Personalized e-Health for Elderly Self-care

and Empowerment*

Viveca Jiménez-Mixco, Maria Fernanda Cabrera-Umpiérrez,

Alberto Esteban Blanco, Maria Teresa Arredondo Waldmeyer,
Daniel Tantinger, and Silvio Bonfiglio

Abstract. This paper describes the OASIS Health monitoring system, a

personalized e-health solution specifically designed for the elderly population in
the context of OASIS EU funded project, with the objective to empower the
elderly so that they meet their social, emotional and psychological needs, take care
for their long-term condition, and prevent further illnesses or accidents. The
system integrates four main areas that cover the main aspects of interest related to
the health management of the users at their own homes: electronic health record
personalization, remote health monitoring, education & coaching, and alerting &
assistance.

Keywords: personalization, electronic health record, self-care, empowerment,

e-Health, elderly.

1 Introduction
The role of self-care in the management of long term conditions is crucial for effective
high quality health care of patients. More and more, patients with chronic diseases and

Viveca Jiménez-Mixco · Maria Fernanda Cabrera-Umpiérrez · Alberto Esteban Blanco ·

Maria Teresa Arredondo Waldmeyer
Life and Supporting Technologies, Universidad Politécnica de Madrid, Avda Complutense
30, Ciudad Universitaria. 28040 – Madrid, Spain
e-mail: {vjimenez,chiqui,aesteban,mta}@lst.tfo.upm.es
Daniel Tantinger
Fraunhofer Institute Fraunhofer-Institut for Integrated Circuits IIS, Am Wolfsmantel 33,
91058 Erlangen, Germany
e-mail: Daniel.Tantinger@iis.fraunhofer.de
Silvio Bonfiglio
FIMI s.r.l, via S. Banfi 1. 21047 SARONNO, Italy
e-mail: Silvio.Bonfiglio@barco.com

P. Novais et al. (Eds.): Ambient Intelligence - Software and Applications, AISC 153, pp. 213–216.
springerlink.com © Springer-Verlag Berlin Heidelberg 2012
214 V. Jiménez-Mixco et al.

elderly people that need continuous health surveillance are able to live in their own
home and surroundings with help from relatives and health professionals. In order to
enable patients to receive a preventative home based self empowered care, a complete
system must be provided; it must help them to manage and monitor their daily health
status, and needs to be connected to the professional medical system at the hospital.
This concept that involves the actions taken towards the possibility of not being
continuously attached to the hospital environment is often called “patient
empowerment” [1]. It implies a re-distribution of power between patients and
physicians and therefore an increase of the individual’ autonomy to make informed
decisions and personally handle their condition for their own health and well being.
This paper presents the approach adopted in Oasis Health Monitoring System
(OHMS), which has been developed within OASIS European project [2]. OASIS
explored the potential of ICT in all aspects of daily life of the elderly to create ambient
intelligence environments that empower them so that they meet their social, emotional
and psychological needs, take care for their long-term conditions, and prevent further
illnesses or accidents. The OHMS represents an effort to advance in a new generation
of telecare services for the elderly devoted to –going beyond the monitoring of the
health status- providing them with an easy-to-use system to personally manage their
health status and assuring their well-being by means of a constant remote control by
professional caregivers.

2 Methodology
The User-centred-design concept has been applied throughout the complete design and
development cycle through the OPAF (OASIS Participatory Analysis Framework)
methodology [3], a participatory design process specifically created within OASIS
framework. Developers were driven by the outcomes of these extensive activities
including interviews, surveys and discussions about use cases in various user forums,
usability tests, and workshops carried out to involve all the stakeholders (i.e. older
adults, informal & formal caregivers, and third parties such as the health care and
emergency support service providers). The iterative consensus building among key
stakeholders and user groups’ representatives enabled the clustering of the
functionality of the OHMS in four main areas that cover the main aspects of interest in
the area: electronic health record personalization, remote health monitoring, education
& coaching, and alerting & assistance. Besides the work performed with users, the
main efforts of the development process were focused on customization. Not only
must the system fulfil the needs of the elderly in general, but of each specific user,
mainly when the subject of the application is the health status. For that purpose, the
definition and management of the user’s electronic health record (EHR) constituted the
central element of the application. The solution for managing the user’s health profile
implements a distributed system of XML files [4], focusing on personalization, data
security and synchronization, and thus ensuring that the stored information is always
valid and up-to-date in both sides of the communication channel (elderly and
professional clients). The EHR contains critical information related to different aspects
of the user’s health and implements a pre-defined protocol to automate (transparently
Personalized e-Health for Elderly Self-care and Empowerment 215

to the user) the processes needed for the management of the user’s health status, thus
adding intelligence to the system, e.g. setting the vital and activity signs that should be
regularly controlled, frequency of measurements, or ranges of parameters that define
the urgency of response in case of emergency.

3 Results
The proposed solution has been deployed in a distributed way with a client-server
approach using Java within Eclipse and Netbeans frameworks, OSGI architecture and
Web-service technologies. On the client side, the elderly user application’s UI has
been carefully designed following the guidelines and the adaptation framework [5]
specifically defined in the context of OASIS that take into account different conditions
of users such as age, mobility, vision or computer literacy. The elderly are provided
with a tablet PC and a set of Bluetooth sensors (3 commercial EC-marked and 3
research prototypes) that will be used to record details of the user’s biomedical
parameters (SpO2, Heart rate, glucose, etc.) and daily activities (Inactive, Walking,
Running, Falling, etc.). All measurements are stored in the user’s health record, so that
any abnormal situation is detected and sent to the alerting module. The Health Coach
module is intended to engage and motivate the elderly with regard to the management
of their health status by providing educational content to make them aware of the
benefits of a healthier lifestyle and how important it is the adherence to the therapeutic
plan prescribed by the doctor to prevent a degeneration of the health conditions.
Finally, the system alerts and notifies about an important event, which can be either the
receipt of a new message from the doctor, a change in the medication treatment, or, the
most important, the warning about a potential dangerous situation. All the information
is managed and controlled remotely by the medical doctor on the server side using the
Medical Center application, which completes the loop of the concept “e-health for
empowerment”. It enables the medical doctor not only to perform a continuous
tracking of the user’s health status, but to be proactive and make decisions on the
performance of the user’s application by setting the medication treatment and
monitoring, defining the educational content and giving them recommendations just as
if the user was present at the hospital for a regular visit. The main innovation of the
OHMS compared to other telecare systems is that, being integrated in OASIS: a) on
one hand the system is able to exchange useful information of other domains (e.g.
nutrition, environment, brain skills, transport, etc.) with any other application of the
platform through the user’s profile, giving the health professional enriched data about
the context of the user, and b) on the other hand, external healthcare providers will be
able to integrate their services in the platform and connect them to the OHMS with a
very small effort. The application prototype has been preliminary tested with 10
Spanish users aged between 55 and 83 in order to get feedback from them related to
the usability of the application. The tests, performed by LST-UPM in Madrid, were
based on the “Think aloud” and the “System usability scale” techniques [6, 7]. Users
were given some time to “play” with the prototype and explore its functionality. By
verbalizing his thoughts, the test user enables the developer to understand how he
views the computer system. After this time, they filled a System Usability Scale
questionnaire related to the complexity, easiness of use and consistence of the system.
The analysis of the results gave an acceptable usability score with an average user
216 V. Jiménez-Mixco et al.

satisfaction index of 73.5 (on a 1-100 scale). With focus on statements and comments
of the participants, the results are being taken into account for further improvements of
the application.

4 Conclusions
The European Union is investing thoroughly for the research and development of
new healthcare technologies to help empower the patients and specifically the
older adults so that they become able to personally take care of their health status
and prevent further illness or accidents. This paper presents the work carried out to
provide a solution for making the self-care and patient empowerment an effective
tool for the management of long term conditions. A personalized e-Health system
for empowerment has been developed carefully customized for elderly users,
including four main areas that enable comprehensive health management: health
profile definition & personalization, health remote monitoring, health coach and
alerting & assisting. The system is currently being fully tested in OASIS pilots in
several countries in Europe (Italy, Romania, Bulgaria, Germany, United Kingdom
and Greece) with hundreds of users, and the results will be extensively analyzed
for further improvement of the system.

Acknowledgments. We would like to thank the whole OASIS Project Consortium This
work was partially funded by EU in OASIS project (FP7, ICT-2007-215754).

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