Dataset Information

A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study.

ABSTRACT: BACKGROUND:Most electronic health (eHealth) interventions offered to patients serve a single purpose and lack integration with other tools or systems. This is problematic because the majority of patients experience comorbidity and chronic disease, see multiple specialists, and therefore have different needs regarding access to patient data, communication with peers or providers, and self-monitoring of vital signs. A multicomponent digital health cloud service that integrates data sharing, collection, and communication could facilitate patient-centered care in combination with a hospital patient portal and care professionals. OBJECTIVE:This study aimed to assess the feasibility and functionality of a new cloud-based and multicomponent outpatient clinic, the "Virtual Outpatient Clinic" (VOC). METHODS:The VOC consists of 6 digital tools that facilitate self-monitoring (blood pressure, weight, and pain) and communication with peers and providers (chat and videoconferencing) connected to a cloud-based platform and the hospital patient portal to facilitate access to (self-collected) medical data. In this proof-of-concept study, 10 patients from both Departments of Internal Medicine and Dermatology (N=20) used all options of the VOC for 6 weeks. An eNurse offered support to participants during the study. We assessed the feasibility, usage statistics, content, adherence, and identified technical issues. Moreover, we conducted qualitative interviews with all participants by following a standard interview guide to identify user experiences, including barriers, facilitators, and potential effects. RESULTS:Most participants successfully used all options of the VOC and were positive about different tools and apps and the integral availability of their information. The adherence was 37% (7/19) for weight scale, 58% (11/19) for blood pressure monitor, and 70% (14/20) and 85% (17/20) for pain score and daily questions, respectively. The adherence for personal health record was 65% (13/20) and 60% (12/20) for the patient portal system. Qualitative data showed that performance and effort expectancy scored high among participants, indicating that using the VOC is convenient, easy, and time-saving. CONCLUSIONS:The VOC is a promising integrated Web-based technology that combines self-management, data sharing, and communication between patients and professionals. The system can be personalized by connecting various numbers of components, which could make it a relevant tool for other patient groups. Before a system, such as the VOC, can be implemented in daily practice, prospective studies focused on evaluating outcomes, costs, and patient-centeredness are needed.

SUBMITTER: de Jong JM

PROVIDER: S-EPMC6231839 | biostudies-other | 2018 Sep

REPOSITORIES: biostudies-other

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A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study.

de Jong Jelske Marije JM Ogink Paula Am PA van Bunningen Carin Gm CG Driessen Rieke Jb RJ Engelen Lucien Jlpg LJ Heeren Barend B Bredie Sebastian Jh SJ van de Belt Tom H TH

Journal of medical Internet research 20180924 9

<h4>Background</h4>Most electronic health (eHealth) interventions offered to patients serve a single purpose and lack integration with other tools or systems. This is problematic because the majority of patients experience comorbidity and chronic disease, see multiple specialists, and therefore have different needs regarding access to patient data, communication with peers or providers, and self-monitoring of vital signs. A multicomponent digital health cloud service that integrates data sharing ...[more]

PMID: 30249584

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Project description:PurposeTo develop a novel four-dimensional (4D) intensity modulated radiation therapy (IMRT) treatment planning methodology based on dynamic virtual patient models.MethodsThe 4D model-based planning (4DMP) is a predictive tracking method which consists of two main steps: (1) predicting the 3D deformable motion of the target and critical structures as a function of time during treatment delivery; (2) adjusting the delivery beam apertures formed by the dynamic multi-leaf collimators (DMLC) to account for the motion. The key feature of 4DMP is the application of a dynamic virtual patient model in motion prediction, treatment beam adjustment, and dose calculation. A lung case was chosen to demonstrate the feasibility of the 4DMP. For the lung case, a dynamic virtual patient model (4D model) was first developed based on the patient's 4DCT images. The 4D model was capable of simulating respiratory motion of different patterns. A model-based registration method was then applied to convert the 4D model into a set of deformation maps and 4DCT images for dosimetric purposes. Based on the 4D model, 4DMP treatment plans with different respiratory motion scenarios were developed. The quality of 4DMP plans was then compared with two other commonly used 4D planning methods: maximum intensity projection (MIP) and planning on individual phases (IP).ResultsUnder regular periodic motion, 4DMP offered similar target coverage as MIP with much better normal tissue sparing. At breathing amplitude of 2 cm, the lung V20 was 23.9% for a MIP plan and 16.7% for a 4DMP plan. The plan quality was comparable between 4DMP and IP: PTV V97 was 93.8% for the IP plan and 93.6% for the 4DMP plan. Lung V20 of the 4DMP plan was 2.1% lower than that of the IP plan and Dmax to cord was 2.2 Gy higher. Under a real time irregular breathing pattern, 4DMP had the best plan quality. PTV V97 was 90.4% for a MIP plan, 88.6% for an IP plan and 94.1% for a 4DMP plan. Lung V20 was 20.1% for the MIP plan, 17.8% for the IP plan and 17.5% for the 4DMP plan. The deliverability of the real time 4DMP plan was proved by calculating the maximum leaf speed of the DMLC.ConclusionsThe 4D model-based planning, which applies dynamic virtual patient models in IMRT treatment planning, can account for the real time deformable motion of the tumor under different breathing conditions. Under regular motion, the quality of 4DMP plans was comparable with IP and superior to MIP. Under realistic motion in which breathing amplitude and period change, 4DMP gave the best plan quality of the three 4D treatment planning techniques.

Project description:BackgroundBlockchain has the potential to disrupt the current modes of patient data access, accumulation, contribution, exchange, and control. Using interoperability standards, smart contracts, and cryptographic identities, patients can securely exchange data with providers and regulate access. The resulting comprehensive, longitudinal medical records can significantly improve the cost and quality of patient care for individuals and populations alike.ObjectiveThis work presents HealthChain, a novel patient-centered blockchain framework. The intent is to bolster patient engagement, data curation, and regulated dissemination of accumulated information in a secure, interoperable environment. A mixed-block blockchain is proposed to support immutable logging and redactable patient blocks. Patient data are generated and exchanged through Health Level-7 Fast Healthcare Interoperability Resources, allowing seamless transfer with compliant systems. In addition, patients receive cryptographic identities in the form of public and private key pairs. Public keys are stored in the blockchain and are suitable for securing and verifying transactions. Furthermore, the envisaged system uses proxy re-encryption (PRE) to share information through revocable, smart contracts, ensuring the preservation of privacy and confidentiality. Finally, several PRE improvements are offered to enhance performance and security.MethodsThe framework was formulated to address key barriers to blockchain adoption in health care, namely, information security, interoperability, data integrity, identity validation, and scalability. It supports 16 configurations through the manipulation of 4 modes. An open-source, proof-of-concept tool was developed to evaluate the performance of the novel patient block components and system configurations. To demonstrate the utility of the proposed framework and evaluate resource consumption, extensive testing was performed on each of the 16 configurations over a variety of scenarios involving a variable number of existing and imported records.ResultsThe results indicate several clear high-performing, low-bandwidth configurations, although they are not the strongest cryptographically. Of the strongest models, one's anticipated cumulative record size is shown to influence the selection. Although the most efficient algorithm is ultimately user specific, Advanced Encryption Standard-encrypted data with static keys, incremental server storage, and no additional server-side encryption are the fastest and least bandwidth intensive, whereas proxy re-encrypted data with dynamic keys, incremental server storage, and additional server-side encryption are the best performing of the strongest configurations.ConclusionsBlockchain is a potent and viable technology for patient-centered access to and exchange of health information. By integrating a structured, interoperable design with patient-accumulated and generated data shared through smart contracts into a universally accessible blockchain, HealthChain presents patients and providers with access to consistent and comprehensive medical records. Challenges addressed include data security, interoperability, block storage, and patient-administered data access, with several configurations emerging for further consideration regarding speed and security.

Project description:BackgroundMultimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ≥65 years) living with multimorbidity.ObjectiveThis paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN).MethodsResearch was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50% in Ireland and 60/120, 50% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium.ResultsThe trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021.ConclusionsProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care.International registered report identifier (irrid)RR1-10.2196/22125.

Project description:BackgroundIncreased empathy may improve patient perceptions and outcomes. No training tool has been derived to teach empathy to emergency care providers. Accordingly, we engaged patients to assist in creating a concept map to teach empathy to emergency care providers.MethodsWe recruited patients, patient caretakers and patient advocates with emergency department experience to participate in three separate focus groups (n = 18 participants). Facilitators guided discussion about behaviors that physicians should demonstrate to rapidly create trust; enhance patient perception that the physician understood the patient's point of view, needs, concerns, and fears; and optimize patient/caregiver understanding of their experience. Verbatim transcripts from the three focus groups were read by the authors, and by consensus, five major themes with 10 minor themes were identified. After creating a codebook with thematic definitions, one author reviewed all transcripts to a library of verbatim excerpts coded by theme. To test for inter-rater reliability, two other authors similarly coded a random sample of 40% of the transcripts. Authors independently chose excerpts that represented consensus and strong emotional responses from participants.ResultsApproximately 90% of opinions and preferences fell within 15 themes, with five central themes: provider transparency, acknowledgment of patient's emotions, provider disposition, trust in physician, and listening. Participants also highlighted the need for authenticity, context, and individuality to enhance empathic communication. For empathy map content, patients offered example behaviors that promote perceptions of physician warmth, respect, physical touch, knowledge of medical history, explanation of tests, transparency, and treating patients as partners. The resulting concept map was named the "Empathy Circle."ConclusionsFocus group participants emphasized themes and tangible behaviors to improve empathy in emergency care. These were incorporated into the Empathy Circle, a novel concept map that can serve as the framework to teach empathy to emergency care providers.

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Dataset Information

A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study.

Publications

A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study.

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