TECHNOLOGY INNOVATION IN THE FACE OF UNCERTAINTY: THE CASE OF \u27MY HEALTH RECORD\u27

In this paper we address the challenges faced when new e-health components are introduced within an existing infrastructural arrangement by focusing on the delicate balance between immediate usefulness and forward-looking preparedness. While e-health solutions are currently seen as a core element of on-going health sector reforms in most European countries, much of the challenges related to their design, development and implementation remain understudied. Based on an interpretive case study of technology innovation in the Norwegian healthcare context, we study the practices of building and putting to use a novel web-based platform for communication between users and providers of healthcare services. In particular, we analyse the conceptual design, the association with the installed base, and the relationship with users as core enacting practices of the project team members. We make use of the concepts of generativity and robustness to bring into focus and articulate possible approaches for change anticipation

Improving nursing practice through interoperability and intelligence

Hospital inpatient care compromises one of the most demanding services in health institutions when providing a careful and continuous healthcare assistance. Such demands require constant update of the patients' electronic health record allied with support systems responsible for monitoring their clinical information. In this context, this paper presents a new web platform for daily monitoring of patients, designed to be used by health professionals, especially nurses. The application is based on React, an open-source JavaScript library for building user interfaces. The developed tool incorporates two main features: the real-time visualization of the data, and the storage of the patient's historic during an inpatient care episode. The storage capability allows keeping the data updated among hospital shifts. Moreover, this work also highlights the required adaptability of this platform for each health units inside a hospital center according with its needs.This work has been supported by Compete POCI-01-0145-FEDER-007043 and FCT - Fundacao para a Ciencia e Tecnologia within the Project Scope UID/CEC/00319/2013

a web-based interactive knowledge-sharing platform for sex- and gender- specific medical education

Background Sex and Gender Medicine is a novel discipline that provides equitable medical care for society and improves outcomes for both male and female patients. The integration of sex- and gender-specific knowledge into medical curricula is limited due to adequate learning material, systematic teacher training and an innovative communication strategy. We aimed at initiating an e-learning and knowledge-sharing platform for Sex and Gender Medicine, the eGender platform (http://egender.charite.de), to ensure that future doctors and health professionals will have adequate knowledge and communication skills on sex and gender differences in order to make informed decisions for their patients. Methods The web-based eGender knowledge-sharing platform was designed to support the blended learning pedagogical teaching concept and follows the didactic concept of constructivism. Learning materials developed by Sex and Gender Medicine experts of seven universities have been used as the basis for the new learning tools. The content of these tools is patient-centered and provides add-on information on gender-sensitive aspects of diseases. The structural part of eGender was designed and developed using the open source e-learning platform Moodle. The eGender platform comprises an English and a German version of e-learning modules: one focusing on basic knowledge and seven on specific medical disciplines. Each module consists of several courses corresponding to a disease or symptom complex. Self-organized learning has to be managed by using different learning tools, e.g., texts and audiovisual material, tools for online communication and collaborative work. Results More than 90 users from Europe registered for the eGender Medicine learning modules. The most frequently accessed module was “Gender Medicine—Basics” and the users favored discussion forums. These e-learning modules fulfill the quality criteria for higher education and are used within the elective Master Module “Gender Medicine—Basics” implemented into the accredited Master of Public Health at Charité—Berlin. Conclusions The eGender platform is a flexible and user-friendly electronical knowledge-sharing platform providing evidence-based high-quality learning material used by a growing number of registered users. The eGender Medicine learning modules could be key in the reform of medical curricula to integrate Sex and Gender Medicine into the education of health professionals

Implementation of a multiplatform system for defining and monitoring of diets

The AquaeVitae project innovatively promotes health and prevents illness, focusing on thermal water-based dietary recommendations. It features an intelligent system, split into a web platform for nutritionists and administrators, and a mobile app for patients, enhancing nutritional planning and client interaction. It was decided to split the system into two parts: a web system for nutritionists and administrators, and a mobile system for patients. Nutrition apps are increasingly popular as they help clients manage their diet and make healthier food choices. Requirements were gathered for each user of the system and use case, entity-relationship and architecture diagrams were created. Prototypes were also developed for the web and mobile layout. This project is centred on the Web application for the nutritionist, using technologies such as Vue.js, TypeScript and Node.js. Our project offers an intuitive layout for managing nutritional plans by simplifying the creation, editing, and updating of health plans. Moreover, we allow easy interaction with patient reports and food diaries. Last, this Web Application was designed to allow an easy update of the food database with new foods, particularly unique thermal-based foods.O projeto AquaeVitae promove de forma inovadora a saúde e previne a doença, centrandose nas recomendações dietéticas baseadas na água termal. Trata-se de um sistema inteligente, dividido numa plataforma web para nutricionistas e administradores e numa aplicação móvel para pacientes, que potencia o planeamento nutricional e a interação com o cliente. Foi decidido dividir o sistema em duas partes: um sistema Web para nutricionistas e administradores e um sistema móvel para pacientes. As aplicações de nutrição são cada vez mais populares, uma vez que ajudam os clientes a gerir a sua dieta e a fazer escolhas alimentares mais saudáveis. Foram recolhidos requisitos para cada utilizador do sistema e foram criados diagramas de casos de uso, de entidade-relacionamento e de arquitetura. Foram também desenvolvidos protótipos para o layout Web e móvel. Este projeto centra-se na aplicação Web para o nutricionista, utilizando tecnologias como Vue.js, TypeScript e Node.js. O nosso projeto oferece um layout intuitivo para a gestão dos planos nutricionais, simplificando a criação, a edição e a atualização dos planos de saúde. Além disso, permitimos uma fácil interação com os relatórios e diários alimentares dos pacientes. Por último, esta aplicação Web foi concebida para permitir uma fácil atualização da base de dados de alimentos com novos alimentos, em particular alimentos de base termal

The new design of a remote real time embedded medical platform

Background: The aim of this work is to develop an electronic medical platform that enables us to monitor the physiological data of a patient and allows in cases of urgent problems to trigger an alarm remotely controlled by an expert to intervene quickly in case of emergency. Methods: In this paper, we present the design of a new medical platform based on Arduino and its shields. This platform is made of two embedded electronic circuits. The first one that may be carried by the patient is implemented using the Arduino Uno and two expanded cards, namely the E-health and the XBee shields. This circuit reads periodically physiological data (ECG, temperature, spo2 etc.) and wirelessly transmits them to the second circuit which is connected to the internet, based on the Arduino Ethernet electronic module and containing the XBee shield and an RFID module, as well as additional electronic circuits to report the critical situations, such as an LCD display and a buzzer to indicate an abnormal situation requiring local supervision.The patient is identified automatically by an RFID tag. Results:This platform was practically implemented as a final electronic product and tested. The results were very satisfactory as the embedded circuit was functioning correctly and we could upload and archive the collected data in real time in a specific database. A web server was also developed which gave remote access to the medical data of the patient making the control by a doctor possible for remote fast treatment. Conclusion: The practical realization of our medical platform allowed us to test in real time remote monitoring of a patient's physiological data while identifying the patient with an RFID tag. &nbsp

PAMTEL-RT: Web-based Multimedia Platform for Tele-Assistance of Pediatric Health Emergencies in Real Time in Training Centers

[EN] In this paper, PAMTEL-RT, a web-based platform to provide remote health professional support and guidance during the initial assistance of emergency situations is presented. In particular, this platform focuses on the pediatric population and has been specifically designed to be used by non-healthcare professionals in training centers, such as educational or sport centers. It allows pediatricians in hospitals to use Information and Communication Technologies to assist or guide, in real-time, training personnel in charge of children when any emergency situation may arise. A direct and secure real-time connection between the medical and training centers is established, allowing sharing multiple media, such as audio, video, images, documents, text and data. Since the implementation relies on standard web-based technologies, cross-network, cross-platform and cross-device support are ensured. At first, an opinion and acceptance survey was conducted to collect requirements from some potential users to consider their opinions when designing and developing the platform. In line with the obtained results, the architecture of the platform has been designed, and a prototype has been developed and preliminarily evaluated through 12 drills/simulations in 7 education and sports centers. In the evaluation, 24 training personnel were involved, who considered that its usability was excellent and that it would have applicability in their centers. Furthermore, they considered that the included functionalities in the platform are appropriate and believed that the use of PAMTEL-RT could be highly effective in the early management of extreme emergency situations, and, in some cases, in avoiding tragic consequences.This work has been partially funded by the Universitat Politecnica de Valencia (UPV) and the Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), under their R&D&I Support Program with references UPV-FISABIO-2017-002-940. Authors also want to thank educational and sport institutions involved in the drills: Gregori Maians and Esclavas del Sagrado Corazón de Jesús Schools in Gandia city; Batoi and Pare Victoria Schools in Alcoi city; and U.E. Gandia Football Club, and C.A. Safor Delikia and C.C. El Garbí athletics clubs, in Gandia cityBoronat, F.; Escrivá, P.; Salvador-Llàcer, P.; Pareja, F.; Pastor, J. (2021). PAMTEL-RT: Web-based Multimedia Platform for Tele-Assistance of Pediatric Health Emergencies in Real Time in Training Centers. Multimedia Systems. 27(2):205-227. https://doi.org/10.1007/s00530-020-00730-0205227272Tomines, A.: Pediatric telehealth: approaches by specialty and implications for general pediatric care. Adv. Pediatr. 66, 55–85 (2019). https://doi.org/10.1016/j.yapd.2019.04.005European Commission. A healthy approach. Technology for personalized, preventative healthcare. ICT Research: the policy perspective. Publications Office of the European Union, 2010. 24 pp. ISBN 978-92-79-16085–1. (2010). https://doi.org/10.2759/33350EXPH (EXpert Panel on effective ways of investing in Health), Assessing the impact of digital transformation of health services, 20 November 2018. https://ec.europa.eu/health/expert_panel/sites/expertpanel/files/docsdir/022_digitaltransformation_en.pdf (2020). Accessed May 2020Olson, C.A., McSwain, S.D., Curfman, A.L., et al.: The current pediatric telehealth landscape. Pediatrics 141(3), e20172334 (2018)Burke, B.L., Jr., Hall, R.W.: Telemedicine: pediatric applications. Pediatrics 136(1), e293-308 (2015). https://doi.org/10.1542/peds.2015-1517McConnochie, K.M., Tan, J., Wood, N.E., et al.: Acute illness utilization patterns before and after telemedicine in childcare for inner-city children: a cohort study. Telemed. J. E Health 13(4), 381–390 (2007)McConnochie, K.M., Wood, N.E., Herendeen, N.E., et al.: Telemedicine in urban and suburban childcare and elementary schools lightens family burdens. Telemed. J. E Health 16(5), 533–542 (2010). https://doi.org/10.1089/tmj.2009.0138Utidjian, L., Abramson, E.: Pediatric telehealth: opportunities and challenges. Pediatr Clin. N. Am. 63(2), 367–378 (2016). https://doi.org/10.1016/j.pcl.2015.11.006Qubty, W., Patniyot, I., Gelfand, A.: Telemedicine in a pediatric headache clinic: a prospective survey. Neurology. 90(19), e1702–e1705 (2018). https://doi.org/10.1212/WNL.0000000000005482Stavas, N., Shea, J., Keddem, S., et al.: Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination. Child Abuse Negl. 85, 47–57 (2018)Vyas, S., Murren-Boezem, J., Solo-Josephson, P.: Analysis of a pediatric telemedicine program. Prog. Telemed. J. E Health (2018). https://doi.org/10.1089/tmj.2017.0281Bala, N., Price, S.N., Horan, C.M., et al.: Use of telehealth to enhance care in a family-centered childhood obesity intervention. Clin. Pediatr. 58(7), 789–797 (2019)mHealth Economics 2017. Current Status and Future Trends in Mobile Health: Research 2 Guidance. http://www.uzelf.org/wp-content/uploads/2017/12/R2G-mHealth-Developer-Economics-2017-Status-And-Trends.pdf (2020). Accessed May 2020Cisotto, G., Casarin, E., Tomasin, S.: Requirements and enablers of advanced healthcare services over future cellular systems. IEEE Commun. Mag. 58(3), 76–81 (2020). https://doi.org/10.1109/MCOM.001.1900349Morosi, S., Jayousi, S., Mucchi, L., et al.: Medical Tele-Monitoring and Tele-Assistance for Diabetics Patients by Means of 5G Cellular Networks, in Proceedings of BodyNets 2019. In: Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, vol 297. Springer, Cham (2019)Montagud, M., Boronat, F., Belda, J., et al.: Use of Web Components to Develop Interactive, Customizable and Multi-Device Video Consumption Platforms, Applications and Usability of Interactive TV, pp. 26–43. Springer, Berlin (2016)Arntzen, I., Bjorch, N., Daoust, F.: Media Synchronization on the Web. In: Montagud, M., Cesar, P., Boronat, F., Jansen, J. (eds.) MediaSync: Handbook on Multimedia Synchronization. Springer, Cham (2018)Pauwels, D., van der Hooft, J., Petrangeli, S., et al.: A Web-based framework for fast synchronization of live video players, IFIP/IEEE Symposium on Integrated Network and Service Management, Lisbon, 2017, pp. 524–530 (2017)Rainer, B., Petscharnig, S., Timmerer, C.: Merge and forward: a self-organized inter-destination media synchronization scheme for adaptive media streaming over HTTP. In: Montagud, M., Cesar, P., Boronat, F., Jansen, J. (eds.) MediaSync: Handbook on Multimedia Synchronization. Springer, Cham (2018)Montagud, M., Boronat, F., Stokking, H., et al.: Inter-destination multimedia synchronization: schemes, use cases and standardization. Multimedia Syst. J. 18(6), 459–482 (2012). https://doi.org/10.1007/s00530-012-0278-9Montagud, M., Boronat, F., Stokking, H., et al.: Design development and assessment of control schemes for IDMS in a standardized RTCP-based solution. COMNET 70(9), 240–259 (2014). https://doi.org/10.1016/j.comnet.2014.06.004Dynamic Adaptive Streaming Over HTTP (DASH): Part 1: media presentation description and segment formats, ISO/IEC Standard 23009-1: 2012 (2012)Gómez, D., Boronat, F., Montagud, M., et al.: End-to-end DASH platform including a network-based and client-based adaptive quality switching module. In: Proc. Int. Conf. Multimedia Syst., Klagenfurt, Austria, Art. no. 38 (2016)Melvin, H., Shannon, J., Stanton, K.: Time, frequency and phase synchronization for multimedia—basics, issues, developments and opportunities. In: Montagud, M., Cesar, P., Boronat, F., Jansen, J. (eds.) MediaSync: Handbook on Multimedia Synchronization. Springer, Cham (2018)Boronat, F., Lloret, J., García, M.: Multimedia group and inter-stream synchronization techniques: a comparative study. Inf. Syst. 34(1), 108–131 (2009). https://doi.org/10.1016/j.is.2008.05.001Montagud, M., Boronat, F., Pastor, J., et al.: Web-based platform for a customizable and synchronized presentation of subtitles in single- and multi-screen scenarios. Multimed Tools Appl (2020). https://doi.org/10.1007/s11042-020-08955-xSu, Y., Yang, Y., Lu, M., et al.: Smooth control of adaptive media playout for video streaming. IEEE TMM 1(7), 1331–1339 (2009)Rainer, B., Timmerer, C.: Self-Organized inter-destination multimedia synchronization for adaptive media streaming. In: Proceedings of the 22nd ACM international conference on Multimedia (MM '14). ACM, New York, NY, USA, pp. 327–336 (2014)Montagud, M., Boronat, F., Roig, B., et al.: How to perform AMP? Cubic adjustments for improving the QoE. Comput. Commun. 103, 61–73 (2017). https://doi.org/10.1016/j.comcom.2017.01.017Hossfeld, T., Seufert, M., Hirth, M., et al.: Quantification of YouTube QoE via crowdsourcing. IEEE ISM (2011). https://doi.org/10.1109/ISM.2011.87Park, S., Kim, J.: An adaptive media playout for intra-media synchronization of networked-video applications. J. Vis. Commun. Image Represent. 19(2), 106–120 (2008)Brooke, J.: Sus-a quick and dirty usability scale. In the book “Usability evaluation in industry”, issue 194, pages 189–194, Taylor and Francis Ed (1996)Bangor, A., Kortum, P., Miller, J.: Determining what individual sus scores mean: adding an adjective rating scale. J. Usability Stud. 4(3), 114–123 (2009

COVID-19 Vaccination Drive in a Low-Volume Primary Care Clinic: Challenges & Lessons Learned in Using Homegrown Self-Scheduling Web-Based Mobile Platforms

Background: The whole of humanity has suffered dire consequences related to the novel coronavirus disease 2019 (COVID-19). Vaccination of the world base population is considered the most promising and challenging approach to achieving herd immunity. As healthcare organizations took on the extensive task of vaccinating the entire U.S. population, digital health companies expanded their automated health platforms in order to help ease the administrative burdens of mass inoculation. Although some software companies offer free applications to large organizations, there are prohibitive costs for small clinics such as the Good Health Associates Clinic (GHAC) for integrating and implementing new self-scheduling software into our e-Clinical Works (ECW) Electronic Health Record (EHR). These cost burdens resulted in a search that extended beyond existing technology, and in investing in new solutions to make it easier, more efficient, more cost-effective, and more scalable. Objective: In comparison to commercial entities, primary care clinics (PCCs) have the advantage of engaging the population for vaccination through personalized continuity of clinical care due to good rapport between their patients and the PCC team. In order to support the overall national campaign to prevent COVID-19 infections and restore public health, the GHAC wanted to make COVID-19 vaccination accessible to its patients and to the communities it serves. We aimed to achieve a coordinated COVID-19 vaccination drive in our community through our small primary care clinic by developing and using an easily implementable, cost-effective self-registration and scheduling web-based mobile platform, using the principle of C.D.S. Five Rights . Results: Overall, the Moderna vaccination drive using our developed self-registration and scheduling web portal and SMS messaging mobile platform improved vaccination uptake (51%) compared to overall vaccination uptake in our town, county (36%), and state (39%) during April-July 2021. Conclusions: Based on our experience during this COVID-19 vaccination drive, we conclude that PCCs have significant leverage as invaluable warriors , along with government and media education available, to engage patients for vaccination uptake; this leads to national preventive health spread in our population, and reduces expenses related to acute illness and hospitalization. In terms of cost-effectiveness, small PCCs are worthy of government-sponsored funding and incentives, including mandating EHR vendors to provide free (or minimal fee) software for patient self-registration and scheduling, in order to improve vaccination drive access. Hence, improved access to personalized informative continuity of clinical care in the PCC setting is a critical link in accelerating similar cost-effective campaigns in patient vaccine uptake

A web-based platform for people with memory problems and their caregivers (CAREGIVERSPRO-MMD): Mixed-methods evaluation of usability

Background: The increasing number of people with dementia (PwD) drives research exploring Web-based support interventions to provide effective care for larger populations. In this concept, a Web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to (1) improve the quality of life for PwD, (2) reduce caregiver burden, (3) reduce the financial costs for care, and (4) reduce administration time for health and social care professionals. Objective: The objective of this study was to evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD or mild cognitive impairment (MCI), informal caregivers, and health and social care professionals with respect to a wider strategy followed by the project to enhance the user-centered approach. A secondary aim of the study was to collect recommendations to improve the platform before the future pilot study. Methods: A mixed methods design was employed for recruiting PwD or MCI (N=24), informal caregivers (N=24), and professionals (N=10). Participants were asked to rate their satisfaction, the perceived usefulness, and ease of use of each function of the platform. Qualitative questions about the improvement of the platform were asked when participants provided low scores for a function. Testing occurred at baseline and 1 week after participants used the platform. The dropout rate from baseline to the follow-up was approximately 10% (6/58). Results: After 1 week of platform use, the system was useful for 90% (20.75/23) of the caregivers and for 89% (5.36/6) of the professionals. When users responded to more than 1 question per platform function, the mean of satisfied users per function was calculated. These user groups also provided positive evaluations for the ease of use (caregivers: 82%, 18.75/23; professionals: 97%, 5.82/6) and their satisfaction with the platform (caregivers: 79%, 18.08/23; professionals: 73%, 4.36/6). Ratings from PwD were lower than the other groups for usefulness (57%, 13/23), ease of use (41%, 9.4/23), and overall satisfaction (47%, 11/23) with the platform (

Reporting an Experience on Design and Implementation of e-Health Systems on Azure Cloud

Electronic Health (e-Health) technology has brought the world with significant transformation from traditional paper-based medical practice to Information and Communication Technologies (ICT)-based systems for automatic management (storage, processing, and archiving) of information. Traditionally e-Health systems have been designed to operate within stovepipes on dedicated networks, physical computers, and locally managed software platforms that make it susceptible to many serious limitations including: 1) lack of on-demand scalability during critical situations; 2) high administrative overheads and costs; and 3) in-efficient resource utilization and energy consumption due to lack of automation. In this paper, we present an approach to migrate the ICT systems in the e-Health sector from traditional in-house Client/Server (C/S) architecture to the virtualised cloud computing environment. To this end, we developed two cloud-based e-Health applications (Medical Practice Management System and Telemedicine Practice System) for demonstrating how cloud services can be leveraged for developing and deploying such applications. The Windows Azure cloud computing platform is selected as an example public cloud platform for our study. We conducted several performance evaluation experiments to understand the Quality Service (QoS) tradeoffs of our applications under variable workload on Azure.Comment: Submitted to third IEEE International Conference on Cloud and Green Computing (CGC 2013