Michael Marschollek

On Health-enabling and Ambient-assistive Technologies

Objectives: To provide an introductory overview on selected areas of health-enabling and ambient-assistive technologies and to suggest relevant fields for future research. Methods: Summarizing the state of the art for 1) ambient environments and 2) health-related sensor technologies, 3) presenting relevant medical conditions and their relation to health-enabling technologies, and 4) illustrating the application of those technologies for lifestyle management with examples for activity monitoring and prevention of overweight. The suggestions for future research are based on own research projects in this field. Results: Health-enabling and ambient-assistive technologies are regarded to have the potential to significantly improve quality of life and efficiency of health care in aging societies. Research on health-enabling and ambient-assistive technologies is highly multidisciplinary. Conclusions: It still has, to a large extent, to be exploratory. An increasing amount of outcomes research through well-designed evaluation studies that explore technical solutions in a social context and in relation to individual needs will be crucial.

Health-enabling technologies for the elderly - An overview of services based on a literature review

BACKGROUND Services for the elderly based on health-enabling technologies promise to contribute significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last years the scientific community has designed a complex variety of these valuable innovations. A systematic overview of the developed services would help to better understand their opportunities and limitations. OBJECTIVE To obtain a systematic overview of services for the elderly based on health-enabling technologies and to identify archetypical service categories. METHODS We conducted a literature review using PubMed and retrieved 1447 publications. We stepwise reduced this list to 27 key publications that describe typical service archetypes. RESULTS We present six archetypical service categories, namely handling adverse conditions, assessing state of health, consultation and education, motivation and feedback, service ordering and social inclusion and describe their implementation in current research projects.

Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms

Background. Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. Objectives. To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. Methods. Summarizing outcomes of literature analyses and results from own research projects in this field. Results. Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. Conclusions. Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.

Assessing elderly persons' fall risk using spectral analysis on accelerometric data - a clinical evaluation study

Falls are among the leading causes for morbidity, mortality and lasting functional disability in the elderly population. Several studies have shown the applicability of accelerometry to detect persons with a high fall risk. Most of these studies have been conducted under laboratory settings and without clear definition of ‘fall risk’ reference measures. The aim of our work is to provide a simple unsupervised method to assess the fall risk of elderly persons as measured by reference clinical fall risk assessment scores. Our method uses parameters computed by spectral analysis on triaxial accelerometer data recorded in a clinical setting, and is evaluated using simple logistic regression classifier models with reference to three clinical reference scores. The overall prediction accuracy of the models ranges from 65.5–89.1%, with sensitivity and specificity between 78.5–99% and 15.4–60.4%, respectively. Our results show that our simple method can be used to detect persons with a high fall risk with a fair to good predictive accuracy when tested against common clinical reference scores. Our parameters are independent of specific test procedures and therefore are suited for use in an unsupervised setting. Our future research will include the evaluation of our method in a large prospective study.

ICT-based health information services for elderly people: Past experiences, current trends, and future strategies

Although health information is readily available on the Internet and has changed the way people deal with their health in many ways, the retrieval of relevant information remains problematic, especially for elderly people. With a focus on elderly people, this paper summarizes current trends in consumer health informatics, discusses past and present intiatives providing health-information services, and proposes a future strategy for the design of sustainable services. A systematic literature review and a review of past German and EU projects concerned with health information services for elderly people are given. Many publications focus on health information services for specific diseases and on their quality and semantic accessibility, yet few deal with presenting and customizing health information for elderly and disabled people. Past experiences from Germany suggest that very often the specific needs of this target group are not met, and therefore accessibility remains largely hypothetical. We propose a strategy with five key points for the design of sustainable health-information services for elderly people. More research is needed to customize web-based health information services to the needs of the user group that needs them most urgently—elderly and disabled people.

Towards New Scopes: Sensor-enhanced Regional Health Information Systems - Part 1: Architectural Challenges

OBJECTIVES To analyze utilization of sensor technology in telemonitoring and home care and to discuss concepts and challenges of sensor-enhanced regional health information systems (rHIS). METHODS The study is based upon experience in sensor-based telemedicine and rHIS projects, and on an analysis of HIS-related journal publications from 2003 to 2005 conducted in the context of publishing the IMIA Yearbook of Medical Informatics. RESULTS Health-related parameters that are subject to sensor-based measurement in home care and telemonitoring are identified. Publications related to telemonitoring, home care and smart houses are analyzed concerning scope and utilization of sensor technology. Current approaches for integrating sensor technology in rHIS based on a corresponding eHealth infrastructure are identified. Based on a coarse architecture of home care and telemonitoring systems ten challenges for sensor-enhanced rHIS are identified and discussed: integration of home and health telematic platforms towards a sensor-enhanced telematic platform, transmission rate guarantees, ad hoc connectivity, cascading data analysis, remote configuration, message and alert logistic, sophisticated user interfaces, unobtrusiveness, data safety and security, and electronic health record integration. CONCLUSIONS Utilization of sensor technology in health care is an active field of research. Currently few research projects and standardization initiatives focus on general architectural considerations towards suitable telematic platforms for establishing sensor-enhanced rHIS. Further research finalized by corresponding standardization is needed. Part 2 of this paper will present experiences with a research prototype for a sensor-enhanced rHIS telematic platform.

The Lower Saxony research network design of environments for ageing: towards interdisciplinary research on information and communication technologies in ageing societies

Worldwide, ageing societies are bringing challenges for independent living and healthcare. Health-enabling technologies for pervasive healthcare and sensor-enhanced health information systems offer new opportunities for care. In order to identify, implement and assess such new information and communication technologies (ICT) the ‘Lower Saxony Research Network Design of Environments for Ageing’ (GAL) has been launched in 2008 as interdisciplinary research project. In this publication, we inform about the goals and structure of GAL, including first outcomes, as well as to discuss the potentials and possible barriers of such highly interdisciplinary research projects in the field of health-enabling technologies for pervasive healthcare. Although GALs high interdisciplinarity at the beginning slowed down the speed of research progress, we can now work on problems, which can hardly be solved by one or few disciplines alone. Interdisciplinary research projects on ICT in ageing societies are needed and recommended.

Defining the user requirements for wearable and optical fall prediction and fall detection devices for home use

One of the major problems in the development of information and communication technologies for older adults is user acceptance. Here we describe the results of focus group discussions that were conducted with older adults and their relatives to guide the development of assistive devices for fall detection and fall prevention. The aim was to determine the ergonomic and functional requirements of such devices and to include these requirements in a user-centered development process. A semi-structured interview format based on an interview guide was used to conduct three focus group discussions with 22 participants. The average age was 75 years in the first group, 68 years in the second group and 50 years in the third group (relatives). Overall, participants considered a fall prediction system to be as important as a fall detection system. Although the ambient, unobtrusive character of the optical sensor system was appreciated, wearable inertial sensors were preferred because of their wide range of use, which provides higher levels of security. Security and mobility were two major reasons for people at risk of falling to buy a wearable and/or optical fall prediction and fall detection device. Design specifications should include a wearable, non-stigmatising sensor at the users wrist, with an emergency option in case of falling.

What Does Big Data Mean for Wearable Sensor Systems?: Contribution of the IMIA Wearable Sensors in Healthcare WG

OBJECTIVES The aim of this paper is to discuss how recent developments in the field of big data may potentially impact the future use of wearable sensor systems in healthcare. METHODS The article draws on the scientific literature to support the opinions presented by the IMIA Wearable Sensors in Healthcare Working Group. RESULTS The following is discussed: the potential for wearable sensors to generate big data; how complementary technologies, such as a smartphone, will augment the concept of a wearable sensor and alter the nature of the monitoring data created; how standards would enable sharing of data and advance scientific progress. Importantly, attention is drawn to statistical inference problems for which big datasets provide little assistance, or may hinder the identification of a useful solution. Finally, a discussion is presented on risks to privacy and possible negative consequences arising from intensive wearable sensor monitoring. CONCLUSIONS Wearable sensors systems have the potential to generate datasets which are currently beyond our capabilities to easily organize and interpret. In order to successfully utilize wearable sensor data to infer wellbeing, and enable proactive health management, standards and ontologies must be developed which allow for data to be shared between research groups and between commercial systems, promoting the integration of these data into health information systems. However, policy and regulation will be required to ensure that the detailed nature of wearable sensor data is not misused to invade privacies or prejudice against individuals.

Providing longitudinal health care information with the new German Health Card—a pilot system to track patient pathways

The paper describes an application system that employs the new German Health Card to provide a technical solution for tracking patient pathways. The aim is to improve the flow and availability of health care information. We used standard software components and technologies in order to facilitate interoperability with multiple system platforms and allow for customizing as the specification process for the German Health Card is not yet completed. Every health care provider contact is recorded on the card and associated medical documents are stored in a central database and can be retrieved via Web Services running on a central application server. The patient pathway can thus be chronologically tracked by the clinician and relevant longitudinal information is made accessible quickly. Our system for tracking patient pathways with the new German Health Card can be regarded as a first example of its great future potential.