Development of an Integrated Telerehabilitation Information Management System to Support Remote Wheelchair Prescription

Information technology (IT) is central in providing Telerehabilitation (TR), which enables people with disabilities access to limited number of qualified practitioners with specialty expertise, especially at rural areas. Prior to 2008, most TR utilized non-integrated IT systems to provide its basic infrastructure. Using this approach, data management has to be done manually over multiple non-integrated systems, increasing the possibility of outdated or missing data. An integrated system that is open, flexible, extensible, and cost-effective was designed and developed as a solution to mitigate this problem. The work described in this dissertation elaborates the process of developing such system, called the Versatile and Integrated System for Telerehabilitation (VISYTER). VISYTER was intended to become a platform that is capable of delivering any TR, and was first used to support Remote Wheelchair Prescription (RWP), a TR effort to support clinicians in rural Pennsylvania to prescribe wheeled mobility and seating devices. The development process of VISYTER consisted of three main phases: identification and verification of requirements, validation, and evaluation. The requirement identification and verification phase involved a group of expert clinicians from RWP with the purpose of identifying the requirement of the system to support RWP: a system that can provide real-time teleconsultation and documentation support for prescribing a wheeled mobility intervention. Validation studies were conducted with help from ten individuals, including physicians, clinicians, and suppliers participated to validate VISYTER in their workplaces. All participants agreed that VISYTER can be used to properly support both the teleconsultation and documentation phase of RWP. Afterward, the usability of VISYTER was evaluated through a comparison study with a commonly utilized videoconferencing system in TR, POLYCOM. Twenty-six clinicians participated in a counterbalanced experimental study to measure the difference in usability for completing client assessment tasks using both systems. The study found VISYTER to be more efficient and less prone to error when compared to POLYCOM. Based on these findings, the study concluded that an integrated system could improve the usability TR delivery when compared to non-integrated systems approach

The role of health kiosks: a scoping review

Background: Health kiosks are publicly accessible computing devices that provide access to services including health information provision, clinical measurement collection, patient self-check-in, telemonitoring and teleconsultation. While the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow. Objectives: We sought to clarify the current and future roles of health kiosks by investigating: (a) the setting, role, and clinical domains in which kiosks are used; (b) whether usability evaluations of health kiosks are being reported and if so, what methods are being utilized; and (c) what the barriers and facilitators are for the deployment of kiosks. Methods: We conducted a scoping review by a bibliographic search of the Google Scholar, PubMed and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers describe the implementation, either as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and through querying key informants. For each article we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and inclusion of usability testing. We then summarized the data in frequency tables. Results: A total of 141 articles were included, 134 primary studies and seven reviews. 47% of the primary studies described kiosks in secondary care settings, other settings included community (23.9%), primary care (17.9%), and pharmacies (6.0%). The most common roles of health kiosks were providing health information (35.1%), taking clinical measurements (20.9%), screening (12.7%), telehealth (8.2%), and patient registration (6.0%). The five most frequent health domains were multiple conditions (24.6%), Human Immunodeficiency Virus (HIV) (7.5%), hypertension (7.5%), pediatric injuries (5.2%), health and wellbeing (4.5%) and drug monitoring (4.5%). Kiosks were integrated in the clinical pathway in 70.1%, opportunistic kiosks accounted for 23.9% and 6.0% were being used in both. Usability evaluations of the kiosk were reported in 20.1% of the papers. Barriers (use of expensive proprietary software) and enablers (handling on-demand consultations) to deploying health kiosks were identified. Conclusions: Health kiosks still play a vital role in the healthcare system, including collecting clinical measurements and providing access to online health services and information to those with little or no digital literacy skills, and others without personal internet access. We identified research gaps, such as training needs for teleconsultations, and scant reporting on usability evaluation methods

Telehealth in the developing world

Co-published with the Royal Society of Medicine Pres

Improving quality of medical service with mobile health software

An increasing number of m-Health applications are being developed benefiting health service delivery. In this paper, a new methodology based on the principle of calm computing applied to diagnostic and therapeutic procedure reporting is proposed. A mobile application was designed for the physicians of one of the Portuguese major hospitals, which takes advantage of a multi-agent interoperability platform, the Agency for the Integration, Diffusion and Archive (AIDA). This application allows the visualization of inpatients and outpatients medical reports in a quicker and safer manner, in addition to offer a remote access to information. This project shows the advantages in the use of mobile software in a medical environment but the first step is always to build or use an interoperability platform, flexible, adaptable and pervasive. The platform offers a comprehensive set of services that restricts the development of mobile software almost exclusively to the mobile user interface design. The technology was tested and assessed in a real context by intensivists