Adapting Telemonitoring Technology Use for Older Adults

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Kristine Williams, PhD, RN, APRN, FNP-BC, FGSA, FAAN; Priya Pennathur, PhD; Ann Bossen, PhD, RN; and Alexander Gloeckner, BBA

ABSTRACT

Telehealth technologies are increasing health care access for patients in the home and in community, rural, and underserved areas. Older adults may be challenged to use new technologies due to aging- related changes, lack of experience, and different attitudes toward their use. The current pilot study evaluated potential issues in one-on-one training/instructions and use of a telemonitoring application. Older adults may benefit from specific adaptations and training to use new health care technologies, and behavioral coding is an effective way to evaluate the user interface for new technologies. Feedback from the current study will be used to adapt the application and training to support dementia caregivers. [Res Gerontol Nurs. 20XX; x(xx):xx-xx.]

 Read more here: adapting-telemonitoring-technology-use-for-older-adults-a-pilot-study(2)

A Novel System for Supporting Autism Diagnosis Using Home Videos: Iterative Development and Evaluation of System Design

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Nazneen Nazneen, Agata Rozga, Christopher J. Smith, Ron Oberleitner, Gregory D Abowd, Rosa I Arriaga JMIR mHealth uHealth 2015 (Jun 17); 3(2):e68 

ABSTRACT

Background: Observing behavior in the natural environment is valuable to obtain an accurate and comprehensive assessment of a child’s behavior, but in practice it is limited to in-clinic observation. Research shows significant time lag between when parents first become concerned and when the child is finally diagnosed with autism. This lag can delay early interventions that have been shown to improve developmental outcomes.

Objective: To develop and evaluate the design of an asynchronous system that allows parents to easily collect clinically valid in-home videos of their child’s behavior and supports diagnosticians in completing diagnostic assessment of autism.

Methods: First, interviews were conducted with 11 clinicians and 6 families to solicit feedback from stakeholders about the system concept. Next, the system was iteratively designed, informed by experiences of families using it in a controlled home-like experimental setting and a participatory design process involving domain experts. Finally, in-field evaluation of the system design was conducted with 5 families of children (4 with previous autism diagnosis and 1 child typically developing) and 3 diagnosticians. For each family, 2 diagnosticians, blind to the child’s previous diagnostic status, independently completed an autism diagnosis via our system. We compared the outcome of the assessment between the 2 diagnosticians, and between each diagnostician and the child’s previous diagnostic status.

Results: The system that resulted through the iterative design process includes (1) NODA smartCapture, a mobile phone-based application for parents to record prescribed video evidence at home; and (2) NODA Connect, a Web portal for diagnosticians to direct in-home video collection, access developmental history, and conduct an assessment by linking evidence of behaviors tagged in the videos to the Diagnostic and Statistical Manual of Mental Disorders criteria. Applying clinical judgment, the diagnostician concludes a diagnostic outcome. During field evaluation, without prior training, parents easily (average rating of 4 on a 5-point scale) used the system to record video evidence. Across all in-home video evidence recorded during field evaluation, 96% (26/27) were judged as clinically useful, for performing an autism diagnosis. For 4 children (3 with autism and 1 typically developing), both diagnosticians independently arrived at the correct diagnostic status (autism versus typical). Overall, in 91% of assessments (10/11) via NODA Connect, diagnosticians confidently (average rating 4.5 on a 5-point scale) concluded a diagnostic outcome that matched with the child’s previous diagnostic status.

Conclusions: The in-field evaluation demonstrated that the system’s design enabled parents to easily record clinically valid evidence of their child’s behavior, and diagnosticians to complete a diagnostic assessment. These results shed light on the potential for appropriately designed telehealth technology to support clinical assessments using in-home video captured by families. This assessment model can be readily generalized to other conditions where direct observation of behavior plays a central role in the assessment process.

JMIR mHealth uHealth 2015;3(2):e68

doi:10.2196/mhealth.4393

Looking to Telehealth Care to Cap Economic Costs and Reach Autism Community

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Summary of “Economic Evaluations for Service Delivery in Autism Spectrum Disorders: Benefit-Cost Analysis for Emerging Telehealth Systems,” (2013), Angjellari-Dajci F., Stachura, M. E., Lawless, W. F., Wood, E. A., and DiBattistto, C. In  I. M. Miranda and M. M. Cruz-Cunha eds. Handbook of Research on ICTs for Healthcare and Social Services: Developments and Applications, Hershey, PA: IGI

Can telehealth medicine, including Behavior Imaging, be the answer to problems millions of Americans are facing? Authors of a new IGI book on autism seem to think so. Traditional in-person interventions—which includes everything from the diagnostic assessment to the supervision of treatments—for those on the autism spectrum have so far been incapable of meeting the growing demand for services and support. With so many people in need of care and unable to get it, telehealth intervention programs have the potential to be the solution we are looking for.

Authors Fiorentina Angjellari-Dajci, Max Stachura, William Lawless, Elena Astapova Wood, and Caroline DiBattisto did an extensive analysis on the subject with the conclusion that telehealth interventions can be immensely more economically beneficial than in-person interventions, especially from the perspective of patients/caregivers. The team of researchers also looked into the economic costs and benefits of a systematic change towards telehealth interventions.

ASYNCHRONOUS TELEHEALTH TECHNOLOGY FOR AUTISM SPECTRUM DISORDER – Lang, M , Oberleitner, R

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Telehealth technology is a tool that allows behavior professionals and others to make valuable observations, gather data, and propose more targeted, appropriate remediation for areas in which an individual with an autism spectrum disorder needs to progress. This tool can be used across natural settings of home, school, and community, and it has practical applications including use in classroom observation and Individualized Education Program (IEP) meetings. The capability of telehealth technology to serve children and families remotely means that parents of children in rural settings can receive more frequent and consistent services from a greater variety of professionals.

This chapter will look at:

-Defining telehealth and asynchronous telehealth for autism (Behavior Imaging® technology)

-How Behavior Imaging® can help professionals observe problem behaviors in the classroom

-How the results of observation via Behavior Imaging can aid at the Individualized Education Program (IEP) of a student with an autism spectrum disorder (ASD)

-How telehealth technology further helps IEP team members

-Case study via the ‘Beacon Day School project’

(Chapter in Cutting Edge Therapies for Autism (May, 2014); available at  www.autismone.org  )

Revising Autism Interventions to Meet Demand, Improve Early Care

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Summary of “Telehealth-based Systems for Diagnosis, Management and Treatment of Autism Spectrum Disorders: Challenges, Opportunities and Applications,” (2013), Angjellari-Dajci F., Lawless, W. F., Agarwal, N., Oberleitner, R.., Coleman, B., Warsi, S., and Kavoossi, M. In  I. M. Miranda and M. M. Cruz-Cunha eds. Handbook of Research on ICTs for Healthcare and Social Services: Developments and Applications, Hershey, PA: IGI

One out of every 110 American children has been diagnosed with Autism Spectrum Disorder (ASD), and the cost of caring for and treating ASD has risen to over 3 million dollars per person. Those are the numbers reported by authors of another chapter in IGI’s new book, Handbook of Research on ICTs for Healthcare and Social Services. With skyrocketing costs and ever-increasing demands, the current in-person delivery methods for ASD are understaffed and unable to handle the slew of problems currently facing the ASD community in America.

However, champions of new telehealth programs, including Behavior Imaging, say—and pilot studies appear to confirm—that telehealth diagnosis, treatment, and management of ASD have the potential to meet demand while also providing the effective early treatment that professionals have now realized is so important. Proponents of telehealth care for ASD argue that while the initial implementation of telehealth interventions could be costlier than in-person care, the long-term results would be more cost- effective, providing every family and individual with the accurate and early care they need.

Behavior Imaging Technology: The Beginning of a New Era for Autism Diagnosis and Assessment

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Summary of “Behavior Imaging®’s Assessment Technology: A Mobile Infrastructure to Transform Autism Diagnosis and Treatment,” (2013), Oberleitner, R., Abowd, G., Suri, J. S. In  M. F. Casanova, A. S. El-Baz, and J. S. Suri, eds. Imaging the Brain in Autism, New York: Springer

Today’s medical community may be looking at a new era of better understanding and better care for individuals with autism, according to the authors of a chapter in Springer’s new book, Imaging the Brain in Autism. Since many children with Autism Spectrum Disorder (ASD) cannot explain their behavior or what triggers it, treatments often require lots of at-home or at-school observation. This can be costly, however, due to the time it takes to travel to a home, and it can also be ineffective if the child isn’t comfortable with the observer. New telehealth technology Behavior Capture resolves both of these issues through home-based cameras that upload recorded videos to an online platform.

And it isn’t just the ability to upload video that makes Behavior Capture so valuable. Through its comprehensive documentation system (called Behavior Connect), doctors and clients or caregivers can annotate videos, upload test results and medical histories, and record questions and comments, all on a secure HIPAA-compliant online program. Professionals are already seeing promising results in Australia, where they have connected rural families with doctors in Melbourne.

Behavior Capture and Behavior Connect technology is also going mobile with a growing suite of smartphone apps. Electronic imaging like this is still in its early stages, but the opportunities for faster, cheaper, and more accurate healthcare are both encouraging and exciting.

Revising Autism Interventions to Meet Demand, Improve Early Care

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Summary of “Telehealth-based Systems for Diagnosis, Management and Treatment of Autism Spectrum Disorders: Challenges, Opportunities and Applications,” (2013), Angjellari-Dajci F., Lawless, W. F., Agarwal, N., Oberleitner, R.., Coleman, B., Warsi, S., and Kavoossi, M. In  I. M. Miranda and M. M. Cruz-Cunha eds. Handbook of Research on ICTs for Healthcare and Social Services: Developments and Applications, Hershey, PA: IGI

One out of every 110 American children has been diagnosed with Autism Spectrum Disorder (ASD), and the cost of caring for and treating ASD has risen to over 3 million dollars per person. Those are the numbers reported by authors of another chapter in IGI’s new book, Handbook of Research on ICTs for Healthcare and Social Services. With skyrocketing costs and ever-increasing demands, the current in-person delivery methods for ASD are understaffed and unable to handle the slew of problems currently facing the ASD community in America.

However, champions of new telehealth programs, including Behavior Imaging, say—and pilot studies appear to confirm—that telehealth diagnosis, treatment, and management of ASD have the potential to meet demand while also providing the effective early treatment that professionals have now realized is so important. Proponents of telehealth care for ASD argue that while the initial implementation of telehealth interventions could be costlier than in-person care, the long-term results would be more cost- effective, providing every family and individual with the accurate and early care they need.

Health Informatics: A Roadmap for Autism Sharing

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beh connect-and-beh captureThis publication outlines recommended principles and approaches for utilizing state-of-the-art information systems technology and population-based registries to facilitate collection, analysis, and reporting of autism patient data.  Such a platform will increase treatment options and registry information to facilitate diagnosis, treatment and research of this disorder. Platform term in article (AIMS) is what is commercially available from 2009-2016 as Behavior Connect.

Read more: Health Informatics A Roadmap-Oberleitner-The Netherlands-Jan, 2005-Book Article