EH 2_2015

EUROPEAN HOSPITAL Vol 24 Issue 2/15 26 IT & TELEMED Health-tracking platforms as part of daily routine Improving medication adherence via a patient-centric platform Bring-your-own- device to the doctor The Connected Care Framework Report: Sascha Keutel Many of today’s smartphones have sensors, such as pedometers and pulse monitors. Wearables are a new class of device that are moving into sensitive areas i.e. being perma- nently worn on the body and always switched on to ensure a continuous data stream. In her lecture From Sensor to Health-Tracking Platform – Technological Concepts for Online- Provision of Health Data, Monika Pobiruchin, research associate at the GECKO Institute for Medicine, Informatics and Economics at Heilbronn University, tackled issues surrounding innovative technolo- gies, uninformed users and the slow legislative process. There are currently different types of health-tracking platforms on the market - for instance interfaces such as ‘Google Fit’ and ‘Apple Health Kit’ – platforms on which Developers and manufacturers run their own products on (such as tracking-apps). Platforms such as ‘dacadoo’ take this a step further. The issue here is not just around pure fitness, i.e. tracking the distance covered, calo- ries burned and pulse rate. ‘These are in fact fitness and health plat- forms. The user can have his health score calculated on a scale between 0 – 1,000, which states how healthy they are,’ Pobiruchin explains. A very different approach is taken by the EU-subsidised research pro- ject DAPHNE, which aims to inte- ‘The core idea behind the Connected Care Framework,’ nephrologist Dr Stefan Becker explained, ‘is to devel- op a patient-centred communication infrastructure that serves as a basis for value-added services. These ser- vices can then be integrated into mainstream healthcare delivery. We focus on medication adherence of chronically ill patients, because this is a big challenge. Studies identi- fied that only one-third of patients who have undergone transplanta- tion adhere to their medical regime. Non-adherence, on the other hand, can jeopardise the success of the procedure. ‘We developed the Connected Care Framework including an app for patients, which is designed to help them to better comply with the medication regime and hence increase patient outcome. ‘The framework uses technol- ogy and data security concepts already implemented in the elec- tronic patient record as an interface between physicians in the out- and in-patient field and their patient. It’s a system that allows adapting its single modules to patients’ needs. We created a personalised app that permits doctors to give feedback in an unstructured way, such as asking ‘How are you? Do you feel good or bad?’ Medical data is processed using a token-based system, permit- ting the patient to authorise those users with whom he or she wants to exchange information.’ How does the apps benefit patients? ‘It involves the patient in the treat- ment process. Via a memory func- tion, for example, it reminds patients to take their medication, or measure their vital parameters at a desig- nated time. It also allows patients to record their moods as well as to look at the medication plan com- piled by a doctor. Where is the app used? German health insurance Techniker Krankenkasse (TK), the leading pub- lic state health insurer by number of insured, is the first to deploy the app in a newly created adherence program, which supports telephone coaching. Apart from the insurance field, the app will be rolled out in the nephrology department of Essen University Hospital and, sometime later, in an out-patient practice. We are also preparing further use cases for pharmaceutical companies.’ What further developments are planned? ‘The communication infrastructure behind the app was developed as a prototype to be rolled out in diverse settings: either in term of use cases, such as general practitioners, reha- bilitation, or in terms of functional- ity by adding modules to support certain modifications of behaviour as needed. ‘We’d also like to explore the app as a communication tool in the pharmaceutical industry and are already in talks with some compa- nies. The intention is to offer a com- plementary service to selling drugs, giving pharma companies a com- petitive edge. By increasing medi- cation compliance, pharmaceutical firms can leverage drug sales. We’ve seen the first advances in this direc- tion with pharmaceutical companies sponsoring telephone hotlines for individuals who have just received an organ transplant. Nephrology associations are especially very interested in this topic.’ grate wearables and other device classes to record and display data. Here, safe data storage and data protection are a priority. Ethical and legal implications Health-related data are very per- sonal and deserve particular pro- tection. However, apparently every third person is currently prepared to make their data available in return for bonuses, vouchers or other benefits. Quite rightly, this makes one wonder: ‘Where is the point in protecting data when patients themselves make the data available online?’ In the first instance, health informatics specialist Pobiruchin does not see a problem: ‘In prin- ciple, I think it’s great that people are doing this. Everyone should be at liberty to post their data on the internet.’ The advantages of weara- bles, apps and smartphones are obvious: Why should a patient keep a diary of symptoms on paper when they can do the same thing with a smartphone - which they carry with them at all times, anyway? Everyone can also use apps to make their emergency contacts available, so these can be accessed as and when needed. Furthermore, patients can also make data available directly to their doctors (GPs) by showing them their smartphones and saying ‘Take a look at this. I’ve measured my blood pressure and pulse – what do you say?’ However, this scenario also has a downside: there is no guarantee that the doctor will actually accept this information. ‘Data measured with smartphones or wearable devices are not trusted in the same way as a blood pressure monitor used in a surgery, for instance,’ Pobiruchin explains. She also has an eye on another danger – because many users don’t know exactly what hap- pens to their data and where it ends up. ‘Users lack the specialist knowl- edge because these technological developments could not have been foreseen five or six years ago. Most of them have completely different ideas as to what can or can’t be done with their data.’ According to Pobiruchin the legal implications need to be given par- ticular consideration: ‘A German provider of a fitness-app who wants to store their customers’ data in a storage facility in the cloud provid- ed by a third party is only permitted to do so if they have specifically entered into a data processing con- tract with the third party. However, the decisive question is: Where is the third party based and what are the laws on data protection in this location? In the USA, for instance, data protection is dealt with in a different way to how it is regulated in Germany or the EU. There is quite a lot of friction between global data management and regional legisla- tion.’ The expert also points to ethi- cal aspects: ‘Through the integration of the data I’ve made available I make myself identifiable. What happens if I have a rare disease, or rare blood group? Even without my name being mentioned, this might make me potentially identifiable. What happens if, for example, insur- ers can then process this data? Will I receive a bonus if my behaviour is perceived as health-conscious, or will I be turned down if it is not?’ These are the issues Pobiruchin is dealing with, and this expert would like to see an intensive discussion on this subject: ‘Informatics is not meant to stoke fears but to throw light on what can be done with data and to encourage a dialogue about dealing with it. We missed out on creating this dialogue with the development of smartphones and should not repeat this mistake with the wearable devices that are currently trendy.’ A research associate at the GECKO Institute for Medicine, Informatics and Economics at Heilbronn University, Monika Pobiruchin received her Diploma in Health Informatics from Heidelberg University in 2010 and is currently writing her doctorate at the Medical Faculty of Heidelberg University. Focus: The automated generation of health economic disease models based on routine clinical data. In 2014, she became one of the co-founders of the project group Consumer Health Informatics within the GMDS e.V. Stefan Becker MD MBA is a senior nephrologist and transplant officer at Essen University Hospital, where he also manages its Institute for Drug Safety. Recently, he spoke with Cornelia-Wels Maug, for European Hospital, about his involvement in e-health projects in the field of connected care that he carries out with interdisciplinary teams, including the Fraunhofer Institute for Software and Systems Engineering (ISST), and particularly the Connected Care Framework launched this April. Source:conhIT2015 PhotographcourtesyofDrStefanBecker PhotographcourtesyofDrStefanBecker Source:Shutterstock/Prykhodov

EH 2_2015

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