Personal Health Systems for Patient Self-management: Integration in Pervasive Monitoring Environments

Personal Health Systems for Patient Self-management: Integration in

Pervasive Monitoring EnvironmentsA.K. Triantafyllidis, V.G. Koutkias, I. Chouvarda, G.D. Giaglis and

N. Maglaveras

Lab of Medical InformaticsFaculty of Medicine, Aristotle University of Thessaloniki

Thessaloniki, [email protected]

MobiHealth 2010Ayia Napa, Cyprus

Presentation Outline

• Background:– Personal Health Systems– Patient Self-management– Pervasive Monitoring Systems

• Scope of the Current Work

• Proposed System:– Functional Attributes– System Architecture

• Results:– Prototype Implementation - Technical Feasibility

• Discussion and Future Work

Personal Health Systems for Patient Self-management: Integration in Pervasive Monitoring Environments

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Personal Health Systems

• Personal Health Information Management towards Wellness• Pervasive Health Monitoring: Anytime, Anywhere, Unobtrusive


Pervasive Health Monitoring Instruments & Situations

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Patient Self-management: Rationale

Rationale (K.R. Lorig, 2003#): “Whether one is engaging in a health promoting activity such as exercise or is living

with a chronic disease such as asthma, he or she is responsible for day-to-day management.”


#K.R. Lorig and H.R. Holman, “Self-management education: History, definition, outcomes, and mechanisms”, Ann Behav Med., vol. 26, no. 1, pp. 1-7, 2003.

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Patient Self-management : Benefits

Enhancement of communication with doctors

Focus on treatment plan, adherence

Self-efficacyConfidence to carry out a behavior/lifestyle necessary to reach a desired goal

Well-being better management


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Pervasive Monitoring Environments

Problems encountered in Health Information Managementby patients

– Limited User-to-System Interactions– Tight to the monitoring plan– Dedicated to the monitoring system functionality– Variable Context (Time – Location – Activity – Situation):

Inappropriate patient feedback


Limited patient involvement with respect to customization and filtering of information

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An Integrated Approach for Patient Self-management

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Target Users & Functionality


• Mobile Personal Health Management System (PHMS) targeted at Chronic Patients who:– Use Remote Monitoring Systems (RMSs)

– Are highly aware of their disease

– Wish to engage more actively in their disease management

• Functional Attributes:

– Patient self-reporting

– Configurations related to the value of the Monitoring Output to the patient

– Monitoring Output presentation preferences

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Patient-driven and Monitoring-driven Information(PDI & MDI)


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System Architecture


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Communication Infrastructure


• Service-Oriented Architecture (SOA):– SOAP (Simple Object Access Protocol)– WSDL (Web Service Description Language)

• Terminology Services:– UMLSKS (Unified Medical Language System

Knowledge Server)

Main Objective: PHMS & RMS Interoperability

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Example Web Service Operations


Patient MDI preferences MDI control

PHMS back-end – MBU interface PHMS back-end – RMS interface

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Patient Configuration Capabilities

• MDI Insertion into the PHR– Whether

• Yes, No and “Send notification” options – When

• Temporal Exceptions

• Presentation Preferences– Terminology (medical vocabulary in use)– MDI detail (e.g. inclusion of the conditions which lead

to the MDI generation)– Information Access Rights


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Example of Components Interaction:MDI Insertion


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Technical Feasibility

• Integration target:– Add-on to existing RMS with minimum configurations

• Requirement:– RMS Web Service Client layer for communication with the PHMS

Integrated & tested with Citizen Health System (CHS)

CHS characteristics:– Sensor-enhanced RMS with MBU– System back-end infrastructure based on Component Object

Model (COM) technology– System-generated feedback

• “Tip” e.g. “Reduce your salt-intake”


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Prototype Implementation


MBU• J2ME-CLDC (Java 2 Micro

Edition- Connected Limited Device Configuration)

– Open platform for mobile applications

• JSR-172 Web Services (Java Specifications Request)

– API for Web Service clients

• Bouncy Castle Crypto API– AES Data encryption

PHMS back-end• Apache Tomcat

– Web application container

• Apache Axis2– Underlying SOAP engine

• SMS Gateway– Needed for “push” operations

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MBU Demo Snapshots (SmartPhone)


Alert generated as MDI into PHMS

Integration of MDI and PDI in patient’s PHR

Insertion of MDI with temporal exceptions

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Discussion: Future Work


• Extensive Evaluation:– Usability aspects– Patient acceptance– Medical perspective

• Integration of appropriate self-management methodologies:– Goal-setting approach

• Elaborate on a generic methodology integrating:– Patient preferences and observations– Handling of context parameters, e.g. location, activity, etc.– Behavioral monitoring based on user-to-system interactions

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Thank you!!!

Personal Health Systems for Patient Self-management: Integration in

Pervasive Monitoring EnvironmentsA.K. Triantafyllidis, V.G. Koutkias, I. Chouvarda, G.D. Giaglis and

N. Maglaveras

Lab of Medical InformaticsFaculty of Medicine, Aristotle University of Thessaloniki

Thessaloniki, [email protected]

Technology

Personal Health Systems for Patient Self-management: Integration in Pervasive Monitoring Environments