On the Design and Evaluation of an eHealth System for Management of Patients in Out-of-Hospital Care

Doctoral thesis, 2011

This thesis covers the design and evaluation of a generic web-based eHealth system into real clinical settings. Moreover, the use of an off-the-shelf video communication system for out-of-hospital care is tested and evaluated. A large part of the thesis will cover the design process of the web-based system (WBS) for out-of- hospital long term disease management. The systems were implemented in two very different settings: heart failure care and neonatal home healthcare. The methods of evaluation are questionnaires, including both patients and nurses. Also, data extracted from a blood pressure monitor, and data extracted from the prototype system database are used in the evaluation. The first study, performed in 2008, indicated that the prototype developed was applicable in the patient group (heart failure). However, several issues concerning the system were found, resulting in the development of a new prototype system. The two subsequent studies, heart failure care and neonatal home healthcare, were performed using the new system. Results from these two studies indicate that the WBS is usable for two very different applications. In heart failure care compliance with the system is very good, however in neonatal care the results are ambiguous. The neonatal evaluations show that even though the patients may be positive towards eHealth systems, the necessity of care personnel participation is vital. If there is no feedback, the patients lose interest and find the system useless. A questionnaire survey studying attitudes towards information and communication technology (ICT) as a tool in health care, and also studying the attitudes towards home follow up, was also performed. The target group was healthcare personnel in heart care, and the questionnaire was sent out to 84 cardiology and medicine clinics in Sweden. All 21 counties and regions in Sweden were included in the dispatch, and of these responses were collected from 17. The results indicate a large interest and confidence in healthcare ICT, and well as in home follow-up and monitoring of patients. A comparison between nurses and physicians indicate a slight difference where nurses in general are more positive than physicians.