A system of concepts to support the integration of Health and social care and assistive domotics services: the Health@Home project.

The main objective of this work is to define a common shared conceptual model that describes the health care environment using the ContSys standard, harmonizing it with the social care and assistive domotics concepts. The development of this model supports the integration of services, the interoperability among systems and the continuity of care across domains.Starting from the identification and extraction of the portion of the ContSys model suitable for the healthcare part, the article provides the methodology adopted to extend it with social and home automation concepts and to integrate them in a unique framework that supports the continuity of care.The integrated model defined in this paper has been adopted in the design phase of an interoperable open platform, called Health@Home, that organizes the provision of a set of health, social and home automation integrated services provided at home.Our model is a starting point to analyze the various determinants of wellbeing able to guarantee a high-level individual's quality of life. At the moment the Health@Home system is at the implementation phase

Creating archetypes for patient assessment with nurses to facilitate shared patient centred care in the older person

The process of what information is captured in documenting patient care assessment and how it is summarised, communicated and interpreted by nurses across different healthcare services is the main focus of this thesis. Currently in Ireland, systems within the domain of healthcare are undergoing transformation. Existing practices where health information is collected at one local health organisation level and often duplicated across differing services will not support the strategic goals of the newly established clinical directorates. The political vision is simple: Ireland must move towards a nationally integrated electronic record to support patient centred care. Whilst the political vision may be simple, the process of implementation is not and forms the main topic of this thesis. Strategic goals to move nationally towards integrated electronic records are motivated by the global concerns of an ageing population associated with an increase in the prevalence of chronic illness and co-morbidity. The main objective of this thesis is to evaluate the impact of a pilot study which identified the semantic and syntactic clinical requirements for the testing and implementation of a shared discharge/transfer summary assessment record for persons over the age of 65. This summary record was designed in accordance with ISO 13606, the International standard for Electronic Healthcare Record (EHR) communication and is underpinned by ISO 18104, the international standard for Categorial Structures for Representation of Nursing Diagnosis and Nursing Actions in Terminological Systems. A participatory action research approach was adopted, using an exploratory mixed methods research study design. This translational study was completed in two local health organisation areas in Dublin with six service providers across the primary, acute and continuing care services over a two year period. The qualitative element of the study involved 17 interviews, 7 focus group sessions with participants including policy makers and nurses from each of the participating services. Quantitative data included questionnaires from nurses (n = 14) and patients (n=5) evaluating the effectiveness of the summary record. The quantitative data also analysed information from a set of cumulative assessment records (n = 16) which were interpreted in tandem with the qualitative data and then analysed statistically. The shared discharge/transfer summary care record was piloted on 16 patients over an extended timeframe. The quantitative data showed a statistical significance commensurate with the qualitative data collected on patient participants. An evaluation of the pilot study produced qualitative data which was used to gain insight into the differing contexts that healthcare professionals practice within. This data was illustrated in graphical configurations to make evident to policy makers the various roles that nurses engage with in the course of their care delivery. Data collected from both the qualitative and quantitative analysis suggest that the test implementation of the record template was fit for purpose. Identification of the clinical requirements and testing of the summary record over a two year period was a labour intensive process which was logistically difficult to implement. One consequence of this study was the education of the nursing participants on gaining a common understanding of what needs to be measured in patient assessment to inform future theory testing for outcome based research. A second consequence was the empowerment of the nursing participants to develop archetypes for inclusion in future electronic healthcare records in Ireland. The prototype archetypes designed for assessment of the older person in this study are at present informing a number of practical applications within the nursing community in Ireland. Over the course of the study the participatory action research design altered in its focus and emerged as a dominant qualitative mixed methods study

pHealth 2021. Proc. of the 18th Internat. Conf. on Wearable Micro and Nano Technologies for Personalised Health, 8-10 November 2021, Genoa, Italy

Smart mobile systems – microsystems, smart textiles, smart implants, sensor-controlled medical devices – together with related body, local and wide-area networks up to cloud services, have become important enablers for telemedicine and the next generation of healthcare services. The multilateral benefits of pHealth technologies offer enormous potential for all stakeholder communities, not only in terms of improvements in medical quality and industrial competitiveness, but also for the management of healthcare costs and, last but not least, the improvement of patient experience. This book presents the proceedings of pHealth 2021, the 18th in a series of conferences on wearable micro and nano technologies for personalized health with personal health management systems, hosted by the University of Genoa, Italy, and held as an online event from 8 – 10 November 2021. The conference focused on digital health ecosystems in the transformation of healthcare towards personalized, participative, preventive, predictive precision medicine (5P medicine). The book contains 46 peer-reviewed papers (1 keynote, 5 invited papers, 33 full papers, and 7 poster papers). Subjects covered include the deployment of mobile technologies, micro-nano-bio smart systems, bio-data management and analytics, autonomous and intelligent systems, the Health Internet of Things (HIoT), as well as potential risks for security and privacy, and the motivation and empowerment of patients in care processes. Providing an overview of current advances in personalized health and health management, the book will be of interest to all those working in the field of healthcare today

Design and implementation of a web application for rehabilitation planning for stroke patients with milder disabilities

Background: Stroke rehabilitation is a complex process that requires collaboration between stroke patients and various health professionals. One important component of the rehabilitation is to set goals collaboratively with health professionals. The goal setting process can be time-consuming. In many cases, it is complicated for the patient and difficult to track for the health professionals. A simple user interface that supports patients, their family members and health professionals can help both sides to make the goal setting and attainment process easier. Objectives: The aim is to design and develop a software for the goal attainment process of stroke patients with milder disabilities that facilitates goal setting process and the traceability of the goal progress for patients and health professionals. Methods: Based on previous evaluated results, the web interface was developed and improved. Using this knowledge, a goal setting interface was added. To analyze the the goal setting process, goal attainment scaling (GAS) was included as well as parts of the International Classification of Functioning, Disability and Health (ICF) core set for stroke. The results were discussed afterwards in focus groups and evaluated based on two stroke patients, one family member and health professionals. Results: We developed an interactive prototype, that can aid the rehabilitation at home by inserting problems with ICF codes and different kinds of goals, creating new activities and tracing goal progress by reviewing the different goals. With the help of the GAS the outcome of the patient’s goals are visualized by a line chart presenting the positive or negative outcomes of the stroke rehabilitation. Conclusion: The interactive prototype showed that it can support stroke patients during their rehabilitation at home. A usability test indicated that the goal setting and attainment process was perceived as useful for patients and their family members. Small improvements have to be made to simplify use and error handling. For health professionals, the prototype could also simplify the documentation process by using ICF in the prototype, and also improving collaboration when using the tool for coordination

Patientenübergreifende, multiple Verwendung von Patientendaten für die klinische Forschung unter Nutzung von Archetypen

Sowohl in der Routineversorgung als auch in klinischen Studien werden immer mehr Daten elektronisch verarbeitet. Trotzdem ist ein Austausch von Daten zwischen beiden Bereichen häufig noch nicht etabliert. Dies führt dazu, dass Daten mehrfach erfasst werden müssen. Die redundante Datenerfassung ist zeitaufwändig und kann zu Inkonsistenzen zwischen Krankenhausinformationssystem (KIS) und Studiendatenmanagementsystem (SDMS) führen. Obwohl ein Datenaustausch zwischen Forschung und Versorgung oft technisch möglich wäre, scheitert er meist noch an mangelnder semantischer Interoperabilität. Archetypen sind ein innovatives Konzept zur Gestaltung von flexiblen und leicht erweiterbaren elektronischen Gesundheitsakten. Sie ermöglichen semantische Interopera-bilität zwischen Systemen, welche dieselben Archetypen nutzen. Das Archetypen-Konzept hat mittlerweile auch Eingang in internationale Standards gefunden (ISO 13606). Die openEHR-Spezifikationen definieren ein mit ISO 13606 kompatibles jedoch weiter-gehendes Modell für elektronische Gesundheitsakten. Bisher wurden Archetypen hauptsächlich für Informationssysteme in der Routineversorgung und weniger für die klinische Forschung entwickelt und genutzt. Ziel dieser Arbeit war es daher, basierend auf den openEHR-Spezifikationen und Archetypen generische Ansätze zu erarbeiten, die eine multiple Verwendung von Daten aus der Versorgung in der Forschung ermöglichen und deren Umsetzbarkeit zu prüfen. In einer Voruntersuchung wurde ermittelt, dass 35 % der in der betrachteten Studie zu erhebenden Merkmalsarten aus dem untersuchten KIS übernommen werden könnten, wenn die Daten dort elektronisch und ausreichend strukturiert vorlägen. In einem zweiten Schritt wurde mit openSDMS der Prototyp eines auf Archetypen basierenden integrierten elektronischen Gesundheitsakten- und Studiendatenmanagementsystems zur Verfügung gestellt. Aus der Voruntersuchung und der Implementierung von openSDMS wurden Anforderungen abgeleitet und eine auf openEHR-Archetypen basierende Referenzarchitektur entwickelt, welche die Nutzung von Daten aus KIS in klinischen Studien unterstützt. Dabei wird sowohl die Integration von KIS beschrieben, die auf Archetypen basieren, als auch von klassischen KIS. Kernkomponenten dieser Architektur sind auf Archetypen basierende semantische Annotationen von Studiendaten sowie Import- und Exportmodule, welche die Archetype Query Language nutzen. Die vorgestellte Referenzarchitektur ermöglicht den Übergang von der multiplen Erfassung hin zur multiplen Verwendung von Daten in Forschung und Versorgung. Um die entwickelte Referenzarchitektur realisieren zu können, werden geeignete Archetypen auch für Forschungsdaten benötigt. Daher wurden Archetypen zur Dokumentation aller Datenelemente der vier CDASH Domänen ‚Common Identifier Variables‘, ‚Common Timing Variables‘, ‚Adverse Events‘ sowie ‚Prior and Concomitant Medications‘ spezifiziert (Studiendaten). Hierzu wurden insgesamt 23 Merkmalsarten basierend auf Archetypen neu definiert, wozu drei bestehende Archetypen spezialisiert und zwei neu entwickelt wurden. Zur Definition von CDASH-konformen elektronischen Datenerhebungsbogen für die betrachteten Domänen wurden, basierend auf den spezifizierten Archetypen, vier openEHR-Templates entworfen. Ferner wurden 71 Merkmalsarten in 16 Archetypen zur Dokumentation von Studien-Metadaten definiert. Alle neu entworfenen Archetypen wurden jeweils in englischer und deutscher Sprache beschrieben und können nun als Referenzinformationsmodell für Forschungsdaten genutzt werden. Ergänzend wurden alle von den bereitgestellten Archetypen definierten Merkmalsarten auf die im Bereich der klinischen Forschung etablierten Modelle BRIDG, CDASH und ODM abgebildet

Modeling shared care plans using CONTsys and openEHR to support shared homecare of the elderly

This case report describes how two complementary standards, CONTsys (European Standard EN 13940-1 for continuity of care) and the reference model of openEHR, were applied in modeling a shared care plan for shared homecare based on requirements from the OLD@HOME project. Our study shows that these requirements are matched by CONTsys on a general level. However, certain attributes are not explicit in CONTsys, for example agents responsible for performing planned interventions, and support for monitoring outcome of interventions. We further studied how the care plan conceptual model can be implemented using the openEHR reference model. The study demonstrates the feasibility of developing shared care plans combining a standard concept model, for example CONTsys with an electronic health records (EHR) interoperability specification, that is the openEHR, while highlighting areas that need further exploration. It also explores the reusability of existing clinical archetypes as building blocks of care plans and the modeling of new shared care plan archetypes

Managing healthcare transformation towards P5 medicine (Published in Frontiers in Medicine)

Health and social care systems around the world are facing radical organizational, methodological and technological paradigm changes to meet the requirements for improving quality and safety of care as well as efficiency and efficacy of care processes. In this they’re trying to manage the challenges of ongoing demographic changes towards aging, multi-diseased societies, development of human resources, a health and social services consumerism, medical and biomedical progress, and exploding costs for health-related R&D as well as health services delivery. Furthermore, they intend to achieve sustainability of global health systems by transforming them towards intelligent, adaptive and proactive systems focusing on health and wellness with optimized quality and safety outcomes. The outcome is a transformed health and wellness ecosystem combining the approaches of translational medicine, 5P medicine (personalized, preventive, predictive, participative precision medicine) and digital health towards ubiquitous personalized health services realized independent of time and location. It considers individual health status, conditions, genetic and genomic dispositions in personal social, occupational, environmental and behavioural context, thus turning health and social care from reactive to proactive. This requires the advancement communication and cooperation among the business actors from different domains (disciplines) with different methodologies, terminologies/ontologies, education, skills and experiences from data level (data sharing) to concept/knowledge level (knowledge sharing). The challenge here is the understanding and the formal as well as consistent representation of the world of sciences and practices, i.e. of multidisciplinary and dynamic systems in variable context, for enabling mapping between the different disciplines, methodologies, perspectives, intentions, languages, etc. Based on a framework for dynamically, use-case-specifically and context aware representing multi-domain ecosystems including their development process, systems, models and artefacts can be consistently represented, harmonized and integrated. The response to that problem is the formal representation of health and social care ecosystems through an system-oriented, architecture-centric, ontology-based and policy-driven model and framework, addressing all domains and development process views contributing to the system and context in question. Accordingly, this Research Topic would like to address this change towards 5P medicine. Specifically, areas of interest include, but are not limited: • A multidisciplinary approach to the transformation of health and social systems • Success factors for sustainable P5 ecosystems • AI and robotics in transformed health ecosystems • Transformed health ecosystems challenges for security, privacy and trust • Modelling digital health systems • Ethical challenges of personalized digital health • Knowledge representation and management of transformed health ecosystems Table of Contents: 04 Editorial: Managing healthcare transformation towards P5 medicine Bernd Blobel and Dipak Kalra 06 Transformation of Health and Social Care Systems—An Interdisciplinary Approach Toward a Foundational Architecture Bernd Blobel, Frank Oemig, Pekka Ruotsalainen and Diego M. Lopez 26 Transformed Health Ecosystems—Challenges for Security, Privacy, and Trust Pekka Ruotsalainen and Bernd Blobel 36 Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine Alexandra Prodan, Lucas Deimel, Johannes Ahlqvist, Strahil Birov, Rainer Thiel, Meeri Toivanen, Zoi Kolitsi and Dipak Kalra 49 EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic Laura Paleari, Virginia Malini, Gabriella Paoli, Stefano Scillieri, Claudia Bighin, Bernd Blobel and Mauro Giacomini 60 A Review of Artificial Intelligence and Robotics in Transformed Health Ecosystems Kerstin Denecke and Claude R. Baudoin 73 Modeling digital health systems to foster interoperability Frank Oemig and Bernd Blobel 89 Challenges and solutions for transforming health ecosystems in low- and middle-income countries through artificial intelligence Diego M. López, Carolina Rico-Olarte, Bernd Blobel and Carol Hullin 111 Linguistic and ontological challenges of multiple domains contributing to transformed health ecosystems Markus Kreuzthaler, Mathias Brochhausen, Cilia Zayas, Bernd Blobel and Stefan Schulz 126 The ethical challenges of personalized digital health Els Maeckelberghe, Kinga Zdunek, Sara Marceglia, Bobbie Farsides and Michael Rigb