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A Home Telemonitoring Pla0orm

I.MaglogiannisUNIVERSITYOFPIRAEUS

DepartmentofDigitalSystemsComputa@onalBiomedicine

Laboratory

Home Telemonitoring

• Remotepa6entmonitoringandtelecare:afocalpointofemerginghealthcareschemes

•  Substan6alposi6veimpactforchroniccondi6ons•  Reducedcosts•  Improvedefficiency•  Superiorcoordina6onbetweencaregivers•  Higherqualityoflife

• AnumberofstudiesontelemonitoringforCOPD:•  U6liza6onoftechnologiesforsymptomsandvitalsignsmonitoring•  Resultshaveindicatedvariouspoten6albenefits•  Similarresultsinstudiesfocusingoncys6cfibrosis

• Absenceofstudiesonlesscommonpulmonarycondi6ons

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Idiopathic Pulmonary Fibrosis

• Chronic,progressiveandirreversible•  Progressiveworseningofdyspneaandpulmonaryfunc6on•  Progressivefibrosisofthelungs•  Acuterespiratorydecline

• Unknowne6ology• Meanageofonset67-69years• Usuallyfatal

•  Mediansurvival6me:2-3yearsaTerdiagnosis

• Pa6entsmayhavesub-clinicalorovertco-morbidcondi6ons(e.g.pulmonaryhypertension,emphysema)

Treatment and Monitoring

•  Evidence-basedrecommenda6onsinclude:•  Long-termoxygentherapyincasesofclinicallysignificantres6nghypoxemia•  Lungtransplanta6oninappropriatepa6ents•  Insufficientevidencetosupportanypharmacologictherapy-someagentsmayhavepossiblebenefitsforindividualpa6ents

•  Thebesttreatmentplanmaydifferforeachindividualpa6ent•  Needformonitoring,inordertoiden6fythecourseofthediseaseandini6ateappropriateinterven6ons

•  Monitoringofoxygensatura6onatrestandwithexer6on•  Commonprac6cewithotherpulmonarydiseases

Raghu,G.etal.“AnOfficialATS/ERS/JRS/ALATStatement:IdiopathicPulmonaryFibrosis:Evidence-basedGuidelinesforDiagnosisandManagement”,AmericanJournalofRespiratoryandCriMcalCareMedicine,vol.183,no.6,pp.788–824,Mar.2011

•  Hometelemonitoringisexpectedto:•  Facilitatemonitoringofpa6entsinruralareas•  Providepa6entswithbe^erawarenessoftheircondi6on•  Increasepa6ents’feelingofsecurity

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• Homecaresystemforassistedindependentliving:

•  Healthmonitoring•  Communica6onandsocialnetworking

•  Emergencyresponse• Vitalsignsmeasurements&physicalac6vitytracking

•  EHR•  24/7helpdeskservice•  Foursubsystems:

•  Mobileapplica6on• Web-basedapplica6on•  Helpdeskapplica6on•  Cloudback-endpladorm

Pla0orm Architecture

ExternalDataSources

DatabaseObjectStorage

BioAssistCloud

Communication

DesktopWebApp

UserManagementAlarms&

Notifications

Patient Contact Att.Doctor

HelpdeskMobileApp

SensorsWearables

WebServiceAPI

Data&EventAnalysis

BioSignals

Use Case Scenarios

• VitalSignsMonitoringandPersonalHealthRecord(PHR)• VideoconferencingandSocialContact• Reminders•  EmergencyCall

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Use Case Scenarios

• Pa6entMonitoringParameters• PHR

Pilot Setup

• RespiratoryMedicineDepartment-UniversityHospitalofLarissa•  6-monthpilotstudytoverifythesolu6on’sfeasibility• Pa6ents(20):

•  6female•  14male•  15withIPF•  5withIPFandemphysema•  Meanage=67.6years

Variable Value (mean ± SD) Age (years) 67,6 ± 8,4 Gender (male/female) 14/ 6 Smoking habit (non-smoker/ex-smoker) 12/ 8 Pack-years 51,26 ± 14,33

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Study Protocol

Pa6ents•  Eachpa6entwasprovidedwith:

•  Androidtabletwithmobileapppre-installed•  BLEpulseoximeter•  BLEbloodpressuremeter

• Reminderstoenforcemeasurementandmedica6onschedule

• Regularassessmentsusingwell-establishedques6onnaires:

•  SaintGeorge’sRespiratoryQues6onnaire•  InterRAI•  User-sa6sfac6onques6onnaires

Study Protocol

A^endingdoctor•  Setthemeasuringscheduleandrespec6vethresholdsforeachpa6ent

• Hasaccesstoeachpa6ent’sPHR

• Receivesweeklyreportsandno6fica6onsforthresholdviola6ons

• Weeklydoctor-pa6entcommunica6onviavideoconferencing

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Study Protocol

A^endingdoctor•  Setthemeasuringscheduleandrespec6vethresholdsforeachpa6ent

• Hasaccesstoeachpa6ent’sPHR

• Receivesweeklyreportsandno6fica6onsforthresholdviola6ons

• Weeklydoctor-pa6entcommunica6onviavideoconferencing

Study Protocol

A^endingdoctor•  Setthemeasuringscheduleandrespec6vethresholdsforeachpa6ent

• Hasaccesstoeachpa6ent’sPHR

• Receivesweeklyreportsandno6fica6onsforthresholdviola6ons

• Weeklydoctor-pa6entcommunica6onviavideoconferencing

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Study Protocol

A^endingdoctor•  Setthemeasuringscheduleandrespec6vethresholdsforeachpa6ent

• Hasaccesstoeachpa6ent’sPHR

• Receivesweeklyreportsandno6fica6onsforthresholdviola6ons

• Weeklydoctor-pa6entcommunica6onviavideoconferencing

Results

ü Allpa6entshavebeenconsistentlyadherenttotheirmeasurementsscheduleandmedica6onregimen

~200 measurements/type

of biosignal per paEent

98.32% Average compliance

to measurement schedule

100% Overall adherence to medicaEon

86.1% Minimum compliance

to measurement schedule

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Results

ü Nosignificanttechnicalissuesorproblemswiththesystem’susabilitywerepresented

ü Approximately70%ofthepar6cipantswereabletousethesystemwithconfidenceevenwithoutsupport

ü Thesystempresentednodifficultyforcaregiversü Communica6onfeaturesappreciatedbyrela6vesofpa6entswholivealone

14 paEents were able to use the system

without any support

20 videocalls/month

on average, between paEents

and relaEves

13’ average

duraEon of videocall

Results

ü Doctorsreviewedpa6ents’measurementsatleastonceaweekü Emergencycallfeaturemostlyusedfortechnicalissuesorsupportü Outgoingcallsfromthehelpdesktopa6entsensuredcomplianceü 3emergencycallsformedicalreasons

43 emergency calls in total

28 outgoing calls

to paEents

8 alerts for threshold violaEon

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Conclusions and Further Work

ü Mostpa6ents-eventhoseofgreaterage-areabletousethesystemconfidently,withoutneedforconstantsupport

ü Thesystemhasintegratedwellwiththepa6ents’dailyrou6nesü Doctorshaveeasilyfamiliarizedthemselveswiththesystemandincorporateditintheircareprocess

ü Con6nuousmonitoringhasalloweddoctorstomakewell-informedadjustmentstotreatment(e.g.ini6ateoxygentherapy)

ü Theemergencycallserviceiscomfor6ngforthepa6ents’rela6vesü Theresultsareindica6veofthebenefitsthatthesystemoffers

Datagatheredviaques6onnaireswillallowforimpactanalysisandassessmentofusersa6sfac6on

Usage in other Chronic Diseases

Each member will be provided with:

•  Service provision through our mobile app

•  Devices interconnection and videoconferencing

Tablet

•  Wireless connection with the mobile app for vital signs monitoring ü  SpO2 ü  Pulse rate ü  Blood pressure ü  Glucose levels ü  Weight ü  Spirometry -  ECG -  Activity / Fall

Wireless medical sensors

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•  Elderly people / chronic paEents – Main users of the pla0orm

•  Members’ relaEves, friends or other close persons – Caring circle

•  AWending doctor of the member

•  Primary support of the member

•  Secondary support of the member – provision of medical advice

Main user categories - Roles

Member

Contact

AHendingDoctor

HelpdeskAgent

MedicalAgent

Ecosystem

Doctors

Helpdesk

Social Contacts

Pharmacists/Caregivers Medication

intake schedule

Reminders

Treatment schedule

Biosignals Monitoring

Electronic Health Record

Reports Emergency call

Fall detection

Alerts

Video calls

Photos and Videos

Push notifications

CARE

MONITORING SUPERVISION

SOCIAL ENGAGEMENT

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SoKware

…createsandmanagesacontactcircletohavevideoconferencewith

…takesvitalsignsmeasurementsthatareavailabletohis/hera^endingdoctor

…createsandmanagesreminderstobeenforcedviasound(tablet)andvibra6on(smartwatch)

…makesemergencycallstobeaddressedbytheservice’shelpdesk

EachMember…

Mobile version

…sharesphotos&videoswithhis/hercontactcircle

…canviewtohis/herPHRandregisternewvitalsignsrecordings

SoKware

…createsandmanagesacontactcircletohavevideoconferencewith

…takesvitalsignsmeasurementsthatareavailabletohis/hera^endingdoctor

…createsandmanagesreminderstobeenforcedviasound(tablet)andvibra6on(smartwatch)

…makesemergencycallstobeaddressedbytheservice’shelpdesk

EachMember…

Mobile version

…sharesphotos&videoswithhis/hercontactcircle

…canviewtohis/herPHRandregisternewvitalsignsrecordings

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•  Member applicaEon also features a desktop version that allows: •  Advanced settings management

•  Use of the application without the need of additional hardware (tablet)

Desktop version

Feature: Contacts DESKTOPVERSION

MOBILEVERSION

•  Contactlist:Allcontactsaredisplayedonthispagewiththeirnameandprofilephoto

•  Onlinecontacts:Clickingonthegreenphoneiconnexttodoctor’sorrela6ve’snamestartsavideocallwithhighvideoandaudioquality

•  Offlinecontacts:Whenacontactisoffline,anenvelopeiconisdisplayednexttohis/hername

•  SearchBioAssistnetwork:Thepa6entcanconnectwithothermembersoftheBioAssistnetwork.

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•  Eachmembercaninteractwithhis/hercircleofcontactsusingstate-ofthe-artWebRTCtechnology

•  Web-basedtechnology,elimina6ngtheneedforaclient

Feature: Videoconference DESKTOPVERSION

MOBILEVERSION

Feature: Reminders DESKTOPVERSION

MOBILEVERSION

Remindersthatcanbefilteredas:

•  MedicalandNon-Medical

•  Pending,ForthcomingorCompleted

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•  SourcesofPHRdata:•  Connec6onwithexternalEHR

providers•  Recordingsofbiosignalsfrom

interconnectedsensors•  A^endingdoctors’input•  Pa6ent’sandcaringcircle’sinput

•  Alldatais6me-stampedandcanbefilteredbysourceoforigin

•  Addi6onaldata:•  Medica6on:listofprescribeddrugs•  Allergies

Feature: Personal Health Record DESKTOPVERSION

MOBILEVERSION

Feature: Gallery

Everycontactcanuploadphotosandsharethemwiththepeopleonhis/herContactlist

Thepa6entcandisplayoraddaddi6onalphotos

Everymembercanviewphotostheothercontactshaveuploaded

Allowingthepa6enttofeel

comfortablewithBioAssistisagreatconcern

DESKTOPVERSION

MOBILEVERSION

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•  Profile:Thepa6entcanchangehis/herprofileimageandaddorupdatepersonalinforma6onlikeweight,address,telephonenumber,etc.

•  SeSngs:Thepa6entcanchangehis/herpassword,orupdatetheire-mailaddressinthissec6on

Features: Account Management

•  EventHistory:Containsallmedicalornon-medicaleventsthatoccurredtothepa6entwhileBioAssistwasopera6onal

DESKTOPVERSION

MOBILEVERSION

•  Setremindersformedica6on,biosignalsmonitoringschedule,medicalappointmentsetc

•  Checkandupdatethepa6ent’sPHR

•  Checkpa6ent’sbiosignalsandsetthedailybiosignalsrecordingschedule

Features of the AWending Doctor Role DESKTOPVERSION

MOBILEVERSION

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Reminderscreatedbythepa6ent,hiscontactsorcaregivers,applyviathetabletand/orsmartwatchtoenhancedrugadherence

Reminders – Smart watch IntegraEon

•  Handlesemergencycallsfrompa6ents(24x7).•  Monitorsalerts(i.e.expiredreminders,biosignalthresholdviola6ons

andfailurestoreceivemedica6on)•  ForwardsanyimportantcasestotheMedicalHelpdesk•  Communicateswithallmembersviadirectvideoconference

Features of the Primary Helpdesk Role

DESKTOPVERSION

MOBILEVERSION

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Help Desk- PaEent data Features of the Primary Helpdesk Role – PaEent Data

DESKTOPVERSION

MOBILEVERSION

Help Desk- PaEent data Features of the Primary Helpdesk Role – PHR

DESKTOPVERSION

MOBILEVERSION

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Help Desk- PaEent data Features of the Primary Helpdesk Role – Biosignal Recordings

DESKTOPVERSION

MOBILEVERSION

QuesEons?

More Details imaglo@unipi.gr