Uranus: A Middleware Architecture for Dependable AAL and Vital Signs Monitoring Applications

The design and realization of health monitoring applications has attracted the interest of large communities both from industry and academia. Several research challenges have been faced and issues tackled in order to realize effective applications for the management and monitoring of people with chronic diseases, people with disabilities, elderly people. However, there is a lack of efficient tools that enable rapid and possibly cheap realization of reliable health monitoring applications. The paper presents Uranus, a service oriented middleware architecture, which provides basic functions for the integration of different kinds of biomedical sensors. Uranus has also distinguishing characteristics like services for the run-time verification of the correctness of running applications and mechanisms for the recovery from failures. The paper concludes with two case studies as proof of concept

Improving Quality of Life: Home Care for Chronically Ill and Elderly People

In this chapter, we propose a system especially created for elderly or chronically ill people that are with special needs and poor familiarity with technology. The system combines home monitoring of physiological and emotional states through a set of wearable sensors, user-controlled (automated) home devices, and a central control for integration of the data, in order to provide a safe and friendly environment according to the limited capabilities of the users. The main objective is to create the easy, low-cost automation of a room or house to provide a friendly environment that enhances the psychological condition of immobilized users. In addition, the complete interaction of the components provides an overview of the physical and emotional state of the user, building a behavior pattern that can be supervised by the care giving staff. This approach allows the integration of physiological signals with the patient’s environmental and social context to obtain a complete framework of the emotional states

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Investigating a TELEmedicine solution to improve MEDication adherence in chronic Heart Failure (TELEMED-HF):Study protocol for a randomized controlled trial

BACKGROUND: Frequent rehospitalisations and poorer survival chances in heart failure (HF) patients may partly be explained by poor medication adherence. There are multiple medication-related reasons for suboptimal adherence, but psychological reasons may also be important. A novel TELEmonitoring device may improve MEDication adherence in HF patients (TELEMED-HF). TELEMED-HF is a randomized, controlled clinical intervention trial designed to examine (1) the efficacy and cost-efficiency of an electronic medication adherence support system in improving and monitoring HF patients' medication adherence; (2) the effect of medication adherence on hospitalizations and health care consumption; as well as on (3) clinical characteristics, and Quality of Life (QoL); and (4) clinical, sociodemographic, and psychological determinants of medication adherence. METHODS/DESIGN: Consecutive patients with chronic, systolic HF presenting to the outpatient clinic of the TweeSteden Hospital, The Netherlands, will be approached for study participation and randomly assigned (1:1) following blocked randomization procedures to the intervention (n = 200) or usual care arm (n = 200). Patients in the intervention arm use the medication support device for six months in addition to usual care. Post-intervention, patients return to usual care only and all patients participate in four follow-up occasions over 12 months. Primary endpoints comprise objective and subjective medication adherence, healthcare consumption, number of hospitalizations, and cost-effectiveness. Secondary endpoints include disease severity, physical functioning, and QoL. DISCUSSION: The TELEMED-HF study will provide us a comprehensive understanding of medication adherence in HF patients, and will show whether telemonitoring is effective and cost-efficient in improving adherence and preventing hospitalization in HF patients. TRIAL REGISTRATION NUMBER: NCT01347528

An intelligent partner system for improving chronic illness care

Chronic care consists of a sequence of actions to treat a specific clinical disorder over time as a function of the ways in which illness progresses and patients respond to management actions. Outcomes depend on physicians' skills to select the actions best suited for their patients and competent self-management. This paper presents the architecture of an intelligent partner system (IPS), which helps to provide doctors with relevant data and skills and empowers chronically ill patients with the information and confidence to manage their health wisely. The services of this intelligent system are presented as 'therapies' for the information-processing 'pathologies' associated with traditional chronic illness care

An ontology-driven architecture for data integration and management in home-based telemonitoring scenarios

The shift from traditional medical care to the use of new technology and engineering innovations is nowadays an interesting and growing research area mainly motivated by a growing population with chronic conditions and disabilities. By means of information and communications technologies (ICTs), telemedicine systems offer a good solution for providing medical care at a distance to any person in any place at any time. Although significant contributions have been made in this field in recent decades, telemedicine and in e-health scenarios in general still pose numerous challenges that need to be addressed by researchers in order to take maximum advantage of the benefits that these systems provide and to support their long-term implementation. The goal of this research thesis is to make contributions in the field of home-based telemonitoring scenarios. By periodically collecting patients' clinical data and transferring them to physicians located in remote sites, patient health status supervision and feedback provision is possible. This type of telemedicine system guarantees patient supervision while reducing costs (enabling more autonomous patient care and avoiding hospital over flows). Furthermore, patients' quality of life and empowerment are improved. Specifically, this research investigates how a new architecture based on ontologies can be successfully used to address the main challenges presented in home-based telemonitoring scenarios. The challenges include data integration, personalized care, multi-chronic conditions, clinical and technical management. These are the principal issues presented and discussed in this thesis. The proposed new ontology-based architecture takes into account both practical and conceptual integration issues and the transference of data between the end points of the telemonitoring scenario (i.e, communication and message exchange). The architecture includes two layers: 1) a conceptual layer and 2) a data and communication layer. On the one hand, the conceptual layer based on ontologies is proposed to unify the management procedure and integrate incoming data from all the sources involved in the telemonitoring process. On the other hand, the data and communication layer based on web service technologies is proposed to provide practical back-up to the use of the ontology, to provide a real implementation of the tasks it describes and thus to provide a means of exchanging data. This architecture takes advantage of the combination of ontologies, rules, web services and the autonomic computing paradigm. All are well-known technologies and popular solutions applied in the semantic web domain and network management field. A review of these technologies and related works that have made use of them is presented in this thesis in order to understand how they can be combined successfully to provide a solution for telemonitoring scenarios. The design and development of the ontology used in the conceptual layer led to the study of the autonomic computing paradigm and its combination with ontologies. In addition, the OWL (Ontology Web Language) language was studied and selected to express the required knowledge in the ontology while the SPARQL language was examined for its effective use in defining rules. As an outcome of these research tasks, the HOTMES (Home Ontology for Integrated Management in Telemonitoring Scenarios) ontology, presented in this thesis, was developed. The combination of the HOTMES ontology with SPARQL rules to provide a flexible solution for personalising management tasks and adapting the methodology for different management purposes is also discussed. The use of Web Services (WSs) was investigated to support the exchange of information defined in the conceptual layer of the architecture. A generic ontology based solution was designed to integrate data and management procedures in the data and communication layer of the architecture. This is an innovative REST-inspired architecture that allows information contained in an ontology to be exchanged in a generic manner. This layer structure and its communication method provide the approach with scalability and re-usability features. The application of the HOTMES-based architecture has been studied for clinical purposes following three simple methodological stages described in this thesis. Data and management integration for context-aware and personalized monitoring services for patients with chronic conditions in the telemonitoring scenario are thus addressed. In particular, the extension of the HOTMES ontology defines a patient profile. These profiles in combination with individual rules provide clinical guidelines aiming to monitor and evaluate the evolution of the patient's health status evolution. This research implied a multi-disciplinary collaboration where clinicians had an essential role both in the ontology definition and in the validation of the proposed approach. Patient profiles were defined for 16 types of different diseases. Finally, two solutions were explored and compared in this thesis to address the remote technical management of all devices that comprise the telemonitoring scenario. The first solution was based on the HOTMES ontology-based architecture. The second solution was based on the most popular TCP/IP management architecture, SNMP (Simple Network Management Protocol). As a general conclusion, it has been demonstrated that the combination of ontologies, rules, WSs and the autonomic computing paradigm takes advantage of the main benefits that these technologies can offer in terms of knowledge representation, work flow organization, data transference, personalization of services and self-management capabilities. It has been proven that ontologies can be successfully used to provide clear descriptions of managed data (both clinical and technical) and ways of managing such information. This represents a further step towards the possibility of establishing more effective home-based telemonitoring systems and thus improving the remote care of patients with chronic diseases