1. Using eHealth as a Tool in Neonatal Care at Home Anna Gund PhD Student Chalmers University of Technology Internet Based System for Chronic Heart Failure Follow-up at Home & ™

2. Outline Background Technical description Applications –Heart Failure –Neonatal home care Future Demo!

3. Background

4. About Care@Distance Financed by VINNOVA and Ortivus AB Began as a design project in 2001 PhD project 2005 - 2011 Teknologie licentiat, 2008 PhD 2011? Adj. Prof. Bengt Arne Sjöqvist, Prof. Kaj Lindecrantz ™

5. Challenges in Society Aging population Chronic diseases Security and integrity Laws and directives Increasing demands Acceptance Costs “Information overflow” / work load Distances Infections CVD

6. Project Goals and Purposes Improve treatment compliance and increase feelings of safety among patients by daily collection of health related data in the home. Improve disease management, and support care givers in decision making. Make personalized care possible, and create customized individualized care.

7. Project Goals and Purpose Introduce and test a solution for early deterioration warning; warn about deteriorating health at an early stage, and to avoid information overflow. Study how eHealth applications should be implemented in order to attain acceptance in the Swedish health care. Investigate how to design business models for successful commercialization

8. Health Care Benefits Daily monitoringSecure patients Better decision support More accurate and safer treatment Early warningsLess acute and unnecessary health deterioration Improved treatment compliance Healthier patients and better care outcomes Personalized careEfficient and correct treatment at an individual level ResultBetter care!

9. Internet Based Solutions Economic Robust Easy to maintain Easy to use Accessible Mobility High internet usage in Sweden

10. Our Solution

11. Internet Patients & Relatives Care Personnel Server ©Anna Gund Drawings by Pernilla Börjesson

12. Technical Description MS SQL Server PHP Virtual Server at Chalmers –MS Server Patients use own computers Commercial medical measuring products –Blood pressure monitor from Omron ©

13. Objective vs Subjective Both objective (signs) and subjective (symptoms) important! How patient feels mirrors the disease. Often symptoms are treated, not only signs.

14. Applications

15. Heart Failure –2% of western population –Most over 60 years of age –Chronic health disorder Signs and Symptoms –Fatigue –Dyspnea –Weight gain (collection of fluid) –Weight loss (loss of appetite) ©

16. Previous trials - Survey Performed at Östra Hospital, Gothenburg, 2007 Evaluation of first prototype Touch sensitive screen, installed program 10 patients, tested system once at clinic 8 out of 10 found the system easy to use Blood pressure monitor difficult ©

17. Previous trials - Pilot Performed 2007 Test of first prototype in home environment 2 patients, 1 month Evaluated by semi-structured interviews Good compliance with system System easy to use Blood pressure monitor a big problem

18. Ongoing Study Harshida Patel (PhD, nurse), Maria Schaufelberger (ÖL) Internet based prototype 13 patients, Östra Hospital Daily measurements at home –Weight –Blood pressure –Symptoms (with follow-up questions) First step - 6 months, finished in December Usability, acceptance, feelings of safety ©

19. Neonatal Care in the Home Prematurely born children (before week 37) When stable moved to home environment Home visits by nurse 2-3 times per week Regular phone calls In home care approximately 3 weeks ©

20. Ongoing Study Kristina Bry (prof), Elisabet Hentz (ÖL), Erika Pedersen (nurse) Large trial for 2 years –Follow-up after 6 months Collaboration within VGR –Östra and Mölndal Hospital –Skövde (Kärnsjukhuset) –NÄL Internet based prototype Web camera communication using Skype ©

21. Ongoing Study Internet based prototype –Parents answer subjective questions daily –Nurse measures weight, head circumference and length (Skövde) Skype –Regular contact with parents –Web camera Usability, acceptance, feelings of safety, care outcomes ©

22. Preliminary Results Both Skype and Internet based prototype accepted by families Positive responses from all groups Skype-families tend to be very positive –Reduced need of home visits Many families decline –Problems with information? Acceptance more difficult among personnel than families –Important to get care personnel involved

23. Future Work Extended trial on heart failure Other patient groups –Hypertension –COPD –Diabetes –Parkinson's and stroke –Depression –Combinations! Information overflow –More or less advanced tools for decision support ©

24. Demo

25. Thank you! Questions? anna.gund@chalmers.se www.care-at-distance.se Welcome to my dissertation December 9 at Chalmers! ™