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Chronic wounds present a significant healthcare challenge in Austria as well as in other countries. The interdisciplinary approach to wound treatment involving various caregivers, doctors, and relatives, poses challenges in documentation and information exchange. To overcome these barriers and promote patient-centered care, a new telehealth-supported treatment pathway for chronic wounds has been developed. The primary focus was to regularly update the status of the chronic wound by responding to predefined questions and transmitted images of the chronic wound. This was achieved by an interdisciplinary team of experts in chronic wound care, providing a new perspective for digital implementation in the healthcare system. [ABSTRACT FROM AUTHOR]

Background: CareNet is the IT-based tool for Case and Care Management (CCM) in Tyrol, which facilitates standardised documentation of CCM activities. Objectives: Analysing the pilot usage of CareNet Tyrol. Methods: Evaluation of the success and user experience of CareNet, expert interviews and a questionnaire-based assessment. Results: Feedback from users in both phases indicated that the CareNet platform provides general benefits, but falls short of fully supporting the daily work of CCM experts and avoiding the need for parallel use of different documentation tools. Conclusion: This paper provides an insight into the ongoing transition to digital documentation for CCM at LIV Tyrol. While user feedback highlights areas for improvement, digital documentation is proved to be beneficial for the CCM team. [ABSTRACT FROM AUTHOR]

Telehealth services are becoming more and more popular, leading to an increasing amount of data to be monitored by health professionals. Machine learning can support them in managing these data. Therefore, the right machine learning algorithms need to be applied to the right data. We have implemented and validated different algorithms for selecting optimal time instances from time series data derived from a diabetes telehealth service. Intrinsic, supervised, and unsupervised instance selection algorithms were analysed. Instance selection had a huge impact on the accuracy of our random forest model for dropout prediction. The best results were achieved with a One Class Support Vector Machine, which improved the area under the receiver operating curve of the original algorithm from 69.91 to 75.88 %. We conclude that, although hardly mentioned in telehealth literature so far, instance selection has the potential to significantly improve the accuracy of machine learning algorithms. [ABSTRACT FROM AUTHOR]

Background: The Integrated Treatment Pathway Stroke Tyrol was introduced for the care of people after an acute stroke event and includes four phases: acute prehospital care, inpatient treatment, inpatient rehabilitation and ambulatory, outpatient rehabilitation. For the 4th phase, the ambulatory rehabilitation of patients after discharge, the ICT platform "StrokeNet Tyrol" was established. Methods: Requirements and processes along the pathway and between the interdisciplinary team were taken into account for implementation based on a modular software architecture. Flexible rights and role concept was developed to support efficient collaboration of the heterogenic professions. Results: The routine usage of 342 users with 8 different roles, 2,219 registered patient cases within the last 4 years and first results of the integrated benchmarking solution give a positive impression regarding feasibility and effectiveness. Conclusion: To this point, a comprehensive infrastructure for the Ambulatory Tyrolean Stroke Pathway has been established. Results from outcome analyses and comparative studies could help to further improve usability and to expand the area of application for other indications. [ABSTRACT FROM AUTHOR]

Background: Telehealth services for chronic diseases are becoming more and more popular since they are expected to improve health outcomes and reduce costs. Especially for diabetes patients, life-long disease management is required. However, there are situations in a patient’s life, when motivation to continue the participation in disease management programs is low and the dropout-risk is high. Objectives: We analysed if an adherence management module provided to healthcare professionals within a pre-existing diabetes telehealth service can improve the long-term adherence. Methods: The adherence to the agreed data submission protocol was determined prior and post implementation of the adherence management module. Results: Adherence to the agreed data submission protocol was higher after implementation of the adherence management module as compared to previous years. Conclusion: Adherence to the agreed data submission protocol can be improved by helping healthcare professionals to identify patients at risk of dropout. Further analyses are indicated to proof these results in a prospective study. [ABSTRACT FROM AUTHOR]

The aim of this paper was to evaluate the effect of telemedical care of gestational diabetes mellitus (GDM) patients with the digital treatment pathway model DiabCare Tirol. Methods: 27 courses of patients with GDM, who were telemonitored through the integrated care program DiabCare Tirol in a diabetes outpatient clinic in Tyrol, Austria during the COVID-19 pandemic in 2020, were analyzed. In addition, randomized controlled trials (RCTs) on telemedicine interventions for GDM were researched, and their results were used for comparison with this disease management method. The patient outcome analysis was used to examine the effects of the integrated care program involving telemonitoring support and compared them to the results of RCTs in which participants were randomly assigned to one of two groups, either mobile monitored or standard treatment group. Results: The feasibility of the digital treatment pathway model was confirmed in practice, as the trend analysis of the 27 GDM patients involved showed significantly improved glycaemic control. Results of RCT studies tend to support the findings of DiabCare Tirol. Conclusion: Benefits of telemonitoring with integrated care to support conventional therapy cannot be dismissed, especially in times of the pandemic. Continuous outcome research with larger patient numbers will be necessary to confirm the effectiveness of telemonitoring in a regular care setting. [ABSTRACT FROM AUTHOR]

Telehealth services for long-term monitoring of chronically ill patients are becoming more and more common, leading to huge amounts of data collected by patients and healthcare professionals each day. While most of these data are structured, some information, especially concerning the communication between the stakeholders, is typically stored as unstructured free-texts. This paper outlines the differences in analyzing free-texts from the heart failure telehealth network HerzMobil as compared to the diabetes telehealth network DiabMemory. A total of 3,739 free-text notes from HerzMobil and 228,109 notes from DiabMemory, both written in German, were analyzed. A pre-existing, regular expression based algorithm developed for heart failure free-texts was adapted to cover also the diabetes scenario. The resulting algorithm was validated with a subset of 200 notes that were annotated by three scientists, achieving an accuracy of 92.62%. When applying the algorithm to heart failure and diabetes texts, we found various similarities but also several differences concerning the content. As a consequence, specific requirements for the algorithm were identified. [ABSTRACT FROM AUTHOR]

Background: Antitachycardial pacing (ATP) is a painless method for terminating ventricular tachycardias (VT) which would otherwise be treated using a painful high energy shock. However, it is well known that not each VT can be successfully terminated by ATP. Furthermore, ATP can be parametrized in several ways using scan, ramp or scan ramp approaches and can be applied in the right ventricle or in both ventricles (biventricular). In this work, we investigate the therapeutically most convenient ATP protocol based on a computer simulation using a patient individual model. Methods: A patient individual model generated from a 3D/4D data set and a hybrid automaton was used for modeling and simulation of different VT scenarios. On the different VTs (from cycle length 288 ms up to 408 ms) different ATP approaches derived from the ADVANCE-CRT trial were applied in order to determine the effectiveness of these approaches. Results: In this computer simulation study we were able to verify and validate the results from the ADVANCE-CRT trial. Biventricular ATP does not prove to be more effective than RV ATP but has a slight advantage in terminating fast VTs. Conclusions: The availability of a patient individual model and knowledge about the ischemic area and the underlying mechanism of the VTs will allow the use of these models to optimize ATP management. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of third most common causes of death and the main cause for permanent disabilities. The Tyrol Stroke Pathway covers, all steps from stroke onset to outpatient rehabilitation. Objectives: The main objective of this paper is to describe how the paper-based documentation in the outpatient rehabilitation can be implemented in an eHealth service for integrated care. Methods: First a state analysis followed by a requirement analysis was performed. An interactive mock-up was designed for further discussion with the stakeholders. After the implementation of the system the evaluation was performed in two steps: feedback from a virtual test phase and a pilot operation was analyzed. Results: First experiences during the virtual test phase with key stakeholders of the therapy pathway showed a high level of acceptance. Users reported an improvement in the communication and documentation processes. Conclusion: Initial results illustrate how a shift from paper-based documentation to an integrated eHealth service can improve communication and documentation in an independent therapy network. [ABSTRACT FROM AUTHOR]

Background: Disease management programs (DMP) are a modern way of treating health conditions and are becoming a part of standard care. One telehealth DMP service has been in regular operation since 2017, named "HerzMobil Tirol". Objectives: This paper investigates, if the electronic health record standard HL7 CDA, which is widely accepted in the health care industry, could be used for telehealth DMP services as well. It is already in use in a legally required integrated element of healthcare in Austria called ELGA. An official guideline from the Austrian Ministry of Health sets the standard for telemonitoring with data logging. Methods: After the background knowledge was built up, requirements have been gathered through existing official guidelines and interviews and existing documentation by "HerzMobil Tirol". Results: Twenty-five requirements were collected, categorized and analyzed to determine if the existing CDA guidelines are suitable or a new standard must be designed. Conclusion: Based on the requirements, it was established that seven specific sections and two different CDA documents are needed. [ABSTRACT FROM AUTHOR]

Background: Telemonitoring offers new opportunities in the treatment of chronically ill patients and could help to improve their quality of life while reducing healthcare costs. Objectives: The willingness to use telemonitoring is examined for both physicians and patients. From the perspective of the most important stakeholders, advantages and disadvantages as well as barriers for telemonitoring are analysed. Methods: A Telehealth Readiness Assessment was carried out with physicians (n=41) and patients (n=47) in a cross-sectional study. A stakeholder survey was conducted by use of interviews (n=28). Results: Average readiness for telemonitoring is 58% for physicians, and 65% for patients. Both are thus in a position where there are several arguments which adversely affect the success of telemonitoring. The most important advantage is the intensified care, while the biggest concerns are data protection as well as the loss of personal communication. The greatest barriers are the lack of funding, the weak clinical and economic evidence and the organisation of the Austrian healthcare system. Conclusion: There are still some barriers to overcome, especially financial, political and organisational. [ABSTRACT FROM AUTHOR]

Background: Diabesity, a combination of diabetes mellitus type 2 and obesity, is one of the biggest global health problems. Individual nutrition therapy and physical activity are effective measures in prevention and treatment. Methods: Requirements for an integrated diabesity service were specified and evaluated in two stages. The aim of the first stage was to perform a feasibility trial in patients with diabesity, using separate diaries. DiabMemory for diabetes and Nutrinaut for nutrition. Based on the results of the first stage, a prototype of an integrated diabesity solution (KIT-Nutriton, AIT) was developed and evaluated. Results: First stage trial was performed with 10 diabesity patients (2f, med:53 y. (IQR:7), T2DM, BMI > 28 kg/m²) with 3 months follow-up and a significant reduction of BMI. Participants noticed concerns about using two separate diary solutions. Results of the field trial with KIT-Nutrition with 14 healthy subjects (3f, med:26 y (IQR: 20,25)) showed that overall, 77.6 % of the intended tasks had been achieved. Conclusion: Results show that the integrated KIT-Nutrition app, providing access to a nutrition database, is feasible and accepted by the users. Before further trials can be made, an extension for regional food terms is recommended. [ABSTRACT FROM AUTHOR]

Functional evaluation of elderly patients is one key component in a comprehensive Geriatric Assessment. The increased workload and high costs associated to close and continuous monitoring in clinical settings may be counterbalanced by the application of ICT-supported remote follow-up. Although clinical parameters and questionnaires can be supported with smartphones and smart gadgets, physical performance trials pose a challenge for community-based approaches with difficulties arising from setting up trials, the lack of guidance and supervision. We developed an ultrasonic-based device to overcome all of these barriers and enable elderly people to perform the Timed Up-and-Go test in an autonomous and unsupervised setting. Moreover, we introduce an algorithm to verify the successful performance of the test in order to increase the reliability of the information provided. [ABSTRACT FROM AUTHOR]

Background: Automatic event detection is used in telemedicine based heart failure disease management programs supporting physicians and nurses in monitoring of patients' health data. Objectives: Analysis of the performance of automatic event detection algorithms for prediction of HF related hospitalisations or diuretic dose increases. Methods: Rule-Of-Thumb and Moving Average Convergence Divergence (MACD) algorithm were applied to body weight data from 106 heart failure patients of the HerzMobil-Tirol disease management program. The evaluation criteria were based on Youden index and ROC curves. Results: Analysis of data from 1460 monitoring weeks with 54 events showed a maximum Youden index of 0.19 for MACD and RoT with a specificity > 0.90. Conclusion: Comparison of the two algorithms for real-world monitoring data showed similar results regarding total and limited AUC. An improvement of the sensitivity might be possible by including additional health data (e.g. vital signs and self-reported well-being) because body weight variations obviously are not the only cause of HF related hospitalisations or diuretic dose increases. [ABSTRACT FROM AUTHOR]

Continual monitoring of patients utilizing mHealth-based telemonitoring applications are more and more used for individual management of patients. A new approach in risk assessment called Rolling Score Concept uses standardized questionnaires for continual scoring of individuals' health state through electronic patient reported outcome (ePRO). Using self-rated questionnaires and adding a specific Time Schedule to each question result in a movement of the questionnaires' scores over time, the Rolling Score. A text-processing pipeline was implemented with KNIME analytics platform to extract a Score Mapping Rule Set for three standardized screening questionnaires in the field of sleep medicine. A feasibility study was performed in 10 healthy volunteers equipped with a mHealth application on a smartphone and a sleep tracker. Results show that the proposed Rolling Score Concept is feasible and deviations of scores are in a reasonable range (< 7%), sustaining the new approach. However, further studies are required for verification. In addition, parameter quantification could avoid incorrect subjective evaluation by substitution of questions with sensor data. [ABSTRACT FROM AUTHOR]

Research in blood transfusions mainly focuses on Donor Blood Management, including donation, screening, storage and transport. However, the last years saw an increasing interest in recipient related optimizations, i.e. Patient Blood Management (PBM). Although PBM already aims at reducing transfusion rates by pre- and intra-surgical optimization, there is still a high potential of improvement on an individual level. The present paper investigates the feasibility of predicting blood transfusions needs based on datasets from various treatment phases, using data which have been collected in two previous studies. Results indicate that prediction of blood transfusions can be further improved by predictive modelling including individual pre-surgical parameters. This also allows to identify the main predictors influencing transfusion practice. If confirmed in a prospective dataset, these or similar predictive methods could be a valuable tool to support PBM with the ultimate goal to reduce costs and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Public health authorities and healthcare professionals are obliged to ensure high quality health service. Because of the high variability of the utilisation of blood and blood components, benchmarking is indicated in transfusion medicine. Objectives: Implementation and validation of a benchmarking framework for Patient Blood Management (PBM) based on the report from the second Austrian Benchmark trial. Methods: Core modules for automatic report generation have been implemented with KNIME (Konstanz Information Miner) and validated by comparing the output with the results of the second Austrian benchmark trial. Results: Delta analysis shows a deviation <0.1% for 95% (max. 1.4%). Conclusion: The framework provides a reliable tool for PBM benchmarking. The next step is technical integration with hospital information systems. [ABSTRACT FROM AUTHOR]

Management of heart failure is usually multidisciplinary and collaboration between stakeholders in a dedicated HI network like the HerzMobil Tirol can be supported by a mHealth-based telemedicine approach. The aim is to gain insights through textual analysis of collaboration notes that might trigger further developments and improvements of the HI network. A reusable pipeline for textual analysis of unstructured textual notes was implemented using the open source analytics software KNIME. After preprocessing, a keyword analysis was performed resulting in a classification of all notes in predefined categories. Results: Medical and organizational issues dominate the communication with health status and therapy aspects as well as clinical treatment, discharge letter and home visits. Beside aspects of data transmission and mobile phone, technological issues are minor topics during the collaboration. It is possible to gain new insights with respect to technology like additional control Apps for mobile phone settings and to the HI network like clinical experts and technical help desk involvement. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases belong to the most common causes of death. Telehealth applications can help to improve therapy and support behavior change. It was the objective of the present work to construct and evaluate within a trial (25 patients) an automated feedback system for a telehealth application to support behavior change. We used a rule-based approach and constructed 26 rules in 9 categories. Rule design and implementation followed the principles of the Austrian Medical Product Law, resulting in an automated rule-based feedback system. Evaluations show high user satisfaction with 80% of all users perceiving the system as useful. [ABSTRACT FROM AUTHOR]

Chronic diseases like Heart Failure are widespread in the ageing population. Affected patients can be treated with the aid of a disease management program, including a telemedical collaborative network. Evaluation of a currently used system has shown that the information of the textual communication is of pivotal importance for the collaboration in the network. Thus, the challenge is to make this unstructured information useable, potentially leading to a better understanding of the collaboration so as to optimize the processes. This paper presents the setup of an analysis pipeline for processing textual information automatically, and, how this pipeline can be utilized to train a model that is able to automatically classify the written messages into a set of meaningful task and status categories. [ABSTRACT FROM AUTHOR]

Continuous medication monitoring is essential for successful management of heart failure patients. Experiences with the recently established heart failure network HerzMobil Tirol show that medication monitoring limited to heart failure specific drugs could be insufficient, in particular for general practitioners. Additionally, some patients are confused about monitoring only part of their prescribed drugs. Sometimes medication will be changed without informing the responsible physician. As part of the upcoming Austrian electronic health record system ELGA, the eMedication system will collect prescription and dispensing data of drugs and these data will be accessible to authorized healthcare professionals on an inter-institutional level. Therefore, we propose two concepts on integrated medication management in mHealth applications that integrate ELGA eMedication and closed-loop mHealth-based telemonitoring. As a next step, we will implement these concepts and analyze - in a feasibility study - usability and practicability as well as legal aspects with respect to automatic data transfer from the ELGA eMedication service. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a growing public health problem. The management of HF is usually multi-disciplinary and should comprise the cooperation of all groups of individuals involved in the care like clinicians, cardiologists, general practitioners, internists, nurses, relatives and patients. There is an ongoing debate with regard to monitoring and the optimal level and intensity of care for which kind of patients. Based on our experience with the recently established HF network HerzMobil Tirol, we developed a concept how to combine mHealth-based telemonitoring and disease management programs. The collaborative HF management concept timely and efficiently closes the feedback loop between patients and care providers and allows for continuity of care. The aim is to gradually adjust intensity of care according to the patients’ level of disease severity and risk of readmission after hospital discharge along the overall trajectory of illness. Next steps will be to investigate how to define shared decision making, rights, duties, responsibilities and liabilities of the individual stakeholders as well as to analyze business models for reimbursement. [ABSTRACT FROM AUTHOR]

A mobile phone-based telemonitoring system for long-term psoriasis therapy is described, intended to increase patients' compliance by optimizing the patient-physician communication. Patients themselves can acquire health parameters and take photos of their psoriasis lesions. The data are sent to a monitoring centre, where they are provided to the patients' physician who returns a feed-back message. The system is currently tested in a study with 20 patients. Preliminary results prove the feasibility and usabililty of such a system and indicate that it is useful for optimizing psoriasis-therapy. [ABSTRACT FROM AUTHOR]