Jeffrey Wood

Feasibility of congestive heart failure telemanagement using a wii-based telecare platform

A gaming platform has been used to implement a Home Automated Telemanagement (HAT) system for chronic disease management in the patients home. The system questions patients with congestive heart failure (CHF) to monitor symptoms, weight changes, and quality of life while educating the patient on their disease. The system is designed to run on the Nintendo Wii videogame console using an active internet connection and the consoles built in internet browser. It questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3 zone CHF action plan. The system is designed to be as simple as possible, making it usable by patients with no prior computer or videogame experience. This telemanagement system has been successfully designed and implemented to optimize the care of patients with CHF.

Design and implementation of Home Automated Telemanagement system for patients with multiple sclerosis.

We developed a Home Automated Telemanagement (HAT) system for the computer-guided management of patients with multiple sclerosis(MS) to monitor patient symptoms, educate patients on their disease, and to instruct and monitor an exercise regimen tailored to the patients specific needs. The home unit runs on a laptop computer connected to a phone line in the patients home. The system questions the patient on their condition, gives detailed step by step exercise instructions, records their exercise compliance, then informs and quizzes the patient on their knowledge of multiple sclerosis. Their exercise regimen is determined by their physical therapist and integrated into the system, keeping a personalized approach to disease management while taking advantage of the convenience the technology supplies. This telemanagement system has been successfully designed and implemented to optimize the care of patients with multiple sclerosis.

Implementing physical telerehabilitation system for patients with multiple sclerosis

Physical rehabilitation was shown to positively affect clinical outcomes in multiple sclerosis (MS). Telemedicine approaches can potentially facilitate home-based rehabilitation however telerehabilitation in MS have not been widely implemented. We developed a Home Automated Telemanagement (HAT) system for the computer-guided management of patients with MS to monitor patient symptoms, educate patients on their disease, and to instruct and monitor an exercise regimen tailored to the patients specific needs. The home unit runs on a netbook in the patients home connected to a remote server via internet. The system questions the patient on their condition, gives detailed step by step exercise instructions, records their daily exercise log, and informs and quizzes the patient on their knowledge of multiple sclerosis. The exercise log is transmitted to the remote HAT server where it is analyzed using decision support algorithms to facilitate MS management. Patient exercise regimen is determined by their physical therapist and can be updated on-line, keeping a personalized approach to disease management while taking advantage of the convenience the technology supplies. This telemanagement system has been successfully designed and implemented to optimize the care of patients with multiple sclerosis.

Using individualized pulse transit time calibration to monitor blood pressure during exercise.

Continuous blood pressure (BP) monitoring during exercise is necessary to ensure exercise safety, particularly in seniors and individuals with cardiovascular conditions. Pulse transit time (PTT) has been suggested for non-invasive BP monitoring however its implementation into clinical practice was hampered by lack of non-expensive practical solutions. The goal of this project was to introduce and to test a practical low-cost solution for using PTT to estimate BP during exercise. Our approach was based on obtaining 3 calibration points during different levels of exertion for each subject and utilizing the resulting individualized BP estimation equitation for patient-specific monitoring of BP during home-based exercise. Evaluation of the proposed approach showed that the mean difference between reference systolic BP (SBP) and estimated SBP was 0.0 mmHg. The optimal way to calculate PTT has been established by comparison of three main characteristic points used to derive PTT.

Using gaming platforms for telemedicine applications: A cross-platform comparison

The goal of this project was to compare the functionality of the most widely used gaming platforms in terms of their applicability for telemedicine applications and to demonstrate the possibility of implementing a comprehensive telemedicine system using these platforms. We implemented a Home Automated Telemanagement (HAT) system for patients with chronic diseases to provide support in following their individualized treatment plans as well as to monitor symptoms, medication use, and quality of life, while educating the patient on their disease. The system was developed for use on the Nintendo Wii, the Microsoft Xbox 360, and the Sony Playstation 3. All three current generation videogame consoles allow for development of internet-based applications designed to be delivered via the consoles web browsers. The HAT system was implemented to be placed in the patients home and to communicate all patient data to a central server implementing real-time clinical decision support. The system questions patients daily on their condition, monitors their vital signs, and provides the patient with instant feedback on their condition. Cognitive walkthrough was used to see what challenges were posed by each platform and interface. We demonstrated that using any of the three gaming platforms it is possible to build a comprehensive telemedicine system that may be usable by patients with no prior computer or videogame experience.

Introducing home telemanagement of congestive heart failure using Xbox gaming platform

Gaming platforms enjoy growing recognition as useful means to facilitate consumer health. The potential of such widely used platforms as Xbox for self-management of chronic health conditions has not yet been fully uncovered. We developed a Home Automated Telemanagement (HAT) system which utilizes Xbox to access personal health record, receive self-care support, and exchange information with health care providers. The system questions patients with congestive heart failure (CHF) to monitor symptoms, weight changes, and quality of life while educating the patient on their disease. The system is designed to run on the Microsoft Xbox videogame console using an active internet connection and a connection to a computer running Windows Media Center. It questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3 zone CHF action plan. The system is designed to be as simple as possible, making it usable by patients with no prior computer or videogame experience. This telemanagement system has been successfully designed and implemented to optimize the care of patients with CHF.

Exploring three perspectives on feasibility of a patient portal for older adults.

INTRODUCTION It is not clear whether older adults with chronic disease and their caregivers are likely to use patient portals. METHODS Older adults with a diagnosis of chronic obstructive pulmonary disease or congestive heart failure were evaluated as well as their caregivers. We explored whether these patients and/or their caregivers were able to use common portal elements. The perspective of informatics experts was ascertained using cognitive walkthrough methodology. RESULTS Fourteen patients and nineteen caregivers were evaluated. Patients required more time on all tasks than caregivers. Patient comments included a request for written instructions for using the system and a guide for interpreting lab results. Caregiver suggestions included improving color contrast and presentation of the current medication list. In the cognitive walkthrough, numerous problems were identified. CONCLUSIONS Older adults with chronic illness and caregivers were interested in using a patient portal however multiple barriers were identified.

Predicting asthma exacerbations using artificial intelligence.

Modern telemonitoring systems identify a serious patient deterioration when it already occurred. It would be much more beneficial if the upcoming clinical deterioration were identified ahead of time even before a patient actually experiences it. The goal of this study was to assess artificial intelligence approaches which potentially can be used in telemonitoring systems for advance prediction of changes in disease severity before they actually occur. The study dataset was based on daily self-reports submitted by 26 adult asthma patients during home telemonitoring consisting of 7001 records. Two classification algorithms were employed for building predictive models: naïve Bayesian classifier and support vector machines. Using a 7-day window, a support vector machine was able to predict asthma exacerbation to occur on the day 8 with the accuracy of 0.80, sensitivity of 0.84 and specificity of 0.80. Our study showed that methods of artificial intelligence have significant potential in developing individualized decision support for chronic disease telemonitoring systems.

Design and Implementation of Home Automated Telemanagement System for Patients with Ulcerative Colitis

We developed a Home Automated Telemanagement (HAT) system for the computer-guided management of patients with ulcerative colitis to monitor symptoms, medication compliance, weight changes, and quality of life, while educating the patients on their disease. The system runs on a laptop computer connected to a phone line and a digital scale placed in the patient’s home. The system questions the patient on their condition, monitors their weight, and provides the patient with feedback on suggested management techniques. Their medication regimen and suggested actions are determined by their physician and integrated in to the system, keeping a personalized approach to disease management while taking advantage of the technology available. This low-cost telemanagement system has been successfully introduced to optimize the care of patients with ulcerative colitis.

Interactive mobile system for smoking cessation

Tobacco use remains the single largest preventable cause of death and disease in the United States. We developed an interactive mobile system to facilitate smoking cessation by identifying which stage of change the patient was currently in and creating a custom intervention and cessation action plan based upon their feedback and experience. It is designed to follow the patient through their smoking cessation experience and adapt to their changing attitudes over time. We piloted this program with 49 current smokers hospitalized at Johns Hopkins Hospital. The mobile smoking cessation system was generally well received by hospitalized patients. Improvement in attitudes and stage of change were noticed between pretest and posttest, suggesting an ability to help change patients attitudes towards smoking and motivate them to quit. Providing real time decision support and tailoring the content shown to the patients to their personal profile can be a viable means in smoking cessation.