M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

A feasibility study for the provision of electronic healthcare tools and services in areas of Greece, Cyprus and Italy

Background: Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods: The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results: The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at-risk" citizens, and a ferry. Conclusions: The results proved the functionality and utilization of the platform in various rural places in Greece, Cyprus and Italy. However, further actions are needed to enable the local healthcare systems and the different population groups to be familiarized with, and use in their everyday lives, mature technological solutions for the provision of healthcare services

Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol.

BackgroundThe potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow.ObjectiveWe aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities.MethodsThis is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of Diabetes Self-care Activities Measure scores, clinical measures, comorbid conditions, health services resource consumption, and technology system usage statistics.ResultsWe have completed phase 1 data collection. Formal analysis of phase 1 data has not been completed. We have obtained institutional review board approval and began phase 1 research in late fall 2016.ConclusionsThe study hypotheses suggest that patients can, and will, improve their activation in chronic care management. Improved activation should translate into improved diabetes self-care. Expected benefits of this research to the scientific community and health care services include improved understanding of how to leverage mHealth technology to activate patients living with type 2 diabetes in self-management behaviors. The research will shed light on implementation strategies in integrating mHealth into the clinical workflow of the PCMH setting.Trial registrationClinicalTrials.gov NCT02949037. https://clinicaltrials.gov/ct2/show/NCT02949037. (Archived by WebCite at http://www.webcitation.org/6oRyDzqei)

Occupational therapists’ views of using a virtual reality interior design application within the pre-discharge home visit process

This article has been made available through the Brunel Open Access Publishing Fund.Background: A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment, to enable patients to function independently after hospital-home discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualise changes prior to implementing them. Customised VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration if developed effectively and integrated into the PHV process. Objective: To explore the perceptions of occupational therapists with regards to using VRIDAs as an assistive tool within the PHV process. Methods: Task-oriented interactive usability sessions, utilising the think-aloud protocol and subsequent semi-structured interviews were carried out with seven Occupational Therapists who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centring around the parameters that impact upon the acceptance, adoption and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results: OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communications and patient involvement, and improved patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully, however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some “fine tuning” may be necessary if the application is to be optimally used in practice. Conclusions: Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customisations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context

TURF for Teams: Considering Both the Team and I in the Work-Centered Design of Systems

Teams are an inherent part of many work domains, especially in the healthcare environment. Yet, most systems are often built with only the individual user in mind. How can we better incorporate the team, as a user, into the design of a system? By better understanding the team, through their user, task, representational, and functional needs, we can create more useful and helpful systems that match their work domain. For this research project, we utilize the TURF framework and expanded it further by also considering teams as a user, thus, creating the TURF for Teams framework. In addition, we chose to examine teams in the emergency department environment. We believe that designing a system with the team also fully incorporated and acknowledged in the work domain will be beneficial for supporting necessary team activities. Using TURF for Teams, we first conducted an observational field study in the emergency department to get a better understanding of the users, teams, tasks, workload, and interactions. We then identified the need for team communications to be better supported, especially in the management of interruptions, and further categorized the interruptions by their function in order to design a team tool that could help team members better manage their interruptions by focusing on the necessary, or domain, types of interruptions and more easily disregarding the unnecessary, or overhead, types of interruptions. We then administered some surveys and conducted a card sort and cognitive walkthrough with emergency clinician participants to help us better identify how to design interfaces for the team tool and simulation that would better match the needs of team communication behaviors observed and reported by emergency clinicians. After designing and developing the team tool and simulation, we conducted an evaluation of this system by having emergency medicine, medicine, and informatics graduate student teams go through the system and utilize the team tool and simulation as a team. Though we had a small sample size, we found that emergency medicine teams found the team tool and simulation to be very usable and they reacted favorably to its potential in helping them better understand and manage their team communications. In summary, we were able to utilize the TURF framework for incorporating teams into the design of systems, in this case a team communication tool and microworld simulation for the emergency department. Our findings suggest that TURF for Teams is a viable framework for designing useful and helpful team based systems for all work domains

A Wearable Platform for Patient Monitoring during Mass Casualty Incidents

Based on physiological data, intelligent algorithms can assist with the classification and recognition of the most severely impaired victims. This dissertation presents a new sensorbased triage platform with the main proposal to join different sensor and communications technologies into a portable device. This new device must be able to assist the rescue units along with the tactical planning of the operation. This dissertation discusses the implementation and the evaluation of the platform

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

A Wearable Platform for Patient Monitoring during Mass Casualty Incidents

Based on physiological data, intelligent algorithms can assist with the classification and recognition of the most severely impaired victims. This book presents a new sensorbased triage platform with the main proposal to join different sensor and communications technologies into a portable device. This new device must be able to assist the rescue units along with the tactical planning of the operation. This work discusses the implementation and the evaluation of the platform