Personalised mobile services supporting the implementation of clinical guidelines

Telemonitoring is emerging as a compelling application of Body Area Networks (BANs). We describe two health BAN systems developed respectively by a European team and an Australian team and discuss some issues encountered relating to formalization of clinical knowledge to support real-time analysis and interpretation of BAN data. Our example application is an evidence-based telemonitoring and teletreatment application for home-based rehabilitation. The application is intended to support implementation of a clinical guideline for cardiac rehabilitation following myocardial infarction. In addition to this the proposal is to establish the patient’s individual baseline risk profile and, by real-time analysis of BAN data, continually re-assess the current risk level in order to give timely personalised feedback. Static and dynamic risk factors are derived from literature. Many sources express evidence probabilistically, suggesting a requirement for reasoning with uncertainty; elsewhere evidence requires qualitative reasoning: both familiar modes of reasoning in KBSs. However even at this knowledge acquisition stage some issues arise concerning how best to apply the clinical evidence. Furthermore, in cases where insufficient clinical evidence is currently available, telemonitoring can yield large collections of clinical data with the potential for data mining in order to furnish more statistically powerful and accurate clinical evidence

MobiHealth-Innovative 2.5/3G mobile services and applications for health care

MobiHealth aims at introducing new mobile value added services in the area of healthcare, based on 2.5 (GPRS) and 3G (UMTS) technologies, thus promoting the use and deployment of GPRS and UMTS. This will be achieved by the integration of sensors and actuators to a Wireless Body Area Network (BAN). These sensors and actuators will continuously measure and transmit vital constants along with audio and video to health service providers and brokers, improving on one side the life of patients and allowing on the other side the introduction of new value-added services in the areas of disease prevention and diagnostic, remote assistance, para-health services, physical state monitoring (sports) and even clinical research. Furthermore, the MobiHealth BAN system will support the fast and reliable application of remote assistance in case of accidents by allowing the paramedics to send reliable vital constants data as well as audio and video directly from the accident site

Disease surveillance and patient care in remote regions: an exploratory study of collaboration among healthcare professionals in Amazonia

The development and deployment of information technology, particularly mobile tools, to support collaboration between different groups of healthcare professionals has been viewed as a promising way to improve disease surveillance and patient care in remote regions. The effects of global climate change combined with rapid changes to land cover and use in Amazonia are believed to be contributing to the spread of vector-borne emerging and neglected diseases. This makes empowering and providing support for local healthcare providers all the more important. We investigate the use of information technology in this context to support professionals whose activities range from diagnosing diseases and monitoring their spread to developing policies to deal with outbreaks. An analysis of stakeholders, their roles and requirements, is presented which encompasses results of fieldwork and of a process of design and prototyping complemented by questionnaires and targeted interviews. Findings are analysed with respect to the tasks of diagnosis, training of local healthcare professionals, and gathering, sharing and visualisation of data for purposes of epidemiological research and disease surveillance. Methodological issues regarding the elicitation of cooperation and collaboration requirements are discussed and implications are drawn with respect to the use of technology in tackling emerging and neglected diseases

Mobile Health Care over 3G Networks: the MobiHealth Pilot System and Service

Health care is one of the most prominent areas for the application of wireless technologies. New services and applications are today under research and development targeting different areas of health care, from high risk and chronic patients’ remote monitoring to mobility tools for the medical personnel. In this direction the MobiHealth project developed and trailed a system and a service that is using UMTS for the continuous monitoring and transmission of vital signals, like Pulse Oximeter sensor , temperature, Marker, Respiratory band, motion/activity detector etc., to the hospital. The system, based on the concept of the Body Area Network, is highly customisable, allowing sensors to be seamlessly connected and transmit the monitored vital signal measurements. The system and service was trialed in 4 European countries and it is presently under market validation

Extending remote patient monitoring with mobile real time clinical decision support

Large scale implementation of telemedicine services such as telemonitoring and teletreatment will generate huge amounts of clinical data. Even small amounts of data from continuous patient monitoring cannot be scrutinised in real time and round the clock by health professionals. In future huge volumes of such data will have to be routinely screened by intelligent software systems. We investigate how to make m-health systems for ambulatory care more intelligent by applying a Decision Support approach in the analysis and interpretation of biosignal data and to support adherence to evidence-based best practice such as is expressed in treatment protocols and clinical practice guidelines. The resulting Clinical Decision Support Systems must be able to accept and interpret real time streaming biosignals and context data as well as the patient’s (relatively less dynamic) clinical and administrative data. In this position paper we describe the telemonitoring/teletreatment system developed at the University of Twente, based on Body Area Network (BAN) technology, and present our vision of how BAN-based telemedicine services can be enhanced by incorporating mobile real time Clinical Decision Support. We believe that the main innovative aspects of the vision relate to the implementation of decision support on a mobile platform; incorporation of real time input and analysis of streaming\ud biosignals into the inferencing process; implementation of decision support in a distributed system; and the consequent challenges such as maintenance of consistency of knowledge, state and beliefs across a distributed environment