Parental evaluation of a telemonitoring service for children with Type 1 Diabetes

Introduction In the past years, we developed a telemonitoring service for young patients affected by Type 1 Diabetes. That service provides data to the clinical staff and offers an important tool to the parents, that are able to oversee in real time their children. The aim of this work was to analyze the parents' perceived usefulness of the service. Methods The service was tested by the parents of 31 children enrolled in a seven-day clinical trial during a summer camp. To study the parents' perception we proposed and analyzed two questionnaires. A baseline questionnaire focused on the daily management and implications of their children's diabetes, while a post-study one measured the perceived benefits of telemonitoring. Questionnaires also included free text comment spaces. Results Analysis of the baseline questionnaires underlined the parents' suffering and fatigue: 51% of total responses showed a negative tendency and the mean value of the perceived quality of life was 64.13 in a 0-100 scale. In the post-study questionnaires about half of the parents believed in a possible improvement adopting telemonitoring. Moreover, the foreseen improvement in quality of life was significant, increasing from 64.13 to 78.39 ( p-value\u2009=\u20090.0001). The analysis of free text comments highlighted an improvement in mood, and parents' commitment was also proved by their willingness to pay for the service (median\u2009=\u2009200\u2009euro/year). Discussion A high number of parents appreciated the telemonitoring service and were confident that it could improve communication with physicians as well as the family's own peace of mind

Telemedical Support in Patients with Chronic Heart Failure: Experience from Different Projects in Germany

The great epidemiological significance and costs associated with chronic heart failure pose a challenge to health systems in Western industrial countries. In the past few years, controlled randomised studies have shown that patients with chronic heart failure benefit from telemedical monitoring; specifically, telemonitoring of various vital parameters combined with a review of the symptoms, drug compliance and patient education. In Germany, various telemedical monitoring projects for patients with chronic heart failure have been initiated in the past few years; seven of them are presented here. Currently 7220 patients are being monitored in the seven selected projects. Most patients (51.1%) are in NYHA stage II, 26.3% in NYHA stage III, 14.5% in NYHA stage I and only 6.6% in NYHA stage IV respectively. Most projects are primarily regional. Their structure of telemedical monitoring tends to be modular and uses stratification according to the NYHA stages. All projects include medical or health economics assessments. The future of telemedical monitoring projects for patients with chronic heart failure will depend on the outcome of these assessments. Only of there is statistical evidence for medical benefit to the individual patient as well as cost savings will these projects continue

Dynamic Capabilities in Home Health: IT-Enabled Transformation of Post-Acute Care

Home health care can enable shorter hospital stays, reduce re-hospitalization, and contribute to lowered out-of-hospital morbidity and mortality. However, recent changes in Medicare payments and regulations in the US have challenged home health care providers’ business models. Against this backdrop, we draw on the dynamic capability perspective to examine how one home health care provider responded to this challenge over the period 2000-2009 by combining adaptive organization principles and information technology (IT) to transform its post-acute care delivery. The transformation leveraged the organization’s existing dynamic capabilities; improved nursing practices; engaged physicians, nurses, managers, and patients; and implemented remote patient monitoring and other IT-enabled innovations. Integrating information systems and health services literatures, we identify the processes targeted by the transformation, analyze how the provider built adaptive care delivery capability enabled by IT, and demonstrate how the transformation led to improved clinical and financial outcomes. In addition, we offer new insights into the micro-foundations of dynamic capabilities by distinguishing between capabilities at the transactional and transformational levels, and explaining how different types of IT-enabled capabilities shaped, and were shaped by, the home health care provider’s responses to environmental changes

Development of Embedded System for Centralized Insomnia System

Insomnia is a common health problem in medical field as well as in psychiatry. The measurement of those factors could be collected by using polysomnography as one of the current standards. However, due to the routine of clinical assessment, the polysomnography is impractical and limited to be used in certain place. The rapid progress of electronic sensors to support IoT in health telemonitoring should provide the real time diagnosis of patient at home too. In this research, the development of centralized insomnia system for recording and analysis of patient with chronic-insomnia data is proposed. The system is composed from multi body sensors that connected to main IOT server. The test has been done for 5 patients and the result has been successfully retrieved in real time

Telemonitoring systems interoperability challenge: an updated review of the applicability of ISO/IEEE 11073 standards for Interoperability in telemonitoring

Proceeding of: 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. EMBS 2007, Lyon, France, 22-26 August, 2007.Advances in Information and Communication Technologies, ICT, are bringing new opportunities and use cases in the field of systems and Personal Health Devices used for the telemonitoring of citizens in Home or Mobile scenarios. At a time of such challenges, this review arises from the need to identify robust technical telemonitoring solutions that are both open and interoperable. These systems demand standardized solutions to be cost effective and to take advantage of standardized operation and interoperability. Thus, the fundamental challenge is to design plug-&-play devices that, either as individual elements or as components, can be incorporated in a simple way into different Telecare systems, perhaps configuring a personal user network. Moreover, there is an increasing market pressure from companies not traditionally involved in medical markets, asking for a standard for Personal Health Devices, which foresee a vast demand for telemonitoring, wellness, Ambient Assisted Living (AAL) and ehealth applications. However, the newly emerging situations imply very strict requirements for the protocols involved in the communication. The ISO/IEEE 11073 family of standards is adapting and moving in order to face the challenge and might appear the best positioned international standards to reach this goal. This work presents an updated survey of these standards, trying to track the changes that are being fulfilled, and tries to serve as a starting-point for those who want to familiarize themselves with them.This research work has been partially supported by projects TSI2005-07068-C02-01 and TSI2004-04940-C02-01 from Ministerio de Educación y Ciencia (Spanish Government), and a personal grant to M. Galarraga from Navarre Regional Government

A Survey of Telecardiology Projects in Italy.

It is estimated that in Italy there are about three million people affected by chronic heart failure. Cardiology is the health care field currently getting the largest benefits from telemedicine. Transmission, using wireless devices, makes possible to achieve virtual hospitalization: it is possible to anticipate the time of discharging and the patient can be remotely controlled by the central station in the ICU of the department of Medicine. Teleconsulting (i.e. a distance consulting between physicians) is applied in telecardiology, it allows the realization of a consulting between cardiology departments and remote services in the same hospital or among far-away hospitals. In this paper some of the most significant cardiac telemonitoring projects in Italy are described. Also reported, the projects involving the applications of implantable cardiac devices which can be controlled remotely. In conclusion, we sketch out the future prospects of telecardiology research and its applications in Italy

Simulation model for cost estimation of integrated care concepts of heart failure patients

BACKGROUND: As a direct result of the population growing older the total number of chronic illnesses increases. The future expenditure for care of chronically ill patients is an ever-present challenge for the health care system. New solutions based on integrated care or the inclusion of telemedical systems in the treatment procedure can be essential for reducing the future financial burden. Therefore a detailed economic model was developed, which enables the comparison of health and cost outcomes for conventional medical care and different integrated care concepts in heart failure treatment. METHODS: F0r modelling, the discrete event technique was used. The model takes outpatient care as well as inpatient care into account to estimate the total occurring costs. It enables the treatment of patients by a physician, a specialist or a clinical ambulance for the simulation of the outpatient care. For inpatient care the model considers the total-costs of the hospitalization and rate of re-admission and furthermore the costs which occur because of special medical treatments or necessary stay at intensive care units. To rate the severity of symptoms patients can be classified using NYHA groups. To outline some of the potential model results, two scenarios have been simulated to compare both methods of care regarding overall costs. RESULTS: The developed simulation model allows comparing health and cost outcomes of different integrated care concepts for the treatment of heart failure patients. Additionally to the simulation of standard outpatient and inpatient care procedures in Austria the approach of a telemedical monitoring system for heart failure patients was implemented in this economic model. With the simulated scenarios it could be shown that under the given simulation parameters the telemedical system can lead to cost savings of up to 8% within the first three years. CONCLUSIONS: The developed model represents a comprehensive tool, which opens a wide field of possible simulation scenarios for the treatment of heart failure patients with special focus on overall cost estimations and reimbursement strategies. The simulated scenarios show that telemedical care has the potential of improved health outcomes and economic benefits

Proposal of an ISO/IEEE11073 platform for healthcare telemonitoring: plug-and-play solution with new use cases

Proceeding of: 29th Annual International Conference of IEEE Engineering in Medicine and Biology Society, (EMBS 2007), Lyon, France, 23-26th august 2007.Remote patient monitoring in e-Health is everyday closer to be a mature technology / service. However, there is still a lack of development in areas such as standardization of the sensor’s communication interface, integration into Electronic Healthcare Record systems or incorporation in ambient-intelligent scenarios. This work identifies a set of use cases involved in the personal monitoring scenario and highlights the related features and functionalities, as well as the integration and implementation difficulties found when these are to be implemented in a system based on the ISO/IEEE11073 (X73) standard. It is part of a cooperative research effort devoted to the development of an end-to-end standards-based telemonitoring solution. Standardization committees are working towards adapting the X73 standard to this emerging personal health devices market and use case identification is essential to direct these revisions.This research work has been partially supported by projects TSI2005-07068-C02-01 and TSI2004-04940-C02-01 from Ministerio de Educación y Ciencia (Spanish Government), and a personal grant to both M.Galarraga and M. Martinez-Espronceda from Navarre Regional Governmen