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
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- T. Berners-Lee, J. Hendler, and O. Lassila, “The Semantic Web,” Scientific American, May 2001.
- P. R. Kongstveld, Essentials of Managed Health Care, 5th ed., Jones & Bartlett Publishers, 2007.
- 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.
- A. Ruttenberg, et al., “Advancing translational research with the Semantic Web”, BMC Bioinformatics, vol 8 suppl 3, 2007.
- HCLSIG - www.w3.org/2001/sw/hcls
- H. Sass, and R. U. Massey, Health Care Systems: Moral Conflicts in European and American Public Policy, Springer, 1998.
