A hackathon as a tool to enhance research and practice on electronic health record systems' interoperability for chronic disease management and prevention.

Objectives: The development of a standardized technical framework for exchanging electronic health records is widely recognized as a challenging endeavor that necessitates appropriate technological, semantic, organizational, and legal interventions to support the continuity of health and care. In this context, this study delineates a pan-European hackathon aimed at evaluating the efforts undertaken by member states of the European Union to develop a European electronic health record exchange format. This format is intended to facilitate secure cross-border healthcare and optimize service delivery to citizens, paving the way toward a unified European health data space. Methods: The hackathon was conducted within the scope of the X-eHealth project. Interested parties were initially presented with a representative clinical scenario and a set of specifications pertaining to the European electronic health record exchange format, encompassing Laboratory Results Reports, Medical Imaging and Reports, and Hospital Discharge Reports. In addition, five onboarding webinars and two professional training events were organized to support the participating entities. To ensure a minimum acceptable quality threshold, a set of inclusion criteria for participants was outlined for the interested teams. Results: Eight teams participated in the hackathon, showcasing state-of-the-art applications. These teams utilized technologies such as Health Level Seven-Fast Healthcare Interoperability Resources (HL7 FHIR) and Clinical Document Architecture (CDA), alongside pertinent IHE integration profiles. They demonstrated a range of complementary uses and practices, contributing substantial inputs toward the development of future-proof electronic health record management systems. Conclusions: The execution of the hackathon demonstrated the efficacy of such approaches in uniting teams from diverse backgrounds to develop state-of-the-art applications. The outcomes produced by the event serve as proof-of-concept demonstrators for managing and preventing chronic diseases, delivering value to citizens, companies, and the research community.

A Digital Health Intervention for Stress and Anxiety Relief in Perioperative Care: Protocol for a Feasibility Randomized Controlled Trial.

BACKGROUND: Stress and anxiety are psychophysiological responses commonly experienced by patients during the perioperative process that can increase presurgical and postsurgical complications to a comprehensive and positive recovery. Preventing and intervening in stress and anxiety can help patients achieve positive health and well-being outcomes. Similarly, the provision of education about surgery can be a crucial component and is inversely correlated with preoperative anxiety levels. However, few patients receive stress and anxiety relief support before surgery, and resource constraints make face-to-face education sessions untenable. Digital health interventions can be helpful in empowering patients and enhancing a more positive experience. Digital health interventions have been shown to help patients feel informed about the possible benefits and risks of available treatment options. However, they currently focus only on providing informative content, neglecting the importance of personalization and patient empowerment. OBJECTIVE: This study aimed to explore the feasibility of a digital health intervention called the Adhera CARINAE Digital Health Program, designed to provide evidence-based, personalized stress- and anxiety-management methods enabled by a comprehensive digital ecosystem that incorporates wearable, mobile, and virtual reality technologies. The intervention program includes the use of advanced data-driven techniques for tailored patient education and lifestyle support. METHODS: The trial will include 5 hospitals across 3 European countries and will use a randomized controlled design including 30 intervention participants and 30 control group participants. The involved surgeries are cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacement, prostate or bladder cancer surgeries, hip and knee replacement, maxillofacial surgery, or scoliosis. The control group will receive standard care, and the intervention group will additionally be exposed to the digital health intervention program. RESULTS: The recruitment process started in January 2022 and has been completed. The primary impact analysis is currently ongoing. The expected results will be published in early 2023. CONCLUSIONS: This manuscript details a comprehensive protocol for a study that will provide valuable information about the intervention program, such as the measurement of comparative intervention effects on stress; anxiety and pain management; and usability by patients, caregivers, and health care professionals. This will contribute to the evidence planning process for the future adoption of diverse digital health solutions in the field of surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT05184725; https://www.clinicaltrials.gov/ct2/show/NCT05184725. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38536.

Policy and Strategy for Interoperability of Digital Health in Europe.

The development of electronic services for healthcare presents challenges related to the effective cooperation of systems and stakeholders in a highly regulated environment. In order to facilitate healthcare for all at the point of need it is important to establish the necessary conditions to guide the development and implementation of digital health solutions that are interoperable by design. Interoperability in eHealth is challenging for various reasons, including the fact that different products and solutions in the market do not follow well-known standards and interoperability guidelines. The paper draws upon the global, European and national policies, strategies, and implementation initiatives to offer an integrated approach towards interoperability in healthcare ecosystems. The authors provide guidelines and recommendations to support interoperability at legal, organizational, semantic, and technical levels.

iCompanion: A Serious Games App for the Management of Frailty.

The term frailty is often used to describe a particular state of health, related to the ageing process, often experienced by older people. The most common indicators of frailty are weakness, fatigue, weight loss, low physical activity, poor balance, low gait speed, visual impairment and cognitive impairment. The objective of this work is the creation of a serious games mobile application to conduct elderly frailty assessments in an accurate and objective way using mobile phone capabilities. The proposed app includes three games (memory card, endless runner, and clicker) and three questionnaires, aiming towards the prediction of signs of memory and reflection deterioration, as well as endurance and strength. The games, when combined with a set of qualified questionnaires, can provide an efficient tool to support adults in identifying frailty symptoms and in some cases prevent further deterioration. At the same time the app can support older adults in improving physical and mental fitness, while gathering useful information about frailty.

Developing an AI-Enabled Integrated Care Platform for Frailty.

Informal care is considered to be important for the wellbeing and resilience of the elderly. However, solutions for the effective collaboration of healthcare professionals, patients, and informal caregivers are not yet widely available. The purpose of this paper is to present the development of a digital platform that uses innovative tools and artificial intelligence technologies to support care coordination and shared care planning for elder care, with a particular focus on frailty. The challenges of shared care planning in the coordination of frailty care are demonstrated, followed by presentation of the design and technical architecture of an integrated platform. The platform incorporates all elements essential for the support of daily activities, coordinated care, and timely interventions in case of emergency and need. This paper describes the challenges involved in implementing the platform and concludes by reporting the necessary steps required in order to establish effective smart care for the elderly.

Integrated Care in the Era of COVID-19: Turning Vision Into Reality With Digital Health.

The lives of millions of people have been affected during the coronavirus pandemic that spread throughout the world in 2020. Society is changing establishing new norms for healthcare education, social life, and business. Digital health has seen an accelerated implementation throughout the world in response to the pandemic challenges. In this perspective paper, the authors highlight the features that digital platforms are important to have in order to support integrated care during a pandemic. The features of the digital platform Safe in COVID-19 are used as an example. Integrated care can only be supported when healthcare data is available and can be sharable and reusable. Healthcare data is essential to support effective prevention, prediction, and disease management. Data available in personal health apps can be sharable and reusable when apps follow interoperability guidelines for semantics and data management. The authors also highlight that not only technical but also political and social barriers need to be addressed in order to achieve integrated care in practice.

Status and Recommendations of Technological and Data-Driven Innovations in Cancer Care: Focus Group Study.

BACKGROUND: The status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)-funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed. OBJECTIVE: This study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020-funded projects. METHODS: Two international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed. RESULTS: Technical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work. CONCLUSIONS: Technology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations.

COVID-19 Mobile Apps: A Systematic Review of the Literature.

BACKGROUND: A vast amount of mobile apps have been developed during the past few months in an attempt to "flatten the curve" of the increasing number of COVID-19 cases. OBJECTIVE: This systematic review aims to shed light into studies found in the scientific literature that have used and evaluated mobile apps for the prevention, management, treatment, or follow-up of COVID-19. METHODS: We searched the bibliographic databases Global Literature on Coronavirus Disease, PubMed, and Scopus to identify papers focusing on mobile apps for COVID-19 that show evidence of their real-life use and have been developed involving clinical professionals in their design or validation. RESULTS: Mobile apps have been implemented for training, information sharing, risk assessment, self-management of symptoms, contact tracing, home monitoring, and decision making, rapidly offering effective and usable tools for managing the COVID-19 pandemic. CONCLUSIONS: Mobile apps are considered to be a valuable tool for citizens, health professionals, and decision makers in facing critical challenges imposed by the pandemic, such as reducing the burden on hospitals, providing access to credible information, tracking the symptoms and mental health of individuals, and discovering new predictors.

An eHealth Platform for the Holistic Management of COVID-19.

The COVID-19 pandemic has posed several challenges on citizens and health systems. Information and Communication Technology (ICT) can be a valuable tool in providing tools for self-assessment and reporting of physical symptoms, early detection of symptom changes, up to date information towards citizen empowerment, personalized recommendations and communication with healthcare providers in case of need. To this direction, this paper reports on the design and implementation of a novel technical infrastructure to support citizens with possible or confirmed COVID-19 disease. The designed platform builds upon an existing personal health record to facilitate symptom tracking, self-management, and personalized recommendations, effective communication channels between patients and clinicians and public health authorities assisting citizens to remain longer safe at home.

Preliminary Assessment of the Interoperability Maturity of Healthcare Digital Services vs Public Services of Other Sectors.

The development of electronic services for healthcare presents challenges related to the effective cooperation of systems and stakeholders in a highly regulated environment. Assessing the interoperability maturity of the provided services helps to identify interoperability issues in public administration. This paper presents a typical healthcare digital service: the inpatient admission in a public hospital in Greece. The Interoperability Maturity Model (IMM) is applied to assess its maturity, identify improvement priorities, and compare it with digital services of the healthcare sector. An analysis is also performed to compare a group of fourteen healthcare digital public services with sixty-seven public services of other sectors in the country. The IMM is a useful tool to facilitate awareness raising and priority setting concerning interoperability in public administration. What is discovered, through this preliminary assessment, is that healthcare digital services seem to have higher overall interoperability maturity than those of other sectors in Greece.

iSupport: Building a Resilience Support Tool for Improving the Health Condition of the Patient During the Care Path.

Anxiety and stress are very common symptoms of patients facing a forthcoming surgery. However, limited time and resources within healthcare systems make the provision of stress relief interventions difficult to provide. Research has shown that provision of preoperative stress relief and educational resources can improve health outcomes and speed recovery. Information and Communication Technology (ICT) can be a valuable tool in providing stress relief and educational support to patients and family before but also after an operation, enabling better self-management and self-empowerment. To this direction, this paper reports on the design of a novel technical infrastructure for a resilience support tool for improving the health condition of patients, during the care path, using Virtual Reality (VR). The designed platform targets, among others, at improving the knowledge on the patient data, effectiveness and adherence to treatment, as well as providing for effective communication channels between patients and clinicians.

The new European interoperability framework as a facilitator of digital transformation for citizen empowerment.

Healthcare is a highly regulated domain. Seamless, online access to integrated electronic health records for citizens is still far from becoming a reality. The implementation of personally managed health data systems still needs to overcome several interoperability, usability, ethics, security, and regulatory issues to deliver the envisioned benefits. This paper offers a policy viewpoint on how the new European Interoperability Framework (EIF) may benefit the implementation of eHealth systems for the management of personal health information for citizens. Interoperability facilitates sharing of health and illness experiences, coordinated care and research for citizen empowerment and improved health outcomes. The adoption of principles relevant to core interoperability and generic user needs and expectations, as described in the new EIF, in line with European and national regulations are quite essential for the development of safe and secure patient access services to support mobility. An interoperability framework facilitates the creation of the appropriate context in which personal health record applications can be designed and implemented in support of disease specific solutions, such as chronic non-malignant pain, diabetes and cancer. It is evident that no solution will fit all circumstances. However, the new EIF, when adapted for personally managed health data, provides a useful and relevant framework to facilitate implementation and adoption of personal health record systems within a coordinated care environment. Practical implications of this work relate to the need of multi-disciplinary cooperation and European level compatibility and sustainability of the underlying infrastructures required to support reliable and secure access to and sharing of medical data, as well as the readiness to address continuously evolving functional and non-functional requirements for regional, national, and cross-border settings.

Designing a Novel Technical Infrastructure for Chronic Pain Self-Management.

Chronic pain is one of the most common health problems affecting daily activity, employment, relationships and emotional functioning. Unfortunately, limited access to pain experts, the high heterogeneity in terms of clinical manifestation and treatment results, contribute in failure to manage efficiently and effectively pain. Information and Communication Technology (ICT) can be a valuable tool, enabling better self-management and self-empowerment of pain. To this direction, this paper reports on the design of a novel technical infrastructure for chronic pain self-management based on an Intelligent Personal Health Record (PHR) platform. The designed platform targets, among others, at improving the knowledge on the patient data, effectiveness and adherence to treatment and providing effective communication channels between patients and clinicians.

Towards a Cross-domain Infrastructure to Support Electronic Identification and Capability Lookup for Cross-border ePrescription/Patient Summary Services.

Seamless patient identification, as well as locating capabilities of remote services, are considered to be key enablers for large scale deployment of facilities to support the delivery of cross-border healthcare. This work highlights challenges investigated within the context of the Electronic Simple European Networked Services (e-SENS) large scale pilot (LSP) project, aiming to assist the deployment of cross-border, digital, public services through generic, re-usable technical components or Building Blocks (BBs). Through the case for the cross-border ePrescription/Patient Summary (eP/PS) service the paper demonstrates how experience coming from other domains, in regard to electronic identification (eID) and capability lookup, can be utilized in trying to raise technology readiness levels in disease diagnosis and treatment. The need for consolidating the existing outcomes of non-health specific BBs is examined, together with related issues that need to be resolved, for improving technical certainty and making it easier for citizens who travel to use innovative eHealth services, and potentially share personal health records (PHRs) with other providers abroad, in a regulated manner.

Delivering a lifelong integrated electronic health record based on a service oriented architecture.

Efficient access to a citizen's Integrated Electronic Health Record (I-EHR) is considered to be the cornerstone for the support of continuity of care, the reduction of avoidable mistakes, and the provision of tools and methods to support evidence-based medicine. For the past several years, a number of applications and services (including a lifelong I-EHR) have been installed, and enterprise and regional infrastructure has been developed, in HYGEIAnet, the Regional Health Information Network (RHIN) of the island of Crete, Greece. Through this paper, the technological effort toward the delivery of a lifelong I-EHR by means of World Wide Web Consortium (W3C) technologies, on top of a service-oriented architecture that reuses already existing middleware components is presented and critical issues are discussed. Certain design and development decisions are exposed and explained, laying this way the ground for coordinated, dynamic navigation to personalized healthcare delivery.

The PICNIC Story.

This chapter describes how the Professionals and Citizens Network for Integrated Care (PICNIC) project was conducted in order to meet its objectives in preparing the regional healthcare providers to implement the next generation, comprehensive, user-friendly, secure healthcare network for patient centred care, and through it contribute to the de-fragmentation of the European market for health telematics. It describes the methodology followed in order to reach certain project results, starting from the selection of common documentation tools and methods, to the delivery of a new model for providing services, assessment plans, and a number of open source software components running on a number of diverse pilots throughout Europe in line with the overall PICNIC architecture.

PICNIC Technology.

A key objective of the Professionals and Citizen Network for Integrated Care (PICNIC) project was to provide products for a European and potentially worldwide software market. The approach followed was through the delivery of a number of Open Source (OS) components, to be integrated into applications that deliver similar services across the participating regions, aiming at their exploitation by other regions and the industry. This chapter describes the technology developed during the lifecycle of the PICNIC project, focusing on the three core services of Clinical Messaging, Access to Patient Data, and Collaboration. For each service, the entire process of how to turn its functional specifications into reusable components and common data sets in order to support Information Technology (IT) services for the next generation of secure, user-friendly healthcare networks is presented by means of common documentation tools. Security and privacy issues are also addressed.

An open, component-based information infrastructure for integrated health information networks.

A fundamental requirement for achieving continuity of care is the seamless sharing of multimedia clinical information. Different technological approaches can be adopted for enabling the communication and sharing of health record segments. In the context of the emerging global information society, the creation of and access to the integrated electronic health record (I-EHR) of a citizen has been assigned high priority in many countries. This requirement is complementary to an overall requirement for the creation of a health information infrastructure (HII) to support the provision of a variety of health telematics and e-health services. In developing a regional or national HII, the components or building blocks that make up the overall information system ought to be defined and an appropriate component architecture specified. This paper discusses current international priorities and trends in developing the HII. It presents technological challenges and alternative approaches towards the creation of an I-EHR, being the aggregation of health data created during all interactions of an individual with the healthcare system. It also presents results from an ongoing Research and Development (R&D) effort towards the implementation of the HII in HYGEIAnet, the regional health information network of Crete, Greece, using a component-based software engineering approach. Critical design decisions and related trade-offs, involved in the process of component specification and development, are also discussed and the current state of development of an I-EHR service is presented. Finally, Human Computer Interaction (HCI) and security issues, which are important for the deployment and use of any I-EHR service, are considered.