On-Cloud Healthcare Clinic: An e-health consultancy approach for remote communities in a developing country

Experience of coronary heart disease patients with a nurse-led eHealth cardiac rehabilitation: Qualitative process evaluation of a randomized controlled trial

BACKGROUND

A previous randomized controlled trial (NeCR) has indicated the effectiveness of nurse-led eHealth cardiac rehabilitation (CR) on modifying the behaviors of patients with coronary heart disease. However, limited qualitative studies explore the experiences of using eHealth CR that led to such benefits.

OBJECTIVE

The study aimed to explore the experiences of patients who participated in the NeCR program.

METHODS

A descriptive qualitative study was employed among 20 intervention group patients who used the eHealth CR website and ranked differently (0-35th percentile, >35th percentile, and > 70% percentile) in the improvement of health-promoting behaviors.

RESULTS

Five themes emerged: the NeCR program has promoted behavior change and mitigated emotional distress post-CHD. Patients described how the NeCR influenced cognitive determinants (knowledge and skill acquisition, having a roadmap, self-monitoring, and self-evaluation and resolution) and offered social support (professional counseling and peer interaction via multimedia chat) toward such change. Patients also appreciated the high affordability, accessibility, reliability of the NeCR, and expressed psychological, contextual, and technical barriers.

CONCLUSIONS

Providing eHealth CR during patient discharge is warranted as an affordable, accessible, and reliable alternative to obtain health benefits. Extensive behavior change techniques, actionable CR guidance, and increased awareness are widely perceived enablers. Offering professional support and moderation is critical for early post-discharge consultation and for introducing direct peer interaction to reassure patients.

Enablers and Challenges for E-health Services- A Systematic Literature Review

The purpose of the paper is to systematically review the literature of enablers and challenges for implementation and adoption e-health service. The review aims to identify the most critical success factors and barriers related with the development and growth of the e-health services under different circumstances. A total 68 relevant publications related to enablers and challenges of e-health services were selected from a total 694 research papers. These publications were thoroughly reviewed to find out the critical factors influencing the e-health services. The findings indicate that there are five broad factors viz. technological, environmental, organizational, social and economical along with four major stakeholders’ viz. citizens, patients, caregivers and service providers which influence the e-health services. These factors act as enablers as well as challenges for proper implementation and adoption of e-health services in different situations. On the basis of the findings of the review, a conceptual diamond model of e-health services adoption has been proposed.

Mobile 5P-Medicine Approach for Cardiovascular Patients

Medicine is heading towards personalized care based on individual situations and conditions. With smartphones and increasingly miniaturized wearable devices, the sensors available on these devices can perform long-term continuous monitoring of several user health-related parameters, making them a powerful tool for a new medicine approach for these patients. Our proposed system, described in this article, aims to develop innovative solutions based on artificial intelligence techniques to empower patients with cardiovascular disease. These solutions will realize a novel 5P (Predictive, Preventive, Participatory, Personalized, and Precision) medicine approach by providing patients with personalized plans for treatment and increasing their ability for self-monitoring. Such capabilities will be derived by learning algorithms from physiological data and behavioral information, collected using wearables and smart devices worn by patients with health conditions. Further, developing an innovative system of smart algorithms will also focus on providing monitoring techniques, predicting extreme events, generating alarms with varying health parameters, and offering opportunities to maintain active engagement of patients in the healthcare process by promoting the adoption of healthy behaviors and well-being outcomes. The multiple features of this future system will increase the quality of life for cardiovascular diseases patients and provide seamless contact with a healthcare professional.

Rural use of health service and telemedicine during COVID-19: The role of access and eHealth literacy

The COVID-19 pandemic has driven a greater reliance on telemedicine, yet rural access, use, and satisfaction with telemedicine and the role of eHealth literacy are unknown. Using a cross-sectional design, 279 (70.6% female) western rural Canadians completed an online survey. The majority of participants reported access to telemedicine, but nearly 1/5 lacked access to online or virtual mental health services. The majority of participants had used health care services following the declared COVID-19 pandemic in North America, and just under half had used telemedicine. Telemedicine satisfaction scores were higher among participants who had used video (M = 4.18) compared to those who used phone alone (M = 3.79) (p = 0.031). Telemedicine satisfaction and eHealth literacy were correlated (r = 0.26, p = 0.005). Participants did not want telemedicine to replace in-person consultations. Telemedicine practice requires that rural residents have the resources, ability and willingness to engage with remote care.

CESCR: CP-ABE for efficient and secure sharing of data in collaborative ehealth with revocation and no dummy attribute

With the rapid advancement of information and communication technologies, there is a growing transformation of healthcare systems. A patient’s health data can now be centrally stored in the cloud and be shared with multiple healthcare stakeholders, enabling the patient to be collaboratively treated by more than one healthcare institution. However, several issues, including data security and privacy concerns still remain unresolved. Ciphertext-policy attribute-based encryption (CP-ABE) has shown promising potential in providing data security and privacy in cloud-based systems. Nevertheless, the conventional CP-ABE scheme is inadequate for direct adoption in a collaborative ehealth system. For one, its expressiveness is limited as it is based on a monotonic access structure. Second, it lacks an attribute/user revocation mechanism. Third, the computational burden on both the data owner and data users is linear with the number of attributes in the ciphertext. To address these inadequacies, we propose CESCR, a CP-ABE for efficient and secure sharing of health data in collaborative ehealth systems with immediate and efficient attribute/user revocation. The CESCR scheme is unbounded, i.e., it does not bind the size of the attribute universe to the security parameter, it is based on the expressive and non-restrictive ordered binary decision diagram (OBDD) access structure, and it securely outsources the computationally demanding attribute operations of both encryption and decryption processes without requiring a dummy attribute. Security analysis shows that the CESCR scheme is secure in the selective model. Simulation and performance comparisons with related schemes also demonstrate that the CESCR scheme is expressive and efficient.

Remote Pulmonary Function Test Monitoring in Cloud Platform via Smartphone Built-in Microphone

With an aging population that continues to grow, health care technology plays an increasingly active role, especially for chronic disease management. In the health care market, cloud platform technology is becoming popular, as both patients and physicians demand cost efficiency, easy access to information, and security. Especially for asthma and chronic obstructive pulmonary disease (COPD) patients, it is recommended that pulmonary function test (PFT) be performed on a daily basis. However, it is difficult for patients to frequently visit a hospital to perform the PFT. In this study, we present an application and cloud platform for remote PFT monitoring that can be directly measured by smartphone microphone with no external devices. In addition, we adopted the IBM Watson Internet-of-Things (IoT) platform for PFT monitoring, using a smartphone's built-in microphone with a high-resolution time-frequency representation. We successfully demonstrated real-time PFT monitoring using the cloud platform. The PFT parameters of FEV1/FVC (%) could be remotely monitored when a subject performed the PFT test. As a pilot study, we tested 13 healthy subjects, and found that the absolute error mean was 4.12 and the standard deviation was 3.45 on all 13 subjects. With the developed applications on the cloud platform, patients can freely measure the PFT parameters without restriction on time and space, and a physician can monitor the patients' status in real time. We hope that the PFT monitoring platform will work as a means for early detection and treatment of patients with pulmonary diseases, especially those having asthma and COPD.

Follow-Up Decision Support Tool for Public Healthcare: A Design Research Perspective

Objectives

Mobile health (m-Health) technologies may provide an appropriate follow-up support service for patient groups with post-treatment conditions. While previous studies have introduced m-Health methods for patient care, a smart system that may provide follow-up communication and decision support remains limited to the management of a few specific types of diseases. This paper introduces an m-Health solution in the current climate of increased demand for electronic information exchange.

Methods

Adopting a novel design science research approach, we developed an innovative solution model for post-treatment follow-up decision support interaction for use by patients and physicians and then evaluated it by using convergent interviewing and focus group methods.

Results

The cloud-based solution was positively evaluated as supporting physicians and service providers in providing post-treatment follow-up services. Our framework provides a model as an artifact for extending care service systems to inform better follow-up interaction and decision-making.

Conclusions

The study confirmed the perceived value and utility of the proposed Clinical Decision Support artifact indicating that it is promising and has potential to contribute and facilitate appropriate interactions and support for healthcare professionals for future follow-up operationalization. While the prototype was developed and tested in a developing country context, where the availability of doctors is limited for public healthcare, it was anticipated that the prototype would be user-friendly, easy to use, and suitable for post-treatment follow-up through mobility in remote locations.

Design and Evaluation of a Contextual Model for Information Retrieval From Web-Scale Discovery Services to Improve Evidence-Based Practice by Health Care Practitioners: Mixed Methods Study

BACKGROUND

Practicing evidence-based health care is challenging because of overwhelming results presented to practitioners by Google-like Web-scale discovery (WSD) services that index millions of resources while retrieving information based on relevancy algorithms with limited consideration for user information need.

OBJECTIVE

On the basis of the user-oriented theory of information need and following design science principles, this study aimed to develop and evaluate an innovative contextual model for information retrieval from WSD services to improve evidence-based practice (EBP) by health care practitioners.

METHODS

We identified problems from literature to support real-world requirements for this study. We used design science research methodology to guide artefact design. We iteratively improved prototype of the context model using artificial formative evaluation. We performed naturalistic summative evaluation using convergent interviewing of health care practitioners and content analysis from a confirmatory focus group consisting of health researchers to evaluate the model's validity and utility.

RESULTS

The study iteratively designed and applied the context model to a WSD service to meet 5 identified requirements. All 5 health care practitioners interviewed found the artefact satisfied the 5 requirements to successfully evaluate the model as having validity and utility. Content analysis results from the confirmatory focus group mapped top 5 descriptors per requirement to support a true hypothesis that there is significant discussion among participants to justify concluding that the artefact had validity and utility.

CONCLUSIONS

The context model for WSD satisfied all requirements and was evaluated successfully for information retrieval to improve EBP. Outcomes from this study justify further research into the model.

Real-Time Remote-Health Monitoring Systems: a Review on Patients Prioritisation for Multiple-Chronic Diseases, Taxonomy Analysis, Concerns and Solution Procedure

Remotely monitoring a patient's condition is a serious issue and must be addressed. Remote health monitoring systems (RHMS) in telemedicine refers to resources, strategies, methods and installations that enable doctors or other medical professionals to work remotely to consult, diagnose and treat patients. The goal of RHMS is to provide timely medical services at remote areas through telecommunication technologies. Through major advancements in technology, particularly in wireless networking, cloud computing and data storage, RHMS is becoming a feasible aspect of modern medicine. RHMS for the prioritisation of patients with multiple chronic diseases (MCDs) plays an important role in sustainably providing high-quality healthcare services. Further investigations are required to highlight the limitations of the prioritisation of patients with MCDs over a telemedicine environment. This study introduces a comprehensive and inclusive review on the prioritisation of patients with MCDs in telemedicine applications. Furthermore, it presents the challenges and open issues regarding patient prioritisation in telemedicine. The findings of this study are as follows: (1) The limitations and problems of existing patients' prioritisation with MCDs are presented and emphasised. (2) Based on the analysis of the academic literature, an accurate solution for remote prioritisation in a large scale of patients with MCDs was not presented. (3) There is an essential need to produce a new multiple-criteria decision-making theory to address the current problems in the prioritisation of patients with MCDs.

Real-Time Remote Health-Monitoring Systems in a Medical Centre: A Review of the Provision of Healthcare Services-Based Body Sensor Information, Open Challenges and Methodological Aspects

Promoting patient care is a priority for all healthcare providers with the overall purpose of realising a high degree of patient satisfaction. A medical centre server is a remote computer that enables hospitals and physicians to analyse data in real time and offer appropriate services to patients. The server can also manage, organise and support professionals in telemedicine. Therefore, a remote medical centre server plays a crucial role in sustainably delivering quality healthcare services in telemedicine. This article presents a comprehensive review of the provision of healthcare services in telemedicine applications, especially in the medical centre server. Moreover, it highlights the open issues and challenges related to providing healthcare services in the medical centre server within telemedicine. Methodological aspects to control and manage the process of healthcare service provision and three distinct and successive phases are presented. The first phase presents the identification process to propose a decision matrix (DM) on the basis of a crossover of 'multi-healthcare services' and 'hospital list' within intelligent data and service management centre (Tier 4). The second phase discusses the development of a DM for hospital selection on the basis of integrated VIKOR-Analytic Hierarchy Process (AHP) methods. Finally, the last phase examines the validation process for the proposed framework.

Rethinking the Meaning of Cloud Computing for Health Care: A Taxonomic Perspective and Future Research Directions

BACKGROUND

Cloud computing is an innovative paradigm that provides users with on-demand access to a shared pool of configurable computing resources such as servers, storage, and applications. Researchers claim that information technology (IT) services delivered via the cloud computing paradigm (ie, cloud computing services) provide major benefits for health care. However, due to a mismatch between our conceptual understanding of cloud computing for health care and the actual phenomenon in practice, the meaningful use of it for the health care industry cannot always be ensured. Although some studies have tried to conceptualize cloud computing or interpret this phenomenon for health care settings, they have mainly relied on its interpretation in a common context or have been heavily based on a general understanding of traditional health IT artifacts, leading to an insufficient or unspecific conceptual understanding of cloud computing for health care.

OBJECTIVE

We aim to generate insights into the concept of cloud computing for health IT research. We propose a taxonomy that can serve as a fundamental mechanism for organizing knowledge about cloud computing services in health care organizations to gain a deepened, specific understanding of cloud computing in health care. With the taxonomy, we focus on conceptualizing the relevant properties of cloud computing for service delivery to health care organizations and highlighting their specific meanings for health care.

METHODS

We employed a 2-stage approach in developing a taxonomy of cloud computing services for health care organizations. We conducted a structured literature review and 24 semistructured expert interviews in stage 1, drawing on data from theory and practice. In stage 2, we applied a systematic approach and relied on data from stage 1 to develop and evaluate the taxonomy using 14 iterations.

RESULTS

Our taxonomy is composed of 8 dimensions and 28 characteristics that are relevant for cloud computing services in health care organizations. By applying the taxonomy to classify existing cloud computing services identified from the literature and expert interviews, which also serves as a part of the taxonomy, we identified 7 specificities of cloud computing in health care. These specificities challenge what we have learned about cloud computing in general contexts or in traditional health IT from the previous literature. The summarized specificities suggest research opportunities and exemplary research questions for future health IT research on cloud computing.

CONCLUSIONS

By relying on perspectives from a taxonomy for cloud computing services for health care organizations, this study provides a solid conceptual cornerstone for cloud computing in health care. Moreover, the identified specificities of cloud computing and the related future research opportunities will serve as a valuable roadmap to facilitate more research into cloud computing in health care.

Real-Time Fault-Tolerant mHealth System: Comprehensive Review of Healthcare Services, Opens Issues, Challenges and Methodological Aspects

The burden on healthcare services in the world has increased substantially in the past decades. The quality and quantity of care have to increase to meet surging demands, especially among patients with chronic heart diseases. The expansion of information and communication technologies has led to new models for the delivery healthcare services in telemedicine. Therefore, mHealth plays an imperative role in the sustainable delivery of healthcare services in telemedicine. This paper presents a comprehensive review of healthcare service provision. It highlights the open issues and challenges related to the use of the real-time fault-tolerant mHealth system in telemedicine. The methodological aspects of mHealth are examined, and three distinct and successive phases are presented. The first discusses the identification process for establishing a decision matrix based on a crossover of 'time of arrival of patient at the hospital/multi-services' and 'hospitals' within mHealth. The second phase discusses the development of a decision matrix for hospital selection based on the MAHP method. The third phase discusses the validation of the proposed system.

Systematic Review of Real-time Remote Health Monitoring System in Triage and Priority-Based Sensor Technology: Taxonomy, Open Challenges, Motivation and Recommendations

The new and ground-breaking real-time remote monitoring in triage and priority-based sensor technology used in telemedicine have significantly bounded and dispersed communication components. To examine these technologies and provide researchers with a clear vision of this area, we must first be aware of the utilised approaches and existing limitations in this line of research. To this end, an extensive search was conducted to find articles dealing with (a) telemedicine, (b) triage, (c) priority and (d) sensor; (e) comprehensively review related applications and establish the coherent taxonomy of these articles. ScienceDirect, IEEE Xplore and Web of Science databases were checked for articles on triage and priority-based sensor technology in telemedicine. The retrieved articles were filtered according to the type of telemedicine technology explored. A total of 150 articles were selected and classified into two categories. The first category includes reviews and surveys of triage and priority-based sensor technology in telemedicine. The second category includes articles on the three-tiered architecture of telemedicine. Tier 1 represents the users. Sensors acquire the vital signs of the users and send them to Tier 2, which is the personal gateway that uses local area network protocols or wireless body area network. Medical data are sent from Tier 2 to Tier 3, which is the healthcare provider in medical institutes. Then, the motivation for using triage and priority-based sensor technology in telemedicine, the issues related to the obstruction of its application and the development and utilisation of telemedicine are examined on the basis of the findings presented in the literature.