Elena Villalba

Integrated personal health and care services deployment: experiences in eight European countries.

OBJECTIVES The deployment and adoption of Integrated Personal Health and Care Services in Europe has been slow and fragmented. There have been many initiatives and projects of this kind in different European regions, many of which have not gone beyond the pilot stage. We investigated the necessary conditions for mainstreaming these services into care provision. METHODS We conducted a qualitative analysis of 27 Telehealth, Telecare and Integrated Personal Health System projects, implemented across 20 regions in eight European countries. The analysis was based on Suters ten key principles for successful health systems integration. RESULTS Out of the 27 cases, we focussed on 11 which continued beyond the pilot stage. The key facilitators that are necessary for successful deployment and adoption in the European regions of our study are reorganisation of services, patient focus, governance mechanisms, interoperable information systems, policy commitment, engaged professionals, national investments and funding programmes, and incentives and financing. CONCLUSION In those cases which provided evidence of success beyond the pilot stage, we observed a promising trend: awareness and introduction of Integrated Personal Health and Care Services in European regions has increased. Further research will reveal the weight of each facilitator and which combinations of facilitators lead to rapid adoption.

Heart Failure Monitoring System Based on Wearable and Information Technologies

Cardiovascular diseases (CVD) are the leading source of death in the western world and in particular, in Europe CVD cause 45% of all deaths. Besides, heart failure (HF), the paradigm of CVD, affects mainly people older than 65. Facing this reality, the European Union funded MyHeart Project, whose mission is empowering citizens to fight CVD by means of a preventive lifestyle and an early diagnosis. This paper presents an innovative integrated solution for the assessment of heart failure: HF management (HFM). HFM is a heart failure disease management system that makes use of innovative approaches, based on information technologies (IT) and wearable technologies, for the continuous assessment of HF progression and cardiovascular risk stratification. By integrating patient data from different sources with special emphasis in the information obtained from extensive ECG processing the system assesses the patients cardiac condition. Rather than just merely evaluating the cardiovascular status, HFM is designed to motivate patients to acquire an active role in their health management and to help them to improve their cardiac condition by promoting physical exercise

User interaction design for a wearable and IT based heart failure system

In Europe, Cardiovascular Diseases (CVD) are the leading source of death, causing 45% of all deaths. Besides, Heart Failure, the paradigm of CVD, mainly affects people older than 65. In the current aging society, the European MyHeart Project was created, whose mission is to empower citizens to fight CVD by leading a preventive lifestyle and being able to be diagnosed at an early stage. This paper presents the design of the user interaction of a Heart Failure Management System, based on daily monitoring of Vital Body Signals, with wearable and mobile technologies, for the continuous assessment of this chronic disease. The user interaction in such systems plays a role of major importance, enabling the usage of technical solutions which motivate people to adopt healthy lifestyles.

Extending Mobile App Analytics for Usability Test Logging

Mobile application development is characterized by reduced development cycles and high time-to-market pressure. Usability evaluation in mobile applications calls for the application of cost-effective methods, specially adapted to such constraints. We propose extending the Google Analytics for Mobile Applications basic service to store specific low-level user actions of interest for usability evaluation purposes. The solution can serve both for lab usability testing, automating quantitative data gathering, and for logging real use after application release. It is based on identification of relevant user tasks and the detailed events worth gathering, instrumentation of specific code for data gathering, and subsequent data extraction for calculating relevant usability–related variables. We validated our application in a real usability test by comparing the automatically gathered data with the information gathered by the human observer. Results shows both measurements are statistically exchangeable, opening promising new ways to perform usability testing cost-effectively and at greater scale.

Self Care System to Assess Cardiovascular Diseases at Home

CUORE is a Heart Failure (HF) Disease Assessment System that uses Information Technologies (IT) and portable monitoring devices, for to assess and to manage the HF progression. The system valuates the cardiac condition integrating patient data from different sources such as blood pressure cuff or questionnaires. Rather than just evaluate the cardiovascular status, the system also aims to motivate patients to have an active role in their health management and to improve their cardiac condition through an active lifestyle. This paper presents the CUORE validation with patients and professionals.

Self care system for heart failure out of hospital patients

CUORE is a Heart Failure (HF) Disease Assessment System that makes use of innovative approaches, based on Information Technologies (IT) and portable monitoring devices, for the continuous assessment of HF progression and cardiovascular risk stratification. The system valuates the cardiac condition integrating patient data from different sources with special emphasis in the information obtained for ECG processing. Rather than just evaluate the cardiovascular status, the system also aims to motivate patients to have an active role in their health management and to improve their cardiac condition by promotion of an active lifestyle. In order to make the system usable the methodology adopted to create the final solution is iterative and it involves users in all stages. This paper presents the conceptualization of CUORE as a solution to self care for heart failure out of hospital patients.

Patient interaction in homecare systems to treat cardiovascular diseases in the long term

The rapid aging of the population worldwide will dramatically increase the number of people affected by chronic diseases in the next years. This social situation makes it necessary a paradigm shift from reactive care to preventive care. New technological paradigms, like Ambient Intelligence and Ubiquitous Computing, allow the development of Personal Health Systems (PHS) that guarantee the continuity of care and a better use of health resources. Therefore, patients should become the centre of the health care process, and PHS should be designed to fulfill the patients goals and needs. User-centred methodologies provide a good framework for designing general use applications, but they do not usually take into account factors like the context where the interaction is taking place or the medical, social and business contexts that surround the patient. This paper presents a model for designing users interaction in medical applications. The final goal is to develop highly usable user interfaces and to improve the user experience, aiming to guarantee the patients adherence to the medical protocols and recommendations.

A MOBILE APPLICATION TO PROMOTE ATTENDANCE AND PARTICIPATION IN THE CLASSROOM

A mobile application is presented that encourages students to attend classes and promotes their active participation, as a means to reduce absenteeism and to provide assistance for the continuous evaluation of the learning process. In this paper we describe the design of the application and provide some preliminary results of its evaluation.

Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – Veterans Health Administration (USA) Case Study Report

The Veterans Health Administration (VHA) is an agency of the United States Department of Veterans’ Affairs (this Department that has the 3rd largest budget among departments of the US administration). The medical assistance program implemented by the VHA is the largest integrated care system in the US (consisting of 150 medical centres and nearly 1,700 facilities comprising community-based outpatient clinics, community living centres, Veterans’ Centres and domiciliary assistance). It provides comprehensive care to almost 9 million veterans every year. The VHA is centrally administered and fully integrated; its services are funded and provided by the federal government. Therefore the VHA works both as a provider and payer, a rather unusual feature in the US health care structure. In fact, VHA is the only truly national health care system in the US, with hospitals or other facilities in every state and major metropolitan area of the country, as well as in Puerto Rico, the Virgin Islands, Guam, American Samoa and the Philippines. The VHA network is divided into 23 Veterans Integrated Service Networks, or VISNs, i.e. regional systems of care working together to better meet local health care needs and provide greater access to care.

Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – Renewing Health Carinthia (Austria) Case Study Report

Renewing Health is a European project (February 2010-December 2013), partly funded by the European Union under the ICT Policy Support Programme, part of the Competitiveness and Innovation framework Programme (CIP), with a total budget of €14 million and European co-financing of €7 million. The project aimed to implement health-related ICT services through large-scale real-life test beds for the validation and subsequent evaluation of innovative eHealth services, using a patient-centred approach and a rigorous common assessment methodology. This case study focuses on the Austrian Partner of the project: the Carinthia region and, more precisely, KABEG (Krankenanstalten Betriebsgesellschaft), the hospital management company in the region. In RENEWING HEALTH, KABEG integrated a set of telemonitoring solutions into their existing systems for two target groups - patients suffering from Diabetes Mellitus Type II and patients suffering from COPD – in order to carry out two pilots to test the effects of the resulting system.