Page 1 of 4
`
`FITBIT EXHIBIT 1018
`
`Page 1 of 4
`
`FITBIT EXHIBIT 1018
`
`

`
`Handbook of Medical Informatics
`
`].H. van Bemmel
`M.A. Musen
`
`Editors
`
`].C. Helder
`
`Managing editor
`
`Houten/Diegem 1997
`
`Bohn
`
`§/taarflleighum
`
`Springer
`
`Page 2 of 4
`
`

`
`“7 1997 Bohn Stafleu Van Loghum, Houten, the Netherlands
`
`All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, copied or
`transmitted, in any form of by any means, electronic, mechanical, photocopying, recording or otherwise without
`written permission from the publisher.
`
`Any person who does any unauthorized act in relation to this publication may by liable to criminal prosecution
`and civil claims for damages.
`
`ISBN 90 313 2294 6 (Bohn Stafleu Van Loghum edition)
`ISBN 3-450-63351-0 (Springer-Verlag edition)
`
`This book will be distributed by Bohn Stafleu Van Loghum in The Netherlands and Belgium, by Springer-Verlag
`in the rest of the world.
`
`Bohn Stafleu Van Loghum
`De Molen 77, 3995 AW Houten, The Netherlands
`Kouterveld 2, B-1831 Diegem, Belgium
`
`Springer-Verlag
`Tiergartenstrasse 17, D-69121 Heidelberg, Germany
`
`'
`
`Dexelopmentsinnecind -
`o\er\ie\\ or the fieid.
`In
`
`professionals of the net: 1
`the assessment on‘ me -
`medical research.
`\$edical infotmatx:~ has - -
`
`-
`
`expancled drarna3c.>.i’.\
`a radical change as "oi
`add'ess the coreoi
`-.. .
`
`-
`
`‘
`
`,
`
`.
`
`- '
`-
`
`-
`~
`nea in promotion
`.-..LI bet'nerno§nsi::le-
`Tne ‘meld of medical ~ '
`-I -
`‘~v'a.'\dbcx:>& 0r'\Edv3-‘
`"eazdw im'on'nan-cs seek -
`
`'~e oe-»elopmen:a'xhe ~
`Siates assisted in 2
`.- ‘
`
`...
`
`:: e~:::moisepa'.m .‘
`2.-.2'e t“.at 2"-ere s new u
`'-:-' 2. '. cosereu, sud: as
`7-. re
`oi rnmd '
`‘I--:-Ms ,
`\\l‘E!’?§ 3'6
`'
`
`~:r'ia:n:x1 afrnonoga ii
`:-‘ :--1:-.~:crr.':a::c~ 5 aamd .
`3:0 can-e to men I’! u a
`:r tic»-:~ :n
`
`.
`
`Purpose
`"e:-.i’.n_1:eiar'1"vr:2~l1ni)I:nt
`---
`'l‘3'—“3C‘ ‘*5 °3'''¥‘‘' '
`
`:1‘
`
`r‘n:r"'*.a:C:~ 5 fritlttlg -*
`~,.;rE. .33_,_—I,;r ,3‘ i ,
`$5.‘: U rfié item
`
`Page 3 of 4
`
`

`
`Data and Information
`
`Example 2:
`
`Imaging
`
`Imaging is an area in health care that is of great impor-
`tance for making a diagnosis. In Chapters 9, IO, and 26
`special attention is paid to this area. Here we discuss
`an example from cardiology. When we are interested
`in the filling of the ventricles with blood as a function
`of time, a radiopaque fluid is injected in the veins and
`is transported to the heart by the blood. X rays are the
`signal 5 that is used to offer information on the size of
`the ventricles. The X rays are radiated toward the chest
`and pass through it, and the received signal 5’ gives
`information about the density of the tissues in between
`the X-ray tube (S) and the sensing device R, which can
`be a photographic emulsion or a photonmultiplier.
`Apparently, the tissue and the body fluids have distort-
`ed (weakened) the original signal s, and this is exactly
`the
`information
`in which we
`are
`interested.
`
`Superimposed on 5‘, however, are also effects from tis-
`sues other than only the heart, such as the lungs and
`the ribs, causing the mixture m from which 5‘ should
`be extracted. After receiving the signal (i.e., the trans-
`mitted picture) processing can be applied to measure
`the area of the ventricles or, in the case of two simul-
`taneous orthogonal or nonparallel pictures, to estimate
`the ventricular volume as a function of time.
`In this
`
`case the cardiac output can, in principle, be measured
`as a function of time.
`
`Example 3:
`Wireless Transmission
`
`In some instances it might be of interest to fix a wire
`less transmitter on the body (e.g., in the case of Halter
`monitoring; see Chapter 12) to implant a transducer or
`even a transmitter in the body (eg, to measure intra-
`cranial pressure). The transmitter S then sends the sig-
`nal s to some receiver R not too far remote from the
`
`body. Radio transmission is used to avoid wires that
`would hamper the natural protrusion of the micro-
`transmitter.
`
`In all three of these examples, both the sender and the
`receiver were man—made and so were the signals gene-
`rated by the user. In the first example, S and R are iden-
`
`22
`
`tical; in the second example, 5 (the X—ray tube) and R
`(the camera) are physically opposite and mechanically
`coupled. In the third example, the connection between
`sender and receiver is looser.
`
`The next few examples deal with other types of com-
`munication in which the patient or organs function as
`sender or receiver. We shall specifically point to the
`disturbance generated in the transmission channel.
`
`Example 4:
`
`Transmission by Natural
`
`Language
`
`During patient history taking, the message 5 is carried
`by natural
`language (i.e.,
`it
`is spoken).
`It should be
`noted that an experienced clinician also acquires
`information from nonverbal messages, such as from
`body language. The receiver, that is, the clinician, has
`enough expertise to extract the message from the mix-
`ture m.
`In this case, however, the disturbance is not
`merely the added noise from the environment but is
`also the fact that the true meaning of the message is
`hidden in the natural
`language.
`In other words,
`to
`comprehend the message, the receiver must immedia-
`tely interpret the message so that a meaningful feed-
`back can be given to the patient. The mere superposi-
`tion of s and n no longer applies here; the message also
`has no truly physical or quantitative value, but is car-
`ried by natural
`language. Only by interpretation and
`coding is the true message filtered out of the mixture of
`words.
`If clinicians have not been properly trained,
`they will be unable to find a meaningful message in
`the medium,
`the language. This is the reason why
`natural language interpretation by computers is extre
`mely difficult and, perhaps, never fully attainable.
`In some applications an artificial situation is created in
`which the patient is still the sender S, but the receiver
`R is a computer that is equipped with a program that
`generates (sends) questions to be answered by the
`patient
`in a structured manner (e.g.,
`in a multiple-
`choice mode).
`In some cases it
`is useful
`to let the
`human interview be preceded by a structured patient-
`computer interview (for a more extensive description
`of the pros and cons of computer-supported data entry,
`see Chapter 7).
`
`Example 5:
`
`Biosignals
`
`Every living cell, organ. or
`for internal communication
`the outside world. In -
`-
`-.
`
`0 --..~
`u
`ation as a biological
`put, and in some circu .-.
`rested in offering this 0
`n r.‘
`ine its response, as we hase
`of the cell that was sti
`
`Such biological signals can
`
`-.
`0 electrochemical. for -
`a cell, which is the rest
`the cell membrane. sud!
`mechanical,
`for e ..
`.
`
`motion by thoracic
`ilows and pressures:
`biochemical, fore .
`
`.-
`
`PO_. or PCO1:
`hormonal,
`for example.
`during labor.
`
`' rnost instances M3 deal 1-‘
`tr 3 indicated aboxe. The --
`.e'. distorted bv the I
`..
`.-
`‘Ls oass differenttissuesal‘
`
`ewarnleofasignalsthat a
`r 'eact'1es the transducer is
`
`-
`
`‘.5 -
`I
`r 1% detected, and du-‘mg -
`he xerine and abdominal
`-
`963%.
`thematernal ECG -u '
`E’ r‘ mirage than the hi :
`‘-‘E
`between Ed .
`Traxotr xaout poggjug ‘yd . _.
`
`mlzv-am .~::rarsrnimd
`2:2-*-e-:nrnearscx'
`.-
`
`.-
`Jrzvnzarabrt-'5emzne‘
`
`%rr-r.;~,;yg3¢fi3:5[55_
`Ugercaneraucutigfi
`
`Page 4 of 4