Remote Rehabilitation: A solution to Overloaded & Scarce Health Care Systems

The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project [1] is focused on introducing wearable sensor systems among elderly communities to support their rehabilitation. It is important to understand the context into which change is introduced. Therefore, an overview of the current state of health care systems in the four partner countries is presented, defining the concept of rehabilitation and how remote rehabilitation is currently delivered. Advantages (e.g. enhanced outcomes, less cost and enhanced patient engagement), and disadvantages of remote rehabilitation (e.g. complexity involved in the use of technology, design and safety issues) are discussed. It is concluded that the key advantage of remote rehabilitation is the potential to support change in patient behaviour, empowering active participation and living independently, with less need to travel for face-to-face sessions. Remote rehabilitation can make enhance quality of health care service delivery. However, all relevant stakeholders including medical staff and patients should be included in the design of the technology employed with a focus on simplicity, usability and robustness. Compliance with Security and the new GDPR regulation will be key to supporting remote rehabilitation. In addition, the diversity of available platforms and devices must also be supported to ensure interoperability. Finally, remote rehabilitation needs to be further validated in practice. Attempts to implement and sustain change should be cognisant of local and current organization of health care and of existing enablers and barriers

Physical Activity Promotion, Assessment, and Engagement in Clinical Settings in the United States

Physical inactivity is an important contributor to morbidity and all-cause mortality and the 2018 Physical Activity Guidelines Advisory Committee recommended that physicians increase their role in physical activity assessment and promotion to combat physical inactivity and related comorbidities. Healthcare providers are increasingly called upon to initiate physical activity promotion with their patients to manage conditions like obesity, diabetes, and cardiovascular diseases. Still, recent reports indicate that less than half of primary care visits include some type of physical activity promotion. Although the National Physical Activity Plan includes some recommendations for clinicians and the healthcare sector on physical activity promotion, it does not include a detailed assessment of the evidence and the processes for standardizing physical activity-related care in the clinical setting. The presented dissertation expands our understanding of exercise promotion in the clinical setting by having: 1) closely examined published studies with focus on how physical activity promotion is conducted, by whom, and under what circumstances in the clinical setting; 2) evaluating the effectiveness of physical activity promotion in the clinical setting, and 3) piloting a weight management tablet application developed to increase patient activation and engagement in the clinic setting at West Virginia University (WVU) Medicine. This dissertation contributes to the evolving field of physical activity assessment, promotion, and counseling in clinical settings. The findings emphasize the importance of integrating physical activity as a standard of care, leveraging technology to enhance assessment and promotion, and the potential of specialized personnel in delivering interventions. The use of theoretical frameworks and interdisciplinary collaboration can further enhance the effectiveness of these interventions. This work sets the stage for future research that can advance healthcare practices, improve patient outcomes, and address the growing burden of chronic diseases associated with physical inactivity

Mobilizing medicine: a design response to the accessibility and cost issues in health care

textNationally, there is increasing concern over the accessibility, cost, and quality of the American health care system. While the quality of the care given is generally out of the control of designers, it has received increased attention in recent years, as is evidenced in the trends of healing gardens, private patient rooms, and improved social settings. As beneficial as these trends are to the patients they serve, they often have a negative effect on overall accessibility and cost of care due to the constant construction and renovations needed and their largely urban presence. While quality health care is very important and should not suffer as a result, how can designers address nonenvironmental sustainability issues of cost and access in the American healthcare system? Due to the trend in increasing cases of chronic illness, as opposed to more pathogenic ailments of the past, the necessity for all healthcare settings to be highly controlled and sterile environments should be reevaluated. While less popular and not as fully developed as the typical facilities most Americans are familiar with, an increase in mobilized health care units could be a solution to the lack of economic and social access and sustainability in the current healthcare model while still providing safe, quality care. By examining current instances of mobile clinics, I will explore the design requirements necessary to make mobile clinics accessible and cost effective. In addition, I will look for facilitators and barriers to these systems, such as improvements in mobile communication technologies and lack of stakeholder support.Architectur

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Remote rehabilitation: a solution to overloaded & scarce health care systems

The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project [1] is focused on introducing wearable sensor systems among elderly communities to support their rehabilitation. It is important to understand the context into which change is introduced. Therefore, an overview of the current state of health care systems in the four partner countries is presented, defining the concept of rehabilitation and how remote rehabilitation is currently delivered. Advantages (e.g. enhanced outcomes, less cost and enhanced patient engagement), and disadvantages of remote rehabilitation (e.g. complexity involved in the use of technology, design and safety issues) are discussed. It is concluded that the key advantage of remote rehabilitation is the potential to support change in patient behaviour, empowering active participation and living independently, with less need to travel for face-to-face sessions. Remote rehabilitation can make enhance quality of health care service delivery. However, all relevant stakeholders including medical staff and patients should be included in the design of the technology employed with a focus on simplicity, usability and robustness. Compliance with Security and the new GDPR regulation will be key to supporting remote rehabilitation. In addition, the diversity of available platforms and devices must also be supported to ensure interoperability. Finally, remote rehabilitation needs to be further validated in practice. Attempts to implement and sustain change should be cognisant of local and current organization of health care and of existing enablers and barriers

Digital Twins for Health: Opportunities, Barriers and a Path Forward

The concept of precision medicine involves tailoring medical interventions to each patient’s specific needs, considering factors such as their genetic makeup, lifestyle, environment and response to therapies. The emergence of digital twin (DT) technology is anticipated to enable such customization. The healthcare field is, thus, increasingly exploring the use of digital twins (DTs), benefiting from successful proof of concept demonstrated in various industries. If their full potential is realized, DTs have the capability to revolutionize connected care and reshape the management of lifestyle, health, wellness and chronic diseases in the future. However, the realization of DTs’ full potential in healthcare is currently impeded by technical, regulatory and ethical challenges. In this chapter, we map the current applications of DTs in healthcare, with a primary focus on precision medicine. We also explore their potential applications in clinical trial design and hospital operations. We identify the key enablers of DTs in healthcare and discuss the opportunities and barriers that foster or hinder their larger and faster diffusion. By providing a comprehensive view of the current landscape, opportunities and challenges, we aim to contribute to DTs’ ongoing development and help policymakers facilitate the growth of DTs’ application in healthcare

Strategic Intelligence Monitor on Personal Health Systems (SIMPHS): Market Structure and Innovation Dynamics

Personal Health Systems (PHS) and Remote Patient Monitoring and Treatment (RMT) have the potential to alter the way healthcare is provided by increasing the quantity and quality of care. This report explores the current status of PHS and, more specifically of the RMT market in Europe. It addresses the question of how these technologies can contribute facing some of the challenges standing in front of the European healthcare delivery systems causes by higher demand pressures through chronic diseases and demographic change combined with diminishing resources for health care. An uptake and diffusion of these services would potentially lead to benefits through a reduction in death rates, and avoid recurring hospitalisation in a cost-effective manner. Yet the report identifies different categories of barriers hampering a full deployment of RMT in Europe. In the concluding part the reports provides a number of tentative policy options specifically aimed at fostering EU-wide deployment of RMT/PHS.JRC.DDG.J.4-Information Societ

Direct Digital Engagement of Patients and Democratizing Health Care

Direct Digital Engagement of Patients and Democratizing Health Car

Patient Sociotechnical Assemblages: The Distributed Cognition of Health Information Management

Personal health records (PHR) are shifting the capabilities and responsibilities of both patients and providers. Influenced by health IT, concepts like patient-centered care, meaningful use, and patient empowerment are commonplace in the healthcare system. As the popularity of personal health records increases, medical providers, healthcare organizations, and health information system stakeholders require a thorough understanding of how patients use these patient facing information portals in conjunction with other artifacts, objects, and practices to manage and maintain their health. Exploring health information management as a distributed sociotechnical assemblage is the conceptual approach of this research. A distributed cognition perspective lends insight to drawing boundaries and establishing connections of personal health information management practices in conjunction with PHR use. The Department of Veterans Affairs provides a unique setting to further understand PHR use and personal health information management practice through the observation of U.S. military veterans enrolled in the My HealtheVet PHR. This context and conceptual framework lead to the research questions for the proposed study: RQ1a: What are the personal health information management practices of veterans who use a personal health record? RQ1b: What health information management practices become distributed beyond the veteran patient? RQ2a: What health information management assemblages emerge from the distributed work of Veterans that use a personal health record? RQ2b: What are key functions of the health information management assemblages of veterans? Through the use of semi-structured in depth interviews, observations, and surveys, data were collected on 22 patients along with their primary care providers and caretakers. Results from a two cycle qualitative coding analysis and analytical cognitive mapping technique reveal bundles of practices for creating reminders, organizing information, and creating information for asking questions and working with primary care providers. Distributed practices emerged that detail the managing of medication, information that is socially distributed, and patient-provider communication through secure messaging. Three health information management assemblage components emerged from the analysis: health events and experiential information, information techniques, and technology and material practices. Each of these components is understood by the ways they become stabilized or destabilized. This research contributes to implications for the design of patient-focused personal health records and informs clinical practice of patient-centered care. The research also makes conceptual and empirical contributions to the practice of health information management and a patient-centered care model of healthcare delivery