Mobile Healthcare Systems: Generating Dynamic Smartphone Apps
to Serve Multiple Medical Specializations
Assisting Monitoring Patient@Home and Health Record Follow-up
Mersini Paschou, Nikolaos Nodarakis, Athanasios Tsakalidis and Evangelos Sakkopoulos
Department of Computer Engineering & Informatics, School of Engineering
University of Patras, Rio Campus, 26500 Patras, Greece
Keywords: Mobile Technologies, Healthcare Applications, Smartphones, Health Care Management, Health Information
Systems, Wireless Technology.
Abstract: During the recent years mobile devices and especially smartphones have been embraced by a rapidly
increasing number of people worldwide. In fact, this trend is expected to evolve even more in the years to
come. One of the many fields of their utilization is the health domain, with numerous applications that
record critical medical data and communicate with other applications in an effort to solve a single health
issue each time. However, these applications demand time and effort for maintenance, both from developers
and users. In this work we propose, design and implement a single solution which gives healthcare
researchers and professionals the ability to create smartphone applications on the fly, regardless of the
desired healthcare content that has to be recorded. The proposed approach applies efficient techniques for
development and is based on dynamically receiving business and UI at the first time of application
download.
1 INTRODUCTION
Smartphone applications are receiving rapid
acceptance and wide distribution with the release of
radically increasing number of smartphones and
respective platforms. This event makes mobile
technology more attractive for new and further
penetration into e-Health, with numerous
applications available currently, which target
different health problems and groups of people.
These applications use the limited resources that are
provided by mobile devices, compared to desktop
systems. However, by seizing a number of
advantages such as portability, Internet access,
location detection services etc. these applications
quickly became very popular and an integral part of
everyday life. (Kao et al., 2012)
An increasing number of healthcare
professionals put into use smartphones' applications
that enable remote monitoring or healthcare
management. Moreover, lots of patients already take
advantage of m-health applications to improve and
assist their own life and health (Global Mobile
Health Market Report 2010-2015). Although the
benefits of m-health applications are positive and
quite promising, much is yet to be done in the
particular domain to make it even more successful
and wide-spread (Paschou et al., 2012). In this work
we discuss how most existing applications that meet
the needs of individual specialties in healthcare &
medicine and function in similar ways, can become
easier to develop, maintain and customise. We
present a novel and efficient smartphone apps
generator. The proposed solution gives healthcare
researchers and professionals the ability to create
data intensive unique smartphone applications just
through a single system.
The rest of the paper is organized as follows:
Section 2 discusses related work. The proposed
system architecture and functionality are presented
in Section 3. Section 4 introduces data entry
applications as approximated for the purposes of this
work. Section 5 describes related technologies and
Section 6 presents an evaluation based on comparing
available mobile health applications with the
respective ones created with the presented tool.
Finally, Section 7 concludes the paper and presents
future steps.
215
Paschou M., Nodarakis N., Tsakalidis A. and Sakkopoulos E..
Mobile Healthcare Systems: Generating Dynamic Smartphone Apps to Serve Multiple Medical Specializations - Assisting Monitoring Patient@Home
and Health Record Follow-up.
DOI: 10.5220/0004237302150220
In Proceedings of the International Conference on Health Informatics (HEALTHINF-2013), pages 215-220
ISBN: 978-989-8565-37-2
Copyright
c
2013 SCITEPRESS (Science and Technology Publications, Lda.)
2 RELATED WORK
Handheld devices have been exploited in many cases
to facilitate health oriented procedures. M-health and
can be defined as "mobile computing, medical
sensor, and communications technologies for health-
care". This emerging concept represents the
evolution of e-health systems from traditional
desktop "telemedicine" platforms to wireless and
mobile configurations. (Altini et al., 2010)
Developments in wireless communications
integrated with developments in pervasive and
wearable technologies will have a radical impact on
future health-care delivery systems. (Istepanian et
al., 2004) Mobile applications solutions are
becoming increasingly popular because they can be
used by a great number of people and target different
health issues or groups of patients (Karan et al.,
2012).
Ambulatory health care offers an effective means
of bringing healthcare services to people all over the
world. With low-cost handsets and the penetration of
mobile phone networks globally, tens of millions of
citizens, even those ones that never had regular
access to a fixed-line telephone or computer, now
use mobile devices as daily tools for communication
and data transfer (Lytras et al., 2009)
There are numerous apps available, for any
possible need, from counting calories and nutrition
information (Silva et al., 2011), logging fitness
workouts (Fujiki, 2010), monitoring vital signs or
provide health tips, apps that calculate disease risks
and body mass index. (Krejcar et al., 2009)
Application for keeping personal health records are
numerous, as well, some provide users’ health
information to physicians or emergency workers.
(Orphanidou et al., 2009) Tips for smoking cessation
or for yoga stretching exercises, detailed information
about medicines (Silva et al., 2009), is only a small
subset of the tasks people can perform using Apps.
(Fox, 2010)
Many consumers nowadays take advantage of m-
Health applications to improve their lives and assist
their health. Benefits of m-Health Applications and
Solutions are widely known and accepted. Many
existing applications meet the needs of individual
specialties in medicine (Chemlal et al., 2011) and
work in similar ways, whether they are stand-alone
applications or they work online. These applications
usually have common characteristics; they record
critical medical data and communicate with other
applications in an effort to solve a health issue.
(Klug et al., 2010) In this paper, we present an open
and versatile solution to ease the development of
data recording mobile applications for almost any
kind of medical specialization.
3 SYSTEM FUNCTIONALITY
AND ARCHITECTURAL
COMPONENTS
Most of the existing applications meet the needs of
individual specialties in medicine and work in
similar ways, whether they are stand-alone
applications or they work online using Wi-Fi, LAN
or Internet. Most healthcare Smartphone
applications have common characteristics; they
record critical medical data and communicate with
other applications in an effort to solve a single
problem each time. Moreover, they demand much
time and effort to meet the needs of patients and
experts at any given time. As a result, a strong need
for re-usability driven implementations stems from
the demand for a continuous software update on
users’ smartphones.
The proposed approach applies efficient
techniques for development and is based on dynamic
reception of business logic and UI at the first time of
smartphone application download. In this way, we
propose removing the healthcare business logic part
from the mobile client application itself and making
it possible to be managed and configured in a
versatile manner remotely. The application is
designed to support patients at home and assist the
physician by recording information about treatments
and results of medical tests and measurements (e.g.
measuring blood pressure, etc.), without the current
overhead of continuous maintenance and by
exchanging messages with a format based on XML
(Extensible Markup Language).
3.1 System Components
Before discussing on the review performed to
choose the different data components that it is
possible to include in a produced App, the system
components that make the solution functional are
presented. The proposed solution consists of a web
interface for the application design, some internet
services and a client application for mobile devices
in Android environment.
The system administrator designs the layout and
functionality of the application, using the web
interface. The result becomes available to the client
application through an Internet service that produces
a configuration file. The client application is respon-
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Figure 1: Proposed system's overview.
sible for translating the file and displaying the final
application to the user.
3.2 System Application Functionality
Through the proposed solution we address and solve
the above issues. Using the proposed approach
(Figure 1) it is easy to deliver e-Health Apps for
biomedical data collection and health metrics
recording for any medical specialty in an automatic
way. The applications that can be designed and
implemented by the system belong to the data-entry
category, which covers the vast majority of the
smartphone apps as we have seen in the related work
section.
The functionality of the proposed solution is
further analyzed in more detail here. The proposed
solution allows the users of the system (doctors and
designers) to navigate to the management page and
enables new users to enrol. After logging in, the App
designer views the page with the applications that
have already been created and may choose to create
a new application, update or permanently delete an
existing one. Furthermore, the user has the option to
disconnect from the system. When creating a new
application the user must choose the fields he/she
wants for the forms of the application and add them.
Each field that has been added to the form may
be modified or deleted. The user can create up to
eight forms. This is the maximum number of
different forms appearing to the majority of related
Apps available online. The limit is provided to keep
the final Apps simple and user friendly and has
nothing to do with the capabilities of the system
itself. Once the above procedure is over, two more
steps are required to complete the application
design.
The user must enter the App title and a splash
screen image that will appear when the smartphone
Application loads. The title/name of each application
must be unique. From this moment on, it is possible
for the doctor to invite patients to download the App
from the respective App store/market in order to
start using it
3.3 System Architecture
The system is composed of four parts: 1) the mobile
device application, 2) Web services which serve the
calls from the mobile device application, contact the
database and return the appropriate response, 3) the
database, which contains the structure and
functionality of applications and 4) the web
interface, which is used for designing the
application. The database, web interface and Web
services are part of the web system.
4 DATA ENTRY HEALTH
MOBILE APPS
Usage of mobile, handheld, computing devices
constantly expands, with smartphones, cellular
phones, personal digital assistants (PDAs), and
pagers supporting an ever increasing array of
activities. To support these activities, systems
provide a variety of text-entry techniques.
Alternatives include stylus-activated soft keyboards
(e.g. a small QWERTY keyboard presented on a
touch-sensitive screen), small physical keyboards,
stylus-based gesture recognition (e.g. Jot and
Graffiti), and telephone keypad-based techniques
(e.g. T9). (Sears and Arora, 2002)
The applications that address health issues
belong to the data-entry category in their majority.
For the sake of this work we have studied a number
of health related applications, available at well-
known e-markets and recorded the type and number
of their controls. The most common types of
controls that are used, according to the results of this
survey procedure, include TextViews, EditTexts,
RadioButtons, Buttons, ImageViews and Spinners.
With this process, we chose the set of controls that
we incorporated in the system presented, for the
development of healthcare applications on the fly.
The user of the system can choose any one of these
controls to include them in her/his application and
customise it according to the respective needs.
MobileHealthcareSystems:GeneratingDynamicSmartphoneAppstoServeMultipleMedicalSpecializations-Assisting
MonitoringPatient@HomeandHealthRecordFollow-up
217
5 RELATED TECHNOLOGIES
For the web part of the system an HTTP server and
MySQL database to store all information related to
applications are required. The application server
used is Apache. The web interface was created using
the open source tool, PHP CodeIgniter. The web
programming language used is PHP and the
technologies HTML5, CSS3, JavaScript, AJAX and
jQuery were used as well. jQuery is a fast and
concise JavaScript Library that simplifies HTML
document traversing, handling events, creating
animation and interactivity with AJAX technology
for rapid development of Internet applications.
To create the Web services that use the REST
model, a respective plug-in for CodeIgniter was
used. For the development and simulation of the
client application on the device the typical ADT
(Android Development Toolkit) plug-in was used.
5.1 Data Transfer
The representation of a resource reflects its current
status, and traits, at the moment a client application
is making the request. They can be considered to be
snapshots of information in time. A simple example
is the representation of a record in a database,
consisting of mapping columns names and XML
tags of an XML file, where the value of each label is
the corresponding value in the column of the entry.
The restriction imposed by the architecture of
RESTful Web services is related to the format of the
data exchanged between the application and the
service. It is very important for the format of the
information to be simple and easy to understand by
humans. Hence for the transfer of data XML and/or
JSON format are used.
5.2 REST Model
Mobile health applications must be easy to create,
deploy, test and maintain, and they must rely on a
scalable and easily integrated infrastructure. (Andry
et al., 2011) A Representational State Transfer
(REST) API integrated with a mobile application
that offer physicians access to their patients’ health
records meets those needs.
REST model defines a set of architectural
principles that allow designing Web services that
focus on system resources and how they are
represented and transferred over HTTP protocol in a
variety of different clients. The number of Internet
services that use REST model has grown
exponentially in recent years and have rendered it to
be the dominant model in the area, having almost
completely replaced SOAP, as its functionality is
considered simpler and easier to understand.
Figure 2: Comparison of blood pressure values recording forms.
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6 EVALUATION AND RESULTS
There is a great number of health Smartphone Apps
that may be designed and produced by the proposed
mechanism automatically. For example a
cardiologist’s Smartphone App can be easily
produced using our system to record blood pressure
(systolic, diastolic and beat rate) data according to a
schedule proposed by the patient’s doctor.
Moreover, a different Smartphone App to record
allergic reactions may be designed by allergiologists
easily to assist patients to record the severance level,
the symptom type (e.g. tears, asthma etc) of allergic
reactions. Our approach does not need any coding at
any programming language and it can be easily used
directly by doctors, though the collaboration with a
Smartphone App designer, a graphics expert or a
programmer can prove to be useful and improve the
functionality of the final App developed.
For evaluation purposes, we have recreated existing
applications using our solution and perform
comparative experimentation with each other to
show that the proposed solution outputs the same
functionality and ease of use Apps with no
programming at all just through the web UI of the
proposed solution. In this section a native
application for android mobile devices is presented
and compared with the one developed using the
presented system and has the same functionality.
The comparison is carried out both at functional
level as well as for issues related to the GUI. The
application used for this purpose is called
Care@HOME and is a mobile monitoring system for
patient Treatment and Blood Pressure Tracking.
(Paschou et al., 2012) Through the respective
controls in the forms presented in Figure 2 date and
time of measurement can be selected and values of
systolic and diastolic pressure can be registered. All
controls of the application have been rendered
automatically. This included textview controls (e.g.
no. 1,4,6,8), edittext controls to insert data for
logging (e.g. no 2,3,5,7,9,10), button (e.g. no 11)
and of course the form itself with its title name. For
other applications under examination, we also
observed that all different controls are rendered
correctly and efficiently.
Overall the proposed solution has received
encouraging feedback from doctors in a number of
healthcare units in Greece and proves to be effective
in delivering end-user Smartphone application with
practically minimum development effort. In this way
it allows healthcare researchers and professionals to
deliver an efficient Smartphone app in order to assist
patient monitoring and follow-up research.
7 CONCLUSIONS AND FUTURE
WORK
Using the integrated system developed and
presented in this work, physician patient interaction
is enhanced, allowing exchange of data and
information flow between them. An important issue
to be addressed is effective policies for sending and
receiving data to minimize the cost and volume of
data for users. Application data related to health
records will be sent to servers storing personal
health record service or directly to physicians. The
implementation could apply alternative network
connections of mobile applications to Web services
and compare them in order to examine how the
volume of data changes, etc. depending on the send /
receive data protocol.
One important aspect of health related data is
their security. Many applications for mobile devices
make use of technical positioning (e.g. GPS or
triangulation via GSM). To protect the privacy of
users from insidious acts, techniques to protect
anonymity of the position will be implemented. This
will be achieved by the use of position
anonymisation system in seeking information and
services, based on location from point to point of
interest for optimizing markets for mobile devices
using external and heterogeneous data sources.
ACKNOWLEDGEMENTS
This research has been co-financed by the European
Union (European Social Fund – ESF) and Greek
national funds through the Operational Program
"Education and Lifelong Learning" of the National
Strategic Reference Framework (NSRF) - Research
Funding Program: Heracleitus II. Investing in
knowledge society through the European Social
Fund.
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