Mobile Health Symposium

Mobile health technologies can transcend the boundaries of health care delivery limitations, and fill gaps in health care services as demands increase. An aging population and overstrained health care resources are realities Canadians face in coming years. Innovative thinking and collaboration across sectors to support ideas from conception into practical application is taking place across Ontario, to address health care needs.

On October 17, 2011, the Nursing Health Services Research Unit at the University of Toronto and Lawrence S. Bloomberg Faculty of Nursing Professor Dr. Diane Doran hosted a one-day symposium to explore the current state of mobile health technologies developments for promoting safer patient care, and potential use for the future. This Mobile Health Symposium “Imagine the Possibilities of M-Health Technologies” featured collaborative research across sectors between nursing, medicine, engineering, human geography and computer science, as well as partnerships with the IT industry.

Some examples of innovations developed by researchers and partners presented during the symposium included use of an iPhone application ‘bant’ to manage diabetes, use of a pressure sensitive bed mat to monitor the mobility of home care clients in bed and while getting in and out of bed , a hand hygiene sensory system linked to electronic badges, and an intelligent cognitive device ‘COACH’ to support health and wellness of older adults living at home.

Scientific Technology Café

The symposium also featured an interactive Technology Café to allow participants to experience live demonstrations of the mobile health innovations in rotating small groups. Industry partners such as IT firms HInext and CellTrak, and researchers were able to showcase their products developed through collaboration. Drs. Rafik Goubran and Frank Knoefel from the Department of Engineering and Design at Carleton University demonstrated a sensory bed mat that can be placed under a regular bed mattress to monitor sleep. Other café stations demonstrated software developed to facilitate communication, care planning, and access to best practice guidelines at point-of-care.

 

Plenary Sessions

Dr. Joseph Cafazzo Assistant Professor in the Department of Health Policy, Management and Evaluation, and the Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine (U of T), gave a keynote address on the role of m-health in self-care. He led a research team to develop the iPhone application ‘bant.’ ‘bant’ was designed to help adolescents with diabetes to  self-manage their blood glucose levels. While other diabetes applications  function mostly as log books and are only available in English, this application is unique in that it is available in multiple languages and it collects data wirelessly from glucometers  and uses prompts to help teens identify changes in treatments or self-management behaviour.

Instead of passive logging of blood sugar, ‘bant’ encourages active self-monitoring through teaching prompts and reward incentives such as earning iTunes dollars. For instance, the application can detect a trend of a series of low lunch readings affecting blood sugar levels, prompting the user to select options such as “adjust basal ??” or “change ratio” to stop the low trend from continuing. The application also helps teens to form a community by linking to social networking media such as Twitter. The application was pilot tested at the Hospital for Sick Children with 20 adolescents. Results indicated that users were satisfied with system, and nearly all indicated that they will continue to use the application.  ‘bant’ currently has approximately 5000 active daily users, with growing numbers around the world.

Dr. Alex Mihailidis, Research Chair in Rehabilitation Technology at the University of Toronto and Associate Professor at the Department of Occupational Science and Occupational Therapy and in the Institute of Biomaterials and Biomedical Engineering (U of T) led a research team in developing the Cognitive Orthosis for Assisting Activities in the Home (COACH). COACH has been developed to track older adults living at home, many of whom have dementia, to improve their safety. COACH is built into homes and provides clients with cues as necessary such as to turn off the tap, and a hands-free personal emergency response system such as calling an ambulance or caregiver when a client has fallen. Research trials have shown that the system is effective in providing assistance to users. Future steps include further work to refine and personalize the system, and move towards commercialization.

Dr. Peter Rosso, Chief Medical Information Officer at University Health Network (UHN) and Associate Professor of Medicine at University of Toronto discussed the requirements of m-health technologies in the acute care setting, the adoption of current technologies, and next steps in acute care m-health solutions. Improved clinical communication to improve patient safety was the overarching benefit of using m-health technologies in acute care. Dr. Rosso reviewed communication flow at UHN and the current challenges of using mobile devices to determine critical  factors to successfully implement mobile health solutions in the acute care setting. Key success factors include ease of access and use, acceptable response time, inclusion of required functionality, meeting security requirements and available support on a long-term basis.

Dr. Geoff Fernie, Vice President of Research at the Toronto Rehabilitation Institute with cross appointments at several departments in the University of Toronto including the Department of Surgery and Department of Mechanical and Industrial Engineering, presented his research on solving the age-old problems of inadequate hand hygiene. His team devised a sensory tool to monitor and support hand washing in clinical settings by sending light and vibration prompts to electronic badges worn by clinicians and patients.

Dr. Diane Doran, Scientific Director of the Nursing Health Services Research Unit, University of Toronto site, presented her research study investigating the integration of bio-mobility information obtained through remote monitoring with decision support technologies to support safer client care. Her study determined the types of useful client data for case managers and an appropriate  prototype display of information.  Client data were collected from a non-intrusive monitoring system included a pressure-sensitive mat that was placed under a regular bed mattress to monitor a person’s mobility and time spent in bed  and a GPS-equipped BlackBerry to monitor a person’s mobility outside of the home. Phrase two of the study included development of the prototype web-based platform with industry partner HInext and the evaluation of the usability of the system in a live community setting through a pilot field study. Results indicated that the client in the  field study was able to learn more about his/her health status and was able to be actively involved in planning care. The client also perceived that the system had the potential to enhance home care safety, especially for older adults. Home care clinicians perceived the system to be helpful in developing individualized care plans and in making informed decisions about client care. Overall, the system was perceived as an excellent communication tool to facilitate inter-professional collaboration.

The Past, Present and Future of Mobile Health Technologies

The day ended with a discussion of the past, present and future of mobile health technologies with panelists Dr. Frank Knoefel and Dr. Rafik Goubran from Carleton University, Dr. Irmajean Bajnok from RNAO, and  Cheryl Reid-Haughian from ParaMed Home HealthCare.

Panel moderator and Lawrence S. Bloomberg Faculty of Nursing Associate Professor Dr. Lynn Nagle referred to current news headlines, including the vision and legacy of Apple founder Steve Jobs, to incite comment from the panelists about the importance of innovation and the tremendous progress that has been made over the years.

Overall, while there was consensus that mobile health technologies cannot fully take over the role of health care clinicians and the social impact of technologies needs be studied to determine negative outcomes, the day’s discussions indicate that there is pervasive consumer demand for such technologies

The possibilities of adapting technologies to meet health care needs are infinite. This symposium clearly demonstrated the human ability to innovate, collaborate and develop technology that was considered impossible in the recent past. In the future, further collaboration between researchers across health care, engineers, computer science sectors and health care decision-makers and end users, will continue to improve and humanize mobile technologies into further real-life application. As m-health technologies evolve, so will approaches to health care from the current reactive approach to a more proactive approach that anticipates needs and interventions to improve health outcomes.

 

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Speaker PowerPoint Presentations

Patient, heal thyself The Role of mHealth in Self-Care (Dr. Joseph Cafazzo)

Intelligent Systems and Homes to Support Health and Wellness of Older Adults
(Dr. Alex Mihailidis)

m-Health@Point of Acute Care: Leaving the Trenches? (Dr. Peter G. Rossos)

Integration of Bio-physiological information with a point-of-care decision support system for safer patient care (Dr. Diane Doran)

The Past, Present and Future of Mobile Health Technologies (Dr. Irmajean Bajnok)