What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.publishedVersionPaid open acces

Central monitoring system for ambient assisted living

Smart homes for aged care enable the elderly to stay in their own homes longer. By means of various types of ambient and wearable sensors information is gathered on people living in smart homes for aged care. This information is then processed to determine the activities of daily living (ADL) and provide vital information to carers. Many examples of smart homes for aged care can be found in literature, however, little or no evidence can be found with respect to interoperability of various sensors and devices along with associated functions. One key element with respect to interoperability is the central monitoring system in a smart home. This thesis analyses and presents key functions and requirements of a central monitoring system. The outcomes of this thesis may benefit developers of smart homes for aged care

A Scalable Home Care System Infrastructure Supporting Domiciliary Care

Technology-mediated home care is attractive for older people living at home and also for their carers. It provides the information necessary to give confidence and assurance to everyone interested in the wellbeing of the older person. From a care delivery perspective, however, widespread deployment of home care technologies presents system developers with a set of challenges. These challenges arise from the issues associated with scaling from individual installations to providing a community-wide service, particularly when each installation is to be fitted to the particular but changing needs of the residents, their in-home carers and the larger healthcare community. This paper presents a home care software architecture and services that seek to address these challenges. The approach aims to generate the information needed in a timely and appropriate form to inform older residents and their carers about changing life style that may indicate a loss of well-being. It unites sensor-based services, home care policy management, resource discovery, multimodal interaction and dynamic configuration services. In this way, the approach offers the integration of a variety of home care services with adaptation to the context of use

Overcoming barriers and increasing independence: service robots for elderly and disabled people

This paper discusses the potential for service robots to overcome barriers and increase independence of elderly and disabled people. It includes a brief overview of the existing uses of service robots by disabled and elderly people and advances in technology which will make new uses possible and provides suggestions for some of these new applications. The paper also considers the design and other conditions to be met for user acceptance. It also discusses the complementarity of assistive service robots and personal assistance and considers the types of applications and users for which service robots are and are not suitable

Service-Oriented Architecture for Patient-Centric eHealth Solutions

The world is in shortage of about 7.2 million healthcare workers in 2013, and the figure is estimated to grow to 12.9 million by 2035, according to the World Health Organization (WHO). On the other hand, the median age of the world’s population was predicted to increase from 26.6 years in 2000 to 37.3 years in 2050, and then to 45.6 years in 2100. Thus further escalating the need for new and efficient healthcare solutions. Telehealth, telecare, and Ambient Assisted Living (AAL) solutions promise to make healthcare services more sustainable, and to enable patients to live more independently and with a higher quality of life at their homes. Smart homes will host intelligent, connected devices that integrate with the Internet of Things (IoT) to form the basis of new and advanced healthcare systems. However, a number of challenges needs to be addressed before this vision can be actualised. These challenges include flexible integration, rapid service development and deployment, mobility, unified abstraction, scalability and high availability, security and privacy. This thesis presents an integration architecture based on Service-Oriented Architecture (SOA) that enables novel healthcare services to be developed rapidly by utilising capabilities of various devices in the patients’ surroundings. Special attention is given to a service broker component, the Information Integration Platform (IIP), that has been developed to bridge communications between everyday objects and Internet-based services following the Enterprise Service Bus (ESB) principles. It exposes its functionalities through a set of RESTfulWeb services, and maintains a unified information model which enables various applications to access in a uniform way. The IIP breaks the traditional vertical “silo” approach of integration, and handles information dissemination task between information providers and consumers by adopting a publish/subscribe messaging pattern. The feasibility of the IIP solution is evaluated both through prototyping and testing the platform’s representative healthcare services, e.g., remote health monitoring and emergency alarms. Experiments conducted on the IIP reveal how performance aspects are affected by needs for security, privacy, high availability, and scalability

Developing methods to improve usefulness of economic Decision Analytical Models: case study in COPD telehealth monitoring

Background: In the light of a scarcity of health resources and the growing needs of the population, there is considerable interest in the potential of telehealth technology to assist patients in self-management of chronic conditions, such as Chronic Obstructive Pulmonary Disease (COPD), heart failure (HF), and diabetes. However, despite ongoing support for this technology from the UK government, the uptake of the technology has been slower than anticipated, with the research suggesting the lack of evidence for the cost-effectiveness of this technology is one of the major barriers. Economic modelling is one of techniques that could facilitate deeper understanding of the long-term consequences and financial outcomes of telehealth interventions. Objective: This thesis documents the process of doctoral research into the methods to enhance the use of decision analytical models in the NHS, using a case study of COPD telehealth. This research is predicated on understanding and challenging assumptions around the methods by which decision models are developed, used, disseminated, and evaluated. The study proposes the ‘end-user mode’ of model dissemination as an alternative to currently used practices. Methods: During the model development process, the conceptual modelling was undertaken using the existing conceptual framework. The framework was altered to suit the needs of the research, with 29 qualitative interviews conducted to elicit stakeholders’ requirements. A usability evaluation of the model was conducted with end-users in a series of 16 tests, with both qualitative and video data analysed. Finally, when the model was released in Open Access, the stakeholder satisfaction was evaluated, using the end-user satisfaction questionnaire to conduct seven further qualitative interviews. A number of specific requirements for the model were elicited during qualitative interviews and fed back to modellers during model development process. The usability evaluation resulted in several problems being identified and eradicated in consecutive phases of development; and the study led to the development of a decision tool that was well-received by NHS stakeholders. The user satisfaction evaluation revealed high satisfaction with the model. Conclusions: The findings suggest that the ‘end-user mode’ approach is viable in the development and the dissemination of a decision model for telehealth. Importantly, several potential areas for future research were identified, including the need to develop methods to improve the uptake and the use of modelling in the NHS, and the development of the concept and instruments for end-user satisfaction in modelling and simulation domain