Alison Marshall

Use of a smartphone for improved self-management of pulmonary rehabilitation

Patients suffering from chronic respiratory disease need to follow a rehabilitative exercise programme, in order to self-manage their illness and improve quality of life. Adherence to the programme is highly dependent on professional support from a physiotherapist and hence declines when patients seek to self-manage in the home. A number of requirements were identified for a Smartphone-based application in which patients are supported remotely and given automatic feedback during exercise. An application is described which will improve adherence during pulmonary rehabilitation.

User-Friendly Interface for the Smartphone-based Self Management of Pulmonary Rehabilitation

A prototype system has been developed, based on a mobile Smartphone linked via Bluetooth to a range of monitoring devices (pulse oximeter, blood pressure monitor, ECG monitor), with a facility to integrate to clinical information systems, to enable individuals to self manage their own healthcare. The system has been developed to be used in specific chronic disease applications. The research study described outlines three specific applications of chronic disease self management - nutrition and exercise monitor for weight reduction; - pulse oximeter and exercise monitor for pulmonary rehabilitation: - blood pressure monitor for coronary heart disease patients. The objectives of the work are to design the system around the clinical application, based on existing health service protocols. The key principles in design are to make the system accessible to and usable by both the medical professional and a lay user. The pulmonary rehabilitation application is explored in more detail, to demonstrate progress towards this end.

A Framework for Improving Trust in Dynamic Service-Oriented Systems

Large-scale data processing systems frequently require users to make timely and high-value business decisions based upon information that is received from a variety of heterogeneous sources. Such heterogeneity is especially true of service-oriented systems, which are often dynamic in nature and composed of multiple interacting services. However, in order to establish user trust in such systems, there is a need to determine the validity and reliability of all the data sources that go into the making of a decision. This paper analyses the concept of provenance and discusses how the establishment of personalized provenance recording and retrieval systems can be used to increase the utility of data and engender user trust in complex service-based systems. An overview of current provenance research is presented, and a real-world project to address the abstract concepts of trust and data quality in industrial and clinical settings is presented. From this, we conclude that the addition of provenance into data processing and decision making systems can have a tangible benefit to improving the trust of system users.

Establishing Stakeholder Needs for Medical Devices

Regulatory bodies require manufacturers of medical devices to use formally planned design processes that provide improved understanding of user and other stakeholder needs, and so enable traceability of designs (e.g. functional requirements and design parameters) to facilitate the control and reduction of risk. Current processes involve significant consultation with users, but are generally unstructured and hence the value of their input is not maximised. User needs and design requirements are not demonstrably aligned. This paper discusses the problem of establishing stakeholder needs from information that typically results from marketing activities and introduces the NASo technique as a means to address these problems. An application of the technique to establish stakeholder needs is demonstrated through a case study of hip joint surgical instruments. The case study showed that the rigour of the NASo technique enabled both the identification of needs, which would otherwise be overlooked, and their documentation in a traceable manner. This is necessary to support not only the derivation of design requirements that are aligned with stakeholder needs but also the prioritisation and quantification, where applicable, of such requirements. The business benefit stemming from this is the confidence gained in evaluating new product and/or service opportunities and in an improved capacity to respond to design changes.Copyright

“Teleswallowing”: a case study of remote swallowing assessment

Purpose – Telemedicine has enabled speech and language therapists (SLTs) to remotely assess swallowing difficulties (dysphagia) experienced by nursing home residents. The new technique, “teleswallowing”, was designed by the Speech and Language Therapy Service at Blackpool Teaching Hospitals NHS Foundation Trust. It allows prompt assessment, avoiding potential risks of aspiration pneumonia, malnutrition, poor rehabilitation, increased hospital stays and reduced quality of life (Hinchey et al., 2005; Langmore et al., 1998). The purpose of this paper is to report on a second pilot of teleswallowing and the concomitant adoption study. Design/methodology/approach – The adoption study employed qualitative methods, including consultations with senior managers, semi-structured interviews with nursing home matrons/managers and nurses, two focus groups and semi-structured interviews with SLTs. The project clinical lead kept an activity log, which was used to estimate resource savings. Findings – Over a three-month ...

Provenance: Current directions and future challenges for service oriented computing

Modern organizations increasingly depend heavily on information stored and processed in distributed, heterogeneous data sources and services to make critical, high-value decisions. Service-oriented systems are dynamic in nature and are becoming ever more complex systems of systems. In such systems, knowing how data was derived is of significant importance in determining its validity and reliability. To address this, a number of advocates and theorists postulate that provenance is critical to building trust in data and the services that generated it as it provides evidence for data consumers to judge the integrity of the results. This paper provides an overview of provenance research with an emphasis on its application in the domain of service-oriented computing. The goal of this paper is not to provide an exhaustive survey of the provenance literature but rather to highlight key work, themes, challenges and issues as well as emerging areas related to the use of provenance as a mechanism for improving trust in data utilized in distributed computing environments.

Renal telemedicine through video-as-a-service delivered to patients on home dialysis: A qualitative study on the renal care team members’ experience

BACKGROUND The Lancashire Teaching Hospitals NHS Trust in the UK has been providing renal care through video-as-a-service (VAAS) to patients since 2013, with support from the North West NHS Shared Infrastructure Service, a collaborative team that supports information and communication technology use in the UK National Health Service. INTRODUCTION Renal telemedicine offered remotely to patients on home dialysis supports renal care through the provision of a live high-quality video link directly to unsupported patients undergoing haemodialysis at home. Home haemodialysis is known to provide benefits to patients, particularly in making them more independent. The use of a telemedicine video-link in Lancashire and South Cumbria, UK, further reduces patient dependence on the professional team. OBJECTIVE The purpose of this paper is to present the perspectives of the renal care team members using the renal telemedicine service to understand the perceived benefits and issues with the service. METHOD Ten semi-structured interviews with members of the renal care team (two renal specialists, one matron, two renal nurses, one business manager, one renal technical services manager, two IT technicians and one hardware maintenance technician) were conducted. Thematic analysis was undertaken to analyse the qualitative data. RESULTS A range of incremental benefits to the renal team members were reported, including more efficient use of staff time, reduced travel, peace of mind and a strong sense of job satisfaction. Healthcare staff believed that remote renal care through video was useful, encouraged concordance and could nurture confidence in patients. Key technological issues and adjustments which would improve the renal telemedicine service were also identified. CONCLUSION The impact of renal telemedicine was positive on the renal team members. The use of telemedicine has been demonstrated to make home dialysis delivery more efficient and safe. The learning from staff feedback could inform development of services elsewhere.

A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution

Introduction Patients Know Best (PKB) provides a patient portal with integrated, patient-controlled digital care records. Patient-controlled personal health records facilitate coordinated management of chronic disease through improved communications among, and about, patients across professional and organisational boundaries. An NHS foundation trust hospital has used PKB to support self-management in patients with inflammatory bowel disease; this paper presents a case study of usage. Methods The stakeholder empowered adoption model provided a framework for consulting variously placed stakeholders. Qualitative interviews with clinical stakeholders and a patient survey. Results Clinicians reported PKB to have enabled a new way of managing stable patients, this facilitated clinical and cost effective use of specialist nurses; improved two-way communications, and more optimal use of outpatient appointments and consultant time. The portal also facilitated a single, rationalised pathway for stable patients, enabling access to information and pro-active support. For patients, the system was a source of support when unwell and facilitated improved communication with specialists. Three main barriers to adoption were identified; these related to concerns over security, risk averse attitudes of users and problems with data integration. Conclusions Patient-controlled personal health records offer significant potential in supporting self-management. Digital connection to healthcare can help patients to understand their condition better and access appropriate, timely clinical advice.

Global Health Equity Foundation and IngeniumCare, LLC: Gathering Appropriate Evidence for Adoption of the ‘CareGo Remote TeleHealthCare System’

Millions of elderly and chronically ill people live at home either alone or with a cognitively impaired family member. Their daily health and safety is a huge concern for their family, friends, and healthcare providers. They worry that a family member could fall, forget to take their medication, become acutely ill suddenly, or experience an emergency situation such as a fire. Often family members live far away, are at work or busy with the responsibilities of caring for their own families. Vulnerable clients have several options for obtaining care including using a NHS community health or social care provider, independent home care service, or moving into an assisted living or longterm care facility. Care in the home is often not offered to the technical level required and it is expensive for NHS or local authorities to provide. Most people’s first choice is to continue living in their own home for as long as possible. The Ingenium CareGo Remote Healthcare System will alert family members or healthcare providers around the clock of potentially dangerous situations, allowing for immediate intervention and assistance. If the service user has missed taking medication or an important health measurement, such as blood pressure or blood sugar, the CareGo system can contact care-givers by phone, SMS text, or email. The CareGo system is an integrated solution combining unified communications, reminders to complete activities, tracks activity completion, and provides activity logs. Wireless devices support performance of health measurements, such as blood pressure, blood glucose, and weight, with data being easily retrievable by family and healthcare providers at any time. Through providing proactive verbal or visible reminders the system cues clients to take their medications on time and displaying the correct dose and administration instructions. A touchscreen Point of Care Appliance (POCA), is placed in the patient’s home and is the heart of the system. The POCA user interface displays large, simplified icons to enable the patient easily to initiate phone, video, twitter, SMS or email communication. It shows a daily calendar with reminders for all important daily activities, such as taking medications, health measurements, treatments, exercises, or going to a doctor’s appointment. CareGo also integrates with home environmental controls and with motion detectors. Graphic icons on POCA connect the client to emergency contacts with one touch, as well as to things such as family photo slides shows and internet based games. CareGo can be used as part of an integrated care coordination plan for patient education, improved adherence with treatments and medications, and compliance with discharge instructions following hospitalization. International Congress on Telehealth and Telecare 2013, London, July 01-03, 2013. 2 International Journal of Integrated Care –Volume 13, 20 November –URN:NBN:NL:UI:10-1-115665– http://www.ijic.org/ This technology is to be piloted in the Billings Clinic in Billings, Montana, USA with 30 patients initially rising to 200 over six months during the first part of 2013. The pilot is to ensure that the system is technically feasible and is acceptable to patients, family and clinicians. The presentation will: • Describe the system briefly; • Discuss the evaluation and evidence gathering methodology; • Describe ways in which the evaluation might be improved to enhance chances of adoption.

Student Supported Consultancy to Address Market Needs: Leeds Source-IT, a Case Study

As universities become more commercially oriented, the demand by local businesses for small scale consultancy increases. Although there is a growing interest from within the academic community to undertake consultancy, as part of a portfolio of commercial activity, there are also real tensions with the core activities of research and teaching. A pilot software services initiative, using students as consultants, is described. The challenges faced are discussed in the context of benefits to the consultants, the host university and to the regional economy.