Les maladies chroniques impliquant le système respiratoire nécessitent un suivi sur la durée. L’activité physique et les paramètres cardiovasculaires sont essentiels pour ces pathologies. Nous nous sommes intéressés en particulier à la BPCO et à l’apnée obstructive du sommeil. La BPCO est caractérisée par un cercle vicieux d’inactivité : une gêne respiratoire entraîne une diminution de l’activité, qui elle-même augmente la gêne respiratoire par désentraînement. Le monitoring de l’activité, en lien avec la SpO2 est donc essentiel pour cette pathologie. Les désaturations nocturnes sont un paramètre cardinal de l’apnée du sommeil. Un actimètre permet d’évaluer la qualité du sommeil, complétant ainsi le suivi de cette pathologie. De plus, l’activité diurne est un indicateur de l’asthénie provoquée par le syndrome. Le but de ce travail a donc été la mise au point d’un actimètre communicant, capable de mesurer l’activité diurne, d’évaluer le temps de sommeil et de s’interfacer avec un oxymètre de pouls pour synchroniser la collecte de données. À partir des données récoltées durant 26 jours d’enRégistrements, nous avons mis au point et évalué un algorithme permettant de mesurer le temps passé assis, debout et allongé. Cet algorithme a été conçu pour être embarqué dans un microcontrôleur, ayant des ressources de calcul limitées. Nous avons également proposé un algorithme de détection des pas, dont le fonctionnement a été validé sur plus de 5 heures de marche, sur 22 patients différents, contre un comptage manuel. Nous avons enfin proposé une méthode de détection des transitions assis-debout pour l’instrumentation du test de levers de chaise de 3 minutes. Lors de l’analyse nocturne, nous avons mis au point un algorithme de détection du temps de sommeil, testé sur 25 nuits. Nous avons également proposé une méthode d’analyse de l’onde de pouls permettant d’extraire le rapport LF/HF de la variabilité cardiaque, permettant de détecter le sommeil paradoxal. Nous avons montré le résultat de l’agrégation des différentes données acquises par le système formé de l’actimètre et de l’oxymètre lors d’une nuit d’examen, comme outils à disposition du praticien. L’actimètre mis au point dans le cadre de ces travaux et les méthodes d’analyse du signal associées sont adaptés au suivi non invasif de pathologies respiratoires. Ils peuvent également être intégrés à un système de télémédecine via une passerelle informatique pour un suivi de long terme. / Chronic diseases affecting the respiratory system require a long-term monitoring. Physical activity and cardiovascular parameters are essential in those pathologies. We focused on two of those diseases : COPD and obstructive sleep apnea. COPD is characterized by a downward cycle of inactivity : a respiratory impairment leads to a reduction of activity, whose in turn worsen the respiratory impairment by a conditioning loss. As a consequence, activity monitoring and SpO2 are essential for the monitoring of this pathology. Nocturnal oxygen desaturation are a main feature of sleep apnea. An actimeter allows for sleep quality evaluation, and is a logical choice for a complementary measure of this disease. Moreover, diurnal activity is an indicator of the degree of physical weakness that can occur as a consequence of sleep apnea. The main goal of the work has been the developement of a connected actimeter, able to monitor diurnal activity, estimate the duration of sleep and collect data from a pulse oximeter to synchronise the data. From 26 days of accelerometric measures, we designed and validated an algorithm that compute the time spend sitting, standing and lying. This algorithm has been designed to be embedded in a microcontroler with limited computing power. We also proposed a step detection algorithm validated on 5 hours of walking, on 22 different patients, against a visual count. Finally, we designed a method to detect the sitting-standing change of posture to monitor the 3-minutes chair stand test. On the nocturnal aspect, we designed an algorithm used to estimate the sleep duration during a night. It as been tested on 25 nights. We also proposed a pulse wave analysis method to extract the LF/HF ratio of cardiac variability, to detect REM sleep. We showed the result of the aggregation of the different parameters collected by the system composed of the actimeter and the oximeter during a monitored night, as a tool to the healthcare professional. The actimeter design in the context of this work and the associated signal processing methods are appropriate to the monitoring of respiratory pathologies with a light equipment. They also can be integrated into a telemedecine system through a gateway computer, allowing for a long-term monitoring.

Aufgabenstellung: Die Europäische Kommission strebt an, die Zahl der Getöteten im Straßenverkehr in der EU bis zum Jahr 2010 zu halbieren, unter anderem durch Einsatz von Telemedizin in der präklinischen Notfallrettung. Ziel dieser Arbeit ist die Untersuchung der Kosten-Wirksamkeit von Telemedizinsystemen für die präklinische Notfallrettung bei Verkehrsunfällen in Deutschland. Methodik: Aus Sicht der Gesellschaft und der Krankenkassen werden drei Varianten eines Telemedizinsystems mit dem Status Quo in Deutschland, das heißt dem "Nicht-Einsatz von Telemedizin" in der präklinischen Notfallrettung, verglichen. Die Analyse erfolgt auf Basis retrospektiv erhobener Daten für einen Zeithorizont von zehn Jahren. Berücksichtigt werden Systemkosten, Kosten der Personenschäden und Strukturkosten des Rettungsdienstes. Diese werden diskontiert und nicht inflationsbereinigt. Der Nutzen wird mittels gewonnener Lebensjahre durch die Verkürzung des therapiefreien Intervalls und die Verbesserung der Laienhilfe gemessen. Aufgrund der Uneinheitlichkeit der Daten werden Annahmen und Abschätzungen getroffen. Ergebnis: Im Basisergebnis ist der Kosten-Wirksamkeits-Quotient für die Variante "Telemedizin für Laienhelfer" (299.366 Euro pro gewonnenes Lebensjahr) höher als für die Variante "Automatische Unfallmeldung" (247.977 Euro pro gewonnenes Lebensjahr). Den besten Kosten-Wirksamkeits-Quotient erzielt die Vollausstattung mit 239.524 Euro pro gewonnenem Lebensjahr. Im Rahmen von multivariaten Sensitivitätsanalysen (best und worst case scenario) wird festgestellt, dass eine Senkung der Systemkosten die Gesamtkosten überproportional reduziert und dass durch eine schnelle Marktdurchdringung der Kosten-Wirksamkeits-Quotient des Telemedizinsystems deutlich verbessert werden kann. Fazit: Für alle drei Varianten des Telemedizinsystems werden hohe Kosten pro gewonnenes Lebensjahr erwartet. Eine Einführung dieser Systeme erscheint nur in einer abgestimmten europäischen Vorgehensweise realistisch. / Objective: Since the European Commission set a goal of reducing the number of road accident deaths across the EU by 2010 to one half, the use of telemedicine for pre-clinical traffic accident emergency rescue is very high on the agenda. The purpose of this study is to assess the cost-effectiveness of telemedical devices for pre-clinical traffic accident emergency rescue in Germany. Methods: Three telemedical devices are compared from the perspective of society and health insurance with baseline assumptions in Germany, i.e. the non-application of telemedicine in pre-clinical emergency rescues. The analysis is based on retrospective statistical data covering a period of ten years. Costs resulting from telemedical device, personal injury, wasted journeys and erroneous dispatching of rescue services are discounted and not adjusted for inflation. The outcome is measured in terms of "life years gained" by reducing therapy-free intervals and improvements in first-aid provided by laypersons. Due to the uncertainty of data, certain assumptions and estimates are necessary. Results: In the base case scenario the cost-effectiveness ratio of the device "Telemedicine for laypersons" (Euro 299,366 per life year gained) would be higher than of the "Automatic Accident Alert" (Euro 247,977 per life year gained). The full equipment device has the best cost-effectiveness ratio (Euro 239,524 per life year gained). Multi-way sensitivity-analysis with best and worst case scenarios show that decreasing costs of telemedical device would disproportionately reduce total costs, and that rapid market penetration would largely increase the cost-effectiveness ratio of the devices. Conclusion: The net costs per life year gained in the application of the three telemedical devices are estimated as quite high. The implementation of the devices seems only realistic as part of a larger European co-ordinated initiative.

The overall aim of this thesis was to develop, deploy and evaluate new IT-based methods for supporting treatment and assessment of treatment of advanced Parkinson’s disease. In this condition a number of different motor and non-motor symptoms occur in episodes of varying frequency, duration and severity. In order to determine outcome of treatment changes, repeated assessments are necessary. Hospitalization for observation is expensive and may not be representative for the situation at home. Paper home diaries have questionable reliability and storage and retrieval of results are problematic. Approaches for monitoring using wearable sensors are unable to address important non-motor symptoms. A test battery system consisting of both self-assessments of symptoms and motor function tests was constructed for a touch screen mobile phone. Tests are performed on several occasions per day during test periods of one week. Data is transmitted over the mobile net to a central server where summaries in different symptom dimensions and an overall test score per patient and test period are calculated. There is a web application that graphically presents the results to treating clinical staff. As part of this work, a novel method for assessment of spiral drawing impairment useful during event-driven sampling was developed. To date, the system has been used by over 100 patients in 10 clinics in Sweden and Italy. Evidence is growing that the test battery is useful, reliable and valid for assessment of symptoms during advanced Parkinson’s disease. Infusion of a levodopa/carbidopa gel into the small intestine has been shown to reduce variation in plasma drug levels and improve clinical response in this patient category. A pharmacokinetic-pharmacodynamic model of this intestinal gel infusion was constructed. Possibly this model can assist the process of individualization of dosage for this treatment through in numero simulations. Results from an exploratory data analysis indicate that severity measures during oral levodopa treatment may be factors to consider when deciding candidates for infusion treatment.

A challenge for the clinical management of Parkinson's disease (PD) is the large within- and between-patient variability in symptom profiles as well as the emergence of motor complications which represent a significant source of disability in patients. This thesis deals with the development and evaluation of methods and systems for supporting the management of PD by using repeated measures, consisting of subjective assessments of symptoms and objective assessments of motor function through fine motor tests (spirography and tapping), collected by means of a telemetry touch screen device. One aim of the thesis was to develop methods for objective quantification and analysis of the severity of motor impairments being represented in spiral drawings and tapping results. This was accomplished by first quantifying the digitized movement data with time series analysis and then using them in data-driven modelling for automating the process of assessment of symptom severity. The objective measures were then analysed with respect to subjective assessments of motor conditions. Another aim was to develop a method for providing comparable information content as clinical rating scales by combining subjective and objective measures into composite scores, using time series analysis and data-driven methods. The scores represent six symptom dimensions and an overall test score for reflecting the global health condition of the patient. In addition, the thesis presents the development of a web-based system for providing a visual representation of symptoms over time allowing clinicians to remotely monitor the symptom profiles of their patients. The quality of the methods was assessed by reporting different metrics of validity, reliability and sensitivity to treatment interventions and natural PD progression over time. Results from two studies demonstrated that the methods developed for the fine motor tests had good metrics indicating that they are appropriate to quantitatively and objectively assess the severity of motor impairments of PD patients. The fine motor tests captured different symptoms; spiral drawing impairment and tapping accuracy related to dyskinesias (involuntary movements) whereas tapping speed related to bradykinesia (slowness of movements). A longitudinal data analysis indicated that the six symptom dimensions and the overall test score contained important elements of information of the clinical scales and can be used to measure effects of PD treatment interventions and disease progression. A usability evaluation of the web-based system showed that the information presented in the system was comparable to qualitative clinical observations and the system was recognized as a tool that will assist in the management of patients.

Το αντικείμενο της διατριβής αυτής είναι η εισαγωγή ενός νέου πρωτοκόλλου (e-SCP-ECG+) με στόχο την μεταφορά και διαχείριση πολλαπλών τύπων πληροφορίας που προέρχονται από ιατρικές συσκευές συλλογής ζωτικών σημάτων, δεδομένα που αφορούν τις αλλεργίες από τις οποίες υποφέρει ο ασθενής, στοιχεία γεωτοποθεσίας, καθώς επίσης και δημογραφικών στοιχείων, από τους ασθενείς σε υπολογιστικούς σταθμούς επεξεργασίας, διαχείρισης και αποθήκευσής της. Ορίζεται επίσης η αρχιτεκτονική ενός Συστήματος Τηλεπαρακολούθησης Υγείας Ασθενούς (ΣΤΥΑ), το οποίο χρησιμοποιεί το πρωτόκολλο e-SCP-ECG+ για τη μεταφορά, τη διαχείριση και την αρχειοθέτηση της συλλεγόμενης πληροφορίας. Η αρχιτεκτονική περιλαμβάνει, επίσης, τη δημιουργία ενός Δικτύου από ΣΤΥΑ, με στόχο την δικτυακή αναζήτηση πληροφορίας σχετικής με τον ασθενή, εξασφαλίζοντας έτσι τη δυνατότητα του ελέγχου της πορείας της υγείας ενός ασθενούς. Το ΣΤΥΑ πέρα από την λειτουργία του σε εργαστηριακό επίπεδο, δοκιμάστηκε πιλοτικά σε πραγματικές συνθήκες. / This dissertation introduces a new protocol named e-SCP-ECG+, which permits the transport and management of multiple information types collected from patients (vital signs, citizen demographic data, other information relative with the treated incident, allergy data, geolocation data, etc.), through a communication network to a Health Reception Center. The dissertation also defines the architecture of a Health Tele-monitoring System (HTS) aiming to protocol’s application and evaluation. The pilot HTS, uses the protocol e-SCP-ECG+, in order to transmit, manage and archive the collected information. The creation of an HTS’s Network is also included in this architecture. This network supports health continuity and gives doctor the ability to search information relative to the patient between different networked HTSs. The pilot HTS, has been tested both on laboratory conditions and in real-world operation.

La téléréadaptation, tout comme d’autres champs en télésanté, est de plus en plus interpelée pour la prestation de services. Le but de ce projet de thèse est d’enrichir l’évaluation de la téléréadaptation afin que les connaissances qui en découlent puissent venir soutenir la prise de décision d’acteurs impliqués à différents niveaux en téléréadaptation. Le premier article présente une revue systématique dont l’objectif était de faire synthèse critique des études en téléréadaptation. La revue rassemble 28 études en téléréadaptation, qui confirment l’efficacité de la téléréadaptation pour diverses clientèles dans différents milieux. Certaines des études suggèrent également des bénéfices en termes de coûts, mais ces résultats demeurent préliminaires. Cette synthèse critique est utile pour soutenir la décision d’introduire la téléréadaptation pour combler un besoin. Par contre, les décideurs bénéficieraient aussi de connaissances par rapport aux changements cliniques et organisationnels qui sont associés à la téléréadaptation lorsqu’elle est introduite en milieu clinique. Les deux autres articles traitent d’une étude de cas unique qui a examiné un projet clinique de téléréadaptation dans l’est de la province de Québec, au Canada. Le cadre conceptuel qui sous-tend l’étude de cas découle de la théorie de structuration de Giddens et des modèles de structuration de la technologie, en particulier de l’interaction entre la structure, l’agent et la technologie. Les données ont été recueillies à partir de plusieurs sources (groupes de discussion, entrevues individuelles, documents officiels et observation d’enregistrements) suivi d’une analyse qualitative. Le deuxième article de la thèse porte sur le lien entre la structure, l’agent et la culture organisationnelle dans l’utilisation de la téléréadaptation. Les résultats indiquent que les différences de culture organisationnelle entre les milieux sont plus évidentes avec l’utilisation de la téléréadaptation, entraînant des situations de conflits ainsi que des occasions de changement. De plus, la culture organisationnelle joue un rôle au niveau des croyances liées à la technologie. Les résultats indiquent aussi que la téléréadaptation pourrait contribuer à changer les cultures organisationnelles. Le troisième article examine l’intégration de la téléréadaptation dans les pratiques cliniques existantes, ainsi que les nouvelles routines cliniques qu’elle permet de soutenir et la pérennisation de la téléréadaptation. Les résultats indiquent qu’il y a effectivement certaines activités de téléréadaptation qui se sont intégrées aux routines des intervenants, principalement pour les plans d’intervention interdisciplinaire, tandis que pour les consultations et le suivi des patients, l’utilisation de la téléréadaptation n’a pas été intégrée aux routines. Plusieurs facteurs en lien avec la structure et l’agent ont contraint et facilité l’intégration aux routines cliniques, dont les croyances partagées, la visibilité de la téléréadaptation, le leadership clinique et organisationnel, la disponibilité des ressources, et l’existence de liens de collaboration. La pérennité de la téléréadaptation a aussi pu être observée à partir de la généralisation des activités et le développement de nouvelles applications et collaborations en téléréadaptation, et ce, uniquement pour les activités qui s’étaient intégrées aux routines des intervenants. Les résultats démontrent donc que lorsque la téléréadaptation n’est pas intégrée aux routines cliniques, elle n’est pas utilisée. Par contre, la téléréadaptation peut démontrée certains signes de pérennité lorsque les activités, qui sont reproduites, deviennent intégrées aux routines quotidiennes des utilisateurs. Ensemble, ces études font ressortir des résultats utiles pour la mise en place de la téléréadaptation et permettent de dégager des pistes pour enrichir le champ de l’évaluation de la téléréadaptation, afin que celui-ci devienne plus pertinent et complet, et puisse mieux soutenir les prises de décision d’acteurs impliqués à différents niveaux en téléréadaptation. / Telerehabilitation, like other telehealth applications, has been increasingly used to provide health services. The goal of this thesis is to enrich the field of telerehabilitation evaluation such that it can better contribute to informed decision making of those involved in telerehabilitation at different levels. The first article is a systematic review of telerehabilitation studies and it was conducted in order to provide a critical synthesis of the current telerehabilitation literature. The revue included 28 studies of telerehabilitation, which, overall, confirmed the efficacy of telerehabilitation when used with a variety of clienteles in different settings. Some of the studies also suggest that there may be some cost benefits associated with telerehabilitation although the findings remain preliminary. Such a synthesis of the literature can contribute to some decisions regarding the pertinence of introducing telerehabilitation. However, decision makers also need information regarding the clinical and organizational changes that are associated with telerehabilitation when implemented in a clinical setting. The next two articles contain the results of a single case study that was centered on a telerehabilitation clinical project implemented in the eastern part of the province of Quebec, in Canada. A conceptual model was developed to guide this study, and it was based on Giddens’ Theory of Structuration and on models of technology structuration, in particular drawing upon the notion of the interaction between structure, agent and technology. Data was collected from several sources (focus groups, interviews, official documents and observation of recordings) and was analyzed using a qualitative analysis approach. The second article in this thesis examined the relationship between structure, agent and organizational culture with respect to telerehabilitation use. The results indicate that differences in organizational culture between the centres are more visible when telerehabilitation is used, which can in some cases lead to conflicts, while in other cases create opportunities for change. In addition, organizational culture also played a role in shared beliefs linked to the technology. Lastly, the results suggest that telerehabilitation could be used to bring about changes in organizational culture. The third article examined how telerehabilitation became integrated into existing clinical practices, how it contributed to the development of new routines and explored the sustainability of telerehabilitation. The results indicate that some activities, namely interdisciplinary care plans were integrated into clinical routines, while consultations and patient follow-up were not. Several factors related to the structure and agent were found to facilitate or hinder the integration of telerehabilitation into routine practices, including shared beliefs, the visibility of telerehabilitation activities, the clinical and organizational leadership, the availability of resources and the existence of collaborations. Sustainability was also observed when telerehabilitation use became more generalized and novel applications were developed, although this was only found to occur for activities which had integrated into routine practice. The results therefore suggest that when telerehabilitation is not integrated into routine practices, it will not be used, but that, on the other hand, telerehabilitation may be sustainable for activities which are repeated and then integrated into routine day-to-day clinical activities. Together, these studies put forth findings which can be useful when implementing new telerehabilitation programs. They also help elucidate directions for future research in order to enrich the field of telerehabilitation evaluation so that it may become more pertinent and comprehensive to support decision-makers involved at all levels of telerehabilitation.

But : La radiothérapie (RT) est disponible seulement dans les grandes villes au Québec. Les patients atteints de cancer vivant en zone rurale doivent voyager pour obtenir ces soins. Toute proportion gardée, moins de ces patients accèdent à la RT. L’accessibilité serait améliorée en instaurant de petits centres de RT qui dépendraient de la télémédecine (téléRT). Cette étude tente (1) de décrire un modèle (population visée et technologie) réaliste de téléRT; (2) d’en estimer les coûts, comparativement à la situation actuelle où les patients voyagent (itineRT). Méthode : (1) À l’aide de données probantes, le modèle de téléRT a été développé selon des critères de : faisabilité, sécurité, absence de transfert des patients et minimisation du personnel. (2) Les coûts ont été estimés du point de vue du payeur unique en utilisant une méthode publiée qui tient compte des coûts en capitaux, de la main d’oeuvre et des frais généraux. Résultats : (1) Le modèle de téléRT proposé se limiterait aux traitements palliatifs à 250 patients par année. (2) Les coûts sont de 5918$/patient (95% I.C. 4985 à 7095$) pour téléRT comparativement à 4541$/patient (95%I.C. 4351 à 4739$) pour itineRT. Les coûts annuels de téléRT sont de 1,48 M$ (d.s. 0,6 M$), avec une augmentation des coûts nets de seulement 0,54 M$ (d.s. 0,26 M$) comparativement à itineRT. Si on modifiait certaines conditions, le service de téléRT pourrait s’étendre au traitement curatif du cancer de prostate et du sein, à coûts similaires à itineRT. Conclusion : Ce modèle de téléRT pourrait améliorer l’accessibilité et l’équité aux soins, à des coûts modestes. / Purpose: Radiotherapy (RT) is centralized in urban areas in Quebec. Patients with cancer living in remote areas must travel to receive RT, and the proportion of RT patients is inferior to that of urban patients. Telemedicine could allow a minimally staffed RT unit to operate at reasonable costs in a rural setting. This study aims (1) to outline a feasible structure and target population for a tele-radiotherapy unit (teleRT); and (2) to estimate the costs of teleRT, compared to the current situation based on travel to urban centres (travelRT). Methods and Materials: (1) We developed an evidence-based teleRT model meeting the criteria of: feasibility & safety, elimination of patient travel, and minimisation of staff migration. (2) Costs were estimated from the public payor perspective using a previously published activity-based costing model for RT. The model included annualized capital costs, labour, and overhead. Results: (1) In our model, teleRT was restricted to 250 palliative care patients per year. (2) The public payor cost of teleRT was 5918$/patient (95% C.I. 4985 to 7095$) as compared to 4541$/patient (95%C.I. 4351 to 4739$) for travelRT. Yearly costs of the teleRT unit was 1,48 M$ (s.d. 0,6 M$), with a net cost increase to the payor of 0,54 M$ (s.d. 0,26 M$) compared to travelRT. Under less stringent conditions, breast and prostate cancer patients could also benefit from teleRT at similar costs to travelRT. Conclusion: Establishing a teleRT unit to treat a small rural population of palliative care patients results in a modest net increase in cost to the public payor and could lead to increased accessibility and equity.

Στην παρούσα διδακτορική διατριβή εξετάζονται οι δυνατότητες που προσφέρουν τα έξυπνα κινητά τηλέφωνα (smartphones) στην παροχή υπηρεσιών φροντίδας σε άτομα με χρόνιες παθήσεις, μέσω των τεχνολογιών τηλεματικής. Για το σκοπό αυτό μελετήθηκε, σχεδιάστηκε και αναπτύχθηκε ένα δίκτυο φορετών ασύρματων αισθητήρων για την αναγνώριση της φυσικής δραστηριότητας, το οποίο καταγράφει δεδομένα της κίνησης και βιολογικά σήματα, τα οποία στη συνέχεια επεξεργάζονται για την αναγνώριση της δραστηριότητας που εκτελείται, σε πραγματικό χρόνο. Σε σχέση με τις μέχρι σήμερα προσεγγίσεις, στην παρούσα εργασία γίνεται συγκριτική μελέτη πολλαπλών τεχνικών αναγνώρισης προτύπων καθώς και τεχνικών που δεν έχουν χρησιμοποιηθεί μέχρι σήμερα, ενώ γίνεται εξέταση των αποτελεσμάτων που προκύπτουν κάνοντας χρήση του συνδυασμού μικρότερου αριθμού δεδομένων. Η πληροφορία της αναγνώρισης της φυσικής δραστηριότητας συνδυάζεται στη συνέχεια με περιβαλλοντικά δεδομένα, ώστε να μελετηθούν τα μοτίβα της καθημερινής δραστηριότητας υγειών ατόμων και ατόμων με χρόνιες παθήσεις. Με την αναζήτηση Emerging Patterns στα αποθηκευμένα δεδομένα, εξετάζεται ο βαθμός συμμόρφωσης στις ιατρικές οδηγίες, αλλά οι δυνατότητες πρόβλεψης των βραχυπρόθεσμων και μακροπρόθεσμων επιπλοκών των χρόνιων παθήσεων. / The present PhD thesis examines the potentials of the usage of the smartphones in order to offer health services to patients with chronic diseases. A wearable wireless sensor network designed and developed in order to record body movement and biosignal data. Physical activity recognition techniques are applied to the recorded data, so that to extract the actual activities performed, in real time. In contrast to the research that has been carried out till today, an extensive comparison between different pattern recognition techniques is performed using all the recorded data and a reduced number of them, applying newly proposed pattern recognition. Furthermore, the recognized physical activities are combined with environmental data, in order to study the daily activity patterns of healthy persons and persons with chronic diseases. Searching for Emerging Patterns in the data, patient conformance to the medical advices, along with short and long term complications of chronic diseases are examined.

Thesis (MEng)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: South Africa’s health sector has not yet shown enough improvement to reach the Millennium Development Goals related to health. One of the problem areas is the low infant and child vaccination coverage in certain areas of South Africa. The use of mobile phones in health care (mHealth) has the potential to strengthen the primary health care system through improved information management. A mobile health solution for vaccination (MHSV) can be used to improve information management of vaccinations, which in turn can improve vaccination coverage. However, the feasibility of implementing such an MHSV in the South African context is unknown. This study therefore investigates the feasibility of using mobile phones to improve information management for child vaccinations in South Africa. Feasibility is determined by using a feasibility framework together with business model development. The feasibility framework, which is informed by a literature study, surveys and a case study, determines the feasibility of an MHSV in terms of human factors, technical feasibility, information management, policies and ethics, and economics. It is found that an MHSV is feasible in South Africa, although certain areas pose challenges that will have to be considered. Complementing the feasibility framework, business models are developed to suggest possible ways in which an MHSV can be deployed in South Africa. These models build on the results from the feasibility framework and are developed using Osterwalder’s business model canvas. The effect of the National Health Insurance (NHI) on these business models is also examined. In order to validate the feasibility framework and business models, interviews were held with experts in health care and mobile phone solutions. These interviews show that the research is valid and that the feasibility framework and business models can be generalised to the wider field of mHealth solutions. / AFRIKAANSE OPSOMMING: Suid-Afrika se gesondheidsektor het nog nie genoeg verbetering getoon om die gesondheidsverwante Millenium Ontwikkelingsdoelwitte te bereik nie. Een van die probleemareas is die besondere lae inentingsdekking van babas en kinders in sekere gebiede van Suid-Afrika. Die gebruik van selfone vir gesondheidsorg hou die potensiaal in om die primêre gesondheidsorgstelsel te versterk deur inligtingsbestuur te verbeter. ’n Inentingsoplossing wat gebruik maak van selfone, bekend as ‘n “mobile health solution for vaccination” (MHSV), kan inligtingsbestuur van inentings verbeter, wat hoër inentingsdekking tot gevolg kan hê. Die haalbaarheid van die implementering van so ’n MHSV in die konteks van Suid-Afrika is egter onbekend. Hierdie studie ondersoek dus die haalbaarheid daarvan om selfone te gebruik vir beter inligtingsbestuur van kinder-inenting in Suid-Afrika. Haalbaarheid word vasgestel deur ’n haalbaarheidsraamwerk en die ontwikkeling van besigheidsmodelle te gebruik. Die haalbaarheidsraamwerk, wat toegelig word deur ’n literatuurstudie, vraelyste en ’n gevallestudie, bepaal die haalbaarheid van ’n MHSV in terme van menslike faktore, tegniese haalbaarheid, inligtingbestuur, beleid en etiek, en ekonomie. Daar word gevind dat ’n MHSV haalbaar is in Suid-Afrika, alhoewel sekere areas uitdagings inhou. Die haalbaarheidsraamwerk word aangevul deur die ontwikkeling van besigheidsmodelle wat moontlike maniere voorstel waarop ’n MHSV in Suid-Afrika ontplooi kan word. Hierdie modelle word geskoei op die resultate van die haalbaarheidsraamwerk en word ontwikkel met behulp van Osterwalder se besigheidsmodelskema (“business model canvas”). Die effek van die nasionale gesondheidversekering op hierdie modelle word ook ondersoek. Onderhoude met kundiges in die veld van selfoonoplossings vir gesondheidsorg word gebruik om die haalbaarheidsraamwerk en die besigheidsmodelle te valideer. Die onderhoude toon dat die navorsing geldig is en dat die haalbaarheidsraamwerk en besigheidsmodelle veralgemeen kan word na die wyer veld van selfoonoplossings vir gesondheidsorg.

Digital Health relates to “health information systems which enable the merging of social-care and healthcare systems. This would impact on the organisation, service delivery as well as the technological infrastructure” (Herselman & Botha, 2016, p.10). However, with relatively sparse research publications emanating from within the Namibian Health domain, and the concept of Namibian Digital Health as an emergent phenomenon, a Namibian Digital Health Innovation Ecosystem Framework would provide a start to conceptualising, developing and implementing such an ecosystem for Namibia and thus unlocking the potential of Digital Health in this country. The purpose of this study is to develop a Namibian Digital Health Innovation Ecosystem Framework based on literature reviews and the feedback from knowledgeable professionals (KPs) in Namibia, as well as global experts. The methodology which was applied in this study to address the purpose, and to answer the research questions, was Design Science Research Methodology and the Design Science Research Methodology (DSRM) process of Peffers, Tuunanen, Rothenberger and Chatterjee (2008), was adopted. Pragmatism is the overall philosophy guiding the study, as proposed by Ackoff’s theory regarding the hierarchy of human understanding (1989) and Shneiderman’s visual information seeking mantra (1996). During Phases 2 and 3 of the study interpretivism and positivism were applied as philosophies, guided by hermeneutics and triangulation, towards understanding the feedback of Knowledgeable Professionals (KPs) in Namibia, as well as the global experts. The study was divided into three phases. The first phase entailed a literature study which identified the components of Digital Health, Innovation and Digital Ecosystems as well as related research of Digital health, Innovation and Digital Ecosystems in developed and developing countries. This process led to the compilation of the initial Namibian Digital Health Innovation Ecosystem Framework using a conceptual approach. In the second phase of the study, the initial Namibian Digital Health Innovation Ecosystem was evaluated by KPs in Namibia using the Delphi method and interviews. Phase 2 adopted both quantitative and qualitative approaches. The findings from Phase 2 resulted in the development of the intermediate Namibian Digital Health Innovation Ecosystem Framework. In Phase 3 of the study, the intermediate framework was validated by global experts. Feedback was collected from global experts through questionnaires which were analysed through qualitative content analysis. The findings, from Phase 3 led to the development of the final Namibian Digital Health Innovation Ecosystems Framework. The guidelines, which can be used by the Namibian government to implement the suggested digital health innovation ecosystem framework, were also provided. / Information Science / D. Litt. et Phil. (Information Systems)