Patients' and Clinicians' Visions of a Future Internet-of-Things System to Support Asthma Self-Management: Mixed Methods Study.

BACKGROUND: Supported self-management for asthma reduces acute attacks and improves control. The internet of things could connect patients to health care providers, community services, and their living environments to provide overarching support for self-management. OBJECTIVE: We aimed to identify patients' and clinicians' preferences for a future internet-of-things system and explore their visions of its potential to support holistic self-management. METHODS: In an exploratory sequential mixed methods study, we recruited patients from volunteer databases and charities' social media. We purposively sampled participants to interview them about their vision of the design and utility of the internet of things as a future strategy for supporting self-management. Respondents who were not invited to participate in the interviews were invited to complete a web-based questionnaire to prioritize the features suggested by the interviewees. Clinicians were recruited from professional networks. Interviews were transcribed and analyzed thematically using PRISMS self-management taxonomy. RESULTS: We interviewed 12 patients and 12 clinicians in the United Kingdom, and 140 patients completed the web-based questionnaires. Patients expressed mostly wanting a system to log their asthma control status automatically; provide real-time advice to help them learn about their asthma, identify and avoid triggers, and adjust their treatment. Peak flow (33/140, 23.6%), environmental (pollen, humidity, air temperature) (33/140, 23.6%), and asthma symptoms (25/140, 17.9%) were the specific data types that patient most wanted. Information about asthma and text or email access to clinical advice provided a feeling of safety for patients. Clinicians wanted automated objective data about the patients' condition that they could access during consultations. The potential reduction in face-to-face consultations was appreciated by clinicians which they perceived could potentially save patients' travel time and health service resources. Lifestyle logs of fitness regimes or weight control were valued by some patients but were of less interest to clinicians. CONCLUSIONS: An automated internet-of-things system that requires minimal input from the user and provides timely advice in line with an asthma action plan agreed by the patient with their clinician was preferred by most respondents. Links to asthma information and the ability to connect with clinicians by text or email were perceived by patients as features that would provide a sense of safety. Further studies are needed to evaluate the usability and effectiveness of internet-of-things systems in routine clinical practice.

Apps to Support Self-Management for People With Hypertension: Content Analysis.

BACKGROUND: Home blood pressure monitoring (HBPM) is one component of effective supported self-management, which may potentially be mediated by mobile apps. OBJECTIVE: The aim of this study was to identify the self-management features (HBPM and broader support strategies) offered by currently available apps and to determine the features associated with download frequency and user ratings. METHODS: We searched Google Play store, Apple App store, National Health Services Apps Library and myhealthapps.net (first search on February 1, 2018; updated August 18, 2018). We included high blood pressure apps available in the United Kingdom and extracted their features, number of downloads, and the average users' rating from the app stores. We mapped the features to the holistic Practical Reviews In Self-Management Support (PRISMS) taxonomy of self-management support. We employed a regression analysis to determine if any features were associated with download frequency or user rating. RESULTS: We included 151 apps. The 3 most common features were as follows: monitoring blood pressure (BP) and charting logs; lifestyle (exercise or dietary) advice; and providing information about hypertension. The other 11 components of the PRISMS taxonomy were rarely featured. There was little evidence to support associations between specific features and the download statistics and rating scores, with only 2 uncommon features achieving borderline significant associations. The presence of social support features, such as a forum, was weakly but significantly (R2=.04, P=.02) correlated with the number of downloads. Apps designed specifically for particular BP monitors/smart watches were weakly associated with a higher rating score (R2=.05, P<.001). Apps with more ratings were associated with more downloads (R2=.91, P<.001). CONCLUSIONS: The functionality of currently available apps is limited to logging BP, offering lifestyle advice, and providing information about hypertension. Future app development should consider broadening the remit to produce a system that can respond flexibly to the diversity of support that enables people to self-manage their hypertension.

Integrating third-party telehealth records with the general practice electronic medical record system: a solution.

BACKGROUND: The implementation of telemonitoring at scale has been less successful than anticipated, often hindered by clinicians' perceived increase in workload. One important factor has been the lack of integration of patient generated data (PGD) with the electronic medical record (EMR). Clinicians have had problems accessing PGD on telehealth systems especially in patient consultations in primary care. OBJECTIVE: To design a method to produce a report of PGD that is available to clinicians through their routine EMR system. METHOD: We modelled a system with a use case approach using Unified Modelling Language to enable us to design a method of producing the required report. Anonymised PGD are downloaded from a third-party telehealth system to National Health Service (NHS) systems and linked to the patient record available in the hospital recording system using the patient NHS ID through an interface accessed by healthcare professionals. The telehealth data are then processed into a report using the patient record. This report summarises the readings in graphical and tabular form with an average calculated and with a recommended follow-up suggested if required. The report is then disseminated to general practitioner practices through routine document distribution pathways. RESULTS: This addition to the telehealth system is viewed positively by clinicians. It has helped to greatly increase the number of general practices using telemonitoring to manage blood pressure in NHS Lothian.

Digital technology in respiratory diseases: Promises, (no) panacea and time for a new paradigm.

In a world where digital technology has revolutionized the way we work, shop and manage our finances it is unsurprising that digital systems are suggested as potential solutions to delivering clinically and cost-effective care for an aging population with one or more long-term conditions. However, recent evidence suggesting that telehealth may not be quite the panacea that was promised, has led to discussions on the mechanisms and role of digital technology in respiratory care. Implementation in rural and remote settings offers significant benefits in terms of convenient access to care, but is contingent on technical and organizational infrastructure. Telemonitoring systems rely on algorithms to detect deterioration and trigger alerts; machine learning may enable telemonitoring of the future to develop personalized systems that are sensitive to clinical status whilst reducing false alerts. By providing access to information, offering convenient and flexible modes of communication and enabling the transfer of monitoring data to support professional assessment, telehealth can support self-management. At present, all too often, expensive 'off the shelf' systems are purchased and given to clinicians to use. It is time for the paradigm to shift. As clinicians we should identify the specific challenges we face in delivering care, and expect flexible systems that can be customized to individual patients' requirements and adapted to our diverse healthcare contexts.

Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial.

OBJECTIVE: To test the effectiveness of telemonitoring integrated into existing clinical services such that intervention and control groups have access to the same clinical care. DESIGN: Researcher blind, multicentre, randomised controlled trial. SETTING: UK primary care (Lothian, Scotland). PARTICIPANTS: Adults with at least one admission for chronic obstructive pulmonary disease (COPD) in the year before randomisation. We excluded people who had other significant lung disease, who were unable to provide informed consent or complete the study, or who had other significant social or clinical problems. INTERVENTIONS: Participants were recruited between 21 May 2009 and 28 March 2011, and centrally randomised to receive telemonitoring or conventional self monitoring. Using a touch screen, telemonitoring participants recorded a daily questionnaire about symptoms and treatment use, and monitored oxygen saturation using linked instruments. Algorithms, based on the symptom score, generated alerts if readings were omitted or breached thresholds. Both groups received similar care from existing clinical services. MAIN OUTCOME MEASURES: The primary outcome was time to hospital admission due to COPD exacerbation up to one year after randomisation. Other outcomes included number and duration of admissions, and validated questionnaire assessments of health related quality of life (using St George's respiratory questionnaire (SGRQ)), anxiety or depression (or both), self efficacy, knowledge, and adherence to treatment. Analysis was intention to treat. RESULTS: Of 256 patients completing the study, 128 patients were randomised to telemonitoring and 128 to usual care; baseline characteristics of each group were similar. The number of days to admission did not differ significantly between groups (adjusted hazard ratio 0.98, 95% confidence interval 0.66 to 1.44). Over one year, the mean number of COPD admissions was similar in both groups (telemonitoring 1.2 admissions per person (standard deviation 1.9) v control 1.1 (1.6); P=0.59). Mean duration of COPD admissions over one year was also similar between groups (9.5 days per person (standard deviation 19.1) v 8.8 days (15.9); P=0.88). The intervention had no significant effect on SGRQ scores between groups (68.2 (standard deviation 16.3) v 67.3 (17.3); adjusted mean difference 1.39 (95% confidence interval -1.57 to 4.35)), or on other questionnaire outcomes. Conclusions In participants with a history of admission for exacerbations of COPD, telemonitoring was not effective in postponing admissions and did not improve quality of life. The positive effect of telemonitoring seen in previous trials could be due to enhancement of the underpinning clinical service rather than the telemonitoring communication. TRIAL REGISTRATION: ISRCTN96634935. FUNDING: The trial was funded by an NHS applied research programme grant from the Chief Scientist Office of the Scottish government (ARPG/07/03). The funder had no role in study design and the collection, analysis, and interpretation of data and the writing of the article and the decision to submit it for publication. NHS Lothian supported the telemonitoring service and the clinical services.