Design and implementation of a secure and user-friendly broker platform supporting the end-to-end provisioning of e-homecare services

We designed a broker platform for e-homecare services using web service technology. The broker allows efficient data communication and guarantees quality requirements such as security, availability and cost-efficiency by dynamic selection of services, minimizing user interactions and simplifying authentication through a single user sign-on. A prototype was implemented, with several e-homecare services (alarm, telemonitoring, audio diary and video-chat). It was evaluated by patients with diabetes and multiple sclerosis. The patients found that the start-up time and overhead imposed by the platform was satisfactory. Having all e-homecare services integrated into a single application, which required only one login, resulted in a high quality of experience for the patients

The MASSIF platform : a modular and semantic platform for the development of flexible IoT services

In the Internet of Things (IoT), data-producing entities sense their environment and transmit these observations to a data processing platform for further analysis. Applications can have a notion of context awareness by combining this sensed data, or by processing the combined data. The processes of combining data can consist both of merging the dynamic sensed data, as well as fusing the sensed data with background and historical data. Semantics can aid in this task, as they have proven their use in data integration, knowledge exchange and reasoning. Semantic services performing reasoning on the integrated sensed data, combined with background knowledge, such as profile data, allow extracting useful information and support intelligent decision making. However, advanced reasoning on the combination of this sensed data and background knowledge is still hard to achieve. Furthermore, the collaboration between semantic services allows to reach complex decisions. The dynamic composition of such collaborative workflows that can adapt to the current context, has not received much attention yet. In this paper, we present MASSIF, a data-driven platform for the semantic annotation of and reasoning on IoT data. It allows the integration of multiple modular reasoning services that can collaborate in a flexible manner to facilitate complex decision-making processes. Data-driven workflows are enabled by letting services specify the data they would like to consume. After thorough processing, these services can decide to share their decisions with other consumers. By defining the data these services would like to consume, they can operate on a subset of data, improving reasoning efficiency. Furthermore, each of these services can integrate the consumed data with background knowledge in its own context model, for rapid intelligent decision making. To show the strengths of the platform, two use cases are detailed and thoroughly evaluated

Clinical observation of deteriorating frail older patients: Improving the competence of homecare professionals

Introduction: Homecare services are providing care to an increasing number of frail older patients with complex care needs. These patients are in a vulnerable state and have an increased risk of deterioration, and the early detection of changes in their clinical condition is highlighted as a means of preventing adverse health outcomes. Clinical observation is an essential prerequisite in identifying deteriorating patients. In homecare, clinical observation is currently insufficient, and little is known about homecare professionals’ detection of deteriorating patients. Therefore, the overall aim of this PhD project is to gain knowledge of clinical observation in homecare and to understand how a competence improvement programme can change homecare professionals’ clinical observation. Consequently, theories on competence and improvement in healthcare have been applied in the thesis. Methodology: This thesis adopted a multi-method qualitative, sequential design consisting of three phases: (1) before the implementation of a competence improvement programme (study 1), (2) during the implementation of the programme (study 2), and (3) after the implementation of the competence improvement programme (study 3), focusing on two homecare districts (homecare A, homecare B) in Norway. The programme was designed to improve homecare professionals’ competence and skills in recognising and responding to deteriorating frail older patients. The first study developed knowledge of homecare professionals’ observational competence in the early recognition of deterioration in frail older patients. Homecare professionals, including nurses, skilled health workers, and assistants were observed during their home visits to patients and interviewed in focus groups. The second study described and analysed the implementation of a competence improvement programme for the systematic observation of frail older patients. Participant observation was used during the implementation activities, and focus group and individual interviews were conducted to describe the experiences of the homecare professionals, managers, and development nurses with the implementation of the competence improvement programme. The third study described the outcomes of the competence improvement programme for the systematic observation of frail older patients. Homecare professionals were observed during their home visits to patients and interviewed in focus groups, while managers and development nurses were interviewed individually. Results: The studies included in this thesis contribute to longitudinal research on a competence improvement programme for the systematic observation of frail older patients in homecare and demonstrate that clinical observation is multifaceted and the improvement of this competence is challenging. In study 1, the homecare professionals’ observational competence before the competence improvement programme was characterised by a focus on patient-situated assessment of changed clinical conditions and how the organisational environment impacted the homecare professionals’ performance of clinical observation. Patients’ physical and mental conditions formed a vital basis for detecting clinical deterioration. Communicating with the patient was highlighted, together with precise nursing documentation. Basic understanding and use of vital sign measurements as part of clinical observation were insufficient in the two homecare districts. Pre-planned workplans organised the homecare professionals’ practice, but actions to follow up on patients’ changed conditions were not reflected in these plans. Collaboration with colleagues was seen as supportive of homecare professionals’ observational competence. In study 2, the homecare professionals perceived the competence improvement programme as important, as the programme would improve their observational competence and confidence in situations with deteriorating patients. However, the competence improvement programme consisted of several learning resources with complex content and was applied differently in the two homecare districts. The homecare professionals described the implementation process of the competence improvement programme as demanding and time-consuming. The homecare professionals were unfamiliar with simulation-based learning and found it more challenging than they had expected. Study 3 reported that two years after the implementation of the competence improvement programme, the frequency of vital signs measurements for the systematic observation of frail older patients varied between the two homecare districts. Although measurements of vital signs had increased for new patients and in the case of patient falls, situation awareness related to the clinical deterioration of patients remained insufficient. However, the homecare professionals reported improved coping with deteriorating patient situations. Regular programme activities integrated into the homecare professionals’ daily work routines sustained the competence improvement programme. Organisational issues affecting the sustainability of the competence improvement programme varied between the two homecare districts. Organisational needs were prioritised by homecare A, but sick leave, personnel turnover, busy work plans, and a change in managers in homecare B affected the maintenance of the programme. Conclusions: This thesis provides knowledge and understanding of homecare professionals’ clinical observation and how a competence improvement programme can change such observational competence. Clinical observation had a low priority before the competence improvement programme, and vital signs were rarely used to detect early deterioration in patients. The competence improvement programme changed clinical observation in defined situations; nevertheless, homecare professionals’ situation awareness of patients’ deterioration was insufficient. The PhD project demonstrates that the implementation of a competence improvement programme is influenced by factors regarding the programme itself, the professionals, the organisation and the external context

The role of age and illness in the adoption of tele-health

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonAbstract — This study investigates how the introduction of Tele-Health impacts the lives of the frail elderly and older adults, and how their condition influences this experience. This study investigates the underlying issues with the adoption of Tele-health by the patients. It also considers the lived experiences of the patients in reference to their disease and age. Method: A qualitative approach was adopted, which was an in-depth interview conducted in Chorleywood Health Centre, a GP practice to the North West of London. Participants consisted of older adults living with chronic diseases, mainly diabetes and COPD, in order to gain a complex understanding of their reaction towards Tele-Health, as they are usually the target market for such tools. 30 participants took part in the study and were provided with a Tele-health service tool. The data were then thematically analysed using the thematic analysis method and transcribed using NVIVO10. Four databases were searched to find relevant literature namely: ScienceDirect, PubMed Central, Scopus and Medline. Research Design: The study adopted Interpretative Phenomenological Analysis (IPA) to collect and analyse data. In IPA, the researcher transcends or suspends past knowledge and experience to understand a phenomenon at a deeper level (Creswell, 2007). It is an approach, which seeks to explore, describe, and analyse the meaning of individual lived experience: “how they perceive it, describe it, feel about it, judge it, remember it, make sense of it, and talk about it with others” (with a sense of ‘newness’ or ‘rawness’ to obtain descriptive and rich data). Results: Nine main themes emerged as influences on their acceptance and adoption of Tele-health: Attitude to aging and Illness, Coping Strategy, Relationship and Support, Patient-Doctor Interaction, Incorporating Patients, Self-Efficacy, Personality, Personal Meaning and Knowledge. The themes were also reviewed at the end of the study to validate the results. Moreover the themes were observed to be considered explicitly by the patients before accepting and adopting the Tele Health service. A new framework, the Patient Technology Adoption Model (PTAM) is derived from the themes. The PTAM indicates the relationship between the factors and may be used to understand the ways in which the patients made their decision to accept the technology or not. Conclusion: This study encourages healthcare providers and decision makers who are responsible for the innovation and implementation of services to make all efforts to understand the consumer and consider conditions that might influence their decisions to accept, adopt or reject health technologies. The study proposes a new framework (PTAM) that highlights that a patient-centred approach should be adopted by healthcare providers and decision makers, as it would facilitate more successes in the health services provided by the NHS

Dynamic selection of interactive eHomeCare services

Ehomecare services can save money and improve patient care due to increased feelings of well-being at home. However, since not all patients are technical experts and ehomecare services are developed by different vendors, using different languages and data definitions, acceptance of ehomecare might become difficult due to the complexity of managing all the different service locations and login information or due to unavailability of requested services. Therefore in this paper the authors present a patient centered application as a facade to the broker platform providing dynamic service selection. The client application is adjusted dynamically to fit the patient's profile, fulfilling the specific needs for each patient personally and presents only the ehomecare services that are of interest to the patient. In order to alleviate users from service localization, the broker platform provides transparent service selection and switching and guarantees that service requests are handled by dynamically selecting the best or least loaded service, this way also providing reliability