Presentation given by Jeongeun Kim at ISHSH 2013

1. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
On-offline Total Service of
Community-based
Healthcare Smart Home
Jeongeun Kim RN, INS, PhD
International Symposium on Healthcare Smart Home (ISHSH) 2013
September 3rd, 2013
Seoul National University Hospital Biomedical Research Institute
This research was supported by a grant (10 High-tech Urban B02) from High-tech Urban Development Program
funded by Ministry of Land, Transport and Maritime Affairs of Korean government.

2. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Healthcare Available Whenever and Wherever
Healthcare Smart Home Service
• To Support Chronic Disease Self-management
• To Improve Daily Habits and Quality of Life
Tailored Health Counseling and Education
Regular Health Monitoring
Early Detection of Health Problems
{objectives
vision
Image by Roberto Mangosi

3. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Service Components
Image by Lego

4. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Spaces
Network Infrastructure
Image by SEOUL Magazine
Residential SpacesCommunity Spaces
Intensive Care Spaces

5. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Service Delivery Framework
Offline Service DeliveryOnline Service Delivery

6. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Participant Management System
Health Education
Health Counseling
Health Programs
Demographics
Health Information
Counseling Records }

7. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Clinical Decision Support System (CDSS)
CDSS
Improved
Self-management
Vital Signs
Monitored in a Residential Space
Personal
Health Characteristics
}
High-risk Group
Intermediate-risk Group
Low-risk Group
[ ]

8. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Service Delivery Process
Vital Signs
Monitored in a Residential Space
Collecting Information
from the System in a Residential Space
Remote Health Monitoring
by u-Health Nurses
Analysis with CDSS
High-risk Group
Intermediate-risk Group
Low-risk Group
Analysis Results
Health Programs
developed by Health Professionals
- Video Consultation
- Health Games
- Health Recreation
Nurses
Qualified Personal Trainers
- Physical Exercise
[

9. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
On/Offline Services for a Residential Space
Online Services in a Residential Space Offline Services in a Residential Space
• u-Health Nurses Visiting Residential Spaces
- Health Counseling
- Health Education
- Education on Equipment Use
• Self-monitoring Vital Signs

10. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
On/Offline Services for a Community Space
• Participants Visiting Community Spaces
- Health Counseling
- Health Education
- Education on Equipment Use
• u-Health Nursing Center
- Remote Health Monitoring
- Video Consultation
Online Services in a Community Space Offline Services in a Community Space

11. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
On/Offline Services for an Intensive Care Space
• u-Health Nurses’Close Monitoring of Vital Signs
- Early Detection of Participants in the High-risk Group
• Tailored Health Counseling
- Referring Them to a Hospital
• CDSS Alerting the Participant to Abnormal Vital Signs
Online Services in an Intensive Care Space Offline Services in an Intensive Care Space

12. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Health Programs (1/2)
• Disease Prevention and Health Promotion
• Community-based Healthcare
• Special Health Programs for the Elderly
Video Consultation – Video Health Counseling and Education Tailored to the Participant’s Health Status
Health Games – Video Games for the Elderly to Exercise

13. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Game Designed for Walking Effects

14. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Health Programs (2/2)
• Disease Prevention and Health Promotion
• Community-based Healthcare
• Special Health Programs for the Elderly
Health Recreation – Recreation Programs for the Elderly to Reduce Stress, Anxiety, and Depression
Physical Exercise – Physical Exercise for the Elderly

15. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Service Results
Image by Alexander Maslennikov

16. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Research
• Subjects:
160 Low-income Elderly Residents in Permanent Rental Houses in Town "G", City "S",
who had Used the u-Health Services from August, 2012 to June, 2013
• Design:
One Group Pretest-Posttest Design
• Tools:
Purpose Tool Description
Effectiveness
Analysis
Korean Questionnaire for
Health-related Habits and Lifestyle
Survey of 11 Health-related Habits and Lifestyle Factors
including Smoking, Drinking, and Sleeping Habits
Effectiveness
Analysis
EQ-5D (EuroQol 5 Dimensions)
Subjective Evaluation of Health-related
Quality of Life (HRQoL) and Health StatusEffectiveness
Analysis
Transtheoretical Model (TTM)
Model to Conceptualize the Process of
Intentional Behavior Change and Maintenance
Effectiveness
Analysis
Korea Form of
Geriatric Depression Scale (KFGD)
Standardized Korean Version of
Geriatric Depression Scale (GDS)
Satisfaction
Analysis
Technology Acceptance Model (TAM)
Information Systems Theory that Models
How Users Come to Accept and Use a Technology

17. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
General, Health, and Service Characteristics
Variable Classification n %
Gender
Male 52 32.5
Gender
Female 108 67.5
Age
65-70 46 28.8
Age
71-75 44 27.5
Age 76-80 34 21.3Age
81-85 27 16.9
Age
86+ 9 5.6
Education
Uneducated 42 26.3
Education
Elementary School 57 35.6
Education Middle School 26 16.3Education
High School 21 13.1
Education
Some College+ 7 4.4
Household
Type
Solitary 85 53.1
Household
Type
Couple Alone 36 22.5
Household
Type
Couple with Child 38 23.8
Duration of
Residence
Less than 5 yrs. 15 9.4
Duration of
Residence
5-10 yrs. 20 12.5
Duration of
Residence
10-20+ yrs. 123 76.9
Variable Classification n %
Monthly
Household
Income
Less than $300 104 65.0
Monthly
Household
Income
$300-500 35 21.9Monthly
Household
Income $500-1,000 13 8.1
Monthly
Household
Income
$1,000-2,000+ 7 4.4
Occupation
Unoccupied 149 93.1
Occupation
Occupied 9 5.6
Duration of
Smoking
Never Smoked 112 70.0
Duration of
Smoking
Former Smoker 21 13.1
Duration of
Smoking
1-10 yrs. 5 3.1Duration of
Smoking 11-20 yrs. 2 1.3
Duration of
Smoking
21-30 yrs. 1 0.6
Duration of
Smoking
30+ yrs. 19 11.9
Frequency of
Drinking
Never Drunk 113 70.6
Frequency of
Drinking
Less than Once a Month 24 15.0
Frequency of
Drinking
2-4 Times a Month 8 5.0
Frequency of
Drinking
2-4 Times a Week 7 4.4
Frequency of
Drinking
Daily 4 2.5
Duration of
Service Use
Less than 6 months 41 25.6Duration of
Service Use More than or Equal to 6 months 119 74.4
Variable Classification n %
Frequency of
Exercise
Never Exercise 60 37.5
Frequency of
Exercise
Less than Once a Week 16 10.0
Frequency of
Exercise
Twice a Week 15 9.4
Frequency of
Exercise
3-4 Times a Week 25 15.6
Frequency of
Exercise
Daily 43 26.9
Health
Examination
within a Year
Yes 101 63.1Health
Examination
within a Year No 56 35.0
Complex
No. 7 104 65.0
Complex
No. 5 56 35.0
Space
Residential Space 127 79.4
Space
Community Space 33 20.6
Disease
Group
Hypertension 97 60.6
Disease
Group
Diabetes 41 25.6Disease
Group Heart & Blood Vessel Diseases 12 7.5
Disease
Group
Chronic Pulmonary Disease 10 6.3
Frequency of
Service Use
Very Good 65 40.6
Frequency of
Service Use
Good 28 17.5Frequency of
Service Use Bad 25 15.6
Frequency of
Service Use
Very Bad 42 26.3

18. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Effectiveness Analysis
n
Mean±SDMean±SD
t (p)n
Pretest Posttest
t (p)
Health-related
Habits and
Lifestyle
Total 160 0.63±.15 0.63±.15
0.00
(1.000)
Health-related
Habits and
Lifestyle
Health-related
Habits
160 0.67±.18 0.63±.17
2.60
(0.010)*
Health-related
Habits and
Lifestyle
Health-related
Lifestyle
160 0.58±.22 0.63±.22
-2.48
(0.014)*
Quality of Life
EQ-5D VAS 122 52.58±21.15 56.93±21.86
-1.94
(0.055)
Quality of Life
EQ-5D (y) 160 0.80±.16 0.72±.22
5.18
(<0.001)*
Depression 155 7.50±3.95 7.77±3.81
-0.83
(0.408)
Stage
PretestPretest PosttestPosttest
Stage
n % n %
Exercise
Precontemplation 62 39.0 53 33.3
Exercise
Contemplation 6 3.8 11 6.9
Exercise Preparation 28 17.6 14 8.8Exercise
Action 8 5.0 9 5.7
Exercise
Maintenance 55 34.6 72 45.3
Diet
Precontemplation 41 25.6 49 30.8
Diet
Contemplation 7 4.4 14 8.8
Diet Preparation 52 32.5 28 17.6Diet
Action 7 4.4 7 4.4
Diet
Maintenance 53 33.1 61 38.4
Changes in
Health
Management
Precontemplation 36 22.5 30 18.9
Changes in
Health
Management
Contemplation 8 5.0 13 8.2Changes in
Health
Management
Preparation 94 58.8 25 15.7
Changes in
Health
Management Action 5 3.1 17 10.7
Changes in
Health
Management
Maintenance 17 10.6 74 46.5
Transtheoretical AnalysisQuestionnaire Scores

19. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Satisfaction Analysis Tool based on TAM
Variable Measurement
Perceived Usefulness
The Degree to which Using the u-Health Platform Service has Its Advantages
Perceived Usefulness
The Degree of Usefulness of the u-Health Platform Service
Perceived Usefulness
The Degree to which Using the u-Health Platform Service Improves a Person's Daily Life
Perceived Usefulness
The Degree to which the Time and Cost are Reduced by Using the u-Health Platform Service
Perceived Ease of Use
The Degree to which Learning How to Use the u-Health Platform Service is Free from Effort
Perceived Ease of Use
The Degree to which a Person Understands How to Use the u-Health Platform Service
Perceived Ease of Use
The Degree of Efforts to be Proficient in Using the u-Health Platform Service
Perceived Ease of Use
The Degree to which a Person Thinks that the u-Health Platform Service is Easy to Use
Attitude toward Using
The Degree to which a Person Likes to Use the u-Health Platform Service
Attitude toward Using The Degree of Benefit from Using the u-Health Platform ServiceAttitude toward Using
The Degree to which Use of the u-Health Platform Service Helps with a Person's Health Management
Behavioral Intention to Use
The Intention to Use the u-Health Platform Service
Behavioral Intention to Use The Intention to Manage Health by Using the u-Health Platform ServiceBehavioral Intention to Use
The Intention to Use the u-Health Platform Service Frequently

20. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Satisfaction Analysis (1/3)
Variable
Mean±SDMean±SD
t pVariable
Pretest Posttest
t p
Perceived Usefulness 2.93±.56 2.96±.85 -.488 .627
Perceived Ease of Use 2.71±.51 2.82±2.61 -1.77 .078
Attitude toward Using 2.98±.42 3.12±.82 -1.95 .053
Behavioral Intention to Use 2.66±.48 2.83±2.78 -2.47 .014*
Variable
r(p)r(p)r(p)r(p)
Variable
Perceived Usefulness Perceived Ease of Use Attitude toward Using Behavioral Intention to Use
Perceived Ease of Use
.407
(<.001)*
- - -
Attitude toward Using
.803
(<.001)*
.429
(<.001)*
- -
Behavioral Intention to Use
.623
(<.001)*
.229
(<.001)*
.764
(<.001)*
-
Pretest-Posttest Comparison
Correlation between Variables

21. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Satisfaction Analysis (2/3)
Statistically Significant Differences According to the General Characteristics:
Pretest
Posttest
-0.08±.75
Male
Female
Perceived Ease of Use
+0.21±.83
Posttest
Pretest
Duration of Residence
Perceived Ease of Use
Less than 5 yrs.
5-10 yrs.
10-20+ yrs.
Statistically Significant Differences According to the Health Characteristics:
No (0.33±.87)
Yes (0.01±.92)
Health Examination within a Year
Attitude toward Using

22. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Satisfaction Analysis (3/3)
Statistically Significant Differences According to the Service Characteristics:
Duration of Service Use
Less than 6 Months
More than or Equal to 6 Months
PerceivedUsefulness
PerceivedEaseofUse
AttitudetowardUsing
Frequency of Service UseChronic Pulmonary Disease
Hypertension
Heart & Blood Vessel Diseases
Diabetes
PerceivedEaseofUse
BehavioralIntentiontoUse
No. 5 (0.33±1.05)
No. 7 (0.00±.63)
Complex
Perceived Ease of Use
Disease Group
PerceivedUsefulness
Diabetes
Heart & Blood Vessel Diseases
Chronic Pulmonary Disease
Hypertension
AttitudetowardUsing
BehavioralIntensiontoUse
Diabetes
Chronic Pulmonary Disease
Hypertension
Heart & Blood Vessel Diseases

23. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Cost-benefit Analysis
Residential Spaces
$753 average medical cost for each person per year
7 days spent in hospital or visits to hospitals or clinics
8 the number of medication days
Community Spaces
$73 average medical cost for each person per year
18 days spent in hospital or visits to hospitals or clinics
87 the number of medication days
For Each Elderly Person Per Year
$627 average medical cost for each person per year
9 days spent in hospital or visits to hospitals or clinics
20 the number of medication days
the Project in 2013
Cost: $201,243
when Considering the Depreciation of the Material Costs
Benefit: $343,290
$132,339 by reducing a doctor’s bill
$210,951 by reducing days spent in hospital
and the number of medication days
Net Profit: $142,047
BCR: 1.71(Benefit-cost Ratio)
Economically Valid

24. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Conclusion

25. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Directions
• The Model of Smart Home with Healthcare Technologies
Operational Guideline
• Guideline for Space Design, Healthcare Programs, and Operational Strategies
, which could be Applied to Housing for the Elderly such as Bogeumjari Housing or Silver Housing
, which could be Applied to Long-term Public Rental Housing as the First Step
Economic Efficiency
• Continued Support from the Government and the Related Public Organizations
to Make the Project Expandable and Sustainable
• Adjusted Distribution of the Resources between Community and Residential Spaces
to Improve the Economic Efficiency
• Reduced Unemployment Rate as a Side-effect
by Promoting Health of the Nation Including the Disadvantaged

26. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Directions
• The Model of Smart Home with Healthcare Technologies
Operational Guideline
• Guideline for Space Design, Healthcare Programs, and Operational Strategies
, which could be Applied to Housing for the Elderly such as Bogeumjari Housing or Silver Housing
, which could be Applied to Long-term Public Rental Housing as the First Step
Economic Efficiency
• Continued Support from the Government and the Related Public Organizations
to Make the Project Expandable and Sustainable
• Adjusted Distribution of the Resources between Community and Residential Spaces
to Improve the Economic Efficiency
• Reduced Unemployment Rate as a Side-effect
by Promoting Health of the Nation Including the Disadvantaged

27. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Suggestions
• Promoting the Value of the Service
The Value of the Service
to Reduce the Service Dropout Rate
26%: No Needs
Visit Hospitals or Clinics Often
22%: No Enough Spaces for the Equipments
Refuse to Install an Internet Connection or the Equipments at Home
Utilization of Community Spaces
• Effective Utilization of Community Spaces
for the Low-cost and High-efficiency Healthcare Smart Home Service
• Community-centered Healthcare Services
since Elderly People Affect Each Other and Stay at the Community Center for Long Time
• Developing Infrastructures and Social Memes
to Provide Healthcare Services to the Elderly

28. ONINTERNATIONAL
SYMPOSIUM
HEALTHCARE
SMART HOME
ISHSH 2013
BUILDABLE,SUSTAINABLE,ANDDISTRIBUTABLE
HEALTHCARESMARTHOME
Thank You.