Organizational effects of information and communication technology (ICT) in elderly homecare: a case study

“The use of information and communication technology (ICT) to support integrated healthcare services in elderly homecare is becoming more established. In particular, ICT can enable information exchange, knowledge sharing and documentation at the point-of-care (POC). The aim of this study was to explore these effects using the Old@Home prototype. Old@Home was perceived to contribute in developing horizontal links for communication between individuals who work together, independent of geographical distance or organizational affiliation, and to contribute to increased work efficiency. The prototype was further seen to reduce professional isolation by providing a holistic overview of the care process. User centred design and implementation of Old@Home was considered key to facilitating acceptance of organizational changes. Participation of care professionals not only led to a better understanding of the needs of involved organizations, but also increased end-users’ involvement and commitment, stimulating them to test and improve the prototype until the final version.”
Abstract
Vivian Vimarlund, Nils-Göran Olve, Isabella Scandurra, Sabine Koch, Health Informatics Journal, Vol. 14, No. 3, 195-210 (2008), DOI: 10.1177/1081180X08092830

Journal of Telemedicine and Telecare, TOC, July 2008

Telerehabilitation for service delivery in speech-language pathology
“Communication disorders in adults and children can have a significant effect on their quality of life and on that of their families. Speech-language pathologists face several challenges in providing assessment and treatment services to such people. Challenges include facilitating equitable access to services and providing appropriate management within a changing social and economic context. Telerehabilitation has the potential to deliver services in the home or local community via videoconferencing and through interactive computer-based therapy activities. This form of service delivery has the capacity to optimize functional outcomes by facilitating generalization of treatment effects within the person’s everyday environment, and enable monitoring of communication and swallowing behaviours on a long-term basis. A number of image-based telerehabilitation applications have been used in the management of adult neurogenic speech and language disorders, stuttering, voice disorders, speech and language disorders in children, laryngectomy and swallowing dysfunction. Further development of such applications and other computer-based therapies, cost-benefit and cost-effectiveness analyses, and professional education are needed if telerehabilitation is to become an integral part of speech-language pathology practice.”
Abstract
Deborah G Theodoros, J Telemed Telecare 2008;14 221-224, doi:10.1258/jtt.2007.007044

Telehealth: a child and family-friendly approach to mental health-care reform
“Limited access to paediatric mental health services and high drop-out rates from treatment result in poor health outcomes for families with children with mental health problems. New ways of delivering care are required. Telehealth is a promising approach. The Family Help programme employs manualized, distance treatment by telephone. Participants in the Family Help programme (both adults and children) have reported a strong therapeutic alliance with their telephone coach. Participants also described how during treatment sessions they felt comfortable and safe in their own home; they did not feel stigmatized or judged; they had little apprehension about self-disclosure and they felt that treatment was delivered at their convenience. Treatment calls were often scheduled after typical working hours. Attrition rates were found to be very low and children actively engaged in the structured, distance treatment. Evidence-based, distance delivery using non-professionals is a promising approach to the delivery of paediatric mental health care.”
Abstract
Patricia Lingley-Pottie and Patrick J McGrath, J Telemed Telecare 2008;14 225-226, doi:10.1258/jtt.2008.008001

Effect of a behavioural health and specialty care telemedicine programme on goal attainment for youths in juvenile detention
“We conducted a pre-post study of the effect of a telepsychiatry counselling service on youths housed in three juvenile detention facilities. In the first year of the telemedicine programme, 321 psychiatry consultations were conducted via telemedicine; in the second year of the programme, 573 psychiatry consultations were conducted. Records for 190 students were then examined by two raters. The total number of behavioural goals for each adolescent increased from 8.2 in the pre-telemedicine year to 8.7 in the first year of telemedicine and then to 10.0 in the second year (P < 0.05). In Year 2 of the study, subjects also had a significantly higher number of goals in four of the five categories: education, family, health and social skills (P < 0.05). Although other changes at the youth detention facilities or in the juvenile justice system may have been partly responsible for the effects observed, the study suggests that telemedicine may be useful for improving the rate of attainment of goals associated with family relations and personality/behaviour."
Abstract
Karen C Fox, Pamela Connor, Elizabeth McCullers, and Teresa Waters, J Telemed Telecare 2008;14 227-230, doi:10.1258/jtt.2008.071102

Non-invasive monitoring of the activities of daily living of elderly people at home – a pilot study of the usage of domestic appliances
“We conducted a feasibility study of a system for non-invasive monitoring of subjects at home. Electrical activity was recorded from room lights and from electrical domestic appliances; this was translated into the probability of physical activity or a particular Activity of Daily Living (ADL). Thirteen volunteer subjects were monitored for a period of 6.4 months (range 3–8). The mean age of the subjects was 80 years and they all lived alone at home; one had moderate Alzheimer’s disease. A one-week validation was carried out to ascertain whether the recorded activity actually occurred. The results showed that daily and nocturnal activity could be well differentiated. The probability of having eaten, taken a bath and going to the toilet could be calculated each day. Eating was the most accurately measured ADL; toileting and bathing results were less accurate. The system appears to be a promising component of home telecare.”
Abstract
Georgina Corte Franco, Floriane Gallay, Marc Berenguer, Christine Mourrain, and Pascal Couturier, J Telemed Telecare 2008;14 231-235, doi:10.1258/jtt.2008.071207

A paediatric therapeutic alliance occurs with distance intervention
“We investigated whether a distance therapeutic alliance occurs when children receive manualized, cognitive-behavioural treatment via telephone, in the absence of face-to-face contact. The therapeutic alliance scores were measured in 55 child–parent pairs. The mean total Working Alliance Inventory child scores were 236 (95% confidence interval [CI]: 232, 240) and the mean parent scores were 245 (95% CI: 242, 247). Parent scores were significantly higher than child scores, although the difference may not be clinically meaningful. This study provides evidence that a strong therapeutic alliance does occur between child–coach and parent–coach pairs when treatment is delivered from a distance by non-professionals. The term ‘child’ encompasses both children and adolescents.”
Abstract
Patricia Lingley-Pottie and Patrick J McGrath, J Telemed Telecare 2008;14 236-240, doi:10.1258/jtt.2008.080101

International telepsychiatry: a study of patient acceptability
“An international telepsychiatry service was established between Denmark and Sweden for cross-cultural patient groups, such as asylum seekers, refugees and migrants. Over an 18-month period starting in mid 2006, 30 patients were treated by telepsychiatry (21 men and 9 women). The patients received mental health care by videoconferencing from providers who spoke the patients’ own language, i.e. without the assistance of interpreters. The total number of telepsychiatry sessions was 203 (range 1–22; average 6.8 sessions per patient). Patients completed a satisfaction questionnaire at the end of treatment. Seven patients (23%) were not able to complete a questionnaire, due to illiteracy and/or a psychotic condition. The rest of the patients (n=23) reported a high level of acceptance and satisfaction with telepsychiatry, as well as a willingness to use it again or recommend it to others. Any disadvantages of telemedicine were compensated by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references. Mentally ill asylum seekers, refugees and migrants are under-served in their mother tongue and telepsychiatry can improve access to scarce health-care resources.”
Abstract
Davor Mucic , J Telemed Telecare 2008;14 241-243, doi:10.1258/jtt.2008.080301

The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit
“We examined records of all admissions to an isolated community neonatal intensive care unit (NICU) in California between 2001 and 2006. We also reviewed the echocardiograms for diagnosis, disposition of patient and necessity for transport. In 2004, a telemedicine link (mainly store-and-forward) was established to a university children’s hospital (UCH) 290 km away. The number of NICU patients having an echocardiogram increased from 280 (27% of 1029 admissions) to 385 (40% of 963, P = <0.001) after telemedicine became available. There was an increase in the proportion of normal studies, from 31% to 37% (P = 0.03), and an increase in the number of patients diagnosed with cardiac pathology from 192 (19% of all admissions) to 241 (25%, P < 0.001). Twenty-four patients were transferred for cardiac reasons during each three-year period; however seven pre-telemedicine transfers were avoidable, compared with two post-telemedicine transfers (P = 0.06). There was a change in referral pattern (65% to the UCH pre-telemedicine, compared with 78% post-telemedicine) although it was not significant (P = 0.10). Thus the availability of the telecardiology link was associated with increases in the utilization of echocardiography, in the proportion of normal studies, and in the percentage of neonates diagnosed with cardiac pathology without an increase in the number transferred for cardiac reasons. There was a reduction in unnecessary transfers and a strengthened relationship with the centre providing the telecardiology service."
Abstract
Tannie Huang, Anita J Moon-Grady, Craig Traugott, and James Marcin, J Telemed Telecare 2008;14 244-248, doi:10.1258/jtt.2008.080102

Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis
“We conducted a randomized controlled multicentre trial to investigate the feasibility of a telerehabilitation intervention for arm/hand function (the Home Care Activity Desk [HCAD] training) in a home setting. Usual care was compared to HCAD training. The hypothesis was that the clinical outcomes of the HCAD intervention would be at least the same as those measured after a period of usual care for patients with stroke, traumatic brain injury (TBI) and multiple sclerosis (MS) with respect to their arm/hand function. Eighty-one patients with affected arm/hand function resulting from either stroke, MS or TBI were recruited in Italy, Spain and Belgium; 11 were lost during follow-up (14%). The outcome measures were the Action Research Arm Test (ARAT) and the Nine Hole Peg Test (NHPT). There were no significant differences between the two groups on the outcome measures (ARAT and NHPT); in both groups, patients maintained or even improved their arm/hand function. The HCAD training was found to be as feasible as usual care in terms of clinical outcomes, and both therapists and patients were satisfied with the HCAD intervention. A telerehabilitation intervention using HCAD may increase the efficiency of care.”
Abstract
Barbara CH Huijgen, Miriam MR Vollenbroek-Hutten, Mauro Zampolini, Eloy Opisso, Montse Bernabeu, Johan Van Nieuwenhoven, Stephan Ilsbroukx, Riccardo Magni, Claudia Giacomozzi, Velio Marcellari, Sandro Scattareggia Marchese, and Hermie J Hermens, J Telemed Telecare 2008;14 249-256, doi:10.1258/jtt.2008.080104

Satisfaction with care in post-stroke patients undergoing a telerehabilitation programme at home
“We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment. We compared the degree of satisfaction of patients undergoing a virtual reality (VR) therapy programme at home (Tele-VR group) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting (VR-group). The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient’s movement was represented. In tele-therapy, the patient equipment was installed in their homes, connected to the hospital by four ISDN lines at a total bandwidth of 512 kbit/s. Rehabilitation data were transmitted via one line and videoconferencing via the other three. Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke, were randomized into VR or Tele-VR groups. A questionnaire was used at the end of treatment to measure each patient’s degree of satisfaction. Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated, except one. In motor performance, the Tele-VR group improved significantly (P ? 0.05), while the VR group showed no significant change. Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required.”
Abstract
Lamberto Piron, Andrea Turolla, Paolo Tonin, Francesco Piccione, Lisa Lain, and Mauro Dam, J Telemed Telecare 2008;14 257-260, doi:10.1258/jtt.2008.080304

Caregivers’ acceptance of electronic documentation in nursing homes
“A comparative study was conducted in two Australian nursing homes operated by the same organization. One home had implemented an electronic documentation system and the other remained paper-based. Survey questionnaires were answered by 14 of the 17 caregivers at the electronic documentation site (82%) and 10 of the 23 caregivers at the paper documentation site (43%). They provided opinions about satisfaction with their home’s documentation system, and the training and support provided. Information was also obtained on the caregivers’ attitudes towards using electronic documentation. The caregivers at the electronic documentation site quickly adapted to the use of the new technology after receiving effective training and support. Caregivers at both homes were satisfied with their homes’ documentation system, and had positive attitudes towards using electronic documentation systems. As an important communication tool, electronic nursing documentation may lead to improved efficacy of telemedicine in nursing home settings.”
Abstract
Ping Yu, David Hailey, and Haocheng Li, J Telemed Telecare 2008;14 261-265, doi:10.1258/jtt.2008.080310

The use of videoconferencing for mental health services in Finland
“The utilization of telemental health (TMH) services in Finland was surveyed in 2006. In total, 135 health-care units provided responses. Eighty-four responses were received from primary care units (health-care centres and clinics) and eight from other clinics, in all hospital districts. The overall rate of TMH consultations was 4 per 100,000 population. The highest TMH consultation per population ratio, 22 per 100,000, was in northern Finland. Most of the sites used telepsychiatry services for less than 10% of clinical outpatient services. The sites with over 20% utilization of clinical TMH services from all psychiatric consultations were all rural health centres. Compared with Finland, the utilization rates of TMH were higher in Canada; that might be due to differences between the countries in the organization of mental health services in primary and specialized care. In Finland TMH consultations made up only a very small proportion of all mental health services. The use of TMH was particularly common in remote areas; however, there were many rural centres that did not utilize clinical TMH. TMH was widely utilized for continuing and medical education.”
Abstract
Arto Ohinmaa, Risto Roine, David Hailey, Marja-Leena Kuusimäki, and Ilkka Winblad, J Telemed Telecare 2008;14 266-270, doi:10.1258/jtt.2008.071212

Use of mobile phone cameras for after-hours triage in primary care
“Mobile phone images might be useful in after-hours triage of primary care. We conducted a study to identify population access to mobile phone cameras and to assess the clinical usefulness of mobile phone cameras. The survey was conducted among 480 patients attending two rural New Zealand practices. There were significantly more Maori owners compared to non-Maori (P = 0.002). Age was a significant factor influencing the ownership of mobile phones. We also conducted a clinical quiz among health professionals to assess how the provision of images on a mobile phone and on CD-ROM (to simulate the image that would be seen if email was used to transmit the images) influenced diagnostic confidence. Ten photographable clinical conditions were used to quiz 30 health professionals who were randomized into three groups of 10 each on diagnostic confidence. Images were found to significantly increase diagnostic confidence in all cases except one. It appears that mobile phone cameras are generally acceptable to patients and likely to be of practical use to rural practitioners in a range of clinical scenarios.”
Abstract
Chandra Jayaraman, Paul Kennedy, Gaelle Dutu, and Ross Lawrenson, J Telemed Telecare 2008;14 271-274, doi:10.1258/jtt.2008.080303

Learning More About the Medical Home and Finding Innovation Where It Lives

“If you are interested in innovation, I think this is a good podcast worth listening to - and the actual audio is more useful than the printed version.
I listened to it the day before I attended the latest Patient Centered Primary Care Collaborative, in Washington, DC.
At the meeting, I was fortunate to run into one of my role models, Susan Edgman-Levitan, PA, and we talked about the idea that the Medical Home is about improving the care of patients where they spend most of their time - where they live, work, and play. We can help patient-centered care flourish by including ideas from everyone involved in the care, including nurses, doctors, allied health practitioners, eye care, oral health care, behavioral health care, just to name a few.”
Article
Ted Eytan, 16 April 2008

Telethinking With Elizabeth A. Krupinski

“Elizabeth Krupinski, Ph.D., is a Research Professor at the University of Arizona in the departments of radiology and psychology, where she has been since 1992. She is the President-Elect of the American Telemedicine Association. Dr. Krupinski received her undergraduate degree from Cornell University and Ph.D. from Temple University, both in experimental psychology. She completed her early training in radiology at the University of Pennsylvania. Her main interests are in medical image perception, assessment of observer performance, and human factors issues. She is Associate Director of evaluation and assessment for the Arizona Telemedicine Program. Dr. Krupinski is an Associate Editor of the Telemedicine and e-Health journal, serves as the Co-editor of the Journal of Telemedicine & Telecare, and is on the editorial board of a number of other journals in radiology. She serves regularly on
review panels for the NIH, DoD, FDA, and TATRC.”
Article
Vicki Glaser, Telemedicine and e-Health, March 1, 2008, 14(2): 117-121, doi:10.1089/tmj.2008.9987.

Study Finds IT-enabled Homecare Could Saves Billions

“A new study from the Washington-based Deloitte Center for Health Solutions finds that better coordination of in-home medical treatment and technological advances could mean a potential $400 billion savings to the U.S. healthcare system.”
Article
Healthcare Informatics, 11 March 2008

FDA to Reclassify Device Software

“The Food and Drug Administration has published a proposed rule to reclassify the regulatory status of certain software used with medical devices. The rule would affect medical devices used in provider organizations and in patient homes.”
Article
Health Data Management, 8 February 2008

Docobo make multi-user version of telehealth device

“Telehealth specialist Docobo has unveiled a multi-user version of its HealthHUB portable home monitor, meaning two or more patients can now utilise one device.
The HealthHUB system enables patients to record vital signs, symptoms, lifestyle and quality of life measures around the clock from any location.”
Article
e-Health Insider Primary Care, 17 January 2008

Thoughts on EHR

Slowly the concept of Electronic Health Records (EHR) is gaining ground. However, not without many difficulties and an amazing silence from the side of the customer/patient.

Josh Seidman from PCHIT asked a very important question: “How much of a prerequisite is an EHR for implementing a PHR?” Absolutely, I would say, there is none without the other.
A couple of years ago it was deemed necessary, at least in the USA, to split the pure medical from the personal part, the so-called personal health record (PHR) (see Tang et al.). In my view this has been a very wrong decision. In stead of implementing a total record, including all aspects, the discussion has now begun how to link one with the other. It seems the world upside-down.

Read the rest of this entry »

A methodology for shifting the focus of e-health support design onto user needs A case in the homecare field

“Background
Epidemiological shifts, financial pressures and changing policy priorities in healthcare initiate reflections on innovative ways to deliver care. Technologies offer opportunities to change health services delivery. One of the emerging fields is telehomecare-applications. Yet, these applications are not always adapted to the user needs and characteristics of the homecare setting, resulting in “system failure”.
Objectives
We describe a generic methodological model to incorporate user perspectives in the design and development process of e-health systems. The model aims at grounding the choice of the technology in a clear understanding of the homecare field, and on interactive reflections with the technology developers.
Discussion
Our methodological approach provides a practical framework for understanding and considering user perspectives. The application of the method within the development of the Coplintho-e-homecare platform demonstrated its usefulness. The experience within the Coplintho-pilot project learned important lessons about the operational use of the method. The methodology is time-consuming and requires scientific input to assess and to document potential user needs, requiring specific means and human resources. The method also requires a very explicit project management of the preparatory phase.”
Abstract
Sofie De Rouck, An Jacobs and Mark Leys, International Journal of Medical Informatics, In Press, Corrected Proof, Available online 8 January 2008

Distribution of Telemedicine in Japan

“Of 1,006 telemedicine projects initiated between 1997 and 2004, 348 were active in 2004, representing a two-fold increase in active programs. There was a four-fold increase in home health and telepathology. Telemedicine is widely distributed in Japan with most serving rural populations, but 30% of the projects in urban areas.
This paper reports the situation of telemedicine in Japan. A comprehensive database search showed that a total of 1,006 telemedicine projects had been implemented from 1997 to 2004. Teleradiology accounted for the largest proportion (37%) of these projects and home-care telemedicine (home telecare) accounted for one third of the total number of projects. The subsequent questionnaire-based survey revealed that 348 projects were active in 2004, indicating a more than twofold increase in the number of ongoing projects from the 151 projects reported in 1997. In particular, the use of home telecare and telepathology has exhibited an approximately fourfold increase since 1997. Telemedicine was most common in remote areas, although approximately 30% of the projects were implemented within urban areas. The number of telemedicine projects peaked twice: in municipalities with populations ranging from 10,000 to 30,000 and in municipalities with populations ranging from 100,000 to 300,000. However, with regard to the population density, there was no characteristic distribution of implementation. The present data suggest that in Japan, there are various population sizes and densities for which telemedicine may be valuable.”
Abstract
Takashi Hasegawa, Sumio Murase. Telemedicine and e-Health. 2007, 13(6): 695-702. doi:10.1089/tmj.2007.0013

ROBOSOFT Introduces a New Robuter Aiming at Assisting People at Home

“The prototype shows how service robots can help elderly and handicapped people staying at home. It is based on robuLAB10, an off-theshelf mobile platform, and a robuBOX™, the generic robotic middleware based on Microsoft® Robotics Studio, that comes with every robot produced by ROBOSOFT: it allows providers of services to customize it and offer various services to their customers.”
Article
e-Health Europe, 2 January 2008

AHIMA to launch PHR campaign, Web site

“Health information professionals are hoping their Web site and an awareness campaign will lead individuals to begin maintaining their own personal health record.”
Article
Jean DerGurahian, Modern Healthcare Online, 27 September 2007

Group Seeks Interoperable Home Health

“An alliance of technology companies formed in the summer of 2006 to facilitate interoperability among home health devices, consumer health devices and health information systems is getting ready to unveil its initial guidelines.”
Article
Health Data Management, 12 September 2007

Lifestyle monitoring as a predictive tool in telecare

“Six people with multiple health problems living in an extra care housing scheme for older people with vision impairment agreed to take part in a telecare trial. An average of 14.8 sensors was installed in each of the flats. The monitoring period began in January 2006 and lasted for 10 months. The data acquired by the sensors installed in each flat was transmitted from the home unit to a central computer. Four interviews were conducted with each participant. Halfway through the study we created a number of case studies of sensor activity at the time of known events in the lives of the participants, together with an attempt to interpret these patterns of activity with the benefit of available contextual information. Although our investigation showed that sensors are capable of identifying some changes in daily routines at the time of important events, the interpretation of such changes requires a large amount of contextual information and the involvement of participants themselves. Various technical and operational difficulties will need to be resolved before it will be possible to use lifestyle monitoring predictively.”
Abstract
Hanson, Julienne; Osipovi?, Dorota; Hinew, Nick; Amaral, Telmo; Curry, Richard; Barlow, James, Journal of Telemedicine and Telecare, Volume 13, Supplement 1

Telehomecare as a solution to current healthcare issues

Arthur van Buitenen*, Patricia Esveld**, Catharina Meijer***
*Pleon BV Strategic Communications, NL
**It Cares BV, NL
***ThuiszorgOnline BV, NL

Abstract:

All our national healthcare systems eventually have to deal with the rising number of elderly people in society. This is what binds us in finding new ways of homecare, using ICT. This workshop is a format to come to concrete next steps in day-to-day practice.

Starting with a vision on future telehomecare and identifying stakeholders, we will demonstrate the opportunities of telehomecare. You will be encouraged to share your knowledge and experience in this area. The aim of the workshop is to come to concrete proposals for actions. After participating in this session, you will have a clear idea on what telehomecare is and how it diminishes pressure on healthcare systems……. starting tomorrow.

Telehomecare and Monitoring

Workhop Organizer:
Dr Malcolm Clarke, Brunel University, UK

This workshop presents papers from EC funded projects that would cover topics related to monitoring patients in the community. The group propose the following as papers

• Cost-Effective Health Services for Interactive Continuous Monitoring of Vital Signs Parameters - the e-Vital Concept
  A. Prentza, ICCS-NTUA, Biomedical Engineering Laboratory, Athens, Greece
  P. Angelidis, INA, Greece
  L. Leondaridis, NetSmart, Greece
  D. Koutsouris, ICCS-NTUA, Biomedical Engineering Laboratory, Greece
• Ambulatory Monitoring for Chronic Patients (eVital)
  K. Zarakovitis, Eurodiagnosi Medical SA, Greece
  P. Angelidis, INA, Greece
  Ch. Kourtidou-Papadeli, Iasis, Greece
  M. Psymarnou, Eurodiagnosi, Greece
• A new model for home care for COPD
  A. Alonso, Biomedical Information Systems. Hospital Clínic de Barcelona. Spain
• A new monitoring service for long term residential care (eVital)
  Tanja Brantan, Brunel University, Uxbridge, UK
  Russell Jones, Chorleywood Health Centre, UK
  Malsolm Clarke, Brunel University, Uxbridge, UK
• A reference architecture for telemonitoring (Telecare)
  Malcolm Clarke, Brunel University, Uxbridge, UK