International Journal of Telemedicine and Applications The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Web-Based Depression Screening and Psychiatric Consultation for College Students: A Feasibility and Acceptability Study Sun, 30 Mar 2014 07:29:47 +0000 Background. A steady rise in the prevalence of depression among college students has negatively affected student quality of life. This study investigates the feasibility and acceptability of a Web-based model, including Skype, to screen and provide psychiatric consultation to depressed college students. Methods. Students completed the 9-item Patient Health Questionnaire (PHQ-9) online; those who screened positive (PHQ-9 ≥ 10) or endorsed any level of suicidal ideation were offered Web-based psychiatric consultation using Skype. After the consultation, students filled out a 7-item satisfaction questionnaire to report on the acceptability of this Web-based method. Results. A total of 972 students consented to the online depression screening and 285 screened positive. Of those, 69 students consented and 17 students successfully completed the psychiatric consultation via Skype. Thirteen (76.4%) students found the interview useful in helping them understand their depression. Fifteen (88.2%) students thought that psychologists and psychiatrists could successfully see patients via videoconferencing. Conclusions. Current online technologies can provide depression screening and psychiatric consultation to college students; those who participated reported a positive experience. Future studies will need to address the low levels of participation among college students and attract students who are underserved, as well as use a videoconferencing platform that adequately protects data confidentiality. Aya Williams, Rachel LaRocca, Trina Chang, Nhi-Ha Trinh, Maurizio Fava, Joseph Kvedar, and Albert Yeung Copyright © 2014 Aya Williams et al. All rights reserved. Is Telephysiotherapy an Option for Improved Quality of Life in Patients with Osteoarthritis of the Knee? Sun, 23 Mar 2014 13:59:52 +0000 This study investigated effect of a 6-week telephysiotherapy programme on quality of life (QoL) of patients with knee osteoarthritis (OA). Fifty patients with knee OA were randomly and equally assigned into two treatment groups: clinic group (CG) and telephysiotherapy group (TG). The CG received physiotherapist-administered osteoarthritis-specific exercises in the clinic thrice weekly for 6 weeks while the TG received structured telephone monitoring with self-administered osteoarthritis-specific exercises for the same duration at home. Participants’ QoL was assessed using WHOQoL-Bref at baseline, second, fourth, and sixth week of intervention. Data were analyzed using ANOVA and independent Student’s -test. Within-group comparison showed significant improvements in physical health domain ( for TG and CG) and psychological domain ( for TG; for CG) of WHOQoL following six-week intervention. However, there were no significant differences () in TG and CG’s social relationship and environment domains. Between-group comparison showed no significant differences () between CG and TG’s physical health, psychological, and social relationships domains of WHOQoL following 6-week intervention. However, there was significant difference in the environment domain (). Telephysiotherapy using telephone medium improved QoL in patients with knee OA comparable to clinic based treatment. Adesola C. Odole and Oluwatobi D. Ojo Copyright © 2014 Adesola C. Odole and Oluwatobi D. Ojo. All rights reserved. Effect of Wireless Channels on Detection and Classification of Asthma Attacks in Wireless Remote Health Monitoring Systems Mon, 10 Feb 2014 13:45:53 +0000 This paper aims to study the performance of support vector machine (SVM) classification in detecting asthma attacks in a wireless remote monitoring scenario. The effect of wireless channels on decision making of the SVM classifier is studied in order to determine the channel conditions under which transmission is not recommended from a clinical point of view. The simulation results show that the performance of the SVM classification algorithm in detecting asthma attacks is highly influenced by the mobility of the user where Doppler effects are manifested. The results also show that SVM classifiers outperform other methods used for classification of cough signals such as the hidden markov model (HMM) based classifier specially when wireless channel impairments are considered. Orobah Al-Momani and Khaled M. Gharaibeh Copyright © 2014 Orobah Al-Momani and Khaled M. Gharaibeh. All rights reserved. Adapting a Database of Text Messages to a Mobile-Based Weight Loss Program: The Case of the Middle East Mon, 06 Jan 2014 12:18:57 +0000 Obesity has become a worldwide epidemic. Qatar, a rapidly developing country in the Middle East, has seen a sharp increase in the prevalence of obesity. The increase can be attributed to several reasons, including sedentary lifestyles imposed by a harsh climate and the introduction of Western fast food. Mobile technologies have been used and studied as a technology to support individuals’ weight loss. The authors have developed a mobile application that implements three strategies drawn from proven theories of behavioral change. The application is localized to the cultural context of its proposed users. The objective of this paper is to present a method through which we adapted the messaging content of a weight loss application to the context of its users while retaining an effective degree of automation. The adaptation addressed body image, eating and physical exercise habits, and regional/cultural needs. The paper discusses how surveying potential users can be used to build a profile of a target population, find common patterns, and then develop a database of text messages. The text messages are automated and sent to the users at specific times of day, as suggested by the survey results. Selma Limam Mansar, Shashank Jariwala, Nawal Behih, Maahd Shahzad, and Aysha Anggraini Copyright © 2014 Selma Limam Mansar et al. All rights reserved. A Framework for Sustainable Implementation of E-Medicine in Transitioning Countries Thu, 26 Dec 2013 09:52:33 +0000 Organizations in developed countries such as the United States of America and Canada face difficulties and challenges in technology transfer from one organization to another; the complexity of problems easily compounds when such transfers are attempted from developed to developing countries due to differing socioeconomic and cultural environments. There is a gap in the formation of research and education programs to address technology transfer issues that go beyond just transferring the technologies to sustaining such transfers for longer periods. This study examined telemedicine transfer challenges in three Sub-Sahara African countries and developed a framework for sustainable implementation of e-medicine. Both quantitative and qualitative research methods were used. The study findings indicate that e-medicine sustainability in Sub-Saharan Africa is affected by institutional factors such as institutional environment and knowledge management practices; technical factors such as the technological environment and technology transfer project environment; social environmental factors such as social environment and donor involvement. These factors were used to model the proposed framework. Stephen Robert Isabalija, Victor Mbarika, and Geoffrey Mayoka Kituyi Copyright © 2013 Stephen Robert Isabalija et al. All rights reserved. Assistive/Socially Assistive Robotic Platform for Therapy and Recovery: Patient Perspectives Sun, 22 Dec 2013 15:01:21 +0000 Improving adherence to therapy is a critical component of advancing outcomes and reducing the cost of rehabilitation. A robotic platform was previously developed to explore how robotics could be applied to the social dimension of rehabilitation to improve adherence. This paper aims to report on feedback given by end users of the robotic platform as well as the practical applications that socially assistive robotics could have in the daily life activities of a patient. A group of 10 former and current patients interacted with the developed robotic platform during a simulated exercise session before taking an experience-based survey. A portion of these participants later provided verbal feedback as part of a focus group on the potential utility of such a platform. Identified applications included assistance with reaching exercise goals, managing to-do lists, and supporting participation in social and recreational activities. The study participants expressed that the personality characteristics of the robotic system should be adapted to individual preferences and that the assistance provided over time should align with the progress of their recovery. The results from this study are encouraging and will be useful for further development of socially assistive robotics. Matthew White, Mary Vining Radomski, Marsha Finkelstein, Daniel Allan Samuel Nilsson, and Lars Ingimar Eugen Oddsson Copyright © 2013 Matthew White et al. All rights reserved. Smartphone Medical Applications for Women’s Health: What Is the Evidence-Base and Feedback? Wed, 18 Dec 2013 09:52:44 +0000 Background. Smartphone medical applications have a major role to play in women’s health with their roles being very broad, ranging from improving health behaviours to undertaking personalised tests. Objective(s). Using Medline, Web of Knowledge, and the PRISMA guidelines 15 randomized controlled trials (RCTs) were identified, with mobile interventions being tested on 1603 females, in relation to key aspects of health. Using a similar systematic approach an iPhone database search identified 47 applications (apps) developed to improve women’s health. Findings. Ten RCTs used text messaging or app interventions to support weight loss, with significant improvements being observed in eight studies. For other aspects of women’s health RCTs are needed to determine possible health benefits. iPhone store data analysis identified that a substantial number of women’s health apps did not have star ratings or feedback comments (68 and 49 per cent, resp.), raising concerns about their validity. Conclusion. Peer-review systems, supporting statements of evidence, or certification standards would be beneficial in maintaining the quality and credibility of future health-focused apps. Patient groups should also ideally be involved in the development and testing of mobile medical apps. Emma Derbyshire and Darren Dancey Copyright © 2013 Emma Derbyshire and Darren Dancey. All rights reserved. Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation Sun, 08 Dec 2013 11:55:13 +0000 Emerging research supports the feasibility and viability of conducting clinical swallow examinations (CSE) for patients with dysphagia via telerehabilitation. However, minimal data has been reported to date regarding the implementation of such services within the clinical setting or the user perceptions of this type of clinical service. A mixed methods study design was employed to examine the outcomes of a weekly dysphagia assessment clinic conducted via telerehabilitation and examine issues relating to service delivery and user perceptions. Data was collected across a total of 100 patient assessments. Information relating to primary patient outcomes, session statistics, patient perceptions, and clinician perceptions was examined. Results revealed that session durations averaged 45 minutes, there was minimal technical difficulty experienced, and clinical decisions made regarding primary patient outcomes were comparable between the online and face to face clinicians. Patient satisfaction was high and clinicians felt that they developed good rapport, found the system easy to use, and were satisfied with the service in over 90% of the assessments conducted. Key factors relating to screening patient suitability, having good general organization, and skilled staff were identified as facilitators for the service. This trial has highlighted important issues for consideration when planning or implementing a telerehabilitation service for dysphagia management. Elizabeth C. Ward, Clare L. Burns, Deborah G. Theodoros, and Trevor G. Russell Copyright © 2013 Elizabeth C. Ward et al. All rights reserved. mHealth in Sub-Saharan Africa Wed, 04 Dec 2013 14:44:16 +0000 Mobile phone penetration rates have reached 63% in sub-Saharan Africa (SSA) and are projected to pass 70% by 2013. In SSA, millions of people who never used traditional landlines now use mobile phones on a regular basis. Mobile health, or mHealth, is the utilization of short messaging service (SMS), wireless data transmission, voice calling, and smartphone applications to transmit health-related information or direct care. This systematic review analyzes and summarizes key articles from the current body of peer-reviewed literature on PubMed on the topic of mHealth in SSA. Studies included in the review demonstrate that mHealth can improve and reduce the cost of patient monitoring, medication adherence, and healthcare worker communication, especially in rural areas. mHealth has also shown initial promise in emergency and disaster response, helping standardize, store, analyze, and share patient information. Challenges for mHealth implementation in SSA include operating costs, knowledge, infrastructure, and policy among many others. Further studies of the effectiveness of mHealth interventions are being hindered by similar factors as well as a lack of standardization in study design. Overall, the current evidence is not strong enough to warrant large-scale implementation of existing mHealth interventions in SSA, but rapid progress of both infrastructure and mHealth-related research in the region could justify scale-up of the most promising programs in the near future. Thomas J. Betjeman, Samara E. Soghoian, and Mark P. Foran Copyright © 2013 Thomas J. Betjeman et al. All rights reserved. The Anticipated Positive Psychosocial Impact of Present Web-Based E-Health Services and Future Mobile Health Applications: An Investigation among Older Swedes Tue, 03 Dec 2013 13:26:28 +0000 This study investigates the anticipated psychosocial impact of present web-based e-health services and future mobile health applications among older Swedes. Random sample’s of Swedish citizens aged 55 years old and older were given a survey containing two different e-health scenarios which respondents rated according to their anticipated psychosocial impact by means of the PIADS instrument. Results consistently demonstrated the positive anticipation of psychosocial impacts for both scenarios. The future mobile health applications scored more positively than the present web-based e-health services. An increase in age correlated positively to lower impact scores. These findings indicate that from a psychosocial perspective, web-based e-health services and mobile health applications are likely to positively impact quality of life. This knowledge can be helpful when tailoring and implementing e-health services that are directed to older people. S. Wiklund Axelsson, L. Nyberg, A. Näslund, and A. Melander Wikman Copyright © 2013 S. Wiklund Axelsson et al. All rights reserved. Mobile Phone Short Message Service (SMS) for Weight Management in Iranian Overweight and Obese Women: A Pilot Study Tue, 17 Sep 2013 09:42:29 +0000 We conducted a text message-based intervention for weight management over three months by two months intervention and one month wash-out period. In a quasi-experimental study with control () and experimental group (), 80 overweight and obese employed women were entered. Participants were recruited via announcement. All subjects attended a face-to-face information session and received a booklet that contained food calorie chart and strategies and recommendations for weight management. The experimental group received text messages (SMS) about weight management twice a day for two months, in addition to the information and the booklet which they had received in the information session. Also, the experimental group was instructed to weekly self-weight and to send the data to the principle researcher. All subjects were measured for baseline and secondary weight in a standardized manner by a nurse, and the data were compared between the two groups. Experimental group lost more weight than the control group (1.5 kg difference, ). Text messaging seems to be an effective channel of communication for weight management in Iranian overweight and obese women. The clinical trial registration number is IRCT201204029360N1. Somayeh Faghanipour, Eftekharalsadat Hajikazemi, Soghra Nikpour, Shabnam al-Sadat Shariatpanahi, and Agha Fatemeh Hosseini Copyright © 2013 Somayeh Faghanipour et al. All rights reserved. Attracting Child Psychiatrists to a Televideo Consultation Service: The TeleLink Experience Thu, 20 Jun 2013 16:45:14 +0000 Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study’s qualitative phase identified four themes in the decision to participate in telepsychiatry: (1) organizational, (2) shared values, (3) innovation, and (4) the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners. Tiziana Volpe, Katherine M. Boydell, and Antonio Pignatiello Copyright © 2013 Tiziana Volpe et al. All rights reserved. Assessing Hospital Readmission Risk Factors in Heart Failure Patients Enrolled in a Telemonitoring Program Sat, 27 Apr 2013 10:29:19 +0000 The purpose of this study was to validate a previously developed heart failure readmission predictive algorithm based on psychosocial factors, develop a new model based on patient-reported symptoms from a telemonitoring program, and assess the impact of weight fluctuations and other factors on hospital readmission. Clinical, demographic, and telemonitoring data was collected from 100 patients enrolled in the Partners Connected Cardiac Care Program between July 2008 and November 2011. 38% of study participants were readmitted to the hospital within 30 days. Ten different heart-failure-related symptoms were reported 17,389 times, with the top three contributing approximately 50% of the volume. The psychosocial readmission model yielded an AUC of 0.67, along with sensitivity 0.87, specificity 0.32, positive predictive value 0.44, and negative predictive value 0.8 at a cutoff value of 0.30. In summary, hospital readmission models based on psychosocial characteristics, standardized changes in weight, or patient-reported symptoms can be developed and validated in heart failure patients participating in an institutional telemonitoring program. However, more robust models will need to be developed that use a comprehensive set of factors in order to have a significant impact on population health. Adrian H. Zai, Jeremiah G. Ronquillo, Regina Nieves, Henry C. Chueh, Joseph C. Kvedar, and Kamal Jethwani Copyright © 2013 Adrian H. Zai et al. All rights reserved. Robust Sounds of Activities of Daily Living Classification in Two-Channel Audio-Based Telemonitoring Mon, 22 Apr 2013 15:20:58 +0000 Despite recent advances in the area of home telemonitoring, the challenge of automatically detecting the sound signatures of activities of daily living of an elderly patient using nonintrusive and reliable methods remains. This paper investigates the classification of eight typical sounds of daily life from arbitrarily positioned two-microphone sensors under realistic noisy conditions. In particular, the role of several source separation and sound activity detection methods is considered. Evaluations on a new four-microphone database collected under four realistic noise conditions reveal that effective sound activity detection can produce significant gains in classification accuracy and that further gains can be made using source separation methods based on independent component analysis. Encouragingly, the results show that recognition accuracies in the range 70%–100% can be consistently obtained using different microphone-pair positions, under all but the most severe noise conditions. David Maunder, Julien Epps, Eliathamby Ambikairajah, and Branko Celler Copyright © 2013 David Maunder et al. All rights reserved. Usability of Telehealth Technologies Mon, 15 Apr 2013 11:49:15 +0000 Zia Agha, Charlene R. Weir, and Yunan Chen Copyright © 2013 Zia Agha et al. All rights reserved. Using Information and Communication Technology in Home Care for Communication between Patients, Family Members, and Healthcare Professionals: A Systematic Review Wed, 10 Apr 2013 10:49:26 +0000 Introduction. Information and communication technology (ICT) are becoming a natural part in healthcare both for delivering and giving accessibility to healthcare for people with chronic illness living at home. Aim. The aim was to review existing studies describing the use of ICT in home care for communication between patients, family members, and healthcare professionals. Methods. A review of studies was conducted that identified 1,276 studies. A selection process and quality appraisal were conducted, which finally resulted in 107 studies. Results. The general results offer an overview of characteristics of studies describing the use of ICT applications in home care and are summarized in areas including study approach, quality appraisal, publications data, terminology used for defining the technology, and disease diagnosis. The specific results describe how communication with ICT was performed in home care and the benefits and drawbacks with the use of ICT. Results were predominated by positive responses in the use of ICT. Conclusion. The use of ICT applications in home care is an expanding research area, with a variety of ICT tools used that could increase accessibility to home care. Using ICT can lead to people living with chronic illnesses gaining control of their illness that promotes self-care. Birgitta Lindberg, Carina Nilsson, Daniel Zotterman, Siv Söderberg, and Lisa Skär Copyright © 2013 Birgitta Lindberg et al. All rights reserved. Patient Perspective on Use of an Interactive Website for Sleep Apnea Thu, 14 Mar 2013 15:47:34 +0000 Incomplete patient adherence with nasal continuous positive airway pressure (CPAP) limits the effectiveness of treatment and results in suboptimal obstructive sleep apnea (OSA) outcomes. An interactive website specifically designed for patients with OSA was designed and utilized in a randomized clinical trial to test its effect on increasing CPAP adherence. The goal of this paper is to report on CPAP adherence, internet use, privacy concerns and user satisfaction in using the website. The original project was designed as a randomized, controlled clinical trial of Usual Care (UC, control) versus MyCPAP group (intervention). Questionnaires were administered to evaluate the patient perspective of using the MyCPAP website. Participation in the MyCPAP intervention resulted in higher CPAP adherence at the two-month time point relative to participation in the UC group (3.4  ±  2.4 and 4.1  ±  2.3 hrs/nt; ; mean  ±  SD). Participants randomized to the MyCPAP website increased their use of the internet to obtain OSA related information, but did not increase their use of the internet to get information on general health or medical conditions. Users had very little concern about their CPAP data being viewed daily or being sent over the internet. Future studies should consider the use of newer evaluation criteria for collaborative adaptive interactive technologies. Carl Stepnowsky, Christine Edwards, Tania Zamora, Robert Barker, and Zia Agha Copyright © 2013 Carl Stepnowsky et al. All rights reserved. Open-Source Telemedicine Platform for Wireless Medical Video Communication Wed, 13 Mar 2013 09:04:21 +0000 An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings. A. Panayides, I. Eleftheriou, and M. Pantziaris Copyright © 2013 A. Panayides et al. All rights reserved. Model Construction for the Intention to Use Telecare in Patients with Chronic Diseases Tue, 05 Mar 2013 13:40:05 +0000 Objective. This study chose patients with chronic diseases as study subjects to investigate their intention to use telecare. Methods. A large medical institute in Taiwan was used as the sample unit. Patients older than 20 years, who had chronic diseases, were sampled by convenience sampling and surveyed with a structural questionnaire, and a total of 500 valid questionnaires were collected. Model construction was based on the Health Belief Model. The reliability and validity of the measurement model were tested using confirmatory factor analysis (CFA), and the causal model was explained by structural equation modeling (SEM). Results. The priority should be on promoting the perceived benefits of telecare, with a secondary focus on the external cues to action, such as promoting the influences of important people on the patients. Conclusion. The findings demonstrated that patients with chronic diseases use telecare differently from the general public. To promote the use and acceptance of telecare in patients with chronic diseases, technology developers should prioritize the promotion of the usefulness of telecare. In addition, policy makers can strengthen the marketing from media and medical personnel, in order to increase the acceptance of telecare by patients with chronic diseases. Jui-Chen Huang and Yii-Ching Lee Copyright © 2013 Jui-Chen Huang and Yii-Ching Lee. All rights reserved. Fundus Autofluorescence Imaging in an Ocular Screening Program Wed, 19 Dec 2012 18:36:06 +0000 Purpose. To describe integration of fundus autofluorescence (FAF) imaging into an ocular screening program. Methods. Fifty consecutive screening participants were included in this prospective pilot imaging study. Color and FAF (530/640 nm exciter/barrier filters) images were obtained with a 15.1MP Canon nonmydriatic hybrid camera. A clinician evaluated the images on site to determine need for referral. Visual acuity (VA), intraocular pressure (IOP), and ocular pathology detected by color fundus and FAF imaging modalities were recorded. Results. Mean ± SD age was 47.4 ± 17.3 years. Fifty-two percent were female and 58% African American. Twenty-seven percent had a comprehensive ocular examination within the past year. Mean VA was 20/39 in the right eye and 20/40 in the left eye. Mean IOP was 15 mmHg bilaterally. Positive color and/or FAF findings were identified in nine (18%) individuals with diabetic retinopathy or macular edema (), focal RPE defects (), age-related macular degeneration (), central serous retinopathy (), and ocular trauma (). Conclusions. FAF was successfully integrated in our ocular screening program and aided in the identification of ocular pathology. Larger studies examining the utility of this technology in screening programs may be warranted. A. M. Kolomeyer, N. V. Nayak, B. C. Szirth, and A. S. Khouri Copyright © 2012 A. M. Kolomeyer et al. All rights reserved. PERCEPT Indoor Navigation System for the Blind and Visually Impaired: Architecture and Experimentation Mon, 17 Dec 2012 14:00:10 +0000 We introduce PERCEPT system, an indoor navigation system for the blind and visually impaired. PERCEPT will improve the quality of life and health of the visually impaired community by enabling independent living. Using PERCEPT, blind users will have independent access to public health facilities such as clinics, hospitals, and wellness centers. Access to healthcare facilities is crucial for this population due to the multiple health conditions that they face such as diabetes and its complications. PERCEPT system trials with 24 blind and visually impaired users in a multistory building show PERCEPT system effectiveness in providing appropriate navigation instructions to these users. The uniqueness of our system is that it is affordable and that its design follows orientation and mobility principles. We hope that PERCEPT will become a standard deployed in all indoor public spaces, especially in healthcare and wellness facilities. Aura Ganz, James Schafer, Siddhesh Gandhi, Elaine Puleo, Carole Wilson, and Meg Robertson Copyright © 2012 Aura Ganz et al. All rights reserved. Standardized Functions for Smartphone Applications: Examples from Maternal and Child Health Thu, 13 Dec 2012 08:59:48 +0000 Millennium Development Goals (MDGs) are unlikely to be met in most low- and middle-income countries (LMIC). Smartphones and smartphone proxy systems using simpler phones, equipped with the capabilities to identify location/time and link to the web, are increasingly available and likely to provide an excellent platform to support healthcare self-management, delivery, quality, and supervision. Smart phones allow information to be delivered by voice, texts, pictures, and videos as well as be triggered by location and date. Prompts and reminders, as well as real-time monitoring, can improve quality of health care. We propose a three-tier model for designing platforms for both professional and paraprofessional health providers and families: (1) foundational functions (informing, training, monitoring, shaping, supporting, and linking to care); (2) content-specific targets (e.g., for MDG; developmentally related tasks); (3) local cultural adaptations (e.g., language). We utilize the Maternal and Child Health (MCH) MDG in order to demonstrate how the existing literature can be organized and leveraged on open-source platforms and provide examples using our own experience in Africa over the last 8 years. Mary Jane Rotheram-Borus, Mark Tomlinson, Dallas Swendeman, Adabel Lee, and Erynne Jones Copyright © 2012 Mary Jane Rotheram-Borus et al. All rights reserved. Experience-Sampling Methodology with a Mobile Device in Fibromyalgia Sun, 09 Dec 2012 09:41:27 +0000 This work describes the usability studies conducted in the development of an experience-sampling methodology (ESM) system running in a mobile device. The goal of the system is to improve the accuracy and ecology in gathering daily self-report data in individuals suffering a chronic pain condition, fibromyalgia. The usability studies showed that the developed software to conduct ESM with mobile devices (smartphones, cell phones) can be successfully used by individuals with fibromyalgia of different ages and with low level of expertise in the use of information and communication technologies. 100% of users completed the tasks successfully, although some have completely illiterate. Also there seems to be a clear difference in the way of interaction obtained in the two studies carried out. Castilla Diana, Botella Cristina, García-Palacios Azucena, Farfallini Luis, and Miralles Ignacio Copyright © 2012 Castilla Diana et al. All rights reserved. Installed Base as a Facilitator for User-Driven Innovation: How Can User Innovation Challenge Existing Institutional Barriers? Thu, 06 Dec 2012 16:22:18 +0000 The paper addresses an ICT-based, user-driven innovation process in the health sector in rural areas in Norway. The empirical base is the introduction of a new model for psychiatric health provision. This model is supported by a technical solution based on mobile phones that is aimed to help the communication between professional health personnel and patients. This innovation was made possible through the use of standard mobile technology rather than more sophisticated systems. The users were heavily involved in the development work. Our analysis shows that by thinking simple and small-scale solutions, including to take the user’s needs and premises as a point of departure rather than focusing on advanced technology, the implementation process was made possible. We show that by combining theory on information infrastructures, user-oriented system development, and innovation in a three-layered analytical framework, we can explain the interrelationship between technical, organizational, and health professional factors that made this innovation a success. Synnøve Thomassen Andersen and Arild Jansen Copyright © 2012 Synnøve Thomassen Andersen and Arild Jansen. All rights reserved. Technological Approaches to Remote Monitoring of Elderly People in Cardiology: A Usability Perspective Thu, 06 Dec 2012 12:13:54 +0000 Moving from the experience gained in home telemonitoring of elderly patients with Congestive Heart Failure, that confirmed a reduction of the rehospitalization rate and an improved monitoring of drugs assumption by the patients, this paper extends the evaluation of technological approaches for remote health monitoring of older adults. Focus of the evaluation is on telemedicine effectiveness and usability, either from a patient’s or a medical operator’s perspective. The evaluation has been performed by testing three remote health platforms designed according to different technological approaches, in a realistic scenario involving older adults and medical operators (doctors and nurses). The aim of the testing activity was not to benchmark a specific solution with respect to the others, but to evaluate the main positive and negative issues related to the system and service design philosophy each solution was built upon. Though preliminary, the results discussed in the paper can be used as a set of guidelines in the selection of proper technological equipments for services targeted to elderly users, from a usability perspective. These results need to be complemented with more focused discussions of the ethical, medical, and legal aspects of the use of technology in remote healthcare. Susanna Spinsante, Roberto Antonicelli, Ilaria Mazzanti, and Ennio Gambi Copyright © 2012 Susanna Spinsante et al. All rights reserved. Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative Wed, 05 Dec 2012 17:00:18 +0000 Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators. Shantanu Nundy, Jonathan J. Dick, Anna P. Goddu, Patrick Hogan, Chen-Yuan E. Lu, Marla C. Solomon, Arnell Bussie, Marshall H. Chin, and Monica E. Peek Copyright © 2012 Shantanu Nundy et al. All rights reserved. Health Information Accessed on the Internet: The Development in 5 European Countries Wed, 05 Dec 2012 13:35:45 +0000 The aim of this study was to summarize and analyse findings from four prior studies on the use of the Internet as a source of health information in five European countries (Norway, Denmark, Germany, Greece, and Portugal). A cross-study comparison of data was performed. All the studies included fit with a trend of a sharp and continuous growth in the use of the Internet for health information access in the major part of the last decade. Importantly, the Internet has become an important mass media source of health information in northern Europe. While the use of the Internet for health information is somewhat less common in the south European countries, its use is also clearly increasing there. We discuss the advantages of cross-study comparisons of data and methodological challenges. As the use of the Internet for health information is likely to peak in some countries in the near future, new population surveys on health information access should focus more on the details of information that is accessed and which sites that are most used and trusted. Per Egil Kummervold and Rolf Wynn Copyright © 2012 Per Egil Kummervold and Rolf Wynn. All rights reserved. Family Interaction and Consensus with IT Support Mon, 03 Dec 2012 11:44:36 +0000 Experience shows that there are great defects in information and collaboration between families and professionals in the health and care sector. In an attempt to improve the quality of the efforts planned and implemented in collaboration with relatives a family-related IT-based collaboration system called CIDC was constructed. With the intention to facilitate communication, information, documentation, and collaboration the system was tested together with parents of children with cognitive impairment. The system contains a number of functions gathered in a so-called e-collaboration room. The person administering and distributing the system authorizes the patient/care recipient or relative to build up an e-collaboration room. The result has been largely positive, but the part, which was supposed to document everyday activities, leaves much to be desired. For this reason a follow-up study was completed, and an iPad was used as a contact book, which with the help of the Dropbox software provided increased insight into the child and improved the contact with parents without losing confidentiality or causing extra workload for the staff. By automatic download from the iPad parents and/or contact persons could easily follow the documentation of children’s everyday activities. Peter Karlsudd Copyright © 2012 Peter Karlsudd. All rights reserved. Telemonitoring of Daily Activity and Symptom Behavior in Patients with COPD Sun, 25 Nov 2012 08:30:08 +0000 Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness), and readiness to change activity behavior. Methods. Thirty-nine patients with COPD (66.0 years; FEV1% predicted: 44.9%) and 21 healthy controls (57.0 years) participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm). Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls ( cpm versus  cpm, ). COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3%) were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels. Monique Tabak, Miriam M. R. Vollenbroek-Hutten, Paul D. L. P. M. van der Valk, Job van der Palen, Thijs M. Tönis, and Hermie J. Hermens Copyright © 2012 Monique Tabak et al. All rights reserved. Monitoring Heart Disease and Diabetes with Mobile Internet Communications Sun, 18 Nov 2012 09:33:49 +0000 A telemedicine system is described for monitoring vital signs and general health indicators of patients with cardiac and diabetic conditions. Telemetry from wireless sensors and readings from other instruments are combined into a comprehensive set of measured patient parameters. Using a combination of mobile device applications and web browser, the data can be stored, accessed, and displayed using mobile internet communications to the central server. As an extra layer of security in the data transmission, information embedded in the data is used in its verification. The paper highlights features that could be enhanced from previous systems by using alternative components or methods. David Mulvaney, Bryan Woodward, Sekharjit Datta, Paul Harvey, Anoop Vyas, Bhaskar Thakker, Omar Farooq, and Robert Istepanian Copyright © 2012 David Mulvaney et al. All rights reserved.