Advancing Health Care Management with the Semantic Web

Abstract

Health Care Management is a combined effort involving the patients and their families/caregivers, professional health care providers, medical schemes, support groups, and employers. Important to all stakeholders is the obtaining and sharing of credible information. The WWW currently allows the sharing and distribution of information that would otherwise not have been available, but it is plagued by the sheer volume of information which is not connected on the semantic level, and of which much is irrelevant and has little guarantee of accuracy. The purpose of the Semantic Web is to bring structure to the content of Web pages allowing software agents to carry out intelligent tasks for the user. This opens a new set of opportunities that can be utilised to improve health care management on a personal and health care provider level. The aim of this research in progress is to identify the needs and match them to the services possible with the Semantic Web.

Introduction

The Internet allows all stakeholders in the health care management team to obtain and share health care information. The knowledge enables patients, in collaboration with family members, medical practitioners, and health care providers, to take more control over the management of their personal health/disease. It also allows health care providers to plan for better health care coordination and delivery.

Although the Internet currently contains valuable and easily accessible information, there are still several limitations. The volume of information that is not consolidated or aggregated impacts on retrieval time and costs. Searches return links to thousands of pages of which few are relevant. Often the information presented is conflicting with little guarantee of accuracy. Web sites are mostly non-interactive and do not provide customisation to specific requirements making it difficult to find an optimum solution. Further, the current Internet lacks in the ability to recognise individuality or supply intuitive support for teamwork and the sharing of information. To supply a better health care service intelligence needs to be added to the data.

The aim of the Semantic Web is to make the Web as intelligent as possible [1]. By describing relationships between objects and properties of objects the Web is no longer seen as links between web pages, but as one large database with information. Together with virtual communities a patient can in future be provided with an individualised, easy to use, encompassing health care management program that adds value to his/her life. Mobile Web extensions broadens the audience in that the Web can be accessed through cell phones and is available 24/7 anywhere a mobile phone can be used.

Web technologies and services are expanding, allowing for more and more applications to be developed. The aim of this research is to identify the needs of Health Care Management and explore how the services of the Semantic Web can be harnessed to improve them. This paper reports on research in progress through a preliminary study on what is currently available by investigating the services provided by two divergent Health Care sites, namely, Health24.com and Google Health, a few examples of Semantic Web applications, and general needs and expectations in Health Care Management. Further research will be aimed at including a broader collection of Health Care Web sites; a more detailed description of needs and expectations in Health Care Management and how patients and practitioners experience and use the current sites; and what extra needs there are that are not currently available, but could be addressed by the Semantic Web.

Services Available on Two Current Health Care Web Sites

A short overview follows of the services currently available on two health care sites with divergent content.

health24.com (June 2008)

The aim of the Health24.com site is to inform and educate visitors on health related matters and help them to find health care service providers. It is a South African site with a majority stake held by Media24 (a Naspers Group publishing company). Funding is mainly through online advertising by medical service and product providers, banks, and retail magazines. They go to great lengths to ensure visitors that their content is not determined by commercial interests.

The content of the site is continually updated by a team of medical specialists and journalists. It covers a wide range of topics, namely, common medical conditions, diet, fitness, pregnancy, parenting, sex, oral health, mind health, and family health for men, woman, children, teens, and pets. The site offers narratives of personal experiences, research articles, graphics and videos, forums, ask an expert (with over 40 experts), quizzes, interactive health tools, competitions, and surveys. Users can subscribe to daily tips and a newsletter. There are also links to medical aid schemes, gyms, and other medical services.

They collect information about a visitor to enable them to provide information regarding a product, service, or event. They also allow the syndication of content by other companies on their own websites, newsletters and intranets.

Health24.com claim to have over half a million visitors of which nearly 75% are in the age group 25 to 49 and 70% are woman. Just over half are parents. A user survey conducted in 2006 indicated that 77% of the Health24.com readers consult the Internet before visiting a health professional.

google.com/health (June 2008)

Google/health is a recent site that adds another dimension to personal health care. After signing up for free, it allows you to not only search for disease related information, but also to store and manage all your health information in one place.

Members enter their profile in terms of conditions, medications, and allergies. The information can be imported from participating doctors, hospitals, labs, and pharmacies and is available 24/7 to a doctor during a consultation, or to hospitals in cases of emergency. With all information in one place interactions between medications, allergies and conditions can be traced, a second opinion can be asked for, and prescriptions can be refilled online. Google has no financial relationships with any company and it is free for the user to connect and share their health information with who they want. Google guarantees security and privacy. Unfortunately it is limited to patients residing in the USA.

Google/health also provides information on ailments such as symptoms, treatment, causes, test and diagnosis, prognosis, prevention, complications, and when to contact a doctor. Illustrations are provided as well as a list of links to web pages with related news, scholar results, related groups, and related search trends. Medical practitioners and hospitals can be searched for by speciality or location with the help of Google maps.

Semantic Web Services

The two health care websites above still require a substantial amount of human intervention. The Semantic Web creates an environment where computer software agents can carry out sophisticated tasks for users [2]. The aim is to create programs that will collect web information and exchange results with other programs. This will allow many of the human tasks to be automated, allowing people and computers to work in cooperation. Web pages are no longer mere text and hyperlinks, but now include machine processable semantics by adding meaning to the content. Coupled with the Mobile web access is possible from anywhere a mobile phone is used.

A typical personal health care example by Bernes-Lee, et al. [3], the creator of the WWW, involves Pete and his sister Lucy who need to take their mother to a specialist for a series of physical therapy sessions. At the doctor’s office Lucy accesses her Semantic Web agent through her Mobile Web browsing device. The agent retrieves information about their mother’s prescribed treatment from the doctor’s agent and looks up several lists of specialists. It checks for those complying with her mother’s insurance, are within a 20-mile radius from her home, and has a good rating on a trusted rating service. The agent then follows up by finding a match between available appointment times supplied by the specialists’ agents through their web sites and Pete and Lucy’s schedules. The agent returns a suggested plan which Lucy and Pete can accept or refine by specifying stricter preferences. Pete’s agent can solicit the help of Lucy’s agent to suggest a new plan. This is but one example of many unexplored possibilities.

On a health care provider level, physicians have shown a slow but discernible movement away from solo towards group practices, requiring collaborative interaction amongst physicians as well as specialists. [4]. Bojārs, et al. [5] discuss how the Semantic Web can be used to bring various social applications together. Through interchange, integration, and creative reuse of data some of the boundaries of current collaborative sites can be crossed. This is accomplished by the intelligent use of Semantic Web data that enables the creation of linked, “mashable” data, thereby improving searching possibilities and interpretation of content retrieved from the sites. Ontologies such as SIOC (Semantically Interlinked Online Communities) are combined with microformats, API’s, and structured and semantic blogging, in an attempt to surpass the current social application limitations towards realizing the “Social Semantic Web”.

On a national level, the TB and HIV/AIDs epidemics require extensive exchange of data and planning by health care authorities. On a more global scale the possibility of an outbreak of bird flu amongst humans, for example, is more a question of “when” than “if”. Organisations are monitoring any flu outbreaks worldwide to enable them to react immediately even in the remotest locations. Here the Semantic and Mobile Web is invaluable in gathering and distributing information.

An area embracing the use of the Semantic Web is Translational Research where the aim is to move discoveries in basic research (the Bench) to application at the clinical level (the Bedside) [6]. Although current tools and standards can already support the implementation of components, challenges exist. Due to the youth of the technologies, there are limited users and gaps in the standards and implementations.

A Semantic Web Health Care and Life Sciences Interest Group (HCLS IG) was set up within the framework of the World Wide Web Consortium to “develop, advocate for, and support the use of Semantic Web technologies for biological science, translational medicine, and health care” [7]. They contend that the application is especially useful in these domains “as they depend on the interoperability of information from many domains and processes for efficient decision support”.

Health Care Management Needs and Expectations

A preliminary literature study on Personal Health Care Management provided the following list of requirements: tracking and monitoring personal health measures (e.g. blood pressure, cholesterol); selecting health providers; managing health costs (e.g. flexible spending, and health reimbursement accounts); understanding/influencing treatments; availability of personalised information that can be controlled by the individual, and is secure, interoperable (includes multiple data sources such as claims, authorizations, and results), and interactive; messaging capability such as health reminders (e.g. appointments, prescription refills), compliance reminders (e.g. mammogram), and helpful suggestions (e.g. availability of generic options); create health plans; and insurance and claims administration [4].

The health care providers such as governments, physicians, hospitals, and pharmacies have their own requirements, for example, accessibility to health information, epidemic risks, consumer based health plans and services, reimbursement and incentives systems, care management, utilisation management, disease management, case management, pharmacy benefits management, behavioural health management, prevention and the use of data and analysis in care management, member services, claims administration, sales and marketing, and health care consumerism [4] [8].

A limited number of the needs and expectations are currently addressed on the Web and then only to a limited audience as in the case of Google/health. Advances made in the Semantic Web allows for more sophisticated health care services to be made available to address the needs and expectations of patients and health care service providers.

Conclusion and Future Work

This research-in-progress paper reports on a preliminary study on how the tools and technologies relating to the Semantic Web can meet the needs and expectations of Health Care Management. In the paper three different aspects were briefly addressed, namely, (1) the services currently available on two divergent current health care sites Health24.com and Google/health; (2) examples of possible health care uses through the Semantic and Mobile Web; and (3) general needs and expectations of Health Care Management.

The continuation of this research will focus on a more detailed look at what is currently available, and at extending the list of needs and expectations to match them with existing, and possibly new, applications of Semantic Web Services.

References

1. B Thuraisingham, XML Databases and the Semantic Web, CRC Press Florida, USA, 2002
2. J. K Durgin and J. S. Sheriff, “The semantic web: A catalyst for future e-business,” Kybernetes, vol. 37 no. 1, pp. 49-65, 2008.
3. T. Berners-Lee, J. Hendler, and O. Lassila, “The Semantic Web,” Scientific American, May 2001.
4. P. R. Kongstveld, Essentials of Managed Health Care, 5th ed., Jones & Bartlett Publishers, 2007.
5. U. Bojārs, J. G. Breslin, A. Finn, and S. Decker, “Using the Semantic Web for linking and reusing data across Web 2.0 communities,” Web Semantics: Science, Services and Agents on the World Wide Web 6, pp. 21-28, 2007.
6. A. Ruttenberg, et al., “Advancing translational research with the Semantic Web”, BMC Bioinformatics, vol 8 suppl 3, 2007.
7. HCLSIG - www.w3.org/2001/sw/hcls
8. H. Sass, and R. U. Massey, Health Care Systems: Moral Conflicts in European and American Public Policy, Springer, 1998.

Xenophobia and Pussyfooting Around the Real Issues

Reading the mainline newspapers and listening to the government's excuses for the xenophobia attacks makes one wonder whether people have lost the ability to see things for what they are. The local George Herald, Thursday 5 June 2008, have been brave enough to come up with some interesting comments on a two page spread addressing the xenophobia attacks in George. Is it that in a smaller town the police and journalists are closer to the population and the real issues or are they less intimidated?

• "Massive unemployment root of attacks" - 65% of the people living in Thembaletu are unemployed
• "Thembalethans looked at the newcomers (Somali shopkeepers) and felt jealous that they could so easily set up a business and make a living here" - Mayor of George
• "A primal trigger is crime and sheer opportunism when people start looting"
• "Most of the Somalians have gone back into the community and were welcomed with open arms by Thembalethans who discovered that their own (South African) shopkeepers had taken advantage of the situation by suddenly upping their prices for commodities like bread, which was sold for R16 for a loaf"
• "There are some rotten apples amongst the Somalians who stole the Halaal food intended for the entire community"
• Criminal elements breaking into houses and vehicles of Somalians
• "A mediation team from the Western Cape Premier's office that will head up and coordinate ongoing efforts of integration of immigrants in local communities, arrived on Monday and will remain in the Southern Cape for a while"
• A Somalian was killed with a knife in the Blanco community hall where the foreigners were staying . The reason is suspected to be over a blanket.

Looking at all the comments it is obvious that the causes of xenophobia has been several and from all sides. The solution of reintegration lets me think of a battered woman being reconciled with her husband. Today sorry, tomorrow the same story? One thing that concerns me is the comments made by several government officials during the attack. Mbeki for one said that they should not attack fellow Africans as they supported them during the struggle, how can they now turn on them? This makes me wonder whether the fact that I am white and, therefore, a colonial (foreigner) and not a fellow African makes me a more legitimate object to attack next time. Add to that the fact that I was the opposition in the struggle adds more fuel to the fire. I am just wondering if an attack was launched at the whites the same type of rhetoric would be used to justify it, and this by a government that is supposed to see to the safety of all its citizens. This does not leave me feeling very comfortable.

Comments on the "White Boy's Club"

Nothing gets we hotter under the collar and more wanting to spit fire than comments such as made on ITWeb "The White Boy's Club". So what if the hard core coders are mostly white males! It has never been an exclusive club, but one by choice and nobody has been excluded from joining regardless of race, gender, or whatever. On the contrary, non-whites and non-boys have been welcomed with open arms. Ask me, I am female and have been begged to join some groups. As lecturers we have rejoiced about every non-white and non-male person joining our IT course. Unfortunately very few females have the interest to sit behind a computer screen 24/7. The ones that did were never discriminated against by their fellow white males, on the contrary. The same is true for the non-white males/females. Unfortunately, mostly the white males have been able to finish the course. Is this their fault that they seem to enjoy the field more than the others and are prepared to put up with the non-glamorous, hours-and-hours slogging, lonesome-existence on their computers? I challenge anybody else to try and join them. It is by no means easy or an exclusive club! I am sick and tired of people classifying everything by race. In 1992 the whites voted for a non-racial country. Since then nothing but race has been pushed down white males' throats. Up to the extent that so many that could have created jobs and build this country have left and are putting their talents to the advantage of other countries. What a disgrace for South Africa and where we could have been in 2008. Let everybody in this country do what they are passionate about and good at. Let's take hands and build this country regardless of race, gender, etc. Let's all become green again as when the Springboks won the World Cup in October 2007 and all these issues were forgotten. We all sat next to each other cheering the Springboks on. It is possible as soon as we all become green again!

"No parents' plea from young facebook users"

The new move to tell it all on blogs and publish pictures on facebook leaves us with some serious privacy issues. An article in last week's "The Sunday Independent" 16 March 2008 discusses the issue of allowing parents to sign on to facebook to keep up with their offspring and their doings. Many children do not want their parents to share in their online disclosures. A professor of communication at the University of Illinois who has extensively studied digital culture, namely, Steve Jones, is quoted as saying: "What they want to keep most private is not something they wish to keep from strangers, it's the things they want to keep from people that know them." He contends that children do not care what someone who does not know them finds out, but they do care about what someone that does know them intimately finds out. The article recommends that rules are set up for their mom and dad's behaviour online. I can believe the concern of children for I have seen some party pictures that students have had on their computers that I would also not show to my parents if I were them. But having them public raises other concerns. It is not your closest family that is your major problem, but future employers and anybody else who would want to draw a profile of you. A good blog can count in your favour but I know from personal experience how a profile drawn from someone's blog discounted him from a possible job before an interview was even conducted. In the same newspaper mentioned above another article appears that discusses someone who lost her job due to some comments made on her blog. In her case all turned out well, but most of us cannot afford these scenarios. I have often read blogs myself to arrive at an understanding of the person I am dealing with. Sometimes I was left breathless at the amount and type of personal detail disclosed. Is it ethical to use blogs and pictures in this way? I do not know, but if you are prepared to make it public, you also have to be prepared to live with the consequences.

Should Computer Science be Taught at Schools

This topic has been a contentious issue since the early 1970's when universities started teaching Computer Science. When I started teaching at the RAU (now UJ), teaching the first years was reserved for the best lecturer, third years for the second best lecturer and second years for the noobs (new lecturers). This was based on the experience that teaching programming is extremely complex. There is a big difference between teaching a computer language and teaching programming where a computer language is used, but the major aim is to change a word problem into code. When schools started making noises that they wanted to teach programming a lot of debate took place. The verdict then was already that it should not be done - not because scholars would not cope, but because of the difficulty to teach it properly. Shortly after that schools included Computer Science (CS) as one of their subjects. Although I must admit that there are some excellent CS teachers, the majority of the better ones have left for greener pastures. This is not surprising in the current schooling system and the need for their skills in industry. Unfortunately this has resulted in the following horror stories:

• A local school, a few years ago, wanted to train new CS teachers (teachers who did not know any programming) by sending them on a three week Java course!!!
• Currently I have three first year students who have had Computer Science at school. Different schools I must add. None of them can use if's and while's, let alone use arrays. They all admit that their teachers could not teach them programming and they passed on theory alone! This is not the first time we have students with this type of experience.
• The projects the scholars have to do for their matric mark is often done for them by someone else. This is not detected by the examiners.
• One of my past lecturers refused to allow his children to do CS at school. They have pursued computer careers after successfully completing a CS degree and post degree studies at a University.
• One of my CS colleague's son believed that he was too dumb to understand programming after his school experience. His mom recognised his talent and convinced him to do it. It took some time for him to gain the confidence that he could actually program. He is successfully employed in a computer programming career at the moment after completing his diploma in IT.
• One of our part-time lecturers begged us to intervene in the local school as his son dearly wanted to pursue a computer career but was totally put off believing that CS was too difficult. He is now following another career path. We have lost many a good prospective student in this way.
• Some grade 10 scholars that I have for extra classes were on the point of dropping CS as they found it too difficult. After two of the parents asked me to intervene with extra classes the kids are now really enjoying it and they are showing a lot of natural ability.
• The word that CS is too difficult has spread in the school and many prospective computer scientists are pursuing a different career.

With the great need in computer specialists we cannot afford to loose these kids that are put off a computer career due to teachers that do not understand how the subject should be taught. The problem is even worse after the recent move to object oriented programming with its added complexity and ridiculous examples in most beginner text books. Although Java is based on classes, they do not have to be taught in the beginning. Basic programming can be taught in the main method. If you have a child who is interested in computers and your local teacher does not have a good track record, rather let him/her take another subject instead of CS. All university courses start their students from the beginning and prefer students with only a background in computer literacy to students that have to be de-taught and retaught in programming.

Get out of the Whining Party - You do Not Need Fancy Equipment to Learn Valuable Skills

What an uplifting experience. I was watching some street soccer on TV this afternoon. A section of a standard street was demarcated and changed into a soccer field for a while. Professional coaches donate some of their time weekly to train "at risk kids". They even compete for a street-cup. If you want to support a worthy cause see their web site Soccer in the Streets. Bravo to the organisers! Life in South Africa so often degenerates into a whining party between the haves and the have-nots. In the 1960's and 1970's (yes, not so long ago) practically all kids played in the quiet streets and the veld and invented their own games. They, for example, learned to be creative by making high jumping poles from broom sticks and an old mattress for landing area. Cricket bats and wickets were invented in the same way. The whole area's kids would have hours of fun and learn several life skills at the same time. Some time ago I had a related argument with someone who whined about the lack of technological equipment in a school. He did not realise how lucky they really were. You only need computers if you want to teach kids to use an office program or if you run a Computer Science Course. (Teaching Computer Science should be banned from all schools - not because the kids cannot cope with the content, but very few teachers can teach it! This is a topic for a separate blogpost, though). Some computers in a library for kids to do research should be sufficient for most primary schools. Let kids learn the other subjects through more exciting ways and learn much needed life skills at the same time. Most lecturers and teachers should also be banned from using data projectors! There is a place and a use for data projectors, but they should definitely NOT be used to run through a slide show that is received as a teacher's aid with a text book. I tried it a few times and fell asleep in my own class!

HELP! I have been if'ed again

Living in a home with more than one coder/hacker sometimes leads to interesting communication. When I ask charlvn whether he wants cauliflower OR broccoli for supper he will answer "yes" in a typical if scenario if(cauliflower OR broccoli) supper else no supper At work we are confronted by a similar situation. The students and staff have been asked to march tomorrow to show their support against racism. The idea originated in the widely distributed and overplayed video shot by students at the Free State University. The video was a stupid idea affecting people's human rights. But it is not more or less stupid than women (or anybody else for that matter) voting for the current ANC president who is an extreme example of a human's rights abuser, unless you do not see a woman as human of course. As much as I do not participate in a march against the latter I will not participate in any march as I believe there are other avenues to express one's dissatisfaction. Well, that said, it still leaves me in a typical if situation: if(do not participate in march tomorrow for Reason1 OR Reason2 OR Reason3) "Though shall be labelled a racist" else "Though shall not be labelled a racist" There is no way out of this one, no matter what my reason for not participating. The answer to the OR will be "yes" and I shall be labelled.