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© Borgis - New Medicine 1/2013, s. 28-30
*Mihály Dió1, Tibor Deutsch1, Judit Mészáros2
Conceptual design of an intelligent ‘telediabetology” system
1Department of Medical Imaging and Technology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Head of Department: Éva Kis, PhD
2Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Dean of the Faculty of Health Sciences: Prof. Judit Mészáros, PhD
Summary
The widespread adoption of information-communication technology in everyday life including the Internet and mobile phones provides a great opportunity to improve the organisation of Diabetes Mellitus (DM) care delivery. This paper presents the conceptual design of an intelligent information system to provide tele-monitoring and tele-care services for insulin-treated diabetic patients twenty four hours per day at the point and time where and when it is needed. The proposed system supports a new visit form called virtual visit during which the patient contacts a computer program instead of a real doctor or nurse for assistance, guidance or advice. In addition to patient self-management, health care personnel are also supported by a wide range of information management and decision support services. We expect that the new architecture shall improve efficiency, patient satisfaction and health results.
Introduction
Diabetes management is far from having reached the desired therapeutic targets. To the contrary, because of the increase of DM prevalence, ageing population and health care costs the current situation shall become worse (1). Several difficulties are consequences of inadequate information management and problem solving.
Traditionally patients and providers communicate during personal encounters called contact visits. Between those visits, however, diabetic patients make hundreds of choices each day but patients lack the knowledge and/or motivation to manage themselves as required. To enable patients to be effective self-managers of their diabetes, they need to be provided with the information and support necessary to make informed decisions day and night. Similarly, between two subsequent visits care providers do not know what is happening to their patients. Clearly they should be notified about impending or actual problems to enable timely feedback or action.
To improve patient safety and also the efficiency and quality of diabetes care, several chronic care models have been developed. These include the ‘self-management” and ‘collaborative management” models (2). The widespread adoption of ICT in everyday life, including the Internet and mobile phones, is providing a great opportunity to improve the organisation of DM care delivery (3-6). Several tele-medicine systems have been published in the literature (7, 8).
Aim of the study
We intend to develop an intelligent information system, which provides comprehensive tele-monitoring and tele-care services for insulin-treated diabetic patients day and night. Patients” home monitoring and life style data are continuously monitored/interpreted and the management team (including the patient) is informed/assisted in the decision making process. The system incorporates a novel chronic care model in which traditional face to face (contact) visits are supplemented by automatic and on-demand virtual visits (9). During such virtual visits patients contact an intelligent agent (computer program) instead of a real doctor/nurse for assistance, guidance or advice. Such intelligent agents serve as a partner in intensive management utilising automated alerts, reminders, reports, advices or guides just-in-time coaches.
THE SYSTEM
The system is composed of three major units. The patient unit (PU) is able to acquire data and provide first-level advice to the patient. The patient unit also facilitates interaction with the health care centre, by automatically uploading data and receiving back any therapeutic plan supplied by the physician or the intelligent system. Portable wireless devices are used in automating data collection. On the patient”s side the mobile phone uses Bluetooth technology and therefore acts as a hub for a wireless network, possibly including several devices (e.g. balance, blood pressure monitor, step-counter, etc.) in addition to the glucometer.
The medical unit (MU) is available through the Health Care Centre (HCC) intranet and consists of a Web application integrating several functionalities, helping the physician in visualising and analysing patients” data, supporting his/her decision and therapy planning, and exchanging messages and/or therapeutic advice with his/her patients (10). The unit is fully integrated with a health care information system and is enhanced by guideline-based reminders and alerts. Furthermore, the MU is equipped with software accepting incoming point-to-point connections from PU and HCC units through standard modems for data, therapies, and messages exchange.
The third unit is the Health Care Centre unit, which receives patient data, hosts databases and runs various programs that organise visits, mediate between patients and care providers and offers different decision support functions. Here everything is monitored in a personal health record. The programs track measurements such as profile information, blood glucose, A1c history, behavioural assessments, vists, etc. This unit is responsible for selecting the appropriate form of feedback and visit including the organisation/scheduling of these visits. The power of HCC unit is that the right information goes to the right person at the right time and in the right format. The visit organiser decides when it is a good time to engage the team, and which team members to involve.

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Piśmiennictwo
1. Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-1053. 2. Sperl-Hillen J, O”Connor PJ, Carlson RR et al.: Improving diabetes care in a large health care system: an enhanced primary care approach. Jt Comm J Qual Improv 2000; 26(11): 615-622. 3. Klonoff DC: Diabetes and telemedicine: is the technology sound, effective, cost-effective, and practical. Diabetes Care 2003; 26(5): 1626-1628. 4. Farmer A, Gibson OJ, Tarassenko L, Neil A: A systematic review of telemedicine interventions to support blood glucose self-monitoring in diabetes. Diabet Med. 2005; 22(10): 1372-1378. 5. Ma C, Warren J, Phillips P, Stanek J: Empowering patients with essential information and communication support in the context of diabetes. Int J Med Inform 2006; 75(8): 577-596. 6. Jaana M, Paré G: Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. J Eval Clin Pract 2007; 13(2): 242-253. 7. Lanzola G, Capozzi D, D”Annunzio G et al.: Going mobile with a multiaccess service for the management of diabetic patients. J Diabetes Sci Technol 2007; 1(5): 730-737. 8. Obstfelder A, Engeseth KH, Wynn R: Characteristics of successfully implemented telemedical applications. Implement Sci 2007; 2(1): 25. 9. Deutsch T, Gergely T: An intelligent partner system for improving chronic illness care. Informatics in Primary Care 2003; 11(1): 13-19. 10. Deutsch T, Gergely T, Trunov V: A computer system for interpreting blood glucose data. Computer Methods and Programs in Biomedicine 2004; 76(1): 41-51.
otrzymano: 2013-02-11
zaakceptowano do druku: 2013-03-06

Adres do korespondencji:
*Mihály Dió
Department of Medical Imaging and Technology, Faculty of Health Sciences, Semmelweis University
1088 Budapest Vas u.17, Hungary
tel.: +36 1 486-59-65
e-mail: diom@se-etk.hu

New Medicine 1/2013
Strona internetowa czasopisma New Medicine