eHealth's potential in providing healthcare for the elderly with risk of falling due to balance disorders, in a global health perspective

Introdução: O processo global e progressivo de envelhecimento populacional e a vulnerabilidade a doenças crónicas, distúrbios do equilíbrio e quedas têm representado um dos principais desafios aos sistemas de saúde. Isto tem motivado o desenvolvimento de estratégias, incluindo a utilização de tecnologia na prestação de cuidados de saúde. Portugal e Cabo Verde têm acompanhado esta tendência, investindo em sistemas e tecnologias de informação. Contudo, a aplicabilidade clínica das soluções digitais no contexto do idoso com alterações do equilíbrio e risco de queda precisa ser explorada. Objetivo: O objetivo desta investigação foi estudar, elaborar, implementar, demonstrar e avaliar uma solução digital para a prestação complementar de cuidados de saúde a idosos com alterações do equilíbrio e risco de queda no contexto português, alinhando posteriormente a sua utilização numa perspetiva global, com o exemplo de Cabo Verde. Métodos: Utilizando Design Science Research Methodology, foi realizado um estudo de métodos mistos com estratégia explanatória sequencial. Inicialmente, foi disponibilizado um questionário no website da Ordem dos Médicos de Portugal para identificar a satisfação e constrangimentos quanto aos dados clínicos disponíveis e a relevância do eHealth no contexto da prestação de cuidados de saúde a idosos com distúrbio do equilíbrio. Foram conduzidas entrevistas individuais a médicos, explorando estratégias para o desenvolvimento de uma solução digital neste contexto. As sugestões contribuíram para o desenho e elaboração do serviço digital, inicialmente testado por cinco idosas e seus cuidadores, como prova de conceito. Este serviço foi avaliado por estes utilizadores e oito médicos com experiência em coordenação de serviços, através de dois grupos focais. Relativamente a Cabo Verde, foi conduzido um Policy Dialogue Workshop (PDW), incluindo a Direção do Hospital Central Doutor Agostinho Neto (HCDAN), para explorar o interesse e potencial utilização do serviço digital no contexto cabo-verdiano. Resultados: A identificação de constrangimentos médicos quanto aos dados clínicos disponíveis e a verificação da relevância do eHealth neste contexto motivaram a elaboração de uma solução digital. Considerando as sugestões dos entrevistados, foi desenhado o serviço digital “EQUILÍBRIO” para monitorização remota, deteção precoce de agravamento clínico, atempada adequação do tratamento e maior interação médica com os doentes. As avaliações dos doentes, cuidadores e médicos foram positivas, com o reconhecimento de vários benefícios, tais como, conforto do doente, maior proximidade médico-doente e potencial redução de recursos presenciais. No caso de Cabo Verde, a Direção do HCDAN e participantes do PDW manifestaram interesse e reconheceram o potencial de utilização do serviço digital, inclusive junto a doentes mais jovens. Conclusão: O serviço digital “EQUILÍBRIO” foi desenhado, implementado e avaliado em contexto clínico. Verificou-se um significativo potencial para aplicabilidade clínica na prestação complementar de cuidados de saúde, permitindo monitorização remota, maior interação médico-doente e participação ativa dos doentes. A implementação deste serviço em Cabo Verde representa uma oportunidade para futura investigação. O envolvimento de outros profissionais de saúde e outros países podem ser considerados como uma promissora cooperação de cuidados de saúde entre os Estados membros da Comunidade dos Países de Língua Portuguesa.Introduction: The global and progressive aging of the populations and vulnerability to chronic diseases, balance disorders and falls have represented one of the main challenges to health systems. This has motivated the development of strategies, including the use of technology for provision of health care. Portugal and Cape Verde have followed this trend, investing in technology-based information systems. However, the clinical applicability of these digital solutions in the context of elderly people with balance disorders and risk of falling needs to be explored. Objective: The objective of this research was to study, develop, implement, demonstrate and evaluate a digital solution for the complementary provision of health care for elderly people with balance disorders and risk of falling in the Portuguese context, subsequently aligning its use in a global perspective, with the example of Cape Verde. Methods: Using the Design Science Research Methodology, an explanatory sequential mixed methods study was performed. Initially, a questionnaire was made available on the website of the Portuguese General Medical Council to identify the satisfaction and difficulties with clinical data availability, and the relevance of eHealth in the context of elderly people with balance disorders. Individual interviews were carried out with physicians, exploring strategies for the development of a digital solution in this context. The suggestions contributed to the design and development of the digital service, initially tested with five elderly women and their caregivers, as a proof-of-concept. This service was evaluated through two focus groups, including these users and eight physicians with experience in coordinating services. In the case of Cape Verde, a Policy Dialogue Workshop (PDW) was carried out, including the Direction of the Hospital Central Doutor Agostinho Neto (HCDAN), to explore the interest and potential use of the digital service in the Cape Verdean context. Results: The identification of medical constraints with availability of clinical data and the identification of the relevance of eHealth in this context encouraged the development of a digital solution. Considering the suggestions of the interviewees, the digital service “BALANCE” was designed, allowing remote monitoring, early detection of clinical deterioration, timely optimization of treatment and greater medical interaction with patients. The patient, caregiver and medical evaluations were positive, with the recognition of several benefits, such as patient comfort, closer physician-patient interaction and potential lower consumption of face-to-face resources. Regarding Cape Verde, the Direction of HCDAN and the participants of the PDW expressed interest and recognized the potential for using the digital service, including among younger patients. Conclusion: The digital service “BALANCE” was designed, implemented and evaluated in the clinical context. There was significant potential for clinical applicability in the provision of complementary health care, allowing remote monitoring, closer physicianpatient interaction and active patient participation. The implementation of this service in Cape Verde is an opportunity for future research. The involvement of other health professionals and countries could be considered as a promising health care cooperation between the member states of Community of Portuguese-Speaking Countries

Towards Interoperability in E-health Systems: a three-dimensional approach based on standards and semantics

Proceedings of: HEALTHINF 2009 (International Conference on Helath Informatics), Porto (Portugal), January 14-17, 2009, is part of BIOSTEC (Intemational Joint Conference on Biomedical Engineering Systems and Technologies)The interoperability problem in eHealth can only be addressed by mean of combining standards and technology. However, these alone do not suffice. An appropiate framework that articulates such combination is required. In this paper, we adopt a three-dimensional (information, conference and inference) approach for such framework, based on OWL as formal language for terminological and ontological health resources, SNOMED CT as lexical backbone for all such resources, and the standard CEN 13606 for representing EHRs. Based on tha framewok, we propose a novel form for creating and supporting networks of clinical terminologies. Additionally, we propose a number of software modules to semantically process and exploit EHRs, including NLP-based search and inference, wich can support medical applications in heterogeneous and distributed eHealth systems.This work has been funded as part of the Spanish nationally funded projects ISSE (FIT-350300-2007-75) and CISEP (FIT-350301-2007-18). We also acknowledge IST-2005-027595 EU project NeO

The Blue Button Project: Engaging Patients in Healthcare by a Click of a Button

The Blue Button project has become a way for many Americans to download their health records by just a click in any way that suits them, such as in print, on a thumb drive, or on their mobile devices and smartphones. Several organizations have developed and applied Blue Buttons on their websites to allow beneficiaries to securely access and view personal medical information and claims. The purpose of this literature review is to highlight the significance of the Blue Button project in the field of health information management. Findings suggest that the project could empower and engage consumers and patients in a healthcare system by allowing access to medical records, thereby promoting better management and overall improvement of their healthcare. To date, the project has gained wide support from insurers, technology companies, and health providers despite the challenges of standardization and interoperability

Clustering Arabic Tweets for Sentiment Analysis

The focus of this study is to evaluate the impact of linguistic preprocessing and similarity functions for clustering Arabic Twitter tweets. The experiments apply an optimized version of the standard K-Means algorithm to assign tweets into positive and negative categories. The results show that root-based stemming has a significant advantage over light stemming in all settings. The Averaged Kullback-Leibler Divergence similarity function clearly outperforms the Cosine, Pearson Correlation, Jaccard Coefficient and Euclidean functions. The combination of the Averaged Kullback-Leibler Divergence and root-based stemming achieved the highest purity of 0.764 while the second-best purity was 0.719. These results are of importance as it is contrary to normal-sized documents where, in many information retrieval applications, light stemming performs better than root-based stemming and the Cosine function is commonly used

Clustering Arabic Tweets for Sentiment Analysis

The focus of this study is to evaluate the impact of linguistic preprocessing and similarity functions for clustering Arabic Twitter tweets. The experiments apply an optimized version of the standard K-Means algorithm to assign tweets into positive and negative categories. The results show that root-based stemming has a significant advantage over light stemming in all settings. The Averaged Kullback-Leibler Divergence similarity function clearly outperforms the Cosine, Pearson Correlation, Jaccard Coefficient and Euclidean functions. The combination of the Averaged Kullback-Leibler Divergence and root-based stemming achieved the highest purity of 0.764 while the second-best purity was 0.719. These results are of importance as it is contrary to normal-sized documents where, in many information retrieval applications, light stemming performs better than root-based stemming and the Cosine function is commonly used

Exploring the facilitators and barriers towards implementation of electronic prescribing, dispensing, and administration of medicines in hospitals in Ireland.

Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. The aim of this doctoral research was to explore this under-researched area in three phases. Phase one: - Phase one focused on critically appraising and synthesising the available evidence on healthcare professionals perceptions, attitudes, and views of the facilitators and barriers to implementing electronic prescribing, electronic dispensing, and/or electronic administration of medicines in the hospital setting. The review protocol was registered with the Centre for Reviews and Dissemination and conducted according to best practice. Key facilitators included systems improved patient safety and provided better access to patients drug records and that team leadership and hardware/software availability and reliability were essential for successful implementation. Key barriers consisted of hardware and network problems, altered work practices, and weakened interpersonal communication between healthcare professionals and with patients. Phase two: - This phase employed a qualitative phenomenological design to gain original insight into the perceptions of local key stakeholders towards the facilitators and barriers to implementing prescribing, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospitals in Ireland using Normalization Process Theory as a theoretical framework. Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two hospital Information Technology managers. Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multidisciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. Phase three: - A similar qualitative methodology was employed in phase three of this research in order to explore the perceptions of national key stakeholders and eHealth leads towards the facilitators and barriers to system implementation. Sixteen consenting invitees participated: eight hospital leads, four government leads, two regulatory leads, and two academics. Key facilitators included enhanced patient safety, workflow efficiencies, improvements in governance, and financial gains. Perceived barriers included the introduction of new drug errors, loss of patient contact, initial time inefficiencies, and issues with the complexity of integration and standardisation of work processes. Overall, adequate technology, stakeholder involvement, and organisational leadership and support are required at a national and local level to drive the eHealth agenda forward. Testing at scale, contingency plans, and ongoing evaluations will assist in determining success or otherwise of system implementation. This research has generated novel findings with many potentially transferable themes identified which extend the evidence base. This will assist organisations to better plan for implementation of medication-related eHealth systems

Wearables at work:preferences from an employee’s perspective

This exploratory study aims to obtain a first impression of the wishes and needs of employees on the use of wearables at work for health promotion. 76 employ-ees with a mean age of 40 years old (SD ±11.7) filled in a survey after trying out a wearable. Most employees see the potential of using wearable devices for workplace health promotion. However, according to employees, some negative aspects should be overcome before wearables can effectively contribute to health promotion. The most mentioned negative aspects were poor visualization and un-pleasantness of wearing. Specifically for the workplace, employees were con-cerned about the privacy of data collection