Abstract

The home environment is different from the hospital and provides many unique challenges to the development of new home health care patient monitoring systems. Development of a home health care monitoring application requires that key issues be resolved. These requirements include: security, responsibility, mobility, ease of use, and event monitoring. In addition, data storage and synchronization, device to device communication, cost, and quality of care issues must be addressed. Background: There is increasing interest in using information and communication technologies (ICTs) in home care settings. The home environment poses a number of challenges, however, such as the varying levels of infrastructure support (i.e., electricity, connection to the Internet, lighting, etc.). Furthermore, home care can range from 'basic' home care visits to 'advanced' replacement of institutional based care. The objective of this paper was to identify the general technical requirements for developing home health care applications for patient monitoring based on experience from a pilot study following patients with diabetes.

Methods: The authors completed a review of the literature, examining a total of 95 articles. In addition to the review, the authors conducted a pilot project to develop a home health care application using the JAVA computer programming language to follow patients with diabetes in a community in Sweden. The authors defined patient monitoring in the home as ranging from patients and caregivers having remote contact with healthcare providers via ordinary or video telephony to patients carrying body sensors measuring physiological parameters, which are sent continuously or intermittently to a clinic.

Findings: The key difference between patient monitoring in the home versus in the hospital is infrastructure support. Hospitals typically use secure intranets and firmly tested and reliable instruments and tools, whereas the home setting relies upon insecure computer networks (ie. Internet), and may experience interference between the technology instruments and the medical devices used. A home health care system must control for security, changing responsibilities, mobility, ease of use, and event monitoring. Security is the technical methods and physical safeguarding of information stored and/or transferred on or between computer systems. Newly introduced technologies may result in changing roles for both the patient (and/or family) and the health care provider, and therefore the roles and responsibilities within all organizational levels must be understood. The mobility of the patient must be considered when developing a home monitoring application, since the requirements for patients may range from fully-mobile to immobile. Patients and health care professionals are not trained experts in the use of technology, and therefore, any application must consider usability issues to ensure that it is easy to use. Event monitoring must be integrated into the application to inform care providers of significant events in the patient's status to support decision-making regarding the patient's care.

The pilot study revealed that other issues must be considered when developing a new system. Patients often have different providers caring for them at the same times, implying a need for improved cooperation between caregivers from different organizations. There must be agreement on how data will be stored and synchronized across different systems, sources, and users (i.e., hospital, clinic, patient's home, medical devices). Other issues include: understanding who is responsible for the continued operation of equipment; understanding how different devices communicate with one another and/or how different devices may monitor a patient's status within the home or outside of the home. Besides these issues, cost and quality of care must be addressed.

Conclusions: The home environment is different from the hospital and provides many unique challenges to the development of new home health care patient monitoring systems. Development of a home health care monitoring application requires that key issues be resolved. These requirements include: security, responsibility, mobility, ease of use, and event monitoring. In addition, data storage and synchronization, device to device communication, cost, and quality of care issues must be addressed.

Reference: Lind L, Sundvall E, Karlsson D, Shahsavar N, Ahlfeldt H. Requirements and prototyping of a home health care application based on emerging JAVA technology. International Journal of Medical Informatics, 2002; 68, 129-139.