Personal Health Systems for Patient Self-management: Integration in Pervasive Monitoring Environments

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Presentation given in the 1st International Conference on Wireless Mobile Communication and Healthcare (MobiHealth), Ayia Napa, Cyprus, October 2010.

The paper was given the Best Student Paper Award.

Triantafyllidis, A., Koutkias, V.G., Chouvarda, I., Giaglis, G.D., Maglaveras, N. Personal Health Systems for Patient Self-management: Integration in Pervasive Monitoring Environments (2010) LNICST, Springer 55/2010, pp. 87-94
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Various personal health systems have been applied in pervasive health monitoring, in which the need for patient involvement and self-management support with appropriate health information management tools has been highlighted. This paper presents a novel approach towards constructing a personalized mobile system, introduced as add-on to existing remote monitoring systems, for the management of health information by the patient himself/herself, with a Personal Health Record (PHR) constituting the system backbone. Particular emphasis is given to interconnection aspects with the monitoring system, so as to enable enhanced customization and management of monitoring-driven information provided to the patients according to their requirements/preferences. Communication issues between the monitoring and the proposed system are handled by using well-defined Web service interfaces for data exchange. Our prototype implementation, along with an application scenario presented, illustrate the applicability and virtue of the current work.

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Personal Health Systems for Patient Self-management: Integration in Pervasive Monitoring Environments

  1. 1. Personal Health Systems for Patient Self-management: Integration inPervasive Monitoring EnvironmentsA.K. Triantafyllidis, V.G. Koutkias, I. Chouvarda, G.D. Giaglis and N. Maglaveras Lab of Medical Informatics Faculty of Medicine, Aristotle University of Thessaloniki Thessaloniki, Greece atriant@med.auth.gr
  2. 2. Presentation Outline • Background: – Personal Health Systems – Patient Self-management – Pervasive Monitoring Systems • Scope of the Current Work • Proposed System: – Functional Attributes – System Architecture • Results: – Prototype Implementation - Technical Feasibility • Discussion and Future Work 2Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  3. 3. Personal Health Systems • Personal Health Information Management towards Wellness • Pervasive Health Monitoring: Anytime, Anywhere, Unobtrusive Pervasive Health Monitoring Instruments & Situations 3Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  4. 4. Patient Self-management: Rationale Rationale (K.R. Lorig, 2003#): “Whether one is engaging in a health promoting activity such as exercise or is living with a chronic disease such as asthma, he or she is responsible for day-to-day management.” #K.R. Lorig and H.R. Holman, “Self-management education: History, definition, outcomes, and mechanisms”, Ann Behav Med., vol. 26, no. 1, pp. 1-7, 2003. 4Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  5. 5. Patient Self-management : Benefits Enhancement of communication with doctors Focus on treatment plan, adherence Self-efficacy Confidence to carry out a behavior/lifestyle necessary to reach a desired goal Well-being better management 5Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  6. 6. Pervasive Monitoring Environments Problems encountered in Health Information Management by patients – Limited User-to-System Interactions – Tight to the monitoring plan – Dedicated to the monitoring system functionality – Variable Context (Time – Location – Activity – Situation): Inappropriate patient feedback Limited patient involvement with respect to customization and filtering of information 6Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  7. 7. An Integrated Approach for PatientSelf-management 7
  8. 8. Target Users & Functionality • Mobile Personal Health Management System (PHMS) targeted at Chronic Patients who: – Use Remote Monitoring Systems (RMSs) – Are highly aware of their disease – Wish to engage more actively in their disease management • Functional Attributes: – Patient self-reporting – Configurations related to the value of the Monitoring Output to the patient – Monitoring Output presentation preferences 8Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  9. 9. Patient-driven and Monitoring-driven Information (PDI & MDI) 9Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  10. 10. System Architecture 10Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  11. 11. Communication Infrastructure Main Objective: PHMS & RMS Interoperability • Service-Oriented Architecture (SOA): – SOAP (Simple Object Access Protocol) – WSDL (Web Service Description Language) • Terminology Services: – UMLSKS (Unified Medical Language System Knowledge Server) 11Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  12. 12. Example Web Service Operations PHMS back-end – MBU interface PHMS back-end – RMS interface Patient MDI preferences MDI control 12Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  13. 13. Patient Configuration Capabilities • MDI Insertion into the PHR – Whether • Yes, No and “Send notification” options – When • Temporal Exceptions • Presentation Preferences – Terminology (medical vocabulary in use) – MDI detail (e.g. inclusion of the conditions which lead to the MDI generation) – Information Access Rights 13Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  14. 14. Example of Components Interaction: MDI Insertion 14Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  15. 15. Technical Feasibility • Integration target: – Add-on to existing RMS with minimum configurations • Requirement: – RMS Web Service Client layer for communication with the PHMS Integrated & tested with Citizen Health System (CHS) CHS characteristics: – Sensor-enhanced RMS with MBU – System back-end infrastructure based on Component Object Model (COM) technology – System-generated feedback • “Tip” e.g. “Reduce your salt-intake” 15Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  16. 16. Prototype Implementation MBU PHMS back-end • J2ME-CLDC (Java 2 Micro • Apache Tomcat Edition- Connected Limited – Web application container Device Configuration) – Open platform for mobile applications • Apache Axis2 – Underlying SOAP engine • JSR-172 Web Services (Java • SMS Gateway Specifications Request) – Needed for “push” operations – API for Web Service clients • Bouncy Castle Crypto API – AES Data encryption 16Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  17. 17. MBU Demo Snapshots (SmartPhone) Alert generated as Integration of MDI and Insertion of MDI with MDI into PHMS PDI in patient’s PHR temporal exceptions 17Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  18. 18. Discussion: Future Work • Extensive Evaluation: – Usability aspects – Patient acceptance – Medical perspective • Integration of appropriate self-management methodologies: – Goal-setting approach • Elaborate on a generic methodology integrating: – Patient preferences and observations – Handling of context parameters, e.g. location, activity, etc. – Behavioral monitoring based on user-to-system interactions 18Personal Health Systems for Patient Self-management: MobiHealth 2010Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus
  19. 19. Thank you!!!Personal Health Systems for Patient Self-management: Integration inPervasive Monitoring EnvironmentsA.K. Triantafyllidis, V.G. Koutkias, I. Chouvarda, G.D. Giaglis and N. Maglaveras Lab of Medical Informatics Faculty of Medicine, Aristotle University of Thessaloniki Thessaloniki, Greece atriant@med.auth.gr

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