Gunnar Hartvigsen, professor, MSc, PhD Nasjonalt senter for samhandling og telemedisin, Universitetssykehuset Nord-Norge

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1 Gunnar Hartvigsen, professor, MSc, PhD Nasjonalt senter for samhandling og telemedisin, Universitetssykehuset Nord-Norge EGENOMSORG VED KRONISK SYGDOM Fredag den 3. december 2010, kl , Eigtveds Pakhus, København

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3 Nasjonalt senter for samhandling og telemedisin ( Approx. 110 employees, research and competence centre Clinic at the University Hospital of North Norway (UNN) World Health Organization Collaborating Centre for Telemedicine since July 2002

4 The Diabetes and Lifestyle team Technologists System developers Medical doctors Nurses Statisticians Researchers PhD students Risk management personnel Lawyers

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6 Self-help tools Personalized and patientoriented tools, i.e. where patients themselves or caregivers use a device, system or service to take better care of their health.

7 Tools for: 1. accessing general and personalized health information 2. health monitoring and perceived safety 3. support with regard to symptoms 4. motivation towards better health habits 5. need for social contact and company

8 Mobile approaches, generally Mobile phones are becoming increasingly important in everyday life and now in healthcare. There has been a steady growth of ICT in health communication and technology is used progressively in telemedicine, wireless monitoring of health outcomes in disease and in the delivery of health interventions. Dr. Holly Blake, BJCN 13(4), 2008 (British Journal of Community Nursing)

9 Mobile approaches, areas Using SMS for health support Behaviour change / clinical care Interactive health diaries Health parameter monitoring Sensor applications Mobile communication (voice and data) Robots Electronic Peak Flow Meter nspire Health, Inc.

10 Mobile tools, characteristics Robots mainly for social support, e.g. the NAO PDA mobile phone Complicated text input (waiting for S.R.) Increasing no. of applications for smartphones More and more involve sensors Many specific tools, few are integrated

11 Examples of mobile tools Disease diaries, e.g. SiDiary Wearable sensors, e.g. as watches Intelligent Pill-box, e.g. SIMpill Use of the mobile phone in dementia care Keeping In Touch Everyday (KITE) project, Int Psychogeriatr Jun;21(3)

12 Hybrids, e.g. AU iida Polaris a phone that can be attached to a cradle and turned into a gentle little robot. as well as monitor your health and give advice on how to maintain or improve your current condition (Japan)

13 The most common functions found in existing technology were gathering and transmitting data for others to use, as well as reporting and informing. Devices capable of integrated analysis and supporting people in making decisions were not yet available commercially.

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15 Årsand, E., Tatara, N., Hartvigsen, G. (2011). Wireless and Mobile Technologies Improving Diabetes Self-Management. Handbook of Research on Mobility and Computing: Evolving Technologies and Ubiquitous Impacts. Edited by Maria Manuela Cruz-Cunha & Fernando Moreira. IGI Global.

16 Årsand, E., Tatara, N., Hartvigsen, G. (2011). Wireless and Mobile Technologies Improving Diabetes Self-Management. Handbook of Research on Mobility and Computing: Evolving Technologies and Ubiquitous Impacts. Edited by Maria Manuela Cruz-Cunha & Fernando Moreira. IGI Global.

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19 Classical education time consuming Only 35% of the patients in Norway achieve the International Diabetes Federation s goal for blood glucose (HbA1c), only 6 % reach all treatment goals

20 Our Aim Generate knowledge about how mobile tools can be designed for supporting selfmanagement

21 by including users Methods Focus group (á 5-8 persons) Paper prototyping / sketching exercise Thinking aloud Scenarios Questionnaire Interview Automatic logging Homework between meetings Prototyping - testing

22 Methods + SW, HW, iterations SW-related design and prototyping HW-related design and prototyping Iterative processes Scenarios Html-demos requirement spec. coding testing and re-prototyping

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24 1.Relatives Some studied concepts Sensor with Bluetooth SMS Data Data 2.Database/ WEB Smartphone 3.EHR at hospital 4. Indications of infectious diseases

25 e.g. BG transfer NO TOUCH NST bluetooth unit Measurement transferred using bluetooth SMS SMS Bluetooth Mobile phone automatically transfers the measurement as an SMS Gammon D, Årsand E, Walseth OA, Andersson N, Jenssen M and Taylor T. Parent-child interaction using a mobile and wireless system for blood glucose monitoring: Pilot users experiences. Journal of Medical Internet Research. December 2005

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27 Transfer of sensordata into EHR Automatic transfer of blood glucose measurements from diabetes patients into the DIPS Electronic Health Record System Walseth OA, Årsand E, Sund T and Skipenes E. Wireless transfer of sensor data into Electronic Health Records. The Medical Informatics Europe (MIE) congress. August 2005, Geneva, Switzerland

28 Info. on SMS SMSserver 1 tablet (3 gram) grape sugar pr. 10 kg. bodyweight will increase the blood glucose with approx. 4 mmol/l, after minutes. Wangberg SC, Årsand E, Andersson N. Diabetes education via mobile text messaging. Journal of Telemedicine and Telecare, Volume 12, Supplement 1, July 2006, pp (2). Royal Society of Medicine Press

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30 Motivation and Aims Main problem How to design mobile devices that will be perceived as motivating and helpful by the users

31 Motivation and Aims Sub-problems 1. How to involve real patients in the design process 2. How to design the data capture systems 3. How to integrate the elements into a mobile health diary

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33 Results - designs acheived The concept: a digital diabetes diary Providing users a better overview of the disease-related factors, in a unit that is always with them their mobile phone.

34 Results - designs acheived instead of paper diaries

35 Results - designs acheived The Few Touch Application

36 Goal Setting element Results - designs acheived

37 Results - designs acheived Physical Activity Sensor Systems Automatically at 10pm. (or button)

38 Results - designs acheived Nutrition Habit Registration System

39 General information Results - designs acheived

40 Automatically transferred data from step counter and blood glucose meter By simply pressing category area in this screen, a user can record their food habit A practical tip is shown. The total number of tips included is 80

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42 Blood Glucose Monitoring appreciated the most average use: 202 measurements (12 users, 167 days) varied from 23 to 564 times average BG for the cohort was 7.9 mmol/l I think it is nice to get this blood glucose graph and see how I am doing, and then I can think back on what I ate. Results user interventions

43 Food Habit Registration Results user interventions the most frequent user had a usage of 11.7 daily inputs average user registered 4.6 daily food and drinks This is a tool that can help you to learn more about yourself, but sometimes I become tired of recording what I eat each day.

44 Physical activity Results user interventions average manually daily transfer = 0.88 (0-3.6) The step counter has had the result that I have a rather routine job when I drive to a meeting, I park as far as possible from the door, and even make a detour. Before I parked as close as possible.

45 Users say: I can clearly see that the blood glucose graph is moving downwards when I manage to hold the focus. I think it is very nice viewing the steps as bar charts then you can see them visually and not only as numbers. When I record the food, I am sometimes unsure about which food is HIGH carbohydrate food and which is LOW. That one gets it visually the combination of all the efforts you do it s incredibly important for further motivation.

46 Results user interventions System Usability Score on SUS questionnaire: 84 (of 100) Quotes: It s difficult to use the finger then I have to push hard, but now I have begun to use the finger. Now, I have got so used to it [the Few Touch application] that in my case I think it has become very easy to use.

47 Quotes after 4 months

48 Data from the second half year Future work

49 Results The Few Touch Application demonstrates promising results using mobile technology in Type 2 diabetes selfmanagement 1 1: Årsand E, Tatara N, Østengen G, Hartvigsen G. Mobile-Phone-based Self-Management Tools for Type 2 Diabetes The Few Touch Application. Journal of Diabetes Science and Technology, March 2010, 4(2), pp

50 Conclusions Conclusions 1. Involving real patients; novel concepts and systems were designed 2. The suggested ICT systems motivated users, and were used on a daily basis 3. It was possible to integrate the three data capture systems into a mobile health diary Several of the users adjusted their medication, food habits and/or physical activity due to use of the Few Touch application

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52 Current project portfolio Few Touch used as a research-vehicle in: Renewing Health: 300 users, T2 DiaStat: utilizing BG measurements, T1 Collocated Personal Diabetes Data: new functionalities, T1 Motivation w/mobile: working in groups, T2 Mobile Terminals: Usability, T1 + T2 Diabetes Lifestyle: TTL, new innovations

53 The Few Touch application Step counter, fully automatic data transfer Blood glucose, fully automatic data transfer or few touch manual registration Few touch registr. of food habits

54 Physical activity

55 Insulin + Nutrition

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57 Applications with food database on a handheld device Various commercial food intake monitoring applications on a handheld device contain food database DietMate Pro BalanceLog CalorieKing The Glycemic Index Planner Many on iphone AppStore Databases contain thousand items Normally food search is done by Category search Text search

58 Our problems what data we should provide with? Food Composition Table (MVT 06) Karbohydrater og insulin (Torild Lilleaas Grønnerud, Knut Dahl Jørgensen, issued by Novo Nordisk) information from guidelines by Helsedirektorat and Norges Diabetes Forbund. Nutrition information from product makers

59 Documenting by phone s camera

60 The way it happened logbook (Type 1) A place to systematize my experiences

61 RENEWING HEALTH REgioNs of Europe WorkINg together for HEALTH Theme: Information Communication Technology (ICT) for Health, Ageing and Inclusion 9 regions Supported by National Health Authorities 50% Feb 2010 to users testing FTA

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