Chronic disease management platform (CHRONIOUS)

Published on: 26/01/2010
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CHRONIOUS is a European project aimed at defining an open platform to manage and monitor patients with chronic diseases during their daily life through the implementation and deployment of a platform that will be worn by the patients.
The project team envisages an adaptive and ubiquitous chronic disease management system that offers continuous monitoring to patients by using several sensors either in a form of a wearable solution or scattered in the patient’s living environment and a series of “intelligent” services to healthcare providers and organisations that aid them in the monitoring of their patients.

The smart wearable platform is based on multi-parametric sensor data processing and is constantly monitoring their activity using audio observation methods and activity sensors, while at the same time tracking their medical condition via vital signs sensors. Any trait of abnormal health status and possible alerting incidents are detected by CHRONIOUS Intelligence. The system generates alerts in case of invalid medical data or if current activity and behaviour lay outside the well established activity patterns and locomotion behaviour of a given patient.

An overarching goal of the proposed system is to underline and emphasize, as well as built upon the partnership between technology-centred and human-centred sciences as technologies for sensing, interacting, computing and communicating become increasingly ubiquitous.

Description of target users and groups

The consortium has identified potential target groups for the exploitation of the system, which include:

  • Citizens and other end users: People suffering from chronic diseases who are sensitive as far as their health is concerned because of their need for continuous medical treatment with a specific health condition monitoring plan. With CHRONIOUS they can improve self-confidence and self care conditions.
  • Health Professionals: Chronic Disease specialists, who perform all medical procedures and monitor chronically ill people in order to provide high-quality and personalised medical care services. Furthermore, they will be able to utilise their time in the most efficient way without their physical presence which in most cases is extremely costly. CHRONIOUS results will not only promote individualizing patient treatment plans but will also improve the ability of clinician-researchers to demonstrate/measure the impact of their interventions. CHRONIOUS will provide them with access to certified medical information, guidelines for the specific disease management, data generated from real patients and promotion of demand-driven medical research, etc.
  • Organisations: Hospitals, Nursing Homes, Clinics and Rehabilitation Centres, which need to provide high quality and personalised health services. Health Care Organizations/In¬stitutes, who wish to provide the abovementioned services to their chronically ill patients.
  • Industries: Businesses, marketing and consulting-oriented corporations who would like to provide the CHRONIOUS system to their clients. Furthermore, new directions for wearable systems are presented in CHRONIOUS and new opportunities arise from the use of sensors for monitoring vital signals, environmental conditions and social context of patients. In conclusion, CHRONIOUS offers great exploitation and business opportunities for the EU health and bio-informatics market.

Description of the way to implement the initiative

While the platform is conceived to be open and adaptable to any kind of chronic disease, during the project it will be applied and tested to patients affected by Chronic Obstructive Pulmonary Disease (COPD) and Kidney Disease (KD). The framework will provide a support to both patients and clinicians. For patients, CHRONIOUS will monitor their status and will suggest actions to take in case of critical conditions; for clinicians, it will provide assistance to define and refine therapies as well as to assess the monitored events.

To this aim the project will develop new wearable sensors to acquire physical and environmental data, and decision support systems to assist the clinicians in their assessments and to provide prompt alerts in case of critical events. Additionally, clinicians will be aided by a new ontology based literature search engine.

Technology solution

The proposed framework’s architecture and structure will be generic and thus it will enable further expansion to the support of the management of other categories of chronic diseases such as Psychiatric Disorders Management, Diabetes, and Asthma etc.

This provides an added value to the proposed solution and a tremendous exploitation potential. Beyond the pilot cases to be investigated in the context of the project, it is envisaged that in its final form CHRONIOUS will be a universal solution to healthcare facilities and professionals for managing all different kind of chronic diseases.

CHRONIOUS will result in the design and development of an open platform for adaptation to the different needs of the above mentioned chronic diseases, exploiting the advantages of new and evolving IT solutions for the different tasks of chronic disease management. Furthermore, CHRONIOUS aims at the metamorphosis of chronic care, by integrating innovative- disease management procedures and IT technologies, such as:

  • Wearable solution for monitoring not only vital parameter but also environmental parameters and social context parameters. The wearable device will be approved both by the users in means of its ergonomic structure and by the medical board in means of the scientific information that must be gathered and monitored (vital, environmental, social parameters). The wearable solution will be ready by the end of the 27th month as part of the 2nd milestone.
  • Simple, customised and adaptive interfaces that take into account the user’s profile, medical history and relating HCI (human-computer interaction) factors. Emphasis will be placed on designing interfaces appropriate for each user category (patients, healthcare professionals etc). The creation of a repository (knowledge base) will provide critical decision support through an automated learning process. Multiple repositories of health related material (hospitals, healthcare centers etc) will be implemented and interconnected, thus exacerbating the beneficial effects of the system. These objectives will be achieved by the 22nd month and will be tested internally by the consortium members in terms of functionality and usability.
  • Implementation of new algorithms and methods to perform perceptual and evaluation of the subject using information from multiple sensors. Multi-fusion from heterogeneous sources decision support system. Research on algorithms that best integrate, analyze and combine data from the different sensors. Intelligent mechanisms and decision support tools for both patients and healthcare professionals (medical staff etc) for chronic disease management components. This objective will be fulfilled by the end of the project and is actually the 3rd milestone. The platform will be ready by the end of the 30th month but the validation procedure will commence at that time and will be completed the last month of the project’s lifetime. Physicians will be involved in this part of the project and will be asked to fill a questionnaire prepared in order to provide clear results on the ease of use, the efficacy and the usability of the system. In the last part of the validation process the outcome variables to test the effectiveness of CHRONIOUS will be the number and duration of acute events, the number and duration of hospitalization, the medical prescriptions and home care assistance required.
  • Appropriate, certified medical content and personalised views on it exploiting intelligent agent techniques coupled with flexible search and retrieval of information. Intelligent indexing system for information classification in relation to user profiling. The medical board along with the pilots and the association that will act as an external quality assurance evaluator will decide which content must be used for this purpose and will evaluate the results. This task involves mainly the ontology and will be developed by the 25th month. In order to reduce the large effort required for developing an ontology, existing Ontologies, pertinent to the specific target diseases, will be investigated and used as a basis for CHRONIOUS work.
  • Interoperability with existing healthcare legacy systems based on standards such as HL7 etc. Alert and reminding mechanisms to inform end-users of several events. Universal, easy access to the system through fixed and wireless devices. Provision of guidelines and standards of the future generations of “chronic disease management systems”. Standard specifications of personal medical record. All the above over a secure platform, taking into account privacy and ethical issues. These objectives will be achieved throughout the project’s lifetime.
Technology choice: Mainly (or only) open standards, Accessibility-compliant (minimum WAI AA)

Main results, benefits and impacts

Concerning the local health institutions, professionals and hospitals, the expected
outcomes are:

  • Decrease of the number of acute events up to 40%.
  • Reduction of costs connected to acute events up to 30%.
  • Reduction of the number and duration of hospitalization up to 20-30%.
  • Control of the medical prescriptions for diagnostic routine examinations up to 60%.
  • Increase of the home care assistance required up to 35%-60%.

Foreseen impacts on patients’ life are:

  • Reduction in the number of routine diagnostic visits to hospitals;
  • active participation of patients in monitoring and in decision-making;
  • lifestyle improvement through integrated reminding and alerting service linked to particular behaviours such as drug intake, eating and daily activities;
  • friendly approaches to new technologies by patients and their families;
  • re-assurance feelings, reducing the intervention time when a critical situation occurs.

Lessons learnt

INNOVATION ON SOFTWARE

  • Guidelines and standards of the future generations of “chronic disease management systems”.
  • Develop COPD and KD ontologies.

INNOVATION ON DATA ANALYSIS

  • Sophisticate monitoring tools containing besides vital and activity parameters:
    • patient Inputted Data (Food, Drug, Questionnaires).
    • Environmental parameters.
    • Social context parameters (stress).

FINAL USERS' (CLINICIANS AND  PATIENTS) BENEFITS

  • User-friendly Interfaces, adaptive to each actor’s needs.
  • Implement an adaptive and personalized platform.
  • Support tools:
    • Mental Tools: Monitoring of patient mental health status.
    • Lifestyle Tools: Hypothetical scenarios to assist decision support.
Scope: International