Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms

From Syndemic Lesson after COVID-19 Pandemic to a "Systemic Clinical Risk Management" Proposal in the Perspective of the Ethics of Job Well Done

The syndemic framework proposed by the 2021-2030 World Health Organization (WHO) action plan for patient safety and the introduction of enabling technologies in health services involve a more effective interpretation of the data to understand causation. Based on the Systemic Theory, this communication proposes the "Systemic Clinical Risk Management" (SCRM) to improve the Quality of Care and Patient Safety. This is a new Clinical Risk Management model capable of developing the ability to observe and synthesize different elements in ways that lead to in-depth interventions to achieve solutions aligned with the sustainable development of health services. In order to avoid uncontrolled decision-making related to the use of enabling technologies, we devised an internal Learning Algorithm Risk Management (LARM) level based on a Bayesian approach. Moreover, according to the ethics of Job Well Done, the SCRM, instead of giving an opinion on events that have already occurred, proposes a bioethical co-working because it suggests the best way to act from a scientific point of view.

Health-Enabling Technologies to Assist Patients With Musculoskeletal Shoulder Disorders When Exercising at Home: Scoping Review

Background

Health-enabling technologies (HETs) are information and communication technologies that promote individual health and well-being. An important application of HETs is telerehabilitation for patients with musculoskeletal shoulder disorders. Currently, there is no overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home.

Objective

This scoping review provides a broad overview of HETs that assist patients with musculoskeletal shoulder disorders when exercising at home. It focuses on concepts and components of HETs, exercise program strategies, development phases, and reported outcomes.

Methods

The search strategy used Medical Subject Headings and text words related to the terms upper extremity, exercises, and information and communication technologies. The MEDLINE, Embase, IEEE Xplore, CINAHL, PEDro, and Scopus databases were searched. Two reviewers independently screened titles and abstracts and then full texts against predefined inclusion and exclusion criteria. A systematic narrative synthesis was performed. Overall, 8988 records published between 1997 and 2019 were screened. Finally, 70 articles introducing 56 HETs were included.

Results

Identified HETs range from simple videoconferencing systems to mobile apps with video instructions to complex sensor-based technologies. Various software, sensor hardware, and hardware for output are in use. The most common hardware for output are PC displays (in 34 HETs). Microsoft Kinect cameras in connection with related software are frequently used as sensor hardware (in 27 HETs). The identified HETs provide direct or indirect instruction, monitoring, correction, assessment, information, or a reminder to exercise. Common parameters for exercise instructions are a patient’s range of motion (in 43 HETs), starting and final position (in 32 HETs), and exercise intensity (in 20 HETs). In total, 48 HETs provide visual instructions for the exercises; 29 HETs report on telerehabilitation aspects; 34 HETs only report on prototypes; and 15 HETs are evaluated for technical feasibility, acceptance, or usability, using different assessment instruments. Efficacy or effectiveness is demonstrated for only 8 HETs. In total, 18 articles report on patients’ evaluations. An interdisciplinary contribution to the development of technologies is found in 17 HETs.

Conclusions

There are various HETs, ranging from simple videoconferencing systems to complex sensor-based technologies for telerehabilitation, that assist patients with musculoskeletal shoulder disorders when exercising at home. Most HETs are not ready for practical use. Comparability is complicated by varying prototype status, different measurement instruments, missing telerehabilitation aspects, and few efficacy studies. Consequently, choosing an HET for daily use is difficult for health care professionals and decision makers. Prototype testing, usability, and acceptance tests with the later target group under real-life conditions as well as efficacy or effectiveness studies with patient-relevant core outcomes for every promising HET are required. Furthermore, health care professionals and patients should be more involved in the product design cycle to consider relevant practical aspects.

Bibliometric analysis of the International Medical Informatics Association official journals

Objectives: This research article aims to analyze the bibliometric characteristics of four official International Medical Informatics Association (IMIA) journals, namely: the International Journal of Medical Informatics, Methods of Information in Medicine, Applied Clinical Informatics, and Informatics for Health and Social Care.Method: We used descriptive bibliometrics to study the trends of literature production, identify documents` types, most prolific authors, institutions, countries, and most cited publications of all four IMIA journals. Additionally, we visualized the content of published publications using bibliometric mapping to identify journals' main themes and the most prolific and most cited research terms.Results: In total, 6,837 publications were published in all four IMIA journals. Among them, there were 5,137 original articles, meaning that articles were the leading document type. Research is being conducted globally among various research institutions. The most prolific countries are the United States of America, the United Kingdom, Germany, the Netherlands, and Canada. Thematic analyses of clusters show that themes are overlapping between all four journals.Conclusion: The journals contribute to the advances in technology related to health information systems, knowledge-based and decision-making systems, health literacy, and electronic health records.

A Regional Health Care Network: eHealth.Braunschweig

Background: Health care network eHealth.Braunschweig has been started in the South-East region of Lower Saxony in Germany in 2009. It composes major health care players, participants from research institutions and important local industry partners.

Objectives: The objective of this paper is firstly to describe the relevant regional characteristics and distinctions of the eHealth.Braunschweig health care network and to inform about the goals and structure of eHealth.Braunschweig; secondly to picture and discuss the main concepts and domain fields which are addressed in the health care network; and finally to discuss the architectural challenges of eHealth.Braunschweig regarding the addressed domain fields and defined requirements.

Methods: Based on respective literature and former conducted projects we discuss the project structure and goals of eHealth.Braunschweig, depict major domain fields and requirements gained in workshops with participants and discuss the architectural challenges as well as the architectural approach of eHealth.Braunschweig network.

Results: The regional healthcare network eHealth.Braunschweig has been established in April 2009. Since then the network has grown constantly and a sufficient progress in network activities has been achieved. The main domain fields have been specified in different workshops with network participants and an architectural realization approach for the transinstitutional information system architecture in the healthcare network has been developed. However, the effects on quality of information processing and quality of patient care have not been proved yet. Systematic evaluation studies have to be done in future in order to investigate the impact of information and communication technology on the quality of information processing and the quality of patient care.

Conclusions: In general, the aspects described in this paper are expected to contribute to a systematic approach for the establishment of regional health care networks with lasting and sustainable effects on patient-centered health care in a regional context.

Home-centered Health-enabling Technologies and Regional Health Information Systems

Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records”.

Objectives: In this paper, we present a prototype of a Home-Centered Health- Enabling Technology (HET-HC), which is able to capture, store, merge and process data from various sensor systems at people’s home. In addition, we present an architecture designed to integrate HET-HC into an exem -plary regional Health Information System (rHIS).

Methods: rHIS are traditionally document-based to fit to the needs in a clinical context. However, HET-HC are producing continuous data streams for which documents might be an inappropriate representation. Therefore, the HET-HC could register placeholder-documents at rHIS. These placeholder-documents are assembled upon user-authenticated request by the HET-HC and are always up-to-date. Moreover, it is not trivial to find a clinical coding system for continuous sensor data and to make the data machine-readable in order to enhance the interoperability of such systems. Therefore, we propose the use of SNOCAP-HET, which is a nomenclature to describe the context of sensor-based measurements in health-enabling technologies.

Results: We present an architectural approach to integrate HET-HC into rHIS. Our solution is the centralized registration of placeholder-documents with rHIS and the decentralized data storage at people’s home.

Conclusions: We concluded that the pre -sented architecture of integrating HET-HC into rHIS might fit well to the traditional approach of document-based data storage. Data security and privacy issues are also duly considered.

Information and communication technology and the future of healthcare: Results of a multi-scenario Delphi survey

Technological advances toward consumer-specific expectations require a sustained commitment and coordination across policy- and decision-makers. The present scenario-based study aimed at identifying prevailing perceptions regarding telehealth applications among Austrian healthcare experts. During a two-round online Delphi survey, panelists rated perceived benefits, obstacles, innovativeness, desirability, and estimated implementation date of 10 telehealth scenarios. Panelists (n = 73, 74% males) perceived that the implementation of telehealth scenarios could especially improve patients' knowledge, quality of social healthcare, and living standard. In contrast, the three top-ranked obstacles were costs, technical prerequisites, and data security. Survey participants rated innovativeness of the presented future scenarios as quite high, whereas perceived desirability was moderate. Overall, ratings suggested precautious attitudes toward technological innovations. The survey findings suggest building taskforces and enhancing communication between healthcare stakeholders to proactively shape the future of telehealth in Austria.

ICT and the future of healthcare: Aspects of pervasive health monitoring

Along with the digital revolution, information and communication technology applications are currently transforming the delivery of health and social care services. This paper investigates prevailing opinions toward future technology-based healthcare solutions among Austrian healthcare professionals. During a biphasic online Delphi survey, panelists rated expected outcomes of two future scenarios describing pervasive health monitoring applications. Experts perceived that the scenarios were highly innovative, but only moderately desirable, and that their implementation could especially improve patients' knowledge, quality of healthcare, and living standard. Contrarily, monetary aspects, technical prerequisites, and data security were identified as key obstacles. We further compared the impact of professional affiliation. Clearly, opinions toward pervasive healthcare differed between the interest groups, medical professionals, patient advocates, and administrative personnel. These data suggest closer collaborations between stakeholder groups to harmonize differences in expectations regarding pervasive health monitoring.

Simulation of Trauma Incidents : Modelling the Evolution of Patients and Resources

Mathematical modeling and simulation with medical applications has gained much interest in the last few years, mainly due to the widespread availability of low-cost technology and computational power. This paper presents an integrated platform for the in-silico simulation of trauma incidents, based on a suite of interacting mathematical models. The models cover the generation of a scenario for an incident, a model of physiological evolution of the affected individuals, including the possible effect of the treatment, and a model of evolution in time of the required medical resources. The problem of optimal resource allocation is also investigated. Model parameters have been identified according to the expertise of medical doctors and by reviewing some related literature. The models have been implemented and exposed as web services, while some software clients have been built for the purpose of testing. Due to its extendability, our integrated platform highlights the potential of model-based simulation in different health-related fields, such as emergency medicine and personal health systems. Modifications of the models are already being used in the context of two funded projects, aiming at evaluating the response of health systems to major incidents with and without model-based decision support.

Is preference for mHealth intervention delivery platform associated with delivery platform familiarity?

BACKGROUND

The aim of this paper was to ascertain whether greater familiarity with a smartphone or tablet was associated with participants' preferred mobile delivery modality for eHealth interventions.

METHODS

Data from 1865 people who participated in the Australian Health and Social Science panel study were included into two multinomial logistic regression analyses in which preference for smartphone and tablet delivery for general or personalised eHealth interventions were regressed onto device familiarity and the covariates of sex, age and education.

RESULTS

People were more likely to prefer both general and personalised eHealth interventions presented on tablets if they reported high or moderate tablet familiarity (compared to low familiarity) and people were more likely to prefer both general and personalised eHealth interventions presented on smartphones if they reported high or moderate smartphone familiarity, were younger, and had university education (compared to completing high school or less).

CONCLUSION

People prefer receiving eHealth interventions on the mobile devices they are most familiar with. These findings have important implications that should be considered when developing eHealth interventions, and demonstrates that eHealth interventions should be delivered using multiple platforms simultaneously to optimally cater for as many people as possible.

Health-Enabling and Ambient Assistive Technologies: Past, Present, Future

BACKGROUND

During the last decades, health-enabling and ambient assistive technologies became of considerable relevance for new informatics-based forms of diagnosis, prevention, and therapy.

OBJECTIVES

To describe the state of the art of health-enabling and ambient assistive technologies in 1992 and today, and its evolution over the last 25 years as well as to project where the field is expected to be in the next 25 years. In the context of this review, we define health-enabling and ambient assistive technologies as ambiently used sensor-based information and communication technologies, aiming at contributing to a person's health and health care as well as to her or his quality of life.

METHODS

Systematic review of all original articles with research focus in all volumes of the IMIA Yearbook of Medical Informatics. Surveying authors independently on key projects and visions as well as on their lessons learned in the context of health-enabling and ambient assistive technologies and summarizing their answers. Surveying authors independently on their expectations for the future and summarizing their answers.

RESULTS

IMIA Yearbook papers containing statements on health-enabling and ambient assistive technologies appear first in 2002. These papers form a minor part of published research articles in medical informatics. However, during recent years the number of articles published has increased significantly. Key projects were identified. There was a clear progress on the use of technologies. However proof of diagnostic relevance and therapeutic efficacy remains still limited. Reforming health care processes and focussing more on patient needs are required.

CONCLUSIONS

Health-enabling and ambient assistive technologies remain an important field for future health care and for interdisciplinary research. More and more publications assume that a person's home and their interaction therein, are becoming important components in health care provision, assessment, and management.

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies--outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL)

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human-machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific "GAL technology", providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL's highly inter- and multidisciplinary aspects, with respect to research into GAL's application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

Consumer preferences for telemedicine devices and services in South Korea

OBJECTIVE

The scope of healthcare has been expanding from caring for sick people to keeping people from becoming sick, and telemedicine will play a significant role in this new healthcare paradigm. This study investigated consumer preferences and willingness to pay for attributes of telemedicine services in South Korea. A market simulation was conducted to examine the market shares of alternative services and their relationships to the perceived usefulness of service types and preferred device types.

MATERIALS AND METHODS

Using a conjoint survey, we collected data on consumer preferences for six telemedicine service attributes. Data analysis used the Bayesian mixed logit model. The market simulation estimated the probabilities of a specific service alternative being chosen using estimated model coefficients.

RESULTS

Wearable devices were the most preferred, followed by smart-home and smartphone devices. Consumers perceived managing blood glucose to be the most useful telemedicine service, followed by monitoring oxygen saturation and blood pressure. The market simulation indicated that consumer preferences for device types were associated with the types of chronic diseases for which management through telemedicine services is perceived to be useful.

CONCLUSIONS

As the focus of healthcare moves from treating patients to keeping individuals healthy, a key factor for the successful deployment of telemedicine services is understanding consumer perceptions and attitudes. The results of this study revealed the dynamics of consumer preferences with regard to service attributes.

Development and clinical validation of an unobtrusive ambulatory knee function monitoring system with inertial 9DoF sensors

Patients suffering from end-stage knee osteoarthritis are often treated with total knee arthroplasty, improving their functional mobility. A number of patients, however, report continued difficulty with stair ascent and descent or sportive activity after surgery and are not completely satisfied with the outcome. State-of-the-art analyses to evaluate the outcome and mobility after knee replacement are conducted under supervised settings in specialized gait labs and thus can only reflect a short period of time. A number of external factors may lead to artificial gait patterns in patients. Moreover, clinically relevant situations are difficult to simulate in a stationary gait lab. In contrast to this, inertial sensors may be used additionally for unobtrusive gait monitoring. However, recent notable approaches found in literature concerning knee function analysis have so far not been applied in a clinical context and have therefore not yet been validated in a clinical setting. The aim of this paper is to present a system for unsupervised long-term monitoring of human gait with a focus on knee joint function, which is applicable in patients' everyday lives and to report on the validation of this system gathered during walking with reference to state-of-the-art gait lab data using a vision system (VICON Motion System). The system KINEMATICWEAR - developed in close collaboration of computer scientists and physicians performing knee arthroplasty - consists of two sensor nodes with combined tri-axial accelerometer, gyroscope and magnetometer to be worn under normal trousers. Reliability of the system is shown in the results. An overall correlation of 0.99 (with an overall RMSE of 2.72) compared to the state-of-the-art reference system indicates a sound quality and a high degree of correspondence. KINEMATICWEAR enables ambulatory, unconstrained measurements of knee function outside a supervised lab inspection.

Wearable sensors in healthcare and sensor-enhanced health information systems: all our tomorrows?

Wearable sensor systems which allow for remote or self-monitoring of health-related parameters are regarded as one means to alleviate the consequences of demographic change. This paper aims to summarize current research in wearable sensors as well as in sensor-enhanced health information systems. Wearable sensor technologies are already advanced in terms of their technical capabilities and are frequently used for cardio-vascular monitoring. Epidemiologic predictions suggest that neuropsychiatric diseases will have a growing impact on our health systems and thus should be addressed more intensively. Two current project examples demonstrate the benefit of wearable sensor technologies: long-term, objective measurement under daily-life, unsupervised conditions. Finally, up-to-date approaches for the implementation of sensor-enhanced health information systems are outlined. Wearable sensors are an integral part of future pervasive, ubiquitous and person-centered health care delivery. Future challenges include their integration into sensor-enhanced health information systems and sound evaluation studies involving measures of workload reduction and costs.

The recommendations from the 2009 SiHIS working conference in Hiroshima--Issues on trustworthiness of health information and patient safety

Held on 21st to 23rd November 2009 in Hiroshima, the SiHIS working conference aimed at finding solutions to approach to an idealistic society where (1) the individual can trust information with full understanding and responsibility, (2) the individual can allow the use of information backed by sound legitimated environment, (3) information can play its role for better healthcare and the improvement of medicine. The purpose of this paper is to propose recommendations from this working conference.

Healthy ageing supported by technology--a cross-disciplinary research challenge

During the last decade, the challenges of an ageing society became focus for extensive scientific, public and political discussions. From discussions in scientific fora within each discipline, there is now a shift towards cross-disciplinary scientific approaches. The aim of this article is therefore, to collect and describe different scientific viewpoints in this regard and to point out research gaps to be addressed in the future. The article is based on a number of review articles and keynote lectures given by the author, and complemented with informal interviews of experts from different scientific fields engaged in the field of technology and ageing. Results show that research has emerged from being technology-focussed to scenario-based taking different scientific perspectives into account. However, the biggest challenge still is to accommodate the need for a holistic integrated service which means to provide personalised services and adapt technology and content to individual needs of different stakeholders. Further, cross-disciplinary research is needed that relates informatics and technology to different stages of the aging process and that evaluates the effects of proposed technical solutions.

Recent progress in sensor-enhanced health information systems - slowly but sustainably

The use of health-enabling technologies is regarded as one important means to face some of the challenges which accompany the demographic change with an expected rise in multi-morbidity and an increased need of care. A precondition for the sensible use of these technologies is their integration in existing information system structures, and - preferably - the enhancement of these into sensor-enhanced health information systems (seHIS). The aim of this review is to report on recent progress in seHIS, and thus to identify relevant areas of research that have to be addressed to provide patient-centered services in a semantically interoperable environment. A literature search in PubMed/Medline was combined with a manual search of papers (n = 1004) in three prominent health/medical informatics journals and one biomedical engineering journal starting from the year 2007. Despite a multitude of papers that present advanced systems using health-enabling technologies, only few papers could be identified that explicitly describe the design of seHIS or the integration of health-enabling technologies into health information systems. Recurring statements emphasise the importance of the following areas of research: patient-centered care using all available sources of information, data security, the stringent use of data representation and device connectivity standards, and adequate methods for data fusion and diagnostic analysis. There is a broad range of research in health-enabling technologies, often focused on specific diseases. The transition from current institution-centered health information systems to person-centered seHIS will be gradual, yet unavoidable for tapping the full potential of health-enabling technologies. seHIS is a growing field of research, and many ambitious challenges are still open. This literature review gives a brief outline of the most frequently mentioned research foci.

A clinical study to assess fall risk using a single waist accelerometer

Falls have various causes and are often associated with mobility impairments. Preventive steps to avoid falls may be initiated, if an increasing fall risk could be detected in time. The objective of this article is to identify an automated sensor-based method to determine fall risk of patients based on objectively measured gait parameters. One hundred fifty-one healthy subjects and 90 subjects at risk of falling were measured during a Timed 'Up & Go' test with a single triaxial acceleration sensor worn on a waist belt. The fall risk was assessed using the STRATIFY score. A decision tree induction algorithm was used to distinguish between subjects with high and low risk using the determined gait parameters. The results of the risk classification produce an overall accuracy of 90.4% in relation to STRATIFY score. The sensitivity amount to 89.4%, the specificity to 91.0% and the reliability parameter kappa equals 0.79. The method presented is able to distinguish between subjects with high and low fall risk. It is unobtrusive and therefore may be applied over extended time periods. A subsequent study is needed to confirm the model's suitability for data recorded in patients' everyday lives.