Valerie M. Jones

Mobile patient monitoring: The MobiHealth system

The emergence of high bandwidth public wireless networks and miniaturized personal mobile devices give rise to new mobile healthcare services. To this end, the MobiHealth system provides highly customizable vital signs tele-monitoring and tele-treatment system based on a body area network (BAN) and a mobile health care (m-health) service platform utilizing next generation public wireless networks. The developed system allows the incorporation of diverse medical sensors via wireless connections, and the live transmission of the measured vital signs to healthcare providers as well as real-time feedback to the patient. Since 2002 the system has undergone substantial development in consecutive EU and national research projects. Diverse trials with different healthcare scenarios and patient groups in different European countries have been conducted in all projects. These have been performed to test the service and the network infrastructure including its suitability for m-health applications.

A framework for the comparison of mobile patient monitoring systems

A mobile patient monitoring system makes use of mobile computing and wireless communication technologies for continuous or periodic measurement and analysis of biosignals of a mobile patient. In a number of trials these systems have demonstrated their user-friendliness, convenience and effectiveness for both patients and healthcare professionals. In this paper we propose a generic architecture, associated terminology and a classificatory framework for comparing mobile patient monitoring systems. We then apply this comparison framework to classify six mobile patient monitoring systems selected according to the following criteria: use of diverse mobile communication techniques, evidence of practical trials and availability of sufficient published scientific information. We also show how to use this framework to determine feature sets of prospective real-time mobile patient monitoring systems using the example of epilepsy monitoring. This paper is aimed at both healthcare professionals and computer professionals. For healthcare professionals, this paper provides a general understanding of technical aspects of the mobile patient monitoring systems and highlights a number of issues implied by the use of these systems. The proposed framework for comparing mobile patient monitoring systems can be used by healthcare professionals to determine feature sets of prospective mobile patient monitoring systems to address particular healthcare related needs. Computer professionals are expected to benefit by gaining an understanding of the latest developments in the important emerging application area of mobile patient monitoring systems.

Mobihealth: Mobile Health Services Based on Body Area Networks

In this chapter we describe the concept of MobiHealth and the approach developed during the MobiHealth project (MobiHealth, 2002). The concept was to bring together the technologies of Body Area Networks (BANs), wireless broadband communications and wearable medical devices to provide mobile healthcare services for patients and health professionals. These technologies enable remote patient care services such as management of chronic conditions and detection of health emergencies. Because the patient is free to move anywhere whilst wearing the MobiHealth BAN, patient mobility is maximised. The vision is that patients can enjoy enhanced freedom and quality of life through avoidance or reduction of hospital stays. For the health services it means that pressure on overstretched hospital services can be alleviated.

Tailoring real-time physical activity coaching systems: a literature survey and model

Technology mediated healthcare services designed to stimulate patients’ self-efficacy are widely regarded as a promising paradigm to reduce the burden on the healthcare system. The promotion of healthy, active living is a topic of growing interest in research and business. Recent advances in wireless sensor technology and the widespread availability of smartphones have made it possible to monitor and coach users continuously during daily life activities. Physical activity monitoring systems are frequently designed for use over long periods of time placing usability, acceptance and effectiveness in terms of compliance high on the list of design priorities to achieve sustainable behavioral change. Tailoring, or the process of adjusting the system’s behavior to individuals in a specific context, is an emerging topic of interest within the field. In this article we report a survey of tailoring techniques currently employed in state of the art real time physical activity coaching systems. We present a survey of state of the art activity coaching systems as well as a conceptual framework which identifies seven important tailoring concepts that are currently in use and how they relate to each other. A detailed analysis of current use of tailoring techniques in real time physical activity coaching applications is presented. According to the literature, tailoring is currently used only sparsely in this field. We underline the need to increase adoption of tailoring methods that are based on available theories, and call for innovative evaluation methods to demonstrate the effectiveness of individual tailoring approaches.

Biosignal and context monitoring: Distributed multimedia applications of Body Area Networks in healthcare

We are investigating the use of body area networks (BANs), wearable sensors and wireless communications for measuring, processing, transmission, interpretation and display of biosignals. The goal is to provide telemonitoring and teletreatment services for patients. The remote health professional can view a multimedia display which includes graphical and numerical representation of patientspsila biosignals. Addition of feedback-control enables teletreatment services; teletreatment can be delivered to the patient via multiple modalities including tactile, text, auditory and visual. We describe the health BAN and a generic mobile health service platform and two context aware applications. The epilepsy application illustrates processing and interpretation of multi-source, multimedia BAN data. The chronic pain application illustrates multi-modal feedback and treatment, with patients able to view their own biosignals on their handheld device.

Context aware body area networks for telemedicine

A Body Area Network (BAN) is a body worn system which provides the user with a set of mobile services. A BAN incorporates a set of devices (eg. mp3 player, video camera, speakers, microphone, head-up display, positioning device, sensors, actuators). A BAN service platform for mobile healthcare and several health BANs targetting different clinical applications have been developed at the University of Twente. Each specialization of the BAN is equipped with a certain set of devices and associated application components, as appropriate to the clinical application. Different kinds of clinical data may be captured, transmitted and displayed, including text, numeric values, images and multiple biosignal streams. Timely processing and transmission of such multimedia clinical data in a distributed mobile environment requires smart strategies. Here we present one approach to designing smart distributed applications to deal with multimedia BAN data; namely the context awareness approach developed in the FREEBAND AWARENESS project.

Future challenges and recommendations

Rapid advances in information technology and telecommunications, and in particular mobile and wireless communications, converge towards the emergence of a new type of “infostructure” that has the potential of supporting a large spectrum of advanced services for healthcare and health. Currently the ICT community produces a great effort to drill down from the vision and the promises of wireless and mobile technologies and provide practical application solutions. Research and development include data gathering and omni-directional transfer of vital information, integration of human machine interface technology into handheld devices and personal applications, security and interoperability of date and integration with hospital legacy systems and electronic patient record. The ongoing evolution of wireless technology and mobile device capabilities is changing the way healthcare providers interact with information technologies. The growth and acceptance of mobile information technology at the point of care, coupled with the promise and convenience of data on demand, creates opportunities for enhanced patient care and safety. The developments presented in this section demonstrate clearly the innovation aspects and trends towards user oriented applications.

Ontology-based generation of dynamic feedback on physical activity

Improving physical activity patterns is an important focus in the treatment of chronic illnesses. We describe a system to monitor activity and provide feedback to help patients reach a healthy daily pattern. The system has shown positive effects in trials on patient groups including COPD and obese patients. We describe the design and implementation of a new feedback generation module which improves interaction with the patient by providing personalised dynamic context-aware feedback. The system uses an ontology of messages to find appropriate feedback using context information to prune irrelevant paths. The system adapts using derived probabilities about user preferences for certain message types. We aim to improve patient compliance and user experience.

Theory repositories via the Web for problem-based learning

This paper describes a series of experiments conducted at the School of Management Studies at the University of Twente designed to improve students’ concentration on the theoretical study materials in a particular course. In 1997 a problem-based learning approach was introduced into a course on organization theory. After the first year it was apparent that acquisition and application of the theoretical principles of the course by student groups was below expectation. In an attempt to remedy this problem, a Web–based collaborative work environment was introduced in 1998 with the intention of encouraging students to read relevant theoretical material and also to reflect more on what they had read, via writing notes about the materials and making these available to others in their group. The collection of reflective documents is called a “theory repository” (King & Star, 1990). In addition to hosting a theory repository, the collaborative work environment was designed to control the flow of work and to enforce rules for groups’ access to the output of other groups, based on their own performance. Further changes were made after the evaluation of the 1998 cycle and a third version of the course was run and evaluated in 1999. A description of the educational setting and of the Web–based collaborative work environment and its theory repository is presented. The three editions of the course are described and the evaluation results over the period 1997-1999 are presented and discussed. The extent to which the discipline of reading improved is evaluated, as are the effects on insight into theory. The evaluation shows that the technical realization works well, but uptake of the instructional tasks for reflection only takes place if these tasks are perceived by the students as being pertinent to their performance in terms of assessment in the course.

Model driven development of m-health systems (with a touch of formality)

We propose a model driven design and development methodology augmented with formal validation and verification (V&V) for the development of mobile health systems. Systems which deliver healthcare services remotely should be developed using robust and trusted engineering technologies. The methodology instantiates steps in the MDA trajectory using formal methods to verify critical properties of models, to test preservation of those properties in the derived implementations and to effect model transformations by correctness preserving transformations. The methodology is described and some initial modelling is reported