Remote healthcare is a demanding as well as emergent research area. The rise of healthcare costs in the developed countries have made the policy makers for trying to find an alternate model of healthcare rather than relying on traditional healthcare system. Although advancement in the sensor technology, forthcomingness of devices like smart phones and improvement in artificial intelligence technology have made the remote healthcare close to reality but still there are plenty of issues to be solved before it becomes a commonly used healthcare model. In this thesis, studies of two vital physiological parameters pulse rate and oxygen saturation were done to unearth some patterns using Case-Based Reasoning technique. A three-tiered application is developed focusing remote healthcare. The results of the thesis could be used as a starting point of further research of two above mentioned physiological parameters in order to detect anomalous condition of health.

Applications of Telehealth in the practice, upgrading of knowledge, and communication of physicians with their colleagues and patients in Canada was explored in this study. The research used exploratory-grounded theory to investigate the opinions of practicing clinicians regarding the use of Telehealth. The study involved conducting semi-structured interviews with physicians who were using or might in the future use Telehealth in their practice. This study was designed to assess the major advantages and shortcomings that Telehealth has to offer in the field of medicine. The research found that clinicians predominantly had a very positive view of Telehealth, although some minor concerns were expressed with respect to the use of Telehealth in private offices and the home (rather than in the hospital). The data indicated that Telehealth can improve overall patient care by bettering the speed and accuracy of communication and diagnosis and the subsequent treatment of patients, saving physicians and patients time and money, reducing waiting lists, aiding the environment, reducing emergency visits and hospitalizations, addressing shortages of physicians (particularly in rural areas), increasing access to specialists, and enabling convenient distance education. These are just some of the many benefits of Telehealth which outweigh its disadvantages. This study also was designed to extract clinicians’ opinions on avenues for improving Telehealth, which thus led to implications for future research. Barriers to the use of Telehealth were found to include concerns about security and IT support, lack of public knowledge of Telehealth’s existence, and installation and maintenance costs for the necessary equipment in the private sector. The study suggests that Telehealth will become more widely available and accessible to the general public. The study also proposes that, through increased governmental support and funding, Telehealth should be advertised and promoted, researched in more depth (in part, to discourage misconceptions regarding Telehealth), collaborated on by stakeholders, and expanded. / Graduate

Maldistribution of healthcare professionals persists in remote and rural communities throughout the world. Adoption of a Community Paramedic (CP) program could improve access to quality healthcare for rural communities. The conceptual framework defined rural communities by their distinct characteristics — community efficacy, weaknesses, attitudes, assets, deficits, local culture, and the driving and restraining forces — and not defined by their small populations or distances to cities. The theoretical foundation was a synthesis of theories of Bandura, Rogers, and Lewin. This study assessed community characteristics that may influence the likelihood of success, sustainability, or program failure of the Australian CP model in a single remote Texas border community. In this qualitative formative bounded case study, 3 bounded groups were examined; data collection was by in-person interviews. Group members were purposively selected: 5 residents and 3 EMS members. The 3rd group consisted of 4 randomly self-selected resident interviews, field observations, news articles, and local social media. Data transcripts were coded using theoretical coding based on the conceptual framework and theoretical foundation. Strong individual and group efficacy, efficacy resilience, adaptability, strong communications, overlapping groups, and a strong sense of community program ownership were evident in this study. The probability of establishing an effective CP program based on the Australian model is high based on study findings. Improved access to quality healthcare in remote and rural communities could result in improved health of community members and significant social change.

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Rural and remote areas of Australia remain the last bastion of health disadvantage in a developed nation with an enviable health score-card. During the last ten years, rural and remote health has emerged as a significant issue in the media and the political arena. This thesis examines print media, policy documents and interviews from selected informants to ascertain how they represent medical practitioners and health services in rural and remote areas of Australia, why they do so, and the consequences of such positions. In many of these representations, rural and remote medical practitioners are aligned with national and cultural mythologies, while health services are characterised as dysfunctional and at crisis point. Ostensibly, the representations and identity formulations are aimed at redressing the health inequities in remote rural and Australia. They define and elaborate debates and contestations about needs and claims and how they should be addressed; a process that is crucial in the development of professional identity and power (Fraser; 1989). The research involves an analysis and critical reading of the entwined discourses of culture, power, and the politics of need. Following Wodak and others (1999), these dynamics are explored by examining documents that are part of the discursive constitution of the field. In particular, the research examines how prevailing cultural concepts are used to configure the Australian rural and remote medical practitioner in ways that reflect and advance socio-cultural hegemony. The conceptual tools used to explore these dynamics are drawn from critical and post-structural theory, and draw upon the work of Nancy Fraser (1989; 1997) and Ruth Wodak (1999). Both theorists developed approaches that enable investigation into the effects of language use in order to understand how the cultural framing of particular work can influence power relations in a professional field. The research follows a cultural studies approach, focussing on texts as objects of research and acknowledging the importance of discourse in the development of cultural meaning (Nightingale, 1993). The methodological approach employs Critical Discourse Analysis, specifically the Discourse Historical Method (Wodak, 1999). It is used to explore the linguistic hallmarks of social and cultural processes and structures, and to identify the ways in which political control and dominance are advanced through language-based strategies. An analytical tool developed by Ruth Wodak, Rudolf de Cillia, Martin Reisigl and Karin Leibhart (1999) was adapted and used to identify nationalistic identity formulations and related linguistic manoeuvres in the texts. The dissertation argues that the textual linguistic manoeuvres and identity formulations produce and privilege a particular identity for rural and remote medical practitioners, and that cultural myth is used to popularise, shore up and advance the goals of rural doctors during a period of crisis and change. Important in this process is the differentiation of rural and remote medicine from other disciplines in order to define and advance its political needs and claims (Fraser, 1989). This activity has unexpected legacies for the rural and remote health sector. In developing a strong identity for rural doctors, discursive rules have been established by the discipline regarding roles, personal and professional characteristics, and practice style; rules which hold confounding factors for the sustainability of remote and rural medical practice and health care generally. These factors include: the professional fragmentation of the discipline of primary medical care into general practice and rural medicine; and identity formulations that do not accommodate an ageing workforce characterised by cultural diversity, decreasing engagement in full time work, and a higher proportion of women participants. Both of these factors have repercussions for the recruitment and retention of rural and remote health professionals and the maintenance of a sustainable health workforce. The dissertation argues that the formulated identities of rural and remote medical practitioners in the texts maintain and reproduce relationships of cultural, political and social power. They have also influenced the ways in which rural and remote health services have been developed and funded. They selectively represent and value particular roles and approaches to health care. In doing so, they misrepresent the breadth and complexities of rural and remote health issues, and reinforce a reputational economy built on differential professional and cultural respect, and political and economic advantage. This disadvantages the community, professions and interest groups of lower value and esteem, and other groups whose voices are often not heard. Thus, regardless of their altruistic motivations, the politics of identity and differentiation employed in the formulated identities in the texts are based on an approach that undermines the redistributive goals of justice and equity (Fraser 1997), and works primarily to develop and advantage the discipline of rural medicine.

Global rise in life expectancy has resulted in an increased demand for affordable healthcare and monitoring services. The advent of miniature and low–power sensor technologies coupled with the emergence of the Internet–of–Things has paved the way towards affordable health monitoring tools in wearable platforms. However, ensuring power–efficient operation, data accuracy and user comfort are critical for such wearable systems. This thesis focuses on the development of accurate and computationally efficient algorithms and low–cost, unobtrusive devices with potential predictive capability for monitoring mobility and cardiac health in a wearable platform. A three–stage complementary filter–based approach is developed to realize a computationally efficient method to estimate sensor orientation in real–time. A gradient descent–based approach is used to estimate the gyroscope integration drift, which is subsequently subtracted from the integrated gyroscope data to get the sensor orientation. This predominantly gyroscope–based orientation estimation approach is least affected by external acceleration and magnetic disturbances. A two–stage complementary filter–based efficient sensor fusion algorithm is developed for real–time monitoring of lower–limb joints that estimates the IMU inclinations in the first stage and uses a gradient descent–based approach in the second stage to estimate the joint angles. The proposed method estimates joint angles primarily from the gyroscope measurements without incorporating the magnetic field measurement, rendering the estimated angles least affected by any external acceleration and insensitive to magnetic disturbances. An IMU–based simple, low–cost and computationally efficient gait–analyzer is developed to track the course of an individual's gait health in a continuous fashion. Continuous monitoring of gait patterns can potentially enable detecting musculoskeletal or neurodegenerative diseases at the early onset. The proposed gait analyzer identifies an anomalous gait with moderate to high accuracy by evaluating the gait features with respect to the baseline clusters corresponding to an individual’s healthy peer group. The adoption of a computationally efficient signal analysis technique renders the analyzer suitable for systems with limited processing capabilities. A flexible dry capacitive electrode and a wireless ECG monitoring system with automatic anomaly detection capability are developed. The flexible capacitive electrode reduces motion artifacts and enables sensing bio–potential over a dielectric material such as cotton cloth. The virtual ground of the electrode allows for obtaining single–lead ECG using two electrodes only. ECG measurements obtained over different types of textile materials and in presence of body movements show comparable performance to other reported ECG monitoring systems. An algorithm is developed separately as a potential extension of the software to realize automatic identification of Atrial Fibrillation from short single–lead ECGs. The association between human gait and cardiac activities is studied. The gait is measured using wearable IMUs and the cardiac activity is measured with a single–lead handheld ECG monitor. Some key cardiac parameters, such as heart rate and heart rate variability and physical parameters, such as age and BMI show good association with gait asymmetry and gait variation. These associations between gait and heart can be useful in realizing low–cost in–home personal monitoring tool for early detecting CVD–related changes in gait features before the CVD symptoms are manifested. / Thesis / Doctor of Philosophy (PhD) / Wearable health monitoring systems can be a viable solution to meet the increased demand for affordable healthcare and monitoring services. However, such systems need to be energy–efficient, accurate and ergonomic to enable long–term monitoring of health reliably while preserving user comfort. In this thesis, we develop efficient algorithms to obtain real–time estimates of on–body sensors' orientation, gait parameters such as stride length, and gait velocity and lower–limb joint angles. Furthermore, we develop a simple, low–cost and computationally efficient gait–analyzer using miniature and low–power inertial motion units to track the health of human gait in a continuous fashion. In addition, we design flexible, dry capacitive electrodes and use them to develop a portable single–lead electrocardiogram (ECG) device. The flexible design ensures better conformity of the electrode to the skin, resulting in better signal quality. The capacitive nature allows for obtaining ECG signals over insulating materials such as cloth, thereby potentially enabling a comfortable means of long–term cardiac health monitoring at home. Besides, we implement an automatic anomaly detection algorithm that detects Atrial Fibrillation with good accuracy from short single–lead ECGs. Finally, we investigate the association between gait and cardiac activities. We observe that some important cardiac signs, such as heart rate and heart rate variability and physical parameters, such as age and BMI show good association with gait asymmetry and gait variation.

<p dir="ltr">Digital Health technologies have revolutionized healthcare delivery, offering innovative solutions that enhance access, improve patient outcomes, and optimize the use of resources. Despite this advancement, health outcomes remain disparate across different social groups, with underprivileged populations at an increased risk of poor health outcomes due to inadequate access to care. Digital Health technologies serve as a critical intervention in mitigating these disparities, particularly for groups affected by geographical, economic, and infrastructural barriers.<br><br>The purpose of this study was to conduct a review of the current state of Digital Health technologies, including Software as a Medical Device (SaMD), Wearable Health, Portable Diagnostic Devices, and remote care platforms, and their impact on healthcare accessibility. Employing qualitative methodology, this metasynthesis emphasized an important discovery: the need for a paradigm shift among stakeholders in healthcare towards integrated and digitally-driven patient care. This shift requires more than just an understanding of new technologies. It demands a fundamental re-evaluation of patient care methods and the orchestration of the entire healthcare system towards integrated digital practices. Importantly, this study found that the pace of digitalization must be carefully managed and cultural factors must be considered and signals the urgency for a balanced approach to digital integration in healthcare.</p>

We introduce a novel integration of real-time, predictive eye-gaze tracking models into a multimodal dialogue system tailored for remote health assessments. This system is designed to be highly accessible requiring only a conventional webcam for video input along with minimal cursor interaction and utilizes engaging gaze-based tasks that can be performed directly in a web browser. We have crafted dynamic subsystems that capture high-quality data efficiently and maintain quality through instances of user attrition and incomplete calls. Additionally, these subsystems are designed with the foresight to allow for future re-analysis using improved predictive models, as well as enable the creation and training of new eye-gaze tracking datasets. As we explored gaze patterns for various user-performed tasks, we developed generalizable eye-gaze metrics that capture and reflect the distinct gaze trends among different cohorts. And through testing various feature extraction and classification methods, we have found promising results that have enabled us to effectively classify individuals with Mild Neurocognitive Disorder (MiNCD) / Mild Cognitive Impairment (MCI) in a crowdsourced pilot study (N = 35) with an average accuracy of 0.94 (f1 = 0.83). Although just the beginning, this work represents the first step towards establishing predictive eye-gaze tracking as an accessible and important modality for healthcare applications moving forward, with the potential to significantly impact remote screening and monitoring of neurocognitive health.