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Gåsvær JI, Jepsen R, Heldal I, Sudmann T. Supporting Collaboration in Rehabilitation Trajectories With Information and Communication Technologies: Scoping Review. JMIR Rehabil Assist Technol 2023; 10:e46408. [PMID: 37432715 PMCID: PMC10369310 DOI: 10.2196/46408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/14/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Despite a surge in health information and communication technology (ICT), there is little evidence of lowered cost or increased quality of care. ICT may support patients, health care providers, and other stakeholders through complex rehabilitation trajectories by offering digital platforms for collaboration, shared decision-making, and safe storage of data. Yet, the questions on how ICT can become a useful tool and how the complex intersection between producers and users of ICT should be solved are challenging. OBJECTIVE This study aims to review the literature on how ICTs are used to foster collaboration among the patient, the provider, and other stakeholders. METHODS This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies were identified by searching MEDLINE (OVID), Embase (OVID), CINAHL (EBSCOhost), AMED (EBSCOhost), and Scopus. Unpublished studies were extracted from OAIster, Bielefeld Academic Search Engine, ProQuest Dissertations and Theses, NARIC, and Google Scholar. Eligible papers addressed or described a remote dialogue between stakeholders using ICT to address goals and means, provide decision support, or evaluate certain treatment modalities within a rehabilitation context. Due to the rapid development of ICTs, searches included studies published in the period of 2018-2022. RESULTS In total, 3206 papers (excluding duplicates) were screened. Three papers met all inclusion criteria. The papers varied in design, key findings, and key challenges. These 3 studies reported outcomes such as improvements in activity performance, participation, frequency of leaving the house, improved self-efficacy, change in patients' perspective on possibilities, and change in professionals' understanding of patients' priorities. However, a misfit between the participants' needs and the technology offered, complexity and lack of availability of the technology, difficulties with implementation and uptake, and lack of flexibility in setup and maintenance reduced the value of ICT for those involved in the studies. The low number of included papers is probably due to the complexity of remote collaboration with ICT. CONCLUSIONS ICT has the potential to facilitate communication among stakeholders in the complex and collaborative context of rehabilitation trajectories. This scoping review indicates that there is a paucity of research considering remote ICT-supported collaboration in health care and rehabilitation trajectories. Furthermore, current ICT builds on eHealth literacy, which may differ among stakeholders, and the lack of sufficient eHealth literacy and ICT knowledge creates barriers for access to health care and rehabilitation. Lastly, the aim and results of this review are probably most relevant in high-income countries.
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Affiliation(s)
- Jo Inge Gåsvær
- Faculty of Health and Social Sciences, Department of Health and Function, Western Norway University of Applies Sciences, Bergen, Norway
- Carasent Norge AS, Dale i Sunnfjord, Norway
| | - Randi Jepsen
- Red Cross Haugland Rehabilitation Center, Flekke, Norway
- Center for Epidemiological Research, Nykøbing F Hospital, Nykøbing Falster, Denmark
| | - Ilona Heldal
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Faculty of Engineering and Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tobba Sudmann
- Faculty of Health and Social Sciences, Department of Health and Function, Western Norway University of Applies Sciences, Bergen, Norway
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2
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Graeber J, Warmerdam E, Aufenberg S, Bull C, Davies K, Dixon J, Emmert K, Judd C, Maetzler C, Reilmann R, Ng WF, Macrae V, Maetzler W, Kaduszkiewicz H. Technology acceptance of digital devices for home use: Qualitative results of a mixed methods study. Digit Health 2023; 9:20552076231181239. [PMID: 37361435 PMCID: PMC10286539 DOI: 10.1177/20552076231181239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/04/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Digital devices have demonstrated benefits to patients with chronic and neurodegenerative diseases. But when patients use medical devices in their homes, the technologies have to fit into their lives. We investigated the technology acceptance of seven digital devices for home use. Methods We conducted 60 semi-structured interviews with participants of a larger device study on their views on the acceptability of seven devices. Transcriptions were analysed using qualitative content analysis. Results Based on the unified theory of acceptance and use of technology, we evaluated effort, facilitating conditions, performance expectancy and social influence of each device.In the effort category, five themes emerged: (a) the hassle to use the device; (b) its usability; (c) comfort; (d) disturbance to daily life; and (e) problems during usage. Facilitating conditions consisted of five themes: (a) expectations regarding a device; (b) quality of the instructions; (c) insecurities with usage; (d) possibilities of optimization; and (e) possibilities to use the device longer. Regarding performance expectancy, we identified three themes: (a) insecurities with the performance of a device; (b) feedback; and (c) motivation for using a device. In the social influence category, three themes emerged: (a) reactions of peers; (b) concerns with the visibility of a device; and (c) concerns regarding data privacy. Conclusions We identify key factors that determine the acceptability of medical devices for home use from the participants' perspective. These include low effort of use, minor disruptions to their daily lives and good support from the study team.
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Affiliation(s)
- Johanna Graeber
- Institute of General Practice, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Elke Warmerdam
- Innovative Implant Development (Fracture Healing), Division of Surgery, Saarland University, Homburg, Germany
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | | | - Christopher Bull
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Kristen Davies
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jan Dixon
- NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne NHS Hospitals Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Kirsten Emmert
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Claire Judd
- NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne NHS Hospitals Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Corina Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, Münster, Germany
- Department of Clinical Radiology University of Münster, Münster, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne NHS Hospitals Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal and Inflammation Theme, NIHR Newcastle Biomedical Research Center, Newcastle upon Tyne NHS Hospitals Foundation Trust and Newcastle University Newcastle upon Tyne, UK
| | - Victoria Macrae
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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3
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Manski-Nankervis JA, Alexander K, Biezen R, Jones J, Hunter B, Emery J, Lumsden N, Boyle D, Gunn J, McMorrow R, Prictor M, Taylor M, Hallinan C, Chondros P, Janus E, McIntosh J, Nelson C. Towards optimising chronic kidney disease detection and management in primary care: Underlying theory and protocol for technology development using an Integrated Knowledge Translation approach. Health Informatics J 2021; 27:14604582211008227. [PMID: 33853414 DOI: 10.1177/14604582211008227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Worldwide, Chronic Kidney Disease (CKD), directly or indirectly, causes more than 2.4 million deaths annually with symptoms generally presenting late in the disease course. Clinical guidelines support the early identification and treatment of CKD to delay progression and improve clinical outcomes. This paper reports the protocol for the codesign, implementation and evaluation of a technological platform called Future Health Today (FHT), a software program that aims to optimise early detection and management of CKD in general practice. FHT aims to optimise clinical decision making and reduce practice variation by translating evidence into practice in real time and as a part of quality improvement activities. This protocol describes the co-design and plans for implementation and evaluation of FHT in two general practices invited to test the prototype over 12 months. Service design thinking has informed the design phase and mixed methods will evaluate outcomes following implementation of FHT. Through systematic application of co-design with service users, clinicians and digital technologists, FHT attempts to avoid the pitfalls of past studies that have failed to accommodate the complex requirements and dynamics that can arise between researchers and service users and improve chronic disease management through use of health information technology.
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Affiliation(s)
| | | | | | - Julia Jones
- Department of Nephrology, Western Health, Australia.,Western Health Chronic Disease Alliance, Australia.,University of Melbourne, Australia
| | | | | | - Natalie Lumsden
- Department of Nephrology, Western Health, Australia.,Western Health Chronic Disease Alliance, Australia
| | | | | | | | | | | | | | | | - Edward Janus
- Western Health Chronic Disease Alliance, Australia.,University of Melbourne, Australia.,General Internal Medicine Unit, Western Health, Australia
| | | | - Craig Nelson
- Department of Nephrology, Western Health, Australia.,Western Health Chronic Disease Alliance, Australia.,University of Melbourne, Australia
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Li J, Varnfield M, Jayasena R, Celler B. Home telemonitoring for chronic disease management: Perceptions of users and factors influencing adoption. Health Informatics J 2021; 27:1460458221997893. [PMID: 33685279 DOI: 10.1177/1460458221997893] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Home telemonitoring has been used as a solution to support the care of individuals living with chronic disease. While effectiveness of telemonitoring have been widely studied, more research is needed to understand the perceptions among patients and clinicians in incorporating telemonitoring into their daily routine and practices. This paper presents an investigation of patients' and clinicians' experiences in a care augmenting telemonitoring service, their perceived impact delivered through the service, and clinicians' perceptions on how the service was introduced in their organizations. This work was embedded in a large multi-site trial of home telemonitoring using a mixed method approach for evaluation. Interviews with clinicians involved in the study were conducted at multiple time points during the trial. Questionnaires were administered to clinicians and patients at the end of the trial. Results showed that both patients and clinicians recognized the benefits of patient empowerment through telemonitoring, and patient-clinician interactions. Results identified the needs of a dedicated telemonitoring clinical care coordinator role, guidelines that translate telemonitoring services into clinical pathways and engagement of different healthcare providers, especially general practitioners, to support the integration of telemonitoring into chronic disease management programs and long-term organizational strategic plans.
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Affiliation(s)
| | | | | | - Branko Celler
- Australian e-Health Research Centre, CSIRO, Australia.,University of New South Wales, Australia
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Cantin-Garside KD, Nussbaum MA, White SW, Kim S, Kim CD, Fortes DMG, Valdez RS. Understanding the experiences of self-injurious behavior in autism spectrum disorder: Implications for monitoring technology design. J Am Med Inform Assoc 2021; 28:303-310. [PMID: 32974678 DOI: 10.1093/jamia/ocaa169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/21/2020] [Accepted: 07/14/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Monitoring technology may assist in managing self-injurious behavior (SIB), a pervasive concern in autism spectrum disorder (ASD). Affiliated stakeholder perspectives should be considered to design effective and accepted SIB monitoring methods. We examined caregiver experiences to generate design guidance for SIB monitoring technology. MATERIALS AND METHODS Twenty-three educators and 16 parents of individuals with ASD and SIB completed interviews or focus groups to discuss needs related to monitoring SIB and associated technology use. RESULTS Qualitative content analysis of participant responses revealed 7 main themes associated with SIB and technology: triggers, emotional responses, SIB characteristics, management approaches, caregiver impact, child/student impact, and sensory/technology preferences. DISCUSSION The derived themes indicated areas of emphasis for design at the intersection of monitoring and SIB. Systems design at this intersection should consider the range of manifestations of and management approaches for SIB. It should also attend to interactions among children with SIB, their caregivers, and the technology. Design should prioritize the transferability of physical technology and behavioral data as well as the safety, durability, and sensory implications of technology. CONCLUSIONS The collected stakeholder perspectives provide preliminary groundwork for an SIB monitoring system responsive to needs as articulated by caregivers. Technology design based on this groundwork should follow an iterative process that meaningfully engages caregivers and individuals with SIB in naturalistic settings.
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Affiliation(s)
- Kristine D Cantin-Garside
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Susan W White
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Sunwook Kim
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Chung Do Kim
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Diogo M G Fortes
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
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6
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Piculell E, Skär L, Sanmartin Berglund J, Anderberg P, Bohman D. A concept analysis of health communication in a home environment: Perspectives of older persons and their informal caregivers. Scand J Caring Sci 2020; 35:1006-1024. [PMID: 33145836 DOI: 10.1111/scs.12928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/27/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health communication (HC) is a vast research field focusing on changing health behaviours, and rapidly evolving technology is creating different ways and possibilities to reach target groups and audiences. In the context of home care, a deeper understanding of HC is lacking, specifically for older persons with care needs and their informal caregivers. The aim of this concept analysis is to identify and construct the meaning of HC from the perspective of older persons in need of care in the home environment and their informal caregivers. MATERIALS AND METHODS This study utilised Rogers' (2000) Evolutionary Concept Analysis Method (EMCA) to create and construct a meaning of the concept of HC. The EMCA was based on a systematic literature review of scientific articles, using CINAHL, Pubmed and Inspec (2000-2017). A total of 29 articles were retrieved and analysed. RESULTS The identified attributes of the concept were as follows: resources of the recipient, influence on decisions and advantages of tailored information. HC was described as both contributing to knowledge as well as being overwhelming where habits and resources influenced the use of information. The attributes led to the following descriptive definition of HC: 'Tailored HC, based on needs and resources of the recipient influence care decisions'. The home environment influenced HC by habits and interactions between older persons and their informal caregivers. CONCLUSIONS The home environment influenced HC in terms of social aspects of interactions and habits and between the older person and the informal caregiver. Tailored information with the use of technology contributed to knowledge in care of older persons and their informal caregivers. HC was shown to contribute to improve care for older people in their home environment.
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Affiliation(s)
- Erik Piculell
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | | | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Doris Bohman
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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7
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MacKinnon M, To T, Ramsey C, Lemière C, Lougheed MD. Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation. Allergy Asthma Clin Immunol 2020; 16:73. [PMID: 32922457 PMCID: PMC7477867 DOI: 10.1186/s13223-020-00470-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/29/2020] [Indexed: 12/04/2022] Open
Abstract
Background Work-related asthma (WRA) accounts for up to 25% of all adults with asthma. Early diagnosis is key for optimal management as delays in diagnosis are associated with worse outcomes. However, WRA is significantly underreported and the median time to diagnosis is 4 years. The objective of this review is to identify the gaps in awareness and reporting of WRA and identify gaps in current knowledge translation strategies for chronic disease in general, and asthma specifically. This will identify reasons for delays in WRA diagnosis, as well inform suggestions to improve knowledge translation strategies for dissemination and implementation of WRA prevention and management guidelines. Methods Non-systematic literature reviews were conducted on PubMed with a focus on work-related asthma screening and diagnosis, and knowledge translation or translational medicine research in asthma and chronic disease. In total, 3571 titles and abstracts were reviewed with no restriction on date published. Of those, 207 were relevant and fully read. Another 37 articles were included and reviewed after citation reviews of articles from the initial search and from suggestions from editors. In total, 63 articles were included in the final review. Results Patients, employers, and healthcare professionals lack awareness and under-report WRA which contribute to the delayed diagnosis of WRA, primarily through lack of education, stigma associated with WRA, and lack of awareness and screening in primary care. Knowledge translation strategies for asthma research typically involve the creation of guidelines for diagnosis of the disease, asthma care plans and tools for education and management. While there are some prevention programs in place for certain industries, gaps in knowledge translation strategies including lack of screening tools currently available for WRA, poor education of employers and physicians in identifying WRA, and education of patients is often done post-diagnosis and focuses on management rather than prevention or screening. Conclusion Future knowledge translation strategies should focus on educating employees and employers well before potential exposure to agents associated with WRA and screening for WRA in primary care to enable health care providers to recognize and diagnose WRA.
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Affiliation(s)
- Madison MacKinnon
- Asthma Research Unit, Kingston Health Sciences Centre, 72 Stuart Street, Kingston, ON K7L 2V7 Canada.,Division of Respirology, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, ON K7L 2V6 Canada
| | - Teresa To
- The Hospital for Sick Children, Research Institute, Dalla Lana School of Public Health, University of Toronto, 686 Bay St, Toronto, ON Canada
| | - Clare Ramsey
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 810 Sherbrook St., Winnipeg, MB R3A1R9 Canada
| | - Catherine Lemière
- Department of Chest Medicine, CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin West, Montreal, QC H4J 1C5 Canada
| | - M Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, 72 Stuart Street, Kingston, ON K7L 2V7 Canada.,Division of Respirology, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, ON K7L 2V6 Canada
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Bell SC, Mall MA, Gutierrez H, Macek M, Madge S, Davies JC, Burgel PR, Tullis E, Castaños C, Castellani C, Byrnes CA, Cathcart F, Chotirmall SH, Cosgriff R, Eichler I, Fajac I, Goss CH, Drevinek P, Farrell PM, Gravelle AM, Havermans T, Mayer-Hamblett N, Kashirskaya N, Kerem E, Mathew JL, McKone EF, Naehrlich L, Nasr SZ, Oates GR, O'Neill C, Pypops U, Raraigh KS, Rowe SM, Southern KW, Sivam S, Stephenson AL, Zampoli M, Ratjen F. The future of cystic fibrosis care: a global perspective. THE LANCET. RESPIRATORY MEDICINE 2020; 8:65-124. [PMID: 31570318 PMCID: PMC8862661 DOI: 10.1016/s2213-2600(19)30337-6] [Citation(s) in RCA: 351] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/19/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
Abstract
The past six decades have seen remarkable improvements in health outcomes for people with cystic fibrosis, which was once a fatal disease of infants and young children. However, although life expectancy for people with cystic fibrosis has increased substantially, the disease continues to limit survival and quality of life, and results in a large burden of care for people with cystic fibrosis and their families. Furthermore, epidemiological studies in the past two decades have shown that cystic fibrosis occurs and is more frequent than was previously thought in populations of non-European descent, and the disease is now recognised in many regions of the world. The Lancet Respiratory Medicine Commission on the future of cystic fibrosis care was established at a time of great change in the clinical care of people with the disease, with a growing population of adult patients, widespread genetic testing supporting the diagnosis of cystic fibrosis, and the development of therapies targeting defects in the cystic fibrosis transmembrane conductance regulator (CFTR), which are likely to affect the natural trajectory of the disease. The aim of the Commission was to bring to the attention of patients, health-care professionals, researchers, funders, service providers, and policy makers the various challenges associated with the changing landscape of cystic fibrosis care and the opportunities available for progress, providing a blueprint for the future of cystic fibrosis care. The discovery of the CFTR gene in the late 1980s triggered a surge of basic research that enhanced understanding of the pathophysiology and the genotype-phenotype relationships of this clinically variable disease. Until recently, available treatments could only control symptoms and restrict the complications of cystic fibrosis, but advances in CFTR modulator therapies to address the basic defect of cystic fibrosis have been remarkable and the field is evolving rapidly. However, CFTR modulators approved for use to date are highly expensive, which has prompted questions about the affordability of new treatments and served to emphasise the considerable gap in health outcomes for patients with cystic fibrosis between high-income countries, and low-income and middle-income countries (LMICs). Advances in clinical care have been multifaceted and include earlier diagnosis through the implementation of newborn screening programmes, formalised airway clearance therapy, and reduced malnutrition through the use of effective pancreatic enzyme replacement and a high-energy, high-protein diet. Centre-based care has become the norm in high-income countries, allowing patients to benefit from the skills of expert members of multidisciplinary teams. Pharmacological interventions to address respiratory manifestations now include drugs that target airway mucus and airway surface liquid hydration, and antimicrobial therapies such as antibiotic eradication treatment in early-stage infections and protocols for maintenance therapy of chronic infections. Despite the recent breakthrough with CFTR modulators for cystic fibrosis, the development of novel mucolytic, anti-inflammatory, and anti-infective therapies is likely to remain important, especially for patients with more advanced stages of lung disease. As the median age of patients with cystic fibrosis increases, with a rapid increase in the population of adults living with the disease, complications of cystic fibrosis are becoming increasingly common. Steps need to be taken to ensure that enough highly qualified professionals are present in cystic fibrosis centres to meet the needs of ageing patients, and new technologies need to be adopted to support communication between patients and health-care providers. In considering the future of cystic fibrosis care, the Commission focused on five key areas, which are discussed in this report: the changing epidemiology of cystic fibrosis (section 1); future challenges of clinical care and its delivery (section 2); the building of cystic fibrosis care globally (section 3); novel therapeutics (section 4); and patient engagement (section 5). In panel 1, we summarise key messages of the Commission. The challenges faced by all stakeholders in building and developing cystic fibrosis care globally are substantial, but many opportunities exist for improved care and health outcomes for patients in countries with established cystic fibrosis care programmes, and in LMICs where integrated multidisciplinary care is not available and resources are lacking at present. A concerted effort is needed to ensure that all patients with cystic fibrosis have access to high-quality health care in the future.
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Affiliation(s)
- Scott C Bell
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Marcus A Mall
- Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany; German Center for Lung Research, Berlin, Germany
| | | | - Milan Macek
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Susan Madge
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jane C Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Pierre-Régis Burgel
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes, Institut Cochin, Paris, France
| | - Elizabeth Tullis
- St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Claudio Castaños
- Hospital de Pediatria "Juan P Garrahan", Buenos Aires, Argentina
| | - Carlo Castellani
- Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Catherine A Byrnes
- Starship Children's Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand
| | - Fiona Cathcart
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Isabelle Fajac
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes, Institut Cochin, Paris, France
| | | | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | | | - Anna M Gravelle
- Cystic Fibrosis Clinic, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Trudy Havermans
- Cystic Fibrosis Centre, University Hospital Leuven, Leuven, Belgium
| | - Nicole Mayer-Hamblett
- University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Joseph L Mathew
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Edward F McKone
- School of Medicine, St Vincent's University Hospital, Dublin, Ireland; University College Dublin School of Medicine, Dublin, Ireland
| | - Lutz Naehrlich
- Universities of Giessen and Marburg Lung Center, German Center of Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - Samya Z Nasr
- CS Mott Children's Hospital, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | - Steven M Rowe
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin W Southern
- Alder Hey Children's Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK
| | - Sheila Sivam
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Anne L Stephenson
- St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Marco Zampoli
- Division of Paediatric Pulmonology and MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Felix Ratjen
- University of Toronto, Toronto, ON, Canada; Division of Respiratory Medicine, Department of Paediatrics, Translational Medicine Research Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Dang S, Ruiz DI, Klepac L, Morse S, Becker P, Levy CR, Kinosian B, Edes TE. Key Characteristics for Successful Adoption and Implementation of Home Telehealth Technology in Veterans Affairs Home-Based Primary Care: An Exploratory Study. Telemed J E Health 2019; 25:309-318. [DOI: 10.1089/tmj.2018.0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stuti Dang
- Miami Veterans Affairs Healthcare System, Miami, Florida
- Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, Florida
- Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, Florida
| | - Diana I. Ruiz
- Miami Veterans Affairs Healthcare System, Miami, Florida
- Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, Florida
| | - Lauren Klepac
- Geriatrics and Extended Care, Office of Clinical Operations and Management, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Susan Morse
- Home & Community Based Care, Stratton Veterans Affairs Medical Center, Albany, New York
| | - Peggy Becker
- Geriatrics and Extended Care, New England Veterans Health Care System, Bedford, Massachusetts
| | - Cari R. Levy
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
- Division of Health Care Policy and Research, School of Medicine, University of Colorado, Aurora, Colorado
| | - Bruce Kinosian
- Division of Geriatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatrics and Extended Care Data Analysis Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Thomas E. Edes
- Geriatrics and Extended Care, Office of Clinical Operations and Management, U.S. Department of Veterans Affairs, Washington, District of Columbia
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De Regge M, Decoene E, Eeckloo K, Van Hecke A. Development and Evaluation of an Integrated Digital Patient Platform During Oncology Treatment. J Patient Exp 2019; 7:53-61. [PMID: 32128372 PMCID: PMC7036686 DOI: 10.1177/2374373518825142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Patient platforms are seen as promising technologies in an integrated care approach to
involve cancer patients in their own health care and to support them in managing their
personal health information. However, few digital platforms have been codesigned with
patients and caregivers. Objective: To develop, implement, and evaluate the feasibility and applicability of a digital
oncology platform (DOP) for patients with cancer. Method: A mixed-method study was used, employing a survey, interviews, and logged data from
caregivers and patients. The DOP was designed in cooperation with Information Technology
(IT) staff, caregivers, and patients. Results: The DOP was actively used by half of the patients. These active patients were positive
about the DOP. Caregivers acknowledged the added value but also indicate that additional
workload was involved. Oncology nurse specialists are the users of the platform. General
practitioners have indicated their interest in the platform. Conclusion: Thanks to the codesign process, the DOP could be tailored to the expectations of the
end users. This study provides insight into which DOP functionalities the patients were
interested in and includes further recommendations for implementation.
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Affiliation(s)
- Melissa De Regge
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium.,Department of Management, Innovation and Entrepreneurship, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
| | - Elsie Decoene
- Cancer Center, Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
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Gøeg KR, Rasmussen RK, Jensen L, Wollesen CM, Larsen S, Pape-Haugaard LB. A future-proof architecture for telemedicine using loose-coupled modules and HL7 FHIR. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 160:95-101. [PMID: 29728251 DOI: 10.1016/j.cmpb.2018.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/28/2017] [Accepted: 03/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Most telemedicine solutions are proprietary and disease specific which cause a heterogeneous and silo-oriented system landscape with limited interoperability. Solving the interoperability problem would require a strong focus on data integration and standardization in telemedicine infrastructures. Our objective was to suggest a future-proof architecture, that consisted of small loose-coupled modules to allow flexible integration with new and existing services, and the use of international standards to allow high re-usability of modules, and interoperability in the health IT landscape. METHODS We identified core features of our future-proof architecture as the following (1) To provide extended functionality the system should be designed as a core with modules. Database handling and implementation of security protocols are modules, to improve flexibility compared to other frameworks. (2) To ensure loosely coupled modules the system should implement an inversion of control mechanism. (3) A focus on ease of implementation requires the system should use HL7 FHIR (Fast Interoperable Health Resources) as the primary standard because it is based on web-technologies. RESULTS We evaluated the feasibility of our architecture by developing an open source implementation of the system called ORDS. ORDS is written in TypeScript, and makes use of the Express Framework and HL7 FHIR DSTU2. The code is distributed on GitHub. All modules have been tested unit wise, but end-to-end testing awaits our first clinical example implementations. CONCLUSIONS Our study showed that highly adaptable and yet interoperable core frameworks for telemedicine can be designed and implemented. Future work includes implementation of a clinical use case and evaluation.
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Affiliation(s)
- Kirstine Rosenbeck Gøeg
- Department of Health Science and Technology, Aalborg University, Fr Bajers Vej 7D 9220 Aalborg Ø, Denmark .
| | - Rune Kongsgaard Rasmussen
- Department of Health Science and Technology, Aalborg University, Fr Bajers Vej 7D 9220 Aalborg Ø, Denmark
| | - Lasse Jensen
- Department of Health Science and Technology, Aalborg University, Fr Bajers Vej 7D 9220 Aalborg Ø, Denmark
| | - Christian Møller Wollesen
- Department of Health Science and Technology, Aalborg University, Fr Bajers Vej 7D 9220 Aalborg Ø, Denmark
| | - Søren Larsen
- Department of Health Science and Technology, Aalborg University, Fr Bajers Vej 7D 9220 Aalborg Ø, Denmark
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12
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Aligning Concerns in Telecare: Three Concepts to Guide the Design of Patient-Centred E-Health. Comput Support Coop Work 2018. [DOI: 10.1007/s10606-018-9309-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Granja C, Janssen W, Johansen MA. Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature. J Med Internet Res 2018; 20:e10235. [PMID: 29716883 PMCID: PMC5954232 DOI: 10.2196/10235] [Citation(s) in RCA: 278] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/09/2018] [Indexed: 01/18/2023] Open
Abstract
Background eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality. Objective Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure. Methods We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles. Results Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1). Conclusions The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.
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Affiliation(s)
- Conceição Granja
- Future Journal, Norwegian Centre for E-health Research, Tromsø, Norway
| | - Wouter Janssen
- Telemedicine and E-health Research Group, University of Tromsø-The Artic University of Norway, Tromsø, Norway
| | - Monika Alise Johansen
- Future Journal, Norwegian Centre for E-health Research, Tromsø, Norway.,Telemedicine and E-health Research Group, University of Tromsø-The Artic University of Norway, Tromsø, Norway
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14
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Antepartum Fetal Monitoring through a Wearable System and a Mobile Application. TECHNOLOGIES 2018. [DOI: 10.3390/technologies6020044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Gerdes M, Gallefoss F, Fensli RW. The EU project "United4Health": Results and experiences from automatic health status assessment in a Norwegian telemedicine trial system. J Telemed Telecare 2017; 25:46-53. [PMID: 28994634 DOI: 10.1177/1357633x17735558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with chronic obstructive pulmonary disease require help in daily life situations to increase their individual perception of security, especially under worsened medical conditions. Unnecessary hospital (re-)admissions and home visits by doctors or nurses shall be avoided. This study evaluates the results from a two-year telemedicine field trial for automatic health status assessment based on remote monitoring and analysis of a long time series of vital signs data from patients at home over periods of weeks or months. METHODS After discharge from hospital treatment for acute exacerbations, 94 patients were recruited for follow-up by the trial system. The system supported daily measurements of pulse and transdermal peripheral capillary oxygen saturation at patients' homes, a symptom-specific questionnaire, and provided nurses trained to use telemedicine ("telenurses") with an automatically generated health status overview of all monitored patients. A colour code (green/yellow/red) indicated whether the patient was stable or had a notable deterioration, while red alerts highlighted those in most urgent need of follow-up. The telenurses could manually overwrite the status level based on the patients' conditions observed through video consultation. RESULTS Health status evaluation in 4970 telemonitor datasets were assessed retrospectively. The automatic health status determination (subgroup of 33 patients) showed green status at 46% of the days during a one-month monitoring period, 28% yellow status, and 19% red status (no data reported at 7% of the days). The telenurses manually downrated approximately 10% of the red or yellow alerts. DISCUSSION The evaluation of the defined real-time health status assessment algorithms, which involve static rules with personally adapted elements, shows limitations to adapt long-term home monitoring with adequate interpretation of day-to-day changes in the patient's condition. Thus, due to the given sensitivity and specificity of such algorithms, it seems challenging to avoid false high alerts.
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Affiliation(s)
- Martin Gerdes
- 1 Centre for e-Health, Department of Information and Communication Technology, Faculty of Engineering and Science, University of Agder, Kristiansand, Norway
| | | | - Rune Werner Fensli
- 1 Centre for e-Health, Department of Information and Communication Technology, Faculty of Engineering and Science, University of Agder, Kristiansand, Norway
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Hargreaves S, Hawley MS, Haywood A, Enderby PM. Informing the Design of "Lifestyle Monitoring" Technology for the Detection of Health Deterioration in Long-Term Conditions: A Qualitative Study of People Living With Heart Failure. J Med Internet Res 2017; 19:e231. [PMID: 28659253 PMCID: PMC5508118 DOI: 10.2196/jmir.6931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/21/2017] [Accepted: 04/28/2017] [Indexed: 11/26/2022] Open
Abstract
Background Health technologies are being developed to help people living at home manage long-term conditions. One such technology is “lifestyle monitoring” (LM), a telecare technology based on the idea that home activities may be monitored unobtrusively via sensors to give an indication of changes in health-state. However, questions remain about LM technology: how home activities change when participants experience differing health-states; and how sensors might capture clinically important changes to inform timely interventions. Objective The objective of this paper was to report the findings of a study aimed at identifying changes in activity indicative of important changes in health in people with long-term conditions, particularly changes indicative of exacerbation, by exploring the relationship between home activities and health among people with heart failure (HF). We aimed to add to the knowledge base informing the development of home monitoring technologies designed to detect health deterioration in order to facilitate early intervention and avoid hospital admissions. Methods This qualitative study utilized semistructured interviews to explore everyday activities undertaken during the three health-states of HF: normal days, bad days, and exacerbations. Potential recruits were identified by specialist nurses and attendees at an HF support group. The sample was purposively selected to include a range of experience of living with HF. Results The sample comprised a total of 20 people with HF aged 50 years and above, and 11 spouses or partners of the individuals with HF. All resided in Northern England. Participant accounts revealed that home activities are in part shaped by the degree of intrusion from HF symptoms. During an exacerbation, participants undertook activities specifically to ease symptoms, and detailed activity changes were identified. Everyday activity was also influenced by a range of factors other than health. Conclusions The study highlights the importance of careful development of LM technology to identify changes in activities that occur during clinically important changes in health. These detailed activity changes need to be considered by developers of LM sensors, platforms, and algorithms intended to detect early signs of deterioration. Results suggest that for LM to move forward, sensor set-up should be personalized to individual circumstances and targeted at individual health conditions. LM needs to take account of the uncertainties that arise from placing technology within the home, in order to inform sensor set-up and data interpretation. This targeted approach is likely to yield more clinically meaningful data and address some of the ethical issues of remote monitoring.
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Affiliation(s)
- Sarah Hargreaves
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Mark S Hawley
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Annette Haywood
- Public Health, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Pamela M Enderby
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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17
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Middlemass JB, Vos J, Siriwardena AN. Perceptions on use of home telemonitoring in patients with long term conditions - concordance with the Health Information Technology Acceptance Model: a qualitative collective case study. BMC Med Inform Decis Mak 2017. [PMID: 28651588 PMCID: PMC5485538 DOI: 10.1186/s12911-017-0486-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Health information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services. Despite its potential benefits for reducing disease exacerbations and hospitalisations, HIT home monitoring is not always accepted by patients. Using the Health Information Technology Acceptance Model (HITAM) this qualitative study examined the usefulness of the model for understanding acceptance of HIT in older people (≥60 years) participating in a RCT for older people with Chronic Obstructive Pulmonary Disease (COPD) and associated heart diseases (CHROMED). Methods An instrumental, collective case study design was used with qualitative interviews of patients in the intervention arm of CHROMED. These were conducted at two time points, one shortly after installation of equipment and again at the end of (or withdrawal from) the study. We used Framework Analysis to examine how well the HITAM accounted for the data. Results Participants included 21 patients aged between 60–99 years and their partners or relatives where applicable. Additional concepts for the HITAM for older people included: concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the ‘sick-role’. In the technology zone, HIT self-efficacy was associated with good organisational processes and informal support; while ease of use was connected to equipment design being suitable for older people. HIT perceived usefulness was related to establishing trends in health status, detecting early signs of infection and potential to self-manage. Due to limited feedback to users opportunities to self-manage were reduced. Conclusions HITAM helped understand the likelihood that older people with LTCs would use HIT, but did not explain how this might result in improved self-management. In order to increase HIT acceptance among older people, equipment design and organisational factors need to be considered. Trial registration ClinicalTrials.gov Identifier: NCT01960907 October 9 2013 (retrospectively registered) Clinical tRials fOr elderly patients with MultiplE Disease (CHROMED). Start date October 2012, end date March 2016. Date of enrolment of the first participant was February 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0486-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jo B Middlemass
- Community and Health Research Unit (CaHRU), University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK
| | - Jolien Vos
- UCL Interaction Centre (UCLIC) University College London, 66-72 Gower Street, London, WC1E 6EA, UK
| | - A Niroshan Siriwardena
- Community and Health Research Unit (CaHRU), University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK.
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Bringing care home: how telemonitoring can expand population health management beyond the hospital. Nurs Adm Q 2016; 38:166-72. [PMID: 24569764 DOI: 10.1097/naq.0000000000000029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With emerging technology, patients are able to access the health care system from settings such as their homes, long-term care facilities, and schools. Telemonitoring allows care teams to oversee patients' clinical data captured and transmitted by specialized devices, with minimal involvement or manual effort, on a near real-time basis. This review was undertaken to provide insight into the capacity of telemonitoring technology to improve population health. Despite the potential of telemonitoring, evidence for its clinical, economic, and patient-reported benefits is inconclusive. Much of the outcome variation seen in the literature may be due to the heterogeneity of the interventions' characteristics, with some telemonitoring programs more effectively integrating into standard practice, targeting patients, and utilizing technology. A particular challenge is the ability to comprehensively leverage data to improve health outcomes. To accomplish this, the mass data collected by the devices must be aggregated with data from other clinical systems and used to develop predictive algorithms that can be embedded across the continuum of care. Innovations such as the Healthe Intent cloud-based platform can support a population health strategy by integrating telemonitoring and electronic health record data.
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Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and Facilitators for Sustainability of Tele-Homecare Programs: A Systematic Review. Health Serv Res 2016; 51:48-75. [PMID: 26119048 PMCID: PMC4722198 DOI: 10.1111/1475-6773.12327] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To identify the barriers and facilitators for sustainability of tele-homecare programs implemented by home health nursing agencies for chronic disease management. DATA SOURCES English-language articles on home telehealth in the CINAHL, PubMed/MEDLINE, PsychInfo, Web of Science, and Cochrane Reviews databases published from January 1996 to December 2013. STUDY DESIGN We performed a systematic literature review. Data extraction using PRISMA guidelines and quality appraisal using the Mixed Methods Appraisal Tool (MMAT) were conducted on relevant empirical studies. Thematic analysis across the studies and narrative summaries were used to synthesize the findings from the included studies. PRINCIPAL FINDINGS Of the initial 3,920 citations, we identified 16 articles of moderate quality meeting our inclusion criteria. Perceptions on effectiveness of tele-homecare programs for achieving intended outcomes; tailoring of tele-homecare programs to patient characteristics and needs; relationship and communication between patient, nurse, and other health care professional users of tele-homecare; home health organizational process and culture; and technology quality, capability, and usability impacted the sustainability of tele-homecare programs. CONCLUSIONS The findings of this systematic review provide implications for sustained usage of tele-homecare programs by home health nursing agencies and can help such programs realize their potential for chronic disease management.
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Affiliation(s)
| | - Bo Xie
- School of Nursing & School of InformationUniversity of Texas – AustinAustinTX
| | | | - Miyong Kim
- School of NursingUniversity of Texas – AustinAustinTX
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20
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Peterson AT, Soberón J, Krishtalka L. A global perspective on decadal challenges and priorities in biodiversity informatics. BMC Ecol 2015; 15:15. [PMID: 26022532 PMCID: PMC4467596 DOI: 10.1186/s12898-015-0046-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 04/24/2015] [Indexed: 11/30/2022] Open
Abstract
Biodiversity informatics is a field that is growing rapidly in data infrastructure, tools, and participation by researchers worldwide from diverse disciplines and with diverse, innovative approaches. A recent ‘decadal view’ of the field laid out a vision that was nonetheless restricted and constrained by its European focus. Our alternative decadal view is global, i.e., it sees the worldwide scope and importance of biodiversity informatics as addressing five major, global goals: (1) mobilize existing knowledge; (2) share this knowledge and the experience of its myriad deployments globally; (3) avoid ‘siloing’ and reinventing the tools of knowledge deployment; (4) tackle biodiversity informatics challenges at appropriate scales; and (5) seek solutions to difficult challenges that are strategic.
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Affiliation(s)
- A Townsend Peterson
- Biodiversity Institute, University of Kansas, 1345 Jayhawk Blvd., Lawrence, KS, 66045, USA.
| | - Jorge Soberón
- Biodiversity Institute, University of Kansas, 1345 Jayhawk Blvd., Lawrence, KS, 66045, USA.
| | - Leonard Krishtalka
- Biodiversity Institute, University of Kansas, 1345 Jayhawk Blvd., Lawrence, KS, 66045, USA.
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Radhakrishnan K, Xie B, Jacelon CS. Unsustainable Home Telehealth: A Texas Qualitative Study. THE GERONTOLOGIST 2015; 56:830-40. [DOI: 10.1093/geront/gnv050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/16/2015] [Indexed: 11/12/2022] Open
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Darlow S, Wen KY. Development testing of mobile health interventions for cancer patient self-management: A review. Health Informatics J 2015; 22:633-50. [PMID: 25916831 DOI: 10.1177/1460458215577994] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the vision of mobile health (mHealth) is beginning to be realized, rigorous intervention development protocols are needed in order to draw optimal efficacy and effectiveness to support patient-centered oncology care. The purpose of the current study was to conduct a review of published articles that describe the development process of mHealth interventions for patients' cancer care self-management. The review search yielded 11 interventions, reported by 14 manuscripts. The following trends emerged: importance of stakeholder engagement during the development process, addressing the unique needs and experiences of cancer patients and care providers, ensuring user satisfaction with the system, and identifying perceived benefits and limitations of the system. This review provides practical suggestions for mHealth intervention development. Assessments of user perceptions should be both qualitative and quantitative, and researchers should follow an established framework when developing a randomized controlled trial employing mHealth.
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Medical devices early assessment methods: systematic literature review. Int J Technol Assess Health Care 2014; 30:137-46. [PMID: 24805836 DOI: 10.1017/s0266462314000026] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study was to get an overview of current theory and practice in early assessments of medical devices, and to identify aims and uses of early assessment methods used in practice. METHODS A systematic literature review was conducted in September 2013, using computerized databases (PubMed, Science Direct, and Scopus), and references list search. Selected articles were categorized based on their type, objective, and main target audience. The methods used in the application studies were extracted and mapped throughout the early stages of development and for their particular aims. RESULTS Of 1,961 articles identified, eighty-three studies passed the inclusion criteria, and thirty were included by searching reference lists. There were thirty-one theoretical papers, and eighty-two application papers included. Most studies investigated potential applications/possible improvement of medical devices, developed early assessment framework or included stakeholder perspective in early development stages. Among multiple qualitative and quantitative methods identified, only few were used more than once. The methods aim to inform strategic considerations (e.g., literature review), economic evaluation (e.g., cost-effectiveness analysis), and clinical effectiveness (e.g., clinical trials). Medical devices were often in the prototype product development stage, and the results were usually aimed at informing manufacturers. CONCLUSIONS This study showed converging aims yet widely diverging methods for early assessment during medical device development. For early assessment to become an integral part of activities in the development of medical devices, methods need to be clarified and standardized, and the aims and value of assessment itself must be demonstrated to the main stakeholders for assuring effective and efficient medical device development.
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Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014; 20:428-38. [PMID: 24731239 DOI: 10.1089/tmj.2013.0166] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Remote monitoring technology (RMT) may enhance healthcare quality and reduce costs. RMT adoption depends on perceptions of the end-user (e.g., patients, caregivers, healthcare providers). We conducted a systematic review exploring the acceptability and feasibility of RMT use in routine adult patient care, from the perspectives of primary care clinicians, administrators, and clinic staff. MATERIALS AND METHODS We searched the databases of Medline, IEEE Xplore, and Compendex for original articles published from January 1996 through February 2013. We manually screened bibliographies of pertinent studies and consulted experts to identify English-language studies meeting our inclusion criteria. RESULTS Of 939 citations identified, 15 studies reported in 16 publications met inclusion criteria. Studies were heterogeneous by country, type of RMT used, patient and provider characteristics, and method of implementation and evaluation. Clinicians, staff, and administrators generally held positive views about RMTs. Concerns emerged regarding clinical relevance of RMT data, changing clinical roles and patterns of care (e.g., reduced quality of care from fewer patient visits, overtreatment), insufficient staffing or time to monitor and discuss RMT data, data incompatibility with a clinic's electronic health record (EHR), and unclear legal liability regarding response protocols. CONCLUSIONS This small body of heterogeneous literature suggests that for RMTs to be adopted in primary care, researchers and developers must ensure clinical relevance, support adequate infrastructure, streamline data transmission into EHR systems, attend to changing care patterns and professional roles, and clarify response protocols. There is a critical need to engage end-users in the development and implementation of RMT.
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Affiliation(s)
- Melinda M Davis
- 1 Oregon Rural Practice-Based Research Network, Oregon Health & Science University , Portland, Oregon
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Archer N, Keshavjee K, Demers C, Lee R. Online self-management interventions for chronically ill patients: Cognitive impairment and technology issues. Int J Med Inform 2014; 83:264-72. [DOI: 10.1016/j.ijmedinf.2014.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 11/11/2013] [Accepted: 01/10/2014] [Indexed: 12/31/2022]
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Boyne JJJ, Vrijhoef HJM. Implementing telemonitoring in heart failure care: barriers from the perspectives of patients, healthcare professionals and healthcare organizations. Curr Heart Fail Rep 2014; 10:254-61. [PMID: 23666901 DOI: 10.1007/s11897-013-0140-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The increasing prevalence of chronic diseases, such as heart failure, presents a substantial challenge to healthcare systems. Telemonitoring is believed to be a useful instrument in the delivery of heart failure care. However, a widespread use of telemonitoring is currently failing for various reasons. This article provides an overview of the barriers for the implementation of telemonitoring in heart failure patients from the perspectives of its users: patients, healthcare professionals and healthcare organisations. In doing so, identified barriers are grouped according to the perceived attributes of innovation by Rogers. Recommendations are provided as to how research can improve the implementation of telemonitoring in heart failure.
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Affiliation(s)
- Josiane J J Boyne
- Department of Health Services Research, Maastricht University Medical Center, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands.
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Jiménez-Fernández S, de Toledo P, del Pozo F. Usability and Interoperability in Wireless Sensor Networks for Patient Telemonitoring in Chronic Disease Management. IEEE Trans Biomed Eng 2013; 60:3331-9. [PMID: 24021636 DOI: 10.1109/tbme.2013.2280967] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper addresses two key technological barriers to the wider adoption of patient telemonitoring systems for chronic disease management, namely, usability and sensor device interoperability. As a great percentage of chronic patients are elderly patients as well, usability of the system has to be adapted to their needs. This paper identifies (from previous research) a set of design criteria to address these challenges, and describes the resulting system based on a wireless sensor network, and including a node as a custom-made interface that follows usability design criteria stated. This system has been tested with 22 users (mean age 65) and evaluated with a validated usability questionnaire. Results are good and improve those of other systems based on TV or smartphone. Our results suggest that user interfaces alternative to TVs and smartphones could play an important role on the usability of sensor networks for patient monitoring. Regarding interoperability, only very recently a standard has been published (2010, the ISO IEEE 11073 Personal health devices) that can support the needs of limited computational power environments typical of patient monitoring sensor networks.
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Abstract
As a society we have to re-imagine our health and social care models to meet the challenge of an ageing population with greater levels of chronic disease. The digital revolution offers us the potential to leverage technological innovations to develop proactive 'connected' health and social care models that are built around the patient's needs to facilitate efficient management of wellness and health throughout their lifespan. However, efforts to utilize technological innovations for this purpose have not been universally successful to date, indicating that technology itself is only part of the solution. To achieve a truly connected, technology enabled, health and social care model we need to overcome some key challenges; first, we need to optimize the process of sensing data from end users in the home and community such that monitoring protocols are built around the person and designed with respect to their needs to provide for accurate and reliable harvesting of target data. We then need to gather and mine large datasets from the home and community to analyse the complex relationships between home and community acquired data and health status. Only then can we begin to design, implement and evaluate new models of care that leverage technology platforms. In meeting this challenge we can leverage technology to transform the way in which we promote and manage wellness and health throughout the lifespan.
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Affiliation(s)
- B M Caulfield
- INSIGHT Centre, University College Dublin, Belfield, Dublin 4, Ireland.
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Buysse HEC, de Moor GJE, de Maeseneer J. Introducing a telemonitoring platform for diabetic patients in primary care: will it increase the socio-digital divide? Prim Care Diabetes 2013; 7:119-127. [PMID: 23273770 DOI: 10.1016/j.pcd.2012.10.085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 10/01/2012] [Accepted: 10/20/2012] [Indexed: 12/31/2022]
Abstract
AIMS This study investigates whether diabetes patients visiting a primary care setting are interested in using a telemonitoring platform and if so, whether characteristics of interested users could be distinguished. METHODS Three questionnaires were administered by 92 diabetes persons recruited between May and September 2011. Descriptive statistics and logistic regression analysis were performed. Special attention was drawn to include patients with low educational levels. RESULTS Patients with middle or high educational levels show quite some interest in the use of a telemonitoring platform, especially for the transmission of glycaemic data or for asking questions. Patients with low educational levels only show a minor interest in using such a platform. CONCLUSIONS It is possibly worthwhile to implement a telemonitoring platform in a primary care setting; however this study did not show immediate profit for implementation in a CHC that organises diabetes clinics on regular basis. In primary care settings where it will be implemented, even if there is a social-digital divide today, the use of a telemonitoring platform could possibly reduce inequity in health care as time could become available for those most in need for face-to-face contact with their physician.
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Affiliation(s)
- Heidi E C Buysse
- Department of Medical Informatics and Statistics, Ghent University, Ghent, Belgium.
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Davis MM, Currey JM, Howk S, DeSordi MR, Boise L, Fagnan LJ, Vuckovic N. A qualitative study of rural primary care clinician views on remote monitoring technologies. J Rural Health 2013; 30:69-78. [PMID: 24383486 DOI: 10.1111/jrh.12027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Remote monitoring technologies (RMTs) may improve the quality of care, reduce access barriers, and help control medical costs. Despite the role of primary care clinicians as potential key users of RMTs, few studies explore their views. This study explores rural primary care clinician interest and the resources necessary to incorporate RMTs into routine practice. METHODS We conducted 15 in-depth interviews with rural primary care clinician members of the Oregon Rural Practice-based Research Network (ORPRN) from November 2011 to April 2012. Our multidisciplinary team used thematic analysis to identify emergent themes and a cross-case comparative analysis to explore variation by participant and practice characteristics. RESULTS Clinicians expressed interest in RMTs most relevant to their clinical practice, such as supporting chronic disease management, noting benefits to patients of all ages. They expressed concern about the quantity of data, patient motivation to utilize equipment, and potential changes to the patient-clinician encounter. Direct data transfer into the clinic's electronic health record (EHR), availability in multiple formats, and review by ancillary staff could facilitate implementation. Although participants acknowledged the potential system-level benefits of using RMTs, adoption would be difficult without payment reform. CONCLUSIONS Adoption of RMTs by rural primary care clinicians may be influenced by equipment purpose and functionality, implementation resources, and payment. Clinician and staff engagement will be critical to actualize RMT use in routine primary care.
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Affiliation(s)
- Melinda M Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon; Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
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Mandal I, Sairam N. Accurate telemonitoring of Parkinson's disease diagnosis using robust inference system. Int J Med Inform 2013. [DOI: 10.1016/j.ijmedinf.2012.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hardisty A, Roberts D. A decadal view of biodiversity informatics: challenges and priorities. BMC Ecol 2013; 13:16. [PMID: 23587026 PMCID: PMC3843378 DOI: 10.1186/1472-6785-13-16] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/04/2013] [Indexed: 11/26/2022] Open
Abstract
Biodiversity informatics plays a central enabling role in the research community's efforts to address scientific conservation and sustainability issues. Great strides have been made in the past decade establishing a framework for sharing data, where taxonomy and systematics has been perceived as the most prominent discipline involved. To some extent this is inevitable, given the use of species names as the pivot around which information is organised. To address the urgent questions around conservation, land-use, environmental change, sustainability, food security and ecosystem services that are facing Governments worldwide, we need to understand how the ecosystem works. So, we need a systems approach to understanding biodiversity that moves significantly beyond taxonomy and species observations. Such an approach needs to look at the whole system to address species interactions, both with their environment and with other species.It is clear that some barriers to progress are sociological, basically persuading people to use the technological solutions that are already available. This is best addressed by developing more effective systems that deliver immediate benefit to the user, hiding the majority of the technology behind simple user interfaces. An infrastructure should be a space in which activities take place and, as such, should be effectively invisible.This community consultation paper positions the role of biodiversity informatics, for the next decade, presenting the actions needed to link the various biodiversity infrastructures invisibly and to facilitate understanding that can support both business and policy-makers. The community considers the goal in biodiversity informatics to be full integration of the biodiversity research community, including citizens' science, through a commonly-shared, sustainable e-infrastructure across all sub-disciplines that reliably serves science and society alike.
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Affiliation(s)
- Alex Hardisty
- School of Computer Science and Informatics, Cardiff University, Queens Buildings,
5 The Parade, Cardiff, CF24 3AA, UK
| | - Dave Roberts
- Department of Zoology, The Natural History Museum, Cromwell Road, London, SW7 5BD,
UK
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Peirce SC, Hardisty AR, Preece AD, Elwyn G. Designing and implementing telemonitoring for early detection of deterioration in chronic disease: Defining the requirements. Health Informatics J 2011; 17:173-90. [DOI: 10.1177/1460458211409717] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with chronic disease may suffer frequent acute deteriorations and associated increased risk of hospitalisation. Earlier detection of these could enable successful intervention, improving patients’ well-being and reducing costs; however, current telemonitoring systems do not achieve this effectively. We conducted a qualitative study using stakeholder interviews to define current standards of care and user requirements for improved early detection telemonitoring. We determined that early detection is not a concept that has informed technology or service design and that telemonitoring is driven by the available technology rather than by users’ needs. We have described a set of requirements questions to inform the design and implementation of telemonitoring systems and suggested the research needed to develop successful early detection telemonitoring. User-centred design and genuine interdisciplinary approaches are needed to create solutions that are fit for purpose, sustainable and address the real needs of patients, clinicians and healthcare organisations.
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