RESEARCH

 

Background of the project

After a pre-study in E-Health financed by VINNOVA, a prototype based on the Activity Theory model was constructed to demonstrate the usability of mobile IT in mobile healthcare.  The prototype has drawn great interest, and a special seminar and demonstration was arranged by request of the company Hjort & Partner in Ronneby. After the seminar all participants from ALMI, Blekinge FoU-enhet, Barndiabetesförbundet Blekinge, Blekinge diabetesförening, Vårdcentralen Sölvesborg, together decided to further develop the IMIS in special focus on need of diabetic patients’ communication and information accessibility between all care-providers and their shared patients. A master thesis has also investigated the security and legal issues of the future application. A need study from both diabetic patients and care-providers’ perspective has also been done within the study. Based on the identified need, it is decided first to design a network-based communication system to support communication and accessibility to patients’ journal before and after the patient visiting a doctor or a nurse. 

 

Relevance to Vinnova’s programs

 According to the two themes of Vinnova’s programs, this project is to integrate the two themes into one system – an Integrated Mobile Information System for Diabetic Homecare (IMIS). First (patient in focus, program 1), the IMIS is to provide the diabetic patients with a mobile-network communication platform for homecare supervision, self-treatment, preparation before face-to-face diagnoses. Second (care provider in focus, program 2), the IMIS is to provide all care providers (doctors, nurses, relatives, etc.) with the same mobile-network communication platform as the patients to access and share the same and right information on right time for a seamless co-operative work among organizations and among persons.

  

Users perspective: The Need of Communication in Diabetic Healthcare

Most diabetic patients regularly contact with their care providers in various ways.  Studies in the USA and in Sweden showed that the self-treatment and supervision of diabetic patients can greatly increase their quality of their daily life if they are provided with reliable and easy access to their care providers (doctors, nurses, relatives, etc.). Also if care providers and diabetic patients are able to communicate with each other before the patient visits the care providers (if the visit is judged necessary after the communication), the quality of the visit is increased, and the quality of care or treatment of the visit gets even improved if they continue communicate after the visit. In Sweden, a guideline for diabetic healthcare stated that ‘To a good quality of diabetic healthcare there needs a team work in which diabetic patients are in centre. They need training, support, and supervising so they can take care themselves, control own situation, and self-treatment. They need to have access to the care team which consists of doctors with competence and interests for diabetic patients, and nurses special trained for diabetic care who can provide with patients good advices, and cooperate with dietician and foot therapist.’ Communication between all the team members are essential if the self- treatment of diabetic patients possible. The Audit Project Syd compared with self- treatment in relation to communication need in diabetic care indicates a strong need for a shared communication platform among care providers and patients.  Other good examples such as Tillit project in Umeå, and OVK project in Blekinge, are also focusing on the communication problem among care-providers and their patients.

The project ‘SMILE’ – a critical alarm system in Home Service conducted in Kalskrona municipality has gained some practical experience how to integrate new mobile technology into practical Home Service. It has been used for facilitating the Home Service by combining alarm, voice communication and information with SMS to handheld devices for the caretakers and has met great success.

The research on ‘Support Mobile Activities in the Municipal Care Work, conducted by the head applicant of this project last year, has led to some very concrete results and clarified framework or working model for further work on the specific application of diabetic healthcare. Especially a strong team has been established including members from municipality of Ronneb Blekinge Diabetesförening, County Council of Blekinge, Kalmar e-health Institute, and Blekinge Institute of Technology. A prototype based on theoretical study of the Activity Theory and preliminary field study has also constructed for demonstration.

 

Expected Results

It is evident from many previous studies mentioned in the above that a shared communication platform between care-providers and diabetic patients could increase greatly the quality, security, integrity, and reliability of patients' life, and also effectively reduce costs for unnecessary visits or delayed treatment. This project will practically verify this hypothesis by providing with such a shared communication platform in real.

The main goal of the project is to create an Internet based and shared communication platform for both diabetic patients and their care-providers (doctors, nurses, relatives, etc.), and thereby to increase the quality of daily life for diabetic patients and the quality of working life for care-providers.

 

Some concrete expected results from the project:

  1. A new software product - A network based and mobile information system (IMIS) that can be used by both patients and all care-providers so as to increase a seamless care chain (doctors, nurses, relatives, etc.). IMIS can be applied generally in different healthcare categories (primary care, home care, elderly care, etc.) to adapt different roles of care-providers (doctors, nurses, relatives, etc.) and also to different groups of patients (diabetic, other chronic diseases, disabled, elderly care, etc.). This will increase the integration of various existed healthcare systems.

  2. From patients perspective, the use of the IMIS system will reduce unnecessary visits with 25-40% through effective and easy access communication with their all care-providers.

  3. Increase co-operation among all care-providers.  The system will increase the access of patients information (journal) for all care-providers at any time and any place. This will also increase the mobility, freedom, and security of working life, and reduce the cost (time) by effective supervision of patients’ themselves at home.

  4. Enhanced network community between researchers (BTH), care-providers, and patients groups since the project group is a co-operative group among the three categories.

  5. Users’ (care-providers and patients) knowledge and capability of using IT will be increased by a training program on how to apply mobile IT in general and the IMIS platform in specific to access needed information for self-treatment and home supervision.

An important research goal is to identify a general and permanent activity model for healthcare by which various care-providers and care-receivers can communicate with each other, and meanwhile the model can integrate with existed applications and to expand to embed future applications. Along this research goal, at least two lic. theses and several scientific publications in international journals and conferences will be published.

 

Research theory, model, and technologies

The platform is based on the Activity Theory model that widely applied in complex social and organizational activity analysis, such as hospital care business. It covers all necessary information needed for carrying out an activity. In our project we innovatively apply the model as the architecture or skeleton for integration and construction of diversified databases. We also apply the model as activity analytical tool to abstract, identify, and condense the big and messy reality of the care business.

To the IMIS platform, the model in the above suggests at least six databases (components) to be constructed, i.e., (1) database for patients (object database) (2) database for care-providers (subject database) (3) tools or instrument base (e.g., alarm, schedule, journal)  (4) community network (5) laws, rules and norms applied in healthcare (6) labour division in healthcare.

The platform will be Internet based and linked to both mobile computers e.g., Nokia communicator, PDA, and stationary computers home with patients or care-providers.  Main program tools to construct the platform are PHP, SQL and Java in Web environment.  The development method is user centred (in this context, both care-providers and diabetic patients are users) and evolutionary prototyping. On line and embedded evaluation will be applied as an important feedback learning mechanism between the users and the designers.

 

The General Platform for Integration

IMIS is based on the general human activity theory and model, and the structure of the IMIS is suitable for all kinds of healthcare activities (primary care, intensive care, home care, elderly care, disabled care, etc.) and cross all healthcare organizations (among municipalities, counties, private care companies, and patients’ relatives). Therefore IMIS can be used to integrate and co-ordinate various healthcare activities under the same fundamental activity system. By sharing the same fundamental activity structure, the healthcare organizations can communicate with each other and have access to the right information no matter time and places world around.

The technology applied in IMIS is also based upon internationally accepted web technology and program language (Java, PHP). By applying those well accepted technologies and solutions, IMIS is not to create a new separate system, but to integrate existed systems (databases).

By modification of terminologies or language in the interface, IMIS also can be applied to international context as a general communication channel world around, and adapt to an international shared information exchange platform.

 

Working Plan and Feasibility

IMIS project has both short and long work plan. In the long run, it is to create a national and international communication channel for healthcare business. This is possible because the structure of the system is based on general activity model, and the model can be applied generally any activity system. The long effort is to connecting people (healthcare-providers and patients) to the system under the general category (databases) defined by the model. This future version of working plan is not included in the current application, but only as future continuous development after the project.

The short working plan will be within the economic budget and the period of three years to create a platform or prototype that focuses on the diabetic home healthcare. After the three years, the prototype will be handed over to IT companies (KHL, is to build up in Softcenter Ronneby) for software product development. Meanwhile, the project will investigate if the structure of IMIS as general as proposed to be able to integrate existed database and also expand to cover new needs of healthcare business. The users, both diabetic patients and all care-providers will participate in the development process (user centred design) and evaluate the system from users perspective. Users education how to use new technology will also be included in the current project plan.

 

Communicating and Expanding the Knowledge

The team of IMIS project consists of researchers from Blekinge institute of technology, users’ organizations from Blekinge diabetesförening, Barndiabetsförbundet, Hospital in Blekinge, project co-ordinator Gjort&Partner AB, and IT company KHL. This co-operative team is a complete knowledge transformation from research, product, and to practical use.

The process of the project includes users’ training program (for diabetic patients and nurses) by which the knowledge generated by the researcher will be successively transformed into practical use. Seminars and demonstrations are main methods for this purpose. Meanwhile, the team will publish scientific papers in international conference, such as ‘Communication in Healthcare’ and at least two licentiate theses will be also scheduled in the end of the project. The end report to Vinnova will include those outcomes for spreading out the result of the project world wide. The users’ groups (Blekinge diabetesförening, Barndiabetsförbundet Blekinge, vårdcentralen Sölvesborg, läkarstaion i Ronneby) will conduct an evaluation about IMIS usability in the end of the project. Through users evaluation report in the end of the project the knowledge generated in the project will reach users who have not participated in the design process.

 

Social Gender Effects

Home healthcare branch is traditionally dominated by female and seen as low paid job. Partly because low level application of modern technology, such as IT. IMIS can balance the role of healthcare to more attractive and modern branch and increase the social position of female healthcare practitioners.

 

References

  1. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 1989;12:365-8

  2. Rachmani R, Levi Z, Slavachevski I, Avin M, Ravid M. Teaching patients to monitor their risk factors retards the progression of vascular complications in high-risk patients with type 2 diabetes mellitus – a randomized prospective study. Diabet Med 2002;19:385-92.

  3. Nationella riktlinjer för vård och behandling vid diabetes mellitus – information till dig som har diabetes mellitus. Socialstyrelsen Stockholm, 1999.Bai G.H. & L-Å Lindberg (1998) “Dialectical Approach to Systems Development”, Systems Research and Behavioral Science, Vol.15 No.1, pp. 47-54.

  4. Omhändertagande av diabetespatienter i Blekinge vid primärvårdens och medicinklinikens diabetesmottagningar. Tema audit Blekinge FoU-enhet Karlshamn, Rapport 2002.

  5. Co-operation for Seamless Healthcare, Document of Seminarium I Kalmar 12-13 Nov. 2002. Kalmar e-health Institute. http://www.kalmare-health.org/ 

  6. Obruten Vårdkedja med IT-stöd (OVK), Tredje Utvärderingen, Barbro Sjöbeck, Meddelande från Belkinge Fou-enhet 2000:4.

  7. Engeström, Y. (1987) Learning By Expanding. Helsinki: Orienta Konsultit.

  8. Engeström Yrjö, Ritva Engeström and Tarja Vähäaho (1999) When The Center Does Not Hold: The Importance of Knotworking, in Activity Theory and Social Practice, Edited by Seth Chaiklin.

  9. Bai Guohua (1997) “Embryonic Approach to the Development of Information Systems”, Journal of Strategic Information Systems, Vol.6 No.4, pp. 299-311.

 

Other related references:

 

Svenska Kommunförbundet Vård, omsorg och socialt stöd i kommunal regi.

 

Svenska Kommunförbundet Aktuellt om äldreomsorgen.

 

CareLink, www.carelink.se.

 

Teldok rapport 119, Vårdkedjan och informationstekniken, Erfarenheter av datorstöd för sjukvård informationsfloder, Jenny Sågänger&Mats Utbult, http://www.teldok.org.

 

European Comission, www.cordis.lu/rtd2002/fp-debate/fp.htm.

 

Health Insurance Portability and Accountability Act (HIPAA), www.hfma.org/kn/hipaa.htm.