[Geriatrics and e-technology in an institution]. / Gériatrie et e-technologie en Ehpad.

The objective of the GER-e-TEC™ project is to provide a personalised medical follow-up of residents in nursing homes with the aid of a telemedicine intelligent platform. It will assist the nursing staff by automatically processing information obtained from sensors and questionnaires in order to give an early warning about high-risk situations. This telemedicine tool will enable health professionals to optimise residents' care.

Deployment of a remote monitoring solution for the elderly: experiment with an elderly patient / Déploiement d'une solution de télésurveillance du sujet âgé : expérimentation auprès d'un patient âgé

Introduction: Telemedicine can help manage patients suffering from chronic pathologies, particularly elderly patients with numerous comorbidities. We experimented with the e-platform, MyPredi, dedicated to the automated, intelligent detection of situations where patients are at risk of decompensation from geriatric syndromes. We focused our experiment on one particular patient included in the GER-e-TEC study. Methods: The MyPredi platform uses on medical sensors that communicate and relay real-time feedback to an intelligent system of physiological information that analyzes medical ontology, ultimately leading to the generation of alerts. These alerts are linked to a deterioration in the patient's state of health due to a decompensation of chronic pathologies. We reported the results of this experiment for the patient who was participating. Results: The telemedicine solution made 6,073 measurements for the patient throughout his hospitalization, averaging 253 measurements per day. The telemedicine solution issued 110 alerts for the patient during his stay, with an average of 5 alerts per day. The patient had 15 mild alerts, 31 moderate alerts, and 64 severe alerts. In terms of sensitivity, the results are 100% for all geriatric risks and very satisfactory in terms of positive and negative predictive value. Conclusion: MyPredi telemedicine platform enables the generation of alerts in an automatic and non-intrusive way relating to the deterioration of a patient's state of health with regard to geriatric risks.

Introduction: La télémédecine est susceptible d'apporter une aide à la prise en charge des patients souffrant de pathologies chroniques, en particulier les sujets âgés porteurs de nombreuses comorbidités. Dans ce cadre, nous avons expérimenté la e-plateforme MyPredi dédiée à la détection automatisée et intelligente des situations à risque de décompensation des syndromes gériatriques, auprès d'un patient inclus pour l'étude GER-e-TEC (pour geriatrics and e-technology). Méthodes: La plateforme MyPredi repose sur des capteurs médicaux communicants permettant de remonter, en temps réel, à un système intelligent des informations physiologiques, et sur une analyse de l'ontologie médicale, ce qui aboutit in fine à la génération d'alertes. Ces dernières sont liées à une dégradation de l'état de santé des patients en rapport avec une décompensation des pathologies chroniques. Nous indiquons les résultats de cette expérimentation pour le patient inclus. Résultats: La solution de télémédecine a réalisé 6 073 mesures pour le patient durant tout le long de son hospitalisation, avec en moyenne 253 mesures par jour. La solution de télémédecine a émis 110 alertes pour le patient durant son séjour, avec en moyenne cinq alertes par jour. Le patient a eu 15 alertes légères, 31 modérées et 64 sévères. On note une sensibilité de 100 % pour l'ensemble des risques gériatriques, avec des résultats très satisfaisants en termes de valeurs prédictives positives et négatives. Conclusion: En pratique, le système de télémédecine MyPredi permet, de façon automatique et non intrusive, de générer des alertes en rapport avec la dégradation de l'état de santé du patient en ce qui concerne les risques gériatriques.

Results of the Second Phase of the GER-e-TEC Experiment concerning the Telemonitoring of Elderly Patients Affected by COVID-19 Disease to Detect the Exacerbation of Geriatric Syndromes.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. This pandemic has created a difficult challenge for global public health. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including elderly patients. Our team developed a telemonitoring program focused on the prevention of geriatric syndromes, the "GER-e-TEC COVID study". METHODS: This second phase took place during the 3rd wave of the epidemic in France, between 14 December 2020 and 25 February 2021, conducted in the University Hospital of Strasbourg. RESULTS: 30 elderly patients affected by COVID-19 disease were monitored remotely; the mean age was 85.9 years and a male/female ratio of 1.5 to 1.11 (36.7%) died during the experiment. The patients used the telemedicine solution for an average of 27.3 days. 140,260 measurements were taken while monitoring the geriatric syndromes of the entire patient group. 4675 measurements were recorded per patient for geriatric disorders and risks. 319 measurements were recorded per patient per day. The telemedicine solution emitted a total of 1245 alerts while monitoring the geriatric syndromes of the entire patient group. In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. Survival analyses showed that gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (decompensated heart failure (p = 0.45), deterioration of general condition (p = 0.12), but significant for death (p = 0.028)). The analyses revealed that the length of the hospital stay was not affected by the number of alerts. The results concerning the predictive nature of alerts are satisfactory. CONCLUSIONS: The MyPredi™ telemedicine system allows for the generation of automatic, non-intrusive alerts when the health of a COVID-19 elderly patient deteriorates due to risks associated with geriatric syndromes.

First Test of an Automated Detection Platform to Identify Risk of Decompensation in Elderly Patients.

INTRODUCTION: We tested the MyPredi™ e-platform which is dedicated to the automated, intelligent detection of situations posing a risk of decompensation in geriatric patients. OBJECTIVE: The goal was to validate the technological choices, to consolidate the system and to test the robustness of the MyPredi™ e-platform through daily use. RESULTS: The telemedicine solution took 3,552 measurements for a hospitalized patient during her stay, with an average of 237 measurements per day, and issued 32 alerts, with an average of 2 alerts per day. The main risk was heart failure which generated the most alerts (n=13). The platform had 100% sensitivity for all geriatric risks, and had very satisfactory positive and negative predictive values. CONCLUSION: The present experiment validates the technological choices, the tools and the solutions developed. LEARNING POINTS: Patients with chronic conditions can be monitored with telemedicine systems to optimise their management, particularly during the COVID-19 pandemic.The goal was to validate the technological choices, to consolidate the system and to test the robustness of the MyPredi™ e-platform, through daily use in an elderly patient.The present experiment demonstrates the relevance of the technological choices, the tools and the solutions developed.

Focus on the Different Projects of Telemedicine Centered on the Elderly In France.

Telemedicine is now in vogue, allowing computer and communication tools to be deployed in different fields of health, such as Cardiology, Dermatology, areas in which it has received interest, and in international studies. As the population ages, older people are increasingly concerned about this innovative practice. This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of geriatric subjects in France. Since the beginning of the 2000's, several telemedicine projects and trials focused on chronic heart failure have been developed in the elderly, and also in the field of dermatology. The potential contribution of second-generation telemedicine projects in terms of mortality, morbidity, and the number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions were previously validated by the original telemedicine projects. We take a look at telemedicine projects in France concerning the elderly.

Telemedicine in elderly patients with heart failure.

Here, we carry out a review of the literature focused on telemedicine projects developed in the field of heart failure. We will particularly detail the remote monitoring project called E-care, dedicated to automated, intelligent detection of situations at risk of heart failure. Prospects for the development of the E-care system in the field of geriatry will also be discussed. Results: Numerous telemedicine projects, based on connected objects or technology sciences of information and communication, have emerged in the last five years or are under development in the field of computer science'heart failure. This is the case of the E-care telemonitoring project, which fits perfectly within the framework of telemedicine 2.0 projects. Their potential contribution in terms of mortality or morbidity, in number of hospitalizations avoided is currently under study or documentation. Their impact in terms of health economics is also being validated, knowing that the oldest telemedicine projects had already validated the economic and social benefits brought by telemedicine solutions.

Ontology-based Medical Decision Support System to Enhance Chronic Patients' Lifestyle within E-care Telemonitoring Platform.

The aim of this paper is to describe an original approach which consists of designing ontology based Medical Decision Support System (MDSS) to enhance the patients' lifestyle. This system is composed of two main parts: data collector which collects relevant lifestyle-related patent data by prompting the only significant questions in connection with the patient's medical background, and advices provider which provides personalized lifestyle advices to the patients regarding their lifestyle changes. The proposed MDSS is integrated within E-care home health monitoring platform in order to: (i) improve the patient's healthy lifestyle; (ii) educate the patients towards their disease; (iii) increase the early detection of risky situation.

Including other system in E-Care telemonitoring platform.

Nowadays, telemonitoring systems are increasingly used, due to the increasing of life expectancy and chronic diseases. Indeed, chronic diseases and disabilities due to advancing age are responsible for health care costs increasingly growing. Telemonitoring systems provide a low cost way to monitor patients and their needs in the comfort of their own homes. In first systems, the data were collected then sent directly to physicians to be interpreted. Nowadays, thanks to technological advancements, software and systems have been developed to process data, on a simple computer or even smartphone. In this paper, we present e-Care telemonitoring system that combines the semantic web and expert system. E-Care is based on generic ontologies and a decision support system. The decision support system uses ontologies as knowledge base and an inference engine to detect abnormal situations. E-Care platform has a generic open architecture, which cans include other knowledge coming from other systems. We'll show how to integrate data of auscultation sounds in this architecture.