The potential impact of home telecare on clinical practice

A look to the future: Pandemic-induced digital technologies in vascular surgery

Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.

Discrepancies in Demand of Internet of Things Services Among Older People and People With Disabilities, Their Caregivers, and Health Care Providers: Face-to-Face Survey Study

BACKGROUND

Home Internet of Things (IoT) services and devices have the potential to aid older adults and people with disabilities in their living environments. IoT services and devices can also aid caregivers and health care providers in conveniently providing care to those in need. However, real-world data on the IoT needs of vulnerable people are lacking.

OBJECTIVE

The objective of this study is to conduct a face-to-face survey on the demand for IoT services among older people and people with disabilities, their caregivers, and health care providers in a real-world setting and to see if there are any differences in the aspects of need.

METHODS

We conducted a face-to-face survey with 500 participants between January 2019 and March 2019. A total of 300 vulnerable people (200 older adults aged ≥65 years and 100 physically disabled people aged 30-64 years) were randomly sampled from either a population-based, prospective cohort study of aging-the Aging Study of Pyeongchang Rural Area (ASPRA)-or from the outpatient clinics at the Asan Medical Center, Seoul, South Korea. Simultaneously, their caregivers (n=150) and health care providers (n=50) participated in the survey. Detailed socioeconomic status, digital literacy, health and physical function, and home IoT service needs were determined. Among all commercially available IoT services, 27 services were classified into five categories: emergency and security, safety, health care, convenience (information), and convenience (operation). The weighted-ranking method was used to rank the IoT needs in different groups.

RESULTS

There were discrepancies in the demand of IoT services among the vulnerable groups, their caregivers, and health care providers. The home IoT service category that was required the most by the vulnerable groups and their caregivers was emergency and security. However, health care providers indicated that the safety category was most needed by the older adults and disabled people. Home IoT service requirements differed according to the different types of disabilities among the vulnerable groups. Participants with fewer disabilities were more willing to use IoT services than those with more disabilities.

CONCLUSIONS

Our survey study shows that there were discrepancies in the demand of IoT services among the vulnerable groups, their caregivers, and health care providers. IoT service requirements differed according to the various types of disabilities. Home IoT technology should be established by combining patients' priorities and individualized functional assessments among vulnerable people.

TRIAL REGISTRATION

Clinical Research Information Service (CRIS; KCT0004157); https://tinyurl.com/r83eyva.

The Role of Information and Communication Technology in Home Services: Telecare Does not Satisfy the Needs of the Elderly

Computer-based information and communication technology (ICT) is used in many service sectors. In home services, it has been considered whether it would be possible to support independent living of the elderly by using ICT; dependant on the needs of the elderly and whether those needs can be satisfied with ICT. In this study, the coping capabilities of 13 elderly clients of a Finnish home service office were assessed using the Finnish RaVa index. All the clients had severe dis abilities and needed help, e.g. to wash and dress. To satisfy such needs, telecare and the telemonitoring of homes are not enough; physical production and human labour are essential in the continuing absence of service robots. Thus, the major focus in organizing home services in the best possible way should be on the use of human labour, not on investing in ICT.

A generic telemedicine infrastructure for monitoring an artificial pancreas trial

Telemedicine systems are seen as a possible solution for the remote monitoring of physiological parameters and can be particularly useful for chronic patients treated at home. Implementing those systems however has always required spending a great effort on the underlying infrastructure instead of focusing on the application cores as perceived by their users. This paper proposes an abstract unifying infrastructure for telemedicine services which is loosely based on the multi-agent paradigm. It provides the capability of transferring to the clinic any remotely acquired information, and possibly sending back updates to the patient. The infrastructure is a layered one, with the bottom layer acting at the data level and implemented in terms of a software library targeting a wide set of hardware devices. On top of this infrastructure several services can be written shaping the functionality of the telemedicine application while at the highest level, adhering to a simple agent model, it is possible to reuse those functional components porting the application to different platforms. The infrastructure has been successfully used for implementing a telemonitoring service for a randomized controlled study aimed at testing the effectiveness of the artificial pancreas as a treatment within the AP@home project funded by the European Union.

A methodology to monitor the changing trends in health status of an elderly person by developing a markov model

In this paper we are proposing a statistical testing methodology to monitor changing trends in the health status of elderly people. The occupancy pattern of elderly people can be modeled using a Markov chain, estimating transition probabilities of the chain and test hypotheses about them. The profile of the person for a given period can be stored as a transition matrix of a discrete, regular, ergodic Markov chain. The observation of the occupancy pattern for a given test period can be established as a test Markov chain using information from sensors such as infrared sensors, magnetic switches etc. In the absence of real time data, we have used uniformly distributed transition probabilities to define the profile of the Markov chain and then generated test Markov chain based on this model. The transition probabilities are extracted for the test and profile Markov chain using Maximum Likelihood Estimates (MLE). The statistical testing of occupancy monitoring establishes a basis for statistical inference about the system performance without generating any real time statistics for the occupancy pattern. Chi square test and likelihood ratio tests ensure that the sequences generated from the two Markov chains are statistically same. Any difference in profile Markov chain and test Markov chain could indicate a changed health status of the elderly person.

Telehealth technologies for managing chronic disease - experiences from Australia and the UK

In developed countries, chronic disease now accounts for more than 75% of health care expenditure and nearly an equivalent percentage of disease-related deaths [1]. The burden of chronic disease (often, but not exclusively, associated with ageing) includes congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), hypertension and diabetes. Over the past several decades there has been an epidemiological shift in disease burden from acute to chronic diseases that has rendered acute care models of health service delivery inadequate to address population health needs.

Perspectives on use of personal alarms by older fallers

BACKGROUND

Personal alarms are proposed as a reliable mechanism for older people to obtain assistance after falling. However, little is known about how older people feel about owning and using personal alarms.

AIM

This paper reports on experiences of independently living older people, who have recently fallen, regarding alarm use and their independence.

METHOD

Volunteers older than 65 years who had sustained a fall in the previous six months were sought via community invitations. Semistructured telephone interviews were conducted to gain information about their fall and their perspectives on personal alarm use. Interviews were content-analyzed to identify key concepts and themes.

RESULTS

Thirty-one interviews were conducted. Twenty callers owned personal alarms. Four subgroups of older fallers were identified; the first group used personal alarms effectively and were advocates for their benefits, the second group owned an alarm but did not use it effectively, the third group did not own alarms mostly because of cost, although were receptive to an alarm should one be provided, and the fourth group did not have an alarm and would not use it even if it was provided.

DISCUSSION

Personal alarms produce positive experiences when used effectively by the right people. The cost of personal alarms prohibits some older fallers from being effective alarm users. However, other elderly fallers remain unwilling to consider alarm use even if one was provided. In view of their cost, personal alarms should be targeted to people who will benefit most. Alternative strategies should be considered when alarms are unlikely to be used appropriately.

Piecewise-linear trend detection in longitudinal physiological measurements

Recently, telecare solutions have been demonstrated as an effective means of monitoring chronic disease at a distance. A clinician may be managing many tens or hundreds of remote patients, prompting the need for a decision support system (DSS) to provide a more automated approach to managing these vast amounts of data. While simple threshold-based alert techniques provide some utility in notifying clinicians of extreme out-of-range parameter values, more incipient changes in a subject's condition may be sooner recognized by identifying trends in the longitudinal parameter data. Here we describe an approach for obtaining a piecewise-linear fit, to longitudinal physiological trend data, comparable with a similar fitting performed by a human observer, using a graphical user interface. The technique has been applied to both simulated and real data, and a comparison performed against the human scoring for each. On simulated data, the method matches or betters the human performance in most cases; with the greatest improvement observed in more noisy data. Similarly, for real physiological data, the deviation from the human marking, as a fraction of total variability of the signal, is less than 0.35.

Home e-health system integration in the Smart Home through a common media server

Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.

Prognosis-a wearable health-monitoring system for people at risk: methodology and modeling

Wearable health-monitoring systems (WHMSs) represent the new generation of healthcare by providing real-time unobtrusive monitoring of patients' physiological parameters through the deployment of several on-body and even intrabody biosensors. Although several technological issues regarding WHMS still need to be resolved in order to become more applicable in real-life scenarios, it is expected that continuous ambulatory monitoring of vital signs will enable proactive personal health management and better treatment of patients suffering from chronic diseases, of the elderly population, and of emergency situations. In this paper, we present a physiological data fusion model for multisensor WHMS called Prognosis. The proposed methodology is based on a fuzzy regular language for the generation of the prognoses of the health conditions of the patient, whereby the current state of the corresponding fuzzy finite-state machine signifies the current estimated health state and context of the patient. The operation of the proposed scheme is explained via detailed examples in hypothetical scenarios. Finally, a stochastic Petri net model of the human-device interaction is presented, which illustrates how additional health status feedback can be obtained from the WHMS' user.

GP-support by means of AGnES-practice assistants and the use of telecare devices in a sparsely populated region in Northern Germany--proof of concept

BACKGROUND

In many rural regions in Germany, the proportion of the elderly population increases rapidly. Simultaneously, about one-third of the presently active GPs will retire until 2010. Often it is difficult to find successors for vacant GP-practices. These regions require innovative concepts to avoid the imminent shortage in primary health care.The AGnES-concept comprises the delegation of GP-home visits to qualified AGnES-practice assistants (AGnES: GP-supporting, community-based, e-health-assisted, systemic intervention). Main objectives were the assessment of the acceptance of the AGnES-concept by the participating GPs, patients, and AGnES-practice assistants, the kind of delegated tasks, and the feasibility of home telecare in a GP-practice.

METHODS

In this paper, we report first results of the implementation of this concept in regular GP-practices, conducted November 2005--March 2007 on the Island of Rügen, Mecklenburg-Western Pomerania, Germany. This study was meant as a proof of concept.The GP delegated routine home-visits to qualified practice employees (here: registered nurses). Eligible patients were provided with telecare-devices to monitor disease-related physiological values.All delegated tasks, modules conducted and questionnaire responses were documented. The participating patients were asked for their acceptance based on standardized questionnaires. The GPs and AGnES-practice assistants were asked for their judgement about different project components, the quality of health care provision and the competences of the AGnES-practice assistants.

RESULTS

550 home visits were conducted. 105 patients, two GPs and three AGnES-practice assistants (all registered nurses) participated in the project. 48 patients used telecare-devices to monitor health parameters. 87.4% of the patients accepted AGnES-care as comparable to common GP-care. In the course of the project, the GPs delegated an increasing number of both monitoring and interventional tasks to the AGnES-practice assistants. The GPs agreed that delegating tasks to a qualified practice assistant relieves them in their daily work.

CONCLUSION

A part of the GPs home visits can be delegated to AGnES-practice assistants to support GPs in regions with an imminent or already existing undersupply in primary care. The project triggered discussions among the institutions involved in the German healthcare system and supported a reconciliation of the respective competences of physicians and other medical professions.

A review of smart homes- present state and future challenges

In the era of information technology, the elderly and disabled can be monitored with numerous intelligent devices. Sensors can be implanted into their home for continuous mobility assistance and non-obtrusive disease prevention. Modern sensor-embedded houses, or smart houses, cannot only assist people with reduced physical functions but help resolve the social isolation they face. They are capable of providing assistance without limiting or disturbing the resident's daily routine, giving him or her greater comfort, pleasure, and well-being. This article presents an international selection of leading smart home projects, as well as the associated technologies of wearable/implantable monitoring systems and assistive robotics. The latter are often designed as components of the larger smart home environment. The paper will conclude by discussing future challenges of the domain.

Electronic health services: an introduction to theory and application

Information and communication technologies have made dramatic changes in our lives. Healthcare communities also made use of these technologies. Using computerized medical knowledge, electronic patients' information and telecommunications a lot of applications are now established throughout the world. These include better ways of information management, remote education, telemedicine and public services. Yet, a lot of people don't know about these technologies and their applications. Understanding the concepts and ideologies behind these terms, knowing how they will be implemented, what is it like to use them and what benefit will be gained, are basic knowledge steps approaching these technologies. Difficulties using these services, especially in developing countries should not be neglected or underestimated.

Attitudes Toward Videotelephones: An Exploratory Study of Older Adults with Depression

Although technology holds promising benefits to support older adults at home, attitudes can be a hindrance to the acceptance and use of new technologies. The aim of this study was to explore attitudes of older adults with depressive symptoms using videotelephones (VTs) in their homes. A descriptive design involving 4 participants who received problem solving interventions from a clinical psychologist via VTs was used. Data analysis revealed that the participants' preattitudes were dependent on their active or passive role in the learning process of the new technology. Their postattitudes were classified as ambivalent and positive. Two participants who had a positive attitude toward the VT expressed a positive behavior use.

Moving research into practice: A decision framework for integrating home telehealth into chronic illness care

Home telehealth is an effective alternative for some aspects of traditional care in chronic illnesses such as diabetes, congestive heart failure and asthma. However, in spite of evidence to support use of home telehealth technologies, they have not been adopted as predicted. A significant challenge for decision-makers is applying results from multiple small studies to the care of large numbers of clients in a health region. Aside from the technology, this complex decision must also include expected client outcomes, variations in nursing resources and their deployment in service delivery. This paper presents research evidence supporting the effectiveness of home telehealth for diabetes care, with attention to the range of technologies and outcome measures reported. It also discusses implications of a recently released national study on "Homecare Indicators" that reported resource allocation and outcomes in home care. The burden of illness, evidence of technology effectiveness and proposed home care outcome indicators are considered together in a decision framework to demonstrate an approach for decision-makers and practitioners to transfer home telehealth research into practice. The resulting decision framework is applied to diabetes care within one large health region in Canada to illustrate its utility as a research transfer strategy.

Rural Outreach in Home Telehealth: Assessing Challenges and Reviewing Successes

Most home health agencies that adopt home telehealth tend to be located in urban or metropolitan areas. This paper discusses a 3-year pilot of home telehealth in four rural areas. Several challenges related to the rural nature of the home health agencies were recognized. These challenges are discussed with recommendations for assessing rural home health agencies for home telehealth. Our findings suggest ways to improve the implementation of home telehealth for rural home health agencies. In addition to the challenges, successes were realized as well. Approximately 145 travel hours and 7500 miles of nurse travel were avoided through the use of home telehealth during the program. Patient examples show improvements in their medical conditions, which the nursing staff thought would not have been accomplished without the more frequent monitoring that home telehealth allowed the agencies to provide.

Home telehealth--current state and future trends

OBJECTIVE

The purpose of this paper is to give an overview about the state of the art in research on home telehealth in an international perspective.

METHOD

The study is based on a review of the scientific literature published between 1990 and 2003 and retrieved via Medline in January/February 2004. All together, the abstracts of 578 publications have been analyzed.

RESULTS

The majority of publications (44%) comes from the United States, followed by UK and Japan. Most publications deal with vital sign parameter (VSP) measurement and audio/video consultations ("virtual visits"). Publications about IT tools for improved information access and communication as well as decision support for staff, patients and relatives are relatively sparse. Clinical application domains are mainly chronic diseases, the elderly population and paediatrics.

CONCLUSIONS

Internationally, we observe a trend towards tools and services not only for professionals but also for patients and citizens. However, their impact on the patient-provider relationship and their design for special user groups, such as elderly and/or disabled needs to be further explored. In general, evaluation studies are rare and further research is critical to determine the impacts and benefits, and limitations, of potential solutions and to overcome a number of hinders and restrictions, such as - the lack of standards to combine incompatible information systems; - the lack of an evaluation framework considering legal, ethical, organisational, clinical, usability and technical aspects; - the lack of proper guidelines for practical implementation of home telehealth solutions.

The role of nurses in installing telehealth technology in the home

Home telehealth involves the use of video conferencing or remote monitoring equipment in patients' homes. The installation of hardware and training of patients has historically been performed by nurses, typically RNs. This article examines the experience of RNs as telehealth installers in the Informatics for Diabetes Education and Telemedicine (IDEATel) project, where RNs were responsible for the installation of the Home Telemedicine Units (HTUs) and for training patients in the use of the HTUs, blood pressure cuffs, and fingerstick glucose meters. Average installation and training time was 166 minutes (SD 51 min). Structured interviews with RN installers revealed that patient education and training accounted for roughly two thirds of the in-home time. Technology-related problems, especially those related to telecommunications, were the primary cause of installation difficulties. Thematic analysis of installer interviews identified eight major themes and confirmed the importance of both clinical and technical knowledge during the telehealth installation process.

Accelerometry: providing an integrated, practical method for long-term, ambulatory monitoring of human movement

Accelerometry offers a practical and low cost method of objectively monitoring human movements, and has particular applicability to the monitoring of free-living subjects. Accelerometers have been used to monitor a range of different movements, including gait, sit-to-stand transfers, postural sway and falls. They have also been used to measure physical activity levels and to identify and classify movements performed by subjects. This paper reviews the use of accelerometer-based systems in each of these areas. The scope and applicability of such systems in unsupervised monitoring of human movement are considered. The different systems and monitoring techniques can be integrated to provide a more comprehensive system that is suitable for measuring a range of different parameters in an unsupervised monitoring context with free-living subjects. An integrated approach is described in which a single, waist-mounted accelerometry system is used to monitor a range of different parameters of human movement in an unsupervised setting.

Do people in rural and remote Queensland delay using health services to manage the episodes of incapacity?

The research project described in the present paper aimed to explore the types of self-reported management which families in relatively 'high', 'moderate' and 'low' medically resourced areas use for episodes of incapacity and the length of time from an initial symptom to the management behaviours. A telephone survey was conducted in rural and remote Queensland, Australia, to explore one or more types of management for the most recent incapacity episode of family members. A respondent indicated at least one type of management for any one episode. These included using a home remedy, self-treatment and an ambulatory doctor's visit. Data were analysed descriptively and analytically. Log transformations were used for all outcomes prior to using bivariate analyses which incorporated the correlation between observations to compare the time from initial symptom to management between groups. Among 394 households contacted, 270 provided information about 697 household members, 269 (38.5%) of whom had had at least one episode of incapacity in the previous 12 months. Among people in each of the three resourced areas, there was a significant difference in the length of time taken to visit accident and emergency (A&E) units. Men visited the units and consulted books earlier than women. Although age was not quite significantly related to the use of A&E units (P = 0.06), data suggested that people 35 years or older tended to take a longer time to use the services than the younger age groups. After taking into account that the members of the same household might take the same time from initial symptoms to management, people who were incapacitated and lived in areas with different levels of medical resources and gender were likely to be different in the time taken to use services at the A&E units.

Using information technology to improve the management of chronic disease

Information and communications technology (ICT) is increasingly being used in management of chronic illness to facilitate shared services (virtual health networks and electronic health records), knowledge management (care rules and protocols, scheduling, information directories), as well as consumer-based health education and evidence-based clinical protocols. Common applications of ICT include home monitoring of vital signs for patients with chronic disease, as well as replacing home visits by nurses in person with telemedicine videophone consultations. A patient-managed Home Telecare System with integrated clinical signs monitoring, automated scheduling and medication reminders, as well as access to health education and daily logs, is presented as an example of ICT use for chronic disease self-management. A clinical case study demonstrates how early identification of adverse trends in clinical signs recorded in the home can either avoid hospital readmission or reduce the length of hospital stay.

Multimedia telehomecare system using standard TV set

Nowadays, there are a very large number of patients that need specific health support at home. The deployment of broadband communication networks is making feasible the provision of home care services with a proper quality of service. This paper presents a telehomecare multimedia platform that runs over integrated services digital network and internet protocol using videoconferencing standards H.320 and H.323, and standard TV set for patient interaction. This platform allows online remote monitoring: ECG, heart sound, blood pressure. Usability, affordability, and interoperability were considered for the design and development of its hardware and software components. A first evaluation of technical and usability aspects were carried forward with 52 patients of a private clinic and 10 students in the University. Results show a high rate (mean = 4.33, standard deviation--SD = 1.63 in a five-points Likert scale) in the global perception of users on the quality of images, voice, and feeling of virtual presence.

Management of episodes of incapacity by families in rural and remote Queensland

People in rural and remote areas have relatively poor health, so limited availability of and accessibility to doctors are major health issues. This cross-sectional study was conducted in rural and remote areas of Central Queensland. Using telephone interviews, the study described the use of formal and informal health services by families in response to episodes of incapacity. An episode of incapacity was defined as inability to conduct ordinary activities for at least half a day due to new or continued illness. Of the 394 households contacted, 270 (68.5%) provided information about 698 household members, of whom 269 (38.5%) reported at least one episode of incapacity in the previous 12 months. The respondents could report more than one type of management of an illness episode. The management of the most recent episode in each member included 68% visiting doctors and 8.2% using services at an accident and emergency unit. Persons living in "least" medically resourced areas were more likely than persons in relatively "high" and "moderate" areas to consult doctors, but were also more likely to first consult books and delay their visits. They also consulted by telephone three times more frequently. Only 7% consulted other health practitioners including nurses and chemists, suggesting that these health practitioners were not used by families in rural and remote areas during episodes of incapacity. Increasing the availability and accessibility of medical care resources in rural and remote areas, using alternative delivery methods such as telemedicine, may meet the health needs of rural populations.

Modelling home televisiting services using systems dynamic theory

A quantitative model was developed to study the provision of a home televisiting service. Systems dynamic theory was used to describe the relationships between quality of care, accessibility and cost-effectiveness. Input information was gathered from the telemedicine literature, as well as from over 75 sessions of a televisiting service provided by the Severo Ochoa Hospital to 18 housebound patients from three different medical specialties. The model allowed the Severo Ochoa Hospital to estimate the equipment needed to support increased medical contacts for intensive cardiac and other patients.

Time-course action analysis of daily life investigations in the Welfare Techno House in Mizusawa

In this study, we have examined the possibility of non-intrusive monitoring at home. We describe the experimental results of the relation between an individual's recorded behavior and the actions detected by the sensors during the course of the subject's daily life. Infrared sensors and the opening of doors and windows and the use of appliances were used. In this paper, it is assumed that the subjects were sleeping when there were no responses by the infrared sensors or when only the bedroom sensor was responding. The sensors were able to detect excretion by using the outputs of the infrared sensor and the water valve of the lavatory, even if a subject did not record it in the time-course of daily life during the investigation. Our findings show that the actions of subjects who stayed at Welfare Techno House (WTH) in Mizusawa could be estimated from outside the house, especially for sleeping and excretion.