This chapter deals with the conceptualization, design and implementation of an m-health solution to support ubiquitous, integrated and continuous health care in hospitals. As the life expectancy of population grows in modern societies, effective healthcare becomes more and more important as a key social priority. Medical technology and high quality, accessible and efficient healthcare is currently demanded by citizens. Existing technologies from the computer field are widely used to improve patient care but new challenges demand the use of new communication, hardware and software technologies as a way to provide the necessary quality, security and response time at the point of care need. In this scenario, mobile and distributed developments can clearly help to increase the quality of healthcare systems as well as reduce the time needed to react to emerging care demands. In this chapter we will discuss important issues related to m-health systems and we deeply describe a mobile application for hospital healthcare. This application offers a modern solution which makes more agile doctor and nurse rounds on behalf of an instant online access to patient records through wireless networks. We also provide a highly usable application that makes simple patient monitoring with handheld devices.
The origins of health telematics and telemedicine did mainly focus on the benefits of communicating and making available medical information from a patient to a remote medical expert instead of having to displace the injured person to a health centre (Bashur, R., 1997). Thus, telemedicine aimed to support people at the point of care wherever, for different reasons, neither the health professional nor the patient could easily travel to meet each other face to face. In this context, multiple new scenario were imagined taking into advantage Information and Communication technologies (ICT) to provide care to people in isolated regions, emergency situations or environments where a difficulty exists to displace a patient who cannot receive on site medical attention. At a parallel pace, medical informatics started to devote significant efforts to deploy health information systems that ensure medical data availability “at the point of care”. Both Hospital Information Systems (HIS) and Department Information Systems (DIS) aimed to provide health professionals with adequate tools that may integrate all the medical data required by health staff (medical doctors, nursery, administrative, health managers, etc.), to treat a patient (Winter A., 2003). Consequently, the concept of Electronic Health Record (EHR) raised and, with diverse levels of success at the market level, important standardization work have been active (CEN TC251, ISO215, HL7) making efforts to structure in a secure and efficient way the enormous amount of data that can be associated to a person´s health history (Dolin R., 2006). However, the traditional view of Medical Informatics focused more on those situations where the health professionals are, for instance, present at their hospital or care centre office providing a consultation service rather than those scenarios that oblige them to be displacing in order to assist in-bed patients in the hospital or elderly and disabled people at home.
A solution for the challenge of mobile care support came from the concept of m-health proposed in the ‘90s to exploit the potentiality of mobile communications to assist care professionals or patients “in movement” (Istepanian R.S.H, 2004). The original scenarios of health telematics were changing and technologies were no longer expected to only provide medical information at a fixed computer or medical device where the specialist is supposed to be located, but to “bring” valuable information to the professional wherever he or she is located, in movement, whichever mobile or wireless network is available. Mobile networks were initially used to transmit data from mobile patients; furthermore, the m-health concept started to think about mobile professionals or wirelessly connected citizens who are displaced from a fixed location. A typical example from the first ideas was the utilization of emerging GSM systems to transmit biomedical signals, like an ECG or blood pressure, in emergency situations where an injured patient is moved from a mobile ambulance unit to the hospital (Pavlopoulos S., 1999). Most advanced research on m-health has mainly treated with the unobtrusive and ubiquitous integration of e-care or telemedicine services with remote health information systems through GPRS/UMTS, WLAN or WPAN technologies as well as provision of context aware health care ad-hoc support including Quality of Service features (Oliver N., 2006) (Wac K., 2007).
Key Terms in this Chapter
M-Health (Mobile Health): It can be understood as mobile computing, medical sensor, and communications technologies for e-health (Istepanian R.S.H., Jovanov E. and Zhang Y.T., 2004)
Mobile Computing: Is a generic term describing your ability to use technology ‘untethered’, that is not physically connected, or in remote or mobile (non static) environments. The term is evolved in modern usage such that it requires that the mobile computing activity be connected wirelessly to and through the Internet or to and through a private network (Wikipedia).
Pervasive / Ubiquitous Computing: Mobile Computing: Pervasive computing is the trend towards increasingly ubiquitous (another name for the movement is ubiquitous computing), connected computing devices in the environment, a trend being brought about by a convergence of advanced electronic - and particularly, wireless - technologies and the Internet (SearchNetworking.com).
Web Service: A reusable component that can be registered, discovered, and invoked using standard internet protocols.
Hospital Information System (HIS): Central medical information system in hospitals where health care related data (e.g.: personnel, patients and their medical history etc.) is stored.
Lightweight Directory Access: Protocol (LDAP):. Is a software protocol for enabling anyone to locate organizations, individuals, and other resources such as files and devices in a network, whether on the public Internet or on a corporate intranet (SearchMobileComputing.com definitions).
Software: Architecture: Architecture is defined as the fundamental organization of a system, embodied in its components, their relationships to each other and the environment, and the principles governing its design and evolution (ANSI/IEEE Std. 1471-2000, 2000).
Telemedicine: The use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care. Telemedicine includes consultative, diagnostic, and treatment services (Websters’s new world medical dictionary).
Medical Informatics: The rapidly developing scientific field that deals with biomedical information, data, and knowledge - their storage, retrieval, and optimal use for problem solving and decision making.
E-Health: Electronic Health. The term e-health encompasses all of the information and communication technologies (ICT) necessary to make the health system work (International Telecommunication Union – ITU, 2003)