This paper presents a telemedicine hardware/software platform for data acquisition, communication, processing, presentation and storage, aimed to remotely monitor lifestyle, vital signs and in general the clinical status of patients affected by chronic diseases. Such platform is useful to support an innovative ICT-based application of the Chronic Care Model (CCM). The platform exploits wearable sensors, a BT/BLE connectivity to the local gateway and then a connection, using standard formats and cyber-secure protocols, to a server-based application and repository. The platform allows clinicians and practitioners to realize aggravations and act promptly, before they become irreversible and lead to hospitalization. The system also implements data analysis, by processing multiple parameters in parallel. As well as monitoring the state of health, the proposed telemedicine platform can be also used to monitor the emotional and psychological state of the patient.
The management of the increasing number of patients affected by cardiovascular, pulmonary, and metabolic chronic diseases represents a major challenge for the National Health System (NHS) in any developed country. Chronic diseases are indeed the main cause of hospitalization, especially for elderly people, leading to sustainability problems due to the huge amount of resources required. In the last years, the adoption of the chronic care model (CCM) as assistive model improved the management of these patients and reduced the related healthcare costs. The diffusion of wireless sensors, portable devices and connectivity enables to implement new information and communication technology (ICT)-based innovative applications to further improve the outcomes of the CCM. This paper presents a telemedicine platform for data acquisition, distribution, processing, presentation, and storage, aimed to remotely monitor the clinical status of chronic patients. The proposed solution is based on monitoring kits, with wireless Bluetooth (BT)/ Bluetooth low energy (BLE) sensors and a gateway (i.e., smartphone or tablet) connected to a web-based cloud application that collects and makes available the clinical information to the medical staff. The platform allows clinicians and practitioners to monitor at distance their patients, according to personalized treatment plans, and to act promptly in case of aggravations, reducing hospitalizations and improving patients’ quality of life.
Covid-19 has brought many difficulties in the management of infected and high-risk patients. Telemedicine platforms can really help in this situation, since they allow remotely monitoring Covid-19 patients, reducing the risk for the doctors, without decreasing the efficiency of the therapies and while alleviating patients’ mental issues. In this paper, we present the entire architecture and the experience of using the Tel.Te.Covid19 telemedicine platform. Projected for the treatment of chronic diseases, it has been technologically updated for the management of Covid-19 patients with the support of a group of doctors in the territory when the pandemic arrived, introducing new sensors and functionalities (e.g., the familiar use and video calls). In Tuscany (Central Italy), during the first wave of outbreak, a model for enrolling patients was created and tested. Because of the positive results, the latter has been then adopted in the second current wave. The Tel.Te.Covid19 platform has been used by 40 among general practitioners and doctors of continuity care and about 180 symptomatic patients since March 2020. Both patients and doctors have good opinion of the platform, and no hospitalisations or deaths occurred for the monitored patients, reducing also the impact on the National Healthcare System.
Congenital heart disease, the most frequent malformation at birth, is usually not fatal but leads to multiple hospitalisations and outpatient visits, with negative impact on the quality of life and psychological profile not only of children but also of their families. In this paper, we describe the entire architecture of a system for remotely monitoring paediatric/neonatal patients with congenital heart disease, with the final aim of improving quality of life of the whole family and reducing hospital admissions. The interesting vital parameters for the disease are ECG, heart rate, oxygen saturation, body temperature and body weight. They are collected at home using some biomedical sensors specifically selected and calibrated for the paediatric field. These data are then sent to the smart hub, which proceeds with the synchronisation to the remote e-Health care center. Here, the doctors can log and evaluate the patient’s parameters. Preliminary results underline the sensor suitability for children and infants and good usability and data management of the smart-hub technology (E@syCare). In the clinical trial, some patients from the U.O.C. Paediatric and Adult Congenital Cardiology- Monasterio Foundation are enrolled. They receive a home monitoring kit according to the group they belong to. The trial aims to evaluate the effects of the system on quality of life. Psychological data are collected through questionnaires filled in by parents/caregivers in self-administration via the gateway at the beginning and at the end of the study. Results highlight an overall improvement in well-being and sleep quality, with a consequent reduction in anxious and stressful situations during daily life thanks to telemonitoring. At the same time, users reported a good level of usability, ease of data transmission and management of the devices.
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