Unobtrusive Health Monitoring in Private Spaces: The Smart Home.

With the advances in sensor technology, big data, and artificial intelligence, unobtrusive in-home health monitoring has been a research focus for decades. Following up our research on smart vehicles, within the framework of unobtrusive health monitoring in private spaces, this work attempts to provide a guide to current sensor technology for unobtrusive in-home monitoring by a literature review of the state of the art and to answer, in particular, the questions: (1) What types of sensors can be used for unobtrusive in-home health data acquisition? (2) Where should the sensors be placed? (3) What data can be monitored in a smart home? (4) How can the obtained data support the monitoring functions? We conducted a retrospective literature review and summarized the state-of-the-art research on leveraging sensor technology for unobtrusive in-home health monitoring. For structured analysis, we developed a four-category terminology (location, unobtrusive sensor, data, and monitoring functions). We acquired 912 unique articles from four relevant databases (ACM Digital Lib, IEEE Xplore, PubMed, and Scopus) and screened them for relevance, resulting in n=55 papers analyzed in a structured manner using the terminology. The results delivered 25 types of sensors (motion sensor, contact sensor, pressure sensor, electrical current sensor, etc.) that can be deployed within rooms, static facilities, or electric appliances in an ambient way. While behavioral data (e.g., presence (n=38), time spent on activities (n=18)) can be acquired effortlessly, physiological parameters (e.g., heart rate, respiratory rate) are measurable on a limited scale (n=5). Behavioral data contribute to functional monitoring. Emergency monitoring can be built up on behavioral and environmental data. Acquired physiological parameters allow reasonable monitoring of physiological functions to a limited extent. Environmental data and behavioral data also detect safety and security abnormalities. Social interaction monitoring relies mainly on direct monitoring of tools of communication (smartphone; computer). In summary, convincing proof of a clear effect of these monitoring functions on clinical outcome with a large sample size and long-term monitoring is still lacking.

Health-Enabling Technologies for Telerehabilitation of the Shoulder: A Feasibility and User Acceptance Study.

BACKGROUND: After discharge from a rehabilitation center the continuation of therapy is necessary to secure already achieved healing progress and sustain (re-)integration into working life. To this end, home-based exercise programs are frequently prescribed. However, many patients do not perform their exercises as frequently as prescribed or even with incorrect movements. The telerehabilitation system AGT-Reha was developed to support patients with shoulder diseases during their home-based aftercare rehabilitation. OBJECTIVES: The presented pilot study AGT-Reha-P2 evaluates the technical feasibility and user acceptance of the home-based telerehabilitation system AGT-Reha. METHODS: A nonblinded, nonrandomized exploratory feasibility study was conducted over a 2-year period in patients' homes. Twelve patients completed a 3-month telerehabilitation exercise program with AGT-Reha. Primary outcome measures are the satisfying technical functionality and user acceptance assessed by technical parameters, structured interviews, and a four-dimensional questionnaire. Secondary endpoints are the medical rehabilitation success measured by the active range of motion and the shoulder function (pain and disability) assessed by employing the Neutral-0 Method and the standardized questionnaire "Shoulder Pain and Disability Index" (SPADI), respectively. To prepare an efficacy trial, various standardized questionnaires were included in the study to measure ability to work, capacity to work, and subjective prognosis of work capacity. The participants have been assessed at three measurement points: prebaseline (admission to rehabilitation center), baseline (discharge from rehabilitation center), and posttherapy. RESULTS: Six participants used the first version of AGT-Reha, while six other patients used an improved version. Despite minor technical problems, all participants successfully trained on their own with AGT-Reha at home. On average, participants trained at least once per day during their training period. Five of the 12 participants showed clinically relevant improvements of shoulder function (improved SPADI score > 11). The work-related parameters suggested a positive impact. All participants would recommend the system, ten participants would likely reuse it, and seven participants would have wanted to continue their use after 3 months. CONCLUSION: The findings show that home-based training with AGT-Reha is feasible and well accepted. Outcomes of SPADI indicate the effectiveness of aftercare with AGT-Reha. A controlled clinical trial to test this hypothesis will be conducted with a larger number of participants.

[Emergency care in nursing homes in the City of Braunschweig: A cross-sectoral view with indicators from deaths, resuscitation, emergency department visits and EMS deployment]. / Notfallversorgung in Pflegeeinrichtungen in der Stadt Braunschweig: Ein sektorenübergreifender Blick anhand von Kennzahlen aus Sterbefällen, Reanimationen, Krankenhauszuweisungen und Rettungsdiensteinsätzen.

INTRODUCTION: General survey of emergency care in nursing homes in the City of Braunschweig. METHODS: Retrospective analysis of data from death registry, resuscitation registry and further routine data from the local health authorities and the emergency medical services (EMS). RESULTS: 30 nursing homes with 3,100 beds (mean: 103; range: 35-250) were included; operators of nursing homes were 18 non-profit organizations; 7 private (local); 5 private (nationwide). Among the inhabitants of these 30 nursing homes 880 deaths occurred, 406 (46 %) in hospital; 4,895 EMS deployments for emergency care; 4,493 (92 %) resulting in emergency department visits; 19 CPRs. EMS deployments without a physician order per bed 1.0 (0.4-1.6); emergency department visits per bed 1.4 (0.7-3.1); rate of EMS deployments without physicians order / emergency department visits 70 % (41-96 %); deaths per bed 0,29 (0.12-0.48); rate of deaths in hospital 46 % (0-62 %); CPRs per 1,000 beds 6.1 (0-28); CPR failure rate 22 (0-83) per 1,000 deaths per year. EMS deployment without physician order was significantly more frequent in privately (nationwide) operated nursing homes 1.2 (1.0-1.4). In the entire urban region, the incidence of EMS deployment without a physician order was 0.2 per inhabitant per year and the rate of hospital deaths was 64 %. CONCLUSION: Compared to the entire population of the City of Braunschweig, EMS deployment was more frequent in nursing homes. The chance of hospital death or failed CPR was slightly lower. There are large variations between the different nursing homes. Indicators from routine data can provide guidance for more specific surveys but do not allow benchmarking.

Substitution of Assisted Living Services by Assistive Technology - Experts Opinions and Technical Feasibility.

Ambient assisted living (AAL) may support ageing in place but is primarily driven by technology. The aim of this work is, to identifying reasons to move into assisted living institutions, their range of service and possible substitutability. We did semi-structured interviews with five experts from assisted living institutions and used results to design and implement assistive technologies in an AAL environment using BASIS, a cross domain bus system for smart buildings. Reasons for moving to assisted living institutions are expected benefits for chronic health problems, safety, social isolation and carefree living. We implemented six application systems for inactivity monitoring, stove shutdown, air quality monitoring, medication and appointment reminders, detection of unwanted situations before leaving and optical ringing of the doorbell. Substitution of selected assisted living services is feasible and has potential to delay necessity to move into assisted living institution if complement social services are installed.

On Teaching International Courses on Health Information Systems. Lessons Learned during 16 Years of Frank - van Swieten Lectures on Strategic Information Management in Health Information Systems.

BACKGROUND: Health information systems (HIS) are one of the most important areas for biomedical and health informatics. In order to professionally deal with HIS well-educated informaticians are needed. Because of these reasons, in 2001 an international course has been established: The Frank - van Swieten Lectures on Strategic Information Management of Health Information Systems. OBJECTIVES: Reporting about the Frank - van Swieten Lectures and about our students' feedback on this course during the last 16 years. Summarizing our lessons learned and making recommendations for such international courses on HIS. METHODS: The basic concept of the Frank - van Swieten lectures is to teach the theoretical background in local lectures, to organize practical exercises on modelling sub-information systems of the respective local HIS and finally to conduct Joint Three Days as an international meeting were the resulting models are introduced and compared. RESULTS: During the last 16 years, the Universities of Amsterdam, Braunschweig, Heidelberg/Heilbronn, Leipzig as well as UMIT were involved in running this course. Overall, 517 students from these universities participated. Our students' feedback was clearly positive. The Joint Three Days of the Frank - van Swieten Lectures, where at the end of the course all students can meet, turned out to be an important component of this course. Based on the last 16 years, we recommend common teaching materials, agreement on equivalent clinical areas for the exercises, support of group building of international student groups, motivation of using a collaboration platform, ensuring quality management of the course, addressing different levels of knowledge of the students, and ensuring sufficient funding for joint activities. CONCLUSIONS: Although associated with considerable additional efforts, we can clearly recommend establishing such international courses on HIS, such as the Frank - van Swieten Lectures.

Facilitating Inter-Domain Synergies in Ambient Assisted Living Environments.

Current Ambient Assisted Living (AAL) environments lack integration of sensors and actuators of other sub-domains. Creating technical and organizational integration is addressed by the BASIS project (Build Automation by a Scalable and Intelligent System), which aims to build a cross-domain home bus system. The main objective of this paper is to present an overview of design, architecture and state of realization of BASIS by describing the requirements development process, underlying hardware design and software architecture. We built a distributed system of one independent building manager with several redundantly meshed segment controllers, each controlling a bus segment with any number of bus nodes. The software system layer is divided into logical partitions representing each sub-domain. Structured data storage is possible with a special FHIR based home centered data warehouse. The system has been implemented in six apartments running under daily living conditions. BASIS integrates a broad range of sub-domains, which poses challenges to all project partners in terms of a common terminology, and project management methods, but enables development of inter-domain synergies like using the same sensor and actuator hardware for a broad range of services and use cases.

Rolling Medical Practice: Ambulant Mobile Medical Care for Rural Areas.

We designed, constructed, and evaluated a mobile medical care vehicle called "Rollende Arztpraxis" (rolling medical practice, RMP) that delivers the full medical care of a general practitioner to increase medical care supply in rural areas. Six communities have been identified, where the RMP has been visited 501 times in 14 months. Two different schedules of stops and treatment times have been tested. We show that the RMP treated mainly elderly and multimorbid patients. An accompanying study showed high acceptance and satisfaction of treated patients and treating doctors. An economic evaluation of three different utilization models with three treatment modes each showed no financial sustainability. We show that ambulatory care in rural areas can be complemented by a mobile care unit, if legal and financial barriers can be overcome.

An HL7-FHIR-based Object Model for a Home-Centered Data Warehouse for Ambient Assisted Living Environments.

Current AAL environments focus on assisting a single person with seperated technologies. There is no interoperability between sub-domains in home environments, like building energy management or housing industry services. BASIS (Building Automation by a Scalable and Intelligent System) aims to integrate all sensors and actuators into a single, efficient home bus. First step is to create a semtically enriched data warehouse object model. We choose FHIR and built an object model mainly based on the Observation, Device and Location resources with minor extensions needed by AAL-foreign sub domains. FHIR turned out to be very flexible and complete for other home related sub-domains. The object model is implemented in a separated software-partition storing all structural and procedural data of BASIS.

Rollende arztpraxis - first results of an ambulant mobile care model for rural areas.

German medical care is going to suffer from a decreasing number of general practitioners due to demographic change. We study if ambulatory care in rural areas can be complementary ensured by a mobile care unit. A medical care van - the "rolling medical practice" (RMP) - has been constructed based on care scenarios created for rural communities in northern Germany. Performance and acceptance of the RMP is evaluated by constant monitoring of anonymized medical documentation and questionnaires. The RMP is visiting six villages on two days a week in a three-week interval. It is constructed from a standard van with a custom box body fully equipped for general care needs. Actually treated care cases meet expectations and are acute as well as chronicle symptoms. Case numbers range from 6 to 50 visits in 5 month. We showed that almost full ranged mobile medical care, as supplement to general medical supply is possible.

Design and implementation of an informed consent process for a standardized health information exchange solution on the example of the lower saxony bank of health.

OBJECTIVE: Multicenter medical treatment requires health related data to be available across institutions. Since health information exchange solutions are emergent, fulfillment of privacy needs, including patients' informed consent, is vital for successful data exchange. METHODS: We designed a software supported consent process for the recently founded Lower Saxony Bank of Health (LSBH) with regard to particularities of German law. To implement the application, web technologies and well-described interfaces to IHE XDS profile components have been used. RESULTS: A two staged process has been developed. A special consent application creates a customized form containing all orally given constraints defined by the patient. The form is printed out and signed by the patient while an electronic policy is created and registered at the LSBH. CONCLUSION: The process completely reflects a conventional informed consent procedure but increases simplicity, clarity and understandability of the consent form. Technical and legal restrictions in Germany create a media split becoming a media crack in some environments. Availability of signature cards could improve the process by making it completely electronic.

Primary care provider's acceptance of health information exchange utilizing IHE XDS.

OBJECTIVE: We assessed primary care providers' perception of a health information exchange system (HIE) based on IHE XDS in the metropolitan area of Braunschweig, Lower Saxony, Germany. DESIGN: An application enabling access to medical documents in an XDS Affinity Domain was developed. We examined usability and factors related to user acceptance. MEASUREMENTS: User perception was probed using system usability scale (SUS) and semi-structured interviews. The framework analysis was used in the review and interpretation of the interview data. RESULTS: The evaluation was performed on 7 participants. The SUS showed an above average usability with a median score of 77.5. Participants submitted suggestions for additional features and improvement of usability. Poor integration of functionality into existing workflows was most frequently criticized. CONCLUSION: We found, that, while usability was well perceived by primary care providers, challenges remain in adoption of XDS based IHE.

Primary care providers' acceptance of health information exchange utilizing IHE XDS.

We assessed primary care providers' perception of a health information exchange system (HIE) based on IHE XDS. The HIE will be part of a regional health network in the metropolitan area of Braunschweig, Lower Saxony, Germany. An application enabling access to medical documents in an XDS Affinity Domain was developed. We examined usability and factors related to user acceptance. User perception was probed using system usability scale (SUS) and semi-structured interviews. The evaluation was performed on 7 participants. The SUS showed an above average usability with a median score of 77.5. During interviews, participants submitted suggestions for additional features and improvement of usability. Poor integration of functionality into existing workflows was most frequently criticized. While usability was well perceived by primary care providers, challenges remain in adoption of XDS based IHE. To speed up document access in time-critical domains, we suggest use of complementary methods, enabling directed communication flows.

Disease patterns addressed by mobile health-enabling technologies--a literature review.

Health-enabling technologies can contribute to a better living with diverse disease patterns, especially at home. Ambient Assisted Living (AAL) provides security and convenience at the main place of residence, but usually cannot be taken on the road. Mobile health-enabling technologies could overcome this barrier of immobility and enable its' users to take advantages of assistive technology with them. The presented literature review examines disease patterns, which can be addressed by mobile health-enabling technologies. Especially chronic diseases, like diabetes, are very responsive for continuous support by portable support technology.