Jürgen Morak

Design and Evaluation of a Telemonitoring Concept Based on NFC-Enabled Mobile Phones and Sensor Devices

Utilization of information and communication technologies such as mobile phones and wireless sensor networks becomes more and more common in the field of telemonitoring for chronic diseases. Providing elderly people with a mobile-phone-based patient terminal requires a barrier-free design of the overall user interface including the setup of wireless communication links to sensor devices. To easily manage the connection between a mobile phone and wireless sensor devices, a concept based on the combination of Bluetooth and near-field communication technology has been developed. It allows us initiating communication between two devices just by bringing them close together for a few seconds without manually configuring the communication link. This concept has been piloted with a sensor device and evaluated in terms of usability and feasibility. Results indicate that this solution has the potential to simplify the handling of wireless sensor networks for people with limited technical skills.

Mobile health (mHealth) based medication adherence measurement – a pilot trial using electronic blisters in diabetes patients

The aim of the present study was to evaluate a mobile health (mHealth) based remote medication adherence measurement system (mAMS) in elderly patients with increased cardiovascular risk treated for diabetes, high cholesterol and hypertension. Cardiovascular risk was defined as the presence of at least two out of the three risk factors: type 2 diabetes, hypercholesterolaemia and hypertension.

Near Field Communication Technology as the Key for Data Acquisition in Clinical Research

Electronic data capture systems are utilized to collect, document, and process research data for clinical trials. Ideally, the workflow of collecting the data could be simplified by using mobile clients that enable for data acquisition at the point-of-care. Mobile phones provide a range of features to act as data acquisition unit for clinical trials. A novel approach towards an automated solution is the combination of mobile phones with Near Field Communication (NFC) technology. This technology enables for easy-to-use data acquisition just by touching items. The aim of this work has been to design and develop an additional path for clinical data acquisition based on mobile phones and NFC technology. The system was utilized in a pilot trial and evaluated regarding usability and feasibility for clinical application.

Innovative telemonitoring system for cardiology: from science to routine operation.

OBJECTIVE Results of the Austrian MOBITEL (MOBIle phone based TELemonitoring for heart failure patients) trial indicate that home-based telemonitoring improves outcome of chronic heart failure (CHF) patients and reduces both frequency and duration of hospitalizations. Based on lessons learned, we assessed the weak points to clear the way for routine operations. METHODS We analyzed the system with respect to recommendations of the ESC Guidelines and experiences gained throughout the trial to identify potential improvements. The following components have been identified: a patient terminal with highest usability, integrated way to document drug-intake and well-being, and automated event detection for worsening of CHF. As a consequence the system was extended by Near Field Communication (NFC) technology and by an event management tool. RESULTS Usability evaluation with 30 adults (14f, median 51y. IQR[45-65]) showed that 21 (8f) were able to immediately operate the system after reading a step-by-step manual. Eight (6f) needed one time demonstration and one man (80y) failed to operate the blood pressure meter. Routine operation of the revised system started in March 2009. Within 9 months, 15 patients (4f, median 74y. IQR[71-83], all NYHA-III) transmitted 17,149 items. 43 events were detected because of body weight gain of more then 2kg within 2 days. 49 therapy adjustments were documented. Three patients stopped using the system, two (1f) because of non-compliance and one (m, 82y) because of death. Overall, the rate of adherence to daily data transfer was 78%. CONCLUSION First results confirm the applicability of the revised telemonitoring system in routine operation.

Electronic data capture platform for clinical research based on mobile phones and Near Field Communication technology

Electronic data capture systems support data acquisition for clinical research and enable the evaluation of new investigational medical devices. In case of evaluating a device the most challenging part is the user interface i.e. the solution how to acquire the data within a clinical setting and to synchronize them with a web-based data centre. The aim of this paper is to describe the development of an electronic data capture system with a mobile data input solution based on mobile phones and Near Field Communication technology. This system was evaluated within a real clinical setting and demonstrated high usability, security and reliability.

Experiences Using Mobile Phones as Patient-Terminal for Telemedical Home Care and Therapy Monitoring of Patients Suffering from Chronic Diseases

Optimizing the treatment of chronic diseases requires continuous monitoring of the health status. With standard information and communication technology this challenge can be solved, with respect to special needs of patients, stated as marginal effort and simple handling. We present a therapy-management-system where patients acquired their health data using a Java-application running on mobile phones. The data were transferred to the health centre, which provided data visualization, individual feedback, reminders and surveillance of critical events. The system was evaluated in the course of two clinical trials with patients suffering from diabetes mellitus. Seven out of ten patients of the first trial returned questionnaires and reported feasibility of the concept for regular daily use. Patients of the second trial reported problems to a telephone-hotline, most were related to faulty data insertion. Based on their high user acceptance and ubiquitous availability mobile phones show the potential to be the patient-terminal of choice.

Near Field Communication-based telemonitoring with integrated ECG recordings

OBJECTIVES Telemonitoring of vital signs is an established option in treatment of patients with chronic heart failure (CHF). In order to allow for early detection of atrial fibrillation (AF) which is highly prevalent in the CHF population telemonitoring programs should include electrocardiogram (ECG) signals. It was therefore the aim to extend our current home monitoring system based on mobile phones and Near Field Communication technology (NFC) to enable patients acquiring their ECG signals autonomously in an easy-to-use way. METHODS We prototypically developed a sensing device for the concurrent acquisition of blood pressure and ECG signals. The design of the device equipped with NFC technology and Bluetooth allowed for intuitive interaction with a mobile phone based patient terminal. This ECG monitoring system was evaluated in the course of a clinical pilot trial to assess the systems technical feasibility, usability and patients adherence to twice daily usage. RESULTS 21 patients (4f, 54 ± 14 years) suffering from CHF were included in the study and were asked to transmit two ECG recordings per day via the telemonitoring system autonomously over a monitoring period of seven days. One patient dropped out from the study. 211 data sets were transmitted over a cumulative monitoring period of 140 days (overall adherence rate 82.2%). 55% and 8% of the transmitted ECG signals were sufficient for ventricular and atrial rhythm assessment, respectively. CONCLUSIONS Although ECG signal quality has to be improved for better AF detection the developed communication design of joining Bluetooth and NFC technology in our telemonitoring system allows for ambulatory ECG acquisition with high adherence rates and system usability in heart failure patients.

Design and Evaluation of Near Field Communication (NFC) Technology Based Solutions for mHealth Challenges

Today’s healthcare systems are facing major challenges generated by the increasing prevalence of chronic diseases. Telehealth services appear as promising approaches to attenuate those challenges by changing the way of delivering healthcare services. Telehealth is based on the inclusion of the last unutilized resource that has to be brought into the process of healthcare, the patient him/herself [1].

An eHealth System for Pressure Ulcer Risk Assessment Based on Accelerometer and Pressure Data

Pressure ulcers are a common skin disease which is associated with pain, reduced autonomy, social isolation, and reduced quality of life. There are several systems for monitoring of pressure ulcer-related risk factors on the market, but up to now no satisfactory solution is available, especially for people with medium pressure ulcer risk. We present a novel pressure ulcer risk assessment and prevention system, which combines the advantages of accelerometer and pressure sensors for monitoring pressure ulcer risk factors. Sensors are used for detection of repositionings of the person lying on the mattress. Sensor data are sent to a tablet where they are analysed and presented graphically. The system was evaluated in a long-term test at the homes of people of the target group. Results indicate that the system is able to detect movements of persons while lying in bed. Weak correlation in between mobility and Braden pressure ulcer risk was found (correlation factor = 0.31). From our data, long-term trends could be visualized as well as 24 h mobility profiles. Such graphical illustrations might be helpful for caregivers in order to optimize care of people with medium to high pressure ulcer risk.

An mHealth system for toxicity monitoring of paediatric oncological patients using Near Field Communication technology

Home-based monitoring might be useful to reduce the burden of long-lasting oncological treatment for children. Current telemonitoring applications focus on chronic diseases or elderly people. Based on the workflow for different stakeholders and the identification of parameters important in paediatric oncology, we developed a prototype of a smartphone-based telehealth system using Near Field Communication technology for monitoring paediatric neuroblastoma patients at home. The parameters blood pressure, heart rate, temperature, body weight, C-reactive protein, white blood cell count, wellbeing, pain level, nausea level and skin alterations could be monitored using a smartphone, a designated app, point-of-care measurement devices and a smart-poster containing RFID tags. The system has been designed to increase the quality of life for paediatric cancer patients. As a future step, a clinical trial is currently being planned to evaluate the system in clinical setting.