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03/2012; , ISBN: 978-953-51-0365-3
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ABSTRACT: The use of structuration theory in the field of information systems is long debated. Questions on its applicability and suitability
have led to many insightful studies and papers in this area. We, in this chapter, draw on these studies and provide a complementary
view on use of ST in studying IS deployment. While doing so, we draw on Giddens’s recent work and utilise telehealth implementation
case study as an example.
KeywordsStructuration theory-Telehealth-Technology acceptance
09/2011: pages 131-142;
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ABSTRACT: We conducted a systematic review of large, well-conducted randomised trials designed to evaluate the effectiveness of telemonitoring on patients with congestive heart failure (CHF). Two people reviewed 125 articles independently and selected 13 articles for final review. These studies concerned 3480 patients. The follow-up period of the studies was 3-15 months. Pooled estimate results showed that there was an overall reduction in all-cause mortality (P = 0.02). There was no overall reduction in all-cause hospital admission (P = 0.84), although there was a reduction in CHF hospital admission (P = 0.0004). There was no reduction in all-cause emergency admission (P = 0.67). There was no significant difference in length of stay in hospital, medication adherence or cost. Telemonitoring in conjunction with nurse home visiting and specialist unit support can be effective in the clinical management of patients with CHF and help to improve their quality of life.
Journal of telemedicine and telecare 01/2011; 17(1):7-14. · 0.92 Impact Factor
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ABSTRACT: This study involves conducting focus group discussions with clinical users (nurses and technicians) prior to the launch of telehealth service in Nottingham, UK, to elicit their initial perceptions about the service. It describes the findings from preliminary phase of otherwise a larger longitudinal study. Using Giddens's concepts from structuration theory and consequence of modernity, we were able to acknowledge trust and sense of security as two very salient aspects that govern adoption of new technological innovation. Unattended, these aspects contribute to arousal of conflict and contradiction within a system. In order for successful telehealth implementations in health care setting, providers of the service, need to focus on ways in which clinical users' trust can be gained and sense of security can be promoted while using the telehealth service and technology.
Studies in health technology and informatics 01/2010; 160(Pt 1):545-9.
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ABSTRACT: We describe our experiences of using remote patient monitoring to support the long term management and clinical intervention in patients with chronic disease. Within the project we developed new algorithms to determine from vital signs collected on a daily basis, those patients requiring clinical investigation for their condition. Our aim was for patients to achieve and sustain clinically recommended values for parameters. In our study, the telemonitoring prompted clinical intervention in 37% of patients. Our approach proved particularly effective for the newly diagnosed, and for those with long term issues of management.
Engineering in Medicine and Biology Society, 2008. EMBS 2008. 30th Annual International Conference of the IEEE; 09/2008
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ABSTRACT: We conducted a systematic review of the literature to critically analyse the technical evaluation and assessment frameworks that have been applied to telemedicine systems. A total of 47 articles met the inclusion criteria. Subjective methods were predominantly used for technical evaluation (59%), e.g., Likert scale. Those including objective measurements (41%) were mainly restricted to simple metrics such as network time delays. Only 3 papers included a rigorous standards-based objective approach. Our investigation has been unable to determine a definitive standards-based telemedicine evaluation framework that exists in the literature that may be applied systematically to assess and compare telemedicine systems. We conclude that work needs to be done to address this deficiency.
Telemedicine and e-Health 04/2008; 14(2):170-83. · 1.42 Impact Factor
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ABSTRACT: We have investigated the use of telemonitoring in three long-term conditions: chronic heart failure (CHF), type 2 diabetes and essential hypertension. Participants were provided with a home telemonitoring unit for a 12-week period and entered physiological data each day. The data were sent automatically via the participant's telephone line to a server and could be viewed via a web browser. An intervention algorithm was developed to improve the accuracy with which patients requiring intervention were recognized compared to existing systems based on a simple threshold. Thirty patients completed the 12-week trial. One patient dropped out, giving data on 29 patients (mean age 70 years, 17 women). The algorithm prompted a clinical intervention in 11 patients (38%). The average time that elapsed before the first intervention was 47 days (SD 21). Primarily the interventions (72%) resulted in changes to medication and health advice. The results suggest that four weeks is sufficient time in which to recognize the need to intervene clinically and that in 12 weeks it is possible to effect a change towards a target.
Journal of Telemedicine and Telecare 02/2008; 14(3):122-4. · 1.21 Impact Factor
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ABSTRACT: An automated personalised intervention algorithm was developed to determine when and if patients with chronic disease in a remote monitoring programme required intervention for management of their condition. The effectiveness of the algorithm has so far been evaluated on 29 patients. It was found to be particularly effective in monitoring newly diagnosed patients, patients requiring a change in medication as well as highlighting those that were not conforming to their medication. Our approach indicates that RPM used with the intervention algorithm and a clinical protocol can be effective in a primary care setting for targeting those patients that would most benefit from monitoring.
Studies in health technology and informatics 02/2008; 136:181-6.
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Malcolm Clarke
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ABSTRACT: This paper describes the process and outcome of the efforts to develop a new standard for Personal Health Data (PHD) based on the existing 11,073 family of standards for medical devices. It identifies the requirements for a standard that is to be applied to small devices with limited resources of processor, memory and power and that will use short range wireless technology. It describes how existing components of 11,073, such the Domain Information Model and nomenclature have been used and adapted to create the new standard.
Studies in health technology and informatics 02/2008; 136:717-22.
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ABSTRACT: We describe our experiences of using remote patient monitoring to support the long term management and clinical intervention in patients with chronic disease. Within the project we developed new algorithms to determine from vital signs collected on a daily basis, those patients requiring clinical investigation for their condition. Our aim was for patients to achieve and sustain clinically recommended values for parameters. In our study, the telemonitoring prompted clinical intervention in 37% of patients. Our approach proved particularly effective for the newly diagnosed, and for those with long term issues of management.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 02/2008; 2008:5863-6.
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ABSTRACT: We describe the impact of a remote patient monitoring (RPM) system implemented in residential care homes.
The service was designed to support the staff in managing patients that presented with non-specific symptoms. The system allows vital signs to be transmitted to a central server. The medical professional may then observe the data and provide advice to the staff on optimum management. Our system has been evaluated for 18 months and largely provided routine measurements.
During this period, three residents presented with non specific symptoms that were investigated using the RPM system. One patient had symptoms over a weekend, and the problem remained unresolved on Monday. The resident continued to only complain of feeling unwell, but reported no specific symptoms. Vital signs data were then sent and the doctor consulted. The electrocardiogram (ECG) showed significant ST segment changes. Repetitive measurements of the ECG, heart rate, and oxygen saturation of the blood (SpO2) were made every 5 minutes. The resident had a history angina and CHF. The staff was asked to give the patient aspirin and anti-angina drug. The ECG was seen to resolve after 40 minutes, but the SpO2 was falling. The decision to send to hospital was taken at this point. Two further patients with significant ECG changes were observed during the period of the project, and again both were asymptomatic, but in these cases the condition resolved and hospital admission was avoided. Feedback from users has been very positive. Staff found that the system gave them support to make better informed decisions on patient management, especially when determining whether to admit the person to hospital when reaching end of life. Further comments were that the system also proved useful to reassure relatives during these final stages.
Our project demonstrated that significant cardiac events occur in the elderly population of residential homes without symptoms; and that RPM can be used by non medical staff to manage asymptomatic patients in the community.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 08/2007; 7 Suppl 1:186-8. · 0.44 Impact Factor
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ABSTRACT: Demographic changes in the population, with a growing proportion of elderly people, make the efficient and effective provision of healthcare for this age group an increasingly important issue. We examine the organisational and human aspects of introducing a Remote Patient Monitoring (RPM) system that uses wireless and broadband networks into three residential care homes in the UK. Stakeholders were identified, and semi-structured one-to-one interviews were carried out in order to identify issues deemed most important to each group. The work is novel, as it requires examination of the issues of communication between healthcare workers in several primary and secondary care organisations. The key finding was the need to identify the changes in working practice and interpersonal communication. A key factor in particular was the change in relationships: staff in the remote centre needing to learn to seek support when reporting and requesting assistance for a problem; and for the staff at the health centres to respond appropriately.
International Journal of Electronic Healthcare 02/2007; 3(1):123-34.
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ABSTRACT: The objective of this study was to investigate an e-health approach to managing patients presenting with vascular-type symptoms. A pilot study of a prospective cohort of patients referred from a single general practitioner practice of 5700 patients using electronic referral, assessment by a practice nurse, and teleconferencing facilities as an adjunct to normal referral and management practice was designed and conducted. Thirty-eight patients aged 30-93 years old (median 72 years) were enrolled in the study between March 2001 and July 2004. Twelve patients had leg ulceration and 12 complained of leg pain. The remainder had a range of symptoms potentially vascular in nature. All but 1 patient had an initial teleconsultation. This initial teleconsultation lasted a median of 11 minutes (interquartile range 9 minutes (min) 59 seconds (sec)-12 min 43 sec). For 10 patients this was their only contact with the hospital. One patient had teleconsultation follow-up only, 26 patients attended the hospital for vascular laboratory studies or angiography, and 8 of these went on to have radiological and/or surgical intervention. Three patients attended the outpatient department for follow up; all other follow-ups were managed via the teleclinic. Overall, 57 standard outpatient attendances in these patients were replaced by teleconsultations. Common vascular-type symptoms can be satisfactorily evaluated across a telelink with the aid of a practice nurse and baseline patient data transmitted electronically. Decisions can be made regarding the need for further investigation and attendance in outpatient clinic can be largely eliminated.
Telemedicine and e-Health 01/2007; 12(6):672-80. · 1.42 Impact Factor
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IJEH. 01/2007; 3:123-134.
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ABSTRACT: Remote patient monitoring (RPM) of physiological measurements offers the potential to provide high quality care to elderly, chronically and acutely ill people in their home environment, while making effective use of healthcare resources. However, despite its clearly demonstrated potential, RPM has not become an integrated part of patient care so far. In this paper, we undertake an extensive systematic literature review to identify the typical setup of RPM projects and services in the UK. We then propose a solution for a clinically and organizationally more integrated service, which is based in primary care. Key to the design is the involvement of other healthcare services such as social care, the emergency department of a hospital, and out-of-hours General Practitioner services, and also the involvement of the patient and their carer/s. This allows a team-based approach with information-sharing across different healthcare sectors, and offers maximum continuity of care for the patient.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 02/2006; 1:6465-8.
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ABSTRACT: Three residential homes to the north-west of London, with their associated medical centres, were equipped with telemonitors to measure several variables, including seven-lead electrocardiogram, blood pressure, oxygen saturation, heart rate, temperature and respiration. The monitors could be operated by non-medical personnel. After recording, the data were transmitted via the Internet to a server. A total of 24 patients with a variety of chronic conditions were monitored regularly for a period of one year. Data transmission was found to be unreliable on occasions and was improved by extending the wireless network in the homes. Data access and presentation were considered acceptable, although suggestions for minor changes were made. No discernible impact on disease management, diagnosis or care was observed as a result of the monitoring. However, interviewees saw several potential benefits and patient acceptance was very good. The monitoring was found to be generally acceptable and feasibility was considered to have been largely proven.
Journal of Telemedicine and Telecare 02/2005; 11 Suppl 1:29-31. · 1.21 Impact Factor
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Malcolm Clarke
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ABSTRACT: The Telecare Interactive Continuous Monitoring System exploits GPRS to provide an ambulatory device that monitors selected vital signs on a continuous basis. Alarms are sent when parameters fall outside preset limits, and accompanying physiological data may also be transmitted. The always-connected property of GPRS allows continuous interactive control of the device and its sensors, permitting changes to monitoring parameters or even enabling continuous monitoring of a sensor in emergency. A new personal area network (PAN) has been developed to support short-range wireless connection to sensors worn on the body including ECG and finger worn SpO2. Most notable is use of ultra low radio frequency to reduce power to minimum. The system has been designed to use a hierarchical architecture for sensors and "derived" signals, such as HR from ECG, so that each can be independently controlled and managed. Sensors are treated as objects, and functions are defined to control aspects of behaviour. These are refined in order to define a generic set of abstract functions to handle the majority of functions, leaving a minimum of sensor specific commands. The intention is to define a reference architecture in order to research the functionality and system architecture of a telemonitoring system. The Telecare project is funded through a grant from the European Commission (IST programme).
Studies in health technology and informatics 02/2004; 103:381-4.
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ABSTRACT: eVital, a European funded project, aims to investigate the issues in the provision of vital signs monitoring services in the community. For the UK pilot, services to monitor the vital signs of patients in residential care homes by remote health care workers have been established. In particular, the aim was to allow the resident's own GP to observe the ECG, blood pressure, SpO2, temperature and respiration whilst still in the health centre and be able to advise on the most appropriate action should a crisis occur. As outcomes, this pilot project was designed to determine feasibility, channels of communication between key players and assess the technology. Trials have been under way for four months and preliminary results are promising. Residential home staff have commented on the extra level security they feel in being able to "summon" medical support for residents for whom they may have concern. Patient's relatives have also commented on the reassurance they experience from knowing that the resident is being monitored.
Studies in health technology and informatics 02/2004; 103:374-80.
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ABSTRACT: We have implemented an 'evidence-based referral' for primary care patients in dermatology, cardiology and peripheral vascular disease. Telemedicine clinics bring together a district nurse, patient and vascular surgeon to discuss diagnosis, management and care. During a 30-month study, a total of 30 patients participated in telemedicine clinics. The mean consultation time fell from 23 to 10 min. In parallel, the type of consultation changed from dermatology to vascular surgery. Nineteen patients participated in vascular telemedicine clinics over the last 16 months of the study. The average consultation time was 10 min (SD 1), which included discussion of the case and negotiation of its management. The average consultation time in the equivalent outpatient clinic in the same hospital for the same consultant was 15 min. The acquisition of the relevant information in primary care could lead to a reduction of 75% in outpatient clinic appointments.
Journal of Telemedicine and Telecare 02/2003; 9 Suppl 1:S71-3. · 1.21 Impact Factor
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ABSTRACT: The fragmentary nature of healthcare provision in the United Kingdom presents particular problems for many patients with vascular disease. The management and organization of this disease are also costly for the National Health Service (NHS). Hence, so any attempt to keep hospital visits to the minimum while at the same time aiding effective treatment is to be welcomed. Information in the current NHS is stored in various places and access to it is restricted. There is no central, complete, patient record that is accessible to all healthcare professionals at the various levels of care. There is also no mechanism that allows the patient to interact with his or her local nurse and/or doctor/general practitioner (at primary-care level) involving the specialist/consultant (at secondary-care level). The concept and conduct of an ulcer care program for such patients are described in this paper. Nurse-led, this novel approach uses an innovative information technology system to bring together the isolated 'islands' of knowledge and information held by both the patient and healthcare professionals involved in their care. The technology described here combines both store and forward and real-time video. Informal feedback from patients, community nurses, doctors/general practitioners, and specialists/consultants suggests that such an approach is well received. However, we conclude with a discussion of the complexities involved in the interaction between technology and people and the implications for the management of healthcare.
Telemedicine and e-Health 02/2003; 9(2):215-21. · 1.42 Impact Factor
