Introduction :La télésurveillance des stimulateurs cardiaques et défibrillateurs sera à terme le standard pour le suivi des patients implantés. Pourtant, des alertes très nombreuses sont générées par ces dispositifs, et constituent un fardeau pour la prise en charge médicale. De plus, les alertes générées le sont indépendamment du contexte médical individuel du patient, et elles pourraient donc être mieux caractérisées. Cette thèse propose un outil de traitement automatique des alertes générées par la survenue de fibrillation atriale, et basé sur une modélisation des connaissances médicales de type ontologie en OWL2. En particulier, le score de risque cardio-embolique CHA2DS2VASc a été évalué par le biais de l’ontologie, ainsi que le statut d’anticoagulation du patient. Matériel et Méthodes :Une ontologie d’application a été créée en OWL2, afin de représenter les concepts nécessaires au raisonnement sur les alertes. Cette ontologie a été utilisée pour raisonner sur 1783 alertes de FA détectées chez 60 porteurs de stimulateurs cardiaques. Les alertes ont été classées automatiquement selon leur importance d’après une échelle de gravité de 1 à 4. La classification automatique a été comparée à celle réalisée par 2 experts médicaux comme référence. Résultats : 1749 alertes sur 1783 (98%) ont été classées correctement. 58 des 60 patients avaient toutes leurs alertes classées à l’identique par le système testé et par les évaluateurs-médecins. Une approche basée ontologie est à même de permettre un raisonnement automatique sur des données issues de dispositifs médicaux connectés, en les contextualisant en fonction des données médicales individuelles du patient. / Introduction :Remote monitoring of cardiac implantable electronic devices (CIED) such as pacemakers and defibrillators is the new follow-up standard. However, the numerous alerts generated in remote monitoring causes a burden for physicians. Morever, many alerts are notified despite the knowledge of patient condition and could be refined. This work proposes an automatic tool for classifying atrial fibrillation alert, based on an ontological knowledge model in OWL2. In particular, CHA2DS2VASc thrombo-embolic risk score and patient anticogulation status are accounted in order to determine alert importance. Materials and methods :An application ontology was designed in OWL2, in order to represent the concepts needed for processing alerts. This ontology was used to infer the importance of 1783 AF alerts among 60 CIED recipients, using a 4-grade scale. Automatic classification was compared to that of 2 medical experts.Results :1749 of 1783 alerts (98%) were correctly classified. 58 of 60 patients had every alerts classified with the same importance by the prototype and the human experts. An ontology-driven automatic reasoning tool is able to classify remote monitoring alerts, by using individual medical context. This technology could be important for managing data generated by connected medical devices.

Rural communities have limited access to health information which is made available on the internet. This is due to poor infrastructure (i.e., lack of clinics or Internet access) and that gives them problems in accessing information within the domain of health. The availability of Information and Communication Technologies (ICTs) in a rural community can provide the community with a number of beneficial solutions to their problems as they maximize the potential of knowledge sharing and delivery. This research seeks to make use of ICTs deployed in the community of Dwesa, in order to contribute to improving the health standards of the community. It seeks to accomplish this by carrying out an investigation and literature review with the aim of understanding health knowledge sharing dynamics in the context of marginalized communities. The knowledge acquired will then be used in the development and implementation of a semantic web-based e-Health portal as part of the Siyakhula Living Lab (SLL) project. This portal will share and deliver western medical knowledge, traditional knowledge and indigenous knowledge. This research seeks to make use of a combination of Free and/or Open Sources Software in developing the portal to make it affordable to the community.

Indiana University-Purdue University Indianapolis (IUPUI) / Retrieving data from a patient in real-time is a challenging operation, especially when requiring information from the network to support the patient’s health. A real-time healthcare system process is conducted with a continual input, processing, and output of data. It needs to have the ability to provide different priorities to different applications, users, or data flows, or to guarantee a certain level of performance to a data flow. The current Internet does not allow applications to request any special treatment. Every packet, including delay-sensitive audio and video packets, is treated equally at the routers. This simplest type service of network is often referred to as best effort, a network service in which the network does not provide any guarantees that data is delivered or that a user is given a guaranteed QoS level or a certain priority. Providing guaranteed services requires routers to manage per-flow states and perform per-flow operations. Such network architecture requires each router to maintain and manage perflow state on the control path, and to perform per-flow classification, scheduling, and buffer management on the data path. This complicated and expensive network architecture is less scalable and robust than today’s modern stateless network architectures such as Random Early Dropping (RED) for congestion control, DiffServ for QoS, and the original IP network. This thesis introduces a new DiffServ-based scheme of IP bandwidth allocation during congestion, called Proportional Allocation of Bandwidth (PAB) which can be used in all networks. In PAB scheme, the bandwidth is allocated in proportion to Subscripted Information Rate (SIR) of the competing flows. PAB implementation uses multiple token buckets to label the packets at the edge of the network and multilevel threshold queue at the IP routers to discard packets during congestion.

The adoption of eHealth is very slow despite evidences showing its benefits. This research examines the individual, clinical, technical and organizational challenges for eHealth adoption from healthcare provider‟s perspectives. A cross-sectional study design with a quantitative paradigm was used. The study was conducted on 312 doctors and nurses randomly selected from ten hospitals in Addis Ababa, Ethiopia. Most respondents viewed eHealth positively with no significant differences in terms of profession or gender. Computer skill, workload, patient interaction, management support, cost and infrastructure were the main concerns. Privacy and security were not the main concerns. Knowledge of eHealth applications and utilization was low, even for evidence-based medicine and online databases. Specialists and males were better aware of eHealth applications. The study showed that eHealth acceptance was good. Increasing eHealth literacy was recommended as a cost effective means for improving access to updated information to improve the quality of healthcare. / Health Studies / M.A. Public Health (Medical Informatics)

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

Australia and many other developed communities are ageing rapidly, placing a strain on the delivery of health services. This thesis examines the use of innovative health services management coupled with information and communication technology (ICT) to more efficiently deliver services to disabled older people in the hospital, community and residential care. The hypothesis explored is that ICT can provide clinical services to older people in poorly serviced communities and groups, thus extending the influence and capabilities of specialist health care professionals. The relevance of these studies is predominantly for those people who live outside the metropolitan regions, particularly in remote and rural communities, and also for those frail older people, who because of disability, are unable to travel to specialist health services. There are a series of studies presented in this thesis which have all been published. They have demonstrated that in a community and rural setting, ICT use in the assessment and management of geriatric syndromes such as dementia is valid and practical. This included the validation of commonly used assessment tools via Telehealth. A Telehealth protocol for assessment of Alzheimer's Dementia (AD) was developed and published. The use of ICT to link health services clinical and administrative data for determining stroke outcomes and disability has been evaluated and a resource utilization prediction model developed. Finally, in residential care a survey and a qualitative study of poor uptake of ICT services in hostels and nursing homes revealed insights into ICT perception by the older people in care facilities and their professional staff. The implications and future development of these studies have been discussed, especially barriers to increased uptake of ICT, cost comparisons and the potential of future technologies such as video conferencing mobile phones.

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.

Three decades of mobile phone diffusion, thousands of mobile-phone-based health projects worldwide ("mHealth"), and tens of thousands of health applications in Apple's iTunes store, but fundamental questions about the effect of phone diffusion on people's healthcare behaviour remain unanswered. Empirical, theoretical, and methodological gaps in the study of mobile phones and health reinforce each other and lead to simplifying assumptions that mobile phones are a ubiquitous and neutral platform for interventions to improve health and healthcare. This contradicts what we know from the technology adoption literature. This thesis explores the theoretical link between mobile phone diffusion and healthcare access; develops and tests a new multidimensional indicator of mobile phone adoption; and analyses the effects of phone use on people's healthcare-seeking behaviour. My mixed methods research design - implemented in rural Rajasthan (India) and Gansu (China) - involves qualitative research with 231 participants and primary survey data from 800 persons. My research yields a qualitatively grounded framework that describes the accessibility and suitability of mobile phones in healthcare-seeking processes, the heterogeneous outcomes of phone use and non-use on healthcare access, and the uneven equity consequences in this process. Quantitative analysis based on the framework finds that mobile phone use in rural India and China increases access to healthcare, but it also invites more complex and delayed health behaviours and the over-use of scarce healthcare resources. Moreover, increasing phone-aided health action threatens to marginalise socio-economically disadvantaged groups further. I present here the first quantitative evidence on how mobile phone adoption influences healthcare-seeking behaviour. This challenges the common view that mHealth interventions operate on a neutral platform and draws attention to potential targeting, user acceptance, and sustainability problems. The framework and tools developed in this thesis can support policy considerations for health systems to evaluate and address the healthcare implications of mobile phone diffusion.

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016. / The delivery of healthcare services should be of a high standard for everyone. For people in the location of Mantunzeleni this is not the case as there are still challenges that they go through in order to gain access to sufficient healthcare services. The location consists of four villages and the other nine which surround the four, in total this makes thirteen villages that are served by one clinic. These villages are divided by forest, rivers and mountains, people have to cross these and walk long distances to get to the clinic. Gaining access to basic healthcare services in rural areas has never been easy, hence this study seeks to understand the role telehealth could play to help improve the situation. It has been reported in the literature that telehealth has potential to address some of the problems experienced by healthcare service providers located in the rural areas. Research questions were posed to address the problem of limited access to healthcare services of under-served communities in rural areas. The study adopted an interpretive approach to understand how the people using healthcare services in the setting attach meaning to their experiences of the healthcare service. The study therefore seeks to understand how telehealth could improve healthcare service delivery through the participants’ views, perceptions and experiences. The research strategy for this study is a single case study without attempting to generalise the findings. Qualitative data was gathered using unstructured interviews, observations and co-design methods. The current state of telehealth and challenges of healthcare services in rural under-served communities was established through a review of relevant literature. It was important to actively involve the respondents in the research process for them to feel a sense of ownership. Data was analysed using a thematic analysis. The findings revealed the challenges currently hampering the delivery of healthcare in the research setting include poor infrastructure, high cost, the shortage of medical professionals, travelling distance, time management and lack of communication about the services. It was also revealed the role telehealth could play a role to improve access to healthcare and the findings indicate that the nurses feel that extending the healthcare service to include alternative access methods to health information, education and expertise could lead to a sense of appreciation, knowledge gain, dealing with distance problems and improved referrals, cost saving to improve healthcare service delivery.