Personalized Service Creation by Non-technical Users in the Homecare Domain

AbstractOne of the conditions for the successful introduction of ICT-based homecare services is to allow non-technical persons such as home nurses to personalize these services. We refer to this process of homecare service personalization as service tailoring. Service tailoring can be done by configuring and composing previously developed and deployed service building blocks. In this paper, we describe an approach that employs predefined information of care-receivers, called user profile, to hide most of the technical details from care-givers who do the service tailoring. First, we define the information to be included in a user profile and patterns that represent composition structures corresponding to common homecare tasks experienced in homecare. Then, we define how the service tailoring process can exploit information contained in the predefined user profiles. After that, we illustrate the approach with a tailoring scenario

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A Model for patient engagement integration in perinatal eHealth development and quality assurance

The aim of this study was to construct a model for patient engagement integration in perinatal eHealth development and quality assurance. The model was developed in four phases. The first three phases produced evidence for the development of a model. In the final phase, a qualitative interpretive synthesis was conducted using grounded theory to articulate a patient engagement model composed of three steps. The first phase was a scoping review aimed at describing the nature and range of patient engagement from the perspective of access, personalization, commitment, and therapeutic alliance within perinatal eHealth. A narrative synthesis was used to describe findings. Phase two consisted of two studies exploring engagement practices of pregnant users during their use of a self-monitoring health promotion eHealth system. A descriptive comparative analysis was completed to understand user engagement patterns based on physical use of the wearable device. A mixed-methods convergence evaluation was conducted to understand the process of accessing the health promotion eHealth system. In phase three a process evaluation tool for parent participation and collaboration (in the neonatal intensive care unit) was developed and psychometrically tested. For the interpretive synthesis, articles from the first three phases of this study were purposively sampled. A deductive codebook was developed using Donabedian’s model, and an adapted version of Lewin’s Action Research Cycle. Donabedian’s model consists of quality assurance through the examination of structure, process, and outcomes. Lewin’s Action Research Cycle informs iterative steps in development and implementation of health systems. Phase four resulted in a model for patient engagement integration in perinatal eHealth development and quality assurance. Three steps of the model were identified as being: Person-centered Perinatal eHealth program mapping; Process evaluation through monitoring of patient engagement processes; and Co-creation of perinatal eHealth programs through real-life testing of perinatal eHealth systems.Malli potilaan osallistumisesta perinataaliajan sähköisen terveydenhuollon kehittämiseen ja laadunvarmistukseen Tutkimuksen tavoitteena oli kehittää malli ohjaamaan potilaan osallistumista perinataaliajan sähköisen terveydenhuollon kehittämiseen ja laadunvarmistukseen. Malli kehitettiin neljässä vaiheessa. Kolmessa ensimmäisessä vaiheessa tuotettiin tutkimusnäyttöä kehittämisen tueksi. Viimeisessä vaiheessa laadullisen tulkitsevan synteesin avulla muodostettiin potilaan sitoutumisen malli. Ensimmäisessä vaiheessa tehtiin kartoittava kirjallisuuskatsaus, joka kuvasi potilaiden sähköiseen terveydenhuoltoon osallistumisen tavat ja laajuuden saatavuuden, yksilöllisyyden, sitoutumisen ja terapeuttisen hoitosuhteen näkökulmasta. Aineisto analysoitiin teorialähtöisellä sisällönanalyysillä ja tulokset kuvattiin narratiivisen synteesin avulla. Toinen vaihe muodostui kahdesta tutkimuksesta, jotka tarkastelivat itsemonitorointisysteemin avulla raskaana olevien henkilöiden osallistumistapoja terveydenedistämiseen. Tutkimuksissa odottajat käyttivät itsemonitorointisysteemiä. Osallistumistapoja analysoitiin puettavan laitteen käyttöajan pohjalta tehtyjen vertailevien analyysien avulla. Monimenetelmällisessä tutkimuksessa muodostettiin analyysin pohjalta ymmärrys itsemonitorointisysteemin saatavuuteen liittyvästä prosessista. Kolmannessa vaiheessa kehitettiin ja psykometrisesti testattiin prosessievaluaatiomittari arvioimaan vanhempien osallistumista ja yhteistyötä henkilökunnan kanssa vastasyntyneiden teho-osastolla. Viimeisen vaiheen tulkitsevaa synteesiä varten valittiin tarkoituksenmukaisia artikkeleita. Donabedianin terveydenhuollon laadunvarmistuksen malli ja Lewinin muokatun toimintatutkimuksen syklin pohjalta muodostettiin teorialähtöinen analyysirunko. Neljännen vaiheen tuloksena muodostettiin malli potilaan osallistumisesta perinataaliajan sähköisen terveydenhuollon kehittämiseen ja laadunvarmistukseen. Malli kostuu kolmesta askeleesta: Yksilökeskeisen sähköisen terveydenhuollon kartoitus, potilaan osallistumisprosessin monitorointiin perustuva prosessievaluaatio ja perinataaliajan sähköisen terveydenhuollon yhteiskehittäminen kliinisessä todellisuudessa

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

AN ATTEMPT TO DEFINE CONTEXT AWARENESS IN MOBILE E-HEALTH ENVIRONMENTS

Nurses, doctors, physiotherapists, psychologists and other professionals or specialists come together to provide care to home residing patients, making continuous assessment, diagnosis and treatment possible beyond the walls of hospitals. Such teams of professionals are focused on each individual patient, and are virtual, i.e. they make decisions without being together physically, dynamically, i.e. professionals come and go as needed, and collaborate, as they combine their knowledge to provide effective care. Our system, coined DITIS, is a web based system that enables the effective management and collaboration of virtual healthcare teams and accessing medical information in a secure manner from a variety of mobile devices from anytime and anyplace, adapting the information according to various parameters like, user role, access right, device capabilities and wireless medium. This paper introduces the DITIS system, and identifies the needs and challenges of co-ordinated teams of multidisciplinary healthcare professionals (HCPs) functioning in a context awareness environment under the wireless environment. Pilo

A collaborative platform for management of chronic diseases via guideline-driven individualized care plans

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians

Health 4.0: Applications, Management, Technologies and Review

The Industry 4.0 Standard (I4S) employs technologies for automation and data exchange through cloud computing, Big Data (BD), Internet of Things (IoT), forms of wireless Internet, 5G technologies, cryptography, the use of semantic database (DB) design, Augmented Reality (AR) and Content-Based Image Retrieval (CBIR). Its healthcare extension is the so-called Health 4.0. This study informs about Health 4.0 and its potential to extend, virtualize and enable new healthcare-related processes (e.g., home care, finitude medicine, and personalized/remotely triggered pharmaceutical treatments) and transform them into services. In the future, these services will be able to virtualize multiple levels of care, connect devices and move to Personalized Medicine (PM). The Health 4.0 Cyber-Physical System (HCPS) contains several types of computers, communications, storage, interfaces, biosensors, and bioactuators. The HCPS paradigm permits observing processes from the real world, as well as monitoring patients before, during and after surgical procedures using biosensors. Besides, HCPSs contain bioactuators that accomplish the intended interventions along with other novel strategies to deploy PM. A biosensor detects some critical outer and inner patient conditions and sends these signals to a Decision-Making Unit (DMU). Mobile devices and wearables are present examples of gadgets containing biosensors. Once the DMU receives signals, they can be compared to the patient’s medical history and, depending on the protocols, a set of measures to handle a given situation will follow. The part responsible for the implementation of the automated mitigation actions are the bioactuators, which can vary from a buzzer to the remote-controlled release of some elements in a capsule inside the patient’s body.             Decentralizing health services is a challenge for the creation of health-related applications. Together, CBIR systems can enable access to information from multimedia and multimodality images, which can aid in patient diagnosis and medical decision-making. Currently, the National Health Service addresses the application of communication tools to patients and medical teams to intensify the transfer of treatments from the hospital to the home, without disruption in outpatient services. HCPS technologies share tools with remote servers, allowing data embedding and BD analysis and permit easy integration of healthcare professionals expertise with intelligent devices.  However, it is undeniable the need for improvements, multidisciplinary discussions, strong laws/protocols, inventories about the impact of novel techniques on patients/caregivers as well as rigorous tests of accuracy until reaching the level of automating any medical care technological initiative

Beyond Organizational Boundaries: The Role of Techno-Legal Configurations

In this paper, we explore how techno-legal configurations shape the evolution of an information infrastructure (II) by focusing on data as its critical components. We define techno-legal configurations as assemblages, which are technologically determined by the functionalities for data storage, processing, sharing and usage, and legally determined by the basis for data processing, such as consent, data-processing agreements or laws. To study II’s evolution we conduct an 11-year study of a regional II in Norway as electronic patient record data and patient-generated healthcare data were shared within and across hospital organizations. We show how the considerations of data as internal and external to organizations are continuously renegotiated across techno-legal configurations, which we define as harmonized space and disparate space. We contribute to the II literature by raising the importance of the law in shaping the boundaries across which data can be produced, shared and used

Comparison of Health and Wellbeing Living Lab Business Models : Preliminary result based on Business Model Canvas Evaluation

The most popular thematic focus area among ENoLL members is the health and wellbeing, which covers nearly a half of all the certified Living Labs. However, the studies evaluating Living Lab (LL) business models in general and especially those focusing on health and wellbeing Living Labs are rare. Therefore, the aim of this study is to assess industry standard Business Model Canvas (BMC) usefulness to compare LL business models. The business models among 12 Baltic Sea Region Health and Wellbeing LLs were described and compared. After the recoding process, the original 241 different BMC attribute spellings were reduced to 87 different attributes. On the average 26.7 attributes were used to describe the LL business model. As an example, two network illustrations are presented to showcase the different Living Lab business models. As a result of the assessment, the need to develop LL specific business modelling tool based on fixed a set of valued attributes was recognized