Advancing telemedicine services for the aging population: The challenge of interoperability

We reflect on our experiences in two projects in which we developed interoperable telemedicine applications for the aging population. While technically data exchange could be implemented technically, uptake was impeded by a lack of working procedures. We argue that development of interoperable health technology for the aging population should go accompanied by a thorough study into working protocols by consulting all end-users and stakeholders

eLabEL: Technology-supported living labs in primary care

Telecare technologies and eHealth applications can support patients and care professionals. However, these technologies are currently not being implemented in primary care. The eLabEL project aims to contribute to a solution for this problem by establishing Living Labs in which patients, healthcare professionals, entrepreneurs and researchers collaborate during the selection, integration, implementation and evaluation of such technologies in primary care. So far, seven primary care centers across the Netherlands have been included. Needs and requirements of healthcare professionals and patients regarding telecare technologies and eHealth applications were studied using semi-structured interviews and focus group interviews respectively. Healthcare professionals and patients were positive towards the use of technologies that can improve accessibility of care for the entire patient population and also expressed a need for technologies that can support self-management in patients with chronic conditions. Requirements voiced by care professionals were the need for clear organization of the user-interface, availability of workflow directives for eHealth usage, minimal steps to perform a task, and integration with their current information system. Patients indicated that care technology should be easy to use and easy to learn, should provide real-time feedback based on self-measured data, and should improve communication between patients and healthcare professionals. Entrepreneurs from the eLabEL consortium will integrate their eHealth and telecare services to meet the requirements of the end-users. The large scale implementation of these technologies will be monitored and the impact on experiences of patients, professionals and organization of care will be studied during a two-year follow-up study. Stakeholders of the eLabEL consortium will join forces to advance the large scale implementation of telecare technologies and eHealth applications in primary care

A maturity model for interoperability in eHealth

Interoperability, the ability of different technological applications to exchange data, is viewed by many as an important goal for eHealth, as it can save money and improve the quality of care and patient safety. However, creating an interoperable infrastructure for eHealth is a difficult task. In this paper, we present a maturity model that aids eHealth developers to determine what level of interoperability they should strive for, and that allows researchers to benchmark interoperable eHealth infrastructures in terms of maturity. For each level in the model, we illustrate what the interoperable infrastructure looks like from the technical point of view, we list implications for working procedures and we discuss the role of standardization. The maturity model has five levels. At level 0, there is no interoperability: The eHealth application is a silo. At level 1, Peer-to-peer systems, single applications are linked for simple data exchange. At level 2, Distributed systems, multiple applications are linked to achieve a common objective. At level 3, Integrated systems, applications from different suppliers are linked in a closed infrastructure. And at level 4, Universal interoperability, finally, applications are linked in an open infrastructure from which everybody is free to (dis)connect. We demonstrate the application of the maturity model via the case of an interoperable eHealth infrastructure for primary care. Reaching the most technically advanced form of interoperability (level 4) is not a goal eHealth developers should always strive for. They should set their goal with regard to the desired interoperability level for their situation and should then determine what they should do in terms of technique, working procedures, and standardization

Should I see a healthcare professional or can I perform self-care: self-referral decision support for patients with low back pain

When people get low back pain (LBP), it is not always evident when to see a general practitioner (GP) or physiotherapist, or to perform self-care. A direct correct referral is essential for effective treatment to prevent the development of chronic LBP the utmost. In the context of designing a tool that is able to provide a referral advice to a patient, 63 healthcare professionals (GPs and physiotherapists) participated in a vignette study. They had to judge 32 LBP cases on 1. see a general practitioner, 2. see a physiotherapist, and 3. perform self-care. In total, 1288 vignettes were judged. Multinomial regression analysis showed that Weight Loss, Trauma, and Nocturnal Pain are the three most significant predictive variables. A decision tree was generated that showed the same conclusion. This decision tree is the basis to build a tool that provides personalized referral advice to patients with LBP from the very beginning