Mobile Health System Research Articles

Tracking and Repairing Damaged Healthcare Databases Using the Matrix

In a distributed mobile e-health care system, e-health service providers exchange data on the fly in response to user queries without any centralized control. Local databases in e-health service providers might be intercepted during the exchange of data and read by intruders; and malicious transactions may damage data that is highly confidential. In this case any centralized control for securing data cannot be assumed to protect confidential data. Therefore, securing health information from malicious attacks has become a major concern. Although prevention techniques are available, the history of system break-ins guarantees that there is no foolproof technique that totally eliminates security loopholes in a computer system. Hence, efficient damage assessment and recovery techniques are needed. Traditional methods require scanning the entire log from the point of attack to the end which is a slow procedure. In this paper, we present an efficient damage assessment and recovery algorithm to recover the database from malicious transactions. The algorithm is based on data dependency and uses a single matrix. The results of this work prove that our algorithm performs better than the other algorithms in both the damage assessment and the recovery stages.

Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics.

Objective Mobile health (mHealth) systems are becoming more common for chronic disease management, but usability studies are still needed on patients’ perspectives and mHealth interaction performance. This deficiency is addressed by our quantitative usability study of a mHealth diabetes system evaluating patients’ task performance, satisfaction, and the relationship of these measures to user characteristics. Materials and Methods We used metrics in the International Organization for Standardization (ISO) 9241-11 standard. After standardized training, 10 patients performed representative tasks and were assessed on individual task success, errors, efficiency (time on task), satisfaction (System Usability Scale [SUS]) and user characteristics. Results Tasks of exporting and correcting values proved the most difficult, had the most errors, the lowest task success rates, and consumed the longest times on task. The average SUS satisfaction score was 80.5, indicating good but not excellent system usability. Data trends showed males were more successful in task completion, and younger participants had higher performance scores. Educational level did not influence performance, but a more recent diabetes diagnosis did. Patients with more experience in information technology (IT) also had higher performance rates. Discussion Difficult task performance indicated areas for redesign. Our methods can assist others in identifying areas in need of improvement. Data about user background and IT skills also showed how user characteristics influence performance and can provide future considerations for targeted mHealth designs. Conclusion Using the ISO 9241-11 usability standard, the SUS instrument for satisfaction and measuring user characteristics provided objective measures of patients’ experienced usability. These could serve as an exemplar for standardized, quantitative methods for usability studies on mHealth systems.

Pilot feasibility of an mHealth system for conducting ecological momentary assessment of mood-related symptoms following traumatic brain injury

Objective: This study assessed pilot feasibility and validity of a mobile health (mHealth) system for tracking mood-related symptoms after traumatic brain injury (TBI).Design: A prospective, repeated measures design was used to assess compliance with daily ecological momentary assessments (EMA) conducted via a smartphone application over an 8-week period.Methods: An mHealth system was developed specifically for individuals with TBI and utilized previously validated tools for depressive and anxiety symptoms (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7). Feasibility was assessed in 20 community-dwelling adults with TBI via an assessment of compliance, satisfaction and usability of the smartphone applications. The authors also developed and implemented a clinical patient safety management mechanism for those endorsing suicidality.Results: Participants correctly completed 73.4% of all scheduled assessments, demonstrating good compliance. Daily assessments took <2 minutes to complete. Participants reported high satisfaction with smartphone applications (6.3 of 7) and found them easy to use (6.2 of 7). Comparison of assessments obtained via telephone-based interview and EMA demonstrated high correlations (r = 0.81–0.97), supporting the validity of conducting these assessments via smartphone application in this population.Conclusions: EMA conducted via smartphone demonstrates initial feasibility among adults with TBI and presents numerous opportunities for long-term monitoring of mood-related symptoms in real-world settings.

Accessibility needs and challenges of a mHealth system for patients with dexterity impairments

Purpose State: An innovative mobile health system called iMHere (interactive Mobile Health and Rehabilitation) has been developed at the University of Pittsburgh to support self-care and adherence to self-care regimens for patients with chronic conditions. The goal of this study is to explore and to identify the accessibility needs and preferences of individuals with dexterity impairments when they use the iMHere system. Method: Participants were asked to perform tasks after a one-week field trial. The time for a participant to complete each task, the number of possible errors a participant made and the number of errors a participant was able to self-correct were recorded and analyzed. The Telehealth Usability Questionnaire was collected to rate participants' experiences. Results: Nine participants with various levels of dexterity abilities were included in the study. A statistically significant negative correlation was identified between participants' dexterity levels and their error ratios by using a Pearson product-moment correlation (r = −0.434, n = 36, p = 0.004). Approximately 51% of errors detected was self-corrected without any help, but other errors called for resolution from a researcher. Conclusions: Due to the diversity of participants' dexterity impairments, their needs and preferences differ one from another. Personalized design may be the key to approaching these challenges in improving accessibility. Implications for Rehabilitation An innovative mobile health system called iMHere has been developed to support self-care and adherence to self-care regimens as part of rehabilitation for patients with chronic conditions. Before populations with these limitations can harness the potential of mHealth, accessibility of mHealth has to be addressed to ensure its quality and value. Dexterity limitations are commonly associated with chronic disease, accidents or aging. The study presented here identified the potential issues and barriers to accessibility related to user interface components for persons with dexterity impairments. The findings should be of interest for those working with mobile health, accessibility, smartphone apps, wellness and self-care.

Providing security and fault tolerance in P2P connections between clouds for mHealth services

The mobile health (mHealth) and electronic health (eHealth) systems are useful to maintain a correct administration of health information and services. However, it is mandatory to ensure a secure data transmission and in case of a node failure, the system should not fall down. This fact is important because several vital systems could depend on this infrastructure. On the other hand, a cloud does not have infinite computational and storage resources in its infrastructure or would not provide all type of services. For this reason, it is important to establish an interrelation between clouds using communication protocols in order to provide scalability, efficiency, higher service availability and flexibility which allow the use of services, computing and storage resources of other clouds. In this paper, we propose the architecture and its secure protocol that allows exchanging information, data, services, computing and storage resources between all interconnected mHealth clouds. The system is based on a hierarchic architecture of two layers composed by nodes with different roles. The routing algorithm used to establish the connectivity between the nodes is the shortest path first (SPF), but it can be easily changed by any other one. Our architecture is highly scalable and allows adding new nodes and mHealth clouds easily, while it tries to maintain the load of the cloud balanced. Our protocol design includes node discovery, authentication and fault tolerance. We show the protocol operation and the secure system design. Finally we provide the performance results in a controlled test bench.

MDurance: A Novel Mobile Health System to Support Trunk Endurance Assessment.

Low back pain is the most prevalent musculoskeletal condition. This disorder constitutes one of the most common causes of disability worldwide, and as a result, it has a severe socioeconomic impact. Endurance tests are normally considered in low back pain rehabilitation practice to assess the muscle status. However, traditional procedures to evaluate these tests suffer from practical limitations, which potentially lead to inaccurate diagnoses. The use of digital technologies is considered here to facilitate the task of the expert and to increase the reliability and interpretability of the endurance tests. This work presents mDurance, a novel mobile health system aimed at supporting specialists in the functional assessment of trunk endurance by using wearable and mobile devices. The system employs a wearable inertial sensor to track the patient trunk posture, while portable electromyography sensors are used to seamlessly measure the electrical activity produced by the trunk muscles. The information registered by the sensors is processed and managed by a mobile application that facilitates the expert's normal routine, while reducing the impact of human errors and expediting the analysis of the test results. In order to show the potential of the mDurance system, a case study has been conducted. The results of this study prove the reliability of mDurance and further demonstrate that practitioners are certainly interested in the regular use of a system of this nature.

Older People with Access to Hand-Held Devices: Who Are They?

Multiple comorbid conditions among older patients require frequent physician office and emergency room visits, at times leading to hospitalization. In recent years, mobile health (m-health) systems utilizing hand-held devices (e.g., smartphones) have been developed, which could be used for health-related interventions. This study investigates sociodemographic and clinical characteristics of individuals who have or have not accessed Internet via hand-held devices. Adults older than 65 years of age who participated in the Health Tracking survey of the Pew Internet and American Life Project in 2012 were included in the analysis. Data were analyzed for prevalence of Internet access via hand-held devices and differences in sociodemographic and clinical characteristics. Different online health information seeking behavior is also reported. In the weighted sample size of 3,116 responses, 472 (15.1%) had access to Internet via hand-held devices. Those with such an access were younger and had higher income and education and better overall quality of life and quality of life at the time of answering the survey. They were more likely to be female and married or living as married. Those with diabetes or significant change in physical condition in the prior year were less likely to have such an access. In the multivariate analysis, older or diabetic individuals had lower probability of such access. Higher likelihood of access was associated with higher income and education, being married, female gender, better quality of life, higher number of comorbid illnesses, and emergency room visit or hospital admission in the last 12 months. Investigators should pay attention to sociodemographic and clinical disparities of older adults to develop feasible m-health interventions.

Detecting COPD exacerbations early using daily telemonitoring of symptoms and k-means clustering: a pilot study.

COPD places an enormous burden on the healthcare systems and causes diminished health-related quality of life. The highest proportion of human and economic cost is associated with admissions for acute exacerbation of respiratory symptoms (AECOPD). Since prompt detection and treatment of exacerbations may improve outcomes, early detection of AECOPD is a critical issue. This pilot study was aimed to determine whether a mobile health system could enable early detection of AECOPD on a day-to-day basis. A novel electronic questionnaire for the early detection of COPD exacerbations was evaluated during a 6-months field trial in a group of 16 patients. Pattern recognition techniques were applied. A k-means clustering algorithm was trained and validated, and its accuracy in detecting AECOPD was assessed. Sensitivity and specificity were 74.6 and 89.7 %, respectively, and area under the receiver operating characteristic curve was 0.84. 31 out of 33 AECOPD were early identified with an average of 4.5 ± 2.1 days prior to the onset of the exacerbation that was considered the day of medical attendance. Based on the findings of this preliminary pilot study, the proposed electronic questionnaire and the applied methodology could help to early detect COPD exacerbations on a day-to-day basis and therefore could provide support to patients and physicians.

Evaluation of the impact of a mobile health system on adherence to antenatal and postnatal care and prevention of mother-to-child transmission of HIV programs in Kenya.

BackgroundThe Millennium Villages Project (MVP) implemented in Western Kenya a mobile Health tool that uses text messages to coordinate Community Health Worker (CHW) activities around antenatal care (ANC) and Prevention of Mother-to-Child Transmission of HIV (PMTCT), named the ANC/PMTCT Adherence System (APAS).MethodsEnd-user changes in health-seeking behavior in ANC and postnatal care (PNC) were investigated following registration of 800 women into APAS. These investigations employed interviews of pregnant women or new mothers (n = 67) and CHWs (n = 20). Ordinal logistic regressions and exact binomial tests were used in the routine data analyses (n = 650, health registers).ResultsAll CHWs interviewed agreed that APAS helped them track pregnant woman efficiently, compared to paper-based tracking forms. Women registered in APAS reported that CHWs reminded them of appointments more regularly than before its inception.The routine data analysis showed that among women who had their 1st ANC visit in the 2nd trimester, women who resided in the MVP cluster and were in APAS had:3 times the odds of going for more ANC visits compared to women who were not registered (but resided in the cluster), after adjusting for the mother’s HIV status in the multivariate model (Adjusted OR = 2.58, 95% CI [1.10-6.01]);twice the odds of going for more ANC visits compared to women who were not registered and resided outside the cluster (Adjusted OR = 2.37, 95% CI [0.99-5.67])Among women not registered, residence inside or outside the cluster did not affect the number of ANC visits made (Adjusted OR = 0.86, 95% CI [0.45-1.69]).The APAS also greatly increased the likelihood of women making the 6 recommended post-delivery baby follow-ups.For women registered in APAS, the MTCT rate at 18 months was significantly different from that of women not registered, and from the global rate of 30%. Women not registered had a 9% MTCT rate at 18 months regardless of residence, while women registered had a 0% transmission rate at both 9 and 18 months.ConclusionsThe incorporation of mHealth tools in CHW programs can improve adherence to ANC and PNC and enhance PMTCT efforts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1358-5) contains supplementary material, which is available to authorized users.

A new mHealth communication framework for use in wearable WBANs and mobile technologies.

Driven by the development of biomedical sensors and the availability of high mobile bandwidth, mobile health (mHealth) systems are now offering a wider range of new services. This revolution makes the idea of in-home health monitoring practical and provides the opportunity for assessment in “real-world” environments producing more ecologically valid data. In the field of insomnia diagnosis, for example, it is now possible to offer patients wearable sleep monitoring systems which can be used in the comfort of their homes over long periods of time. The recorded data collected from body sensors can be sent to a remote clinical back-end system for analysis and assessment. Most of the research on sleep reported in the literature mainly looks into how to automate the analysis of the sleep data and does not address the problem of the efficient encoding and secure transmissions of the collected health data. This article reviews the key enabling communication technologies and research challenges for the design of efficient mHealth systems. An end-to-end mHealth system architecture enabling the remote assessment and monitoring of patient's sleep disorders is then proposed and described as a case study. Finally, various mHealth data serialization formats and machine-to-machine (M2M) communication protocols are evaluated and compared under realistic operating conditions.

Automatic messaging for improving patients engagement in diabetes management: an exploratory study.

Mobile health systems aiming to promote adherence may cost-effectively improve the self-management of chronic diseases like diabetes, enhancing the compliance to the medical prescription, encouraging and stimulating patients to adopt healthy life styles and promoting empowerment. This paper presents a strategy for m-health applications in diabetes self-management that is based on automatic generation of feedback messages. A feedback assistant, representing the core of architecture, delivers dynamic and automatically updated text messages set up on clinical guideline and patient's lifestyle. Based on this strategy, an m-health adherence system was designed, developed and tested in a small-scale exploratory study with T1DM and T2DM patients. The results indicate that the system could be feasible and well accepted and that its usage increased along with adherence to prescriptions during the 4weeks of the study. A more extensive research is pending to corroborate these outcomes and to establish a clear benefit of the proposed solution.

MHealth in the Prevention and Control of Non-Communicable Diseases in India: Current Possibilities and the Way Forward.

Mobile health technology has been used effectively for healthcare delivery in many developing countries. India is currently facing an epidemic of Non-Communicable Diseases (NCDs). With greater availability of cheaper phones in the market, the user base of mobile phones in India is increasing rapidly. The present review was thus conducted to explore the current possibilities and future scope of mobile health for NCD prevention and control in India. Literature search was conducted using MEDLINE, EMBASE, and Cochrane Library to collect information regarding mobile health interventions. Two authors extracted the data and included studies if at least the abstract was available. Information from key reports and government websites were also included. We examined information from domains such as need for mobile health in NCDs in India, and the advantages, scope and challenges of mobile health for healthcare delivery in India. Existing mobile health systems in India, current evidence of mobile health use in NCDs, and the recent mobile health related initiatives taken by Government of India were also assessed. Though we found some examples of current mobile phone usage in many health related programmes in India, data from mobile health research is scarce, particularly for NCDs. The current evidence base needs to be strengthened. There is also a need for identifying various opportunities in the recent initiatives taken by Government of India. It can be concluded that though mobile health has many advantages, there are numerous challenges which need to be addressed before scaling it up at the national level.

Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.

A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as "cost-utility" OR "cost utility" AND "telemedicine," "cost-effectiveness" OR "cost effectiveness" AND "mobile health," etc. In the articles searched, there were no limitations in the publication date. The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.

Towards a cooperative security system for mobile-health applications

Mobile health (m-Health) system architectures are typically based on mobile and wireless communications, and use mobile devices with data exchange supported by Web services (WS). Although m-Health systems offer mobility as a potential and precious resource they also present several challenged issues and constraints, such as, battery and storage capacity, broadcast constraints, interferences, disconnections, noises, limited bandwidths, and network delays. Furthermore, constant mobility and often-required Internet connectivity also exposes and compromises the privacy and confidentiality of the m-Health system information. This paper proposes a novel data encryption solution for mobile health systems, considering a novel and early-proposed cooperation strategy. This encryption solution, tries to guarantee the best confidentiality, integrity, and authenticity of m-Health systems users data. The paper also presents a performance evaluation study comparing the performance an m-Health application with and without the DE4MHA.

Towards a cooperative security system for mobile-health applications

Mobile health (m-Health) system architectures are typically based on mobile and wireless communications, and use mobile devices with data exchange supported by Web services (WS). Although m-Health systems offer mobility as a potential and precious resource they also present several challenged issues and constraints, such as, battery and storage capacity, broadcast constraints, interferences, disconnections, noises, limited bandwidths, and network delays. Furthermore, constant mobility and often-required Internet connectivity also exposes and compromises the privacy and confidentiality of the m-Health system information. This paper proposes a novel data encryption solution for mobile health systems, considering a novel and early-proposed cooperation strategy. This encryption solution, tries to guarantee the best confidentiality, integrity, and authenticity of m-Health systems users data. The paper also presents a performance evaluation study comparing the performance an m-Health application with and without the DE4MHA.

A Typology of Revenue Models for Community Health Worker Programs

Community Health Workers (CHWs), a presence in almost every developing country, have proven instrumental in improving their communities’ health. CHWs in most countries are volunteers relying on programs with marginal government support and irregular external funding. A lack of incentives is a fundamental challenge to realizing the full potential of CHW programs. CHW programs often suffer from high attrition rates, poor efficiency and lack of coordination and accountability. This article argues that there is a dynamic interdependence between CHW programs and entrepreneurial mobile health (mHealth) systems trying to become economically self-sustaining. This interdependence can be leveraged to design effective, efficient and sustainable mHealth ventures that enable, complement and augment CHW programs with the shared objective of improving the healthcare system in developing countries. This article presents a typology of eight business models where CHWs function as the channels and champions for mHealth ventures. The target audiences of this article are innovators and entrepreneurs seeking to launch sustainable mHealth ventures by leveraging the civic infrastructure of community health workers in developing countries.

Using Mobile Health (mHealth) and geospatial mapping technology in a mass campaign for reactive oral cholera vaccination in rural Haiti.

BackgroundIn mass vaccination campaigns, large volumes of data must be managed efficiently and accurately. In a reactive oral cholera vaccination (OCV) campaign in rural Haiti during an ongoing epidemic, we used a mobile health (mHealth) system to manage data on 50,000 participants in two isolated communities.MethodsData were collected using 7-inch tablets. Teams pre-registered and distributed vaccine cards with unique barcodes to vaccine-eligible residents during a census in February 2012. First stored on devices, data were uploaded nightly via Wi-fi to a web-hosted database. During the vaccination campaign between April and June 2012, residents presented their cards at vaccination posts and their barcodes were scanned. Vaccinee data from the census were pre-loaded on tablets to autopopulate the electronic form. Nightly analysis of the day's community coverage informed the following day's vaccination strategy. We generated case-finding reports allowing us to identify those who had not yet been vaccinated.ResultsDuring 40 days of vaccination, we collected approximately 1.9 million pieces of data. A total of 45,417 people received at least one OCV dose; of those, 90.8% were documented to have received 2 doses. Though mHealth required up-front financial investment and training, it reduced the need for paper registries and manual data entry, which would have been costly, time-consuming, and is known to increase error. Using Global Positioning System coordinates, we mapped vaccine posts, population size, and vaccine coverage to understand the reach of the campaign. The hardware and software were usable by high school-educated staff.ConclusionThe use of mHealth technology in an OCV campaign in rural Haiti allowed timely creation of an electronic registry with population-level census data, and a targeted vaccination strategy in a dispersed rural population receiving a two-dose vaccine regimen. The use of mHealth should be strongly considered in mass vaccination campaigns in future initiatives.

Phases in development of an interactive mobile phone-based system to support self-management of hypertension.

Hypertension is a significant risk factor for heart disease and stroke worldwide. Effective treatment regimens exist; however, treatment adherence rates are poor (30%–50%). Improving self-management may be a way to increase adherence to treatment. The purpose of this paper is to describe the phases in the development and preliminary evaluation of an interactive mobile phone-based system aimed at supporting patients in self-managing their hypertension. A person-centered and participatory framework emphasizing patient involvement was used. An interdisciplinary group of researchers, patients with hypertension, and health care professionals who were specialized in hypertension care designed and developed a set of questions and motivational messages for use in an interactive mobile phone-based system. Guided by the US Food and Drug Administration framework for the development of patient-reported outcome measures, the development and evaluation process comprised three major development phases (1, defining; 2, adjusting; 3, confirming the conceptual framework and delivery system) and two evaluation and refinement phases (4, collecting, analyzing, interpreting data; 5, evaluating the self-management system in clinical practice). Evaluation of new mobile health systems in a structured manner is important to understand how various factors affect the development process from both a technical and human perspective. Forthcoming analyses will evaluate the effectiveness and utility of the mobile phone-based system in supporting the self-management of hypertension.

Patient monitoring in mobile health: opportunities and challenges.

ABSTRACTBackground:In most countries chronic diseases lead to high health care costs and reduced productivity of people in society. The best way to reduce costs of health sector and increase the empowerment of people is prevention of chronic diseases and appropriate health activities management through monitoring of patients. To enjoy the full benefits of E-health, making use of methods and modern technologies is very important.Methods:this literature review articles were searched with keywords like Patient monitoring, Mobile Health, and Chronic Disease in Science Direct, Google Scholar and Pub Med databases without regard to the year of publications.Results:Applying remote medical diagnosis and monitoring system based on mobile health systems can help significantly to reduce health care costs, correct performance management particularly in chronic disease management. Also some challenges are in patient monitoring in general and specific aspects like threats to confidentiality and privacy, technology acceptance in general and lack of system interoperability with electronic health records and other IT tools, decrease in face to face communication between doctor and patient, sudden interruptions of telecommunication networks, and device and sensor type in specific aspect.Conclusions:It is obvious identifying the opportunities and challenges of mobile technology and reducing barriers, strengthening the positive points will have a significant role in the appropriate planning and promoting the achievements of the health care systems based on mobile and helps to design a roadmap for improvement of mobile health.

Technology Acceptance Model for Mobile Health Systems

Technology Acceptance Model for Mobile Health Systems