Telemonitoring System Research Articles

Earthquake magnitude prediction in Indonesia using a supervised method based on cloud radon data

In the challenging realm of earthquake prediction, the reliability of forecasting systems has remained a persistent obstacle. This study focuses on earthquake magnitude prediction in Indonesia, leveraging supervised machine learning techniques and cloud radon data. We present an analysis of the tele-monitoring system, data collection methods, and the application of regression-based machine learning algorithms. Utilizing a comprehensive dataset spanning 30 training instances and 105 test instances, the study evaluates multiple metrics to ascertain the efficacy of the prediction models. Our findings reveal that the linear regression approach yields the best earthquake magnitude prediction method, with the lowest values across multiple evaluation metrics: standard deviation 0.40, mean absolute error (MAE) 0.30, mean absolute percentage error (MAPE) 6%, root mean square error (RMSE) 0.52, mean squared error (MSE) 0.28, symmetric mean absolute percentage error (SMAPE) 0.06, and conformal normalized mean absolute percentage error (cnSMAPE) 0.97. Additionally, we discuss the implications of the research results and the potential applications in enhancing existing earthquake prediction methodologies.

Newcard telemonitoring system improves survival in comparison both with traditional approaches and other French telemonitoring systems in chronic heart failure

Abstract Background in the NEWTS3 Study, the French National Health Data System (SNDS) was used to comprehensively collect medico economic data for patients between 2017 and 2020. We have shown a decrease in all-cause mortality with the Newcard telemonitoring system (NewTM) in comparison with traditional approaches in Chronic Heart Failure (CHF). This effect seemed to be greater in the group of patients included in the specific year 2020 Purpose The aim of the NEWTS3EXT study is on one hand to confirm those results by adding 2021 and 2022 data to the follow up of the 2020 population. On the other hand, a new evaluation was performed for NewTM patients matched with patients followed by other telemonitoring French systems (TLM). Methods All NewTM patients monitored at least 3 months between 2017 and 2020 were included. For each patient, anonymised data was retrieved from the SNDS. Control Group (CG) was randomly selected from an exhaustive extraction of SNDS of patients with CHF without telemonitoring. This CG was matched in a 1:3 ratio to NewTM patients using a propensity score including baseline characteristics, presence of comorbidities and presence of significative treatments. TLM group was randomly selected from an extraction of SNDS of patients with CHF including a reimbursement of telemonitoring but not followed by Newcard. This TLM group was matched in a 1:1 ratio to NewTM patients using the same propensity score. Binomial negative GEE models were used on matched data sets to assess differences. Results 53.97 % of the patients were included during the 2020 year (571 patients). During 2020, the COVID first year, the prognosis of patients with HF is known as more positive. Despite that, we show a consistent gain in survival rates for the NewTM group (OR 0.707 p=0.0025) (fig 1) For the second arm of the study, 919 NewTM patients were matched to 919 TLM patients. We show also an increase statically significative in survival rates in the NewTM group versus TLM group at 48 months (OR 0.832 p=0.0394) (fig 2) Conclusion In this part of the NEWTS3 program, we confirm the effect on all-cause mortality of the Newcard telemonitoring system in comparison with a control group even on the specific 2020 population which is known to have a better prognostic. On the other hand, it is one of the first comparison between one specific solution and a group of others. Explaining the positive result on all-cause mortality for the NewTM must be a mix of plenty of specificities especially in a complex process like telemonitoring of HF. To help to find the best place for telemonitoring in the care pathway of HF, we can emphasize on the high level of adherence of the NewTM patients (data collected every 1.4 days) and on the precise process to ensure that every alert is followed by a medical response.

Telemonitoring activities of daily living in home healthcare services to support aging in place

Abstract Context Assessing older adults’ abilities to carry out their activities of daily living (ADLs) is a key determinant in the provision of homecare services for aging in place. Amidst a growing aging population and lack of human resources, continuous remote monitoring technology appears promising to support health and social care professionals (HSCPs) in identifying service needs. However, implementation studies conducted in real-life settings are lacking. This study is part of an on-going action design research project aimed at developing an ambient telemonitoring system monitoring ADLs to support clinical decision making. It focused on the initial step of implementation and aimed to understand 1) which HSCPs would want to use the system, 2) for which care recipient they requested it, and 3) for which reasons. Methods A multiple embedded case study utilizing mixed methods was conducted across 3 healthcare establishments in Quebec, Canada. Descriptive statistics from surveys and medical records was conducted to describe the profile of HSCPs and their care recipients. An inductive qualitative analysis was carried out through interviews with 23 HSCPs, in charge of 31 care recipients, to deepen our understanding of the reasons why they requested the system. Results HSCPs were primarily women (89%) occupational therapists (43%). Home care recipients were also primarily women (74%), with documented refusal of homecare services (65%), diagnosed with cognitive decline (94%), and living in a single-family home or apartment (68%). Overall, interviews revealed HSCPs challenges in getting the necessary information to assess their care recipients needs, despite the presence of in-home services and other strategies in place (e.g. informal carer support). Moreover, the telemonitoring system was perceived as promising for risk management. Conclusions There is an interest for the use of ADL telemonitoring technology in the delivery of home healthcare services for aging in place. Key messages • To facilitate its integration in practice, we explored the need for, and value of, ADLs telemonitoring technology by health and social care professionals (HSCPs) in real-life contexts. • By studying the integration of innovative technologies in home healthcare practices, such as ADLs telemonitoring, we aim to support HSCPs practice in fulfilling older adults desire to age in place.

1487P Telemonitoring system effectiveness for alleviating cancer pain in patients with advanced cancer

1487P Telemonitoring system effectiveness for alleviating cancer pain in patients with advanced cancer

Factors predictive of extensive use of CPAP treatment in obstructive sleep apnoea.

In patients with obstructive sleep apnoea (OSA), the benefits of continuous positive airway pressure (CPAP) therapy are increased for every additional hour of daily CPAP usage. However, the data of predictors of extensive usage is scarce, if any. Therefore, we evaluated potential predictors affecting extensive treatment usage. In this retrospective study, we compiled an institutional cohort of consecutive patients diagnosed with who started CPAP therapy 1999-2022 and were included in a wireless telemonitoring system in May 2022 (N = 14,394). Patients using CPAP device ≥ 9h/d were stratified into a younger (< 65 years; N = 124) and an older group (≥ 65 years; N = 131). We found 255 patients (male 61%) eligible for our study, with a median age of 65 (interquartile range, IQR 55-73) years, and mean body mass index (BMI) of 36 ± 6.9kg/m2. Median CPAP use was 10h/d (IQR 10-11). BMI and depressive symptoms (DEPS) in the younger group were higher than in the older group (37.9 ± 7 vs. 34.6 ± 6.4kg/m2, p < 0.001 and 11 (IQR 5-20) vs. 7 (IQR 5-14), p = 0.01, respectively). During follow-up, the BMI of the younger group increased (39.9 ± 12.5kg/m2 vs. 37.9 ± 7kg/m2, p = 0.009). DEPS values decreased in the younger group and became comparable between the groups. In multivariate models, the baseline BMI independently predicted extensive CPAP use among the younger age group, and the mask leak among the older group. BMI at baseline in the younger and mask leak in the older group could be independent predictive factors for extensive use of CPAP.

Adherence to Short-Duration Treatment (3HP) for Latent Tuberculosis among International Migrants in Manaus, Amazonas: Evaluation of the Efficacy of Different Treatment Modalities.

Migration, a multifaceted phenomenon, has a significant impact on health. Migrants perform similar movement patterns within their country of origin, in transit, and in the country of destination, thus making it difficult to monitor TB treatment throughout the journey. The objective was to compare the effectiveness of different treatment modalities in adherence to the short-term regimen for LTBI (3HP) among international migrants and refugees. This is a quasi-experimental study conducted in Manaus-AM. The study population was made up of international migrants. The certification and monitoring of medication intake employed three strategies: self-administration (SA), directly observed conventional therapy (DOT), and Video Telemonitoring System for Tuberculosis Treatment (VDOT). The VDOT group and SA group exhibited the lowest rate of treatment dropout or interruption at 16.1%, followed by the DOT group at 23.1%. The results suggest that the most effective strategy for ensuring adherence among migrants and refugees was VDOT (OR_adj 0.26; CI 0.7-0.94), suggesting that migrants may be more likely to adhere to and complete their treatment. The results show that relying on different treatment strategies, adapted to the individuals' needs and risk factors, is a viable and effective way of providing person-centered TB care.

Health outcomes of telemonitoring of patients with type-2 diabetes mellitus: One-year results from a randomized controlled trial (Optimizing care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus).

Telehealth increases care accessibility to patients with type-2 diabetes mellitus but the duration of its implementation to sustain optimal glycaemic control remains unclear. This study aimed to assess the health outcomes of these patients using the Optimizing care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus (OPTIMUM) home tele-monitoring (HTM) system 6 months post-intervention, compared to standard care. An open-labelled randomized controlled trial involving 330 participants with type-2 diabetes mellitus, aged 26-65 years, and suboptimal glycaemic control (HbA1c = 7.5%-10%) was conducted. Intervention group received OPTIMUM HTM for 6 months followed by usual care for another 6 months, while control group received usual care for 12 months. OPTIMUM HTM includes in-app video-based tele-education, tele-monitoring of the blood pressure, capillary glucose and weight via Bluetooth devices and mobile applications, followed by algorithm-based tele-management by the OPTIMUM HTM team. Assessments using self-care inventory scale and medication adherence were administered for both groups at baseline, 6-month, and 12-month timepoints. Complete data from 156 (intervention) and 159 (control) participants, with comparable demographic profiles, were analysed. Both groups showed a significant reduction in HbA1c from baseline (p < 0.001). From 6-month to 12-month time-points, the intervention group was twice as likely to maintain their HbA1c ≤ 8% (adjusted odds ratio = 2.02, 95%CI = 1.18-3.49; p < 0.011). The intervention group demonstrated higher scores for self-care behaviours (adjusted odds ratio = 3.83 [95%CI = 1.68-5.97], p = 0.001) and not skipping medications (adjusted odds ratio = 2.32 [95%CI = 1.09-4.97], p = 0.030) at 12 months. The OPTIMUM HTM system enabled patients to maintain their glycaemic control beyond the intervention period. The favourable outcomes could be the effect of telehealth in sustaining self-care behaviour and medication adherence.

Efficacy of a Telemonitoring System as a Complementary Strategy in the Treatment of Patients With Heart Failure: Randomized Clinical Trial.

Episodes of decompensation are the main cause of hospital admissions in patients with heart failure. For this reason, the use of mobile apps emerges as an excellent strategy to improve coverage, real-time monitoring, and timeliness of care. ControlVit is an electronic application for early detection of complications studied within the context of a tertiary university hospital. Patients were randomized to the use of ControlVit versus placebo, during a 6-month follow-up. The primary outcome was the difference in numbers of readmissions and deaths for heart failure between both groups. One hundred forty patients were included (intervention = 71, placebo = 69), with an average age of 66 years old; 71% were men. The main etiology of heart failure was ischemic (60%), whereas the main comorbidities were arterial hypertension (44%), dyslipidemia (42%), hypothyroidism (38%), chronic kidney disease (38%), and diabetes mellitus (27%). The primary outcome occurred more frequently in the control group: readmission due to decompensation for heart failure (control group n = 14 vs intervention group n = 3; P = .0081), and death (control group n = 11 vs intervention group n = 3; P = .024). In heart failure patients, ControlVit is a useful and supplementary tool, which reduces hospital admissions due to episodes of decompensation.

Cost-Effectiveness of a Home Telemonitoring System for Asian Adults with Type 2 Diabetes Mellitus.

Background: Telemonitoring programs have been found to be effective in improving diabetic control by promoting patients' self-management of diabetes through medication adherence, dietary modifications, and exercise. Nonetheless, few studies have assessed the cost-effectiveness of telemonitoring for the self-management of diabetes based on real-world data. Methods: A randomized controlled trial entitled Optimizing care of Patients via Telehealth In Monitoring and Augmenting their control of Diabetes Mellitus was conducted among adults with Type 2 Diabetes Mellitus in Singapore. Individuals in the intervention group (n = 159) underwent a telemonitoring program comprising of remote patient monitoring, education, individualized health coaching, and teleconsultations, whereas individuals in the control group (n = 160) received regular care. Economic evaluation was conducted from health care system and societal perspectives in 2020 in Singapore dollars, using health outcomes and costs documented at baseline and at 6 month follow-up. One-way sensitivity analyses and bootstrapping to generate scatter plot on cost-effectiveness planes were done. Results: The adjusted reduction in HbA1c scores was greater in the intervention group by -0.41 (95% confidence interval [CI], -0.65 to -0.17), while the change in utility scores was higher in the intervention group by 0.011 (95% CI, -0.016 to 0.0378). From a health care perspective, the incremental cost-effectiveness ratio (ICER) of the telemonitoring program per unit improvement in HbA1c, per additional case of well-controlled diabetes, and per unit improvement in quality adjusted life years was SGD 580.44, SGD 9100.15, and SGD 21,476.36, respectively. From a societal perspective, the ICERs were SGD 817.20, SGD 12,812.02, and SGD 30,236.36, respectively. Conclusions: The Optimizing care of Patients via Telehealth In Monitoring and Augmenting their control of Diabetes Mellitus telemonitoring program was effective and potentially cost-effective for the management and control of diabetes among patients in primary care.

Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study.

The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce. The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy.The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues.

TELECUORE: FEASIBILITY OF A HOSPITAL–TERRITORIAL TELEMEDICINE PROJECT IN CHRONIC HEART FAILURE

Abstract Background Since February 2023, Cardiology department of AUSL Piacenza has started a telemedicine project named “TeleCuore,” aimed at exploring the impact of a multiparametric telemonitoring system on the management of patients affected by chronic heart failure (CHF). OBJECTIVES assess organizational sustainability, satisfaction among involved figures, and the clinical impact at 9 months of an extensive telemonitoring project targeting patients with CHF. Materials and Methods 250 patients with CHF and recent clinical instability were recruited and equipped with the Adilife device to monitor and transmit weight, temperature, blood pressure, heart and respiratory rate, oxygen saturation, and single–lead ECG. These data are managed by case manager (CM), cardiologists, respiratory and perfusion pathophysiology technicians (TFCPC), general practitioner to optimize patient therapy, empowerment, and reduce acute admissions through timely teleconsultations/televisits. Every 6 months, patients are asked to complete a Quality of Life questionnaire (KCCQ–23) and a satisfaction questionnaire regarding the project, which is also administered to healthcare professionals. Results Over 9 months, positive patient engagement is confirmed, with over 92,000 total transmitted measurements. The most monitored parameter is heart rate (4 times/week). At questionnaire analysis, 80% of patients believes TeleCuore helps them remember parameter measurements, and 70% adopt a correct lifestyle through phone conversations with CM. For over 50%of them the project contributes improving their relationship with healthcare professionals. For 90%of healthcare professionals there is better team collaboration and patient education. Both clinicians and patients (100%) believe that TeleCuore improves the effectiveness of follow–up visits: patients arrive more prepared (30%), and staff can dedicate more time to patients (30%) and access information before the visit (10%). The patients KCCQ score varies from a medium of 71 at baseline to a medium of 78 at 6 months analisys. Conclusions TeleCuore project demonstrates that telemedicine can facilitate patient management and empowerment. Professional figures (CM and TFCPC) are crucial for project execution, working alongside clinical cardiologists for proper alert management, patient education on therapy adherence, and correct lifestyle. An ongoing analysis aims to quantify whether TeleCuore can reduce hospitalizations related to acute heart failure.

TELEMONITORING IN PATIENTS WITH CHRONIC HEART FAILURE: EXPERIENCE FROM THE TELECUORE PROJECT IN PIACENZA

Abstract Background Starting from February 2023, the Piacenza’s Hospital has approved the use of a cardiological telemonitoring system called ‘TeleCuore’ project. This system, through the monitoring of various vital parameters which are frequently sent by patients via a dedicated platform, allows for remote assessment of the clinical status of 250 individuals with chronic heart failure (CHF). Objectives The objective of this study is to analyze the number and nature of alerts in the data sent by patients and the consequences on patient’s management derived from the alerts received through the telemedicine system. Materials and Methods 250 patients with CHF identified following recent episodes of clinical instability have been equipped with a home monitoring device (Adilife system). This involves collecting the following data: body weight, temperature, blood pressure, heart and respiratory rate, oxygen saturation, and single–lead EKG. These data are daily filtered by perfusionist technicians (TFCPC) and dedicated nurses, reviewed by the Case Manager and cardiologists. In case of recognition of altered parameters, the platform generates alerts according to pre–set clinical parameters, enabling proactive and personalized interventions on patients. In the 9 months of the TeleCuore project, 494 alerts were received, with 119 (24%) judged not clinically relevant, while 375 (76%) required operator intervention. Of these, 99 were due to weight gain (26%), 40 to low blood pressure (11%), 42 to high blood pressure (11%), 33 to tachycardia episodes (9%), 30 to bradycardia (8%), 49 for technic issues with the weight scale (13%), 78 for EKG artifacts (21%), and 4 for previously unknown atrial fibrillation (1%). 25 patients (8%) were invited for ambulatory clinical evaluation, 28 (7%) were managed through teleconsultation, and the remaining majority (85%) was handled via telephone contact for therapy adjustments (60.5%). 39.4% underwent re–training on the correct device use in the first month. Conclusions The TeleCuore Project is a pilot cardiological telemedicine initiative. Initial data confirm the utility of this system in optimizing the follow–up of patients with CHF, allowing for instant therapeutic adjustments based on the patient’s clinical progress. Teamwork of different healthcare professionals have emerged as crucial for the proper management of alerts. Further data will be needed to assess whether TeleCuore also helps reduce hospitalizations related to CHF.

Establishment of a digital electrocardiogram telemonitoring system and remote consultation service.

The use of telemonitoring electrocardiogram (ECG) improves the detection rate of various arrhythmias as it offers an extended recording time and does not impose activity restrictions. However, many community hospitals lack the resources to conduct this test due to a lack of cardiac function specialists and antiquated screening equipment. To establish a digital ECG telemonitoring system and remote consultation service between tertiary hospitals and community medical service stations to improve diagnosis and treatment effectiveness. We used the PI ECG telemonitoring data acquisition system, with a personal digital assistant (PDA) or computer serving as the platform for ECG acquisition, storage, display, printing, and transmission. We introduced this system to standardize the storage and transmission of ECG telemonitoring data, and ensure accurate transmission, reproducibility, and preservation of data. The implementation of the PI ECG telemonitoring data acquisition system enabled the sharing of remote ambulatory electrocardiography data between Beijing Shijitan Hospital and its affiliated community hospitals. This has resulted in reduced waiting times for patients to receive reports (from 0.3 to 1 hour, to 0.1 or less), shortened consultation times (from 2 hours to 0.1 hour), and improved patient satisfaction with consultations (> 20% of the patients reported they were highly satisfied). The system successfully combined the goals of intelligence, real-time synchronization, and efficiency, revolutionizing ECG telemonitoring diagnosis in the network era. Sharing digital telematics information between tertiary and community hospitals enables a tiered approach to diagnosis and treatment and allows for more efficient, accurate, and convenient remote diagnostics.

Automatic Medical Assistance with Dynamic Tele Monitoring System

The optimization of our wearable assist system (AS) to monitor isolated patients on isolation wards. A wearable chest patch and finger-worn pulse oximeter were used to estimate and transmit continuous temp, Heart Rate (HR), and peripheral blood Oxygen Saturation (SpO2) data from ambulatory patients on these isolation wards to nurse bays remote from these patients, with a view to minimizing the risk of infection for nursing staff. Our virtual High-Dependency Unit system used a secure web-based architecture and protocols to transmit the vital-sign data in real time from wireless Android tablet devices, operating as patient data collection devices by the bedside in the isolation rooms, into the clinician dashboard interface Available nremotely via any modern web- browser. Although Internet of Things buttons have seen some success as consumer products, little has been reported on their application in hospital systems. The system can be used to check the health condition of the patient by using three sensor such as heart beat sensor, temperature sensor and pressure sensor and also to monitor the saline droplet condition of patients in each patient’s bed in rural public hospital. Therefore, a particular interest is focused on continuous monitoring techniques. For continuous monitoring, Atmega328 microcontroller is used. In this case several sensor unit is considered. the sensed value is equal to normal value, it stops further process. Otherwise it sends control signals to patient via Actuator.

NEW HOME BLOOD PRESSURE TELEMONITORING SYSTEM IN AN AGED COMMUNITY: PROTOCOL OF THE DIGITAL CARDIOVASCULAR PREVENTION FEASIBILITY STUDY

Objective: We sought to (i) determine the precise feasibility of a new telemonitoring-based healthcare system in a community of aged individuals and (ii) clarify the clinical implications of blood pressure variabilities in a time series until the end of life for the management of hypertension in elderly patients. Design and method: We have devised a simple, easy-to-use blood-pressure monitoring system and automated telemonitoring system, i.e., the DICAP (DIgital Cardiovascular Prevention) system, that obtains all of the different blood pressure values measured in a time series in different settings in community-dwelling elderly individuals in their homes and other facilities. Results: The feasibility of the DICAP system was confirmed by the successful serial transmission of the home blood pressure data of the community-dwelling hypertensive patients including those who were not familiar with digital technology and those who resided at different community locations. Among the first-recruited 221 subjects, 92.3% have been monitoring their blood pressure with the DICAP &gt;12 times/week. Conclusions: The newly developed DICAP system using a cellular blood-pressure monitoring device suggests the possibility of being feasible and acceptable for the management of hypertension among elderly community-living individuals.

FetalCare: A Home Telemonitoring System for Wearable Fetal-ECG and EHG Acquisition During Pregnancy

FetalCare: A Home Telemonitoring System for Wearable Fetal-ECG and EHG Acquisition During Pregnancy

Feasibility of an Integrated Telemonitoring System for Home-Recorded EEG with Automated AI-Based EEG Analysis.

Self-recorded EEG by patients at home might present a viable alternative to inpatient epilepsy evaluations. We developed a novel telemonitoring system comprising seamlessly integrated hard- and software with automated AI-based EEG analysis. The first complete study participation results demonstrate feasibility and clinical utility. Our telemonitoring solution potentially improves treatment of patients with epilepsy and moreover might help to better distribute resources in the healthcare system.

Automatic Medical Dispatcher with Dynamic Telemonitoring System Using IoT in Rural Areas

Accessing quality healthcare in rural areas can be challenging, often requiring individuals to travel long distances to nearby towns or cities. To address this issue, the Anytime Medical Machine (AMM) project was developed, leveraging Internet of Things (IoT) technology to provide on-the-spot medical consultations. AMM, a part of the Internet of Medical Things (IoMT), is designed for primary deployment in rural areas. Through AMM, individuals can receive consultations from qualified doctors without the need to travel. Doctors can prescribe medications and provide treatment recommendations, reducing both time and expenses associated with travel. The system collects patient data using sensors for temperature, heart rate, and blood oxygen saturation (SPO2), transmitting this information to doctors via a Wi-Fi module. The doctor-patient interaction is facilitated through secure video conferencing, requiring a unique username and password for each user to prevent misuse. After analyzing the patient's health parameters, the doctor prescribes appropriate medication, which is then dispensed through AMM. Patient information is securely uploaded to a cloud server for future reference, and the system is maintained by an administrator who refills medications as needed. Keywords- Rural Healthcare, Remote Consultation, IoT Healthcare, Medical IoT, Telemedicine, Remote Monitoring, Cloud-Based Healthcare, Healthcare Accessibility

Health data space nodes for privacy-preserving linkage of medical data to support collaborative secondary analyses.

The potential for secondary use of health data to improve healthcare is currently not fully exploited. Health data is largely kept in isolated data silos and key infrastructure to aggregate these silos into standardized bodies of knowledge is underdeveloped. We describe the development, implementation, and evaluation of a federated infrastructure to facilitate versatile secondary use of health data based on Health Data Space nodes. Our proposed nodes are self-contained units that digest data through an extract-transform-load framework that pseudonymizes and links data with privacy-preserving record linkage and harmonizes into a common data model (OMOP CDM). To support collaborative analyses a multi-level feature store is also implemented. A feasibility experiment was conducted to test the infrastructures potential for machine learning operations and deployment of other apps (e.g., visualization). Nodes can be operated in a network at different levels of sharing according to the level of trust within the network. In a proof-of-concept study, a privacy-preserving registry for heart failure patients has been implemented as a real-world showcase for Health Data Space nodes at the highest trust level, linking multiple data sources including (a) electronical medical records from hospitals, (b) patient data from a telemonitoring system, and (c) data from Austria's national register of deaths. The registry is deployed at the tirol kliniken, a hospital carrier in the Austrian state of Tyrol, and currently includes 5,004 patients, with over 2.9 million measurements, over 574,000 observations, more than 63,000 clinical free text notes, and in total over 5.2 million data points. Data curation and harmonization processes are executed semi-automatically at each individual node according to data sharing policies to ensure data sovereignty, scalability, and privacy. As a feasibility test, a natural language processing model for classification of clinical notes was deployed and tested. The presented Health Data Space node infrastructure has proven to be practicable in a real-world implementation in a live and productive registry for heart failure. The present work was inspired by the European Health Data Space initiative and its spirit to interconnect health data silos for versatile secondary use of health data.

Weight telemonitoring of heart failure versus standard of care in a real-world setting: Results on mortality and hospitalizations in a 6-month nationwide matched cohort study.

Evaluating the benefit of telemonitoring in heart failure (HF) management in real-world settings is crucial for optimizing the healthcare pathway. The aim of this study was to assess the association between a 6-month application of the telemonitoring solution Chronic Care Connect™ (CCC) and mortality, HF hospitalizations, and associated costs compared with standard of care (SOC) in patients with a diagnosis of HF. From February 2018 to March 2020, a retrospective cohort study was conducted using the largest healthcare insurance system claims database in France (Système National des Données de Santé) linked to the CCC telemonitoring database of adult patients with an ICD-10-coded diagnosis of HF. Patients from the telemonitoring group were matched with up to two patients from the SOC group based on their high-dimensional propensity score, without replacement, using the nearest-neighbour method. A total of 1358 telemonitored patients were matched to 2456 SOC patients. The cohorts consisted of high-risk patients with median times from last HF hospitalization to index date of 17.0 (interquartile range: 7.0-66.0) days for the telemonitoring group and 27.0 (15.0-70.0) days for the SOC group. After 6 months, telemonitoring was associated with mortality risk reduction (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.56-0.89), a higher risk of first HF hospitalization (HR 1.81, 95% CI 1.55-2.13), and higher HF healthcare costs (relative cost 1.38, 95% CI 1.26-1.51). Compared with the SOC group, the telemonitoring group experienced a shorter average length of overnight HF hospitalization and fewer emergency visits preceding HF hospitalizations. The results of this nationwide cohort study highlight a valuable role for telemonitoring solutions such as CCC in the management of high-risk HF patients. However, for telemonitoring solutions based on weight and symptoms, consideration should be given to implement additional methods of assessment to recognize imminent worsening of HF, such as impedance changes, as a way to reduce mortality risk and the need for HF hospitalizations. Further studies are warranted to refine selection of patients who could benefit from a telemonitoring system and to confirm long-term benefits in high-risk and stable HF patients.