Using e Health as a Tool in Neonatal

Using e. Health as a Tool in Neonatal Care at Home & Internet Based System for Chronic Heart Failure Follow-up at Home Anna Gund Ph. D Student Chalmers University of Technology ™

Outline • Background • Technical description • Applications – Heart Failure – Neonatal home care • Future • Demo!

Background

About Care@Distance ™ • Financed by VINNOVA and Ortivus AB • Began as a design project in 2001 • Ph. D project 2005 - 2011 • Teknologie licentiat, 2008 • Ph. D 2011? • Adj. Prof. Bengt Arne Sjöqvist, Prof. Kaj Lindecrantz

Challenges in Society • • • Aging population Chronic diseases Security and integrity Laws and directives Increasing demands Acceptance Costs “Information overflow” / work load CVD Distances Infections Causes of Death in Europe

Project Goals and Purposes • Improve treatment compliance and increase feelings of safety among patients by daily collection of health related data in the home. • Improve disease management, and support care givers in decision making. • Make personalized care possible, and create customized individualized care.

Project Goals and Purpose • Introduce and test a solution for early deterioration warning; warn about deteriorating health at an early stage, and to avoid information overflow. • Study how e. Health applications should be implemented in order to attain acceptance in the Swedish health care. • Investigate how to design business models for successful commercialization

Internet Based Solutions • Economic • Robust • Easy to maintain % • Easy to use • Accessible • Mobility • High internet usage in Sweden Internet Usage Among the Eldely in Sweden 60 50 40 30 Every week 20 Every day 10 0 2007 2008 2009 Year 2010

Our Solution

Care Personnel Internet Patients & Relatives Server ©Anna Gund Drawings by Pernilla Börjesson

Technical Description • • • MS SQL Server PHP Virtual Server at Chalmers – MS Server • • Patients use own computers Commercial medical measuring products – Blood pressure monitor from Omron ©

Objective vs Subjective • Both objective (signs) and subjective (symptoms) important! • How patient feels mirrors the disease. • Often symptoms are treated, not only signs.

Applications

Heart Failure • Heart Failure – 2% of western population – Most over 60 years of age – Chronic health disorder • Signs and Symptoms – Fatigue – Dyspnea – Weight gain (collection of fluid) – Weight loss (loss of appetite) ©

Previous trials - Survey • Performed at Östra Hospital, Gothenburg, 2007 • Evaluation of first prototype • Touch sensitive screen, installed program • 10 patients, tested system once at clinic • 8 out of 10 found the system easy to use • Blood pressure monitor difficult ©

Previous trials - Pilot • • Performed 2007 Test of first prototype in home environment 2 patients, 1 month Evaluated by semi-structured interviews Good compliance with system System easy to use Blood pressure monitor a big problem

Ongoing Study • • • Harshida Patel (Ph. D, nurse), Maria Schaufelberger (ÖL) Internet based prototype 13 patients, Östra Hospital Daily measurements at home – Weight – Blood pressure – Symptoms (with follow-up questions) First step - 6 months, finished in December Usability, acceptance, feelings of safety ©

Neonatal Care in the Home • Prematurely born children (before week 37) • When stable moved to home environment • Home visits by nurse 2 -3 times per week • Regular phone calls • In home care approximately 3 weeks ©

Ongoing Study • Kristina Bry (prof), Elisabet Hentz (ÖL), Erika Pedersen (nurse) • Large trial for 2 years – Follow-up after 6 months • Collaboration within VGR – Östra and Mölndal Hospital – Skövde (Kärnsjukhuset) – NÄL • • Internet based prototype Web camera communication using Skype ©

Ongoing Study • Internet based prototype – Parents answer subjective questions daily – Nurse measures weight, head circumference and length (Skövde) • Skype – Regular contact with parents – Web camera • Usability, acceptance, feelings of safety, care outcomes ©

Preliminary Results • Both Skype and Internet based prototype accepted by families • • Positive responses from all groups • Many families decline – Problems with information? • Acceptance more difficult among personnel than families – Important to get care personnel involved Skype-families tend to be very positive – Reduced need of home visits

Future Work • • • Extended trial on heart failure Other patient groups – Hypertension – COPD – Diabetes – Parkinson's and stroke – Depression – Combinations! © Information overflow – More or less advanced tools for decision support

Demo

Thank you! Questions? ™ anna. gund@chalmers. se www. care-at-distance. se Welcome to my dissertation December 9 at Chalmers!