The Design Blueprint for a Large-Scale Telehealth Platform

Technological innovation plays a crucial role in digital healthcare services. A growing number of telehealth platforms are concentrating on using digital tools to improve the quality and availability of care. Virtual care solutions employ not only advanced telehealth technology but also a comprehensive range of healthcare services. As a result, these can reduce patient healthcare costs as well as increase accessibility and convenience. At the same time, the healthcare service provider can leverage healthcare professionals to get a better perspective into the needs of their patients. The objective of this research is to provide a comprehensive design blueprint for a large-scale telehealth platform. Telehealth is the digital healthcare service combining online services and offline access for healthcare facilities to offer various healthcare services directly to patients. This design blueprint covers the digital healthcare ecosystem, new patient journey design for digital health services, telehealth functionality design, and an outline of the platform infrastructure and security design. Ultimately, telehealth platforms establish a completed digital healthcare service and new ecosystem that provides better care for every patient worldwide.

Evaluation of Tele-rheumatology during the COVID-19 Pandemic in Asian Population: A Pilot Study

Objective. Rheumatoid arthritis (RA) is a chronic autoimmune condition associated with a potential for deformities. It is one of the common conditions to seek health care. Hence, the present study was conducted to assess the telemedicine services for patients suffering from rheumatoid arthritis during the COVID-19 pandemic in an Asian Indian population. Methods. A prospective study was conducted (March 2020–June 2020) in the telemedicine department of a premier northern Indian tertiary care institution. Out of the total patients enrolled ( N = 7577 ) in telemedicine services, 122 rheumatoid arthritis patients (1.6%) were followed for 1 month to assess change in functional status by modified Health Assessment Questionnaire (mHAQ). Telephonic interviews of the enrolled patients were conducted to determine the level of understanding of advice given by consultants, barriers during the consultation, and satisfaction with teleconsultations for rheumatology clinics. Results. For the native people, language of the clinicians was the main barrier (20%) in telerheumatology. Saving of time and money was observed as beneficial factors for patients. More than three-quarters of all rheumatoid arthritis patients were ready to use teleconsultation in the near future. A similar proportion of patients were in support for the recommendation of these services to other persons. Conclusion. We report the successful use of telemedicine services in the evaluation and management of rheumatic diseases in the current COVID-19 pandemic situation.

Experimental Study of a Deep-Learning RGB-D Tracker for Virtual Remote Human Model Reconstruction

Tracking movements of the body in a natural living environment of a person is a challenging undertaking. Such tracking information can be used as a part of detecting any onsets of anomalies in movement patterns or as a part of a remote monitoring environment. The tracking information can be mapped and visualized using a virtual avatar model of the tracked person. This paper presents an initial novel experimental study of using a commercially available deep-learning body tracking system based on an RGB-D sensor for virtual human model reconstruction. We carried out our study in an indoor environment under natural conditions. To study the performance of the tracker, we experimentally study the output of the tracker which is in the form of a skeleton (stick-figure) data structure under several conditions in order to observe its robustness and identify its drawbacks. In addition, we show and study how the generic model can be mapped for virtual human model reconstruction. It was found that the deep-learning tracking approach using an RGB-D sensor is susceptible to various environmental factors which result in the absence and presence of noise in estimating the resulting locations of skeleton joints. This as a result introduces challenges for further virtual model reconstruction. We present an initial approach for compensating for such noise resulting in a better temporal variation of the joint coordinates in the captured skeleton data. We explored how the extracted joint position information of the skeleton data can be used as a part of the virtual human model reconstruction.

Development of a Mobile Application Platform for Self-Management of Obesity Using Artificial Intelligence Techniques

Obesity is a major global health challenge and a risk factor for the leading causes of death, including heart disease, stroke, diabetes, and several types of cancer. Attempts to manage and regulate obesity have led to the implementation of various dietary regulatory initiatives to provide information on the calorie contents of meals. Although knowledge of the calorie content is useful for meal planning, it is not sufficient as other factors, including health status (diabetes, hypertension, etc.) and level of physical activity, are essential in the decision process for obesity management. In this work, we present an artificial intelligence- (AI-) based application that is driven by a genetic algorithm (GA) as a potential tool for tracking a user’s energy balance and predicting possible calorie intake required to meet daily calorie needs for obesity management. The algorithm takes the users’ input information on desired foods which are selected from a database and extracted records of users on cholesterol level, diabetes status, and level of physical activity, to predict possible meals required to meet the users need. The micro- and macronutrients of food content are used for the computation and prediction of the potential foods required to meet the daily calorie needs. The functionality and performance of the model were tested using a sample of 30 volunteers from the University of Ghana. Results revealed that the model was able to predict both glycemic and non-glycemic foods based on the condition of the user as well as the macro- and micronutrients requirements. Moreover, the system is able to adequately track the progress of the user’s weight loss over time, daily nutritional needs, daily calorie intake, and predictions of meals that must be taken to avoid compromising their health. The proposed system can serve as a useful resource for individuals, dieticians, and other health management personnel for managing obesity, patients, and for training students in fields of dietetics and consumer science.

Knowledge, Applicability, and Barriers of Telemedicine in Egypt: A National Survey

Objectives. The study is aimed at evaluating knowledge, attitude, and barriers to telemedicine among the general population in Egypt. Methods. A questionnaire-based cross-sectional design was carried out among the general Egyptian population. A convenience sampling method was used to approach the eligible participants from University Teaching Hospitals of eight governorates from May to July 2020. Results. A total of 686 participants filled the questionnaire (49.4% were males, mean age 36.7 ± 11.2 years old). Half of the participants stated that they previously used a telemedicine tool, mainly to follow up laboratory results (67.3%). Video or phone calls (39.3%) and mobile applications (23.7%) were the most commonly recognized telemedicine tools by the participants. The included participants exhibited a high level of knowledge and attitude towards telemedicine. On the other hand, 21.9% stated that telemedicine services could jeopardize patient privacy. 32.8% reported that telemedicine service could lead to disclosing medical information to people who are not authorized to do so. Almost half of the participants agreed to strongly agreed that telemedicine service could increase medical errors. 60.80% of the participants said that they are more likely to prefer telemedicine than traditional ways. However, 13.70% stated that telemedicine is more likely to be challenging to use. Conclusion. The Egyptian population has high knowledge about the applications of telemedicine. In addition, the vast majority of Egyptians appear to perceive the benefits of telemedicine positively and are willing to use it. However, some barriers that have been found must be taken into consideration to adopt telemedicine successfully, especially for people who are old, are low educated, and live in remote areas. Future studies should address the utility of telemedicine in improving the quality of healthcare and patient’s health outcome and quality of life.

Teleophthalmology Service: Organization, Management, Actual Current Applications, and Future Prospects

Teleophthalmology (TO) consists of the clinical and therapeutic approach to the patient (e-Health) using informatic and telecommunication systems. Already widespread worldwide, it aims to improve patient care, expand the healthcare offer, and access to medical care by reducing overall costs. Despite the organizational, legal, and management difficulties, the substantial economic investments necessary for the start-up of equipped structures and efficient territorial services are amply rewarded by economic results and optimal services for professionals and patients. This review specifically analyses the current scenario of teleophthalmology, the points for and against its application in different sociodemographic realities, and in particular, the current and future fields of use.

Telehealth Interventions for Family Caregivers of Persons with Chronic Health Conditions: A Systematic Review of Randomized Controlled Trials

Objective. The purpose of this study was to provide an in-depth analysis of the components and outcomes of telehealth interventions for family caregivers of individuals with chronic health conditions. Methods. A systematic review of 17 databases was conducted for randomized controlled trials published between January 2002 and January 2017. Interventions were analyzed based on type of telecommunication modality, caregiver and care recipient characteristics, intervention components, and caregiver outcomes. Results. A total of 57 articles met criteria for inclusion. Telephone was the most frequently used mode of telehealth delivery and focused primarily on caregivers of older adults with dementia and stroke. Skills training was the most prevalent treatment strategy across telephone, web, and combined telephone and web modalities. Improved psychological functioning was reported most frequently across telehealth modalities. Conclusion. Telehealth is an effective tool in delivering caregiver interventions and leads to significant improvement in caregiver outcomes. Telephone was used most often to deliver cognitive-behavioral and psychoeducational strategies as compared to web and combined telephone and web modalities. Further research is needed to examine the effects of telehealth interventions on caregiving skills and self-efficacy, as well as health outcomes.

Referral Activity in Three Store-and-Forward Networks during the COVID-19 Coronavirus Pandemic

We surveyed three well-established store-and-forward telemedicine networks to identify any changes during the first half of 2020, which might have been due to the effect of the COVID-19 coronavirus pandemic on their telemedicine operations. The three networks all used the Collegium Telemedicus system. Various quantitative performance indicators, which included the numbers of referrals and the case-mix, were compared with their values in previous years. Two of the three networks surveyed (A and B) provided telemedicine services for any type of medical or surgical case, while the third (network C) handled only pediatric radiology cases. All networks operated in Africa, but networks A and C also provided services in other resource-constrained regions. Two of the networks (networks B and C) used local staff to submit referrals, while network A relied mainly on its expatriate staff. During the first half of 2020, the numbers of referrals received on network B increased substantially, while in contrast, the numbers of referrals on network A declined. All three networks had relatively stable referral rates during 2018 and 2019. All three networks delivered a service that was rated highly by the referrers. One network operated at relatively high efficiency compared to the other two, although it is not known if this is sustainable. The networks which were more reliant on local referrers saw little reduction—or even an increase—in submitted cases, while the network that had the most dependence on international staff saw a big fall in submitted cases. This was probably due to the effect of international travel restrictions on the deployment of its staff. We conclude that organizations wanting to build or expand their telemedicine services should consider deliberately empowering local providers as their referrers.

Antecedents of Intention to Adopt Mobile Health (mHealth) Application and Its Impact on Intention to Recommend: An Evidence from Indonesian Customers

Introduction. Mobile health (mHealth) applications gain popularity due to the increasing number of mobile phone usage and internet penetration, which might help some of Indonesia’s medical issues. However, the uptake of mHealth applications is still low in Indonesia. This study is aimed at understanding the factors that drive individuals to adopt mHealth applications and their impact on the intention to recommend. Methods. We applied a new model that combines three different theories with some other constructs: an extended unified theory of acceptance and use of technology, diffusion of innovation, and the internet customer trust model. The study used a cross-sectional study design with partial least squares causal modeling approach. Results. There are 787 respondents in our study, with the majority of them being female, young adults. Our model could explain 53.2% of the variance of intention to adopt while explaining 48.3% of the variance of intention to recommend. Initial trust in mHealth platform ( β = 0.373 , p = < 0.001 ), facilitating conditions ( β = 0.131 , p = < 0.01 ), and performance expectancy ( β = 0.099 , p = < 0.05 ) are the top three most important drivers of intention to adopt mHealth applications. Lastly, importance-performance map analysis (IPMA) showed that the mHealth application’s initial trust is the most important construct with a high-performance score. Discussion. Mobile health developers and managers need to improve initial trust in the mHealth platform, facilitating conditions, and performance expectancy when developing the applications. With a medium Q 2 predict , these factors can be applied out of the research context with medium predictive power.

Telerehabilitation Using Fitness Application in Patients with Severe Cystic Fibrosis Awaiting Lung Transplant: A Pilot Study

Purpose. The purpose of this study was to pilot a home-based pulmonary rehabilitation (PR) program administered via a telemedicine approach using a combination of fitness application and self-selected activity in lung transplant candidates with cystic fibrosis (CF). Methods. We recruited adult patients with CF. The main outcome was adherence, measured by number of sessions completed in 12 weeks. Secondary outcomes were adverse events, six-minute walk distance (6MWD), and dyspnea. Participants were provided a personalized exercise program and equipment including a fitness application that provided exercise videos, recorded exercise time, and corresponding heart rate. We reviewed data daily and provided text messages with feedback. We compared our study outcomes to a retrospective data set of CF patients who participated in a 24-session outpatient hospital-based PR program. Data presented as mean ± standard deviation . Results. Eleven patients participated in the home PR program, 45% female, age 33 ± 7 years , FEV1 27 ± 5 % predicted. Sessions completed were 19 ± 12 home-based PR vs. 9 ± 4 hospital-based PR, p = .03 . Fifty percent of the home-based group completed ≥24 sessions in 12 weeks versus 0% of the hospital-based patients ( p = .03 ). There were no adverse events during exercise. Completers of the home-based program demonstrated a clinically meaningful lower decline in 6 MWD than noncompleters (6MWD − 7 ± 15 vs. − 86 ± 108 meters ). Only one participant performed a post 6 MWD in the hospital-based PR. Conclusion. Patients with severe CF demonstrated adherence to home PR delivered using fitness application and self-selected activity with no adverse events. This program style may be a viable solution for telerehabilitation in severe CF and is particularly relevant in the COVID era.