Leili Lind

Requirements and prototyping of a home health care application based on emerging java technology

IT support for home health care is an expanding area within health care IT development. Home health care differs from other in- or outpatient care delivery forms in a number of ways, and thus, the introduction of home health care applications must be based on a rigorous analysis of necessary requirements to secure safe and reliable health care. This article reports early experiences from the development of a home health care application based on emerging JAVA technologies. A prototype application for the follow-up of diabetes patients is presented and discussed in relation to a list of general requirements on home health care applications.

A system for symptom assessment in advanced palliative home healthcare using digital pens.

Symptom control is one of the most important components of delivering effective palliative care, and adequate symptom assessment is a prerequisite for good symptom control. Patients receiving treatment in palliative home healthcare is geographically separated from the caregivers making symptom control a challenge, a challenge that could be met by the use of information and communication technology. Technologies of today offer different ways for patients to assess their symptoms at home and send the assessments to the healthcare provider. Examples are the use of a PC, a touch-tone telephone, and a digital pen, which require different kinds of infrastructure in the patients home, and which differ in strengths and weaknesses. As part of an ongoing quality assurance work within the hospital-based home care clinic at Linköping University Hospital, the project has designed, developed and implemented an IT-support system for pain assessments for patients at home using digital pen and mobile Internet technology. A questionnaire study indicated that pain assessment using digital pens was accepted by patients and that problems mainly arose from the use of the visual-analogue scale.

Old-and With Severe Heart Failure: Telemonitoring by Using Digital Pen Technology in Specialized Homecare: System Description, Implementation, and Early Results.

Telehealth programs for heart failure have been studied using a variety of techniques. Because currently a majority of the elderly are nonusers of computers and Internet, we developed a home telehealth system based on digital pen technology. Fourteen patients (mean age, 84 years [median, 83 years]) with severe heart failure participated in a 13-month pilot study in specialized homecare. Participants communicated patient-reported outcome measures daily using the digital pen and health diary forms, submitting a total of 3 520 reports. The reports generated a total of 632 notifications when reports indicated worsening health. Healthcare professionals reviewed reports frequently, more than 4700 times throughout the study, and acted on the information provided. Patients answered questionnaires and were observed in their home environment when using the system. Results showed that the technology was accepted by participants: patients experienced an improved contact with clinicians; they felt more compliant with healthcare professionals’ advice, and they felt more secure and more involved in their own care. Via the system, the healthcare professionals detected heart failure–related deteriorations at an earlier stage, and as a consequence, none of the patients were admitted into hospital care during the study.

Digital pen-based telemonitoring of elderly heart failure patients.

Considering that a majority of elderlies are non-users of computers and Internet we developed a telemonitoring system for elderly heart failure (HF) home care patients based on digital pen technology - a technology never used before by this patient group. We implemented the system in clinical use in a 13 months long study. Fourteen patients (mean/median age 84 years) with severe HF participated. They accepted the technology and performed daily reports of their health state using the digital pen and a Health Diary form. Via the system the clinicians detected all HF-related deteriorations at an early stage and thereby prevented hospital re-admissions for all patients during the study, implying improved symptom control and large cost savings.

Electronic patient-reported symptom assessment in palliative end-of-life home care

Good symptom control in palliative end-of-life home care requires adequate access to patients’ symptom assessments. The aim of the study was to investigate the feasibility of an electronic symptom assessment reporting system to support symptom control. A randomised controlled study was performed during April 2008–December 2009. The intervention consisted of a networked digital-pen-based information system. The primary outcome measure chosen was the time span from the patients reporting of a symptom to the care providers’ noticing this assessment. Patients with at least moderately severe symptoms were invited to participate in the study. Eighteen (11 intervention, seven control) patients from four home care centres participated, submitting a total of 330 symptom assessments. There was a significantly shorter median time span from reporting to noticing for assessments in the intervention group. The system used allowed both frequent and regular symptom reporting from patients that can contribute to more correct and prompt medical decisions in palliative end-of-life home care. Trial registration number: ISRCTN09750271.

Archetype Representation of PROMs

A home telehealth system allowing chronic-obstructive pulmonary disease (COPD) and heart-failure (HF) patients to communicate patient-reported outcome measures (PROMs) has been implemented in routine care at Linkoping University Hospital, Sweden [1]. The system makes use of digital pen technology and Health Diary forms printed on paper for allowing even elderly severely ill patients to use the system. In order to facilitate the integration of information from the system into the EHR health information standards were investigated. The EHR system in use at the hospital is to start using openEHR archetypes in the coming years, thus the international library of archetypes from openEHR was used (http://openehr.org/CKM). Three different forms were developed: two for reporting symptoms for COPD and HF patients respectively and one for reporting vital parameters. The symptoms reported included breathlessness and, for COPD patients, the amount of coughing and production of phlegm. Vital parameters included blood pressure, morning weight, SpO2, FEV1%, and temperature. Further, information about the patients’ selfadministration of medications was included. For each of the three forms a separate template was created. In total, 12 archetypes were used to represent information in all three forms. For most information items there were archetypes available to meet the needs. Only few items posed a problem for formalization, for example residuals (“other medication”) in medication information, and that participants, i.e. the patient, next-ofkin, and caregiver, were only categorized and not identified in the forms. Still, this application shows that even existing archetypes, mostly developed for other use case, can be used for representing PROM information. To test the templates, sample XML instances were generated. Next step would be to allow the telehealth system to export openEHR-formatted information using the templates created.