Department of Health Information Management, School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States.
JMIR Mhealth Uhealth. 2013 Jul 11;1(2):e10. doi: 10.2196/mhealth.2391.
Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population.
The project's goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians.
We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery.
There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient's self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients' conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau.
The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized.
慢性病患者易发生继发性并发症，通过坚持自我护理常规可以预防这些并发症。除了急性护理外，他们还能从接受有效的治疗中获益最多，通常是在生活环境中定期随访和自我护理支持。脊髓脊膜膨出（SB）患者就是这样一个群体，这是美国最常见的永久性出生缺陷。匹兹堡大学的一项健康计划，其中健康协调员监督慢性病患者的护理，已取得显著改善的结果。然而，时间限制和旅行成本限制了其规模。移动远程医疗服务的提供可能是改善更多人获得护理的一种解决方案。
该项目的目标是开发和实施一种新的移动医疗系统，以支持复杂的自我护理任务、持续遵守治疗方案、监测依从性以及在患者和临床医生之间建立安全的双向通信。
我们开发并实施了一种名为 iMHere（移动健康和康复）的新型移动医疗系统架构，该架构由智能手机应用程序、临床医生门户和连接两者的双向通信协议组成。实施 iMHere 的过程包括：（1）需求分析，以确定需要支持的临床重要功能；（2）设计和开发应用程序和临床医生门户；（3）开发应用程序和临床医生门户之间高效的实时双向数据交换；（4）对患者进行可用性研究；（5）在临床服务提供中实施移动医疗系统。
确定了 9 个相关的应用程序功能，其中 5 个被认为是优先级。设计和开发了 5 个应用程序来解决以下问题：药物治疗、皮肤护理、膀胱自我导尿、肠道管理和心理健康。这些应用程序旨在支持患者的自我护理任务、将依从性数据发送到临床医生门户，并从门户接收个性化治疗方案。基于 Web 的门户专为临床医生设计，用于监测患者的病情并支持自我护理方案。双向通信协议旨在促进应用程序和门户之间安全高效的数据交换。在可用性研究的 3 个阶段中，发现了自我护理工作流程、导航和界面以及应用程序和门户之间通信方面的可用性问题。在临床实施的头 6 个月中，有 14 名患者使用了该系统，其中 1 名因无线连接不良而退出。即使是针对药物治疗和皮肤护理等复杂问题的应用程序，患者也一直在高度使用。使用模式显示出在第一个月内使用量增加，然后趋于平稳。
该系统能够支持自我护理和治疗方案的依从性、监测依从性、支持临床医生与患者的互动，并且已经得到了广泛的应用。
