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Nursing Implications of Padlet Research Group 2

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Group 2 consisted of Llambi, Lecia, and Shelby. Overall, group 2 worked really well together. We all took a subtopic and gathered information to share on the padlet. Llambi was responsible for making the padlet and sharing it, Lecia helped gather information and made the overview video, and I made the summary video at the end. We all shared responsibility of responding to other students' comments and questions. Through the week and even before the week we had several group calls and a group message going where we would communicate with each other to get an idea of what everyone was doing and what we were going to do next.
~Shelby Paquet

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Group 2
I really enjoy working with Lecia and Shelby in this project.
Consistently we had a good cooperation and coordination with each other.  Each team member took ownership of each area and executed effectively and timely. We divided the information gathering by subtopic. I was responsible for organizing all the resources in to the padlet. Lecia was the master mind behind our questions, and the author of the introductory video.
Shelby took charge by leading the summery video.
I would gladly work with Lecia, and Shelby on future assignments. I give them full credits.
~Llambi Filipi

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Group 2 consisted of myself, Shelby and Llambi.  I do not exaggerate when I say, it was a real pleasure working on this assignment with these two fellow students.  We initially communicated through the group discussion board but soon began to meet by phone and it was immediately apparent that we were a good fit for each other.  We bonded as we planned our project.  We divided the subtopics equally, researched our topics and submitted what we found to the group discussion board so that each of us could review each other’s findings and decide what to place on the Padlet page.  Llambi was comfortable with overseeing the Padlet page and organized all our articles, internet links and videos.  Shelby and I viewed it regularly and gave our input as needed.  I recorded the overview video but it was posted only after Llambi and Shelby viewed it and agreed with the content.  Shelby recorded the wrap up video but just like with the overview video, we all give our input by way of communication through phone calls and texts messages.  All-in-all our group worked very well together making this a pleasurable experience.

~Lecia Hoskins

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Connected-patients  1  - Connected Health: the definition

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Connected-patients  1  - Connected Health: the definition

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"Connected Health encompasses terms such as wireless, digital, electronic, mobile, and tele-health and refers to a conceptual model for health management where devices, services or interventions are designed around the patient’s needs, and health related data is shared, in such a way that the patient can receive care in the most proactive and efficient manner possible,” the researchers explained"

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Connected health and digital health tools have the power to enhance patient engagement, patient access to care, and patient empowerment.

Source: Thinkstock

- As healthcare technology continues to permeate the medical industry, experts are continuing to evaluate how connected health tools can impact patient engagement and the overall patient experience.

As noted in a 2013 study in the International Journal of Medicine, connected health includes a broad set of definitions.

"Connected Health encompasses terms such as wireless, digital, electronic, mobile, and tele-health and refers to a conceptual model for health management where devices, services or interventions are designed around the patient's needs, and health related data is shared, in such a way that the patient can receive care in the most proactive and efficient manner possible," the researchers explained.

Top connected health tools include telehealth, remote patient monitoring tools, wearable technology, secure messaging tools, mobile apps, and other digital tools that help connect patients to their providers.

Connected health is useful because it bridges the gaps between patient, provider, and patient health. Connected health has received much praise in recent years, with healthcare experts saying these tools can revolutionize the patient experience with care. Entire connected health departments have emerged in hospitals across the country, and increasingly organizations are investing in their own connected health tools.

READ MORE: mHealth Games Can Improve Patient Education about Health Payers

But how exactly does connected health impact the patient? What are the benefits these tools have on patient care and patient experience?

Although connected health touches on a large number of patient care points, providers can look to two central patient experience domains: patient access to care and patient empowerment. Through various modalities, connected health tools improve patient care access and self-efficacy, working to deliver on central tenets of patient engagement.
Connected health supporting patient access to care
Foremost, connected health allows patients to connect with their medical providers more quickly and conveniently than ever before. One top tool for digital patient care access is telehealth.

Patients and providers alike can use telehealth through two central modalities. First, patients can use direct-to-consumer telehealth, on which they speak to their providers using video conference. From there, providers conduct an analysis and usually provide a diagnosis and treatment plan.

READ MORE: How mHealth Technology Supports Patient Engagement Strategies

Second, providers can connect with one another to share consults, expertise, and knowledge during patient care. For example, a provider in an urban, free-standing emergency department might consult a clinician in a larger, city-based hospital. The hospital clinician may have knowledge, equipment, or specialist expertise that the rural provider does not, making the telehealth consult ideal for patient care.

Patients have reported high satisfaction with telehealth, as the technology makes it easier for them to access basic healthcare needs on convenient technology platforms. In some cases, it allows patients to access care when they otherwise would have gone without.

In fact, patients are asking for access to telehealth more and more, showed a June 2017 survey from the Advisory Board. Seventy-seven percent of patients have requested access to some sort of telehealth because the tools increase their access to care.

Although telehealth is growing in popularity, it is certainly not the only form of connected health that supports better patient access to care. Secure messaging tools (many of which are hosted on patient portals) allow patients to message their providers when they have a medical question.

Secure messages are not stand-ins for provider care, but they can mitigate patient concerns. In some cases, secure messages can let a patient know that they do not necessarily need to visit the doctor's office, saving both patient and medical industry time and money.

READ MORE: mHealth Presents Opportunities for Improved Patient Engagement
Driving patient empowerment with connected health technology
Benefits of connected health go beyond the logistical factors - they also improve the way patients interact with and perceive their healthcare. When patients manage their own health using connected health tools, patient empowerment and self-efficacy increase.

Improved patient empowerment is usually the result of using wearables, remote patient monitoring devices, or diet and fitness apps (although self-efficacy improvements are not limited to those tools).

The above-mentioned technologies put patients in charge of their own care. For example, a fitness wearable helps a patient set her own fitness goals and track her progress toward those goals. A remote patient monitoring system will alert a diabetic patient when his sugars are too high, allowing the patient to make is own adjustments.

Increases in patient empowerment occur because these tools directly connect patients with their providers' efforts to improve wellness, according to David Albert, MD, founder and CEO of AliveCor, a mobile ECG technology developer.

"We're entering a new phase of patient centricity," Albert said in an interview with mHealthIntelligence.com. "Patients are becoming more and more responsible for their own healthcare, and that creates opportunities for engagement."

Connected health tools make patients accountable for their own health actions by providing an immediate view of where patients are falling short on their wellness path. Connected health can also help patients adjust their efforts.

Surveys have found that patients are intrigued by connected health tools because they help promote self-efficacy. A 2017 Accenture survey found that patients want convenient access to care, better patient education, and avenues to manage their care on their own.

Patients say providers are in charge of delivering these tools but are currently falling short. Only 21 percent of providers have offered their patients access to connected health, patient respondents said. This comes despite the fact that 44 percent of patients said they'd use connected health at their provider's behest. Thirty-one percent of patients said the same of payer encouragement.

But as healthcare professionals continue to see the benefits of connected health, they are continuing to adopt these tools into their practices. Seventy-one percent of providers have adopted telehealth, for example. More providers are looking into how patient-facing tools can enhance patient care experiences as well.

With the rising tide of consumerism in healthcare, providers are likely to continue their foray into connected health. These tools will allow patients to more easily and conveniently access their care while playing a key role as an arbiter of wellness.

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What Is the Role of Connected Health in Patient Engagement?

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Source: Thinkstock - As healthcare technology continues to permeate the medical industry, experts are continuing to evaluate how connected health tools can impact patient engagement and the overall patient experience. As noted in a 2013 study in the International Journal of Medicine, connected health includes a broad set of definitions.

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Connected-patients    2 -           Mobile apps

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Connected-patients    2 -           Mobile apps

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"Mobile apps allow providers to effectively streamline communication between patients, providers, and their caregivers and allows for 24/7 management of a patient’s condition along with the ability to personalize healthcare per patient."

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The top hospital and health system mobile apps offer interoperability and secure care coordination to enhance clinical communication and workflows.

Source: Thinkstock

- Providers are adopting the use of mHealth in the form of mobile apps in their pursuit of easing clinical communication between providers and patients as well as improve the management of hospital workflows.

Mobile apps allow providers to effectively streamline communication between patients, providers, and their caregivers and allows for 24/7 management of a patient's condition along with the ability to personalize healthcare per patient.

Apps provide organizational incentives for adoption such as reduced costs in workflow management. Providers leverage mobiles apps as a secure platform to manage and access important healthcare data without compromising the security of data.

The top 10 healthcare mobile app vendors includes interoperable platforms, secure two-way messaging, and patient-provider interactivity based on data gathered from Definitive Healthcare. Apps and vendors are listed in alphabetical order.

AirStrip, AirStripOB/Cardiology

READ MORE: How to Design and Develop a Mobile Health Application

AirStrip offers a mobile, interoperable platform that allows care coordination between multiple devices and multiple care settings. Data from an electronic health records, health information exchanges, medical devices, and other monitoring solutions can be accessed between smartphones, tablets, and computers from hospitals, post-acute care centers, and community-based care organizations. The AirStrip platform gives providers a tool to compact all this data into one platform that can be accessed via telemedicine, and integrates with other vendor systems.
Aetna, ITriage
This patient-facing mobile app allows patients to directly find information on their health conditions and gives them step-by-step guidance to treat conditions in the most effective way possible. ITriage gives patient directions on whether their conditions require a visit to the emergency room, turn-by-turn navigation to the appropriate provider, and a map of facilities in their Innovation Health insurance network. The app allows patients to review previous claims and securely store health information. ITriage is free to download for patients covered by Innovation Health under Aetna.
Cerner, CareAware Connect
CareAware Connect offers providers a mobile solution to complete workflows and manage clinical communications on a single device. Multiple teams - from care teams to ancillary staff - can collaborate and communicate for the purpose of improving care coordination. Users can also view patient data from a list that includes vitals, measurements, allergies, and orders on medication and care services. CareAware can be used with bar codes to manage medication administration and similar tools to associate patients in a mobile directory.

READ MORE: Top 10 Telemedicine Solutions by Hospital Site Implementations
DSS Inc.
DSS Inc. gives providers a suite of EHR-based mobile features that enhance care coordination, patient care and safety, and provides interoperable workflows aimed at reducing administrative costs. DSS provides both clinical and administrative tools that range from emergency room and home health mobile care management to automatic billing systems and scheduling tools. Recently, DSS was awarded the Faster Care for Veterans Pilot Contract for a mobile scheduling tool veterans can use from a PC or any mobile device.
Epic Systems, MyChart Mobile
Patients can download the MyChart on either the App Store or Google Play to access health data from previous in-office visits to providers. Viewable data includes test results, immunizations, medication, and health conditions indicated by a provider. MyChart also allows a patient to confirm appointments, pay their healthcare bills, and upload patient-generated data such as fitness metrics from a wearable health device. Through the app, patients can directly message their providers and confirm/schedule appointments.
GetWellNetwork, Marbella
READ MORE: Wearable Device, mHealth, Telehealth Markets Expected to Grow

Through the Marbella platform providers, nurses, and other caregivers within a health system can use their smartphone to manage patient rounding. Marbella can be used to specify patient data collection outside of general roundings, including safety and quality audits. The app integrates with other vendor systems and offers users real-time alerts and tracking to mitigate manual follow-ups. Marbella can be used in clinics, hospitals, and waiting rooms on any mobile device.
MEDITECH, Ambulatory EHR
Ambulatory EHR allows providers to access complete web charts, giving them instant access to patient records across healthcare organizations on a single mobile device. Providers can tap on a patient's record to view test results, order prescriptions, schedule appointments and procedures, and note the progress of health conditions. Another part of the Ambulatory EHR platform includes population management tools that help identify at-risk patients.
PatientKeeper
The mobile app edition of the PatientKeeper Computerized Patient Order Entry (CPOE) system allows providers to order labs, radiology, medications, and similar services for their patients across all hospital departments. Catalogues for procedures and medications are kept in the mobile CPOE, so providers aren't required to rebuild lists for new patients. Providers also can "favorite" procedures and medications that are recurring for patients, as a way to save time. For hospitals, PatientKeeper acts as an alternative to telephone orders that may cause organizational inefficiencies and allows providers to keep track of allergies, test results, patient vitals, and related health data.
PatientSafe, PatientTouch System
PatientTouch is a provider- and executive-facing mobile app that connects clinical communication with enterprise management. Providers use the app to connect departments and other parts of the care continuum. Care teams use the app to connect clinical workflows, clinical communication, and coordinated care under an umbrella to improve care efficiency. PatientTouch also comes with an enterprise software that centralizes the assignments of all users, roles, and groups in a health system. Also included is an analytics dashboard that tracks user adoption, aggregated data, and high-risk patient populations.
Spok, Spok Mobile
The Spok mobile app gives providers a unified place to coordinate clinical care and improve clinical communication. Spok updates providers with "delivered/read" messaging from several different devices. Providers can also organize messaging by priority, and securely message members of the care team. Other features of the Spok app include integration with current EHR systems, provider preferences for certain procedures or care responsibilities, and hospital-wide scheduling. Providers can access the app from their preferred devices such as smartphones or watches.

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Top 10 Healthcare Mobile Apps Among Hospital, Health Systems

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Source: Thinkstock - Providers are adopting the use of mHealth in the form of mobile apps in their pursuit of easing clinical communication between providers and patients as well as improve the management of hospital workflows.

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"Telehealth involves the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long distance patient/clinician contact and care, advice, reminders, education, intervention, monitoring and remote admissions"

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It's time to put today's technology to good use for our health, the environment and our budget. This short (less than 2 min) video shows you how Telehealth can help you take care of your health - close to home!

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Health literacy 1 -               Definition

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Health literacy 1 -               Definition

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"Health literacy is the ability to obtain, read, understand, and use healthcare information in order to make appropriate health decisions and follow instructions for treatment."

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Health Literacy  2 -                           A survey

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Health Literacy  2 -                           A survey

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America's Health Literacy: Why We Need Accessible Health Information

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Health literacy-the ability to obtain, process, and understand basic health information and services to make appropriate health decisions-is essential to promote healthy people and communities. Health care institutions and public health systems play a critical role in health literacy, because they can make it easier or more difficult for people to find and use health information and services.

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Health literacy 5  -                    Programs for teens

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Health literacy 5  -                    Programs for teens

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Two grants from the U.S. Department of Education-Institute of Education Sciences, one for improving the understanding of health needs and information by youth transitioning from high school to independent living and one for training postdoctoral researchers, have been awarded to University of Nebraska-Lincoln research professors Alexandra Trout and Kristin Duppong Hurley in the Academy for Child and Family Well Being.

A $1.5 million grant will be used to develop a web-based health literacy program for high school-age youth with high-incidence disabilities. The four-year project led by Trout, which began July 1, will culminate with a randomized trial of 70 students from Lincoln Public Schools in the fourth year.

The desire to pursue a health literacy program stemmed from an after-care program Trout and her colleagues developed in partnership with Boys Town. That program, called On the Way Home, was designed to help youth leaving residential programs like Boys Town to return to their homes.

"What we found with our first On the Way Home study was that although most youth were quite successful, a few continued to struggle," Trout said. "Some returned to care, some ended up in the juvenile justice system, and some dropped out of school. We spent a lot of time talking about those few cases - what went wrong and what we could have done better. One of the things we noticed was that several of these kids were really struggling with other health issues."

The researchers observed that many teenagers did not have the knowledge to independently navigate and manage their own health care. While life skills, vocational education/employment and post-secondary education have been focal points of preparing youth for the transition from high school to independent living, health care management has often been overlooked.

"In schools, the health curriculum typically addresses health care on a very philosophical level. Although youth are learning important general concepts, the applied questions such as, 'You're going to a doctor appointment, what do you need to have with you?' 'When do you go to the doctor versus the ER?' 'How do you identify a doctor?' 'How do you access health insurance?' are not addressed," Trout added.

During the first year of the study, the UNL researchers will conduct focus groups with students who are preparing to transition from high school, those who have recently made the transition and have had to face their health care needs on their own, and the educators who work with those populations.

The researchers will present the focus groups with an example of a health literacy instruction program to demonstrate the curriculum both as it is currently in paper-and-pencil format and how it is anticipated to look in a web-based format. After getting feedback from the groups, the curriculum will be modified to a web-based approach.

In the second and third years of the study, the researchers will conduct small feasibility studies and continue to modify the curriculum. Year four will include a small randomized trial with 35 students in a treatment group and another group of 35 who will receive only the traditional health curriculum. The groups will be compared to see whether the web-based health literacy curriculum improves the students' health literacy and prepares them for transition. Youth and educator satisfaction with the web-based curriculum will also be assessed.

"At the end of the four years, we will have an intervention that is fully developed and the preliminary data on curriculum efficacy necessary for a larger-scale evaluation," Trout said.

The second grant, an award of more than $625,000, will be used to train three postdoctoral researchers for two years each over a four-year period. Recruitment for the postdoctoral fellowship program, which is led by Duppong Hurley and Trout, will begin in September, with the first researcher joining the Academy for Child and Family Well Being in summer 2017.

"Our program is unique because in most postdoctoral programs you're working with just one person. Here, they will collaborate with multiple researchers at UNL in the Academy for Child and Family Well Being, as well as working at Boys Town and in ongoing opportunities in the schools and other family service agencies," Duppong Hurley said. "It allows them to get into the field and learn about applied research, and helps them understand how their research helps those in community services and agencies."

This is the second time the Academy for Child and Family Well Being has received a postdoctoral research grant. The first round was used to train four students through a variety of research projects, with the fourth finishing her appointment this summer. Those four individuals have obtained faculty positions at the University of South Carolina, University of Texas at San Antonio, Tennessee State University and UNL.

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Researchers to create a health care literacy program for teens

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Two grants from the U.S. Department of Education-Institute of Education Sciences, one for improving the understanding of health needs and information by youth transitioning from high school to independent living and one for training postdoctoral researchers, have been awarded to University of Nebraska-Lincoln research professors Alexandra Trout and Kristin Duppong Hurley in the Academy for Child and Family Well Being.

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Health literacy 4   -                   Health literacy education in school aged-children

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Health literacy 4   -                   Health literacy education in school aged-children

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Health literacy 3 -                    Health literacy program for children, by the university of Nebraska-Lincoln.

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Health literacy 3 -                    Health literacy program for children, by the university of Nebraska-Lincoln.

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Healthcare Organization Approaches to Engagement

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Healthcare Organization Approaches to Engagement

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Re-imagining the patient experience.

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eCW Podcast Season 3 Ep. 2: Improving Patient Experience Part 1

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Consumer Demand for Informaiton 2 - A Survey

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Consumer Demand for Informaiton 2 - A Survey

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Attention has become a precious commodity in the digital age.But how's this for a brand wakeup call? Consumers in the United States spend about the same amount of time sleeping each day-an average 7.8 hours-as they do engaging with digital content.

That's one of many eye-opening findings in a new research report from Adobe, CMO.com's parent company, which surveyed over 1,000 consumers. The number of digital consumption hours is even higher for the younger generations, such as Millennials, who spend 9.6 hours per day, on average, consuming digital content.

"The challenge today for brands is that there's so much more content being created, and so it has become very competitive in terms of getting people's attention," said Loni Stark, senior director of strategy and product marketing at Adobe. "It's becoming harder and harder to stand out. That's why many brands are setting the bar higher by engaging with customers on a personal level with content and messaging that is personalized, relevant, and more likely to garner engagement."

According to Stark, personalization strategies are becoming table stakes for brands that want to effectively compete in the digital landscape. Indeed, 67% of respondents said it's important for brands to automatically adjust content based on their current context. And when they don't? A whopping 42% of respondents said they get annoyed when their content isn't personalized. That's followed by 33% who get annoyed when content is poorly designed, and 29% when content isn't optimized for their devices. What's more, an alarming 66% of consumers said encountering any of these situations would stop them from making a purchase.

The Adobe survey also found that consumers are not only engaging with digital content more, but 55% are doing so across various devices simultaneously. That speaks to the difficulty of catching their attention. When asked about engaging with content on newer devices, consumers said they expect to engage the most with home entertainment streaming devices and smart speakers/home assistants.

As for the purchase process specifically, consumers said they engage on multiple channels throughout. For example, 48% of consumers will visit a brand's website to research a product. Interestingly, 37% of teens and 27% of Millennials use video channels to do so. For the actual purchase, 59% of consumers go to online marketplaces, while 49% visit a store. Following the purchase, more than half (51%) go back to the brand's website to engage. Also important to note: A full 58% of consumers use a smartphone or connected device in a store to help inform their purchases.

"This is why brands need to connect experiences across online and offline channels," Stark told CMO.com. "We're finding that the branded mobile app is turning into a loyalty tool, while the website is more about discovery."

View the full study below, or click here to view a larger version on SlideShare.

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Consumer Demand For Personalized Content Reaches All-Time High

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Attention has become a precious commodity in the digital age.But how's this for a brand wakeup call? Consumers in the United States spend about the same amount of time sleeping each day-an average 7.8 hours-as they do engaging with digital content.

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As patients strive to manage their own health and illnesses, many wonder how to get a copy of their health data to share with their physicians, load into apps, donate to researchers, link to their genomic data, or have on hand just in case. To seek diagnosis or better care (see table), many patients are taking steps outside traditional doctor-patient relationships. Some join 23andMe to obtain genetic information. Others bring data to the Undiagnosed Diseases Network at the National Institutes of Health (NIH). Patients are coalescing with others with the same disease in what the Patient Centered Outcomes Research Institute calls patient-powered research networks. But such patients have found no easy way to get copies of their electronic health records (EHRs).

In 1994, when the World Wide Web was only 2 years old, Massachusetts Institute of Technology computer scientist Peter Szolovits, presaging the consumer health information technology (IT) movement, proposed, in the Guardian Angel Project, using the Web for patient management of health and health data. Yet getting patients electronic copies of their health records has remained an elusive goal. Industry giants have scars to show for their attempts. Why have the barriers been so high? And what is the path to a patient-driven health information economy?

In 1998, we developed the Personal Internetworked Notary and Guardian (PING, later called Indivo), an NIH-funded system for automatically and continuously updating a patient-controlled data repository. Indivo downloaded automatic updates from EHRs and enriched them with patient annotations. These repositories, controlled by patients and sharable with others, were meant to drive an ecosystem of third-party apps. After we demonstrated Indivo to technology companies in 2006, Google and Microsoft launched similar personally controlled health records - GoogleHealth and Microsoft Healthvault. Walmart and other employers offered Indivo as an employee benefit. Yet today most U.S. patients still don't have electronic copies of their records.

One explanation is the wider adoption of a competing technology: patient portals, offering a view of a subset of EHR data. Many portals are "bolt-on" features from EHR vendors; others are homegrown. In its criteria for achieving stage 2 "Meaningful Use" of health IT, the Office of the National Coordinator for Health Information Technology attempted to promote data access by requiring health care organizations to provide 50% of their patients with timely access after health care encounters. Patients were invited to use portals at all their providers' practices (a solution that caused a condition sometimes called "hyperportalosis"). Since the measure of success was that 5% of patients "view, download, or transmit" their health information, most implementations defaulted to view-only. Hence, the data are unavailable to patients, other providers, and third-party apps; virtually no apps in the Apple or Google stores have access to health system data.

Getting patients electronic copies of their health records has remained an elusive goal. Industry giants have scars to show for their attempts. Why have the barriers been so high? And what is the path to a patient-driven health information economy?"

Federal regulation defining a patient's right to health data has failed to ensure access. Since 1996, the Health Insurance Portability and Accountability Act (HIPAA) has required health care organizations to provide patients with access to any data that are "readily producible," in the format the patient requests. Organizations haven't responded. Ironically, HIPAA is one of the most commonly cited reasons for not transmitting patient data. The patient right was reasserted under the Health Information Technology for Economic and Clinical Health Act - with a similarly negligible effect on data sharing.

"Data liquidity" - flow among data generators and customers - carries risks. Competitive intelligence might be released about, for example, high-value markets or hospital-acquired infections. Some organizations fear security breaches or leakage of patients from their provider network. Transferring data to another product may jeopardize the EHR vendor's business model, as vendors may have trouble retaining customers if exclusivity is broken.

And technological approaches have fallen short. Under the Meaningful Use program, the intended lingua franca for data liquidity was the Consolidated Clinical Document Architecture, but it was never sufficiently standardized to support robust document exchange. The Blue Button, a Veterans Health Administration technology that allowed veterans to easily download their EHR data, was ably marketed but never matured.

Now, intersecting trends have set the stage for a fresh start. Nearly two thirds of Americans own smartphones, with online access, apps, and both local and cloud storage of data. As health care reimbursement shifts toward risk-based contracting, providers seek to understand the totality of patients' experience, which requires aggregating data across care silos. As the clinical research infrastructure accommodates pragmatic studies and incorporates patient-centered outcomes in therapeutics development, patients are increasingly asked to report on adverse events and end points and donate health data to trials. Fortunately, the belief that it's dangerous to allow patients access to health data is slowly dissolving, with the advent of programs such as Beth Israel Deaconess Medical Center's Open Notes, in which doctors and patients jointly read and create chart entries.

Moreover, there's now a huge amount of electronic data (albeit a subset of what's needed); 95% of U.S. hospitals and 54% of office practices use certified health IT. And EHRs and hospitals are implementing data-access standards such as the Fast Health Interoperability Resources (FHIR) and the Substitutable Medical Applications Reusable Technologies (SMART) Health IT apps interface. Finally, large-scale undertakings such as President Barack Obama's Precision Medicine Initiative are promising to return participant-level data to study subjects.

Successful translation of these technologies into a productive health information economy awaits only cooperation from data producers and purveyors."

Sensing an opportunity, Silicon Valley has picked up the gauntlet. In 2015, Apple released HealthKit, which provides a simple interface for devices including heart-rate monitors and pulse oximeters, creating a de facto data repository under patients' control. Companies such as We Are Curious are creating communities of people seeking answers to health questions. Amazon, Microsoft, and Google are collaborating with health care systems to store big data in the cloud.

Patient expectations have finally caught up with Szolovits's aspirations for a "guardian angel" digital assistant that cares for a patient over a lifetime. Consumers expect to have their data available and sharable. Other industries have embraced similar principles: in response to customer demand, for example, Facebook now enables users to download their own data.

A patient-controlled health-record infrastructure can support the development of highly desirable health system qualities. First, it allows a patient to effectively become a health information exchange of one: as data accumulate in a patient-controlled repository, a complete picture of the patient emerges. If patients can obtain their data wherever they go, they can share them with physicians as needed - rather than vice versa. We believe the Meaningful Use program would have been more successful if it had rewarded clinicians for storing data in patient-controlled repositories rather than in EHRs that fragment data across the health care system.

The need for a copy of one's data is most obvious in life-and-death situations in which patients have failed to find answers in their health care system. Journeys like Matt Might's search for a diagnosis of his son's genetic condition suggest that patients may be among the most sophisticated users of health data. Might, a computer scientist, connected with a research team using whole-exome sequencing to discover that his son had two different mutations in the NGLY1 gene. Those invaluable sequence data were extremely difficult to obtain and share.

Such activated patients, however, represent the tip of an iceberg of dissatisfaction with health care and need for greater data access and control. The requisite technology is no longer mysterious or expensive; it's a set of commodity-level toolkits for data exposure, transfer, and storage. Successful translation of these technologies into a productive health information economy awaits only cooperation from data producers and purveyors.

The government can help stimulate such participation, and Meaningful Use 3 does require providers to make data available for patient access over an application programming interface (API). But whether or not the Meaningful Use program survives the backlash against it, IT purchasers can demand uniform, useful implementation of an open API. Health care providers and patients can advocate for and collaborate in developing key enabling policies and toolkits (see Steps toward Creating a Patient-Driven Information Economy) that leverage an API for patient data access.
Steps toward Creating a Patient-Driven Information Economy

1. Both the Centers for Medicare and Medicaid Services and private insurers can offer strong incentives for health care organizations to provide data to patients after encounters through a standardized electronic mechanism - initially one encounter at a time, but eventually with automatic updates.

2. Federal health IT policy can promote, and health systems purchasing IT can demand, a uniform, standard, public API for health data that can catalyze the development of an ecosystem of apps, for both clinicians and patients, that run on health data. The Meaningful Use Stage 3 Final Rule is the first major step in this direction, requiring certified EHR technology to provide an API through which patients can have access to their EHR data in a timely fashion.

3. The research community and regulatory agencies can vet a set of online reference tools that define, by demonstration as well as specification, how consent can be delivered for global or narrowly defined transfer of patient data to and from patient-controlled data repositories; essential functionality will include roles for guardians and proxies as well as easy ways to change the scope of, or revoke, consent.

4. The health care system can adopt a rigorous authentication framework, borrowing approaches from other sectors of e-commerce, so that we can identify patients and allow them to obtain and use their data.

From the Computational Health Informatics Program, Boston Children's Hospital, and the Department of Biomedical Informatics, Harvard Medical School - both in Boston.

1. Mandl KD, Szolovits P, Kohane IS. Public standards and patients' control: how to keep electronic medical records accessible but private. BMJ 2001;322:283-287.

2. Mandl KD, Kohane IS. Tectonic shifts in the health information economy. N Engl J Med 2008;358:1732-1737.

3. Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Inform Assoc 2008;15:1-7.

4. D'Amore JD, Mandel JC, Kreda DA, et al. Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative. J Am Med Inform Assoc 2014;21:1060-1068.

5. Mnookin S. One of a kind. The New Yorker. July 21, 2014:32-8.
This Perspective article originally appeared in The New England Journal of Medicine as "Time for a Patient-Driven Health Information Economy?"

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Patient Demand for Patient-Driven Health Information

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As patients strive to manage their own health and illnesses, many wonder how to get a copy of their health data to share with their physicians, load into apps, donate to researchers, link to their genomic data, or have on hand just in case.

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Connected Patients  5 -           Smart Healthcare Connecting Systems with Real Time Health

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Connected Patients  5 -           Smart Healthcare Connecting Systems with Real Time Health

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Intelligent Healthcare

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Smart Healthcare  Connecting Systems with Real Time Health I

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Consumer demand for Information 3 - Emerging solutions 

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Consumer demand for Information 3 - Emerging solutions 

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It was on an Emirates flight that the idea for Oneview suddenly hit Mark McCloskey - how come he could access 500 channels of entertainment at 36,000 feet, yet when he was in hospital for an operation he was stuck sharing one TV in a ward with four others.

The entrepreneur, who had sold his Easycash business to Ulster Bank for an undisclosed sum, set about researching an entertainment solution for hospitals.

What resulted, however, was a "bedside point-of-care terminal", that not only gave patients access to free-to-air TV and video-on-demand, but also information on their diagnosis, video conferencing, email, Skype, meal ordering and healthcare treatment.

The Oneview terminal is a bedside workstation that enables the provision of valuable information, communications and entertainment services for medical practitioners, hospital staff, administrators and patients by providing an interface to hospital IT systems at the patient's bedside.

This service can be delivered through bedside terminals, PCs, smart phones and PC tablets. The patient can also access valuable content such as educational items at home prior to and subsequent to their hospital stay.

"Hospitals choose the hardware. They can have iPads, phones, TVs or touchscreen terminals and we provide the software. We are totally agnostic. We don't care what the hardware is," chief executive James Fitter says.

"A doctor can come into the ward or room and pull up MRI scans, test results, patient information or X-rays on a device by the bedside when they are making their daily rounds. The patients can also access information about their condition on the monitor and learn about it."

The Oneview terminal also provides multi-lingual support allowing doctors and patients who speak different languages to communicate with each other, and medical records.

"For example, a Puerto Rican nurse could communicate to a Russian patient through the system easily."

The company was founded in 2007, but it was only in the last six months that the directors really began seeing the fruits of their labour, according to McCloskey.

"We spent the previous five years researching the market in detail - during which time we discovered out competitors in the field were either TV-based or telephony companies.

"Rather than have bedside screens or tablets that just provided entertainment, we did integration of clinical records and educational videos. All of our competitors just concentrated on entertainment."

After discovering most hospitals use Windows applications, the company decided to develop its solution using Windows also, to allow for seamless integration. The electronic health records, drug dispensing, hospital information systems, are all Windows systems, according to Fitter.

"We chose to develop in Windows, so everytime we put our software in we have to pay Bill Gates $89. Hospitals all use Windows applications though," Fitter says.

The healthcare company, whose solutions are already in use on four continents, recently signed a deal to provide its solution to the Chris O'Brien Lifehouse at the Royal Prince Alfred Hospital in Sydney.

The news follows HP selecting the company as partner of choice to deliver patient infotainment as part of its global digital hospital programme.

However, it took an investment believed to me in the region of €5 million before the company was able to get to market.

Positive response
"I met Mark at a dinner party through mutual friends last June. I discovered the IT sector was starved of venture capital. I wanted to marry my investment experience with IT start-ups so came on board," Fitter says.

Fitter had previously spent 25 years in the financial services industry, being appointed as the managing director of Deutsche Bank in 1998, and global head of emerging market equities in 2001. He subsequently founded and managed an independent asset management company in Dubai from 2006 to 2009.

"I realised Mark's company balance sheet was causing problems. The response was universally positive from hospitals. They loved his product but not his balance sheet. There was too much debt on his balance sheet and when you are supplying software on a five-year contract they need to know you will still be around in five years."

"Mark had beaten Siemens and IBM in a tender for a hospital in Melbourne. He sent his balance sheet through and they rejected him as a result. They feared he would be out of business in 12 months."

With the help of Fitter, the company raised money and bought the debt back from the banks so it could have an unencumbered balance sheet.

McCloskey quickly realised he was going to have to become export-orientated if he wanted the company to be a success.

Middle east market
"It is a serious investment for hospitals to make. Hospitals are very committee- based to it takes a long time for decisions to be made.

"The health system in Ireland doesn't have any money. We realised we had to go outside Ireland if we were going to make any money."

Fitter says their next mission is to conquer the Japanese and Saudi markets.

" Japan has the highest concentration of hospital beds in the world, with 1.7 million. In 2014-2015 we hope to get into the Japanese market."

The company also recently entered the Middle East market, having won the contract for two hospitals in Riyadh.

"Saudi and Australia are similar-sized countries. They both have 25 million people but Saudi is expanding quicker. The Ministry for Health there is building 132 hospitals over the next four years."

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Bedside device combines access to medical information with entertainment options

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It was on an Emirates flight that the idea for Oneview suddenly hit Mark McCloskey - how come he could access 500 channels of entertainment at 36,000 feet, yet when he was in hospital for an operation he was stuck sharing one TV in a ward with four others.

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Despite the growing digital health market, relatively few products are designed to meet the unique needs of low-income, high-need, high-cost individuals. To address this gap, the Center for Health Care Strategies (CHCS), with support from Kaiser Permanente Community Benefit, held the first of three national Super-Utilizer Health Innovation Challenges in 2015 to explore the viability of developing digital health products for this population.

This brief examines submissions from the first challenge, including:

Specific issues the products address;

Target audiences for the tools;

Types of technologies employed; and

Functionality used to drive improved outcomes.

Results from the challenge reveal insights that may help guide the development of digital tools for people with complex needs - such as addressing the social determinants of health and broadening the range of technologies used. Upcoming piloting opportunities will help foster partnerships between health systems and developers to further the evidence base for these tools.
The Digital Health Initiative is part of CHCS' Innovations in Complex Care Program, which seeks to develop and test new strategies to improve health care quality and control spending for Medicaid's highest-need, highest-cost populations.

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Digital Health Innovation Super-Utilizer Challenge: Themes and Lessons - Center for Health Care Strategies

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Despite the growing digital health market, relatively few products are designed to meet the unique needs of low-income, high-need, high-cost individuals. To address this gap, the Center for Health Care Strategies (CHCS), with support from Kaiser Permanente Community Benefit, held the first of three national Super-Utilizer Health Innovation Challenges in 2015 to explore the viability of developing digital health products for this population.

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Internet for Health Education          2 - Top Health literacy sites

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Internet for Health Education          2 - Top Health literacy sites

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Cancer.gov

Centers for Disease Control and Prevention (CDC)

familydoctor.org

healthfinder®

HIV InSite

Kidshealth®

Mayo Clinic

MedlinePlus (English | Spanish)

NetWellness [currently offline; you can still access health topics pages from September 20, 2017, through the Internet Archive website]

National Institute on Aging: Health Information

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MLA : For Health Consumers and Patients : Top Health Websites

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The Consumer and Patient Health Information Section (CAPHIS) of MLA evaluates websites based on the following criteria: credibility, sponsorship/authorship, content, audience, currency, disclosure, purpose, links, design, interactivity, and disclaimers. The following websites have been deemed particularly useful (in each area, sites are listed in alphabetical, NOT ranked, order).

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"Wearables, with the help of improved technology have been developed greatly and are considered reliable tools for long-term health monitoring systems. These are applied in the observation of a large variety of health monitoring indicators in the environment, vital signs, and fitness."

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Abstract

Objectives

Wearable devices are currently at the heart of just about every discussion related to the Internet of Things. The requirement for self-health monitoring and preventive medicine is increasing due to the projected dramatic increase in the number of elderly people until 2020. Developed technologies are truly able to reduce the overall costs for prevention and monitoring. This is possible by constantly monitoring health indicators in various areas, and in particular, wearable devices are considered to carry this task out. These wearable devices and mobile apps now have been integrated with telemedicine and telehealth efficiently, to structure the medical Internet of Things. This paper reviews wearable health care devices both in scientific papers and commercial efforts.

Methods

MIoT is demonstrated through a defined architecture design, including hardware and software dealing with wearable devices, sensors, smart phones, medical application, and medical station analyzers for further diagnosis and data storage.

Results

Wearables, with the help of improved technology have been developed greatly and are considered reliable tools for long-term health monitoring systems. These are applied in the observation of a large variety of health monitoring indicators in the environment, vital signs, and fitness.

Conclusions

Wearable devices are now used for a wide range of healthcare observation. One of the most important elements essential in data collection is the sensor. During recent years with improvement in semiconductor technology, sensors have made investigation of a full range of parameters closer to realization.

Keywords: Delivery of Health Care, Information Storage and Retrieval, Internet, Mobile Applications, Smartphone, Telemedicine

I. Introduction

The Internet of Things (IoT) is a new concept, providing the possibility of healthcare monitoring using wearable devices. The IoT is defined as the network of physical objects which are supported by embedded technology for data communication and sensors to interact with both internal and external objects states and the environment [ 1].

In the last decade, wearable devices have attracted much attention from the academic community and industry and have recently become very popular. The most relevant definition of wearable electronics is the following: "devices that can be worn or mated with human skin to continuously and closely monitor an individual's activities, without interrupting or limiting the user's motions" [ 2]. provides more transparent information on the importance of wearable devices and the IoT market [ 3, 4, 5].

Table 1

Today, the range of wearable systems, including micro-sensors seamlessly integrated into textiles, consumer electronics embedded in fashionable clothes [ 6], computerized watches, belt-worn personal computers (PCs) with a head mounted display [ 7], glasses [ 8], which are worn on various parts of the body [ 9] are designed for broadband operation. The field of wearable health monitoring systems is moving toward minimizing the size of wearable devices, measuring more vital signs, and sending secure and reliable data through smartphone technology. Although there has been an interest in observing comprehensive bio/non-bio medical data for the full monitoring of environmental, fitness, and medical data recently [ 10], but one obvious application of wearable systems is the monitoring of physiological parameters in the mobile environment. The majority of commercially available wearable devices are one-lead applications to monitor vital signs. However, most of such recreational devices are not suitable for the medical monitoring of high risk patients. Those devices that have been qualified for medical use are usually simple [ 11].

The objective of this paper is to review wearable health care devices both in scientific papers and commercial efforts. Our aim is to address the most important wearable devices, which measure effective parameters in health status directly. Readers can obtain comprehensive and useful information on the most reliable currently available devices and technical concepts in this area.

The rest of this review paper is organized as follows. The need for health monitoring when the user is in motion and under changing environmental conditions are investigated in Section II. In Section III recent research efforts in wearable devices are presented in three subsections. The first subsection discusses motion tracking and the research approaches and implementations in this area, and then some of the most recent commercial devices are compared. We then discuss the monitoring of environmental conditions and vital signs through wearable devices in subsections 2 and 3. In Section IV, the challenges of potentially available devices are discussed. Conclusion are finally summarized with suggestions for future works.

II. Wearable Devices in Health Monitoring

In today's world, where time is precious, people, the working class especially, spend most of the day shuttling between various tasks and tend to ignore their health and fitness [ 6]. Even a simple appointment with a doctor in a clinic can require several tests set for diagnosis, prescription, and finally treatment, which can take a lot of time. Therefore, many patients only go to a clinic when they are suffering from a serious illness. Hence, many people are seeking for an alternative, such as a device that can be worn on the body, which would not only continuously monitor the user's health in real time but also provide timely insights on various health parameters to the user as well as his or her physician [ 6].

1. Motion Trackers

The measurement of human movement (motion tracking) has several useful applications in sports, medical, and other branches of studies. Such applications include fall risk assessment, quantifying sports exercise, studying people habits, and monitoring the elderly. Wearable trackers are becoming increasingly popular for two main reasons. They can motivate the user during the daily workout to perform more exercise, while providing activity measurement information through a smartphone without manual calculation [ 12]. Also, they enable the wearer to become aware of the daily distance walked, which is very useful to ensure that the user maintains sufficient activity in the daily routine to maintain a healthy life. In particular, to accurately observe motion of the human body, 3-axis accelerometers, magnetometers, and gyroscopes sensors obtain data, each for a specific purpose. These sensors can be used for human activity recognition in the ubiquitous computing domain as well [ 13]. Gyroscopes and magnetometers are auxiliary sensors that can be separately be combined with accelerometers to compensate the lack of accuracy in obtained data for motion tracking. In most cases, the combination of these three sensors lead to 9DoF.

Human motion detection has a wide range of application, from sports and recreation to biomedical. In recent years, consumer electronics have employed many semiconductor-based tracking system to allow users to access various kinds of interface control that use body motions and gestures [ 14]. An important application of motion tracking is health care. However, due to need for high accuracy in the biomedical field, these devices are not typically designed only for medical application. The initial concept of using uniaxial accelerometer sensors in motion tracking was introduced in 1996 by Veltink and Boom [ 15]. To introduce the concept of motion tracking in the medical application world, multiple clinical studies have been performed on posture estimation using accelerometers [ 16, 17, 18]. An accelerometer alone cannot provide precise information; therefore, in 1997, researchers improved the performance of trackers and integrated semiconductor-based gyroscopes to perform bio-mechanical assessments and gait analysis [ 19]. Four years later in 2002, Mayagoitia et al. [ 20] introduced the initial framework of tracking lower extremities with a fusion of accelerometers and gyroscopes in the 2D sagittal plane. When the trackers became more reliable using an integrated gyroscope, the primary focus for clinical applications using inertial motion tracking was gait analysis [ 21]. To apply this device for clinical purposes, and in particular gait motion, gravity sensitive accelerometers are used to estimate the tilt angles between the gravity vector and the sensor's axes [ 19]. The first version of the most recently integrated sensors (accelerometer, gyroscope, and magnetometer) which provide very accurate data with 9DoF, was proposed in 2006 by Roetenberg [ 22]. He proposed using a set of tri-axial accelerometers, tri-axial gyroscopes, and a magnetometer to estimate and monitor human motion.

A few 9DoF wireless inertial measurement units (IMUs) are commercially available and have been used for research projects [ 23, 24, 25]. Due to the high risk of falling in the elderly, motion trackers as wearable devices are used in medical health monitoring for fall detection.

1) Motion measurement in body tracking

A new design was presented by Bertolotti et al. [ 26] to apply for objective measurements of trunk or limb movements for the assessment of human body balance and control abilities. This system is based on a 72 MHz, 32-bit CPU (STM32F303VC; STMicroelectronics, Geneva, Switzerland) embedding a high performance ARM CortexM4, 32-bit RISC core, with the potential of supporting several sensors externally with high performance in both SPI and I2C mode. In this research, the sensor components (STMicroelectronics sensors) have a linear range and a sensitivity that allow proper measurement of body movements. Online processing, in the sense of data acquisition from different sensors, filtering, and data generation are performed at a high frequency of up to 72 MHz. Body movements are measured using 9DoF sensors: three inertial sensors, an accelerometer, a magnetometer, and a gyroscope. The full-scale values of the sensors can be modified by means of specific commands sent by the microcontroller [ 27, 28]. The size of the whole device, including all components in the box (circuit board, the Bluetooth module, and the battery) are 60 mm × 35 mm × 20 mm. The box is made of transparent plastic to allow the observation of LED indicators working on the board. The device proposed and implemented by this research group was designed to be used for three kinds of movement monitoring. The first and second types of movement monitoring are referred to as short- and long-term data monitoring. In the first type, the device is only connected to a PC to observe the results. In the second case, data are observed and locally stored for long-term monitoring. In the third type, the most important component is the body network, i.e. multiple units deployed on the subject's body and wired to a gateway unit, which can have a local memory or a wireless connection to a PC or hand-held device (full body monitoring of exercises) [ 29].

2) Commercially available user devices applied in research papers

The following two subsections report on the advantages and disadvantages of commercially available devices and the tools that have been used in research for performance evaluation.

2. Vital Signs Measurement

Many wearable devices have been implemented to measure critical elements in healthcare monitoring. The majority of these devices are in one lead such as electrocardiogram (ECG) and electroencephalogram (EEG) measurement, skin temperature, etc. There have been recent efforts in wearable devices to provide multi-task vital signs measurement. Here, we present the most creative and recent papers in this area.

Many devices, structures, designs, and solutions for remote wearable ECG monitoring, which plays a vital role in health monitoring have been proposed in the literature and industry. Generally, these solution are hard to implement and are not efficient enough in power consumption or performance. Some of them are remarkable but do not have the possibility of merging with other out signals from different systems.

1) Body-worn smart clothing

To obtain health care status's signals from various physiological indicators due to forming a source data center for comprehensive health monitoring, a 'smart clothing' design was presented in [ 44]. To make smart clothing systems intelligent, an infrastructure incorporating smartphones, mobile applications, cloud computing, and big data analytic is required to communicate in the structured design [ 45].

Although several research approaches in the field of health monitoring have been proposed and implemented, the existing solutions in different aspects have failed for long-term health monitoring [ 45]. Traditional health monitoring, which often collects one or a very limited number of physiological signals, is not very useful for chronic diseases in a full-range health monitoring system.

Sensor deployment on the body is the main difference between old wearable devices and smart clothing [ 45]. In smart clothing, all sensors which are used to measure the vital signs are integrated into textile clothing. Sensor placement is a critical point that has to be performed properly. To provide efficiency and a well-formed design, the quality of the used sensors, proper positioning, layout of flexible electricity cable, weak signal acquisition equipment, low-power wireless communications, and user comfort [ 45] are crucial factors. The fabric of the smart clothing to be worn, has to be comfortable. In this design, it has been tried to measure only vital and necessary parameters. Now the used sensors and also the location they are placed on the body are described ().

2) Wire-based wearable devices: limited physiological and environmental parameters measurement

In [ 47], a novel approach to medical monitoring was introduced by Sanfilippo and Pettersen. The methodology is wire-based and many vital signs are measured. This wearable integrated health-monitoring system is based on the e-Health Sensor Platform [ 48] V2.0, which is the first biometric shield for Arduino and Raspberry Pi. However this device is not licensed for medical health monitoring. The system allows researchers to measure and investigate health through body monitoring by using 10 sensors to observe vital signs and perform motion tracking. EEG, ECG, and body temperature measurement are carried out by these sensors, which are connected to the platform. A push button is considered for emergency cases. Collected data are used in two scenarios. In the first, the user is monitored in real time, and in the second, sensitive data are transmitted to be analyzed for medical diagnosis.

In this paper, a wearable health sensor monitoring system based on a multi-sensor fusion approach is outlined. The implemented device consists of a chest-worn device that embeds a controller board, an ECG sensor, a temperature sensor, an accelerometer, a vibration motor, a color-changing light-emitting diode (LED), and a push-button [ 47].

The embedded vibration motor makes it possible to actuate distinctive haptic feedback patterns according to the wearer's health state. Haptic feedback, informs the wearer about his or her health status in three different states. When it does not vibrate, it indicates a normal state; through low-frequency and high-frequency vibration, abnormal data observation and potential risk are indicated, respectively [ 49].

To address privacy concerns, data is encrypted before transmission. Data collected for permanent storage are sent to cloud storage, while data to be visualized in real-time, are sent directly to a laptop or smart phone.

The structural framework is based on a multi-sensor fusion approach. In particular, a client-server pattern is adopted in [ 47]. A chest-worn device, comprising an Arduino Uno board based on the ATmega328 micro-controller, an Arduino Wi-Fi Shield, e-Health Sensor Shield, a vibrating motor, and push button, operates as a client and remotely communicates with a server. The server is implemented in three levels of logic and communication.

The device structure is implemented in three layers (). The bottom and basic layer is Arduino ATmega328. To enable communication capabilities to this proposed wearable device, an Arduino Wi-Fi Shield [ 50] is stacked on top of the adopted controller board, which forms the second layer. In detail, the Arduino Wi-Fi Shield allows the client to communicate with the server by using the 802.11 wireless specification (Wi-Fi) [ 48]. The communication between the Arduino Wi-Fi Shield and the Arduino Uno board uses long wirewrap headers that extend through the shield. The third and top layer is implemented when the wearer's biometric data are gathered, and an e-Health Sensor Shield [ 51] is stacked on top of the adopted communication module.

III. Challenges and Bottlenecks for Medical IoT

Leading wearable devices based on IoT platforms must provide simple, powerful application access to IoT devices. Many platforms and structures have been proposed by the scientific community, and commercial devices are already available for bio-metric/medical parameter measurement. However, there are serious challenges in this way. The following are four key capabilities that leading platforms must enable:

- Simple and secure connectivity: A good IoT platform is expected to provide easy connection of devices and perform device management functions in three levels of data collection, data transmission to a hub, and permanent storage and observation in a medical station. These steps must be secured; therefore, data encryption is necessary.

- Power consumption: To provide the wearer with easy device management and long-term monitoring without interruption, power loss is becoming more important. This is strictly correlated to the number of parameters that are observed, efficient code programming, as well as good data packing, encryption, and compression.

- Wearability: Wearable devices have been designed for various types of bio-medical monitoring to assisting users in living long, healthy lives. This point is more significant when these devices are intended to be worn by elderly users. Therefore, such devices must be easy to wear, easy to carry, and comfortable. These requirements are fulfilled with a light, small, and well-structured device. A wearable device is expected to be small and light weight, and should be able to be used for a long time.

- Reduced risk in data loss: When data is collected by a microcontroller and transmitted to a smartphone or cloud storage, there is a possibility of disconnection and consequently data loss. This must be reduced as much as possible to provide safe health monitoring. It may be possible through temporary data saving (buffering) in the microcontroller providing a large memory.

IV. Conclusion

Wearable devices are becoming popular in various fields from sport and fitness to health monitoring. In particular, due to the increasing elderly population throughout the world, wearable devices are becoming important for long-term health monitoring. The main aim of this work was to give a comprehensive overview of this area of research and to report the full range of tools in area of wearable health monitoring devices. In this review paper, we have reported both research works and commercial devices to study and investigate the currently available technology. In preparing this paper, we studied the literature from various points of view. Based on consultation with expert scientists in environmental engineering and medicine, we believe that, motion trackers, gas detectors, and vital signs are the most important elements in health monitoring; therefore, to achieve the full range of health monitoring, all these parameters were studied. In each field, a variety of methodologies are employed, but not all are efficient and effective. The most important criteria in this study was the possibility of using the device in the real world, performance, efficiency, and power consumption. In addition, we considered the price of each device. Finally, the most challenging bottleneck and some conclusions regarding the promising future in the IoT is presented.

Among all implemented works so far, no efficient solution has been proposed for comprehensive monitoring in gas detection, motion tracking, and vital sign monitoring to integrate all these into a single device. It might be possible to realize this in future work by creating a system with following characteristics:

- #MULTIPLE sensors on ONE sensor node,

- #MULTIPLE nodes on ONE individual,

- #MULTIPLE individuals on ONE cloud system.

Monitoring of an individual with number of parameters in his working/living environment is possible. Moreover, computational models and software development for data encryption and data compression have to be investigated for more efficiency. In the first scenario above, which seems to be the best approach, there are serious restrictions in available sensors. To realize this wearable possibility, appropriate components must be located properly and must function well. In the second scenario, tasks can be dedicated to each node. For instance, motion tracking sensors can be implemented on one sensor node, and vital sign monitoring can be implemented on another. The third scenario is merging of the first and second methodology, which could widen the range of users and the range of practical application.

Acknowledgments

We would also like to express our gratitude to Professor Norbert Stoll for valuable technical guidance and sharing his knowledge to complete this work.

Footnotes

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

References

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14. To G, Mahfouz MR. Modular wireless inertial trackers for biomedical applications; Proceedings of 2013 IEEE Topical Conference on Power Amplifiers for Wireless and Radio Applications (PAWR); 2013 Jan 20-23; Austin, TX. pp. 172-174.

15. Veltink PH, Boom HB. 3D movement analysis using accelerometry theoretical concepts. In: Pedotti A, Ferrarin M, Quintern J, Reiner R, editors. Neuroprosthetics: from basic research to clinical applications. Berlin: Springer; 1996. pp. 317-326.

22. Roetenberg D. Inertial and magnetic sensing of human motion [dissertation] Enschede: University of Twente; 2006.

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32. Frank K, Diaz EM, Robertson P, Sanchez FJ. Bayesian recognition of safety relevant motion activities with inertial sensors and barometer; Proceedings of 2014 IEEE/ION Position, Location and Navigation Symposium (PLANS); 2004 May 5-8; Monterey, CA. pp. 174-184.

33. Yun X, Bachmann ER, Moore H, Calusdian J. Self-contained position tracking of human movement using small inertial/magnetic sensor modules; Proceedings of 2007 IEEE International Conference on Robotics and Automation; 2007 Apr 10-14; Rome, Italy. pp. 2526-2533.

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Wearable Devices in Medical Internet of Things: Scientific Research and Commercially Available Devices

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Wearable devices are currently at the heart of just about every discussion related to the Internet of Things. The requirement for self-health monitoring and preventive medicine is increasing due to the projected dramatic increase in the number of elderly ...

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Patient Engagement vs the Engaged Patient Reframe Health Lab

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Patient engagement is a critical development in modern health care. Continuous advancements in treatment and research are essential, but often these advancements overlook the fact