H@H

By using wearable sensors developed by H@H, patients’ physio‐pathological cardiovascular and respiratory parameters are acquired and transferred to a remote server. The gathered data are continuously monitored by an automatic processing system and accessible by the medical staff, who can take action in case of necessity.

The involvement of end users’ since the first stages of the project was fundamental for the definition of user requirements. The rationale was to device a flexible and efficient system, taking into consideration both medical and patients’ needs and expectations: for the physicians the telemonitornig system can not be an excessive workload with respect to their regular activities, on the other side, the impact on the patient must be minimal. For these reasons it was developed a system directly integrated with the Hospital Information System (HIS) based on Operating Protocol (OP). The OP consists of a set of actions that the patient must follow during the monitoring. The OP can be customized depending on the patient’s needs and possible disease evolution when necessary. The actions are simple tasks like taking measurements or replying to simple questions.

H@H Architecture

The system has the typical client/server architecture (see Figure 1). The client side is located at patient’s home and consists of a home gateway and a set of biomedical sensors. The server side, installed at the health service facilities, accepts and processes data from gateways making them available in the Hospital
Information System.

Figure 1

The Bluetooth technology was chosen for the communication between the sensors and the gateway, due to the wide diffusion of available devices on the market. On the other side, ADSL is the primary transmission channel for data communication between the gateway and the server, while the mobile broadband (GSM/GPRS/UMTS) is used as secondary data channel. Redundant access technologies ensure flexibility and fault tolerance. Furthermore alert messages are sentas SMSs directly to the physician, the patient’s relatives and the caregivers.

Sensor Devices

The sensing module consists of a set of wireless and wearable sensors to measure the main vital signs.Most significant vital parameters that a CHF patient has to measure are 3 leads ECG, SpO2, weight, blood pressure, chest impedance, respiration and posture. Table 1 shows the features of the sensor devices.

In order to achieve an asset for the implementation and to reduce project risks, the sensing module was divided into two possible configurations: basic and advanced. Basic partitioning is intended as the minimum set of requirements to achieve a complete and useful telemonitoring system. In the advanced configuration additional features were considered in order to enlarge the kind of CHF patients to be enrolled into the telemonitoring program.

Home Gateway

The home gateway includes all needed computation and communication resources. The home gateway is responsible of the acquisition, management and forwarding of data on vital signs captured by the biomedical pool of sensors. The acquisition consists of handling all the sensor‐dependent communication protocols in order to receive specific data sets and extract their information content. Data management includes a first level of analysis, consisting of comparisons with thresholds in order to detect anomalies, and the permanent storage of data waiting to be transferred, so that power supply failures do not result in data loss. Collected data are made available also for local consultations. The transmission process allows flooding data into the patient’s Hospital Information System (HIS) record. The following list summarizes all the gateway functionalities:

  • Acquisition of data from wireless sensors;
  • Data forwarding to a remote collection server using a safe and reliable connection;
  • Reminder function, in order to help patient to follow the medical therapy and perform the planned measurements;
  • Detection and management of emergency events, both coming from threshold comparison on incoming data or manually submitted by the patient through a selectable list of symptoms;
  • Execution of an operating protocol customized basing on patient’s needs;
  • System failure detection and management during data acquisition or data transmission to the server;

The gateway device is based on a netbook integrating all the computation and communication resources. In order to simplify the use of the gateway, the original keyboard of the netbook was replaced by a simpler keypad, realized as a membrane keybo.

Server Module

The server side, installed at the health service facilities, accepts and processes data from the gateways making them available in the Hospital Information System. The H@H server is a web‐based application that receives data from all controlled gateways, providing a detailed process of analysis based on expert systems and finally updating the patient record in the HIS. It exports graphical interfaces that allow the clinicians to request and display: the data of a patient to detect early changes in vital signs, the historical data of a patient, monitoring the progress of the disease and to update the operating protocol. The server platform main functions are related to the patient management since their enrolment when the physician inserts the patient data and configures the OP on the basis of the patient needs. During the monitoring period the server collects patient measurements coming from the gateway. The physician can always access patient clinical data, comparing the patient heath status in different periods by means of measurement trends. The platform also highlights the alarms shown during the monitoring with respect to the OP established for that patient or simply to report symptoms manually indicated by the patient. If necessary, the physician can modify the OP at any time by producing an automatic and transparent update of the gateway.

Server‐Gateway Communication

As data exchanged between the gateway and the server involves the public Internet, the HTTPS protocol uses HTTP messages over an SSL channel established after certificate validation, fitting completely the requirements of confidentiality, authenticity and integrity for the data traffic and the web service interaction.

Objectives

The Health at Home project (H@H) aims at solving societal problems related to the provision of healthcare services for elderly citizens affected by Chronic Hearth Failure (CHF), by enabling remote self-management of the patients and connecting in‐hospital care of the acute syndrome with out‐of‐hospital follow‐up. The new home care model should allow planning, controlling and monitoring of activities carried out by patient, caregivers, social and sanitary professionals, enabling the medical staff to monitor situations at distance and take action in case of necessity by the involvement of public and private health organizations. This new strategy will decrease the acting time in cases of destabilization of CHF patients and will reduce avoidable hospital re‐admissions, resulting in an improved quality of life for the patient and in a cost reduction for the National Sanitary System.

 

H@H Demonstration and results

A technical validation of the system has been implemented involving 30 patients with CHF disease in NYHA class III and IV, with an average age of 62 years and recently hospitalized for HF. The minimum period of monitoring was one month. A specific testing protocol and a questionnaire have been developed to gather patients, caregivers and physicians feedbacks and validate the system. The results show a very limited number of activity misses (<3%), mostly in the first days of monitoring, confirming also the property of such system to improve the therapy compliance. Moreover, the number of false positive alarms is less than 5%. No connectivity and transmission problems, including data lost, occurred. All end‐users reported a positive feedback and good satisfaction level in the final questionnaire. Physicians reported that the use of this platform does not load up in a significant way their regular activity, but represents a valid means to control at distance the evolution of the followed patients thanks to the high quality of acquired signals and alarms detection capability. All physicians involved in the demonstration are definitively in favour of the adoption of the H@H system. The 89% of the patients report a very high satisfaction level, highlighting the friendliness of the solution and the easiness to follow the daily therapy.

Expected results and impact

The H@H system is expected to enhance the quality of life of CHF patients (at present 14 million of European Citizens with an incidence of 3,6 million of new cases per year), to improve the effectiveness and cost management of specialized centres thus reducing costs for the public sanitary system. H@H ICT technologies have been successfully proved through an initial demonstration phase, while the clinical validity and the economic analysis for this new healthcare model has to be validated on a wider number of patients.

Partners

Partners involved in the H@H project

OrganizationTypeCountryWebsite
ISTITUTO NAZIONALE DI RIPOSO E CURA PER ANZIANI V.E. II (INRCA)R&DItalywww.inrca.it
FUNDACIÓ PRIVADA CETEMMSA (CETEMMSA)R&DSpainwww.cetemmsa.com
SPEED AUTOMAZIONE Srl (SPD)Large IndustryItalywww.speedautomazi
GLOBAL SECURITY INTELLIGENCE LIMITED (GSI)SMEUnited Kingdomglobalseci.com
AB.ACUS Srl (ABACUS)SMEItalywww.ab-acus.com
INSTITUTE OF SOCIOLOGY, HUNGARIAN ACADEMY OF SCIENCES (ISO)R&DHungarysocorg.socio
ASSOCIATION OF CATHOLIC ORGANIZATIONS OF SENIOR CITIZENS (UNIEKBO)End UserNetherlandswww.uniekbo.nl
  • Project name: Health@Home
  • Website: www.health‐at‐home.eu
  • Coordinator: Consorzio Pisa Ricerche, Italy
  • Duration: 30 Months
  • Starting Date: 01.02.2009
  • Total budget: € 2.699.799
  • Public contribution: € 1.178.600

Contact

Luca Fanucci

E.: l.fanucci@cpr.it

T.: +39 050 2217668