The act of people collecting their health data through health apps on their smartphones is becoming increasingly popular. Still, it is difficult for healthcare providers to use this patient-generated health data since health apps cannot easily share its data with the health care providers’ Electronic Health Records (EHR). Simultaneously, it is becoming increasingly popular to use low-code platforms for software development. This thesis explored using low-code platforms to create applications intended to collect patient-generated health data and send it to EHRs by creating a web application prototype with the low-code platforms Mendix and Better EHR Studio. During the web application prototype development, the developer conducted a diary to capture their impressions of Mendix to show how a developer experiences developing in a low-code platform compared to traditional programming. The result shows that it is impractical to create applications intended to collect patient-generated health data with the two low-code platforms chosen. The analysis of the conducted diary showed that using a low-code platform is straightforward but also challenging for an experienced software developer.

This thesis presents a case study of an open pit mine proposal in Kamloops, BC. During an integrated Environmental (Impact) Assessment (EA) process mandated by the Provincial and Federal governments, stakeholders addressed the mine’s environmental, social, heritage, economic, and health-related impacts. At the end of a 7-year process, the application was denied. My research sought to examine how health was conceptualized in the EA, and, specifically, had the mine been approved, how would the permit conditions have protected the public from adverse health effects. To that end, I conducted a review of health-related documents incorporated in the EA and studied the results through a Health Impact Assessment (HIA) lens based on guidance from the International Finance Corporation (IFC). As well as reviewing and analyzing the EA documents, I conducted interviews with participants in and outside the formal stakeholder group, as prescribed by the IFC HIA Guidance. Specifically, my analysis was based on the scoping phase of the assessment, and the baseline health profile that was included, using this internationally recognized HIA framework. My results show that the social determinants of health were not factored into the EA as per HIA best practice. Many in the formal stakeholder group, and outside of it, felt that institutional barriers prevented inclusion of the social determinants of health in the assessment. That finding raises questions about the reality of EA processes to protect public health. / Graduate

During the last few years, there has been increasing interest in making medical records more centered around patients. Empowering the patient more in the care process has proven to increase the quality of care. It can also enable increased data sharing among different actors, where today patient health data is locked into thousands of separate data silos. Meanwhile, growth in portable medical devices and patient-generated health data (PGHD) poses a new source of valuable data which today has limited utilization in clinical settings. In solving these issues of data availability without compromising the privacy of patients, blockchain has been suggested to play an important role through a more patient-centric model of controlling information. The purpose of this study is to investigate how blockchain can solve data availability and security issues in the healthcare system. We explore the research question from a Sweden-specific context by first defining the current state of the Swedish health data ecosystem, and then analyzing how blockchain helps in increasing the availability and security of personal health data. Qualitative methods were used, and data was collected through both a literature review and an interview study where 16 semi-structured interviews were conducted with Swedish governmental agencies, EMR providers, informaticians, as well as blockchain experts. The current issues in data availability and security in the Swedish healthcare system were identified together with the benefits of using blockchain in this context. Our findings suggest that Sweden has already solved many of the problems other countries face, limiting the marginal benefit of using blockchain. However, problems of sharing raw data persist and blockchain has benefits in managing accesses to health data from both regulatory and privacy perspectives. There are also benefits of using the technology for ensuring the quality of PGHD as well as providing increased security for health data. Lastly, we propose and discuss three separate blockchainbased solutions to be used in healthcare. A major contribution to literature lies in finding that system barriers in form of legislation and technical and semantic interoperability are issues that first need to be resolved in order to harvest the full value of using blockchain technology - issues often understated in other papers. We call for future studies to investigate practical use-cases such as small-scale consortiums addressing specific data sets or patient groups to provide proof-of-concept on how the technology performs in terms of cost, integrity, security, and scalability in for personal health data. / Patientdata är i dagsläget spridd i tusentals data-silos i sjukvården. Att involvera patienten i vårdprocessen har visat sig förbättra vårdresultatet, vilket senaste åren ökat diskussioner om att göra hälsodata mer tillgänglig och centrerad kring patienten. Samtidigt växer användandet av portabla medicinska apparater och patient-genererad information snabbt, och utgör nu en ny datakälla som i dagsläget i princip inte utnyttjas i den kliniska kontexten. För att lösa dessa problem och öka tillgängligheten av data utan att äventyra patientens integritet har blockkedjeteknologi föreslagits spela en viktig roll genom en mer patientcentrerad modell av informationsdelning. Syftet med denna studie är att undersöka hur blockkedjor kan lösa problemen med tillgänglighet av sjukvårdsdata inom vårdsystemet. Vi undersöker frågeställningen utifrån en svensk kontext genom att först definiera de existerande problem relaterade till datatillgänglighet och säkerhet i det svenska vårdsystemet, för att sedan analysera blockkedjans roll för att lösa dessa problem. Studien är av kvalitativ natur där datainsamling gjorts genom dels en litteraturstudie, och dels genom en intervjustudie, där 16 semistrukturerade intervjuer genomförts med svenska myndigheter, journalsystems-leverantörer, informatiker samt blockkedje-experter. Nuvarande problem inom datatillgänglighet och datasäkerhet identifierades tillsammans med de fördelar som finns av att använda blockkedjor i sammanhanget. Våra resultat visar att Sverige redan har löst många av de problem många andra länder idag möter, vilket potentiellt minskar den marginella nyttan av att använda blockkedjor. Dock existerar fortfarande problem när det gäller delning av digitala kopior av journaler mellan aktörer, och en blockkedjelösning har fördelar ur både regulatoriska perspektiv och integritetsperspektiv. Vidare finner vi fördelar av att använda blockkedjor för att försäkra kvaliteten av patient-genererad hälsodata, samt för att öka säkerheten i arkitekturer som möjliggör datadelnin. Slutligen föreslår vi och diskuterar tre olika blockkedjelösningar för den svenska sjukvårdssektorn. Ett av huvudbidragen till litteraturen ligger i att identifiera systembarriärer i form av legislativa åtgärder samt teknisk och semantisk interoperabilitet - problem som måste lösas för att till fullo kunna åtnjuta fördelarna av en blockkedjelösning. Vi uppmanar framtida studier att undersöka praktiska användningsområden såsom småskaliga konsortium för att vidare bidra med hur tekniken levererar på frågor kopplade till kostnad, integritet, säkerhet och skalbarhet för personlig hälsodata.

Indiana University-Purdue University Indianapolis (IUPUI) / BACKGROUND: The pathophysiology of diabetes mellitus and the need for vigilant monitoring of serum glucose levels lends itself well to prompt medical intervention by healthcare providers that can significantly reduce morbidity and mortality and improve patient quality of life. The effect of intervention in diabetes can be assessed by following objective laboratory measurements such as hemoglobin A1C, which is abnormal with poorly controlled diabetes and returns to normal with proper management. There are mobile technologies now available that allow for self-monitoring and intervention in this patient population. Using a systematic approach this paper will assess the benefits of Short Message Services and mobile technology in managing patients with diabetes and improving adherence and other outcomes. OBJECTIVE: To assess the benefits and disadvantages the use of mobile technology could have in the management of diabetes. METHODOLOGY: A systematic review of articles on this topic was performed. A total of 759 articles were initially identified by searching various search engines, from which only 39 articles met all of the inclusion/exclusion criteria of this systematic review. FINDINGS: The initial review of literature indicated that the use of mobile technology in patients with diabetes resulted in improved disease outcomes as indicated by parameters such as a decrease in hemoglobin A1C, and an increase in sustainable blood glucose levels. CONCLUSION: Mobile technology is found to be a promising tool in the management of diabetes, but further research is needed because there is a lack of reliable studies, trials, and systematic reviews. Physicians and other healthcare professionals are rapidly adopting mobile technology for use in clinical practice because they understand the rising phenomenon of mobile technology.

Pediatric obesity is skyrocketing nowadays worldwide. Therefore, helping and supporting clinicians in curing children is needed. As Health IT is soaring thanks to the emergence of a cutting-edge technology, treatments can now be followed closely and daily to give a personalized therapy. Thus, this thesis investigates how to build a clinical decision support tool to address this issue. The study was carried with the company Evira by following the user-centered design thinking method. The user research, carried out with semi-structured interviews at Martina Barnsjukhuset and Capio Vårdcentral Zinkensdamm, provided the users needs. A prototype was developed with considering this user research and requirements. Next, it was tested by experts during task-based and semi-structured interviews. This evaluation phase concluded that the prototype was intuitive and effective. By using different metrics, it allowed clinicians to see the activity of the patients, the irregularities and variation of their weight, their weighting habits, and the gender distribution of the patients. The final tool corrected some of the requests obtained during the evaluation. Thus, the proposed interface could support the decision of clinicians to improve treatment effectiveness and enable better resource planning. Further research can still be carried out in order to fine-tune this tool. / Fetma hos barn ökar kraftigt i dag över hela världen. Därför behövs det hjälp och stöd till kliniker för att behandla barn. Eftersom hälso- och sjukvårdsinformatik är på frammarsch tack vare framväxten av en banbrytande teknik kan behandlingar nu följas noga och dagligen för att ge en personlig behandling. I denna avhandling undersöks värdet av ett kliniskt beslutsstöd för att lösa detta problem. Studien genomfördes tillsammans med företaget Evira genom att följa metoden för användarcentrerat designtänkande. Användar- forskningen, som genomfördes med semistrukturerade intervjuer på Martina Barnsjukhuset och Capio Vårdcentral Zinkensdamm, gav användarnas behov. En prototyp utvecklades med hänsyn till denna användarundersökning och dessa krav. Därefter testades den av experter under uppgiftsbaserade och semistrukturerade intervjuer. I denna utvärderingsfas konstaterades att prototypen var intuitiv och effektiv. Den gjorde det möjligt för kliniker att se patienternas aktivitet och effektiviteten i behandlingen. Det slutliga verktyget korrigerade några av de önskemål som framkom under utvärderingen. Det föreslagna gränssnittet ökade således behandlingseffektiviteten och möjliggjorde bättre resursplanering. Ytterligare forskning kan fortfarande utföras för att finslipa detta verktyg.

Les deux dernières décennies ont été marquées par une augmentation significative des données collectées dans les systèmes d'informations. Cette masse de données contient des informations riches et peu exploitées. Cette réalité s’applique au secteur de la santé où l'informatisation est un enjeu pour l’amélioration de la qualité des soins. Les méthodes existantes dans les domaines de l'extraction de processus, de l'exploration de données et de la modélisation mathématique ne parviennent pas à gérer des données aussi hétérogènes et volumineuses que celles de la santé. Notre objectif est de développer une méthodologie complète pour transformer des données de santé brutes en modèles de simulation des parcours de soins cliniques. Nous introduisons d'abord un cadre mathématique dédié à la découverte de modèles décrivant les parcours de soin, en combinant optimisation combinatoire et Process Mining. Ensuite, nous enrichissons ce modèle par l’utilisation conjointe d’un algorithme d’alignement de séquences et de techniques classiques de Data Mining. Notre approche est capable de gérer des données bruitées et de grande taille. Enfin, nous proposons une procédure pour la conversion automatique d'un modèle descriptif des parcours de soins en un modèle de simulation dynamique. Après validation, le modèle obtenu est exécuté pour effectuer des analyses de sensibilité et évaluer de nouveaux scénarios. Un cas d’étude sur les maladies cardiovasculaires est présenté, avec l’utilisation de la base nationale des hospitalisations entre 2006 et 2015. La méthodologie présentée dans cette thèse est réutilisable dans d'autres aires thérapeutiques et sur d'autres sources de données de santé. / During the last two decades, the amount of data collected in Information Systems has drastically increased. This large amount of data is highly valuable. This reality applies to health-care where the computerization is still an ongoing process. Existing methods from the fields of process mining, data mining and mathematical modeling cannot handle large-sized and variable event logs. Our goal is to develop an extensive methodology to turn health data from event logs into simulation models of clinical pathways. We first introduce a mathematical framework to discover optimal process models. Our approach shows the benefits of combining combinatorial optimization and process mining techniques. Then, we enrich the discovered model with additional data from the log. An innovative combination of a sequence alignment algorithm and of classical data mining techniques is used to analyse path choices within long-term clinical pathways. The approach is suitable for noisy and large logs. Finally, we propose an automatic procedure to convert static models of clinical pathways into dynamic simulation models. The resulting models perform sensitivity analyses to quantify the impact of determinant factors on several key performance indicators related to care processes. They are also used to evaluate what-if scenarios. The presented methodology was proven to be highly reusable on various medical fields and on any source of event logs. Using the national French database of all the hospital events from 2006 to 2015, an extensive case study on cardiovascular diseases is presented to show the efficiency of the proposed framework.

Digital teknik och den ökade digitalisering som är under ständig utveckling i världen medför att strukturer i samhällen ändras och likaså vårt sätt att leva, då stora mängder data samlas in. Sverige är bland de ledande länderna i världen när det kommer till användning av ny teknik och varannan svensk har minst en uppkopplad enhet i sitt hem. Smartklockor som de senaste åren stigit i popularitet ger många möjligheter till insamling av hälsodata, vilket kan leda till integritetsproblem. Syftet med detta arbete är att undersöka attityder hos studenter (20–30 år) som använder smartklockor genom att utgå från teorin om integritetsparadoxen. Integritetsparadoxen menar att människors beteende grundar sig på ett risktänk, men det verkliga beteende, hur de agerar, istället grundar sig på tillit. För att besvara syftet har fem kvalitativa intervjuer genomförts där författarna sedan analyserat hur studenterna förhåller sig till risk, tillit, integritet och deras medvetenhet kring hälsodatadelning. Det visade sig att studenterna var positiva till datadelning men synen på integritet skiljde sig åt. Risk var något som studenterna sa sig tas i beaktande, men när studenterna väl fattade beslut, såsom att ladda ner en applikation, grundade sig utfallet på tillit. / Digital technology and the increasing digitalization that is constantly evolving worldwide means that structures in our society and our way of living are changing, when large amounts of data are being collected. Sweden is among the leading countries in the world when it comes to the use of new technology and every other swede has at least one connected device. Smartwatches have risen in popularity in recent years and provide many opportunities for the collection of health data, which for the users may lead to privacy problems. The purpose of this thesis is to research the attitudes of students (20-30 years old) using smartwatches based on the theory of the privacy paradox. The theory of the privacy paradox explores the relationship between the user’s behavioral intention based on the risks and their actual behavior based on trust. To fulfill the purpose the researchers conducted five qualitative interviews. The authors then analyzed the answers about how students relate to risk, trust, privacy and their awareness of sharing health data. It turned out that the students were optimistic about data sharing but the view of privacy differed. Risk was something that they said was taken into account but when the students actual decisions were made, such as downloading an application, the outcome was based on trust.

Människor använder sig allt mer av digitala hälsoplattformar, vilket gör att det genereras mängder av hälsodata från användarnas digitala aktiviteter. Syftet med detta examensarbetet är att med hjälp av en konceptdriven designforskning framställa ett designkoncept för att hantera denna stora mängd hälsodata. Målet med konceptet är att det ska skapa en möjlighet för individer att själva hantera och få tillgång till sin hälsodata som genereras, för att i sin tur även kunna utnyttja det till något meningsfullt.  Med hjälp av en metodologisk guide har konceptet utvecklats, för att ta fram teoretiskt förankrade egenskaper och sammanställa dem till ett koncept i form av en modell. För att få in extern kritik av konceptet involverades tio användare, vilket i sin tur ledde till revidering och kontextualisering av HealthLab. I resultatet presenteras slutgiltligt koncept av Healthlab. Konceptet ska fungera som en multiplattform vars syfte är att samla in externa hälsodata, för att användarna ska få in flera aspekter i deras träning, som ska i sin tur hjälpa till att bidra till en bättre träningsupplevelse. Det slutgiltiga resultatet av HealthLab är tänkt att vara en framtidsvision för att vägleda och väcka nya tankesätt hos forskare och designers. / People are increasingly using digital health platforms, which means that lots of health data is generated from users' digital activities. The purpose of this paper is to develop a design concept to manage this large amount of health data, with the help of concept-driven design research. The goal of the concept is to create an opportunity for individuals to manage and access their generated health data, in order to use it for something meaningful.  With the aid of a methodological guide, the concept has been developed, to create theoretically anchored qualities and to compile them into a concept in the form of a model. To get external criticism of the concept, ten users were involved, which in turn led to revision and contextualisation of HealthLab. In the result, a final concept model is presented of HealthLab. The concept will serve as a multiplatform whose purpose is to collect external health data so that users can get several aspects of their training, which in turn will contribute to a better training experience. The final result of HealthLab is intended to be a vision for the future to guide and awaken new ways of thinking among researchers and designers.

Indiana University-Purdue University Indianapolis (IUPUI) / Physical activity monitoring using wearable sensors give valuable information about patient's neuro activities. Fall among ages of 60 and older in US is a leading cause for injury-related health issues and present serious concern in the public health care sector. If the emergency treatments are not on time, these injuries may result in disability, paralysis, or even death. In this work, we present an approach that early detect fall occurrences. Low power capacitive accelerometers incorporated with microcontroller processing units were utilized to early detect accurate information about fall events. Decision tree algorithms were implemented to set thresholds for data acquired from accelerometers. Data is then verified against their thresholds and the data acquisition decision unit makes the decision to save patients from fall occurrences. Daily activities are logged on an onboard memory chip with Bluetooth option to transfer the data wirelessly to mobile devices. In this work, a system prototype based on neurosignal activities was built and tested against seven different daily human activities for the sake of differentiating between fall and non-fall detection. The developed system features low power, high speed, and high reliability. Eventually, this study will lead to wearable fall detection system that serves important need within the health care sector. In this work Inter-Integrated Circuit (I2C) protocol is used to communicate between the accelerometers and the embedded control system. The data transfer from the Microcontroller unit to the mobile device or laptop is done using Bluetooth technology.

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