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Wearable Technologies and Telehealth in Care Management for Chronic Illness
Abstract
Telehealth is the use of technology for remote patient monitoring and care. Wearables are small electronic devices that can seamlessly collect data about a patient for prolonged periods of time and support the implementation of telemedicine in the patient’s natural environment. In a reality where patients are becoming older and sicker, medicine is becoming more and more a multidisciplinary team work and healthcare resources are limited, telehealth holds promise as a way to improve patient care while cutting on costs. It may improve coordination between care providers, allow for bringing top notch expertise to remote, rural settings, provide a more complete picture of the patient’s condition and support independent living of the elderly and patients with chronic diseases. In this chapter, we review some of the related technology and application and portrait how they may be integrated in the near future in the healthcare delivery system.
... This implies that any electronic devices that can be worn on a person's body can be classified as wearables since they have wireless communication capabilities that can be integrated into gadgets, accessories, or clothing (Nahavandi, et al., 2021). However, Zhu and Cahan (2016) build on this definition by referring to wearable devices based on their built-in sensors that track users' movements, location and provide biometric identification. This is in addition to wearable technology capabilities to capture and transfer data to cloud storage through wireless communication synched with the smartphone ). ...
... Smartwatch users expressed that smartwatch wearables can be a life-saving tool due to its ability to detect health conditions or risks in advance (Zhu and Cahan 2016). This shows that the data collected by smartwatches can track health patterns and identify early signs of serious medical conditions for users. ...
... This shows that the data collected by smartwatches can track health patterns and identify early signs of serious medical conditions for users. During COVID-19 pandemic, smartwatch wearables have proven to be a useful tool to detect early signs of infection which were crucial in effectively mitigating the transmission of the virus Wearables provide real-time data of users' health patterns which is crucial in identifying potential diagnoses before a patient seeks professional medical care or before they even start showing symptoms (Zhu and Cahan 2016). Users' testimonials bear true to this important feature of smartwatch wearables in detecting medical conditions such as sleep apnea, heart attack, influenza 2 and irregular heartbeat of an unborn baby. ...
Globally, the use of Artificial Intelligence (AI) wearables including smartwatches has gained traction. AI-Smartwatches have emerged as powerful communication tools and their increased use for personal eHealth is driven by capabilities to facilitate micro-engagements with users. Micro-engagements enhance user experience and active interaction by providing real-time feedbackthat triggers the user to act. While smartwatches have the potential to effectively drive positive user health behaviour through instant communication, it is imperative to examine the strategic use of communication of these devices by smartwatch users. The purpose of this study was to examine AISmartwatch user experiences, specifically micro-engagement perceptions. Theoretically, the study was underpinned by The Unified Theory of Acceptance and Use of Technology. A qualitative approach, using a netnography design provided results from online discourses expressed on X (formerly known as Twitter), in response to a question tweeted about the effectiveness of smartwatches. Results indicate that the use of AI-smartwatches has propelled active personal engagement with health. Users reported tracking various aspects of their health due to instantly available data that is in turn used to seek solutions from health professionals. Conversely, it is unclear whether lay people who are not health professionals are skilled in interpreting the instant data that they are exposed to. This study provides much-needed insight into user experiences of strategic use of communication through AI-powered smartwatch devices using data-driven micro-engagements. It will inform Health Professionals, Health Service Organisations and AI Technology Developers among others regarding practice as well as improvement of technological services for digital public health.
... The current issue and full text archive of this journal is available on Emerald Insight at: https://www.emerald.com/insight/0959-3845.htm quality of life for older people with special needs. A WT is a smart device with radio frequency identification (RFID) capability that can be worn on the human body; the Fitbit and iWatch devices are examples of this technology (Gao et al., 2015;Zhu and Cahan, 2016). WTs suggest innovative solutions for currently unresolved issues in service delivery within traditional business models and provide transparent, accurate and reliable data for aged care services (Baig et al., 2019). ...
... Second, WTs may have different socio-economic impacts compared to other similar technologies. For instance, the use of WTs in aged care service operations intends to improve aged care service delivery, the cost-benefit of health care, healthcare monitoring and social engagement among older adults (Gao et al., 2015;Watt et al., 2019;Zhu and Cahan, 2016). However, the use of smartphones or tablets in aged care is still a challenge for both scholars and caregivers as these technologies are "detrimental to cognitive performance" due to the potential for disturbance and loss of focus in the operational environment (Gill et al., 2012, p. 107). ...
... This is critical because caregivers are the first contact for older adults in care-proving organizations, and they can encourage the older adult to wear the technology (Gao et al., 2015;Nasir and Yurder, 2015); (2) Caregivers play a vital role in managing aged care in care-providing organizations (Watt et al., 2019). When a caregiver adopts and then accepts a new technology that has proven to be cost-effective (Baig et al., 2019;Zhu and Cahan, 2016), care-providing organizations can invest in these technologies and implement their use within the management of aged care-service operations. ...
Purpose
This study focuses on the adoption of wearable technologies in a context where care-providing organizations can offer, in collaboration with caregivers, better care. Drawing on dual-factor theory and from the caregiver perspective, this study identifies and examines factors of technology adoption in four developing countries.
Design/methodology/approach
This study was undertaken using a quantitative approach. A survey was distributed among 1,013 caregivers in four developing countries in Asia including Iran, Azerbaijan, Turkmenistan and Iraq and collected quantitative data for model validation and hypotheses analysis. Building on the technology adoption literature, we identified six constructs that impact the behavioral intention of caregivers to use wearable technologies in aged care-providing organizations.
Findings
Our dual-factor model was successfully validated, and all hypotheses were supported. However, different results were found in the selected countries within the cross-country analysis.
Originality/value
This study has significant implications for the study of emerging technologies in aged care service operations. It provides a theoretical framework that may be adapted for future research, enabling practitioners in aged care to better understand the crucial role of technology adoption in service operations. Less attention was paid to the adoption of wearable technologies in aged care, particularly in developing countries, where healthcare services in aged care impose heavy costs on care providers.
... An ICT-supported KM approach may include collective intelligence processes, information-shared analysis, planning problem-solving, and actions to promote health and well-being, follow-up, and accountability. [31][32][33] SWT, a noninvasive technology for remote, unobtrusive, and real-time recording of physiological data (heart rate, blood pressure, skin conductance, respiratory rate and volume, movement, and blood glucose) virtually without discomfort, allows a person to carry out their habitual daily activities while being monitored and guarded in their natural context. 33 This technology opens tremendous possibilities for early detection and prevention of disease progression, relapses, and crises through the development of predictive tools including all the related biopsychosocial indices. ...
... [31][32][33] SWT, a noninvasive technology for remote, unobtrusive, and real-time recording of physiological data (heart rate, blood pressure, skin conductance, respiratory rate and volume, movement, and blood glucose) virtually without discomfort, allows a person to carry out their habitual daily activities while being monitored and guarded in their natural context. 33 This technology opens tremendous possibilities for early detection and prevention of disease progression, relapses, and crises through the development of predictive tools including all the related biopsychosocial indices. 2. Home-based, outreach health care. ...
... This entails a set of procedures to merge services from different agencies and formal and informal resources in the relationship with the individual, family, and community. This approach is intended to tackle all main factors affecting a disease in a systemic and overarching manner, [19][20][21][22][23][24]33 centered on improving the coordination among services and resources and the engagement of all stakeholders (including the patients and their communities) in decision-making, treatment, prevention, and health promotion. 22,44 Aging persons with CD are perhaps the best example of cases with multifaceted and multilayered problems needing such a multidimensional approach to their care. ...
Current trends in health care delivery and management such as predictive and personalized health care incorporating information and communication technologies, home-based care, health prevention and promotion through patients’ empowerment, care coordination, community health networks and governance represent exciting possibilities to dramatically improve health care. However, as a whole, current health care trends involve a fragmented and scattered array of practices and uncoordinated pilot projects. The present paper describes an innovative and integrated model incorporating and “assembling” best practices and projects of new innovations into an overarching health care system that can effectively address the multidimensional health care challenges related to aging patient especially with chronic health issues. The main goal of the proposed model is to address the emerging health care challenges of an aging population and stimulate improved cost-efficiency, effectiveness, and patients’ well-being. The proposed home-based and community-centered Integrated Healthcare Management System may facilitate reaching the persons in their natural context, improving early detection, and preventing illnesses. The system allows simplifying the health care institutional structures through interorganizational coordination, increasing inclusiveness and extensiveness of health care delivery. As a consequence of such coordination and integration, future merging efforts of current health care approaches may provide feasible solutions that result in improved cost-efficiency of health care services and simultaneously increase the quality of life, in particular, by switching the center of gravity of health delivery to a close relationship of individuals in their communities, making best use of their personal and social resources, especially effective in health delivery for aging persons with complex chronic illnesses.
... Table 2 below shows the taxonomy of 25 articles systematically reviewed using the inclusion and exclusion criteria. According to Chawla and Davis (2013), Zhu and Cahan (2016), and Casselma, Onopa, and Khansa (2017), tracking and managing of patients' disease and care in real-time response based on data available through wearable devices are improving through BDA applications and tools. The literature review also revealed an improvement in healthcare efficiencies through the use of BDA in areas such as securing patient data and financial management (Sonnati, 2017), quality of care (Fosso, Anand, & Carter, 2013) and predicting specific patients for re-admission (Bates et al., 2012). ...
... A review on BDA in "health informatics" by Kumar and Singh (2015) provided insight on how healthcare industries are adopting big data capabilities mainly for data management and quality decision-making. From the perspectives of telehealth in care management, Zhu and Cahan (2016) argue that wearable technologies have become the conduit for large data generation from patients. Big data analytics capabilities, therefore, leverage on telehealth and wearable technologies to manage and provide real-time analysis to respond to patients with a chronic illness before readmission. ...
Demand for improvement in healthcare management in the areas of quality, cost, and patient care has been on the upsurge because of technology. Incessant application and new technological development to manage healthcare data significantly led to leveraging on the use of big data and analytics (BDA). The application of the capabilities from BDA has provided healthcare institutions with the ability to make critical and timely decisions for patients and data management. Adopting BDA by healthcare institutions hinges on some factors necessitating its application. This study aims to identify and review what influences healthcare institutions towards the use of business intelligence and analytics. With the use of a systematic review of 25 articles, the study identified nine dominant factors driving healthcare institutions to BDA adoption. Factors such as patient management, quality decision making, disease management, data management, and promoting healthcare efficiencies were among the highly ranked factors influencing BDA adoption.
... Indeed, technology could be used to provide intervention remotely, facilitate more economical use of both healthcare resources (on the part of the healthcare service provider) and selfmanagement resources (on the part of the healthcare service recipient) (Zhu and Cahan 2016). ...
... Technology also offers the opportunity to continuously capture relevant variables (e.g. movement behaviour) that can inform personalisation for more effective intervention and self-management (Zhu and Cahan 2016;Felipe et al. 2015). ...
Chronic pain is a prevalent disorder that affects engagement in valued activities. This is a consequence of cognitive and affective barriers, particularly low self-efficacy and emotional distress (i.e. fear/anxiety and depressed mood), to physical functioning. Although clinicians intervene to reduce these barriers, their support is limited to clinical settings and its effects do not easily transfer to everyday functioning which is key to self-management for the person with pain. Analysis carried out in parallel with this thesis points to untapped opportunities for technology to support pain self-management or improved function in everyday activity settings. With this long-term goal for technology in mind, this thesis investigates the possibility of building systems that can automatically detect relevant psychological states from movement behaviour, making three main contributions. First, extension of the annotation of an existing dataset of participants with and without chronic pain performing physical exercises is used to develop a new model of chronic disabling pain where anxiety acts as mediator between pain and self-efficacy, emotional distress, and movement behaviour. Unlike previous models, which are largely theoretical and draw from broad measures of these variables, the proposed model uses event-specific data that better characterise the influence of pain and related states on engagement in physical activities. The model further shows that the relationship between these states and guarding during movement (the behaviour specified in the pain behaviour literature) is complex and behaviour descriptions of a lower level of granularity are needed for automatic classification of the states. The model also suggests that some of the states may be expressed via other movement behaviour types. Second, addressing this using the aforementioned dataset with the additional labels, and through an in-depth analysis of movement, this thesis provides an extended taxonomy of bodily cues for the automatic classification of pain, self-efficacy and emotional distress. In particular, the thesis provides understanding of novel cues of these states and deeper understanding of known cues of pain and emotional distress. Using machine learning algorithms, average F1 scores (mean across movement types) of 0.90, 0.87, and 0.86 were obtained for automatic detection of three levels of pain and self-efficacy and of two levels of emotional distress respectively, based on the bodily cues described and thus supporting the discriminative value of the proposed taxonomy. Third, based on this, the thesis acquired a new dataset of both functional and exercise movements of people with chronic pain based on low-cost wearable sensors designed for this thesis and informed by the previous studies. The modelling results of average F1 score of 0.78 for two-level detection of both pain and self-efficacy point to the possibility of automatic monitoring of these states in everyday functioning. With these contributions, the thesis provides understanding and tools necessary to advance the area of pain-related affective computing and groundbreaking insight that is critical to the understanding of chronic pain. Finally, the contributions lay the groundwork for physical rehabilitation technology to facilitate everyday functioning of people with chronic pain.
... Promising devices that can be worn have emerged as a management tool for an array of ongoing illnesses. These potentially powerful management tools can help several chronic conditions, among them: diabetes, cardiovascular diseases (e.g., hypertension and heart failure), ongoing respiratory conditions (e.g., sleep apnea and chronic obstructive pulmonary disease (COPD)), obesity, ongoing mental health issues (like anxiety and depression), and disorders of the musculoskeletal system (e.g., arthritis) [7][8][9]. ...
The management of chronic diseases has been revolutionized by the advent of wearable health technology. These devices provide personalized and real-time health data to patients. The problem that this technology is most frequently used to address is obesity and its consequences, heart disease, and certain cancers. Numerous studies have shown a correlation between being at a healthy weight and having a lower risk of developing these conditions. Yet, many smart health devices in the wearable technology sector are only, and most of the time, within the context of weight management or obesity. The major research question directing this exploration is as follows: How can the use of wearable technologies be effective in improving the management and quality of life of people with chronic health problems? The question carries with it another that is almost as important: Does the use of these devices move us toward a more moral and just healthcare system, or does it unfairly advantage some groups of patients over others? This research will focus on three specific types of wearable devices, chosen as representative case studies. They are (1) the smartwatch, a more recent advancement in wearable technology that monitors the user's heart rate and physical activity; (2) the continuous glucose monitor (CGM), which presents real-time glucose levels for the user; and (3) the continuous positive airway pressure (CPAP) device, also called a respirator, worn during sleep by individuals diagnosed with sleep apnea. Each of these devices has the potential to not only revolutionize the management of chronic health conditions but also raise some important questions about the ethics of doing so.
... Nurses can leverage wearable devices to monitor vital signs, track physical activity, and collect health data. These devices facilitate remote patient monitoring, enabling nurses to identify trends, detect abnormalities, and intervene promptly (Zhy & Cahan, 2022). Wearable devices enhance patient engagement, promote preventive care, and support nurses in delivering personalized and proactive healthcare. ...
The climatic factor has played dominant role on affecting agricultural production in the region. This study focused on analyzing the impact of Climate change in agricultural production in two districts of Nepal. Sunsari district had experienced the highest annual temperature increased (0.0038°C/yr) during 1990 and 2022, whereas the Saptari district had faced sharp decline in rainfall (11.442 mm/yr). Climate change resulted into climate induced disasters such as recurring drought, catastrophic flooding, mass wasting and emergence of pests. The climate data during 1990 and 2022, was used to find climate trend analysis. The inter-annual climatic patterns across time were examined using the trend analysis test and trend line slope. The HH survey concluded with increased in temperature and crop diseases emergence along with increase in the frequency of pests, drought and floods, and decreased in rainfall as perceived by majority of respondents. These parameters were expected to cause negative effect on crop output, human health, animals and vegetation. An increasing tendency in temperature and declining trend in precipitation were the two main climatic trends that were observed in the study area. Climate trends in Barahakshetra of Sunsari district of the KRB showed an increasing rate of precipitation of 7.8021 mm/year. The linear trend analysis of pre-monsoon time showed the precipitation was increasing at the rate of 3.4424 mm/year. The trend of post-monsoon rainfall increased significantly at the rate of 1.7956 mm/year. The Climatic trends as indicated by Barmajhiya Station in the Saptari district of the KRB showed decreasing rate of annual precipitation with 11.442 mm/year. In Saptari district, the annual production of paddy has been observed in decreasing trend of 1092.9 Mt. per year, with the increasing trend of cultivation area with 673.55 ha per year. The decreasing trend of cultivation area was observed with 17.918 ha per year. The HHs survey ascertained that, the majority of respondents perceived the increased temperature and drought with heavy rainfall and flood in the locality. The springs and ponds were at stake resulting into water scarcity with low discharge in rivers.
... Nurses can leverage wearable devices to monitor vital signs, track physical activity, and collect health data. These devices facilitate remote patient monitoring, enabling nurses to identify trends, detect abnormalities, and intervene promptly (Zhy & Cahan, 2022). Wearable devices enhance patient engagement, promote preventive care, and support nurses in delivering personalized and proactive healthcare. ...
This article explores the integration of technology, interdisciplinary collaboration, evidence-based practice, and improved resources and training in the nursing profession as innovative strategies for advancing patient-centered care. The integration of technology has revolutionized healthcare delivery, enabling improved access, communication, and empowerment for patients. Electronic health records (EHRs), telehealth platforms, and mobile health applications facilitate personalized care planning, remote patient monitoring, and patient education. Evidence-based practice is a cornerstone of patient-centered care, promoting the use of the best available evidence in clinical decision-making. By integrating research findings and evidence-based guidelines into practice, nurses can deliver high-quality care that is tailored to individual patient needs. Evidence-based practice enhances patient safety, improves outcomes, and increases patient satisfaction. Improved resources and training are essential for supporting patient-centered care. Adequate staffing levels, patient-centered infrastructure, and ongoing professional development opportunities enable nurses to deliver care that is responsive to individual patient needs. By investing in training and resources, healthcare organizations create an environment that fosters patient-centered communication, engagement, and satisfaction. Patient-centered care not only improves health outcomes but also enhances patient experiences, empowers individuals to actively participate in their own care, and ultimately leads to a healthcare system that revolves around the needs and well-being of the patients it serves.
... However, financial potential and human resource enhancement are hindered by chronic fragility. According to [50], people's health issues are impacted by their level of [51]. A non-REC-producing approach produces toxins that endanger human life, whereas the REC further develops LE decisively [52]. ...
The purpose of the study is to investigate the relationships and potential impacts of environmental pollutants, human resources, GDP, sustainable power sources, financial assets, and SAARC countries from 1995 to 2022. Board cointegration tests, D-H causality, cross-sectional reliance (CSD), Saville and Holdsworth Restricted (SHL), and the DSK Appraisal Strategy were among the logical techniques employed to discover long-term connections between these components. Results demonstrate that GDP growth, renewable energy sources (REC), and environmental pollution (ENP) all contribute to SAARC countries’ progress. However, future opportunities and HR are negatively impacted by increased ecological pollution. The results of the two-way causality test demonstrate a strong correlation between HR and future possibilities. Opportunities for the SAARC countries are closely related to the growth of total national output, the use of green electricity, and public support sources. Ideas for tackling future projects are presented in the paper’s conclusion. These include facilitating financial development, reducing ecological pollution, financing the progress of human resources, and promoting the use of sustainable power sources.
... Wearable sensors are an expanding field of research, with growing applications in telehealth [1], fitness tracking [2], and mass casualty incident management [3]. Various shapes of wearable sensors of physiological parameters are under development, such as patches [4][5][6][7], bands [8][9][10], or watches [11]. ...
The HeartPy Python toolkit for analysis of noisy signals from heart rate measurements is an excellent tool to use in conjunction with novel wearable sensors. Nevertheless, most of the work to date has focused on applying the toolkit to data measured with commercially available sensors. We demonstrate the application of the HeartPy functions to data obtained with a novel graphene-based heartbeat sensor. We produce the sensor by laser-inducing graphene on a flexible polyimide substrate. Both graphene on the polyimide substrate and graphene transferred onto a PDMS substrate show piezoresistive behavior that can be utilized to measure human heartbeat by registering median cubital vein motion during blood pumping. We process electrical resistance data from the graphene sensor using HeartPy and demonstrate extraction of several heartbeat parameters, in agreement with measurements taken with independent reference sensors. We compare the quality of the heartbeat signal from graphene on different substrates, demonstrating that in all cases the device yields results consistent with reference sensors. Our work is a first demonstration of successful application of HeartPy to analysis of data from a sensor in development.
... In order to overcome this limitation, wearable medical devices, which use ICT (Information & Communication Technology), have recently been developed for chronic disease management. Prevention and management of chronic diseases can be ensured through exercise [52][53][54][55]. The use of medical devices to promote physical activity leads to obesity and hypercholesterolemia management, and through the linkage between these medical devices and local clinic-centered, effective management of chronic diseases can be achieved through periodic monitoring. ...
This study aimed to analyze the demographic characteristics and health behaviors related to chronic diseases and to identify factors that may affect chronic diseases. Data from the Seventh Korea National Health and Nutrition Examination Survey were used, and 3795 adults aged above 40 years were included. The following demographic variables were obtained: sex, age, education, income, type of health insurance, and private insurance. The following health behavior factors were also analyzed: medical checkup, drinking, smoking, exercise, obesity, and hypercholesterolemia. Participants with lower socioeconomic status had a higher risk of developing chronic diseases. Meanwhile, those with private health insurance had a lower risk of developing chronic diseases. In addition, participants who underwent medical checkups and performed exercises had a lower risk, while those with obesity and hypercholesterolemia had a higher risk of developing chronic diseases. It is necessary to manage chronic diseases through comprehensive programs, rather than managing these diseases individually, and through community primary care institutions to improve health behaviors.
... The high cost of implementing wearable systems that enable data sensing in a large scale is also an open challenge. More of developments in wearable technologies for telehealth and associated challenges for clinical adoption are presented in [9,11,12]. ...
... Instead of improving the visual quality of the video technology, we suggest to augment video consultations beyond visual acuity. In this regard, squeezable interfaces [44] and wearable technologies [48] have the potential to capture fine-details of the patient's movements such as weight distribution and range of movements. Additionally, Microsoft Kinect based systems [47] and Vicon Tracking system e.g., [41] could also be utilized to get orientation and posture related information of the patient. ...
While physiotherapists are increasingly organizing video consultations, assessment of lower body movements over video remains a challenge. We present a wearable technology, SoPhy that captures and presents information related to three key aspects of lower limb movements - range of foot movement, weight distribution and foot orientation. SoPhy consists of a pair of socks embedded with sensors for the patients to wear, and a web-interface that displays the captured information to physiotherapists in real-time. The objective of this demonstration is to offer first-hand experience of SoPhy and to create conversations around designing technologies for supporting bodily communication in video consultations.
... However; such an application is not a final solution to detect all types of coma, but it potentially could save lives of many patients, if widely used among the diabetic patients around the world. As per Xinxin Zhu, Amos Cahan [25], Tele-health is the use of technology for remote patient monitoring and care. Wearables are small electronic devices that can seamlessly collect data about a patient for prolonged periods of time and support the implementation of telemedicine in the patient's natural environment. ...
Wearable electronics are electronic products which are implemented by using both electronics technologies and computing devices that a person can wear usually on a daily basis and integrated into clothing. Wearable devices come in many forms with various levels of complexity. Currently, the market for these products is quickly growing, especially within the devices targeted at the common consumer. This is due to the rapid improvements in electronic and computing technology during the last decade. However, despite these advances there still remain unanswered questions on the future success of these products. As a result both this technology and the potential benefits and drawbacks for everyday wearable electronics, a lot of research is on. The main aim of this study is to provide a literature focus to the researchers working on wearable electronics.
... However; such an application is not a final solution to detect all types of coma, but it potentially could save lives of many patients, if widely used among the diabetic patients around the world. As per Xinxin Zhu, Amos Cahan [25], Tele-health is the use of technology for remote patient monitoring and care. Wearables are small electronic devices that can seamlessly collect data about a patient for prolonged periods of time and support the implementation of telemedicine in the patient's natural environment. ...
Wearable electronics are electronic products which are implemented by using both electronics technologies and computing devices that a person can wear usually on a daily basis and integrated into clothing. Wearable devices come in many forms with various levels of complexity. Currently, the market for these products is quickly growing, especially within the devices targeted at the common consumer. This is due to the rapid improvements in electronic and computing technology during the last decade. However, despite these advances there still remain unanswered questions on the future success of these products. As a result both this technology and the potential benefits and drawbacks for everyday wearable electronics, a lot of research is on. The main aim of this study is to provide a literature focus to the researchers working on wearable electronics.
... Instead of improving the visual quality of the video technology, we suggest to augment video consultations beyond visual acuity. In this regard, squeezable interfaces [44] and wearable technologies [48] have the potential to capture fine-details of the patient's movements such as weight distribution and range of movements. Additionally, Microsoft Kinect based systems [47] and Vicon Tracking system e.g., [41] could also be utilized to get orientation and posture related information of the patient. ...
This paper investigates the challenges of bodily communication during video-based clinical consultations. While previous works describe the lack of eye contact and gestures over video, it is unclear how these limitations impact the course of a clinical consultation, particularly in a domain like physiotherapy where the focus is on improving body movements and functioning. To contribute to this understanding, we conducted observations of 10 naturally occurring video and face-to-face consultations for physiotherapy. We found that clinicians rely on a variety of incidental bodily cues and fine-details of body movements to assess and examine the patient. These bodily cues were noticeable during face-to-face consultations; however, a variety of bodily cues got missed over video. Consequently, video consultations became conversational where the clinicians used verbal conduct to get a fair understanding of the patient's health. To guide design of future video consultation systems, we reflect on our understanding as 4 design sensitivities: Visual Acuity, Field-of-view, Clinical Asymmetries, and Time Sequence.
Telemedicine over Internet of Things (IoT) and wearable devices produces an exponential growth in data quantity that enhances transmission, processing, and archival. Deployment of cloud computing (CC) for handling massive data introduces long delay in storage. Earlier studies reported that energy spent for the transmission of data produced by wearable devices is considerably higher compared to sensing and computation. Therefore, energy-efficient clustering techniques based on metaheuristic algorithms become essential for continual healthcare monitoring in telemedicine systems. This chapter develops a new multiobjective water wave optimization (MOWWO) algorithm with support vector machine (SVM), called MOWWO-SVM model for cluster-based healthcare monitoring using wearable devices for telemedicine systems. The presented MOWWO-SVM model operates on two main stages such as clustering and classification. A novel metaheuristic MOWWO algorithm-based clustering technique is applied to determine the cluster heads (CHs ). Besides, the received data at the CHs from wearables are sent to the cloud server for further processing through the fog devices. At last, the SVM model is applied as a disease diagnosis tool and the parameters of SVM are tuned by the MOWWO algorithm. To validate the effectual outcome of the MOWWO-SVM, a comprehensive set of experiments were carried out. The resultant experimental values signified the superiority of the MOWWO-SVM model with the higher average sensitivity, specificity, and accuracy of 95.354%, 93.324%, and 93.868%, respectively.
Presently, Internet of Things (IoT) and wearables have become advanced technologies that intend to ease life and aid people in every aspect of life. They find use in smart healthcare where several wearables and IoT devices are used to monitor the health status of the patients. At the same time, Alzheimer’s disease (AD) is a dynamic, permanent, and neuro-degenerative illness that mainly affects elder people and it progressively degrades the efficiency of the brain, thereby affects memories, learning, and behaviors. The advent of machine learning algorithms has led to the design of IoT and wearables-enabled automated AD diagnosis and classification model. In this view, this chapter introduces an effective IoT and wearables-enabled AD detection and classification model using stacked sparse autoencoder (ADC-SSAE). The proposed ADC-SSAE model enables the wearables to collect patient data and medical examination takes place on the captured data. In addition, the region of interest extraction and bilateral filtering based preprocessing take place to raise the image quality. Besides, local texton XOR patterns (LTxXORP) model is applied as a feature extractor to derive a useful set of features from the preprocessed data. At last, SSAE model is utilized as a classification model to determine the proper class labels of the applied input data. An extensive range of simulations was performed to highlight the better outcome of the ADC-SSAE model. The experimental values obtained by the ADC-SSAE model have ensured the efficacy of the ADC-SSAE model over the compared methods.
Wearable smart sensors are emerging technology for daily monitoring of vital signs with the reducing discomfort and interference with normal human activities. This study highlights the usage of different types of sensors to improve epidemic disease control. However, essential vital signs to be measured in epidemics and emergencies are body temperature, respiratory rate, ECG, heart rate, and SpO2. A complete breakdown of wearable systems used in emergencies such as epidemics is given. Notably, implementing suitable technological solutions could enhance the management and control of epidemic disorders and providing constant monitoring of vital indications.
Methods: In this study, SID, Magiran, PubMed, ScienceDirect, IEEE and Springer databases were searched with the keyword of” Usage of wearable sensors and technologies in health” in English sources and the Persian equivalent of “wearable technologies in health” as the keyword in Persian sources. All articles related to the application and features of wearable technologies in health were selected. Repetitive articles and those without full-text were excluded from the study.
Results: A total of 100 articles were found that after excluding repetitive and irrelevant articles, just 30 articles were studied. In this study, after examining the papers, general and medical applications of wearable technologies, physiological parameters that can be monitored as well as diseases that can be controlled by these technologies are completely explained.
Conclusion: Better understanding of wearable technologies application in health field has an undeniable impact on their advancement. Use of these systems plays an important role in improving the health of people.
Background:
Rare diseases can lead to a significant reduction in quality of life for patients and their families. Ensuring the patients voice is central to clinical decision making is key to delivering, evaluating and understanding the efficacy of therapeutic interventions. Patient reported outcome measures (PROMs) are used to capture the patient's views about their health status and facilitate our understanding of the impact of these diseases and their treatments on patient's quality of life and symptoms.
Main text:
This review explores some of the current issues around the utilisation of PROMs in rare diseases, including small patient populations and dearth of valid PROMs. Difficulties in validating new or current PROMs for use in clinical trials and research are discussed. The review highlights potential solutions for some of the issues outlined in the review and the implementation of PROMs in research and clinical practice are discussed.
Conclusion:
Patient input throughout the development of PROMs including qualitative research is essential to ensure that outcomes that matter to people living with rare disease are appropriately captured. Given the large number of rare diseases, small numbers of patients living with each condition and the cost of instrument development, creative and pragmatic solutions to PROM development and use may be necessary. Solutions include qualitative interviews, modern psychometrics and resources such as item banking and computer adaptive testing. Use of PROMs in rare disease research and clinical practice offers the potential to improve patient care and clinical outcomes.
Purpose:
Independent mobility is one of the most pressing problems facing people who are blind. We present the EyeCane, a new mobility aid aimed at increasing perception of environment beyond what is provided by the traditional White Cane for tasks such as distance estimation, navigation and obstacle detection.
Methods:
The "EyeCane" enhances the traditional White Cane by using tactile and auditory output to increase detectable distance and angles. It circumvents the technical pitfalls of other devices, such as weight, short battery life, complex interface schemes, and slow learning curve. It implements multiple beams to enables detection of obstacles at different heights, and narrow beams to provide active sensing that can potentially increase the user's spatial perception of the environment. Participants were tasked with using the EyeCane for several basic tasks with minimal training.
Results:
Blind and blindfolded-sighted participants were able to use the EyeCane successfully for distance estimation, simple navigation and simple obstacle detection after only several minutes of training.
Conclusions:
These results demonstrate the EyeCane's potential for mobility rehabilitation. The short training time is especially important since available mobility training resources are limited, not always available, and can be quite expensive and/or entail long waiting periods.
This paper reviews what we know about prediction in relation to mood disorders from the perspective of clinical, biological, and physiological markers. It then also presents how information and communication technologies have developed in the field of mood disorders, from the first steps, for example, the transition from paper and pencil to more sophisticated methods, to the development of ecological momentary assessment methods and, more recently, wearable systems. These recent developments have paved the way for the use of integrative approaches capable of assessing multiple variables. The PSYCHE project stands for Personalised monitoring SYstems for Care in mental HEalth.
Falls and fall-related injuries are major incidents, especially for elderly people, which often mark the onset of major deterioration of health. More than one-third of home-dwelling people aged 65 or above and two-thirds of those in residential care fall once or more each year. Reliable fall detection, as well as prevention, is an important research topic for monitoring elderly living alone in residential or hospital units. The aim of this study is to review the existing fall detection systems and some of the key research challenges faced by the research community in this field. We categorize the existing platforms into two groups: wearable and ambient devices; the classification methods are divided into rule-based and machine learning techniques. The relative merit and potential drawbacks are discussed, and we also outline some of the outstanding research challenges that emerging new platforms need to address.
Background:
Significant information is available about government-reimbursed telehealth services such as Medicare and Medicaid across the United States. Although currently 20 states mandate reimbursement for telehealth services and some private insurers have voluntarily covered those services in other states, relatively little is known about telehealth provider experiences with reimbursement from private insurance payers.
Materials and methods:
To investigate this, the American Telemedicine Association's (ATA's) Telemental Health Special Interest Group (SIG), the Policy Group, and the Business and Finance SIG, with the help of ATA staff, conducted a national private payer reimbursement online survey in 2012 using Survey Monkey™ (Palo Alto, CA) ( www.surveymonkey.com/ ).
Results:
Survey responses were received from respondents in 46 of the 50 states. The survey found that telehealth services are being reimbursed by private payers but that progress in reimbursement has been relatively slow compared with earlier surveys.
Conclusions:
Key findings from this study were that government payers as well as several major private payers are highly influential in payment policies for telehealth private payers, that private payers have administrative rules regarding telehealth reimbursement that are barriers to services and reimbursement, and that some providers would benefit from being better informed about billing and coding for telehealth services and how to advocate for telehealth services reimbursement.
To provide an overview of the current concepts regarding telementoring with robotic surgery highlighting recent advances with respect to urological minimally invasive surgery (MIS).
As robotic surgery continues to evolve, telementoring will become a viable alternative to traditional on-site surgical proctoring.
MIS represents one of the most important breakthroughs in medicine over the past few decades. Newcomers to MIS need the guidance of more experienced, 'high volume' mentors to achieve the superior outcomes promised by MIS over conventional techniques.Telementoring, a subset of telemedicine, allows a surgeon at a remote site to offer intraoperative guidance via telecommunication networks. MIS lends itself well to telementoring techniques for several reasons; the primary surgeon performing MIS is working off of video images of the surgical field or images sent to a console. As such, the mentor is seeing the exact same images as the primary surgeon. In this review, we highlight many of the latest technologies in telemedicine, which are applicable to MIS and provide an overview of the pitfalls, which need to be overcome to make telementoring (and eventually telesurgery) a standard tool in the MIS arsenal.
Nowadays society is demanding more and more smart healthcare services that allow monitoring patient status in a non-invasive way, anywhere and anytime. Thus, healthcare applications are currently facing important challenges guided by the u-health (ubiquitous health) and p-health (pervasive health) paradigms. New emerging technologies can be combined with other widely deployed ones to develop such next-generation healthcare systems. The main objective of this paper is to review and provide more details on the work presented in "LOBIN: E-Textile and Wireless-Sensor-Network-Based Platform for Healthcare Monitoring in Future Hospital Environments", published in the IEEE Transactions on Information Technology in Biomedicine, as well as to extend and update the comparison with other similar systems. As a result, the paper discusses the main advantages and disadvantages of using different architectures and communications technologies to develop wearable systems for pervasive healthcare applications.
Despite extensive preventive efforts, falls continue to be a major source of morbidity and mortality among elderly. Real-time detection of falls and their urgent communication to a telecare center may enable rapid medical assistance, thus increasing the sense of security of the elderly and reducing some of the negative consequences of falls. Many different approaches have been explored to automatically detect a fall using inertial sensors. Although previously published algorithms report high sensitivity (SE) and high specificity (SP), they have usually been tested on simulated falls performed by healthy volunteers. We recently collected acceleration data during a number of real-world falls among a patient population with a high-fall-risk as part of the SensAction-AAL European project. The aim of the present study is to benchmark the performance of thirteen published fall-detection algorithms when they are applied to the database of 29 real-world falls. To the best of our knowledge, this is the first systematic comparison of fall detection algorithms tested on real-world falls. We found that the SP average of the thirteen algorithms, was (mean ± std) 83.0% ± 30.3% (maximum value = 98%). The SE was considerably lower (SE = 57.0% ± 27.3%, maximum value = 82.8%), much lower than the values obtained on simulated falls. The number of false alarms generated by the algorithms during 1-day monitoring of three representative fallers ranged from 3 to 85. The factors that affect the performance of the published algorithms, when they are applied to the real-world falls, are also discussed. These findings indicate the importance of testing fall-detection algorithms in real-life conditions in order to produce more effective automated alarm systems with higher acceptance. Further, the present results support the idea that a large, shared real-world fall database could, potentially, provide an enhanced understanding of the fall process and the information needed to design and evaluate a high-performance fall detector.
Psychosis has various causes, including mania and schizophrenia. Since the differential diagnosis of psychosis is exclusively based on subjective assessments of oral interviews with patients, an objective quantification of the speech disturbances that characterize mania and schizophrenia is in order. In principle, such quantification could be achieved by the analysis of speech graphs. A graph represents a network with nodes connected by edges; in speech graphs, nodes correspond to words and edges correspond to semantic and grammatical relationships.
To quantify speech differences related to psychosis, interviews with schizophrenics, manics and normal subjects were recorded and represented as graphs. Manics scored significantly higher than schizophrenics in ten graph measures. Psychopathological symptoms such as logorrhea, poor speech, and flight of thoughts were grasped by the analysis even when verbosity differences were discounted. Binary classifiers based on speech graph measures sorted schizophrenics from manics with up to 93.8% of sensitivity and 93.7% of specificity. In contrast, sorting based on the scores of two standard psychiatric scales (BPRS and PANSS) reached only 62.5% of sensitivity and specificity.
The results demonstrate that alterations of the thought process manifested in the speech of psychotic patients can be objectively measured using graph-theoretical tools, developed to capture specific features of the normal and dysfunctional flow of thought, such as divergence and recurrence. The quantitative analysis of speech graphs is not redundant with standard psychometric scales but rather complementary, as it yields a very accurate sorting of schizophrenics and manics. Overall, the results point to automated psychiatric diagnosis based not on what is said, but on how it is said.
Teleradiology has become a reality for several years now, but its existence still has not been freed from all controversies. From the beginning the military has been the driving force for teleradiology. Today teleradiology has many purposes worldwide ranging from services for expert or second opinions to international commercial diagnostic reading services. Ten years ago image quality, transmission speed and image compression were important issues of debate. Today the focus is on clinical governance, medico-legal issues and quality assessment. The increasing use of teleradiology reflects the changing world of clinical practice, service delivery and technology.
Telehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery--synchronous or real time video communication--rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area.
A systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded.
36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study.
Delivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care.
Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine.
A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured.
This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis.
As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results.
We conducted a systematic review of the literature for assessing the value of home monitoring for heart failure (HF) patients. The abstracts of 383 articles were read. We excluded those in which either no home monitoring was done or only the technical aspects of the telemedicine application were described. Forty-two studies met the selection criteria. We classified the results into feasibility (technical and institutional) and impact (on the clinical process, on patient health, on accessibility and acceptability of the health system, and on the economy). Evaluating the articles showed that home monitoring in HF patients is viable, given that: (1) it appears to be technically effective for following the patient remotely; (2) it appears to be easy to use, and it is widely accepted by patients and health professionals; and (3) it appears to be economically viable. Furthermore, home monitoring of HF patients has been shown to have a positive impact on: (1) the clinical process, supported by a significant improvement of patient follow-up by adjustment of treatment, diet or behaviour, as well as hospital readmissions and emergency visits reduction; (2) the patient's health, supported by a relevant improvement in quality of life, a reduction of days in hospital, and a decrease in mortality; and (3) costs resulting from the use of health resources.
Intensive care unit telemedicine involves nurses and physicians located at a remote command center providing care to patients in multiple, scattered intensive care units via computer and telecommunication technology. The command center is equipped with a workstation that has multiple monitors displaying real-time patient vital signs, a complete electronic medical record, a clinical decision support tool, a high-resolution radiographic image viewer, and teleconferencing for every patient and intensive care unit room. In addition to communication functions, the video system can be used to view parameters on ventilator screens, infusion pumps, and other bedside equipment, as well as to visually assess patient conditions. The intensivist can conduct virtual rounds, communicate with on-site caregivers, and be alerted to important patient conditions automatically via software-monitored parameters. This article reviews the technology's background, status, significance, clinical literature, financial effect, implementation issues, and future developments. Recommendations from a University HealthSystem Consortium task force are also presented.
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.
Background:
The safety and effectiveness of automated glycemic management have not been tested in multiday studies under unrestricted outpatient conditions.
Methods:
In two random-order, crossover studies with similar but distinct designs, we compared glycemic control with a wearable, bihormonal, automated, "bionic" pancreas (bionic-pancreas period) with glycemic control with an insulin pump (control period) for 5 days in 20 adults and 32 adolescents with type 1 diabetes mellitus. The automatically adaptive algorithm of the bionic pancreas received data from a continuous glucose monitor to control subcutaneous delivery of insulin and glucagon.
Results:
Among the adults, the mean plasma glucose level over the 5-day bionic-pancreas period was 138 mg per deciliter (7.7 mmol per liter), and the mean percentage of time with a low glucose level (<70 mg per deciliter [3.9 mmol per liter]) was 4.8%. After 1 day of automatic adaptation by the bionic pancreas, the mean (±SD) glucose level on continuous monitoring was lower than the mean level during the control period (133±13 vs. 159±30 mg per deciliter [7.4±0.7 vs. 8.8±1.7 mmol per liter], P<0.001) and the percentage of time with a low glucose reading was lower (4.1% vs. 7.3%, P=0.01). Among the adolescents, the mean plasma glucose level was also lower during the bionic-pancreas period than during the control period (138±18 vs. 157±27 mg per deciliter [7.7±1.0 vs. 8.7±1.5 mmol per liter], P=0.004), but the percentage of time with a low plasma glucose reading was similar during the two periods (6.1% and 7.6%, respectively; P=0.23). The mean frequency of interventions for hypoglycemia among the adolescents was lower during the bionic-pancreas period than during the control period (one per 1.6 days vs. one per 0.8 days, P<0.001).
Conclusions:
As compared with an insulin pump, a wearable, automated, bihormonal, bionic pancreas improved mean glycemic levels, with less frequent hypoglycemic episodes, among both adults and adolescents with type 1 diabetes mellitus. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov numbers, NCT01762059 and NCT01833988.).
Wearable sensors have garnered considerable recent interest owing to their tremendous promise for a plethora of applications. Yet the absence of reliable non-invasive chemical sensors has greatly hindered progress in the area of on-body sensing. Electrochemical sensors offer considerable promise as wearable chemical sensors that are suitable for diverse applications owing to their high performance, inherent miniaturization, and low cost. A wide range of wearable electrochemical sensors and biosensors has been developed for real-time non-invasive monitoring of electrolytes and metabolites in sweat, tears, or saliva as indicators of a wearer's health status. With continued innovation and attention to key challenges, such non-invasive electrochemical sensors and biosensors are expected to open up new exciting avenues in the field of wearable wireless sensing devices and body-sensor networks, and thus find considerable use in a wide range of personal health-care monitoring applications, as well as in sport and military applications.
Aim
This systematic review aimed to provide a comprehensive description of the methodologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary Disease (COPD) and to explore patients’ adherence and satisfaction with the use of telemonitoring systems.
Methods
A literature search was performed from June to August and updated until December of 2012 on Medline, Embase, Web of Science and B-on databases using the following keywords: [tele(-)monitoring, tele(-)health, tele(-)homecare, tele(-)care, tele-home health or home monitoring] and [Chronic Obstructive Pulmonary Disease or COPD]. References of all articles were also reviewed.
Results
Seventeen articles were included, 12 of them published from 2010 to the present. The methodologies were similar in the training provided to patients and in the data collection and transmission processes. However, differences in the type of technology used, telemonitoring duration and provision of prompts/feedback, were found. Patients were generally satisfied and found the systems useful to help them manage their disease and improve healthcare provision. Nevertheless, they reported some difficulties in their use, which in some studies were related to lower compliance rates.
Conclusions
Telemonitoring interventions are a relatively new field in COPD research. Findings suggest that these interventions, although promising, present some usability problems that need to be considered in future research. These adjustments are essential before the widespreading of telemonitoring.
The present work describes the first example of real-time non-invasive lactate sensing in human perspiration during exercise events using a flexible printed temporary-transfer tattoo electrochemical biosensor that conforms to the wearer's skin. The new skin-worn enzymatic biosensor exhibits chemical selectivity towards lactate with linearity up to 20 mM and demonstrates resiliency against continuous mechanical deformation expected from epidermal wear. The device was applied successfully to human subjects for real-time continuous monitoring of sweat lactate dynamics during prolonged cycling exercise. The resulting temporal lactate profiles reflect changes in the production of sweat lactate upon varying the exercise intensity. Such skin-worn metabolite biosensors could lead to useful insights into physical performance and overall physiological status, hence offering considerable promise for diverse sport, military and biomedical applications.
The frequent monitoring of glucose is an essential part of diabetes management. Despite the fact that almost all the commercially successful blood glucose monitoring devices are invasive, there is an immense need to develop non-invasive glucose monitoring (NGM) devices that will alleviate the pain and suffering of diabetics associated with the frequent pricking of skin for taking the blood sample for glucose testing. There have been numerous developments in the field of NGM during the last decade, which stress the need for a critical review. This manuscript aims to review the various NGM techniques and devices. The challenges and future trends in NGM are also discussed.
Picture archiving and communication systems (PACS) and the Internet have changed how clinicians interact with their clinical colleagues, both during the day and at night. Teleradiology may improve the quality of life for radiologists but it also improves the quality of the interpretations for the patients. Given the opportunity this provides to connect subspecialist clinicians with subspecialist radiologists, daytime and nighttime teleradiology is likely to increase. Although teleradiology may worsen the commoditization that started with PACS, patient care will likely be improved, and that should always be the highest priority.
Wearable technology and integrated systems, so called Smart Wearable Systems (SWS) have demonstrated during the last 10-15 years significant advances in terms of, miniaturisation, seamless integration, data processing & communication, functionalisation and comfort. This is mainly due to the huge progress in sciences and technologies e.g. biomedical and micro & nano technologies, but also to a strong demand for new applications such as continuous personal health monitoring, healthy lifestyle support, human performance monitoring and support of professionals at risk. Development of wearable systems based of smart textile have, in addition, benefited from the eagerness of textile industry to develop new value-added apparel products like functionalized garments and smart clothing. Research and development in these areas has been strongly promoted worldwide. In Europe the major R&D activities were supported through the Information & Communication Technologies (ICT) priority of the R&D EU programs. The paper presents and discusses the main achievements towards integrated systems as well as future challenges to be met in order to reach a market with reliable and high value-added products.
The area of Micro and Nano systems (MNS) focuses on heterogeneous integration of technologies (e.g. electronics, mechanics and biotechnology) and implementation of multiple functionalities (e.g. sensing, processing, communication, energy and actuation) into small systems. A significant amount of MNS activities targets development and testing of systems enabling biomedicine and personal health solutions. Convergence of micro-nano-bio and Information & communication technologies is being leading to enabling innovative solutions e.g. for in-vitro testing and in vivo interaction with the human body for early diagnosis and minimally invasive therapy. Of particular interest are smart wearable systems such as smart textiles aiming at the full integration of sensors/actuators, energy sources, processing and communication within the clothes to enable non-invasive personal health, lifestyle, safety and emergency applications. The paper presents on going major R&D activities on micro-nano-bio systems (MNBS) and wearable systems for pHealth under the European Union R&D Programs, Information and Communication Technologies (ICT) priority; it also identifies gaps and discusses key challenges for the future.
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.
To obtain a systematic overview of services for the elderly based on health-enabling technologies and to identify archetypical service categories.
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.
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.
There are clear trade-offs between functionality, battery lifetime and battery volume for wearable and implantable wireless-biosensors which energy harvesting devices may be able to overcome. Reliable energy harvesting has now become a reality for machine condition monitoring and is finding applications in chemical process plants, refineries and water treatment works. However, practical miniature devices that can harvest sufficient energy from the human body to power a wireless bio-sensor are still in their infancy. This paper reviews the options for human energy harvesting in order to determine power availability for harvester-powered body sensor networks. The main competing technologies for energy harvesting from the human body are inertial kinetic energy harvesting devices and thermoelectric devices. These devices are advantageous to some other types as they can be hermetically sealed. In this paper the fundamental limit to the power output of these devices is compared as a function of generator volume when attached to a human whilst walking and running. It is shown that the kinetic energy devices have the highest fundamental power limits in both cases. However, when a comparison is made between the devices using device effectivenesses figures from previously demonstrated prototypes presented in the literature, the thermal device is competitive with the kinetic energy harvesting device when the subject is running and achieves the highest power density when the subject is walking.
We present a light-weight, cheap and low-power, wearable system for assisting the visually impaired in performing routine mobility tasks. Our system extends the range of the white cane by providing the user with vibro-tactile cues corresponding to the location of obstacles and a safe path for traversal through a cluttered environment. The presented approach keeps cognitive load to a minimum, and while being autonomous, adapts to the changing mobility requirements of a navigating user. In this paper, we provide an overview of the hardware and algorithmic components of our system, and show results of pilot studies with human test subjects. Our system operates at 20Hz, and significantly improves mobility performance compared to using only the white cane.
To evaluate the impact of Home Monitoring (HM) technology on detection and treatment of atrial fibrillation (AF).
One hundred and sixty-six patients (mean age 73 +/- 10 years, 112 males) received HM devices [121 pacemakers, 22 implantable cardioverter defibrillators (ICDs), and 23 ICDs combined with cardiac resynchronization therapy]. A nurse consulted the cardioreports on the website and submitted the alerts for AF (new onset AF, persistent AF, and AF burden of >10% for >5 consecutive days) to the physician. During a mean follow-up of 488 +/- 203 days, 42 patients (26%) had alerts for AF. Twenty-two patients had no history of AF before implant. In nine patients, no further action was taken. For the remaining 33 patients, an unscheduled follow-up was performed: in 16, antiarrhythmic drug therapy was introduced/modified; in 15, anticoagulation was started; in 2, antiplatelet drugs were introduced; in 7, an external cardioversion was performed; in 2 patients, the device was reprogrammed to avoid intermittent atrial undersensing during AF; and in 4 patients, no further action was taken. In four cases the arrhythmia was not confirmed (false positive). The median time to the first intervention for AF was 50 days (148 days before the scheduled follow-up).
The HM technology allowed early detection of AF in paced patients and early reaction to optimize medical treatment.
Heart failure (HF) is associated with high direct and indirect costs to the patients and the healthcare system. This systematic review aims to analyze existing economic data to determine whether telemonitoring of patients with HF will result in decreased costs. The Scopus and PubMed databases were searched independently by two reviewers for journal articles that reported on an economic analysis (i.e., calculated monetary amounts or percentage change in costs) of a study using a HF telemonitoring system. Only articles describing telemonitoring systems with a component of home physiological measurements were included. Eleven articles met the inclusion criteria, describing 10 different HF telemonitoring systems. Nine of the 10 studies analyzed the direct costs to the healthcare system. All the studies found cost reductions from telemonitoring compared to usual care, which ranged between 1.6% and 68.3%. Cost reductions were mainly attributed to reduced hospitalization expenditures. Only one study discussed the impact of HF telemonitoring on direct patient costs. The study found a 3.5% lower travel cost for patients using telemonitoring compared to those in the usual care group. The single study that was found for indirect costs described the willingness to pay for telemedicine by patients with HF (55% of the patients with HF were willing to pay 40). Available data from existing studies suggest that although HF telemonitoring will require an initial financial investment, it will substantially reduce costs in the long term, particularly by reducing rehospitalization and travel costs.
To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology.
Technical limitations and the issue of time delay for transmission of digitized information across existing telecommunication lines had been a source of concern about the feasibility of performing a complete surgical procedure from remote distances.
To verify the feasibility and safety in humans, the authors attempted remote robot-assisted laparoscopic cholecystectomy on a 68-year-old woman with a history of abdominal pain and cholelithiasis. Surgeons were in New York and the patient in Strasbourg. Connections between the sites were done with a high-speed terrestrial network (ATM service).
The operation was carried out successfully in 54 minutes without difficulty or complications. Despite a round-trip distance of more than 14,000 km, the mean time lag for transmission during the procedure was 155 ms. The surgeons perceived the procedure as safe and the overall system as perfectly reliable. The postoperative course was uneventful and the patient returned to normal activities within 2 weeks after surgery.
Remote robot-assisted surgery appears feasible and safe. Teletransmission of active surgical manipulations has the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and to improve surgical training worldwide.
In response to new developments and interest in the area of telepsychiatry, literature on this topic has greatly increased over the past three years. Because of this increase, the authors conducted a literature review of telepsychiatry to update a previously published review that covered the years 1970 to 2000.
A search was conducted on the MEDLINE, PsycINFO, and Telemedicine Information Exchange (TIE) databases for literature published from March 2000 to March 2003 on telepsychiatry applications, using the following terms: telepsychiatry, telepsychology, telemental health, videoconferencing, and video conferencing.
Sixty-eight publications were identified over this three-year period, exceeding the 63 publications identified in the previous literature review. The authors summarize the results of findings in six areas: novel clinical demonstrations and current program descriptions; the reliability of clinical assessments; clinical outcomes; satisfaction of patients and clinicians; cost and cost-effectiveness; and legal, regulatory, and ethical issues. Studies describing existing programs and novel clinical applications support the belief that the use of telepsychiatry is expanding. Overall, studies continued to support the notion that telepsychiatry assessments can produce reliable results, telepsychiatric services can lead to improved clinical status, and patients and clinicians are satisfied with treatment delivered via telepsychiatry. Evidence supported the notion that telepsychiatry is a cost-effective means of delivering mental health services; however, this conclusion was based on limited studies of economic models of telepsychiatry programs. Also limited were papers on the topics of legal, regulatory, and ethical issues.
Despite the rapid increase in information on telepsychiatry, methodologically sound studies in the area of telepsychiatry are still infrequent.
Telepsychiatry in the form of videoconferencing brings enormous opportunities for clinical care, education, research, and administration. Focusing on videoconferencing, we reviewed the telepsychiatry literature and compared telepsychiatry with services delivered in person or through other technologies.
We conducted a comprehensive review of telepsychiatry literature from January 1, 1965, to July 31, 2003, using the terms telepsychiatry, telemedicine, videoconferencing, effectiveness, efficacy, access, outcomes, satisfaction, quality of care, education, empowerment, and costs. We selected studies for review if they discussed videoconferencing for clinical and educational applications.
Telepsychiatry is successfully used for various clinical services and educational initiatives. Telepsychiatry is feasible, increases access to care, enables specialty consultation, yields positive outcomes, allows reliable evaluation, has few negative aspects in terms of communication, generally satisfies patients and providers, facilitates education, and empowers parties using it. Data are limited with regard to clinical outcomes and cost-effectiveness.
Telepsychiatry is effective. More short- and long-term quantitative and qualitative research is warranted on clinical outcomes, predictors of satisfaction, costs, and educational outcomes.
Technical limitations, mostly related to the issue of time delay for transmission of digitized information, had prevented the development of remote surgery intended as performance of a complete surgical procedure from long distances. To overcome the issue of time delay, tests and researches performed with the joined effort of surgeons, robotic and telecommunication engineers convinced our group that use of the high-speed terrestrial network [asynchronous transfer mode (ATM) service], rather than satellite connections, would significantly reduce the time lag for transmission of data. Using ATM technology, our group demonstrated the feasibility of performing surgery across transoceanic distances by safely carrying out a laparoscopic cholecystectomy, first on an animal model and later (September 7, 2001), on a patient. Using ATM technology, the mean time lag for transmission of data and images was 155 msec despite a total round-trip distance of 14,000 km. Teletransmission of active surgical manipulations have the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and improve surgical training worldwide. However, several limitations remain for remote surgery to become commonplace. Among these, the need to render ATM network available to hospitals, costs of technology, ethical and liability issues, and possible conflicts of jurisdictions between countries involved.
A systematic review of accident and emergency teleconsultation services was carried out. Studies (English language only) conducted worldwide and published between 1996 and 2003 were included. Evidence relating to technical feasibility, clinical effectiveness, cost effectiveness and level of local management was used as the main outcome measure. Thirty-one studies met the selection criteria. Only two studies were randomized controlled studies. All studies provided evidence that that the service was technically feasible. Of the studies, 97% suggested that the service was clinically effective; 48% (15) of the studies gave figures for the level of local management achieved. The range for local management was 35-100% with a mean of 76%. Only 23% of the studies provided evidence to suggest that the service was cost effective. The case for cost-effectiveness is far from proven and this area of research requires immediate attention if potential users are to be convinced of the value of telemedicine.
This paper examines the potential effects of using video-conferencing within the field of mental health in the UK. In order to assess the usefulness of telepsychiatric services, an electronic search was conducted for articles published between August 1998 and July 2006 using the MEDLINE, EMBASE, PsychINFO and Telemedicine and Information Exchange (TIE) databases. The search was carried out using the following terms: telepsychiatry, videoconferencing and telepsychology. A total of 178 articles were identified and based on review of the abstracts 72 were identified as being specific to efficacy, cost-effectiveness and satisfaction with psychiatric services delivered via videoconferencing. This paper concludes that the use of video conferencing can enhance psychiatric services within the UK especially for those patients who live in rural areas. Current advances in technology make this an increasingly more reliable and cost-effective method for assessing patients. The limitations of telemedicine are discussed and it is clear that this type of care is not suitable for all patients. Further research is required to assess the types of patients that telepsychiatry is most suitable for.
Home telemonitoring represents a patient management approach combining various information technologies for monitoring patients at distance. This study presents a systematic review of the nature and magnitude of outcomes associated with telemonitoring of four types of chronic illnesses: pulmonary conditions, diabetes, hypertension, and cardiovascular diseases.
A comprehensive literature search was conducted on Medline and the Cochrane Library to identify relevant articles published between 1990 and 2006. A total of 65 empirical studies were obtained (18 pulmonary conditions, 17 diabetes, 16 cardiac diseases, 14 hypertension) mostly conducted in the United States and Europe.
The magnitude and significance of the telemonitoring effects on patients' conditions (e.g., early detection of symptoms, decrease in blood pressure, adequate medication, reduced mortality) still remain inconclusive for all four chronic illnesses. However, the results of this study suggest that regardless of their nationality, socioeconomic status, or age, patients comply with telemonitoring programs and the use of technologies. Importantly, the telemonitoring effects on clinical effectiveness outcomes (e.g., decrease in the emergency visits, hospital admissions, average hospital length of stay) are more consistent in pulmonary and cardiac studies than diabetes and hypertension. Lastly, economic viability of telemonitoring was observed in very few studies and, in most cases, no in-depth cost-minimization analyses were performed.
Home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data, empowers patients, influences their attitudes and behaviors, and potentially improves their medical conditions. Future studies need to build evidence related to its clinical effects, cost effectiveness, impacts on services utilization, and acceptance by health care providers.
The desire to provide continuous intensivist management for all intensive care unit (ICU) patients in the face of a massive shortfall of available intensivists prompted the introduction of remote ICU care programs in 1999. The past several years have seen a dramatic increase in the number of health systems adopting this care model. These health systems have increased our understanding of both the ability of this new care model to improve clinical outcomes and the clinical processes that are required to achieve program quality goals. Health systems have begun to expand the scope of activities of the remote care team, capitalizing on the potential of this new operational and technology platform to leverage scarce personnel and achieve increases in both clinical effectiveness and provider efficiency. This review summarizes the current state of remote ICU care programs in the United States.
Telehealth has great potential to improve access to care but its adoption in routine health care has been slow. The lack of clarity about the value of telehealth implementations has been one reason cited for this slow adoption. The Center for Information Technology Leadership has examined the value of telehealth encounters in which there is a provider both with the patient and at a distance from the patient. We considered three models of telehealth: store-and-forward, real-time video and hybrid systems. Evidence from the literature was extrapolated using a simulation, which found that the hybrid model was the most cost-effective of the three. The simulation predicted savings of $4.3 billion per year if hybrid telehealth systems were to be implemented in emergency rooms, prisons, nursing home facilities and physician offices across the US. We also conducted a sensitivity analysis to determine which factors most affected costs and savings. For all three telehealth models, the highest sensitivities were to the cost of a face-to-face visit, the cost of a telehealth visit and the success rate of a telehealth visit, i.e. the proportion of telehealth visits that avoided the need for a face-to-face visit. Payers, providers and policy-makers should work together to remove the barriers to the adoption of telehealth in order to make it widely available to all.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security and breach notification rules
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Telehealth licensure report. Health Resources and Services Administration Retrieved from http
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What are the reimbursement issues for telehealth? Health Resources and Services Administration Retrieved from http:// www. hrsa. gov/ healthit/ toolbox
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Health Resources and Services Administration
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Convergence: market shares, strategies, and forecasts, worldwide
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Telemedicine Association standards & guidelines
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Chronic care: making the case for ongoing care. Princeton: Robert Wood Johnson Foundation
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Office of the National Coordinator for Health Information Technology (US)
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