Search

The development of electronic services for healthcare presents challenges related to the effective cooperation of systems and stakeholders in a highly regulated environment. In order to facilitate healthcare for all at the point of need it is important to establish the necessary conditions to guide the development and implementation of digital health solutions that are interoperable by design. Interoperability in eHealth is challenging for various reasons, including the fact that different products and solutions in the market do not follow well-known standards and interoperability guidelines. The paper draws upon the global, European and national policies, strategies, and implementation initiatives to offer an integrated approach towards interoperability in healthcare ecosystems. The authors provide guidelines and recommendations to support interoperability at legal, organizational, semantic, and technical levels.

The development of electronic services for healthcare presents challenges related to the effective cooperation of systems and stakeholders in a highly regulated environment. In order to facilitate healthcare for all at the point of need it is important to establish the necessary conditions to guide the development and implementation of digital health solutions that are interoperable by design. Interoperability in eHealth is challenging for various reasons, including the fact that different products and solutions in the market do not follow well-known standards and interoperability guidelines. The paper draws upon the global, European and national policies, strategies, and implementation initiatives to offer an integrated approach towards interoperability in healthcare ecosystems. The authors provide guidelines and recommendations to support interoperability at legal, organizational, semantic, and technical levels.

The term frailty is often used to describe a particular state of health, related to the ageing process, often experienced by older people. The most common indicators of frailty are weakness, fatigue, weight loss, low physical activity, poor balance, low gait speed, visual impairment and cognitive impairment. The objective of this work is the creation of a serious games mobile application to conduct elderly frailty assessments in an accurate and objective way using mobile phone capabilities. The proposed app includes three games (memory card, endless runner, and clicker) and three questionnaires, aiming towards the prediction of signs of memory and reflection deterioration, as well as endurance and strength. The games, when combined with a set of qualified questionnaires, can provide an efficient tool to support adults in identifying frailty symptoms and in some cases prevent further deterioration. At the same time the app can support older adults in improving physical and mental fitness, while gathering useful information about frailty.

The term frailty is often used to describe a particular state of health, related to the ageing process, often experienced by older people. The most common indicators of frailty are weakness, fatigue, weight loss, low physical activity, poor balance, low gait speed, visual impairment and cognitive impairment. The objective of this work is the creation of a serious games mobile application to conduct elderly frailty assessments in an accurate and objective way using mobile phone capabilities. The proposed app includes three games (memory card, endless runner, and clicker) and three questionnaires, aiming towards the prediction of signs of memory and reflection deterioration, as well as endurance and strength. The games, when combined with a set of qualified questionnaires, can provide an efficient tool to support adults in identifying frailty symptoms and in some cases prevent further deterioration. At the same time the app can support older adults in improving physical and mental fitness, while gathering useful information about frailty.

Background Stress and anxiety are psychophysiological responses commonly experienced by patients during the perioperative process that can increase presurgical and postsurgical complications to a comprehensive and positive recovery. Preventing and intervening in stress and anxiety can help patients achieve positive health and well-being outcomes. Similarly, the provision of education about surgery can be a crucial component and is inversely correlated with preoperative anxiety levels. However, few patients receive stress and anxiety relief support before surgery, and resource constraints make face-to-face education sessions untenable. Digital health interventions can be helpful in empowering patients and enhancing a more positive experience. Digital health interventions have been shown to help patients feel informed about the possible benefits and risks of available treatment options. However, they currently focus only on providing informative content, neglecting the importance of personalization and patient empowerment. Objective This study aimed to explore the feasibility of a digital health intervention called the Adhera CARINAE Digital Health Program, designed to provide evidence-based, personalized stress- and anxiety-management methods enabled by a comprehensive digital ecosystem that incorporates wearable, mobile, and virtual reality technologies. The intervention program includes the use of advanced data-driven techniques for tailored patient education and lifestyle support. Methods The trial will include 5 hospitals across 3 European countries and will use a randomized controlled design including 30 intervention participants and 30 control group participants. The involved surgeries are cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacement, prostate or bladder cancer surgeries, hip and knee replacement, maxillofacial surgery, or scoliosis. The control group will receive standard care, and the intervention group will additionally be exposed to the digital health intervention program. Results The recruitment process started in January 2022 and has been completed. The primary impact analysis is currently ongoing. The expected results will be published in early 2023. Conclusions This manuscript details a comprehensive protocol for a study that will provide valuable information about the intervention program, such as the measurement of comparative intervention effects on stress; anxiety and pain management; and usability by patients, caregivers, and health care professionals. This will contribute to the evidence planning process for the future adoption of diverse digital health solutions in the field of surgery. Trial Registration ClinicalTrials.gov NCT05184725; https://www.clinicaltrials.gov/ct2/show/NCT05184725 International Registered Report Identifier (IRRID) DERR1-10.2196/38536

BACKGROUND Stress and anxiety are psychophysiological responses commonly experienced by patients during a perioperative process that can increase pre- and post-surgical complications to a comprehensive and positive recovery. Preventing and intervening stress and anxiety can help patients achieve positive outcomes on health and wellbeing. Similarly, provision of education about the surgery can be a crucial component and it is inversely correlated to preoperative anxiety levels. However, few patients receive stress and anxiety relief support prior to a surgery and, resource constraints make face-to-face education sessions untenable. Digital health (DH) interventions can be helpful in empowering patients and enhancing a more positive experience. DH interventions are showing to help patients feel informed about possible benefits and risks of available treatment options. However, currently they focus only on providing informative content, neglecting the importance of personalization and patient empowerment. OBJECTIVE This study aims to explore the feasibility of a DH intervention called CARINAE designed to provide personalized stress- and anxiety-management evidence-based methods enabled by a comprehensive digital ecosystem that incorporates wearable, mobile and virtual reality technologies. CARINAE includes the use of advanced data-driven techniques for tailored patient education and lifestyle support. METHODS The trial will include 5 hospitals across 3 European countries, and will use a randomized-controlled design including 30 intervention participants and 30 control group participants. The involved surgeries are cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacement, prostate or bladder cancer surgeries, hip and knee replacement, maxillofacial surgery, or scoliosis. The control group will receive the standard care and the intervention group will additionally be exposed to the CARINAE intervention. RESULTS The recruitment process starts by January 2022, and the primary impact analysis is expected to be conducted by May 2022. CONCLUSIONS This manuscript details a comprehensive protocol for a study that will provide valuable information about the CARINAE intervention such as the measurement of comparative intervention effects on stress, anxiety and pain management and usability by patients, caregivers and healthcare professionals. This will contribute to the evidence planning process for the future adoption of diverse DH solutions in the surgery field. CLINICALTRIAL Trial was registered in ClinicalTrials.gov: NCT05184725.

This work presents, analyzes, and discusses the digital transformation challenges that need to be addressed for the development of quality electronic medical record (EMR) systems in Greece in the aftermath of the 2019 coronavirus disease pandemic. The authors highlight quality EMR characteristics and provide an overview of factors affecting their adoption within the wider context of the European digital single market towards supporting continuity of care. Key challenges addressed include the linking of EMRs with the medical practice workflow in a standardized manner, building trust and acceptance by making the best use of champions to build capacity, and by financing the digital transformation transition and sustainability in a coordinated manner. Foreseen benefits include better support of medical decisions across all stages of the patient journey, patient empowerment through virtual dossiers with clinically significant information, enhancement of vendor potential to implement innovative tools to support continuity of care, and acceleration of evidence-based research.

This paper analyzes the clinical and technological characteristics of cancer mobile apps that enable patients to securely record, manage, and share their information. It proposes an integrated approach towards developing quality mobile health apps for cancer and discusses issues relevant to the enhancement of patient experience and acceptance, adherence to treatment, and effective support of coordinated care. Regulation, standardization, and interoperability together with the existence of useful, accurate, and reliable tools for active patient engagement are important aids towards efficient cancer disease management. Improving quality of life and well-being, in a secure and safe manner that respects the patients' privacy, seems to be a key challenge, together with the exploitation of the outcomes of recent research projects, relevant to end user digital engagement towards an integrated approach for the introduction of trustworthy, interoperable, usable, adaptable, and quality mobile health apps.

BACKGROUND Major chronic diseases such as cardiovascular disease (CVD), diabetes, and cancer impose a significant burden on people and health care systems around the globe. Recently, deep learning (DL) has shown great potential for the development of intelligent mobile health (mHealth) interventions for chronic diseases that could revolutionize the delivery of health care anytime, anywhere. OBJECTIVE The aim of this study is to present a systematic review of studies that have used DL based on mHealth data for the diagnosis, prognosis, management, and treatment of major chronic diseases and advance our understanding of the progress made in this rapidly developing field. METHODS A search was conducted on the bibliographic databases Scopus and PubMed to identify papers with a focus on the deployment of DL algorithms that used data captured from mobile devices (eg, smartphones, smartwatches, and other wearable devices) targeting CVD, diabetes, or cancer. The identified studies were synthesized according to the target disease, the number of enrolled participants and their age, and the study period as well as the DL algorithm used, the main DL outcome, the data set used, the features selected, and the achieved performance. RESULTS In total, 20 studies were included in the review. A total of 35% (7/20) of DL studies targeted CVD, 45% (9/20) of studies targeted diabetes, and 20% (4/20) of studies targeted cancer. The most common DL outcome was the diagnosis of the patient’s condition for the CVD studies, prediction of blood glucose levels for the studies in diabetes, and early detection of cancer. Most of the DL algorithms used were convolutional neural networks in studies on CVD and cancer and recurrent neural networks in studies on diabetes. The performance of DL was found overall to be satisfactory, reaching >84% accuracy in most studies. In comparison with classic machine learning approaches, DL was found to achieve better performance in almost all studies that reported such comparison outcomes. Most of the studies did not provide details on the explainability of DL outcomes. CONCLUSIONS The use of DL can facilitate the diagnosis, management, and treatment of major chronic diseases by harnessing mHealth data. Prospective studies are now required to demonstrate the value of applied DL in real-life mHealth tools and interventions.

The COVID-19 pandemic has posed several challenges on citizens and health systems. Information and Communication Technology (ICT) can be a valuable tool in providing tools for self-assessment and reporting of physical symptoms, early detection of symptom changes, up to date information towards citizen empowerment, personalized recommendations and communication with healthcare providers in case of need. To this direction, this paper reports on the design and implementation of a novel technical infrastructure to support citizens with possible or confirmed COVID-19 disease. The designed platform builds upon an existing personal health record to facilitate symptom tracking, self-management, and personalized recommendations, effective communication channels between patients and clinicians and public health authorities assisting citizens to remain longer safe at home.

During the burst of the coronavirus pandemic, in early-midst 2020, public health authorities worldwide considered appropriate identification, isolation and contact tracing as the most appropriate strategy for infection containment. This work presents an outbreak response tool, designed for public health authorities to effectively track suspect, probable and confirmed incidence cases in a pandemic by means of a mobile app used by citizens to provide immediate feedback. It is developed based on an already existing personal health record app, which has been extended to properly accommodate specific needs that emerged during the crisis. The aim is to better support human tracers and should not be confused with proximity tracking apps. It respects safety and security regulations, while at the same time it conforms to international standards and widely accepted medical protocols. Issues relevant to privacy concerns, and interoperability with available patient registries and data analytics tools are also examined to better support public healthcare delivery and contain the spread of the infection.

BackgroundA vast amount of mobile apps have been developed during the past few months in an attempt to “flatten the curve” of the increasing number of COVID-19 cases.ObjectiveThis systematic review aims to shed light into studies found in the scientific literature that have used and evaluated mobile apps for the prevention, management, treatment, or follow-up of COVID-19.MethodsWe searched the bibliographic databases Global Literature on Coronavirus Disease, PubMed, and Scopus to identify papers focusing on mobile apps for COVID-19 that show evidence of their real-life use and have been developed involving clinical professionals in their design or validation.ResultsMobile apps have been implemented for training, information sharing, risk assessment, self-management of symptoms, contact tracing, home monitoring, and decision making, rapidly offering effective and usable tools for managing the COVID-19 pandemic.ConclusionsMobile apps are considered to be a valuable tool for citizens, health professionals, and decision makers in facing critical challenges imposed by the pandemic, such as reducing the burden on hospitals, providing access to credible information, tracking the symptoms and mental health of individuals, and discovering new predictors.

BACKGROUND A vast amount of mobile apps have been developed during the past few months in an attempt to “flatten the curve” of the increasing number of COVID-19 cases. OBJECTIVE This systematic review aims to shed light into studies found in the scientific literature that have used and evaluated mobile apps for the prevention, management, treatment, or follow-up of COVID-19. METHODS We searched the bibliographic databases Global Literature on Coronavirus Disease, PubMed, and Scopus to identify papers focusing on mobile apps for COVID-19 that show evidence of their real-life use and have been developed involving clinical professionals in their design or validation. RESULTS Mobile apps have been implemented for training, information sharing, risk assessment, self-management of symptoms, contact tracing, home monitoring, and decision making, rapidly offering effective and usable tools for managing the COVID-19 pandemic. CONCLUSIONS Mobile apps are considered to be a valuable tool for citizens, health professionals, and decision makers in facing critical challenges imposed by the pandemic, such as reducing the burden on hospitals, providing access to credible information, tracking the symptoms and mental health of individuals, and discovering new predictors.

BACKGROUND The status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)–funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed. OBJECTIVE This study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020–funded projects. METHODS Two international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed. RESULTS Technical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work. CONCLUSIONS Technology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations.

Chronic pain is one of the most common health problems affecting daily activity, employment, relationships and emotional functioning. Unfortunately, the lack of specialized health care personnel, and the high heterogeneity in terms of clinical manifestation and treatment results contribute in failure to manage efficiently and effectively pain. Information and communication technology (ICT) can be a valuable tool, enabling patients and healthcare professional empowerment and better self-management of pain. To this direction, this article reports on the design of a novel technical infrastructure to support effectively and efficiently chronic pain management, based on an Intelligent Personal Health Record platform on top of already available ICT tools. The designed platform targets, among others, at improving the knowledge on the patient data, effectiveness and adherence to treatment and providing effective communication channels between patients and healthcare professionals.

Background Major chronic diseases such as cardiovascular disease (CVD), diabetes, and cancer impose a significant burden on people and health care systems around the globe. Recently, deep learning (DL) has shown great potential for the development of intelligent mobile health (mHealth) interventions for chronic diseases that could revolutionize the delivery of health care anytime, anywhere. Objective The aim of this study is to present a systematic review of studies that have used DL based on mHealth data for the diagnosis, prognosis, management, and treatment of major chronic diseases and advance our understanding of the progress made in this rapidly developing field. Methods A search was conducted on the bibliographic databases Scopus and PubMed to identify papers with a focus on the deployment of DL algorithms that used data captured from mobile devices (eg, smartphones, smartwatches, and other wearable devices) targeting CVD, diabetes, or cancer. The identified studies were synthesized according to the target disease, the number of enrolled participants and their age, and the study period as well as the DL algorithm used, the main DL outcome, the data set used, the features selected, and the achieved performance. Results In total, 20 studies were included in the review. A total of 35% (7/20) of DL studies targeted CVD, 45% (9/20) of studies targeted diabetes, and 20% (4/20) of studies targeted cancer. The most common DL outcome was the diagnosis of the patient’s condition for the CVD studies, prediction of blood glucose levels for the studies in diabetes, and early detection of cancer. Most of the DL algorithms used were convolutional neural networks in studies on CVD and cancer and recurrent neural networks in studies on diabetes. The performance of DL was found overall to be satisfactory, reaching >84% accuracy in most studies. In comparison with classic machine learning approaches, DL was found to achieve better performance in almost all studies that reported such comparison outcomes. Most of the studies did not provide details on the explainability of DL outcomes. Conclusions The use of DL can facilitate the diagnosis, management, and treatment of major chronic diseases by harnessing mHealth data. Prospective studies are now required to demonstrate the value of applied DL in real-life mHealth tools and interventions.

Informal care is considered to be important for the wellbeing and resilience of the elderly. However, solutions for the effective collaboration of healthcare professionals, patients, and informal caregivers are not yet widely available. The purpose of this paper is to present the development of a digital platform that uses innovative tools and artificial intelligence technologies to support care coordination and shared care planning for elder care, with a particular focus on frailty. The challenges of shared care planning in the coordination of frailty care are demonstrated, followed by presentation of the design and technical architecture of an integrated platform. The platform incorporates all elements essential for the support of daily activities, coordinated care, and timely interventions in case of emergency and need. This paper describes the challenges involved in implementing the platform and concludes by reporting the necessary steps required in order to establish effective smart care for the elderly.

Chronic pain is one of the most common health problems affecting daily activity, employment, relationships and emotional functioning. Unfortunately, the lack of specialized health care personnel, and the high heterogeneity in terms of clinical manifestation and treatment results contribute in failure to manage efficiently and effectively pain. Information and communication technology (ICT) can be a valuable tool, enabling patients and healthcare professional empowerment and better self-management of pain. To this direction, this article reports on the design of a novel technical infrastructure to support effectively and efficiently chronic pain management, based on an Intelligent Personal Health Record platform on top of already available ICT tools. The designed platform targets, among others, at improving the knowledge on the patient data, effectiveness and adherence to treatment and providing effective communication channels between patients and healthcare professionals.

The purpose of this work is to analyze the digital transformation challenges related to the implementation of quality electronic medical record systems in Greece, within the wider frame of the European digital single market. The authors explore characteristics of quality, interoperable and secure electronic medical records, and provide an overview of the challenges and factors affecting their adoption, implementation, and operation. Key challenges relate to linking electronic medical records with the workflow, building trust and acceptance by making the best use of champions and key stakeholders, and financing the digital transformation transition and sustainability. The foreseen benefits include better support of medical decisions across all stages of the patient pathway, patients empowered to carry with them clinically significant information, fostering research, and unlocking the full potential of vendors to implement innovative tools to support continuity of care.

Enabling data exchange between electronic medical records (EMRs) and personal health apps has the potential to boost the secondary usage of health data, eventually increasing the quality of life. In this paper, the authors present a mobile app architecture that enables the integration of legacy cross-enterprise document sharing (XDS) and next generation fast healthcare interoperability resources (FHIR) compatible electronic medical record (EMR) systems with personal mobile applications. The realization of this architecture is achieved by linking EMR information from multiple providers at the point of care, with a personal health app for citizens, combining the benefits and potential of both XDS and FHIR.

Coping with breast cancer and its consequences has now become a major socioeconomic challenge. The BOUNCE EU H2020 project aims at building a quantitative mathematical model of factors associated with optimal adjustment capacity to cancer. This paper gives an overview of the project targets and on the algorithmic methods focusing on modeling the psychological resilience trajectories during breast cancer treatment.

The development of electronic services for healthcare presents challenges related to the effective cooperation of systems and stakeholders in a highly regulated environment. Assessing the interoperability maturity of the provided services helps to identify interoperability issues in public administration. This paper presents a typical healthcare digital service: the inpatient admission in a public hospital in Greece. The Interoperability Maturity Model (IMM) is applied to assess its maturity, identify improvement priorities, and compare it with digital services of the healthcare sector. An analysis is also performed to compare a group of fourteen healthcare digital public services with sixty-seven public services of other sectors in the country. The IMM is a useful tool to facilitate awareness raising and priority setting concerning interoperability in public administration. What is discovered, through this preliminary assessment, is that healthcare digital services seem to have higher overall interoperability maturity than those of other sectors in Greece.

Anxiety and stress are very common symptoms of patients facing a forthcoming surgery. However, limited time and resources within healthcare systems make the provision of stress relief interventions difficult to provide. Research has shown that provision of preoperative stress relief and educational resources can improve health outcomes and speed recovery. Information and Communication Technology (ICT) can be a valuable tool in providing stress relief and educational support to patients and family before but also after an operation, enabling better self-management and self-empowerment. To this direction, this paper reports on the design of a novel technical infrastructure for a resilience support tool for improving the health condition of patients, during the care path, using Virtual Reality (VR). The designed platform targets, among others, at improving the knowledge on the patient data, effectiveness and adherence to treatment, as well as providing for effective communication channels between patients and clinicians.

Sensor-based health systems can often become difficult to use, extend and sustain. The authors propose a framework for designing sensor-based health monitoring systems aiming to provide extensible and usable monitoring services in the scope of pervasive patient care. The authors’ approach relies on a distributed system for monitoring the patient health status anytime-anywhere and detecting potential health complications, for which healthcare professionals and patients are notified accordingly. Portable or wearable sensing devices measure the patient's physiological parameters, a smart mobile device collects and analyses the sensor data, a Medical Center system receives notifications on the detected health condition, and a Health Professional Platform is used by formal caregivers in order to review the patient condition and configure monitoring schemas. A Service-oriented architecture is utilised to provide extensible functional components and interoperable interactions among the diversified system components. The framework was applied within the REMOTE ambient-assisted living project in which a prototype system was developed, utilising Bluetooth to communicate with the sensors and Web services for data exchange. A scenario of using the REMOTE system and preliminary usability results show the applicability, usefulness and virtue of our approach.

The ever-growing demand for acquiring, managing, and exploiting patient health-related information has led to the development of several mobile health apps to support cancer patients. This chapter analyzes the clinical and technological characteristics of mobile apps enabling cancer patients to securely record, manage, and share their information online. It discusses issues relevant to increasing patient experience and acceptance, improving adherence to treatment, and effective support of coordinated care. Outcomes of recent research projects relevant to end user digital engagement, trust, interoperability, and usability/adaptability lead to an integrated approach towards developing quality mobile health apps. Improving quality of life and wellbeing in a secure and safe manner that respects the patients' privacy seems to be the key challenge. Regulation, standardization, and interoperability together with the existence of useful, accurate, and reliable tools for active patient engagement are imperative for efficient cancer disease management.

Chronic pain is one of the most common health problems affecting daily activity, employment, relationships and emotional functioning. Unfortunately, limited access to pain experts, the high heterogeneity in terms of clinical manifestation and treatment results, contribute in failure to manage efficiently and effectively pain. Information and Communication Technology (ICT) can be a valuable tool, enabling better self-management and self-empowerment of pain. To this direction, this paper reports on the design of a novel technical infrastructure for chronic pain self-management based on an Intelligent Personal Health Record (PHR) platform. The designed platform targets, among others, at improving the knowledge on the patient data, effectiveness and adherence to treatment and providing effective communication channels between patients and clinicians.

Recent developments have shown that disasters have the tendency to grow both in size and frequency all over the world. Earthquakes in Eastern Mediterranean region denote a major hazard. It is well known that this area hosts very complex active tectonics, accommodates major seismic sources and suffers from many deadly earthquakes. One of the main challenges after a mass disaster event is the care for the directly or indirectly affected population, gathering rapidly in great numbers at specific areas. For the appropriate organization of the emergency shelters, components such as coordination, communication and medical care are considered very important. The medical needs of evacuees must be identified and appropriate care and support must be provided. This paper presents the Information and Communication Technologies (ICT) developed to support emergency services and temporary accommodation in order to speed up the initial procedures and improve the provided help to the affected people.

Healthcare is a highly regulated domain. Seamless, online access to integrated electronic health records for citizens is still far from becoming a reality. The implementation of personally managed health data systems still needs to overcome several interoperability, usability, ethics, security, and regulatory issues to deliver the envisioned benefits. This paper offers a policy viewpoint on how the new European Interoperability Framework (EIF) may benefit the implementation of eHealth systems for the management of personal health information for citizens. Interoperability facilitates sharing of health and illness experiences, coordinated care and research for citizen empowerment and improved health outcomes. The adoption of principles relevant to core interoperability and generic user needs and expectations, as described in the new EIF, in line with European and national regulations are quite essential for the development of safe and secure patient access services to support mobility. An interoperability framework facilitates the creation of the appropriate context in which personal health record applications can be designed and implemented in support of disease specific solutions, such as chronic non-malignant pain, diabetes and cancer. It is evident that no solution will fit all circumstances. However, the new EIF, when adapted for personally managed health data, provides a useful and relevant framework to facilitate implementation and adoption of personal health record systems within a coordinated care environment. Practical implications of this work relate to the need of multi-disciplinary cooperation and European level compatibility and sustainability of the underlying infrastructures required to support reliable and secure access to and sharing of medical data, as well as the readiness to address continuously evolving functional and non-functional requirements for regional, national, and cross-border settings.

The ever-growing demand for acquiring, managing and exploiting patient health related information has led to the development of many e-Health systems and applications. However, despite the number of systems already developed and the apparent need for such systems, end users can only collect online and exploit, only a limited set of information for health purposes in the context of personalized, preventive and participatory medicine. To this direction, this paper initially presents the personal health record (PHR) concept, related work and best practices for the development of PHR systems in a standardized manner. It also outlines the proposal for meaningful use criteria in the United States (US) and the health level seven (HL7) personal health record system functional model (PHR-S FM). Focus is put on trying to link core functionality modules of the Integrated Care Solutions TM PHR system, designed to support the citizen, paying emphasis on wellbeing, home care and the management of chronic diseases with PHR-S FM personal health functions, in a preliminary effort towards the exploration of functional models to support interoperability. Based on accumulated experiences from many European Union (EU) research projects, the paper concludes by providing directions towards achieving wider PHR adoption and meaningful use.

This paper draws upon the experience of production level implementations, initiated through public procurement, of four regional health information networks (RHINs). The RHINs are being implemented in four regional health authorities (RHAs) in Greece to support patient-centred services. This paper focuses on three key areas: (i) engineering issues related to the deployment of an integrated electronic health record (EHR) system, (ii) management issues regarding implementation and planning, and (iii) socio-organizational issues influencing the outcome of large scale EHR implementations. The complexity of the health sector is also presented focusing on EHR barriers and enablers at institutional and regional levels. Reasons why EHR system implementations have not progressed as expected are also discussed.

Objective The paper presents an application of the “Fit between Individuals, Task and Technology” (FITT) framework to analyze the socio-organizational-technical factors that influence IT adoption in the healthcare domain. Method The FITT framework was employed as the theoretical instrument for a retrospective analysis of a 15-year effort in implementing IT systems and eHealth services in the context of a Regional Health Information Network in Crete. Quantitative and qualitative research methods, interviews and participant observations were employed to gather data from a case study that involved the entire region of Crete. Results The detailed analysis of the case study based on the FITT framework, showed common features, but also differences of IT adoption within the various health organizations. The emerging picture is a complex nexus of factors contributing to IT adoption, and multi-level interventional strategies to promote IT use. Conclusion The work presented in this paper shows the applicability of the FITT framework in explaining the complexity of aspects observed in the implementation of healthcare information systems. The reported experiences reveal that fit management can be viewed as a system with a feedback loop that is never really stable, but ever changing based on external factors or deliberate interventions. Management of fit, therefore, becomes a constant and complex task for the whole life cycle of IT systems.

Like several other chronic diseases the proper and effective management of diabetes requires the full involvement of patients and informal caregivers by implementing self care for personal health maintenance with treatment of diabetes and prevention of complications. Patient empowerment is a necessary pre-requisite of effective disease self-management. Self-management can help people with chronic diseases to remain in the workforce and active members of their community. Programs on chronic disease self-management teach and support patients to identify warning symptoms, measure and evaluate vital signs, decide the most suitable treatment for them, and take medications. In the context of the REACTION project, a diabetes management platform for patients in rural areas was designed and developed. In this paper we present the patient portal, the methodology adopted for the technology evaluation and our preliminary results after an extensive field test on citizens with diabetes.

This paper analyzes the methodology and preliminary results of the usability evaluation of large scale technology services for the prevention and management of chronic conditions of elderly people. REMOTE, a three years European project in the Ambient Assisted Living domain, aims to define and establish a multidisciplinary and integrated approach to research and development of advanced technology services for addressing real needs of elderly people. The target population included citizens at risk due to geographic and social isolation in combination with specific chronic conditions and the coexistence of lifestyle risk factors, such as obesity, blood pressure, poor eating/drinking habits, stress and others. Technology services provided by the project include wearables and sensors for detecting body temperature, heart rate, human posture, as well as sensors and actuators to be installed in premises for providing context information, such as air temperature, human location and motion. The article presents the usability evaluation plan that was developed for the purposes of the project, as well as some preliminary results from the usability evaluation.

BackgroundDiabetes, a metabolic disorder, has reached epidemic proportions in developed countries. The disease has two main forms: type 1 and type 2. Disease management entails administration of insulin in combination with careful blood glucose monitoring (type 1) or involves the adjustment of diet and exercise level, the use of oral anti-diabetic drugs, and insulin administration to control blood sugar (type 2). ObjectiveState-of-the-art technologies have the potential to assist healthcare professionals, patients, and informal carers to better manage diabetes insulin therapy, help patients understand their disease, support self-management, and provide a safe environment by monitoring adverse and potentially life-threatening situations with appropriate crisis management. MethodsNew care models incorporating advanced information and communication technologies have the potential to provide service platforms able to improve health care, personalization, inclusion, and empowerment of the patient, and to support diverse user preferences and needs in different countries. The REACTION project proposes to create a service-oriented architectural platform based on numerous individual services and implementing novel care models that can be deployed in different settings to perform patient monitoring, distributed decision support, health care workflow management, and clinical feedback provision. ResultsThis paper presents the work performed in the context of the REACTION project focusing on the development of a health care service platform able to support diabetes management in different healthcare regimes, through clinical applications, such as monitoring of vital signs, feedback provision to the point of care, integrative risk assessment, and event and alarm handling. While moving towards the full implementation of the platform, three major areas of research and development have been identified and consequently approached: the first one is related to the glucose sensor technology and wearability, the second is related to the platform architecture, and the third to the implementation of the end-user services. The Glucose Management System, already developed within the REACTION project, is able to monitor a range of parameters from various sources including glucose levels, nutritional intakes, administered drugs, and patient’s insulin sensitivity, offering decision support for insulin dosing to professional caregivers on a mobile tablet platform that fulfills the need of the users and supports medical workflow procedures in compliance with the Medical Device Directive requirements. ConclusionsGood control of diabetes, as well as increased emphasis on control of lifestyle factors, may reduce the risk profile of most complications and contribute to health improvement. The REACTION project aims to respond to these challenges by providing integrated, professional, management, and therapy services to diabetic patients in different health care regimes across Europe in an interoperable communication platform.

Predictions, risk assessment and risk profiling are among the various decision support techniques that medical professionals increasingly rely on to provide early diagnose in patients with elevated risks and to slow down the rapid increase in prevalence of chronic diseases. The introduction of risk assessment tools and applications for chronic diseases in large scale longitudinal clinical studies, presents many challenges due to the nature of the data (studies last around a decade) and the complexity of the models. In this paper, we give an overview of research work on risk assessment tools and applications for diabetes complications. We also introduce the REACTION project and its vision in the field of risk assessment for diabetes complications.

This paper analyzes the methodology and preliminary results of four focus groups conducted for the diabetes project Reaction, a four year European project that aims to develop an intelligent service platform for remote monitoring of glucose levels with diabetes management and therapy to patients in different healthcare regimes across Europe. The focus groups aimed to investigate opinions, concerns, issues and ideas about management of disease, technology services, privacy and confidentiality of people involved with diabetes. The focus groups were conducted in four different European countries to assist in the user centric design of the services to reach beyond the boundaries of the project.

Dealing with life threatening situations demands efficiency and effectiveness of operations including optimizing the emergency response time, and utilizing resources and personnel as best appropriate for each incident. In this paper, we look at the efforts of the regional Emergency Medical Department (EMD) of Crete to introduce new technologies for optimizing emergency response, including the computerization of triage protocols and telemedicine.

Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. Discussion The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process. Summary The EHR implementation experience depends on a variety of factors including the technology, training, leadership, the change management process, and the individual character of each ambulatory practice environment. Sound processes must support both technical and personnel-related organizational components. Additional research is needed to further refine recommendations for the small physician practice and the nuances of specific medical specialties.

International audience; The aim of this study was to investigate the perception and attitudes of people in Greece regarding the use of the internet for Health and Illness (H&I). It is the Creek part of a survey conducted concurrently in 7 European countries in 2005 and 2007, to establish eHealth consumer trends across Europe. METHOD: 1000 men and women aged between 15 and 80 years, in telephone interviews expressed their opinion on the use of the internet for H&I. The sample was stratified for age, occupation, and geographic location of residence. The questionnaire used is based on earlier Norwegian surveys (2000-2002) and was translated to national languages, including Greek, using the dual focus method. Four questions designed specifically for Greece explored the acceptance of innovative eHealth services. RESULTS: In all Creek regions, the internet is considered an important information source for H&I by 37.7-38.5% of the respondents, internet use for H&I, however, varies considerably between urban and rural areas (29.5% vs 18.5%), reaffirming the existence of the digital divide in Greece. While personal contact with health professionals ranks first among information sources for H&I, half the internet users for H&I go online in search of information before or after a medical appointment. Moreover, 59% of the internet users for H&I make their decision about whether to consult a health professional based partly on information found on the internet. Of the internet users, 58.5% feel relief after consulting the internet on H&I issues. Regarding eHealth, 26% of the respondents feel comfortable with medical visits via computer or video-phone. Furthermore, 46% would grant remote access to their medical data to expedite diagnosis. Given the opportunity, 61.7% would access their Electronic Health Record (EHR) online, 59.2% even with an annual fee. CONCLUSIONS: Perception and use of the internet as an information source for H&I assert the existence of a wide digital divide in Greece. However, favorable disposition towards online EHR access and hesitance towards telemedicine suggest that this divide can be bridged with education, user-oriented services, and incentives.