Real-time Health Information Research Articles

Evaluation of immediate and 12-week effects of a smartphone sun-safety mobile application: a randomized clinical trial.

Mobile applications on smartphones can communicate a large amount of personalized, real-time health information, including advice on skin cancer prevention, but their effectiveness may be affected by whether recipients can be convinced to use them. To evaluate a smartphone mobile application (Solar Cell) delivering real-time advice about sun protection for a second time in a randomized clinical trial. A previous trial conducted in 2012 used a randomized pretest-posttest design. For the present trial, we collected data from a volunteer sample of 202 adults 18 years or older who owned a smartphone. Participants were recruited nationwide through online promotions. Screening procedures and a 3-week run-in period were added to increase the use of the mobile application. We conducted follow-ups at 3 and 8 weeks after randomization to examine the immediate and the longer-term effects of the intervention. Use of the mobile application. The application gave feedback on sun protection (ie, sun-safety practices and the risk for sunburn) and alerted users to apply or to reapply sunscreen and to get out of the sun. The application also displayed the hourly UV Index and vitamin D production based on the forecast UV Index, time, and location. Percentage of days with the use of sun protection, time spent outdoors in the midday sun (days and hours), and the number of sunburns in the last 3 months. Participants in the intervention group used wide-brimmed hats more at 7 weeks than control participants (23.8% vs 17.4%; F = 4.07; P = .045). Women who used the mobile application reported using all sun protection combined more than men (46.4% vs 43.3%; F = 1.49; P = .04), whereas men and older individuals reported less use of sunscreen (32.7% vs 35.5%; F = 5.36; P = .02) and hats (15.6% vs 17.9%; F = 4.72; P = .03). The mobile application initially appeared to confer weak improvement of sun protection. Use of the mobile application was greater than in a previous trial and was associated with greater sun protection, especially among women. Strategies to increase the use of the mobile application are needed if the application is to be deployed effectively to the general adult population.

ESalud: designing and implementing culturally competent ehealth research with latino patient populations.

eHealth is characterized by technology-enabled processes, systems, and applications that expedite accurate, real-time health information, feedback, and skill development to advance patient-centered care. When designed and applied in a culturally competent manner, eHealth tools can be particularly beneficial for traditionally marginalized ethnic minority groups, such as Latinos, a group that has been identified as being at the forefront of emerging technology use in the United States. In this analytic overview, we describe current eHealth research that has been conducted with Latino patient populations. In addition, we highlight cultural and linguistic factors that should be considered during the design and implementation of eHealth interventions with this population. With increasing disparities in preventive care information, behaviors, and services, as well as health care access in general, culturally competent eHealth tools hold great promise to help narrow this gap and empower communities.

Patient-centered care, collaboration, communication, and coordination: a report from AMIA's 2013 Policy Meeting.

In alignment with a major shift toward patient-centered care as the model for improving care in our health system, informatics is transforming patient-provider relationships and overall care delivery. AMIA's 2013 Health Policy Invitational was focused on examining existing challenges surrounding full engagement of the patient and crafting a research agenda and policy framework encouraging the use of informatics solutions to achieve this goal. The group tackled this challenge from educational, technical, and research perspectives. Recommendations include the need for consumer education regarding rights to data access, the need for consumers to access their health information in real time, and further research on effective methods to engage patients. This paper summarizes the meeting as well as the research agenda and policy recommendations prioritized among the invited experts and stakeholders.

실시간 의료 정보 공유 프레임워크 기반의 스마트 의료 클라이언트 개발

실시간 의료 정보 공유 프레임워크 기반의 스마트 의료 클라이언트 개발

Deeper, longer phenotyping to accelerate the discovery of the genetic architectures of diseases.

Deeper, longer phenotyping to accelerate the discovery of the genetic architectures of diseases.

Design and Implementation of Real-Time Health Information Sharing Framework for N-Screen Service

Design and Implementation of Real-Time Health Information Sharing Framework for N-Screen Service

Hospital Information Management Using Open Source Software: Results of the MIDA Project in 3 Hospitals in Rwanda

Background and Purpose: The health sector in many developing countries, especially in sub-Saharan Africa, suffers since a long time from poor health information collection and analysis systems. This study evaluates the results of 3 projects financed by the Migration for Development in Africa-Great Lakes (MIDA GL) program in 3 Rwandan hospitals: Kigali University Teaching Hospital (CHUK), Neuro-psychiatric hospital Caraes-Ndera (NPH-CN) and Gihundwe district hospital (GDH). These projects aimed to empower hospital staff in collecting and analyzing hospital information by using OpenClinic, an open source hospital information management system. Methods: The first analysis at CHUK used the results of a CAP (competence, ability, practice) survey addressed to healthcare staff in using OpenClinic, in 2010 and 2012. The second method analyzed results of NPH-CN and GDH in the OpenClinic software utilization between 1/1/2011 and 31/12/2012. Results: Results showed that routine OpenClinic utilization increased by 20% (from 36.0% to 56.3%) at CHUK between 2010 and 2012 and skills levels increased significantly in admission (+9.2%) and laboratory (+10.0%) departments where the training programs were run. The results obtained from the hospitals of Gihundwe and Ndera showed that the 2 hospitals almost doubled their income one year after implementation and indicators like case load, encounter load and numbers of provided health care deliveries continue to increase linearly, demonstrating the continuity of OpenClinic utilization. Clinical modules however have not yet been well adopted in Ndera and Gihundwe: reason for encounter documentation and diagnostic coding are not being performed systematically. Conclusion: The MIDA GL funding allowed 3 Rwandan hospitals to implement the OpenClinic tool easily and to improve its utilization by gathering and centralization of health information in real-time. The improvement of user skills level in OpenClinic enabled them to take ownership of the tool proving the need for regular staff training and evaluations in the OpenClinic utilization. Keywords: MIDA, Empowering healthcare staff, OpenClinic utilization, Hospital information system, Rwanda

Ontology driven interactive healthcare with wearable sensors

Ubiquitous healthcare is the service that offers health-related information and contents to users without any limitations of time and space. Especially, to offer customized services to users, the technology of acquiring context information of users in real time is the most important consideration. In this paper, we researched wearable sensors. We proposed the ontology driven interactive healthcare with wearable sensors (OdIH_WS) to achieve customized healthcare service. For this purpose, wearable-sensor-based smart-wear and methods of data acquisition and processing are being developed. The proposed system has potential value in healthcare. A smart wear using wearable sensors is fabricated as a way of non-tight and comfortable style fitting for the curves of the human body based on clothes to wear in daily life. The design sample of the smart wear uses basic stretch materials and is designed to sustain its wearable property. To offer related information, it establishes an environment-information-based healthcare ontology model needed for inference, and it is composed of inside-outside context information models depending on the users' context. The modeling of the proposed system involved combinations of information streams, focusing on service context information. With the proposed service inference rules, customized information and contents could be drawn by the inference engine. In the established OdIH_WS, real-time health information monitoring was achieved. The results of system performance and users' satisfaction evaluations confirmed that the proposed system is superior to other existing systems.

Management of ECG Cables and Leadwires

Electrocardiography (ECG) is the non-invasive capture and display (either on a screen or as a hard copy, such as a strip recording or page printout) of cardiac electrical activity. ECG provides a quick and highly reliable estimate of a patient’s cardiovascular health, making it one of the most common non-invasive medical applications. ECG is used for monitoring cardiac activity, for the purpose of diagnosis and therapy in clinics, and all areas of the hospital, including operating rooms and intensive care units (ICU). Physicians can use ECG to quickly measure heart rate and cardiac rhythm of a patient. The physician can also identify abnormalities in how electrical impulses propagate through the heart and detect evidence of coronary artery disease, prior heart attacks, and thickening of the cardiac muscle.1–4 For more detailed information about a patient’s cardiac electrical activity, a physician may request longer-term ECG recordings through the use of a Holter monitor (an ambulatory ECG) or during intentionally “loading” of the heart with a stress test, such as having the patient exercise on a treadmill. Continuous ECG monitoring during anesthesia provides vital information regarding a patient’s condition throughout a surgical procedure. Continuous ECG data acquisition using a bedside monitor provides real-time health information for a patient in an ICU. In some instances, pacemakers or defibrillators (external and internal) significantly alter the appearance of the body-surface ECG. Many medical activities, including life supporting or life saving ones, depend on efficient acquisition of ECG data. ECG has been used since Willem Einthoven invented the first practical ECG in 1903, receiving the Nobel Prize in Medicine in 1924 for his invention.5 ECG systems have evolved over many years. Now, ECG systems are built with similar building blocks, and all have similar external components. Electrical or mechanical failures occur infrequently for ECG devices themselves; however, malfunctions due to problems with ECG electrodes, leadwires, and ECG (patient) cables are common.6 This article reviews these problems and presents the results from a 2010 AAMI survey of biomedical equipment technicians (BMET)s and clinical engineers (CE)s. The article covers issues related to clinical management of the cables and leadwires, as well as potential improvements in the design of new medical devices to increase efficiency and reliability. ECG cables, leadwires, and electrodes are used to connect the human body to many different types of ECG devices. Hospitals usually have many medical devices that record and display ECG signals including Holter monitors, stress-testing equipment such as treadmills, patient monitors, telemetry units, defibrillators, and diagnostic electrocardiographs (often referred to as ECG or EKG carts). Large multi-specialty clinics may have treadmills and Holters, but these are generally run through a cardiology subspecialty group. (Smaller clinics and physicians’ offices also use some of these devices, but patient monitors and telemetry units are typically not on site.) These facilities stock large numbers of ECG cables, leadwires, and electrodes needed to use these devices. Poor electrodes and worn-out leadwires or ECG cables routinely cause failures that clinical users may not be able to readily identify. ECG cables and leadwires should be tested by a BMET regularly—or whenever an ECG device seems to be malfunctioning—and replaced when necessary. Leadwires should only be used if they remain in good condition (i.e., intact insulation, unbroken, no visible signs of wear). If a BMET is not available, cliniAhmet Turkmen, PhD, MS, BS, is an assistant professor with the Engineering and Technology Department at the University of Wisconsin–Stout. He is a co-chair of the AAMI ECG Committee. E-mail: turkmena@ uwstout.edu

Body area networks and technologies

Body Area Networks (BAN) are formed by networks of devices, which are placed on or in close vicinity of the human body, and in the case of some specialized medical applications, inside the body as implants. Technologies for BANs have gained significant international interest in recent years from researchers both in academia and industry. This has been driven in no small part by the huge potential for commercial exploitation and the prospect of technologically revolutionizing everyday life. The future applications that will benefit from advances in BAN technology include healthcare, fitness, sports, security, and interactive gaming. One key area where BANs are already having a considerable impact is Ambient Assisted Living (AAL). By adopting BAN technologies, AAL has begun to improve quality of life and provide much greater independence for today's aging society. Here, wearable sensors and actuators with a wireless interface are noninvasively worn by the user and wirelessly connected to a gateway, either cellular or internet, to provide real-time health information remotely to medical staff or to other family members. While much innovation has occurred, a number of critical challenges still exist that will determine the future acceptance and success of BANs. Among these are challenges related to wireless node design such as ease-ofuse, efficiency and reliability, and to the wireless interface such as optimum network topology, protocol, and security. These challenges are made even more difficult to overcome due to the constraints placed on wearable technology when compared to other wireless systems. In particular, the desirable compact, low-form factor of the wireless devices used in BAN applications puts extremely severe limitations on battery size, and thus, power consumption. In addition, badly chosen mounting arrangements and reduction of antenna size can cause decreased efficiency, and thus, lower the quality of the radio link. There are of course other important factors, such as sociological aspects of acceptance; however, they are not discussed here as they fall outside the context of this special issue, which is focused on the technological aspects of BANs. To advance our understanding of these challenges and how they may be surmounted, the content of this special issue addresses the following important questions: How does the BAN propagation channel behave? How should an antenna be designed to be worn on the body? What is a reasonable transmit power to use? What are the feasible receiver performances? What are the best modulation schemes to use to provide good performance, robustness, and sufficient bit rate for different applications? How can the protocol layer guarantee sufficient quality of service and reliability? Within the last few years, an extensive amount of research has been performed to provide answers to such essential questions, which are regularly posed to the BAN designer. In particular, the IEEE 802.15.6 task group was L. Ouvry (*) CEA-Leti Minatec Campus, 17 rue des Martyrs, 38054 Grenoble Cedex, France e-mail: laurent.ouvry@cea.fr