Personal Health Systems Research Articles

The direct effect of institutional factors on healthcare information systems (HIS) organisational interoperability in Malaysian public hospitals.

Background: Organisational interoperability (OIoP) of the Healthcare Information System (HIS) is crucial for the success of HIS, however little is known about the impact of institutional factors. Objective: This cross-sectional study aimed to investigate the direct effect of institutional factors on OIoP for HIS in public sector hospitals in Malaysia. Methods: A conceptual OIoP framework was developed using the Personal Health Systems Interoperability and Refined eHealth European Interoperability frameworks. A self-administered questionnaire survey was used to solicit data from 300 healthcare professionals. Data were assessed through an Exploratory Factor Analysis followed by a Confirmatory Factor Analysis. Results: Structured equation modelling revealed Security and Privacy Compliance, and Stakeholder Engagement and Awareness to significantly and positively affect OIoP (R2 = 0.380). Conclusion: Healthcare organisations should prioritise clear and effective policies and regulations and enough budget and resources for the suggested framework.

Comparative Effects of Wearing Knee Support Brace and Kinesiotaping on Pain, Physical Activity Level and Kinesiophobia in Patients with Knee Osteoarthritis

Background: Osteoarthritis (OA), primarily affecting knees, hips, and hands, is the most prevalent form of arthritis, with knee OA being a significant cause of disability in older individuals. It poses a substantial burden on personal health and healthcare systems, characterized by symptoms like joint pain, restricted motion, and muscle weakness. Objective: This study aimed to compare the effectiveness of knee support braces and kinesiotaping in managing symptoms of knee OA, focusing on pain reduction, physical activity enhancement, and kinesiophobia mitigation. Methods: Conducted at the University of Lahore Teaching Hospital from December 2022 to July 2023, this randomized controlled trial enrolled individuals aged 45-60 years with grade II-III medial compartment knee OA. Participants were purposively sampled and randomly allocated into two groups: the knee brace group and the kinesiotaping group. Data collection involved the Visual Analogue Scale (VAS) for pain, the International Physical Activity Questionnaire Short-Form (IPAQ-SF) for physical activity level, and the Tampa Scale of Kinesiophobia (TSK) for measuring kinesiophobia. Interventions included a three-month rehabilitation program with either knee braces or kinesiotaping, supplemented with a home exercise program. Statistical analysis was performed using SPSS version 25, employing parametric tests like independent sample t-tests and repeated measures ANOVA. Results: The study comprised 96 participants, with a mean age distribution across groups ranging from 45 to 60 years. At baseline, pain scores were comparable between groups. However, significant reductions in pain scores were noted in the kinesiotaping group at the 4th (mean difference = 0.39, p = 0.001), 8th (mean difference = 0.39, p = 0.001), and 12th weeks (mean difference = 0.71, p = 0.000). Physical activity levels, as per IPAQ-SF, also showed significant improvements in the kinesiotaping group at the 4th, 8th, and 12th weeks. Kinesiophobia levels, measured by TSK, decreased significantly in the kinesiotaping group over the study period. Conclusion: Kinesiotaping was found to be more effective than knee braces in reducing pain, enhancing physical activity levels, and decreasing kinesiophobia in patients with knee OA. These findings suggest that kinesiotaping could be a preferred non-surgical intervention in the management of knee OA symptoms.

Osteopathic management of non-specific neck pain: Preliminary findings from a cross sectional study of Australian osteopaths

ObjectiveNeck pain is a highly prevalent condition that leads to considerable pain and disability. There is an economic cost to neck pain at both a personal and broader health system level. Neck pain may be classified as ‘non-specific’ neck pain (NSNP) when there is an absence of identifiable underlying disease or abnormal anatomical structure. Osteopaths play a role in the management of NSNP, but it is unclear how osteopaths specifically manage this condition. This study explores what osteopaths do for patients with NSNP. MethodsCross sectional design. Via an online survey. ResultsAll participants in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP. Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain and only a small number completed continuing professional development (CPD) related to the clinical management of NSNP. ConclusionThis study demonstrates Australian osteopaths use a range of manual therapy techniques and education strategies in clinical practice for the management of NSNP in line with clinical practice guidelines. Implications for clinical practice•All osteopaths in this study reported applying soft tissue techniques, using exercise prescription, discussing physical activity levels, physical fitness, stress management, pain education and posture and ergonomics for patients with NSNP.•Less than half of the osteopaths in this study reported using PROMs in clinical practice for the management of non-specific neck pain.•Only a small number of Australian osteopaths completed continuing professional development (CPD) related to the clinical management of NSNP.

Self-powered information conversion based on thermogalvanic hydrogel with interpenetrating networks for nursing aphasic patients

In recent years, an increase in the use of wearable electronics has been observed in daily life due to the rapid development of personal medical health systems and the Internet of Things. Environment-friendly quasi-solid-state thermogalvanic hydrogels are enabled to convert low-grade heat into electricity and expected to be used for signal conversion in smart medical applications. However, existing wearable models in nursing are not entirely applicable for aphasic patients. Herein, we introduced a thermogalvanic interpenetrating network hydrogel (TG-IPNH) with [Fe(CN)6]3-/[Fe(CN)6]4- as a redox pair and KCl as a ion provider for thermodiffusion, which not only has good flexibility but also prominent thermoelectric property with the thermal current up to 124 μA at the temperature difference of 10 K. Relying on the gel’s sensitive correlative thermoelectric response to temperature triggered by a finger and in combination with Morse Code, a self-powered gel wristband for information conversion has been developed to provide real-time help and assistance to aphasic patients. This gel-based wristband device can be potentially applied as a supplementary interaction route for them who have language impairment, especially in intelligent healthcare and emergency rescue.

HASTALARIN PERİODONTAL KEMİK KAYBI VE TEDAVİ İHTİYACININ COVID-19'A GÖRE DEĞERLENDİRİLMESİ

Objective: This study aimed to evaluate patients' periodontal bone loss and treatment needs according to the COVID-19 and determine whether there is a relationship between COVID-19 and periodontal disease.
 Method: This cross-sectional study included patients admitted to the periodontology department for treatment between April 2021 and July 2021. According to the personal health system records of the patients, a positive real-time polymerase chain reaction (PCR) test indicated a positive COVID-19 history [COVID(+)], whereas no positive PCR in the records was defined as a negative history [COVID(-)]. Periodontal treatment need was assessed by the Community Periodontal Index of Treatment Needs (CPITN). In addition, periodontal bone loss (PBL) was measured from the digital panoramic radiographs according to the Progressive Rate Index (PRI). 
 Results: The study was conducted with 138 patients [COVID(+) 73, COVID(-) 65]. There was no statistically significant difference between COVID(+) and COVID(-) in terms of age and sex. The number of smokers in COVID(-) was significantly higher than COVID(+) (p: 0.045). No significant difference was found between the groups regarding the PRI and the presence of PBL. While COVID(+) had a greater percentage of score 0, 1, 3, and 4 than COVID(-); COVID(-) had a higher percentage of score 2 (p

Impacts of the COVID-19 pandemic on a human research islet program

ABSTRACT Designated a pandemic in March 2020, the spread of severe acute respiratory syndrome virus 2 (SARS-CoV2), the virus responsible for coronavirus disease 2019 (COVID-19), led to new guidelines and restrictions being implemented for individuals, businesses, and societies in efforts to limit the impacts of COVID-19 on personal health and healthcare systems. Here we report the impacts of the COVID-19 pandemic on pancreas processing and islet isolation/distribution outcomes at the Alberta Diabetes Institute IsletCore, a facility specializing in the processing and distribution of human pancreatic islets for research. While the number of organs processed was significantly reduced, organ quality and the function of cellular outputs were minimally impacted during the pandemic when compared to an equivalent period immediately prior. Despite the maintained quality of isolated islets, feedback from recipient groups was more negative. Our findings suggest this is likely due to disrupted distribution which led to increased transit times to recipient labs, particularly those overseas. Thus, to improve overall outcomes in a climate of limited research islet supply, prioritization of tissue recipients based on likely tissue transit times may be needed.

Effect of Electronic Portal Messaging With Embedded Asynchronous Care on Physician-Assisted Smoking Cessation Attempts

Despite the substantial health and financial burdens of smoking and the availability of effective, evidence-based interventions in primary care settings, few smokers and physicians use these strategies for smoking cessation. To evaluate whether electronic outreach to smokers with embedded asynchronous care increases the number of quit attempts and explore the roles of the message sender (ie, primary care physician [PCP] vs health care system) and patient-related characteristics. This quality improvement randomized clinical trial was designed to measure 2 factors: (1) electronic outreach messaging with and without a survey link to asynchronous care and (2) messaging by a personal PCP or health system. The study was conducted within the electronic health record and portal messaging platform of a large health system in the South Central US. Participants were adult patients 18 years or older who were designated as smokers in their electronic health records. Data were collected from January 13 to February 24, 2020, with participating PCPs surveyed in July 2020. Portal messages encouraging a quit attempt and offering physician assistance were sent to smokers who were randomly selected and assigned to 1 of 4 conditions (message with or without embedded asynchronous care and PCP or system as sender). Half of the messages contained an invitation to come to clinics and the other half contained a link to access asynchronous care. The primary outcome was electronic health record-documented quit attempts (1 indicates quit attempt; 0, no quit attempt), which were tracked 30 days after the electronic outreach. Secondary outcomes included physician perceptions of the electronic outreach intervention, using a 5-point scale to assess perceptions of workload, comfort with providing medication from survey information, and further interest in the program 6 months after the intervention. A total of 188 participants (99 women [52.4%] and 89 men [47.3%]) with mean (SD) age of 55.2 (13.9) years were randomized to 1 of 4 conditions. Group 1 (n = 46) received a message from the PCP without a link to the survey; group 2 (n = 48) received a message from the PCP with a link to asynchronous care in the form of the survey. Group 3 (n = 47) received a message from the health system without a link to the survey; group 4 (n = 47) received a message from the health system with a link to the survey. No statistically significant difference in documented quite attempts was found among the 4 study groups. There was also no statistically significant difference in quit attempts between the group that received the asynchronous care survey link and the group that did not (odds ratio, 2.50 [95% CI, 0.72-8.72]). However, the quit attempt rate for those with asynchronous care offered (9 of 95 [9.5%]) was more than double the quit attempt rate for those with in-person care offered (4 of 93 [4.3%]). This quality improvement randomized clinical trial did not find a statistically significant difference in physician-assisted quit attempts among patients who received electronic with asynchronous care vs those who received outreach alone, regardless of whether the message source was a PCP or a health system. However, the program engaged patients in difficult-to-reach rural areas as well as younger patients. ClinicalTrials.gov Identifier: NCT05172219.

MXene/TMD Nanohybrid for the Development of Smart Electronic Textiles Based on Physical Electromechanical Sensors

AbstractWearable technologies are becoming gradually prevalent as a personal health system, facilitating unceasing real‐time monitoring of human health on a regular basis and outside the clinical environments. In this perspective, an urgent requirement for extensively sensitive and wearable sensors has increased to examine health during life activities. The fabrication of Ti3C2Tx/SnSe2 nanohybrid E‐textile based multifunctional physical sensors (pressure, strain) on the cotton substrate to monitor an individual's health during daily activities is demonstrated here. The fabricated nanohybrid E‐textile based physical sensors display an extraordinary sensitivity of 14.959 kPa–1 in the applied pressure range of 1.477–3.456 kPa and a gauge factor of 14.108 for 5–25% of applied strain. In addition, these physical sensors show exceptional stability of ≈2500 cycles for a pressure sensor and ≈3000 cycles for a strain sensor which signifies the sturdiness of the sensor. Detailed underlying physics and transduction mechanism are explained by Schottky barrier and tunneling resistance mechanism. Further, an android/iOS/web‐based app is developed to validate wireless integration of the fabricated multifunctional physical sensors for demonstration toward smart shoe and crepe bandage applications.

Global stakeholder perspectives of home birth: a systematic scoping review

Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g., high-resource versus low- and middle-resource countries). Research evidence of stakeholders’ perspectives of home birth could usefully inform personal and policy decisions about choosing and providing home birth, but the current literature is fragmented and its breadth is not fully understood.We conducted a systematic scoping review to understand how the research literature on stakeholders’ perspectives of home birth is characterized in terms of populations, settings and identified issues, and what potential gaps exist in the research evidence. A range of electronic, web-based and key informant sources of evidence were searched. Located references were assessed, data extracted, and descriptively analyzed using robust methods.Our analysis included 460 full reports. Findings from 210 reports of studies in high-resource countries suggested that research with fathers and same-sex partners, midwives, and vulnerable populations and perspectives of freebirth and transfer to hospital could be synthesized. Gaps in primary research exist with respect to family members, policy makers, and those living in rural and remote locations. A further 250 reports of studies in low- and middle-resource countries suggested evidence for syntheses related to fathers and other family members, policy makers, and other health care providers and examination of issues related to emergency transfer to hospital, rural and remote home birth, and those who birth out of hospital, often at home, despite receiving antenatal care intended to increase healthcare-seeking behavior. Gaps in primary research suggest an examination is needed of perspectives in countries with higher maternal mortality and among first-time mothers and young mothers.Our scoping review identified a considerable body of research evidence on stakeholder perspectives of home birth. These could inform the complex factors influencing personal decisions and health system planning around home birth in both high- and low- and middle-resource countries. Future primary research is warranted on specific stakeholders worldwide and with vulnerable populations in areas of high maternal mortality.

Proof-of-concept trial results of the HeartMan mobile personal health system for self-management in congestive heart failure

This study tested the effectiveness of HeartMan—a mobile personal health system offering decisional support for management of congestive heart failure (CHF)—on health-related quality of life (HRQoL), self-management, exercise capacity, illness perception, mental and sexual health. A randomized controlled proof-of-concept trial (1:2 ratio of control:intervention) was set up with ambulatory CHF patients in stable condition in Belgium and Italy. Data were collected by means of a 6-min walking test and a number of standardized questionnaire instruments. A total of 56 (34 intervention and 22 control group) participants completed the study (77% male; mean age 63 years, sd 10.5). All depression and anxiety dimensions decreased in the intervention group (p < 0.001), while the need for sexual counselling decreased in the control group (p < 0.05). Although the group differences were not significant, self-care increased (p < 0.05), and sexual problems decreased (p < 0.05) in the intervention group only. No significant intervention effects were observed for HRQoL, self-care confidence, illness perception and exercise capacity. Overall, results of this proof-of-concept trial suggest that the HeartMan personal health system significantly improved mental and sexual health and self-care behaviour in CHF patients. These observations were in contrast to the lack of intervention effects on HRQoL, illness perception and exercise capacity.

A Personal Health System for Self-Management of Congestive Heart Failure (HeartMan): Development, Technical Evaluation, and Proof-of-Concept Randomized Controlled Trial.

BackgroundCongestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadequately validated.ObjectiveThe HeartMan project aims to develop a personal health system that would comprehensively address CHF self-management by using sensing devices and artificial intelligence methods. This paper presents the design of the system and reports on the accuracy of its patient-monitoring methods, overall effectiveness, and patient perceptions.MethodsA mobile app was developed as the core of the HeartMan system, and the app was connected to a custom wristband and cloud services. The system features machine learning methods for patient monitoring: continuous blood pressure (BP) estimation, physical activity monitoring, and psychological profile recognition. These methods feed a decision support system that provides recommendations on physical health and psychological support. The system was designed using a human-centered methodology involving the patients throughout development. It was evaluated in a proof-of-concept trial with 56 patients.ResultsFairly high accuracy of the patient-monitoring methods was observed. The mean absolute error of BP estimation was 9.0 mm Hg for systolic BP and 7.0 mm Hg for diastolic BP. The accuracy of psychological profile detection was 88.6%. The F-measure for physical activity recognition was 71%. The proof-of-concept clinical trial in 56 patients showed that the HeartMan system significantly improved self-care behavior (P=.02), whereas depression and anxiety rates were significantly reduced (P<.001), as were perceived sexual problems (P=.01). According to the Unified Theory of Acceptance and Use of Technology questionnaire, a positive attitude toward HeartMan was seen among end users, resulting in increased awareness, self-monitoring, and empowerment.ConclusionsThe HeartMan project combined a range of advanced technologies with human-centered design to develop a complex system that was shown to help patients with CHF. More psychological than physical benefits were observed.Trial RegistrationClinicalTrials.gov NCT03497871; https://clinicaltrials.gov/ct2/history/NCT03497871.International Registered Report Identifier (IRRID)RR2-10.1186/s12872-018-0921-2

Oral health as predictors of family functioning: A cross-cultural adaptation and validation of Hindi version of family impact scale – A cross-sectional study

Abstract Background The effect of individuals oral disease patterns on the family has been too little explored. Despite awareness of the importance of the family unit for personal health and health care system, the family unit has been infrequently studied from the public health point of view. Objective The specific aim of the study was to evaluate children's oral health as predictors of family functioning and to validate psychometric properties of Hindi version of family impact scale among 12-15-year-olds. Material and methods A total of 225 parent-child pair participated in the study. A cross-cultural translation, adaptation and validation of Hindi version of family impact scale (FIS) was conducted. Test-retest reliability was assessed by the intraclass correlation coefficients (ICC) using a two-way mixed-effect model. Discriminant validity was verified by family impact scores among parent-child pair with and without oral diseases. Construct validity was corroborated by association between the scale scores with global indicators of oral health and overall well-being. Clinical examinations were conducted using modified WHO criteria (1997). Influence of independent variables on the FIS were assessed using regression analysis. Results Mean impact score was 25.16 ± 5.96 with almost non-existent floor effect (4%) and no ceiling effect in the population. Inter Class Correlation for FIS scale was 0.86 indicating perfect agreement. Parents of children with dental caries and poor oral hygiene reported higher overall FIS scores (p Conclusions This study provides evidence that oral disorders have a significant impact on family functioning. The Hindi version of the FIS exhibited good psychometric properties, with acceptable validity and reliability. Future research needs to explore the consequences of higher family impact scores and focus on strategies to reduce the impacts of oral conditions on the family.

Health tracker: data acquisition and analysis for monitoring health trends and assessing disease risk

This paper describes HealthTracker, a mobile health application to record, store, display, and analyze personal health data. This application allows an individual to log several types of data encompassing their personal health. HealthTracker serves as a model for both a recording and a recommending system. Its goal is to serve as a bridge for future personal health systems to build from. A person’s health information is displayed in an easy-to-understand manner but is also practical for medical professionals. Users should find the system useful and effective no matter if they use it simply or extensively. Currently, the system serves as a prototype for determining the practical applications for smart health systems running on mobile platforms.

Applications of e-Health to Support Person-Centered Health Care at the Time of COVID-19 Pandemic.

Background: Many e-health services were launched after countries relaxed their telehealth regulations to combat the coronavirus disease 2019 (COVID-19) pandemic. e-Health technologies that support person-centered health care are crucial for the patient's needs. In this systematic review, we examined how e-health applications are used to support person-centered health care at the time of COVID-19. Methodology: Literature was systematically searched without language restriction and publication status between January 1 and May 25, 2020, to describe e-health's support on the person-centered health care to control the COVID-19 pandemic. PubMed, ScienceDirect, and CINAHL, MedRxiv, and Web of Science were used. Two researchers independently assessed the eligibility of each retrieved record. All included studies were subsequently rescreened by the researchers. The systematic review was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Results: We identified 60 articles and selected 8 studies that met the inclusion criteria. Most of the studies used e-health technologies to facilitate clinical decision support and team care. Patient's engagement and access to health care from their homes were enhanced using telehealth and mobile health. Electronic health records were used to avail reliable data to health care providers and health authorities to make evidence-based decisions. Conclusion: Although there are limited studies to evaluate the effectiveness of e-health technologies for person-centered health care, the reviewed studies indicated e-health's potentials to improve the quality of health care and personalized health systems during COVID-19 pandemic. Further research should be done to better understand applications of e-health to improve the quality of health care and patients' outcomes and evaluate its cost-effectiveness.

A survey on semanticized and personalized health recommender systems

AbstractHealth 3.0 is a health‐related extension of the Web 3.0 concept. It is based on the semantic Web which provides for semantically organizing electronic health records of individuals. Health 3.0 is rapidly gaining ground as a new research topic in many academic and industrial disciplines. Due to the recent rapid spread of wearable sensors and smart devices with access to social media, migrating health services from the traditional centre‐based health system to personal health care is inevitable. In this current era of greater personalization, treating patients' health problems according to their profile and medical data gathered is possible using the latest information technologies. Consequently, personalized health recommender systems have gained importance. Empowering the utility of advanced Web technology in personalized health systems is still challenging due to pressing issues, such as lack of low cost and accurate smart medical sensors and wearable devices, existing investment in legacy Web system architecture in health sector, heterogeneity of medical data gathered by myriad health care institutions and isolated health services, and interoperability issues as well as multi‐dimensionality of medical data. By tracing recent developments, this paper offers a systematic review through recent research on semantic Web‐enabled personalized health systems, namely, semanticized personalized health recommender systems with the key enabling technologies, major applications, and successful case studies. Critical questions derived from the research studies were discussed, and main directions of open issues were identified leading to recommendations for future study in the field of personalized health recommender systems.

Patient empowerment for cancer patients through a novel ICT infrastructure.

As a result of recent advances in cancer research and "precision medicine" approaches, i.e. the idea of treating each patient with the right drug at the right time, more and more cancer patients are being cured, or might have to cope with a life with cancer. For many people, cancer survival today means living with a complex and chronic condition. Surviving and living with or beyond cancer requires the long-term management of the disease, leading to a significant need for active rehabilitation of the patients. In this paper, we present a novel methodology employed in the iManageCancer project for cancer patient empowerment in which personal health systems, serious games, psychoemotional monitoring and other novel decision-support tools are combined into an integrated patient empowerment platform. We present in detail the ICT infrastructure developed and our evaluation with the involvement of cancer patients on two sites, a large-scale pilot for adults and a small-scale test for children. The evaluation showed mixed evidences on the improvement of patient empowerment, while ability to cope with cancer, including improvement in mood and resilience to cancer, increased for the participants of the adults' pilot.

Scalability of cancer SurvivorLink™: A cluster randomized trial among pediatric cancer clinics

BackgroundChildren diagnosed with cancer are living longer and the survivor population is growing. However, most survivors develop late effects of radiation and chemotherapy shortly to years after completion of therapy, and the receipt of follow-up visits that are recommended by the Children's Oncology Group (COG) is suboptimal nationally. AimsThe aims of this study are to: 1) evaluate the impact of a patient-controlled electronic personal health record (ePHR) and system (SurvivorLink) on care visit attendance, risk-based surveillance, and other secondary outcomes (i.e., patient activation, quality of life (QOL)); 2) measure the use, acceptability, and perceived usefulness of, and satisfaction with SurvivorLink; and 3) assess facilitators and barriers to implementation. MethodsThis hybrid effectiveness–implementation, clustered randomized control trial (RCT) evaluates the effect of SurvivorLink among pediatric cancer survivors and their parents on receipt of follow-up cancer care. We will recruit 20 pediatric survivor clinics with half receiving the intervention and half acting as a waitlist control. Parents of survivors and survivors will complete baseline, 3 and 12 month surveys that assess SurvivorLink use, patient self-efficacy, and intentions to return for follow-up. We will use mixed methods and multi-informant assessment to assess implementation outcomes (i.e., acceptability, feasibility, appropriateness). DiscussionNew approaches are needed to facilitate the receipt of long-term follow-up care among pediatric cancer survivors. This study will assess whether SurvivorLink is effective in increasing receipt of follow-up cancer care. Moreover, it will explore the influences of context and other moderators of clinical practice change in pediatric cancer survivorship.

Personalized Health Systems-Past, Present, and Future of Research Development and Implementation in Real-Life Environment.

Personal health systems (PHS) are designed to provide the individual with tailored care while enabling the healthcare system to deliver high-quality care to large populations and maintain a sustainable system. Solutions using electronic health records (EHRs) that include predictive models for the risk of disease onset and deterioration enable the care provider to better identify and treat patients with chronic disease and provide personalized prevention. These tools are well-accepted by doctors and have been proven to improve health outcomes and reduce costs. Integrated telecare programs were implemented for comorbid patients showing improved clinical outcomes self-management and quality of life (QoL). However, different patient populations benefit in different ways from these care plans, and thus, continuous evaluation, service adaptation in a real-life environment set with clear outcome measures, is required for best results. The challenge of the PHS today is to acquire patient-generated data (PGD) and behavioral and patient-reported outcomes (PROs) for PHS development that can be combined with existing clinical data. Some initiatives of healthcare organizations [health maintenance organizations (HMOs)] in Israel demonstrate how this goal can be achieved with relatively small efforts by using a stepwise and agile approach to service implementation that improve service by enabling adoption and adaptation of the service in the short term while collecting data for advanced PHS development in the long term. This approach, combined with programs and incentive payments at the national level, creates an environment and infrastructure for collaboration between healthcare, academia, and industry for research, development, and implementation of future PHS. This article presents examples of PHS development and implementation from the Israeli healthcare system. We discuss the lessons learned and suggest new approaches for research, development implementation, and evaluation of PHS that will address the needs of future healthcare.

Revocable Cloud-Assisted Attribute-Based Signcryption in Personal Health System

Revocable Cloud-Assisted Attribute-Based Signcryption in Personal Health System

ISO/IEEE 11073 Personal Health Device (X73-PHD) Standards Compliant Systems: A Systematic Literature Review

Since the introduction of the ISO/IEEE 11073 personal health device (X73-PHD) standards, as part of ISO/IEEE 11073 family of standards, it has been applied to many health systems developed for personal use. In this systematic literature review, we review existing literature collected using three databases: Scopus, Pub Med, and Web of Science. We propose a classification for personal health systems based on the location in which they are used, the technology used to develop them, and the purpose which is determined by the targeted users. We found 51% of the devices used in such systems are standardized while approximately 40% are not and five systems did not specify the device status (9%). Various adaption techniques were used for standardization. Besides, the pulse oximeter is the most used device in such systems since it was used in 43% of them. In addition, we present the role of the X73-PHD standards in the Internet of Things (IoT) and tele-healthcare systems, discuss the challenges of utilizing this set of standards in health monitoring systems and converting the non-standardized devices into standardized ones. Finally, we propose the requirements of personal health systems based on our review of the literature.