Rune Fensli

A wearable ECG-recording system for continuous arrhythmia monitoring in a wireless tele-home-care situation

New wireless technology for tele-home-care purposes gives new possibilities for monitoring of vital parameters with wearable biomedical sensors, and will give the patient the freedom to be mobile and still be under continuously monitoring and thereby to better quality of patient care. This paper describes a new concept for wireless and wearable electrocardiogram (ECG) sensor transmitting signals to a diagnostic station at the hospital, and this concept is intended for detecting rarely occurrences of cardiac arrhythmias and to follow up critical patients from their home while they are carrying out daily activities.

Remote Patient Monitoring Within a Future 5G Infrastructure

Systems of wearable or implantable medical devices (IMD), sensor systems for monitoring and transmitting physiological recorded signals, will in future health care services be used for purposes of remote monitoring. Today, there exist several constraints, probably preventing the adoption of such services in clinical routine work. Within a future 5G infrastructure, new possibilities will be available due to improved addressing solutions and extended security services in addition to higher bandwidth in the wireless communication link. Thus 5G solutions can represent a paradigm shift regarding remote patient’s monitoring and tracking possibilities, with enhancement in transmitting information between patients and health care services. Some aspects of new possibilities are highlighted in describing a realistic scenario within a future 5G framework.

Towards Improved Healthcare Performance: Examining Technological Possibilities and Patient Satisfaction with Wireless Body Area Networks

This paper investigates the benefits of using less intrusive wireless technologies for heart monitoring. By replacing well established heart monitoring devices (i.e. Holter) with wireless ECG based Body Area Networks (BAN), improved healthcare performance can be achieved, reflected in (1) high quality ECG recordings during physical activities and (2) increased patient satisfaction. A small scale clinical trial was conducted to compare both technologies and the results illustrate that the wireless ECG monitor was able to detect ECG signals intended for arrhythmia diagnostics. Furthermore, from a patient’s perspective, both technologies were evaluated using three dimensions, namely; hygienic aspects, physical activity, and skin reactions. Results demonstrate that the wireless ECG BAN showed better performance, especially regarding the hygienic aspects. It was also favourable for use during physical activities, and the signal quality of the wireless sensor system demonstrated good performance regarding signal noise and artefact disturbances. This paper concludes that wireless cardiac monitoring systems have significant benefits from a patient’s perspective, and further clinical trials should be conducted to further evaluate the new ECG based BAN system, to identify the possibility of widespread adoption and utilisation of wireless technology for arrhythmia diagnostics.

Human Factors Affecting the Patient’s Acceptance of Wireless Biomedical Sensors

In monitoring arrhythmia, the quality of medical data from the ECG sensors may be enhanced by being based on everyday life situations. Hence, the development of wireless biomedical sensors is of growing interest, both to diagnose the heart patient, as well as to adjust the regimen. However, human factors such as emotional barriers and stigmatization, may affect the patient’s behavior while wearing the equipment, which in turn may influence quality of data. The study of human factors and patient acceptance is important both in relation to the development of such equipment, as well as in evaluating the quality of data gathered from the individual patient. In this paper, we highlight some important aspects in patient acceptance by comparing results from a preliminary clinical trial with patients using a wireless ECG sensor for three days out-of-hospital service, to available published results from telehomecare projects, and discuss important aspects to be taken into account in future investigations.

Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study

BackgroundDemographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice.MethodsA Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed.ResultsNineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change.ConclusionsThis study identified several important challenges for coordination and it supports previous research. IMC in health care services deals with challenges other than coordination, and these must be addressed specifically. Our study contributes to extended knowledge of theoretical and practical implications in the field of coordination and IMC in health care sector.

The EU-project United4Health: User-centred design of an information system for a Norwegian telemedicine service

Introduction Organizational changes of health care services in Norway brought to light a need for new clinical pathways. This study presents the design and evaluation of an information system for a new telemedicine service for chronic obstructive pulmonary disease patients after hospital discharge. Methods A user-centred design approach was employed composed of a workshop with end-users, two user tests and a field trial. For data collection, qualitative methods such as observations, semi-structured interviews and a questionnaire were used. Results User workshop’s outcome informed the implementation of the system initial prototype, evaluated by end-users in a usability laboratory. Several usability and functionality issues were identified and solved, such as the interface between the initial colour scheme and the triage colours. Iterative refinements were made and a second user evaluation showed that the main issues were solved. The responses to a questionnaire presented a high score of user satisfaction. In the final phase, a field trial showed satisfactory use of the system. Discussion This study showed how the target end-users groups were actively involved in identifying the needs, suggestions and preferences. These aspects were addressed in the development of an information system through a user-centred design process. The process efficiently enabled users to give feedback about design and functionality. Continuous refinement of the system was the key to full development and suitability for the telemedicine service. This research was a result of the international cooperation between partners within the project United4Health, a part of the Seventh Framework Programme for Research of the European Union.

Reference Design for Smart Collaborative Telehealth and Telecare Services Based on IoT Technologies

The demographic development shows aging societies through-out the globe, leading to higher demands on the health and care systems due to age-related disabilities, chronic diseases, etc. Telehealth and telecare services for more efficient support of health and care providers are needed, which can be significantly improved by the continuous technological developments in areas such as sensor devices, Internet of Things (IoT), cloud services, and data analysis. This paper addresses the potential of selected emerging technologies to make eHealth systems smarter, more collaborative and more efficient. As a result of the analysis of the most promising technological trends, characteristics of future telehealth and telecare services are derived, requirements are identified, and a future eHealth reference design is proposed.

A REST-based publish/subscribe platform to support things-to-services communications

The term “Internet of Things” has been used widely in recent years, bringing up a grand idea of connecting physical objects with one another through both wired and wireless networks. Maturity of the Internet Protocol has pushed 21st century communications between devices to go all-IP, which includes everyday objects. Many new services are deployed in the “cloud”, utilising the Internet infrastructure and the Web, and information from everyday objects can play an important role. This paper presents an information integration platform which enables everyday objects to communicate with Internet services based on event-driven service-oriented architecture paradigm. A proof-of-concept prototype that has been developed is also described, and two application scenarios within healthcare domain are presented as well.

eHealth-Extended Care Coordination: Development of a Collaborative System for Inter-municipal Dementia Teams: A Research Project with a User-Centered Design Approach

In Norway, a health reform was recently adopted to improve continuity of care. Services that were carried out in hospitals were transferred to municipalities. Small and medium size municipalities have established inter-municipal cooperation to provide specialized services across borders. The research project eHealth-extended Care Coordination studied the inter-municipal cooperation for assessment of dementia, identifying a need for improved communication and coordination. This paper presents the development process of a collaborative information system for dementia assessment using a user-centered design approach. Mixed methods, such as observations, semi-structured interviews and questionnaire, were used for data collection. The results showed that end-user involvement usefully informed the development. The information system effectively supported collaborative work and shared access to information for the inter-municipal team.

The EU project “United4Health”: Results and experiences from automatic health status assessment in a Norwegian telemedicine trial system:

Introduction Patients with chronic obstructive pulmonary disease require help in daily life situations to increase their individual perception of security, especially under worsened medical conditions. Unnecessary hospital (re-)admissions and home visits by doctors or nurses shall be avoided. This study evaluates the results from a two-year telemedicine field trial for automatic health status assessment based on remote monitoring and analysis of a long time series of vital signs data from patients at home over periods of weeks or months. Methods After discharge from hospital treatment for acute exacerbations, 94 patients were recruited for follow-up by the trial system. The system supported daily measurements of pulse and transdermal peripheral capillary oxygen saturation at patients’ homes, a symptom-specific questionnaire, and provided nurses trained to use telemedicine (“telenurses”) with an automatically generated health status overview of all monitored patients. A colour code (green/yellow/red) indicated whether the patient was stable or had a notable deterioration, while red alerts highlighted those in most urgent need of follow-up. The telenurses could manually overwrite the status level based on the patients’ conditions observed through video consultation. Results Health status evaluation in 4970 telemonitor datasets were assessed retrospectively. The automatic health status determination (subgroup of 33 patients) showed green status at 46% of the days during a one-month monitoring period, 28% yellow status, and 19% red status (no data reported at 7% of the days). The telenurses manually downrated approximately 10% of the red or yellow alerts. Discussion The evaluation of the defined real-time health status assessment algorithms, which involve static rules with personally adapted elements, shows limitations to adapt long-term home monitoring with adequate interpretation of day-to-day changes in the patient’s condition. Thus, due to the given sensitivity and specificity of such algorithms, it seems challenging to avoid false high alerts.