Mobile clinical decision support systems and applications: a literature and commercial review

The final publication is available at Springer via http://dx.doi.org/10.1007/s10916-013-0004-y[EN] Background: The latest advances in eHealth and mHealth have propitiated the rapidly creation and expansion of mobile applications for health care. One of these types of applications are the clinical decision support systems, which nowadays are being implemented in mobile apps to facilitate the access to health care professionals in their daily clinical decisions. Objective: The aim of this paper is twofold. Firstly, to make a review of the current systems available in the literature and in commercial stores. Secondly, to analyze a sample of applications in order to obtain some conclusions and recommendations. Methods: Two reviews have been done: a literature review on Scopus, IEEE Xplore, Web of Knowledge and PubMed and a commercial review on Google play and the App Store. Five applications from each review have been selected to develop an in-depth analysis and to obtain more information about the mobile clinical decision support systems. Results: 92 relevant papers and 192 commercial apps were found. 44 papers were focused only on mobile clinical decision support systems. 171 apps were available on Google play and 21 on the App Store. The apps are designed for general medicine and 37 different specialties, with some features common in all of them despite of the different medical fields objective. Conclusions: The number of mobile clinical decision support applications and their inclusion in clinical practices has risen in the last years. However, developers must be careful with their interface or the easiness of use, which can impoverish the experience of the users.This research has been partially supported by Ministerio de Economía y Competitividad, Spain. This research has been partially supported by the ICT-248765 EU-FP7 Project. 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Patients\u27 Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test

Les quatre textes ont en commun de présenter certaines évolutions récentes de l’histoire politique en Allemagne. Ils prennent tous position face à trois tournants historiographiques. La notion d’histoire culturelle du politique peut servir d’emblème au premier de ces tournants : le politique est envisagé non plus comme une succession d’événements ni comme le fruit de déterminations structurelles dont il serait la superstructure ou l’écume, mais comme l’expression de valeurs et de procédures o..

Flexibility Support for Homecare Applications Based on Models and Multi-Agent Technology

In developed countries, public health systems are under pressure due to the increasing percentage of population over 65. In this context, homecare based on ambient intelligence technology seems to be a suitable solution to allow elderly people to continue to enjoy the comforts of home and help optimize medical resources. Thus, current technological developments make it possible to build complex homecare applications that demand, among others, flexibility mechanisms for being able to evolve as context does (adaptability), as well as avoiding service disruptions in the case of node failure (availability). The solution proposed in this paper copes with these flexibility requirements through the whole life-cycle of the target applications: from design phase to runtime. The proposed domain modeling approach allows medical staff to design customized applications, taking into account the adaptability needs. It also guides software developers during system implementation. The application execution is managed by a multi-agent based middleware, making it possible to meet adaptation requirements, assuring at the same time the availability of the system even for stateful applications.This work was financed in part by the University of the Basque Country (UPV/EHU) under project UFI 11/28, by the Regional Government of the Basque Country under Project IT719-13, and by the MCYT&FEDER under project DPI 2012-37806-C02-01

A Component-Based Approach for Securing Indoor Home Care Applications

eHealth systems have adopted recent advances on sensing technologies together with advances in information and communication technologies (ICT) in order to provide people-centered services that improve the quality of life of an increasingly elderly population. As these eHealth services are founded on the acquisition and processing of sensitive data (e.g., personal details, diagnosis, treatments and medical history), any security threat would damage the public's confidence in them. This paper proposes a solution for the design and runtime management of indoor eHealth applications with security requirements. The proposal allows applications definition customized to patient particularities, including the early detection of health deterioration and suitable reaction (events) as well as security needs. At runtime, security support is twofold. A secured component-based platform supervises applications execution and provides events management, whilst the security of the communications among application components is also guaranteed. Additionally, the proposed event management scheme adopts the fog computing paradigm to enable local event related data storage and processing, thus saving communication bandwidth when communicating with the cloud. As a proof of concept, this proposal has been validated through the monitoring of the health status in diabetic patients at a nursing home.This work was financed under project DPI2015-68602-R (MINECO/FEDER, UE), UPV/EHU under project PPG17/56 and GV/EJ under recognized research group IT914-16

Ingeniería basada en modelos aplicada a sistemas distribuidos sensibles al contexto.

239 p.En esta Tesis Doctoral se plantea una metodología, soportada por mecanismos y herramientas, que da soporte al ciclo de desarrollo de aplicaciones distribuidas sensibles al contexto, aquéllas que supervisan su entorno físico con objeto de detectar cambios en él y reaccionar rápida y adecuadamente. Son aplicaciones presentes en diferentes campos de aplicación que demandan requisitos tales como ejecución en entornos distribuidos y heterogéneos, personalización de la supervisión, adaptación a cambios relevantes en su contexto, gestión de la calidad específica de cada aplicación, disponibilidad y recuperación ante situaciones de fallo. En concreto, se propone una aproximación de modelado genérica que permite la especificación y diseño de estas aplicaciones, independientemente de la plataforma de gestión responsable de su ejecución y atendiendo a los diferentes expertos que participan: expertos de dominio y desarrolladores de software. Se hace uso de la ingeniería dirigida por modelos para lograr la separación de dominios necesaria. Así, el experto de dominio realiza el diseño arquitectónico en el que se especifican todos sus requisitos, mientras que el desarrollador de software se centra en el diseño e implementación de la solución software correspondiente. Por tanto, la aproximación de modelado recoge los requisitos de las aplicaciones que una plataforma de gestión debe cumplir en tiempo de ejecución, al mismo tiempo que captura la información necesaria para la generación de su código. También se plantea un entorno de desarrollo integrado, basado en dicha aproximación, que da soporte al ciclo de desarrollo, cuyo prototipo se ha validado en un demostrador en el campo de la asistencia domiciliaria

Mobile Monitoring and Reasoning Methods to Prevent Cardiovascular Diseases

With the recent technological advances, it is possible to monitor vital signs using Bluetooth-enabled biometric mobile devices such as smartphones, tablets or electric wristbands. In this manuscript, we present a system to estimate the risk of cardiovascular diseases in Ambient Assisted Living environments. Cardiovascular disease risk is obtained from the monitoring of the blood pressure by means of mobile devices in combination with other clinical factors, and applying reasoning techniques based on the Systematic Coronary Risk Evaluation Project charts. We have developed an end-to-end software application for patients and physicians and a rule-based reasoning engine. We have also proposed a conceptual module to integrate recommendations to patients in their daily activities based on information proactively inferred through reasoning techniques and context-awareness. To evaluate the platform, we carried out usability experiments and performance benchmarks

Integração de usabilidade no paradigma de IoT em telesaúde: Automatização ao serviço da usabilidade

Durante os últimos anos os países desenvolvidos têm sofrido um shift demográfico fomentado pelo aumento da população idosa e pela redução da taxa de natalidade. A proeminência destes fatores nas sociedades atuais despoletou desafios de natureza societal, técnica e económica em várias áreas de atuação. Nessas áreas, destaca-se a área de saúde pela sua sensibilidade e relevância para o quotidiano de utilizadores com necessidades especiais (pessoas idosas, deficientes motores, entre outros). Nesse sentido, para mitigar os desafios impostos nos sistemas de saúde, têm-se adotado tecnologias de informação e comunicação para o dimensionamento de soluções dedicadas, que visam satisfazer necessidades específicas – os ecossistemas AAL (Ambiente de Vida Assistida). Apesar do seu atual estado de desenvolvimento, enfrentam múltiplos desafios relacionados com a autonomia, robustez, segurança, integração, interação humano-computador, armazenamento de dados e usabilidade, que condicionam a sua aceitação junto dos principais intervenientes [1][2][3][4]. O foco do desenvolvimento desta tipologia de ecossistemas sobre o paradigma tecnológico fomentou o desenvolvimento de aplicações específicas centralizadas sobre a mitigação de lacunas técnico-científicas [5][6][7][8], e é apontado como um dos motivos para os seus atuais níveis de adesão. A maximização da sua introdução no mercado impõe que o seu dimensionamento se centralize sobre o utilizador final, em termos de design, requisitos funcionais e não funcionais; e contemple o contexto de integração e continuidade de cuidados inseridos num sistema complexo, por contabilização da diversidade multidimensional dos utilizadores, da natureza das tarefas, do contexto de utilização e das plataformas tecnológicas [5]. Neste contexto, a usabilidade e a utilidade percecionada adquirem um papel de destaque, devido à sua estreita relação com o público-alvo. A necessidade crescente a nível empresarial de minimização do tempo necessário à colocação de produtos no mercado tem motivado a colocação da usabilidade do produto dimensionado em segundo plano [9][10][11]. Fator que aliado à morosidade do processo de análise e ao número de dependências, existência de profissionais na área, de utilizadores finais disponíveis para testar os protótipos dimensionados, entre outras, inviabiliza um estudo extensivo da usabilidade do produto antes, durante e após o seu desenvolvimento. No sentido de mitigar as lacunas identificadas no processo em termos de tempo de execução e dependências explícitas, visar-se-á dotar equipas de desenvolvimento de uma ferramenta que analise o produto dimensionado em tempo real ao nível das linhas orientadoras definidas na literatura. Para quantificar as linhas orientadoras especificadas, impor-se-á a sua parametrização baseada na informação existente na literatura. Nesse sentido, a tese visa compilar os parâmetros necessários a quantificar as linhas orientadoras definidas na literatura: Jakob Nielsen, Gerhardt‐Powals, Shneiderman, Weinschenk e Barker, e Tognazzini. Através da parametrização definir-se-á a base para traduzir linhas orientadoras em lógica a utilizar no dimensionamento de uma ferramenta de análise de usabilidade em tempo real das interfaces. Ferramenta que conferirá aos intervenientes diretos no ciclo de desenvolvimento, os programadores, uma forma objetiva de analisar a usabilidade do produto dimensionado sem requerer a intervenção de entidades externas a título inicial.In the past few years there has been a significant growth of the elderly population in both developing and developed countries. This event provided new economic, technical and demographic challenges to current societies in several areas and services. Among them the healthcare services can be highlighted, due to its impact in people daily lives. As a natural response an effort has been made by both the scientific and industrial community to develop alternatives, which could mitigate the current healthcare services bottlenecks and provide means in aiding and improve the end-user life quality. Through a combination of information and communication technologies specialized ecosystems have been developed, however multiple challenges arose, which compromise their adoption and acceptance among the main stakeholders, such as their autonomy, robustness, security, integration, human-computer interactions, and usability. As consequence an effort has been made to deal with the technical related bottlenecks, which shifted the development process focus from the end-user to the ecosystem’s technological impairments. Despite there being user related issues, such as usability, which remains to be addressed. Therefore, this thesis focuses over the ecosystem’s usability through the analysis of the process used to check the ecosystem’s compliance level with the usability guidelines subset from Jakob Nielsen and Rolf Molich, from Ben Shneiderman, from Weinschenk and Barker and from Tognazzini; and the identification of the quantifiable parameters for each principle that could aid in the heuristics evaluation process by maximizing its objectivity improve its overall accuracy. Through this quantification the base ground is set up to translate the broad guidelines defined in the literature to business rules that can be used to create a tool to check an interface usability overall status in real time. Tool which will provide the main entities in the development cycle an objective approach to check the usability of the product/service created without the intervention of real users in the initial stage of the project