PEGASO: Fit For Future: connected health and long-term strategy

16 Nov
Elisa Puigdomènech

Developing a platform based on mHealth that has mobile applications (apps), a game and intelligent sensors has been the goal of the European project  PEGASO Fit For Future, which began in December 2013 and ended last July.

It is a platform that aims to improve both the lifestyles of adolescents (diet, physical activity and hours of sleep) and the knowledge that they might have about these life styles. To achieve this, intelligent sensors (t-shirt and bracelet) which record the physical activity and hours of sleep of an individual and also different apps which record the intake of food by means of a diary and footsteps taken by means of an accelerometer were developed and tested.

The PEGASO Fit For Future platform detects which lifestyles a user has and makes recommendations on how to improve them. In addition, it incorporates a gamification component: based on how healthy the lifestyle of a user is as well as how much their knowledge improves, which are then converted into obtaining a greater or lesser amount of points.

As an example, here we can see a screenshot of a fictitious user:

Professionals from different areas collaborated in the project: developers of games, apps and sensors, design and gaming experts, health professionals (doctors, nurses, experts in nutrition, experts in physical activity and psychologists) and also experts in health technology assessment and public health.

There were two different phases of the project: the development phase of the platform and the assessment phase.

During the development phase, while some professionals put their efforts into ensuring the quality and appropriateness of the medical and clinical content of the platform, others concentrated on aspects of a technological nature.

Nevertheless, the opinions of the end users themselves, adolescents, were always kept in mind during this process. In three iterative stages, boys and girls in Catalonia, Lombardy, England and Scotland tested this technology out in the different stages of its development.

The proposals for improvement made by the adolescents including their preferences were, whenever possible, kept in mind for the later versions of the platform. The aim was to guarantee as far as possible that what was being developed was practical for and accepted by the end users.

The last stage of the project was the assessment of the platform. The assessment of the different elements (apps, games and sensors) was to see if they really did help to improve the lifestyles and knowledge about lifestyles among adolescents and to assess the experience of the user after having used the platform.

To this end, a pilot study was carried out with adolescents from Catalonia, Lombardy, Scotland and England in which 365 mobile phones with the PEGASO platform installed were used by adolescents.

After six months of use, the intervention was assessed by means of validated questionnaires, a qualitative methodology and data obtained from the platform itself. A control group was introduced allowing for comparisons to be made with adolescents that did not have access to the platform.

The results of this study will help to evaluate whether new technologies are practical in helping adolescents improve both their lifestyles and knowledge about these lifestyles, a population group accustomed to using new technologies and that, in general, do not often visit health professionals.

Getting closer to the population by using mobile technology and the recreational aspect of gaming could be a good strategy for an intervention of this type related to the promotion of healthy lifestyles among adolescents. At a population level, it is a long-term strategy and hence the slogan “Fit For Future” of the PEGASO project.

Post written by Elisa Puigdomènech.

Time to digitally disconnect?

14 Sep

It is very common to see groups of people looking at their mobile devices in any place at any time: on holiday, at work, at home, in the underground, on the bus, in a congress, ….. wherever. It is also common to take advantage of our holidays to say that we will make the most of these days to disconnect from our routines. Does this include disconnecting our mobile phones, tablets, laptops, the TV or email?

At AQuAS, as an agency involved in health assessment, we do not know this. What we do know is that there is more and more talk of connected health, a term which includes mHealth, eHealth and all related concepts, which have been a part of everyday life for some time now.

At a level of the Catalan system of health, we have in this post by Òscar Solans an example of the development of technological tools which involve new ways of interaction between patients and the health system. In this way, La Meva Salut and eConsult are useful tools when placing the patient, the person that is, at the centre of all the interactions there are with the health professionals coming from different fields.

At a European level, Jean Patrick Mathieu and Rossana Alessandrello wrote about how complex the subjects of interoperability and the implementation of mobile technological solutions are, in this other post. This was the framework for the European project DECIPHER whose goal was to facilitate the access to health information from different countries and health systems.

Let’s change the perspective. At an individual level, who does not have an app downloaded on their mobile phone? Which of these apps have to do with something related to health, such as weight control, for example, or as support when doing physical exercise, to keep track of menstrual cycles, fertility calendars or aspects of mental and emotional health? And no need to limit ourselves to talking about mobile devices: who has not heard of calculators for aspects of health such as calculators of life expectancy?

Downloading an app is very easy and can even be free. In this post by Elisa Puigdomènech, she highlighted the fact that in mid-2016 The Economist explained there were some 165,000 apps related to health. This figure must no doubt have increased.

What does the success of an app depend on? What guarantees of quality and safety do they offer?

Regarding the first question, the user experience was the subject on which Elisa Puigdomènech put the emphasis, based on the experience obtained in the PEGASO project. Along the same lines, Santi Gómez spoke about the fact that the development of a health application must, in all phases of its development, include the participation of those who will ultimately be the end users.

And in terms of the second question, any health intervention should be safe, be based on evidence, on the best quality knowledge available and should be assessable. This is the premise with which we at the AQuAS work and this is the role that an assessment agency can play when thinking about connected health. Thus, this post by Toni Dedéu places the emphasis on the fact that technologists, assessors, professionals and citizens have the opportunity to work together and combine their expertise but not forgetting the speed of innovation.

In conclusion, the assessment of connected health is a current topic. This article was recently published, and is a good example of a proposal for a conceptual framework. We end this post with an editorial about innovation and evidence which invites one to reflect on assessment and innovation.

Post written by Marta Millaret (@MartaMillaret)

 

La Meva Salut (My Health) and eConsulta (eConsultation): deploying the model of remote care in Catalonia

18 May
Òscar Solans

The management of information is key to the health system from the perspective of a greater integration between patients and professionals of different levels. Shared information, transparency, evaluation and the readjustment of healthcare processes need to be primary lines of action so as to situate the patient at the centre of the different interactions with professionals of different fields.

The expansion of information technologies has created new opportunities which enable people to participate actively in the monitoring of care processes offering a unique opportunity to facilitate communication and improve a patient’s commitment. The new model of care which the Health Plan Catalonia 2016-2020 proposes is aimed at putting more focus on patients and to that effect, tools have been developed that improve the relationship between citizens and the health system making it all easier.

In Catalonia, we have a personal health folder available since 2009, Cat@Salut La Meva Salut (LMS), accessed by using a digital certificate or using a user name and password which are provided by a citizen’s primary healthcare reference centre.

You can read this article published in the magazine Annals de Medicina.

La Meva Salut is a personal digital space for consultation and interaction, which puts relevant health information generated by public healthcare centres in Catalonia at the disposal of citizens, in a safe and confidential way. This information includes such things as the current medication plan, vaccines administered, diagnoses, clinical information, results of tests and complementary examinations

When considering La Meva Salut, we can say that it is a strategic project which promotes the participation and co-responsibility of citizens in prevention and the care of their health, fostering awareness and knowledge related to their pathologies and making it possible for them to participate in the clinical process of care.

La Meva Salut offers cross-cutting and strategic services of the Catalan Department of Health and it also allows different health providers to incorporate more personalised services according to the more specific needs of patients in each entity, which are standardised in La Meva Salut.

In this way, La Meva Salut offers a unique gateway to the virtual health system allowing citizens, who identify themselves only once, to use services of different centres in an integrated and personalised way. Some of these services already in use, are, among others: changing primary care doctors, requesting appointments to see a primary care doctor and for international vaccination services, service of patient communities (allows groups of patients to be created for sharing opinions and dealing with different pathologies with the help of an administrator that is usually a health professional), and the monitoring of patients with chronic pathologies.

This article has recently been published in the magazine New Perspectives in Medical Records.

The most noteworthy cross-cutting services that the Department of Health has made available are:
• Consultation of waiting lists for surgery
• Consultation of pending appointments and tests of any health provider in an integrated way
• Obtainment of organ donor’s card
• Consultation of the Advance Directives document
• Inclusion by the patient of clinical variables in their clinical history
• Secure mail service, eConsulta

The goals of La Meva Salut and the eConsulta service are in line with the Non-Face-to-Face Model of Care of the Catalan Health Department, which aims to guarantee, improve and facilitate the access to the Catalan Health System and to offer options for non-face-to-face care by providing added comfort both to professionals and citizens in the process of care.

Data for access to La Meva Salut

eConsulta is an asynchronous and bidirectional remote communications tool between a citizen and health professional that complements face-to-face care. The access by citizens is only possible via La Meva Salut, in a safe environment which guarantees confidentiality in communication. Citizens are authenticated each time they enter and the professional can only consult or respond from their work station; in this way, the information is stored in the repositories of the Health Dept. incorporating them into the electronic clinical history of each citizen.

This is a new channel of agile communication to resolve a citizen’s consultations in a virtual manner. Either the professional or the patient can begin a dialogue. The access of citizens to the health system is thus made easier and a solution is provided to a part of healthcare needs without needing to programme face-to-face visits, with the corresponding saving of paperwork and time this means for citizens and professionals.

Data used in eConsultation in Primary Care in Catalonia*

What do these two tools, La Meva Consulta and eConsulta, offer the professional?

We can answer this question briefly and clearly:

  • These tools represent a new model in the relationship with citizens where they are invited to participate in the care process and, moreover, have the possibility of adding information (via La Meva Salut)
  • The new channel of communication generated by these tools allows notifications and documents to be sent in a safe way and, ultimately, to establish a non-face-to-face type of relationship with patients. In models such as Kaiser Permanente in the United States, the number of face-to-face visits has been reduced considerably
  • Tele•    Substitution of face-to-face visits with virtual visits such as the updating of the online medication plan, results of normal tests and the monitoring of some types of pathologies

As happens with any change, the inclusion of technologies in processes requires users to adapt to new uses despite these having clear benefits.

This new way of interaction between patients and the health system has come to stay as happened in other sectors, such as in banking, for example, where processes have been changed significantly.

On the other hand, technologies increase the levels of security of access to information, enabling alerts of pathological results to be generated, providing support tools to clinical decision making, improving the self-management of agendas with the use of eConsulta, substituting low added value tasks with others that require a clinical interpretation and dedication to patients that need more time and knowledge.

The challenge in Catalonia is the deployment of a new model of care that promotes the use of online services, with the objective – once implemented – of fundamentally changing the care process in health centres by empowering patients and achieving a safer medical practice.

With careful development and the joint effort of professionals and citizens, each one in their role, these services can be incorporated  successfully into the organisation of healthcare.

Post written by Òscar Solans (@osolans), functionally in charge of eSalut (eHealth) in the Catalan Health Department.

The main challenge in mHealth is understanding each other

3 Mar
Toni Dedéu - DECIPHER final event 2017
Toni Dedéu

In recent years, the debate about what we should do with health apps has centred around accreditation, certification or assessment. At the same time, multiple lists of health apps recommended by a range of known and recognised initiatives have been drawn up.

An example of this would be the iSYScore2017 ranking of the Fundació iSYS which was presented in the context of the CAMFiC a few weeks ago.

rànquing apps salut

In this context, and with the Mobile World Congress 2017 in Barcelona in full swing, we can ask ourselves what role a Health Technology Assessment (HTA) agency has when considering mHealth.

There is a reality which we cannot evade. Any health intervention needs to be based on evidence, on knowledge of the highest quality at hand, and must be evaluated.

This cannot be done by turning our backs on the real world or innovation. A health app is a tool to carry out a health intervention and so health apps need to be seen as just another intervention, but of course, with some characteristics of their own which will mean there is an extra demand placed on one and all.

Technologists, HTA experts, professionals and citizens have the opportunity to understand each other if we want to be facilitators of recommending safe apps in health. We are not talking about initiatives that can be developed from one sector only and it is not only about apps.

Now more than ever, we need to be flexible and work from a multidisciplinary position. We already talk about co-creation and co-design; quite simply, of co-produced mHealth initiatives based on the expertise of multiple agents including, obviously, citizens.

AQuAS is participating in the assessment of several mHealth projects financed by the European Commission. The PEGASO project stands out, centred on promoting healthy lifestyles among adolescents, and DECIPHER, as an integral solution to facilitate the geographical mobility of patients with chronic diseases such as diabetes type 2 and m-resist, centred on schizophrenia and patients resistant to treatment.

We are faced with the challenge of integrating totally different fields such as the language of technologists and developers; the speed of innovation and the culture of assessment. In addition, this needs to be done without losing sight of the key role of scientific societies and the different points of view of health professionals and end users.

We know there is a lot of work to be done. Technologists and experts in health technology assessment, respectively, have the opportunity to learn a lot from each other. It is about sharing knowledge and expertise to facilitate, ultimately, health tools for citizens and professionals, which have been assessed, are based on evidence, are safe and reliable and have a strong collaborative component.

MWC17
Digital Health and Wellness Summit – MWC17

 

Post written by Toni Dedéu (@Toni_Dedéu) and Elisa Puigdomènech.

mHealth & user experience: the user decides

23 Feb
Marta Millaret - Elisa Puigdomènech - MWC2017
Marta Millaret and Elisa Puigdomènech

The Economist recently published an article in which they reported that the number of mobile health applications, or apps, was in the region of 165.000, a very high figure that poses many questions.

A large part of these apps are related to well-being and promoting healthy lifestyles, but what makes us choose one over another?

The first thing that comes to mind is that mobile health apps, being a health technology, could and should be assessed based on their impact on health and this is where we are faced with our first problem.

While there is a gold standard when assessing this impact in the area of medication and static interventions in randomized clinical trials, how is this impact assessed in a highly dynamic world? In a world that can include a range of components that users can use depending on their needs? Where pressure is added due to the fact that advances in technology are being made in leaps and bounds and we cannot wait for years before getting results? It is not that simple.

If we venture into the area of mHealth, the first thing we find is great diversity. The design, requirements and assessment of an app developed to help manage diabetes in older people is very different to an app aimed at providing a dose for some medication where improving its adherence is sought, or an app to promote not drinking alcohol among young people before sitting in the driver’s seat, or an app to manage depression and anxiety.

What are we trying to say with all this? Easy and complex at the same time: the intervention that one wants to do via a health app and the target users will determine their use and their adherence.

And we are only just beginning. Apart from aspects related to health and the suitability of content or other more technological factors such as interoperability and security -by no means simple-, other factors come onto the scene such as acceptability, usability and satisfaction, factors related to User Experience (UX).

User Experience in mHealth is essential given that the main aim of it all is to make the tools which are being developed viable, accepted and used by the population who they are meant for, and also that the aim for which they were designed be respected.

After all, the end user who has the last word in deciding whether a health app is used or not, and this is why their participation in all phases of developing these mHealth tools is crucial.

Pursuing these aims of feasibility, acceptability and usability can make us reflect on, for example, the difficulty some old-age people may have when learning to use a smartphone for the first time. However, these obstacles related to the generational factor also exist among young people with new languages.

We suggest let yourself surprised by this video that shows how some adolescents react and interact when using Windows 95 for the first time.

The Mobile World Congress 2017 will be taking place in Barcelona next week. Monday will be one of the days circled into the diary of many professionals interested in subjects on mobiles and health with the Digital Health & Welness Summit 2017 programme.

DWHW 2017

But not everything will be happening at the Mobile. Another important mHealth event will take place on March 1st at the Palau Robert in Barcelona with the DECIPHER project final event.

logo decipherTo be continued

Post written by Elisa Puigdomènech and Marta Millaret (@martamillaret).