Presentation given in the 1st International Conference on Wireless Mobile Communication and Healthcare (MobiHealth), Ayia Napa, Cyprus, October 2010. The paper was given the Best Student Paper Award. Triantafyllidis, A., Koutkias, V.G., Chouvarda, I., Giaglis, G.D., Maglaveras, N. Personal Health Systems for Patient Self-management: Integration in Pervasive Monitoring Environments (2010) LNICST, Springer 55/2010, pp. 87-94 -------------------------------------- Various personal health systems have been applied in pervasive health monitoring, in which the need for patient involvement and self-management support with appropriate health information management tools has been highlighted. This paper presents a novel approach towards constructing a personalized mobile system, introduced as add-on to existing remote monitoring systems, for the management of health information by the patient himself/herself, with a Personal Health Record (PHR) constituting the system backbone. Particular emphasis is given to interconnection aspects with the monitoring system, so as to enable enhanced customization and management of monitoring-driven information provided to the patients according to their requirements/preferences. Communication issues between the monitoring and the proposed system are handled by using well-defined Web service interfaces for data exchange. Our prototype implementation, along with an application scenario presented, illustrate the applicability and virtue of the current work.

1. Personal Health Systems for Patient
Self-management: Integration in
Pervasive Monitoring Environments
A.K. Triantafyllidis, V.G. Koutkias, I. Chouvarda, G.D. Giaglis and
N. Maglaveras
Lab of Medical Informatics
Faculty of Medicine, Aristotle University of Thessaloniki
Thessaloniki, Greece
atriant@med.auth.gr

2. Presentation Outline
• Background:
– Personal Health Systems
– Patient Self-management
– Pervasive Monitoring Systems
• Scope of the Current Work
• Proposed System:
– Functional Attributes
– System Architecture
• Results:
– Prototype Implementation - Technical Feasibility
• Discussion and Future Work
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

3. Personal Health Systems
• Personal Health Information Management towards Wellness
• Pervasive Health Monitoring: Anytime, Anywhere, Unobtrusive
Pervasive Health Monitoring
Instruments & Situations
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

4. Patient Self-management: Rationale
Rationale (K.R. Lorig, 2003#): “Whether one is engaging in
a health promoting activity such as exercise or is living
with a chronic disease such as asthma, he or she is
responsible for day-to-day management.”
#K.R. Lorig and H.R. Holman, “Self-management education: History, definition, outcomes,
and mechanisms”, Ann Behav Med., vol. 26, no. 1, pp. 1-7, 2003.
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

5. Patient Self-management : Benefits
Enhancement of communication with doctors
Focus on treatment plan, adherence
Self-efficacy
Confidence to carry out a behavior/lifestyle necessary to
reach a desired goal
Well-being better management
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

6. Pervasive Monitoring Environments
Problems encountered in Health Information Management
by patients
– Limited User-to-System Interactions
– Tight to the monitoring plan
– Dedicated to the monitoring system functionality
– Variable Context (Time – Location – Activity – Situation):
Inappropriate patient feedback
Limited patient involvement with respect to
customization and filtering of information
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

7. An Integrated Approach for Patient
Self-management
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8. Target Users & Functionality
• Mobile Personal Health Management System
(PHMS) targeted at Chronic Patients who:
– Use Remote Monitoring Systems (RMSs)
– Are highly aware of their disease
– Wish to engage more actively in their disease management
• Functional Attributes:
– Patient self-reporting
– Configurations related to the value of the Monitoring Output
to the patient
– Monitoring Output presentation preferences
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

9. Patient-driven and Monitoring-driven Information
(PDI & MDI)
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

10. System Architecture
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

11. Communication Infrastructure
Main Objective: PHMS & RMS Interoperability
• Service-Oriented Architecture (SOA):
– SOAP (Simple Object Access Protocol)
– WSDL (Web Service Description Language)
• Terminology Services:
– UMLSKS (Unified Medical Language System
Knowledge Server)
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

12. Example Web Service Operations
PHMS back-end – MBU interface PHMS back-end – RMS interface
Patient MDI preferences MDI control
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

13. Patient Configuration Capabilities
• MDI Insertion into the PHR
– Whether
• Yes, No and “Send notification” options
– When
• Temporal Exceptions
• Presentation Preferences
– Terminology (medical vocabulary in use)
– MDI detail (e.g. inclusion of the conditions which lead
to the MDI generation)
– Information Access Rights
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

14. Example of Components Interaction:
MDI Insertion
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

15. Technical Feasibility
• Integration target:
– Add-on to existing RMS with minimum configurations
• Requirement:
– RMS Web Service Client layer for communication with the PHMS
Integrated & tested with Citizen Health System (CHS)
CHS characteristics:
– Sensor-enhanced RMS with MBU
– System back-end infrastructure based on Component Object
Model (COM) technology
– System-generated feedback
• “Tip” e.g. “Reduce your salt-intake”
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

16. Prototype Implementation
MBU PHMS back-end
• J2ME-CLDC (Java 2 Micro • Apache Tomcat
Edition- Connected Limited – Web application container
Device Configuration)
– Open platform for mobile
applications • Apache Axis2
– Underlying SOAP engine
• JSR-172 Web Services (Java • SMS Gateway
Specifications Request) – Needed for “push” operations
– API for Web Service clients
• Bouncy Castle Crypto API
– AES Data encryption
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

17. MBU Demo Snapshots (SmartPhone)
Alert generated as Integration of MDI and Insertion of MDI with
MDI into PHMS PDI in patient’s PHR temporal exceptions
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

18. Discussion: Future Work
• Extensive Evaluation:
– Usability aspects
– Patient acceptance
– Medical perspective
• Integration of appropriate self-management methodologies:
– Goal-setting approach
• Elaborate on a generic methodology integrating:
– Patient preferences and observations
– Handling of context parameters, e.g. location, activity, etc.
– Behavioral monitoring based on user-to-system interactions
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Personal Health Systems for Patient Self-management: MobiHealth 2010
Integration in Pervasive Monitoring Environments Ayia Napa, Cyprus

19. Thank you!!!
Personal Health Systems for Patient
Self-management: Integration in
Pervasive Monitoring Environments
A.K. Triantafyllidis, V.G. Koutkias, I. Chouvarda, G.D. Giaglis and
N. Maglaveras
Lab of Medical Informatics
Faculty of Medicine, Aristotle University of Thessaloniki
Thessaloniki, Greece
atriant@med.auth.gr