be developed also be attended by industry or hospital joint initiative of Greece and the both in the Greek and English language. specialized personnel that needs quick European Commission, (EC) for the In particular, as it concerns the access to advanced education for im- development of educational activities program with acronym PROMESIP, mediate applications in their working in all levels of education. Especially in this leads to the acquisition of two environment. The number of students the context of higher education through degrees, Master of Science (MSc) registered annually in this program is in EPEAEK it was the aim of the ministry and Doctor of Philosophy (PhD). This the order of 10. to fund development of graduate program is an inter-departmental The second graduate program programs with a unified approach in program involving the medical school, available from the medical school of Greece, and to provide infrastructure the department of electrical & computer the Aristotle University addresses the such as digital libraries and technology engineering and the department of issue of medical research methodology for the development of graduate based computer science. The degrees are and technology bearing the acronym research and development (R&D) awarded from the medical school PROMESI. Medical students as well activities. These programs were which acts as the program coordinator. as students with degrees in biology, designed to lead to the acquisition of The students who participate have a pharmacology or dentistry can partici- both Master and PhD degrees. The degree in electrical & computer pate in this program. This program

Yearbook of Medical Informatics 2003 189 Research and Education aims to give the medical student the education domain, in hospitals, and in in the DIABCARD-3 project where background needed on technology and applied research environments. a chip card medical information MI related tools that shall be used for system was developed for use in the any research endeavor the student Medical Informatics Research in routine treatment and management shall concentrate on. In this program, the Aristotle University of diabetic patients [5]. the Master lasts for two years (three · New information processing semesters coursework and one for a Research in the wider field of Medical techniques were developed based thesis), and the PhD lasts for a minimum Informatics and Information Technol- on neural networks (NN) and of two additional years. Coursework is ogies is going on since the early 90’s in spectrotemporal analysis. For offered in the following disciplines. the Medical School through the example, real-time ischemia beat Laboratory of Medical Informatics. A detection techniques based on · Mathematics, especially calculus large number of research projects usually neural networks and non-linear · Biostatistics and principles of funded through the Greek Secretariat of PCA were developed usable in ICU research methodology Research and technology, the ministry settings [6],[7]. QRS/PVC classi- · Medical Informatics and Bio- of education, and the European Com- fication based on non-linear medical Engineering mission have been carried out covering transformations and NN were also · Office automation and data man- different facets of Medical Informatics developed [8], and ECG spectro- agement techniques and IT in health. More specifically the temporal analysis for use in the · Advanced physiology following areas were primarily addressed clinical environment for evaluating · Systems morphology and anatomy over the past 12 years: the success of thrombolysis and for · Molecular biology explaining atrial fibrillation mecha- · Biological systems simulation and · Electronic health records nisms in patients who underwent identification · Integration of IT platforms for CABG are other examples of the · Medical technology and telematics health care telematics applications research efforts of the team in the applications · Medical data security and integrity Medical Informatics Laboratory, in

· Medical technology and sensors – · Versatile medical data representa- collaboration with the clinical teams instruments tion and interfacing of the A’ Cardiology Clinic in the · Workshops and lectures on · Medical decision making AHEPA hospital [9]. advanced topics in Medical · Simulation and modeling of · In the image processing domain, Research Technology biological and clinical systems for research concentrated on the proc- aid in clinical research essing of angiograms for the extrac- The coursework of PROMESI aims · Telemedicine and pervasive tion of the coronary tree, and for to provide the medical students with computing applications in home care the quantitative measurement of links to the basic sciences so that they delivery for chronic disease patients the geometric parameters of the can use them in their routine clinical · Biomedical signal and image arteries using primarily watersheds practice or clinical research. The processing & interpretation and region merging techniques [10], Master degree is concluded with the as well as in the analysis of 4-D submission of a thesis, and lasts four Research and development in the MRI data from the heart concen- semesters, just as is the case with above mentioned areas have resulted trating on the left ventricular wall PROMESIP. Each semester the in a number of publications, project motion analysis using NN, student spends a minimum of 250 hours deliverables and products. The list that deformable models and wavelet attending lectures and laboratories. follows summarizes the most important techniques [11]. Specialized workshops and lectures results of the research and development · Research was also conducted in are also part of this program. The that took place in the Lab of Medical the development of versatile and number of students registered in the Informatics. user friendly interfaces especially PROMESI program on a yearly basis related with the use of the electronic is in the order of 15. · New electronic health record sys- health records and the information The students who received a Master tems were developed in the context processing modules [12]. from both PROMESI and PROMESIP of the I4C project where a multi- · In the context of the IST project at a rate of 35% continued with their media electronic health record was with acronym CHS (Citizen Health dissertation, whereas the rest are developed for cardiac patients focus- System), we developed a generic working in the industry, the informatics ing on the continuity of care [4], and contact center, though which we

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were able to deliver monitoring and Discussion Acknowledgment prompting services to chronic dis- This work was supported in part by ease patients such as congestive At the Aristotle University and the EPEAEK projects PROMESI, heart failure (CHF) and diabetic more specifically in the Laboratory of PROMESIP and KEDIP of the Greek patients [13]. Clinical trials for the Medical Informatics, considerable Ministry of Education and by the production of evidence based mate- work started in the previous years in projects IST-1999-13352 with acronym rial regarding the feasibility of using Medical Informatics related areas. CHS and IST-2001-33369 with such approaches in regional health Analogous attempts have been made acronym PANACEIA-ITV funded by delivery enhancing quality of care both in Europe [18] and the USA [19]- the European Commission. and quality of life are currently [21]. In the present paper the program carried out. for Medical Informatics in the Aristotle References · In the context of the IST project University of Thessaloniki was with acronym PANACEIA-ITV, presented. Medical Informatics in the 1. Van Bemmel JH. Medical Informatics, Art the use of the iTV platform for the medical school of the Aristotelian or Science?, Methods Inf Med delivery of home care is addressed. University is offered both at the under- 1996;35:157-72. In the context of this project graduate and graduate levels, some- 2. Maglaveras N. Medical Informatics Education. In: Iakovidis I, Maglavera S, research on the use of intelligent thing that is unique in the Greek Univer- Trakatellis A. User Acceptance of Health agents in regulating information and sity system. The experience with the Telematics Applications, Health Technol- requests flow in a health provision application of these programs are quite ogy and Informatics Series. IOS Press; environment based on the active encouraging. Today more than 2000 1998;56:135-42. 3. Van Bemmel JH, Musen MA. Handbook service provision (ASP) model is users both students and faculty use the of Medical Informatics. New York: Springer very active at this moment [14]. INTERNET and networking facilities Verlag; 1997. · Finally simulation of important offered by the Medical School’s node 4. Van Bemmel JH, van Ginneken AM, Stam physiological phenomena in easy to of the Aristotelian University which is H, Assanelli D, MacFarlane PW, use platforms for research and the Laboratory of Medical Informatics. Maglaveras N, et al. Integration and Communication for the Continuity of

clinical purposes using applied math- It is also a fact that medical students, Cardiac Care (I4C), J Electrocardiology ematics is another important area when they start learning MI just in 1998;31(supp):60-8. of research. Such examples are time, for example during their freshman 5. Gogou G, Mavromatis A, Maglaveras N, models of the cardiac tissue simu- year, they can become extremely Pappas C, Engelbrecht R. DIABCARD- CCMIS – A portable and scalable CPR for lating infarction, and studying competent network managers and can diabetes care. IEEE Trans Biomed Eng reentrant mechanisms by simulating engineer innovative solutions for the 2002;49(12) (in press). wave propagation in microscopic management of medical information 6. Maglaveras N, Stamkopoulos T, Pappas level [15],[16], as well as looking that will be subsequently used to C, Strintzis M. An adaptive back- into problems related to the most confront medical problems. Also, the propagation neural network for real-time ischemia episodes detection. Development accurate modeling of the dipole strength and practice of the young and performance analysis using the function at a cellular level and using medical students seems to affect the European ST-T database. IEEE Trans this in the propagation velocity older generation too, by increasing Biomed Eng 1998;45(7):405-13. estimation as well as in the estimation awareness of the use of MI in everyday 7. Stamkopoulos T, Diamantaras KI, Maglaveras N, Strintzis M. ECG analysis of the electrode distance from the clinical practice, and thus creates the using non-linear PCA neural networks for surviving myocardium for use in need for continuing education pro- ischemia detection. IEEE Trans Signal Proc the ablation procedure and in de- grams. This is also a reason why there 1998;46(11):3058-67. tecting the correct activation instant is a high demand for graduate studies 8. Maglaveras N, Stamkopoulos T, from fractionated electrograms for in the field of Medical Informatics and Diamantaras KI, Pappas C, Strintzis M. ECG pattern recognition and classification use in implantable devices [17]. Medical Research Technology at the using non-linear transformations and neural Aristotle University, since a number of networks: A review. Int J Med Inf A number of dissertations were medical and IT students realize that 1998;52:191-208. produced through the above mentioned the future lies in the combination of 9. Maglaveras N, Chouvarda I, Dakos G, Vassilikos V, Mochlas S, Louridas G. activities, six of them are finished scientific disciplines, and that the Analysis of Atrial Fibrillation after CABG already and another five are under domain of health is one of those using Waveletes. Comput Cardiol, IEEE development, showing the close relation domains, where collaboration of multiple Comp Soc Press 2002 (in press). of applied research and projects that disciplines is a must for the development 10. Haris K, Efstratiadis SN, Maglaveras N, run on national and European levels. of successful systems and services. Pappas C, Gourassas J, Louridas G. Model- based morphological segmentation and Yearbook of Medical Informatics 2003 191 Research and Education

labeling of coronary angiograms. IEEE Trans myocardial tissue in healed infarction. A p.108-12. Med Imaging 1999;18(10):1003-15. comparison between model and experiment. 20. Cimino JJ, Allen BA, Clayton PD. Medical 11. Stalidis G, Maglaveras N, Efstratiadis S, Am J Physiol 1995;269 (Heart Circ Physiol. Informatics training at the Columbia Dimitriadis A, Pappas C. Model-Based 38):H1441-9. University and the Columbia-Presbyterian Processing Scheme for Quantitative 4-D 16. Maglaveras N, van Capelle FJL, de Bakker Medical Center. In: van Bemmel JH, Cardiac MRI Analysis Version. IEEE Trans JMT. Wave propagation simulation in McCray AT, editors. 1995 IMIA Yearbook Inf Technol in Biomed 2002;6(1):59-72. normal and infarcted myocardium: of Medical Informatics. Stuttgart: 12. Maglaveras N, Chouvarda I, Koutkias V, Computational and modeling issues. Med Schattauer; 1995. p.125-9. Meletiadis S, Haris K, Balas EA. Information Inform 1998;23(2):105-18. 21. Shortliffe EH. Medical Informatics training technology can enhance quality in regional 17. Chouvarda I, Maglaveras N, de Bakker J, at Stanford University School of Medicine. health delivery. Methods Inf Med van Capelle FJL, Pappas C. Deconvolution In: van Bemmel JH, McCray AT, editors. 2002;41(5) (in press). and wavelet based methods for membrane 1995 IMIA Yearbook of Medical 13. Maglaveras N, Koutkias V, Chouvarda I, current estimation from simulated Informatics. Stuttgart: Schattauer; 1995. Goulis DG, Avramides A, Adamidis D, et fractionated electrograms. IEEE Trans p.105-9. al. Home Care Delivery through the Mobile Biomed Eng 2001;48(3):294-301. Telecommunications Platform: The Citizen 18. Le Beux P, Burgum A, Jarno P, Siregar P. Health System (CHS) Perspective. Int J Medical Informatics Training and Research Med Inf 2002 (in press). at Rennes University School of Medicine. Address of the first author: 14. Koutkias V, Chouvarda I, Maglaveras N. In: van Bemmel JH, McCray AT. editors. Nicos Maglaveras, PhD Agent-based Monitoring and Alert 1998 IMIA Yearbook of Medical Infor- Associate Professor Generation for a Home Care Telemedicine matics. Stuttgart: Schattauer; 1998. p.71-7. Aristotle University System. Proc AMIA Annual Conference; 19. Balas EA, Reid JC, Mitchell JA. Health The Medical School 2002. Informatics training at the University of Lab of Medical Informatics - Box 323 15. Maglaveras N, de Bakker JMT, van Capelle Missouri. In: van Bemmel JH, McCray AT, 54124 Thessaloniki, Macedonia FJL, Pappas C, Janse M. Activation delay editors. 1997 IMIA Yearbook of Medical Greece in bifurcating strands of surviving Informatics. Stuttgart: Schattauer; 1997. E-mail: [email protected]

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