0000000000122198
AUTHOR
Rune Fensli
A SOA-based health service platform in smart home environment
The increasing demand for a good healthcare quality has brought Information and Communication Technology to an important role in healthcare domain. The trend in decreasing number of formal healthcare workers gives further pressure to move non-urgent treatments to the patients' homes. However, delivering healthcare services to meet the changing needs of inhabitants in a smart home requires an open and flexible service creation and integration environment so that the modification of existing services as well as creation of new services can be achieved in a timely manner. This paper presents a vision of a logical integration platform in a smart home environment, integrating various devices and…
User-centred Design of the User Interface of a Collaborative Information System for Inter-municipal Dementia Team
In the Norwegian Health sector there are currently undergoing changes at local, regional and national level triggered by recent health reforms. Municipalities are facing for first time the duty of implementing new primary health services. Inter-municipal coordination (IMC) health care teams have been created to operate across borders to share costs, extend geographical range of operation and optimise resources. This study focuses on the development and evaluation of the user interface (UI) functional prototype of a collaborative information system for IMC dementia team in Norway. Employing a user-centred design approach, the interface prototype was built based on the information gathered on…
Diagnostic Accuracy and Usability of the ECG247 Smart Heart Sensor Compared to Conventional Holter Technology
Background. Heart rhythm disorders, especially atrial fibrillation (AF), are increasing global health challenges. Conventional diagnostic tools for assessment of rhythm disorders suffer from limited availability, limited test duration time, and usability challenges. There is also a need for out-of-hospital investigation of arrhythmias. Therefore, the Norwegian ECG247 Smart Heart Sensor has been developed to simplify the assessment of heart rhythm disorders. The current study aimed to evaluate the diagnostic accuracy and usability of the ECG247 Smart Heart Sensor compared to conventional Holter monitors. Methods. Parallel tests with ECG247 Smart Heart Sensor and a Holter monitor were perform…
A REST-based publish/subscribe platform to support things-to-services communications
The term “Internet of Things” has been used widely in recent years, bringing up a grand idea of connecting physical objects with one another through both wired and wireless networks. Maturity of the Internet Protocol has pushed 21st century communications between devices to go all-IP, which includes everyday objects. Many new services are deployed in the “cloud”, utilising the Internet infrastructure and the Web, and information from everyday objects can play an important role. This paper presents an information integration platform which enables everyday objects to communicate with Internet services based on event-driven service-oriented architecture paradigm. A proof-of-concept prototype …
The EU project "United4Health": Results and experiences from automatic health status assessment in a Norwegian telemedicine trial system.
Introduction Patients with chronic obstructive pulmonary disease require help in daily life situations to increase their individual perception of security, especially under worsened medical conditions. Unnecessary hospital (re-)admissions and home visits by doctors or nurses shall be avoided. This study evaluates the results from a two-year telemedicine field trial for automatic health status assessment based on remote monitoring and analysis of a long time series of vital signs data from patients at home over periods of weeks or months. Methods After discharge from hospital treatment for acute exacerbations, 94 patients were recruited for follow-up by the trial system. The system supported…
Usability Evaluation of Electronic forms and Collaborative Assessment Report in an Inter-municipality Health Care team for Dementia Diagnose
Despite that paper-based medical procedures have historically been the most common way of registering and exchanging patient data; it does not avoid the potential risks of unauthenticated access; unregistered data loss; legibility and difficulty to share the data with third parties. The Coordination Reform 2009 (Samhandlingsreformen) has demanded from municipalities to implement health services for citizens based on electronic messaging that eases the access to and sharing of patient data. In the context of the Research project “Collaboration without borders” (Samhandling uten grenser); electronic forms and collaborative assessment report by videoconference have been usability tested in thi…
Critical issues for employees in inter-municipal health care services: a multiple case study
Abstract Background Traditional, hierarchical government structures have recently been challenged by increased complexity, fragmented services and heavy public demand. When healthcare services become fragmented and decentralised, they require redesign. Inter-municipal cooperation is a strategy to deal with current challenges and future demographic changes. Few studies exist that can help us conceptualize challenges regarding employment in this context and inform managers in the involved municipalities. This study aims to identify critical issues for employees in inter-municipal health care services and to elaborate on how and why these issues are experienced. Methods A multiple qualitative …
User Experiences and Satisfaction with an Electronic Health Record System
Electronic health records have a crucial role for communication and information management in health care organizations. Electronic health records have improved the access to up-dated medical information at the point-of-care, but they have also been linked to usability issues and user problems. This paper presents a study about the user experience among health care professionals regarding an electronic health record system in Norway. Qualitative research methods were used, with interviews and observations made at a university hospital, where 14 clinical end-users of an electronic health record system contributed. The aim was to study the user experiences and the user satisfaction regarding …
A Decision-support Algorithm for Self-management of Anticoagulation Therapy Used in a Smartphone Application
Warfarin for anticoagulation therapy is used by patients with specific cardiovascular diseases to control the ability of blood clotting. Traditional ways for self-management of the therapy are based on paper forms and procedures. This paper presents an algorithm developed for the smartphone application “Warfarin Guide”, which is a computer-assisted decision-support system used to help patients with self-management of their anticoagulation therapy related to International Normalized Ratio (INR) values. The algorithm was based on clinical guidelines for Warfarin therapy and it was adapted for the software application to address challenges with regular INR checks and adjustments for temporary …
Towards Improved Healthcare Performance: Examining Technological Possibilities and Patient Satisfaction with Wireless Body Area Networks
Published version of an article from the journal: Journal of Medical Systems. he original publication is available at Springerlink. http://dx.doi.org/10.1007/s10916-009-9291-8 This paper investigates the benefits of using less intrusive wireless technologies for heart monitoring. By replacing well established heart monitoring devices (i.e. Holter) with wireless ECG based Body Area Networks (BAN), improved healthcare performance can be achieved, reflected in (1) high quality ECG recordings during physical activities and (2) increased patient satisfaction. A small scale clinical trial was conducted to compare both technologies and the results illustrate that the wireless ECG monitor was able …
Clinical evaluation of a wireless ECG sensor system for arrhythmia diagnostic purposes
Accepted version of an article in the journal: Medical Engineering and Physics. Also available from the publisher at: http://dx.doi.org/10.1016/j.medengphy.2013.03.002 In a clinical study, a novel wireless electrocardiogram (ECG) recorder has been evaluated with regard to its ability to perform arrhythmia diagnostics. As the ECG recorder will detect a "non-standard" ECG signal, it has been necessary to compare those signals to "standard" ECG recording signals in order to evaluate the arrhythmia detection ability of the new system. Simultaneous recording of ECG signals from both the new wireless ECG recorder and a conventional Holter recorder was compared by two independent cardiology specia…
Design Requirements for a Patient Administered Personal Electronic Health Record
Published version of a chapter in the book: Biomedical engineering, trends in electronics, communications and software. Intech, 2011 Open Access
Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study
Published version of an article in the journal: BMC Health Services Research. Also available from the publisher at: http://dx.doi.org/10.1186/1472-6963-13-451 Open Access Background: Demographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice. Methods. A Delphi study of consensus development was …
Agder Living Lab: From Ideas to Large-Scale Deployment and Long-Term User Adoption of Inclusive Health Solutions
End-user involvement is a central part in the strategy of public and private organisations to generate user-driven innovative solutions to real-world problems. The Living lab concept is an instrument to create user-centered solutions, with almost 400 recognized in the European Network of Living Labs (ENoLL) since 2006. Living labs cover diverse topics, such as smart-cities, innovative learning and digital health. A national initiative in Southern Norway has funded the Agder Living Lab (ALL) for eHealth, a user-centered innovation environment participated by multisectorial public and private partners. ALL implements a quadruple-helix model represented by citizens, industry, academia and gove…
Sensor acceptance model:measuring patient acceptance of wearable sensors
Summary Objectives: This project focuses on how patients respond to wearable biomedical sensors, since patient acceptance of this type of monitoring technology is essential for enhancing the quality of the data being measured. There is a lack of validated questionnaires measuring patient acceptance of telemedical solutions, and little information is known of how patients evaluate the use of wearable sensors. Methods: In information systems research, surveys are commonly used to evaluate the user satisfaction of software programs. Based on this tradition and adding measures of patient satisfaction and health-related quality of life (HRQoL), a Sensor Acceptance Model is developed. The model i…
Telemedicine Follow Up of Chronic Obstructive Pulmonary Disease Integrated into a Patient-Centered Health Care Team-Setting Impacts on Patient Empowerment and Safety
Health care services are facing challenges with a growing ageing population prone to chronic conditions and multi-morbidities. Telemedicine applications have the potential to enhance patient’s safety at home by monitoring of chronic diseases, promoting coping and independence. The research project Patients and Professionals in Productive Teams aims to study patient-centered teamwork across organizational borders, supported by technology. This paper describes the research agenda for a study on how telemedicine follow-up impacts on chronic obstructive pulmonary disease patients’ quality of life and possible effects on patient empowerment, in the health region of Southern Norway. The outcome i…
Evaluation of international standards for ECG-recording and storage for use in tele-medical services
This report is written to clarify which of the international standards for ECG recordings that can be used in tele-medical services, where the recordings should be transmitted by wireless telecommunication facilities and finally stored as information integrated into the patients Electronic Health Record (EHR). Some principals for recording, transmission and storage of digital vital signs parameters are highlighted and important aspects of wireless communication of recorded signals from biomedical sensors are described, in order to understand the significance and differences in the storing formats to be used. Even if most of the relevant standards are not yet ratified (the last meeting in IS…
eHealth-Extended Care Coordination: Development of a Collaborative System for Inter-municipal Dementia Teams: A Research Project with a User-Centered Design Approach
- In Norway, a health reform was recently adopted to improve continuity of care. Services that were carried out in hospitals were transferred to municipalities. Small and medium size municipalities have established inter-municipal cooperation to provide specialized services across borders. The research project eHealth-extended Care Coordination studied the inter-municipal cooperation for assessment of dementia, identifying a need for improved communication and coordination. This paper presents the development process of a collaborative information system for dementia assessment using a user-centered design approach. Mixed methods, such as observations, semi-structured interviews and questio…
Reference Design for Smart Collaborative Telehealth and Telecare Services Based on IoT Technologies
The demographic development shows aging societies through-out the globe, leading to higher demands on the health and care systems due to age-related disabilities, chronic diseases, etc. Telehealth and telecare services for more efficient support of health and care providers are needed, which can be significantly improved by the continuous technological developments in areas such as sensor devices, Internet of Things (IoT), cloud services, and data analysis. This paper addresses the potential of selected emerging technologies to make eHealth systems smarter, more collaborative and more efficient. As a result of the analysis of the most promising technological trends, characteristics of futur…
Security, Reliability and Usability of mHealth Environments
Mobile technologies confer mobility and autonomy on patients with the advantage of access to home care and health care services on demand. However, these benefits impose challenges to the future health care services. For instance, computation capacity of a conventional smartphone provides applications and services with sufficient power of calculation and automation to assist in daily life activities and medical purposes. Combined with a user-friendly interface, mobile technologies can be an easy and efficient manner to help people who are in a condition of cognitive deterioration or have a chronic disease which demands a close connection to near family members and/or to health care services.
Remote ECG Monitoring by ECG247 Smart Heart Sensor
Background. Heart rhythm disorders are common and may be associated with serious complications. The quality of the ECG signal is crucial to detect and classify arrhythmias. Most available devices for assessment arrhythmias do not allow for remote monitoring. The Norwegian ECG247 Smart Heart Sensor is a new remote patch monitor developed to simplify the assessment of arrhythmias. This study was aimed at evaluating the quality of the ECG signal from the ECG247 Smart Heart Sensor compared to standard 12-lead ECG. Methods. ECG recordings with ECG247 Smart Heart Sensor and a standard 12-lead ECG recorder were performed in 97 volunteers at Sorlandet Hospital, Arendal, Norway, in 2019. All ECGs we…
Remote Patient Monitoring Within a Future 5G Infrastructure
Published version of an article from the journal: Wireless Personal Communications. The original publication is available at Spingerlink. http://dx.doi.org/10.1007/s11277-010-0078-5 Systems of wearable or implantable medical devices (IMD), sensor systems for monitoring and transmitting physiological recorded signals, will in future health care services be used for purposes of remote monitoring. Today, there exist several constraints, probably preventing the adoption of such services in clinical routine work. Within a future 5G infrastructure, new possibilities will be available due to improved addressing solutions and extended security services in addition to higher bandwidth in the wireles…
User-Centered Design of a National Medical Registry for Tick-Borne Diseases
Tick-borne diseases are increasing in a global perspective, with Lyme disease and tick-borne encephalitis as the most frequent. The Norwegian National Advisory Unit on Tick-borne Diseases is preparing the development of a national medical registry for clinical follow-up of patients with tick-borne diseases based on the best practice guidelines and for research purposes. This paper presents the methodological approach of a user-centered design process applied in the initial phase of the registry development. A user workshop identified user needs, requirements and proposed a service workflow for the registry operation. As the next step, a simulation of the proposed service workflow was perfor…
Recommendations of a Laboratory Infrastructure for Simulation of Telemedicine Services
In Norway, a health reform targeting coordination and continuity of care has urged municipalities to re-organize their services as there is an increasing use of remote monitoring and sensor technologies in citizens’ homes. In this context, the research project “Telemedicine Agder” is an opportunity to study the implementation, organization and operation of large scale telemedicine services, and identify the service models of the future. As part of the project, simulation of a telemedicine service for remote monitoring of diabetes II was tested in a clinical laboratory with key informants from municipalities, hospital and research partners. This paper presents the technical and physical infr…
Usability Evaluation of a Collaborative Health Information System - Lessons from a User-centred Design Process
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How to enhance digital support for cross-organisational health care teams? A user-based explorative study
Health care service provision of individualised treatment to an ageing population prone to chronic conditions and multimorbidities is threatened. There is a need for digitally supported care, that is, (1) person-centred, (2) integrated, and (3) proactive. The research project 3P, Patients and Professionals in Productive Teams, aimed to validate and verify the prerequisites for health care systems run with patient-centred service models. This paper presents an explorative study of the digital support of a cross-organisational health care team in Norway, providing services to elderly frail people with multimorbidities in hospital discharge transition. Qualitative research methods were employe…
Barriers to exchanging healthcare information in inter-municipal healthcare services: a qualitative case study
Abstract Background In recent years, inter-municipal cooperation in healthcare services has been an important measure implemented to meet future demographic changes in western countries. This entails an increased focus on communication and information sharing across organisational borders. Technology enables efficient and effective solutions to enhance such cooperation. However, the systems in the healthcare sector tend not to communicate with one another. There is a lack of literature focusing on communication and information sharing in inter-municipal healthcare services. The aim of this article is to investigate both the characteristics of communication and information sharing, and the f…
A Case Study of Technology Use and Information Flow at a Danish E-clinic
Author´s accepted manuscript (postprint). © 2020 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works. There is an urgent call from health organizations, health professionals and health authorities to re-design care delivery for patients with chronic conditions and multimorbidities. The research project 3P- Patients and Professionals in Productive Teams aims to study health…
Human Factors Affecting the Patient’s Acceptance of Wireless Biomedical Sensors
In monitoring arrhythmia, the quality of medical data from the ECG sensors may be enhanced by being based on everyday life situations. Hence, the development of wireless biomedical sensors is of growing interest, both to diagnose the heart patient, as well as to adjust the regimen. However, human factors such as emotional barriers and stigmatization, may affect the patient’s behavior while wearing the equipment, which in turn may influence quality of data. The study of human factors and patient acceptance is important both in relation to the development of such equipment, as well as in evaluating the quality of data gathered from the individual patient. In this paper, we highlight some impo…
An Approach Towards Information Quality Management of Electronic Health Records
Electronic Health Records (EHR) management systems, have gained attention in many countries as public organizations working in health domain (such as hospitals and municipalities) use them to lift the quality of health care. EHRs are considered as the basis for establishing Health Information Service (HIS) systems. In spite of remarkable advantages of EHRs, the lack of quality metrics can reduce the efficiency of high level systems that are based on them. Particularly, it is smart to design a mechanism to assure the quality of data generated by sensors. In this paper, we propose an architecture in which EHRs are enriched with metadata to provide the information quality. Our architecture emp…
The EU-project United4Health: User-centred design of an information system for a Norwegian telemedicine service.
Introduction Organizational changes of health care services in Norway brought to light a need for new clinical pathways. This study presents the design and evaluation of an information system for a new telemedicine service for chronic obstructive pulmonary disease patients after hospital discharge. Methods A user-centred design approach was employed composed of a workshop with end-users, two user tests and a field trial. For data collection, qualitative methods such as observations, semi-structured interviews and a questionnaire were used. Results User workshop’s outcome informed the implementation of the system initial prototype, evaluated by end-users in a usability laboratory. Several us…
The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly : Combined Scoping and Systematic Intervention Review
Source at https://doi.org/10.2196/12517. Background: There is a call for bold and innovative action to transform the current care systems to meet the needs of an increasing population of frail multimorbid elderly. International health organizations propose complex transformations toward digitally supported (1) Person-centered, (2) Integrated, and (3) Proactive care (Digi-PIP care). However, uncertainty regarding both the design and effects of such care transformations remain. Previous reviews have found favorable but unstable impacts of each key element, but the maturity and synergies of the combination of elements are unexplored. Objective: This study aimed to describe how the literature o…