Yes / Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods: To inform the action research, in-depth case studies of each telehealth service were conducted (May 2012–June 2013). Each service was then supported by researchers through two cycles of action research to implement changes to increase adoption of telehealth, completed over a seven month period (July 2013–April 2014). The action research was studied via observation of multi-stakeholder workshops, analysis of implementation plans, and focus groups. Results: Action research participants included 57 staff and one patient, with between eight and 20 participants per site. The case study findings were identified as a key source of information for planning change, with sites addressing common challenges identified through this work. For example, refining referral criteria; standardizing how and when patients are monitored; improving data sharing; and establishing evaluation processes. Sites also focused on raising awareness of telehealth to increase adoption in other clinical teams and to help secure future financial investment for telehealth, which was required because of short-term funding arrangements. Specific solutions varied due to local infrastructures, resources, and opinion, as well as previous service developments. Local telehealth champions played an important role in engaging multiple stakeholders in the study. Conclusions: Action research enabled services to make planned changes to telehealth and share learning across multiple stakeholders about how and when to use telehealth. However, adoption was impeded by continual changes affecting telehealth and wider service provision, which also hindered implementation efforts and affected motivation of staff to engage with the action research, particularly where local decision-makers were not engaged in the study. Wider technological barriers also limited the potential for change, as did uncertainties about goals for telehealth investment, thereby making it difficult to identify outcomes for demonstrating the added value over existing practice. / This study was funded by a grant from the Assisted Living Innovation Platform, with support from the Technology Strategy Board and the Economic and Social Research Council.

Yes / In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology–enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an “intelligent shoe.”. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer. To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes. Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers. Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system. The study revealed that the system should also encourage independent use and the setting of personalized goals or activities. Conclusions: Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities.

Text in English / Telehealth makes healthcare services accessible by underserved and resource-constrained rural communities of developing countries such as Ethiopia. However, the limitation of frameworks on telemedicine-based healthcare inequality reduction is a challenge for developing countries. In Ethiopia there are four telemedicine projects; however, there is no evidence that any of these projects have been evaluated by considering contextual issues. This academic research explored telehealth practices in Ethiopia with the aim of developing a comprehensive telehealth evaluation framework for developing countries. Such a conceptual framework could be used to inform health institutes and governmental policy makers and in so doing create a vehicle for the implementation of improved health practices in Ethiopia. A grounded theory approach is used to qualitatively explore the usefulness of telemedicine practices in Ethiopia, in mitigating healthcare inequality. Grounded theory makes use of emerging insights in order to contribute to new knowledge. From the inductive analysis of the study, themes such as barrier removal, service quality, synergetic effect, localization, technical setup, resource utilization and managerial readiness emerged to formulate a framework for evaluating telemedicine-based healthcare inequality reduction in the context of developing countries like Ethiopia. This study contributes to the understanding of the question of how telemedicine practices can be evaluated, to support the healthcare service and reduce the healthcare inequalities in resource constrained communities in Ethiopia. Moreover, the framework could be used during evaluation of telemedicine-based healthcare inequality reduction in the context of developing countries like Ethiopia. / School of Computing / Ph.D. (Information Systems)

Die Idealvorstellung eines vollständig digitalisierten Behandlungsalltags rückt mit fortschreitender technologischer und informationeller Entwicklung stetig näher an die Realität. Zu Beginn bestand lediglich die Möglichkeit einer elektronischen Patientenakte, hinzu kamen vielfältige Möglichkeiten der digitalen Bildgebung und wurden schließlich um das Ziel eines vollständigen digitalen Workflows ergänzt. Die Planung der interdisziplinären kieferorthopädischen / kieferchirurgischen Versorgung von Patienten mit Lippen-Kiefer-Gaumen-Spalten (LKGS) wird momentan noch hauptsächlich analog durchgeführt. Eine volldigitalisierte Behandlungsplanung und –freigabe unter intersektoraler Einbeziehung aller beteiligten Behandler findet nicht statt. Neu entwickelte, digitale kieferorthopädische und –chirurgische Produkte, welche bis vor ein paar Jahren noch nicht denkbar waren, unterstützen den digitalen Workflow maßgeblich. 3D-Scanner und 3D-Fotoaufnahmen erstellen digitale Modelle, deren Daten zur Integration in den digitalen Workflow durch Softwareprozesse verarbeitet werden müssen. Um einen einfachen und strukturierten Zugriff auf die gesamten 3D Daten zu gewährleisten, ist die Idee entstanden, die anfallenden Daten und Unterlagen zu digitalisieren und in einer für diesen Zweck entwickelten Datenbank zu speichern und zu bearbeiten. Die konsequente Verwendung von digitalen 3D-Analysen und der Verzicht auf die aufwändige Erstellung der Diagnostik- und Therapieplanung aus einer Kombination von Gipsmodellen und 2D-Daten (z.B. Röntgenbilder) führen zu einer fundamentalen und richtungsweisenden Veränderung des Behandlungsplanungsprozesses. Räumlich und monetär aufwendige Bearbeitungsprozesse werden eingespart und Behandlungspläne können rascher erstellt werden, da sich alle notwendigen Unterlagen gebündelt in einem System wiederfinden. Weiterhin wird die Strahlenbelastung der Patienten wesentlich verringert, da eine Doppeldiagnostik durch mehrmaliges Anfertigen von Röntgenaufnahmen, DVTs und CTs in verschiedenen Abteilungen vermieden wird. Die Kommunikation, der Austausch und die konsiliarische Zusammenarbeit zwischen den Behandlern erfolgt unter Verwendung der europaweit ersten offenen, überregionalen telemedizinischen Plattform zur Verbesserung der medizinischen Versorgung – CCS TELEHEALTH OSTSACHSEN (THOS). [... aus der Einleitung]

Syftet med uppsatsen var att undersöka hur man med hjälp av digital design kan stödja den psykiska hälsan hos individer i USA under Covid-19 pandemin. Covid-19 är den första pandemin som utspelar sig i ett utvecklat digitalt samhälle där både mHealth/telehealth-design är välstuderat. Studien undersöker specifikt hur designelement för en mHealth-applikation kanen mHealth-applikation kan stödja en stor grupp användare under en global pandemi. Uppsatsen undersöker hur design kan öka användandet av mHealth för att söka hjälp mot psykisk ohälsa, som uppstått på grund av isolering till följd av den amerikanska statens riktlinjer under Covid-19 pandemin. Med hjälp av tidigare forskning gällande designriktlinjer för mHealth-applikationer, inkluderande design och element att tänka på när man designar applikationer för psykisk ohälsa, framtogs en prototyp av en mHealth-applikation. Denna prototyp testades därefter av sex respondenter som alla lider av depression till följd av isolering. Efter think aloud-observation under testandet av prototypen genomfördes en kvalitativ intervju för att undersöka respondenternas upplevelse av applikationen. Resultatet av studien påpekar vikten av användarens integritet, inkluderande design och element som efterfrågats i tidigare studier av mHealth-applikationer. Dessa resultat stödjer också de åtaganden tidigare forskninglagt fram och i sin tur visar denna studie att en mobilapplikation kan designas föratt stödja människor med deras psykiska ohälsa i relation till Covid-19 isoleringen. / The goal of this thesis was to investigate how the use of digital design could help people with their mental health during the covid-19 pandemic. Covid-19 is the first and only pandemic where both mHealth and telehealth design has been well developed. Our thesis explores how design elements can increase the will of users to use mHealth applications, especially for users whose mental health has been impacted by covid-19 restrictions in the United States. Based on the scientific articles regarding mHealth design, a prototype was made. This includes inclusive design and design elements focused on people with mental health struggles. The prototype was tested by six users who all reported feeling down because of isolation during covid-19. During the study, users were asked to test the prototype and ‘think aloud’, followed by a qualitative interview to better understand the user’s experience, feelings, and thoughts on the prototype. The results show the importance of a patient's integrity, the importance of inclusive design, and the appreciation of certain design elements. The results are in line with results from previous research and offer evidence on how to design a mHealth application to support people with their mental health during a pandemic.

Information Systems (IS) innovations in healthcare sector are seen as panacea to control burgeoning demand on healthcare resources and lack of streamlining in care delivery. Two particular manifestations of such innovations are telehealth and electronic records in its two forms: the electronic medical records and the electronic health records. Deployment efforts concerning both of these IS-innovations have encountered a rough terrain and have been slow. Problems are also faced while evaluating the effectiveness of innovations on health and care delivery outcomes through strategies such as randomised controlled trials- particularly in case of telehealth. By taking these issues into account, this research investigates the issues that affect IS innovation deployment and its evaluation. The strategy adopted in this research was informed by recursive philosophy and theoretical perspectives within IS that strived to expound this recursive relationship. It involved conducting two longitudinal case studies that are qualitative in nature. The first study involved telehealth deployment and its evaluation in the UK, while the second case study involved the deployment of electronic medical/health records in the US. Data was collected through focus group discussions, interviews and online discussion threads; and was analysed thematically. The results of this research indicate that there are nine issues that arise and affect the deployment and evaluation of IS innovation in healthcare; and these are design, efficiency and effectiveness, optimality and equity, legitimacy, acceptance, demand and efficacy, expertise, new interaction patterns, and trust. These issues are attributes of relationships between the IS innovation, context of healthcare and the user. The significance of these attributes varies during the deployment and evaluation process, and due to iterative nature of IS innovation. This research further indicates that all the attributes have either direct or indirect impact on work practices of the user.

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

O objetivo do presente trabalho de pesquisa é reduzir o nível de atenção requerido para o uso do sistema Borboleta por meio de reconhecimento de fala na navegação através das funcionalidades do sistema, permitindo ao profissional dar maior atenção ao paciente. A metodologia de desenvolvimento do projeto inclui uma revisão bibliográfica para definir o estado da arte da área, uma pesquisa sobre o software disponível para reconhecimento de fala, uma coleta de dados dos comandos do sistema em português brasileiro para treinar e testar o sistema, uma etapa de projeção e desenvolvimento para definir a arquitetura de integração com o Borboleta, e uma fase de testes para medir a precisão do sistema e seus níveis de usabilidade e aceitação por parte do usuário. / The current document presents research that addresses the goal of reducing the user attention level required by Borboleta operation by providing speech recognition capabilities to augment navigation through the software functions, allowing the professional to pay more attention to the patient. The project methodology is composed of a bibliography revision to establish the state-of-the-art of the field, a review of available speech recognition software, data collection of Brazilian utterances to train and test the system, a design and development stage that defined the system architecture and integration with Borboleta and a testing process to measure the system accuracy, its usability and acceptance level.

Grâce au progrès de la médecine et à l’essor des technologies, l’espérance de vie ne cesse de progresser, cette augmentation s’accompagnant d’une apparition de besoins spécifiques pour les seniors. Sachant que huit français sur dix souhaitent continuer à vivre à domicile en cas de perte d’autonomie, équiper les seniors d’une solution de suivi de leur état de santé à distance pourrait le leur permettre et ce dans de bonnes conditions. Dans ce contexte, nous avons identifié trois verrous que nous avons cherché à lever au cours de cette thèse. Le premier concerne l’interopérabilité des capteurs de santé qui se trouve mise à mal par l’adoption massive des protocoles propriétaires par les fabricants. Pour y remédier, nous proposons une passerelle facilitant la communication avec les capteurs de santé, qu’ils soient médicaux ou de bien-être, en faisant abstraction des multitudes de protocoles de communication propriétaires et standards. Le deuxième obstacle concerne l’erreur de mesure due à la manipulation d’un capteur de santé par des personnes non initiées en absence d’un professionnel de santé. Nous illustrons cette problématique à travers l'exemple d'un tensiomètre de poignet pour lequel nous proposons une méthode permettant de guider l’utilisateur dans son bon positionnement en respectant les recommandations des fabricants grâce à l'apport d'une montre connectée. Le dernier challenge a trait à la question de la multimodalité et plus précisément à la contextualisation de la mesure. Il s'agit ici de la fusion de données provenant d’un ensemble d’objets connectés dans un système de télésuivi décliné sous l'angle de la prise de la tension artérielle dans l'objectif de placer l’usager en situation d'effectuer une mesure de tension conforme aux recommandations des sociétés savantes. L'expérimentation qui a été conduite a permis d’évaluer l’acceptabilité du système proposé. / Thanks to medical progress and new technologies, life expectancy is growing continuously leading to the emergence of specific needs for elderly. With eighty percent of French willing to keep living at home even with loss of autonomy, offering a remote health monitoring system would allow them to do so in good conditions. In this context, we identified three challenges. The first one concerns health sensors interoperability which is declining because of proprietary protocols largely adopted by manufacturers in their products. To deal with this issue, we propose a middleware that simplifies the communication with the multitude of protocols, proprietary and standard, to improve interoperability with both medical and wellness devices. The second challenge reports to reliability and more particularly to measurement errors due to device handling by the user in absence of clinician. We illustrate this point with a wrist blood pressure monitor and propose a method that guides the user in properly positioning the device thanks to a smartwatch. The last challenge relates to multimodality and more precisely to the measure contextualization. It consists of combining different types of data from a set of sensors in a health monitoring system to ensure that blood pressure is measured in compliance with learned societies recommendations. The experiment we have conducted allows to evaluate the users' acceptability of the proposed solution.

Esta pesquisa analisou as concepções, expectativas e vivências dos docentes, discentes e residentes médicos, frente à proposta pedagógica da disciplina optativa Telessaúde do curso de medicina da Universidade federal do Tocantins - UFT, como uma estratégia inovadora de formação de recursos humanos em saúde. Para o alcance dos objetivos propostos utilizou-se uma metodologia quali-quantitativa por meio de estudo exploratório e descritivo, utilizando análise documental, estudo de caso e um instrumento de percepção atitudinal do tipo Likert, que foi aplicado aos docentes, preceptores e discentes dos cursos da saúde (medicina, enfermagem e nutrição), jornalismo e ciências da computação da Universidade Federal do Tocantins que cursaram a disciplina Optativa Telessaúde no período de 2011 a 2014. Foram distribuídos 30 instrumentos, com 28 asserções cada, randomizadas por cinco dimensões: A disciplina optativa Telessaúde como programa estimulador da inovação curricular; A disciplina optativa Telessaúde como ferramenta qualificadora da gestão em saúde (redes de atenção); A disciplina optativa Telessaúde como ferramenta contributiva na fixação médica no Tocantins; A disciplina optativa Telessaúde como ferramenta contributiva no fortalecimento da Educação Permanente em Saúde – EPS; A disciplina optativa Telessaúde como ferramenta de estímulo a interprofissionalidade. Nenhuma asserção foi perdida no processo de validação quanto à dispersão, evidenciando uma ótima validação de conteúdo. A confiabilidade foi testada pela fórmula de Spearman – Brown usando o método teste – reteste com R = 0,97, pelo teste de homogeneidade com p-valor de 0,032 e ANOVA com p –valor de 0,059, o que configurou excelente densidade estatística para os resultados encontrados. Todas as dimensões ficaram em zona de conforto. A análise dos dados permite a sustentação de que aspectos inovadores foram identificados na construção e desenvolvimento da referida disciplina tais como: assertividade na escolha dos conteúdos, uso adequado de metodologias ativas de ensino-aprendizagem bem como das TICs. Algumas dificuldades foram identificadas como número insuficiente de docentes, pouca participação dos preceptores apontando para a necessidade de aprimoramento da integração ensino-serviço e por último eventuais dificuldades na conectividade. Este estudo traz subsídios para avanços na referida disciplina à luz dos princípios da inovação pedagógica, aprendizagem significativa e interprofissionalidade. / This research analyzed the conceptions, expectations and experiences of the teachers, students and medical residents, forefront of the pedagogical proposal of the optional discipline Telehealth from the Medicine´s course of the Federal University of Tocantins, like an innovative strategy of training human resources in health. To reach the proposed objectives was used a methodology qualitative and quantitative through exploratory and descriptive study, using document analysis, case study and an attitudinal perception instrument like Likert, that was applied to teachers, preceptors and students of health courses (medicine, nursing and nutrition), journalism and computer science at the Federal University of Tocantins who attended the optional discipline Telehealth in the period 2011 to 2014. 30 instruments were distributed, with 28 statements each, randomized for five dimensions: the optional discipline telehealth as a stimulator of curriculum innovation program; the optional discipline telehealth as health management tool qualifying (care networks); the optional discipline telehealth as contributory tool in the medical setting in Tocantins; the optional discipline telehealth as contributory tool in the strengthening of Continuing Health Education; the optional discipline telehealth as a stimulus tool inter professionalism. No proposition had been lost in the validation process on dispersed, showing a great validation of content. The reliability was tested by the Spearman – Brown´s formula using the test-retest method with R = 0,97, by the test homogeneity with p-value 0,032 and ANOVA with p-value 0,059, which sets great statistical density for the founded results. All dimensions were in the comfort zone. The data analysis allows the support that innovative aspects have been found in the construction and development from said subject such as: assertiveness in the choice of contents, proper use of teaching and learning active methodologies well as the TIC´s. Some difficulties have been identified as insufficient number of teachers, low participation of preceptors pointing to the need to improve the teaching-service integration and lastly any difficulties in connectivity. This study provides subsidies for advances in the discipline in the light of the principles of pedagogical innovation, meaningful learning and inter professionalism.